Treatment of acute (≤4 weeks) high-grade acromioclavicular (AC) joint separation (types III-VI) is still controversial. Currently, the two modern techniques that are widely used include hook plate fixation and coracoclavicular (CC) ligament fixation using a suspensory loop device (tightrope, synthetic ligament or absorbable polydioxansulfate sling). These techniques are both reported to have superior clinical outcomes. This systematic review and meta-analysis aimed to assess and compare clinical outcomes of hook plate fixation versus fixation of the CC ligament using a loop suspensory fixation (LSF) device for the treatment of AC joint injury. These clinical outcomes consist of the Constant-Murley score (CMS), pain visual analog score (VAS) and postoperative complications. Relevant comparative studies were identified from MEDLINE and Scopus from inception to October 5, 2015. Five of 571 studies were eligible; 5, 3, 3, and 5 studies were included in the pooling of CMS, pain VAS, surgical time and postoperative complications, respectively. The unstandardized mean difference (UMD) of the CMS for LSF was 4.43 [95 % confidence interval (CI) 0.73, 8.14], which was statistically significantly higher than the CMS in hook plate fixation. For VAS, the UMD was 0.02 points (95 % CI -3.54, 3.73) higher than LSF but without statistical significance. The surgical time of LSF was 16.21 min (95 % CI 6.27, 26.15) statistically significantly higher than hook plate fixation. LSF had a lower chance of postoperative complications by 0.62 units (95 % CI 0.30, 1.32) when compared to hook plate fixation, but this also was not statistically significant. In acute high-grade AC joint injuries, loop suspensory fixation had higher postoperative functional CMS and mean surgical time when compared to hook plate fixation. However, for postoperative VAS and complication rates, there were no statistically significant differences between groups.
Background: Tension band wiring is considered the standard treatment for olecranon fracture. A recentstudy proved that it can be used for the fracture as distal to the coronoid process.
Objective: The study aimed to investigate whether tension band wiring can be used in proximal ulnarfracture fixation up to and distal to the coronoid process.
Methods: Models of simple proximal ulnar fracture including 4 intraarticular and 2 extraarticularfractures were created. Fixation was completed using tension band wiring technique, and biomechanicalresponses were evaluated using finite element analysis. After a physiologic load was applied, thefracture displacement, von Mises stress, and stiffness were recorded.
Results: All fracture models were able to withstand the load of daily activities with a maximumdisplacement of 50% of the articular surface. In addition, the von Mises stress was the highest in themiddle articular fracture. The mean transcortical K-wire tension band wiring stiffness of the intraarticular and extra-articular fractures was 1144.89 N/mm and 1231.45 N/mm, respectively.
Conclusion: Tension band wiring is another option to treat proximal ulnar fractures with the ability towithstand immediate postoperative load.
Background: Volar locking plate (VP) and Kirschner wire (K-wire) fixations of distal end radius fractures are the most frequently used techniques that produce similar long term clinical results. However, inadequate fixation strength of the K-wire may cause pin loosening or migration. Although these complications can be prevented by immobilization, joint stiffness and a prolonged recovery period can occur.
Objective: Herein, a technique that provided more stability, allowing immediate motion after fixation by linking the K-wires into a single system (locked K-wire system) was proposed.
Methods: We evaluated biomechanical responses of the locked K-wire system and a VP in extraarticular distal radius fracture models AO/OTAa type 23A2 and 23A3 using three-dimensional finite element analysis. All models were tested under axial, bending, and torsional loads.
Results: From the simulation results, the total displacement was greater in the dorsal wedge fracture than that from the simple fracture under all loads for both fixation systems. The locked K-wire system and the VP could withstand immediate physiologic load with maximum displacements of 1.15 mm and 1.39 mm, respectively.
Conclusion: Considering the immediate physiologic load resistance and the ability to preserve its position during the bone-healing period, the locked K-wire system might be used as an alternative to fix distal radius fractures.
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