BackgroundProximal tibia fractures are one of the most familiar fractures. Surgical approaches are usually needed for anatomical reduction. However, no single treatment method has been widely established as the standard care. Our present study aims to compare the stress and stability of intramedullary nails (IMN) fixation and double locking plate (DLP) fixation in the treatment of extra-articular proximal tibial fractures.MethodsA three-dimensional (3D) finite element model of the extra-articular proximal tibial fracture, whose 2-cm bone gap began 7 cm from the tibial plateau articular surface, was created fixed by different fixation implants. The axial compressive load on an adult knee during single-limb stance was imitated by an axial force of 2500 N with a distribution of 60% to the medial compartment, while the distal end was fixed effectively. The equivalent von Mises stress and displacement of the model was used as the output measures for analysis.ResultsThe maximal equivalent von Mises stress value of the system in the IMN model was 293.23 MPa, which was higher comparing against that in the DLP fixation model (147.04 MPa). And the mean stress of the model in the IMN model (9.25 MPa) was higher than that of the DLP fixation system in terms of equivalent von Mises stress (EVMS) (P < 0.0001). The maximal value of displacement (sum) in the IMN system was 8.82 mm, which was lower than that in the DLP fixation system (9.48 mm).ConclusionsThis study demonstrated that the stability provided by the locking plate fixation system was superior to the intramedullary nails fixation system and served as an alternative fixation for the extra-articular proximal tibial fractures of young patients.

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BackgroundTraumatic sternoclavicular joint dislocations are rare; closed reduction is the primary treatment. The failure of closed reduction or a prominent insult to the skin may require surgery to ensure the best possible outcome.MethodsThe records of 5 patients operated at our institution for sternoclavicular joint dislocation were reviewed. All patients were treated with open reduction and single 3.5-mm locking plate was used for fixation. Outcomes were evaluated with the Constant Shoulder Score (CSS) and Disability of the Arm, Shoulder, and Hand (DASH) questionnaire. Intraoperative and postoperative complications were recorded.ResultsAll the patients had an average follow-up of 14 months (range, 11–16 months). At the final follow-up, the mean CSS score was 89.5 (range, 78–98) and the mean DASH score was 9.0 (range, 4–16). There were no early complications, including wound infection or neurologic or vascular deficits; there were also no broken or loosened screws or plates. No case of redislocation or arthrosis was observed.ConclusionOur study indicates that open reduction and fixation with a single locking plate for the treatment of traumatic sternoclavicular joint dislocation is a safe, relatively simple surgical procedure that can lead to satisfactory outcomes.

Surgery is usually recommended for displaced glenoid fractures, with open reduction and internal fixation as the standard operative treatment. Three approaches have been recommended in the reduction of glenoid fractures: Anterior, posterior and combined; however, a traditional approach may be difficult due to a high position or a comminuted Ideberg type III fracture. The combined approach results in a longer incision and more soft tissue injury when associated with an acromial fracture. The present study describes two complicated glenoid fractures: One case was a comminuted Ideberg type III fracture associated with an Ogawa type II acromial fracture; the second case was an Ideberg type IV fracture with associated superior shoulder suspensory complex injuries. In these cases, the acromial approach was modified to achieve satisfactory exposure and fixation of the complicated fracture. After a 1-year follow-up, the patients had a satisfactory outcome.

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