Anterior inferior plating versus superior plating for middle 1/3rd clavicle fracture: a prospective comparative study

<p class="abstract"><strong>Background: </strong>Fractures of the clavicle are common injuries that may result from direct blow or transmitted forces. Deformities are shortening and depression of lateral fragments. Various techniques are performed out of which superior and anteroinferior plating are widely used with each having its own merits and drawbacks. Our study compares the outcome between above mentioned techniques.</p><p class="abstract"><strong>Methods: </strong>We conducted a prospective comparative study of 60 patients who has met inclusion criteria and out of which 30 patients were treated with anteroinferior technique and 30 patients were treated with superior plating technique. Outcome measure were assessed through constant and murley score.</p><p class="abstract"><strong>Results: </strong>The demographic analysis of our study showed that the incidence of fracture is predominant among males (63.3%) with RTA being the most common mode of injury. AO/OTA classification which was used in our study revealed A1 as the most frequently involved group. Each group had 2 patients with infection post operatively which was managed with appropriate antibiotics. Increased incidence of delayed union was found in anterioinferior group (13.3%) with decreased hardware prominence in comparison with superior plating.</p><p class="abstract"><strong>Conclusions:</strong> There were no significant differences in functional outcome between both the groups except the fact that superior plating had higher chances of plate prominence. So either of the surgical technique can be employed depending upon the feasibility of surgeon.</p>

Replica Plating

This chapter describes how Esther Lederberg, in daring to re-purpose her compact makeup pad as a kind of ink stamp, developed the new Replica Plating Technique but later her husband Joshua seemed to claim sole credit for this discovery. The Lederbergs demonstrated the effectiveness of the new plating technique in their study of spontaneous bacterial mutations, using the technique to resolve a longstanding question of bacterial mutations: Did mutations occur spontaneously or was some other process of adaptation involved? While at first, Joshua defended Esther’s co-equal contribution to the invention of replica plating, in later publications, he seemed to claim sole credit, by ignoring her contributions. This is a classic example of the Matilda Effect, when a male colleague is given sole credit for an invention by unfairly ignoring the female colleague’s contribution. Some of the Lederbergs’ colleagues recognize Esther as the primary inventor of replica plating, since she had the reputation of an experimental genius; others assumed that the creative insight was Joshua’s.

Functional Outcome of Intercondylar Distal Humerus Fractures Surgically Treated with Open Reduction and Internal Fixation with a Principle Based on Orthogonal Plating Technique

Introduction: Owing to the complex articular structure, paucity of metaphyseal bone and thin soft tissue covering, treatment of intra-articular distal humerus fractures still pose challenge to surgeons. Although it comprises 2% of all fractures the massive complication rate to the treatment is worrisome. This study aims to evaluate the outcome of surgical treatment of these fractures by open reduction and internal fixation by dual orthogonal plates. Objectives: The objective of the study is to evaluate the functional outcome of intercondylar humerus fractures managed with open reduction and internal fixation with orthogonal dual plating technique. Methodology: Eighteen patients (19 – 68 years old) with AO/OTA type 13C fractures were evaluated after surgery for one year with MEPS and range of motion. Complications were categorized as major or minor complications. Functional comparisons were made between simple articular type C1/C2 and complex articular type C3 fractures at one year. Result: There were 2 (11.11%) type C1 fracture and 8 (44.44%) each in type C2 and C3 fractures. Eight (44.44%) patients obtained excellent, 7 (38.89%) obtained good and 3 (16.7%) obtained fair results. There was no poor outcome. Average MEPS score was 83.33 and there was no significant between the subgroups (p = 0.07). The average flexion was 118.06° and it was significantly impaired in type C3 fractures (p = 0.03). Three patients obtained full extension, and remaining patients had mean extension deficit of 12°. Average arch of motion was 108.06° with significant difference between two subgroups (p = 0.008). The mean arc of motion for supination-pronation was 154.44°. There was 5 minor and 2 major complications (total - 38.9%). Conclusion: The surgical management with open reduction and internal fixation by dual plates in orthogonal configuration for the intercondylar distal humeral AO type C fractures has good or excellent functional outcome in majority of the patients.