Objective: The intramedullary nail fixation approach currently used for midshaft clavicle fractures is associated with complications, including nail loosening and displacement, nail end protrusion and soft tissue irritation. In this study, we propose a novel intramedullary fixation technique using the ortho-bridge system (OBS) to improve clinical outcomes and avoid the issues linked with treating midshaft clavicle fractures. Methods: Sixty-three patients with midshaft clavicle fractures were randomly categorized into a control group (n = 35) and an observation group (n = 28). The control group received internal fixation with a locking plate, while the observation group underwent OBS intramedullary fixation. Surgical time, intraoperative blood loss, incision length, fracture healing time, removal of internal fixation, visual analog scale (VAS) for shoulder pain, Constant Shoulder Score and complication occurrence were compared between the two groups. Results: In preoperative general data, such as sex, age and fracture types were not significantly different between the two groups (P > 0.05). However, the observation group showed better outcomes than the control group in terms of surgical time, intraoperative blood loss and total incision length (P< 0.05). Additionally, the observation group exhibited significantly shorter fracture healing time and internal fixation removal time than the control group (P < 0.05). VAS scores at postoperative day 1, week 1, month 1 and month 3 were lower in the observation group than in the control group (P< 0.05).Furthermore, the observation group had higher Constant Shoulder Scores at 1, 3,and 6 months than the control group (P < 0.05), with no significant difference at 1 year postoperatively (P > 0.05). Lastly, complication incidence in the observation group was significantly lower than that in the control group (P < 0.05). Conclusion: The study revealed that compared to locking plate internal fixation for midshaft clavicle fractures, OBS intramedullary fixation offers advantages, including reduced surgical trauma, lesser postoperative pain, faster fracture healing, earlier shoulder joint function recovery and fewer complications. Additionally, this approach provides better aesthetic outcomes and comfort in the surgical area. Therefore, this technique may have potential clinical application as a novel treatment for midshaft clavicle fractures.

Background: A locking compression plate (LCP) of the distal femur is used as an external fixator for lower tibial fractures. However, in clinical practice, the technique lacks a standardized approach and a strong biomechanical basis for its stability. Methods: In this paper, internal tibial LCP fixator (Group IT-44), external tibial LCP fixator (Group ET-44), external distal femoral LCP fixator (Group EF-44, group EF-33, group EF-22), and conventional external fixator frame (Group CEF-22) were used to fix the unstable fracture models of the lower tibial segment, and anatomical studies were performed to standardize the operation as well as to assess the biomechanical stability and adjustability of the distal femoral LCP external fixator by biomechanical experiments. Results: It was found that the torsional and flexural stiffness of the group EF-44 and group EF-33 were better than those of the group IT-44 and group ET-44 (p<0.05); the flexural stiffness of the group EF-22 was similar to that of the group IT-44 (p>0.05); and the compressive stiffness of all three EF groups was better than that of the group ET-44 (p<0.05). In addition, the flexural and compressive stiffnesses of the three EF groups decreased with the decrease in the number of screws (p<0.05), while the torsional stiffnesses of the three groups did not differ significantly between the two adjacent groups (p>0.05). In the last point, the group ET-44 had the worst stability (P<0.05). Conclusions: The study shows that the distal femoral LCP has good biomechanical stability and adjustability, and it is superior to the tibial LCP as an external fixator for distal tibial fractures, as long as the technique is used in a standardized manner according to the anatomical studies in this article.

Background A locking compression plate (LCP) of the distal femur is used as an external fixator for lower tibial fractures. However, in clinical practice, the technique lacks a standardized approach and a strong biomechanical basis for its stability. Methods In this paper, internal tibial LCP fixator (Group IT-44), external tibial LCP fixator (Group ET-44), external distal femoral LCP fixator (Group EF-44, group EF-33, group EF-22), and conventional external fixator (Group CEF-22) frames were used to fix unstable fracture models of the lower tibial segment, and anatomical studies were performed to standardize the operation as well as to assess the biomechanical stability and adjustability of the distal femoral LCP external fixator by biomechanical experiments. Results It was found that the torsional and flexural stiffnesses of group EF-44 and group EF-33 were higher than those of group IT-44 and group ET-44 (p < 0.05); the flexural stiffness of group EF-22 was similar to that of group IT-44 (p > 0.05); and the compressive stiffness of all three EF groups was higher than that of group ET-44 (p < 0.05). In addition, the flexural and compressive stiffnesses of the three EF groups decreased with the decrease in the number of screws (p < 0.05), while the torsional stiffness of the three groups did not differ significantly between the two adjacent groups (p > 0.05). Group CEF-22 showed the highest stiffnesses, while group ET-44 had the lowest stiffnesses (P < 0.05). Conclusions The study shows that the distal femoral LCP has good biomechanical stability and adjustability and is superior to the tibial LCP as an external fixator for distal tibial fractures, as long as the technique is used in a standardized manner according to the anatomical studies in this article.