Search Results (4)

Introduction: Cold welding is an anecdotally well-known complication of removal of metalwork, most commonly at the screw–plate interface, and can often complicate extraction of implants after fracture fixation. Even though this phenomenon is familiar amongst the orthopedic community, there is relatively little formalized discussion or literature pertaining to its identification and management clinically. In addition, as far as we can establish, there does not seem to be a paper that discusses the various techniques described in the literature that are employed to combat cold welding. Methods: A systematic review was carried out in accordance with the PRISMA guidance, with two independent reviewers and a third person to arbitrate for any discrepancies. Manuscripts were identified using a search of PubMed/MEDLINE and Google Scholar. Studies eligible for inclusion were tabulated and the results categorized qualitatively with respect to the technique described for removal of the implants. Results: A total of 272 manuscripts were identified using a search of PubMed/MEDLINE and Google Scholar, and of these 14 were ruled to be eligible for inclusion reporting on 292 patients. Common locations of the cold-welded screws included femur, tibia, distal radius and clavicle. The most common technique for metalwork removal was using either bolt cutters or burrs to cut the plates between the screws and mobilize the screw and plate as one unit. Other techniques included using specialized removal tools and cutting between the screw head and body. There was no appreciable correlation between the specific anatomic location of the welded implant and the technique used in its removal. From the studies, it was found that, of the total number of screws (n = 1654), 58 (3.5%) were cold welded. The mean time to metalwork removal was 1104 days (36.8 months). Conclusions: As far as we can tell, this is the first systematic review pertaining to the phenomenon of cold welding specifically, and with this project we have collated the techniques used to remove implants affected by cold welding from a variety of different articles. Our work aims to highlight the relative paucity of literature in this area and provide a number of accessible and safe techniques to facilitate the removal of cold-welded implants in fracture fixation. Full article

The human clavicle’s unique S-shaped, three-dimensional structure complicates fracture management. This study evaluated the anatomical conformity of pre-contoured anatomical plates using 3D-printed clavicle models. CT scans from 30 patients (15 males and 15 females) were used to create these models. Three brands of distal clavicle plate systems (Acumed, Synthes, and Arthrex) were tested for fit. Measurements included the distance from the distal end of the clavicle to the plate’s lateral end, the gap between the clavicle and the plate, and the overhang distance. Results showed significant differences in clavicle length between sexes, with men having a mean length of 156.1 ± 7.6 mm and women 138.4 ± 4.3 mm, both with normal distribution (p > 0.05). The mean lateral distance was 7.9 ± 1.7 mm, and the mean medial gap was 3.6 ± 3.0 mm, showing no significant differences between products or sexes. The mean overhang distance was 5.8 ± 4.6 mm, with larger values in women for the Acumed (p = 0.037) and Arthrex (p = 0.000) plates. Overall, pre-contoured plates exhibited notable discrepancies, especially in shorter clavicles. Full article

Background: Despite its fair-to-moderate reliability, the “modified Neer classification” is widely accepted and used. The purpose of this study was to reevaluate its applicability. Methods: Of n = 59 patients with distal clavicle fractures, fractures were classified on standard radiographs. Afterwards, an MRI examination was performed, and fractures reclassified. The primary outcome parameter was quantifying the rate of misclassification. The secondary outcome parameters were the evaluation of the ligamentous injury constellations. Results: In all cases, the fracture course and ligamental integrity could be assigned to the fracture type. Correction of the classification was necessary in n = 5 (8.5%) cases. In n = 3 (5%) cases, a correction was necessary from Neer I to Craig IIc and thus from conservative to operative treatment. Mean coracoclavicular distance (CCD) in Neer I was 10.2 ± 2.1 mm versus 14.2 ± 3.9 mm in Craig IIc (p = 0.02). The mean fracture angle in Neer I was 25.1 ± 3.3° versus 36.8 ± 4.4° in Craig IIc (p = 0.02). Conclusion: Cross-sectional imaging resulted in higher precision. Nevertheless, recommendations remain for standard radiographs. The CCD and fracture angle should be considered. An angle of >30° can be assumed as a parameter of instability. A previously undescribed fracture type does not seem to exist. The modified Neer classification is an appropriate and complete fracture classification. Full article

We investigated the complications and frequency of hook plate fixation in patients with shoulder trauma. We reviewed 216 cases of hook plate fixation use at our hospital between January 2010 and May 2020. Finally, we included 76 cases of acute distal clavicle fracture (DCF) and 84 cases of acute acromioclavicular joint dislocation (ACD). We investigated all complications after hook plate use, bony union in the DCF group, and reduction loss in the ACD group. We defined painful shoulder stiffness (PSS) as aggravating resting pain with stiff shoulder, and pain on shoulder elevation (PSE) as continued shoulder pain on elevation without PSS before plate removal. PSS was managed with intra-articular steroid injections or manipulation with or without arthroscopic capsular release (ACR). PSS occurred in 36 and 33 cases of DCF and ACD, respectively. PSE occurred in 17 of 76 fractures and 13 of 84 dislocations. However, no iatrogenic rotator cuff injury was verified by magnetic resonance imaging in patients with PSS or PSE. Subacromial erosion in patients with hook plate fixation should be considered a sequela and not a complication because it is unavoidable in surgery with an AO-type hook plate. The most common complication was PSS, followed by PSE. Full article