Background Calcaneal fractures are relatively common but complex,while the treatment of these fractures is still controversial.The objective of this study was to compare the biomechanical stability of minimally invasi...Background Calcaneal fractures are relatively common but complex,while the treatment of these fractures is still controversial.The objective of this study was to compare the biomechanical stability of minimally invasive,locking,and non-locking plating systems used for fixing Sanders type Ⅱ and type Ⅲ calcaneal fractures.Finite element analysis was used for comparing the three types of plating systems.This study helped in guiding the clinical management of calcaneal fractures.Methods The CT data acquired from a volunteer was used to construct a finite element model of calcaneus.The fracture lines were made according to Sanders type Ⅱ （A,B,C） and type Ⅲ （AB,AC,BC） and six calcaneal fractures models were constructed accordingly.Three fixation methods used in clinical treatment were simulated by design tools （minimally invasive plating with percutaneous screws,Y-size non-locking plating,and locking plating） and then fixed to these fracture models with the help of clinical principles.The single minimally invasive plating fixation was also tested to compare the function of percutaneous screws.Then,the neutral force was applied on established methods.The displacement and presses distribution condition in various plating models were analyzed and compared.Results The levels of displacement and compressive press on the bone around fixation or strains on plating were within the physiological limit,indicating that the three methods were suitable for application.Compared with the locked and unlocked plates,the minimally invasive plating caused a relatively lower displacement without the high stress in bone or fixation.The minimum stress in fixation was observed in locking plate as the distribution of stress was concentrated in the anterior part of locking plate.Conclusions The minimally invasive plating method could be a better alternative method in treating Sanders type Ⅱ and type Ⅲ calcaneal fractures.The observed stiffness of locking plate was not obviously stronger than unlocked plate.展开更多
Background Accurate and precise preoperative planning can provide information instrumental for performing less invasive articular fracture surgery. The purpose of this study was to determine that computer-assisted pre...Background Accurate and precise preoperative planning can provide information instrumental for performing less invasive articular fracture surgery. The purpose of this study was to determine that computer-assisted preoperative planning （CAPP） has the potential to improve efficiency and time in the operating room. Methods Sixty-four patients with proximal humeral fractures were treated using locking plates by minimally invasive plate osteosynthesis （MIPO） with CAPP. The time needed for virtual segmentation, reduction, and fixation of the fracture fragments were recorded. Intra and interobserver reliabilities were analyzed using the intraclass correlation coefficient. The clinical function was analyzed using Constant Score and radiology. Results The mean total time required for CAPP of two-part, three-part, and four-part proximal humeral fractures were （13.63±1.38） minutes, （23.14±2.18） minutes, and （39.61±3.01） minutes, respectively. The intra and interobserver reliabilities for all variables were high, ranging from 0.785 to 0.992. The mean operation time was （50.1±6.7） minutes. Fifty- two patients were followed up with an average time of 34.2 months. The mean Constant Score of the injury side was （82.5 ± 9.9）. Three of the fifty-two patients had four complications. Conclusion The application of CAPP was efficient and reliable, and provided excellent clinical and radiographic outcomes for the treatment of proximal humerus fractures by MIPO.展开更多
文摘Background Calcaneal fractures are relatively common but complex,while the treatment of these fractures is still controversial.The objective of this study was to compare the biomechanical stability of minimally invasive,locking,and non-locking plating systems used for fixing Sanders type Ⅱ and type Ⅲ calcaneal fractures.Finite element analysis was used for comparing the three types of plating systems.This study helped in guiding the clinical management of calcaneal fractures.Methods The CT data acquired from a volunteer was used to construct a finite element model of calcaneus.The fracture lines were made according to Sanders type Ⅱ （A,B,C） and type Ⅲ （AB,AC,BC） and six calcaneal fractures models were constructed accordingly.Three fixation methods used in clinical treatment were simulated by design tools （minimally invasive plating with percutaneous screws,Y-size non-locking plating,and locking plating） and then fixed to these fracture models with the help of clinical principles.The single minimally invasive plating fixation was also tested to compare the function of percutaneous screws.Then,the neutral force was applied on established methods.The displacement and presses distribution condition in various plating models were analyzed and compared.Results The levels of displacement and compressive press on the bone around fixation or strains on plating were within the physiological limit,indicating that the three methods were suitable for application.Compared with the locked and unlocked plates,the minimally invasive plating caused a relatively lower displacement without the high stress in bone or fixation.The minimum stress in fixation was observed in locking plate as the distribution of stress was concentrated in the anterior part of locking plate.Conclusions The minimally invasive plating method could be a better alternative method in treating Sanders type Ⅱ and type Ⅲ calcaneal fractures.The observed stiffness of locking plate was not obviously stronger than unlocked plate.
文摘Background Accurate and precise preoperative planning can provide information instrumental for performing less invasive articular fracture surgery. The purpose of this study was to determine that computer-assisted preoperative planning （CAPP） has the potential to improve efficiency and time in the operating room. Methods Sixty-four patients with proximal humeral fractures were treated using locking plates by minimally invasive plate osteosynthesis （MIPO） with CAPP. The time needed for virtual segmentation, reduction, and fixation of the fracture fragments were recorded. Intra and interobserver reliabilities were analyzed using the intraclass correlation coefficient. The clinical function was analyzed using Constant Score and radiology. Results The mean total time required for CAPP of two-part, three-part, and four-part proximal humeral fractures were （13.63±1.38） minutes, （23.14±2.18） minutes, and （39.61±3.01） minutes, respectively. The intra and interobserver reliabilities for all variables were high, ranging from 0.785 to 0.992. The mean operation time was （50.1±6.7） minutes. Fifty- two patients were followed up with an average time of 34.2 months. The mean Constant Score of the injury side was （82.5 ± 9.9）. Three of the fifty-two patients had four complications. Conclusion The application of CAPP was efficient and reliable, and provided excellent clinical and radiographic outcomes for the treatment of proximal humerus fractures by MIPO.
