Open reduction internal fixation (ORIF) metal plates provide exceptional support for unstable bone fractures; however, they often result in debilitating soft-tissue adhesions and their rigid shape cannot be easily customized by surgeons. In this work, a surgically feasible ORIF methodology, called AdhFix, is developed by combining screws with polymer/hydroxyapatite composites, which are applied and shaped in situ before being rapidly cured on demand via high-energy visible-light-induced thiol-ene coupling chemistry. The method is developed on porcine metacarpals with transverse and multifragmented fractures, resulting in strong and stable fixations with a bending rigidity of 0.28 (0.03) N m 2 and a maximum load before break of 220 (15) N. Evaluations on human cadaver hands with proximal phalanx fractures show that AdhFix withstands the forces from finger flexing exercises, while short-and long-term in vivo rat femur fracture models show that AdhFix successfully supports bone healing without degradation, adverse effects, or soft-tissue adhesions. This procedure represents a radical new approach to fracture fixation, which grants surgeons unparalleled customizability and does not result in soft-tissue adhesions.

We tested the anti-adhesional effect of a new thiol-ene-based coating in a rabbit model. In 12 New Zealand white rabbits, the periosteum and cortex of the proximal phalanx of the second toe of both hind paws was scratched. Stainless steel plates were fixated with screws. One plate was coated with DendroPrime and the other left bare. The non-operated second toes of both hind paws of an additional four rabbits served as controls. Seven weeks after surgery, the soft tissue adhesion to the plates was evaluated macroscopically, and joint mobility was measured biomechanically. Toe joint mobility was about 20% greater and statistically significant in specimens with coated plates compared with the bare plates. Soft tissue overgrowth and, in some cases, synovitis or adhesions between the plate and the tendon were observed on all bare plates but not on any of the coated plates. We conclude that the thiol-ene-based coating can improve joint mobility by about 20%. This material has a potential to reduce adhesion around plates in fracture surgery.

Customizable Bone Fracture Fixation In article number 2105187, Michael Malkoch and co‐workers reveal a fixation treatment for complex bone fractures, called AdhFix, which combines the strength of screw fixators with the customizability of hydroxyapatite containing composite plates, which can be built‐up and cured with thiol‐ene coupling chemistry on the bone fracture site. AdhFix is proposed as a non‐degradable and highly customizable fixator of bone fractures.

Background There is a lack of detailed epidemiological studies of finger fractures, the most common fracture of the upper extremity. Methods Based on data of 21 341 finger fractures in the Swedish Fracture register, a national quality registry that collects data on all fractures, this study describes anatomical distribution, cause, treatment, age distribution, and result in terms of patient related outcome measures (PROMs). Results The most common finger fracture was of the base of the 5th finger, followed by the distal phalanx in the 4th finger. Open fractures were most common in the distal phalanges, especially in the 3rd finger. Intraarticular fractures were most frequent in the middle phalanges. Fall accidents was the most common cause of a fracture. The mean age at injury was 40 years (38 for men, 43 for women). 86% of finger fractures in adults were treated non-operatively. Men were more frequently operated than women. Finger fractures did not affect hand function or quality of life and there were no relevant differences in PROMs between fracture type, treatment, or sex. Conclusion This study presents detailed information about the various types of finger fractures which can be used as point of reference in clinical work and for future studies.