Treatment of distal humeral fractures using conventional implants. Biomechanical evaluation of a new implant configuration

<p>Abstract</p> <p>Background</p> <p>In the face of costly fixation hardware with varying performance for treatment of distal humeral fractures, a novel technique (U-Frame) is proposed using conventional implants in a 180° plate arrangement. In this in-vitro study the biomechanical stability of this method was compared with the established technique which utilizes angular stable locking compression plates (LCP) in a 90° configuration.</p> <p>Methods</p> <p>An unstable distal 3-part fracture (AO 13-C2.3) was created in eight pairs of human cadaveric humeri. All bone pairs were operated with either the "Frame" technique, where two parallel plates are distally interconnected, or with the LCP technique. The specimens were cyclically loaded in simulated flexion and extension of the arm until failure of the construct occurred. Motion of all fragments was tracked by means of optical motion capturing. Construct stiffness and cycles to failure were identified for all specimens.</p> <p>Results</p> <p>Compared to the LCP constructs, the "Frame" technique revealed significant higher construct stiffness in extension of the arm (P = 0.01). The stiffness in flexion was not significantly different (P = 0.16). Number of cycles to failure was found significantly larger for the "Frame" technique (P = 0.01).</p> <p>Conclusions</p> <p>In an in-vitro context the proposed method offers enhanced biomechanical stability and at the same time significantly reduces implant costs.</p

Artificial Ligament Reconstruction of Sternoclavicular Joint Instability: Report of a Novel Surgical Technique With Early Results

Symptomatic instability of the sternoclavicular (SC) joint is an uncommon problem. The majority of patients respond well to nonoperative measures, although a small number require reconstructive surgery for symptomatic instability, with varying surgical techniques reported in the literature. We report a series of 5 operations (in 4 patients) with chronic SC joint instability treated by reconstruction of SC and costoclavicular ligaments using an artificial ligament weave (LARS: Ligament Augmentation and Reconstruction System). Preoperative and postoperative disabilities of the Arm, Shoulder, and Hand (DASH) Scores and Oxford Shoulder Scores were collected to evaluate the outcomes. The patients had a mean age of 20 years (range, 17 to 22 y), with 2 male and 2 female patients. Three of the patients had traumatic dislocation of the SCJ and 1 patient had bilateral symptomatic atraumatic instability. Anterior instability was observed in 4 joints and posterior instability in 1 joint. In all cases, reconstruction was achieved with a 30 mm LARS ligament. Postoperative follow-up was for an average of 29 months (range, 19 to 41 mo). The DASH Score improved from 51.7 points (range, 24.2 to 75.0) preoperatively to 13.7 points (range, 8.3 to 20.8) postoperatively. The Oxford Shoulder Scores improved from 20.6 preoperatively (range, 15 to 32) to 41.8 postoperatively (range, 39 to 47). All patients returned to full activity including competitive sports. In conclusion, stabilization of the SC joint using a LARS ligament with a weave technique is a feasible option for young, active patients with symptomatic SC joint instability after failure of nonoperative treatment