Biomechanically, repairing a midshaft clavicle fracture with a superior plate was more favorable compared to anterior-inferior plating in terms of both load to failure and bending failure stiffness. Furthermore, superior locked CDCP plates show improved bending failure stiffness over superior CDCP plates.
Flexible intramedullary nail fixation provides excellent fixation in children with unstable tibial shaft fractures, but few published series demonstrate the results and complications with this technique in children. A retrospective review of 19 patients was performed, as well as a biomechanical analysis of two implant configurations. Outcome measures included union rates, residual deformity, and complications. Union occurred in all cases. Five patients (26%) had complications. None required repeat operation. Two (11%) angular deformities (>/=10 degrees) occurred with the medial C and S construct, versus none with the double C. The C and S construct was more stable to mechanical testing with axial and torsional loading. Flexible intramedullary nail fixation is a straightforward technique that reliably produces good results. While the C and S construct was superior in biomechanical testing, the double C construct is more reliable and straightforward and remains by far the authors' preferred technique.
In this porcine model, mechanical tethering during growth altered spinal morphology in the coronal and sagittal planes, leading to vertebral and disc wedging proportional to the duration of tethering. The resulting concave thickening of the disc in response to the tether was not anticipated and may suggest a capacity for the nucleus pulposus to respond to the compressive loads created by growth against the tether.
There was not a clear biomechanical advantage to performing any particular fixation method in this study. This suggests that the surgeon can use their clinical judgment and experience to determine the fixation technique.
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