Background: This study examines the comparison of biomechanical strengths of three kinds of the most familiar implants available in Indonesia: conventional and locking sacroiliac plates and screws, also iliosacral screws. Despite the common thought that iliosacral screws are preferred compared to conventional plates and screws due to its biomechanic superiority, this study tested whether the locking plates and screws could offer an alternative.Materials and Methods: This study was an in vitro experimental study with a Randomized Post Test - Only Control Group Design using pelvic bones from male cadavers aged 20-50 y.o. Twelve samples were divided into three treatment groups and one control group. Group P1 was fixed with two conventional plates, P2 was fixed with two locking plates, P3 was fixed with two iliosacral screws, and control group K with sacroiliac joint was intact. Each group was given an increasing load until a vertical shift of the sacroiliac joint ≥ 2.0 mm was obtained.Results: The average force load for 2 mm displacement among the fixation systems being tested shows a statistically significant difference (p0.05). Load failure force for 2 mm displacement in the locking plate and screw group has the highest average (591.33 ± 56.08 N) compared to the iliosacral screw group (583.67 ± 73.56 N) and conventional plate and screw group (574 ± 106.05 N).Conclusions: Biomechanically, the fixation system using two locking anterior sacroiliac plates and screws is more stable than the iliosacral screws and conventional sacroiliac plates and screws.
Background: CPT is a disorder characterized by a nonunion tibial fracture that occurs spontaneously or after trivial trauma. Therapy usually includes surgical management and aims to gain lifetime bony union, avoid leg length discrepancy, and to prevent mechanical axis deviation, surrounding soft tissue lesion, joint stiffness, and pathological fracture. CPT remains to be a challenging orthopedic issue due to the difficulty to gain and to maintain the union and a functional limb. The combined VFG and ESIN is one of our preferred method in Surabaya.Case: A 13-year-old boy complained about crooked right lower leg since 1-year old, and fractured at 11 years old. In January 2014, the patient underwent ORIF ESIN combined with free VFG. The patient got bony union 24 months after the ORIF ESIN and VFG surgery. RUST modified scoring system showed a score out of 3, which signified that there was a radiographically significant union at the site of tibial pseudoarthrosis.Discussion: The combined VFG and ESIN is to maintain bony union and stability. Intramedullary fixation offers a good tibial alignment and prevents refracture. Hypertrophy and the vitality of VFG support the bony union. The level of success rate in both primary and secondary union is a benefit shown after VFG therapy.Conclusion: The combination of VFG after complete resection of tibial pseudoarthrosis and ESIN in this case report showed a success in achieving and maintaining the bony union, thus this therapy became one of the preferences as a suitable standard therapy that we use in our hospital institution.
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