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Our objective is to compare the results of three different methods of osteosynthesis used in severely injured digits, namely the K-wire group, the K-wire & Wire-loop group and the Plate & Screws group. The results of 38 patients with 50 severely injured fingers managed between 1994 and 2000 were reviewed. Majority of them had serious injury caused by electric-saw and Zone III was the most common level of injury using Biemer's classification. Using the scoring system of Nakamura and Tamai, excellent and good results were obtained in 59.5% of the patients. The rate of bony complications was different among the three methods of osteosynthesis though the final functional outcomes were comparable. The rate of bony complications in this series was 20.4%, which included non-union (7), migration of K-wires (2) and infection (1). All occurred in K-wire and K-wire & Wire-loop groups. Plate & Screws, therefore, is the preferred method of bony fixation if further operation for non-union is to be avoided. This is more so for the proximal injuries.

In this work, a testing protocol has been set up, in order to quantify the load-sharing imposed near the fracture site by an interlocking-type intramedullary nail. A simulated single-leg stance has been applied to a composite fiberglass femur in three different configurations simulating: an intact femur, a fractured nailed femur and a fully healed nailed femur. The repeatability of the measurements and the influence of ilio-tibial band muscle force have been investigated. The tested nail proved to share with the femoral shaft an amount of the total applied load ranging from 50% immediately after the nailing to 80% at full healing.

Rigid fracture fixation plates offer stability to the fractured bone, but are known to result in stress shielding of the bone. This stress shielding results in bone resorption; which in-turn results in re-fracture of the bone after the bone-plate is removed. The aim of this research was to design a stiffness graded bone-plate to reduce the stress shielding effect. Stiffness grading of bone plate model was achieved by tapering the bone-plate along its length. A 3D finite element model of human femoral diaphysis and bone-plates with traditional design and tapered design were constructed using commercial finite element software Abaqus. These models were loaded in combined compression and bending, similar to the loads during walking. Stress distribution and the location of neutral axis were obtained for (a) Bone (b) Bone with traditional bone-plate and (c) Bone with tapered bone-plate. Results showed that tapered bone-plate results in substantial reduction in stress shielding in bone when compared to traditional bone-plate. The taper was optimized for reduction in stress shielding and adequate mechanical strength. We recommend tapered bone-plate instead of traditional uniform bone-plate for fracture fixation.

The aim of this paper is to compare the biomechanical characteristics of a newly designed assembly locking compression plate (NALCP) and traditional locking compression plate (LCP) for internal fixation of femoral-shaft comminuted fractures. A femoral-shaft wedge fracture model (AO classification 32-C2.1) was created in six pairs of femoral specimens ($n=12$) randomly divided into two equal groups. Biomechanical properties were tested with axial and torsional loading tests. The relative maximum displacement of fracture blocks and strain was recorded. A strain diagram was made; the fatigue test results of NALCP specimens under axial load were recorded. Under axial load, the relative maximum displacement of fracture blocks in the $X$, $Y$, and $Z$ axes was smaller in NALCP specimens than in LCP specimens ($P<0.05$ and 0.01, respectively). Under torsional load, the relative maximum displacement of fracture blocks in the $X$ and $Z$ axes in NALCP specimens was less than that in LCP specimens ($P<0.01$) but no statistically significant difference in the $Y$ axes ($P>0.05$) was found. In both cases, the main NALCP strain was higher than the LCP strain ($P<0.01$) but no statistically significant difference in mean strain ($P>0.05$) was found. Our NALCP provides strong mechanical stability for comminuted femoral fractures and can effectively avoid stress concentration, reduce stress shielding, and facilitate bone healing.

The proximal interphalangeal joint (PIPJ) is a complex anatomical structure. In managing fracture dislocations about the PIPJ, the aim is to restore a congruent joint that allows for smooth gliding motion. Detailed knowledge of the anatomy and biomechanics of the PIPJ is necessary in managing these injuries with predictable success. The breadth of techniques previously described in the treatment of such injuries is testament to the difficulties faced in achieving optimal clinical and radiological outcomes. In this article we detail the anatomy and biomechanics of the PIPJ and summarize current literature and principles for the treatment of dorsal fracture dislocations.

Background: Tension band wiring (TBW) has traditionally been used for simple olecranon fractures, but due to its many complications, locking plate (LP) is increasingly being employed. To reduce the complications, we developed a modified technique for olecranon fracture repair, locked TBW (LTBW). The study aimed to compare (1) the frequency of complications and re-operations between LP and LTBW techniques, (2) clinical outcomes and the cost efficacy.

Methods: We retrospectively evaluated data of 336 patients who underwent surgical treatment for simple and displaced olecranon fractures (Mayo Type ⅡA) in the hospitals of a trauma research group. We excluded open fractures and polytrauma. We investigated complication and re-operation rates as primary outcomes. As secondary outcomes, Mayo Elbow Performance Index (MEPI) and the total cost, including surgery, outpatients and re-operation, were examined between the two groups.

Results: We identified 34 patients in the LP group and 29 patients in the LTBW group. The mean follow-up period was 14.2 ± 3.9 months. The complication rate in the LTBW group was comparable to that in the LP group (10.3% vs. 17.6%; p = 0.49). Re-operation and removal rates were not significantly different between the groups (6.9% vs. 8.8%; p = 1.000 and 41.4% vs. 58.8%; p = 1.00, respectively). Mean MEPI at 3 months was significantly lower in the LTBW group (69.7 vs. 82.6; p < 0.01), but mean MEPI at 6 and 12 months were not significantly different (90.6 vs. 85.2; p = 0.06, 93.9 vs. 95.2; p = 0.51, respectively). The mean cost/patient of the total cost in the LTBW group were significantly lower than those in the LP group ($5,249 vs. $6,138; p < 0.001).

Conclusions: This study showed that LTBW achieved clinical outcomes equivalent to those of LP and was significantly more cost effective than LP in the retrospective cohort.

Level of Evidence: Level III (Therapeutic)

Forearm non-union poses a challenge in orthopaedic surgery due to its intricate anatomy and functional significance. This review provides a comprehensive overview of the assessment, diagnosis and management of forearm non-union. Initial evaluation involves a meticulous history, physical examination and imaging studies to identify factors contributing to non-union, including infection. Surgical approaches are discussed, with emphasis on restoring biomechanical stability and promoting bone healing. Treatment options range from autografts to allografts, with considerations for vascularised bone transfers in complex cases. Decision-making strategies are outlined, considering patient-specific factors and individualised treatment plans. Special considerations for specific types of forearm non-unions are addressed, along with postoperative care protocols to optimise healing and functional outcomes. Overall, this review aims to provide clinicians with a comprehensive understanding of forearm non-union management based on current evidence and clinical practice.

Level of Evidence: Level V (Therapeutic)