Ability of modern distal tibia plates to stabilize comminuted pilon fracture fragments: Is dual plate fixation necessary?

Penny, Phillip; Swords, Michael; Heisler, Jason; Cien, Adam; Sands, Andrew K.; Cole, Peter A.

doi:10.1016/j.injury.2016.05.026

Cited by 31 publications

(20 citation statements)

References 9 publications

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“…In a recent study, it was shown that anterolateral plating may not be sufficient in stabilizing the medial malleolar fragment [67]. To achieve sufficient stability, supplementation with an additional medial plate is recommended [65,68]. Regarding metaphyseal fragments, in rather simple fractures, absolute stability can be reached by the use of lag screws, whereas in comminuted fracture patterns, bridging constructs provide adequate stability [65].…”

Section: Ankle Fracturesmentioning

confidence: 99%

Biomechanics of Osteoporotic Fracture Fixation

Hollensteiner

Sandriesser

Bliven

et al. 2019

Curr Osteoporos Rep

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Purpose of Review Fractures of osteoporotic bone in elderly individuals need special attention. This manuscript reviews the current strategies to provide sufficient fracture fixation stability with a particular focus on fractures that frequently occur in elderly individuals with osteoporosis and require full load-bearing capacity, i.e., pelvis, hip, ankle, and peri-implant fractures. Recent Findings Elderly individuals benefit immensely from immediate mobilization after fracture and thus require stable fracture fixation that allows immediate post-operative weight-bearing. However, osteoporotic bone has decreased holding capacity for metallic implants and is thus associated with a considerable fracture fixation failure rate both short term and long term. Modern implant technologies with dedicated modifications provide sufficient mechanical stability to allow immediate weight-bearing for elderly individuals. Depending on fracture location and fracture severity, various options are available to reinforce or augment standard fracture fixation systems. Summary Correct application of the basic principles of fracture fixation and the use of modern implant technologies enables mechanically stable fracture fixation that allows early weight-bearing and results in timely fracture healing even in patients with osteoporosis.

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Section: Ankle Fracturesmentioning

confidence: 99%

Biomechanics of Osteoporotic Fracture Fixation

Hollensteiner

Sandriesser

Bliven

et al. 2019

Curr Osteoporos Rep

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“…Understanding common fracture patterns can yield insight into surgical approaches and fixation strategies for rib fractures when required. 29 To the authors' knowledge, a comprehensive fracture map using rib unfurling technology has not been published.…”

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confidence: 99%

Mapping of common rib fracture patterns and the subscapular flail chest associated with operative scapula fractures

Thomas

Lindquist

Paull

et al. 2021

J Trauma Acute Care Surg

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BACKGROUND:Rib fractures occur in approximately 10% of trauma patients and are associated with more than 50% of patients with scapula fractures. This study investigates the location and patterns of rib fractures and flail chest occurring in patients with operatively treated scapula fractures. Novel frequency mapping techniques of rib fracture patterns in patients who also injure the closely associated scapula can yield insight into surgical approaches and fixation strategies for complex, multiple injuries patients. We hypothesize that rib fractures have locations of common occurrence when presenting with concomitant scapula fracture that requires operative treatment. METHODS:Patients with one or more rib fractures and a chest computed tomography scan between 2004 and 2018 were identified from a registry of patients having operatively treated scapula fractures. Unfurled rib images were created using Syngo-CT Bone Reading software (Siemens Inc., Munich, Germany). Rib fracture and flail segment locations were marked and measured for standardized placement on a two-dimensional chest wall template. Location and frequency were then used to create a gradient heat map. RESULTS:A total of 1,062 fractures on 686 ribs were identified in 86 operatively treated scapula fracture patients. The mean ± SD number of ribs fractured per patient was 8.0 ± 4.1 and included a mean ± SD of 12.3 ± 7.2 total fractures. Rib fractures ipsilateral to the scapula fracture occurred in 96.5% of patients. The most common fracture and flail segment location was ipsilateral and subscapular; 51.4% of rib fractures and 95.7% of flail segments involved ribs 3 to 6. CONCLUSION:Patients indicated for operative treatment of scapula fractures have a substantial number of rib fractures that tend to most commonly occur posteriorly on the rib cage. There is a pattern of subscapular rib fractures and flail chest adjacent to the thick bony borders of the scapula. This study enables clinicians to better evaluate and diagnose scapular fracture patients with concomitant rib fractures.

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“…17 During the past few decades, various treatment strategies for these fractures have been developed. [18][19][20] In 1979, Ruedi and Allgower 2 first reported good and excellent results of primary ORIF in 84 patients, and ORIF became the gold standard for treatment of Pilon fracture at that time. However, other authors have had difficulties reproducing the same outcomes, especially when ORIF was attempted for high-energy trauma; high postoperative complication rates and a poor prognosis were reported.…”

Section: Discussionmentioning

confidence: 99%

Two-stage open reduction and internal fixation versus limited internal fixation combined with external fixation: a meta-analysis of postoperative complications in patients with severe Pilon fractures

et al. 2018

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ObjectivesTwo-stage open reduction and internal fixation (ORIF) and limited internal fixation combined with external fixation (LIFEF) are two widely used methods to treat Pilon injury. However, which method is superior to the other remains controversial. This meta-analysis was performed to quantitatively compare two-stage ORIF and LIFEF and clarify which method is better with respect to postoperative complications in the treatment of tibial Pilon fractures.MethodsWe conducted a meta-analysis to quantitatively compare the postoperative complications between two-stage ORIF and LIFEF. Eight studies involving 360 fractures in 359 patients were included in the meta-analysis.ResultsThe two-stage ORIF group had a significantly lower risk of superficial infection, nonunion, and bone healing problems than the LIFEF group. However, no significant differences in deep infection, delayed union, malunion, arthritis symptoms, or chronic osteomyelitis were found between the two groups.ConclusionTwo-stage ORIF was associated with a lower risk of postoperative complications with respect to superficial infection, nonunion, and bone healing problems than LIFEF for tibial Pilon fractures.Level of evidence2.

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Ability of modern distal tibia plates to stabilize comminuted pilon fracture fragments: Is dual plate fixation necessary?

Cited by 31 publications

References 9 publications

Biomechanics of Osteoporotic Fracture Fixation

Biomechanics of Osteoporotic Fracture Fixation

Mapping of common rib fracture patterns and the subscapular flail chest associated with operative scapula fractures

Two-stage open reduction and internal fixation versus limited internal fixation combined with external fixation: a meta-analysis of postoperative complications in patients with severe Pilon fractures

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