Anatomic Locking Plate Fixation and Coracoclavicular Stabilisation with Multistrand Titanium Cable for Unstable Distal Clavicle Fracture

Objective: The aim of this study was to introduce a modified surgical procedure using anatomic locking plate (ALP) fixation and coracoclavicular (CC) stabilisation with multistrand titanium cable (MTC) to repair unstable distal clavicle fractures, and to estimate clinical effects of these people. Materials and methods: Between July 2016 and April 2018, we treated 7 patients with unstable distal clavicle fracture by ALP fixation and CC stabilisation with MTC. After the surgery, we followed up every patient for at least 24 months and analysed their clinical results. Results: The average term required for fracture healing was 9.9 (range, 9–12 weeks) and all cases are successful in fracture healing. The average Constant score was 94.6 points (range, 92–100) at the last follow-up; the modified University of California, Los Angeles (UCLA) shoulder rating scale was 33.4 points (range, 31–35) at the last follow-up. There was no infection, hardware failure and iatrogenic fracture in all the cases. Conclusions: ALP fixation and CC stabilisation with MTC is a really good method for the treatment of unstable distal clavicle fractures. This surgical technique can provide stable fixation for early functional exercise, and prevent extra shoulder joint damage.

Immediate weight-bearing after locking plate fixation of the Ludloff osteotomy

Category: Bunion Introduction/Purpose: One of the more common and versatile osteotomies to correct moderate hallux valgus deformities is the Ludloff osteotomy. This oblique osteotomy is typically stabilized with screws and patients kept non-weight bearing until healed. Complications include malunion, nonunion and loss of correction, which can occur due to poor compliance with non- weight bearing protocols. Elderly, obese and physically weak patients can have difficulty remaining non-weight bearing. A novel anatomic-locking plate and fixation method was developed that allows immediate weight bearing after a Ludloff osteotomy. We analyzed the results of a consecutive cohort of patients who underwent a Ludloff osteotomy stabilized with this method. The cohort included all patients presenting with a moderate to severe hallux valgus deformities. Complications, radiographic & clinical outcomes were studied. Methods: In this IRB approved retrospective cohort study, we analyzed clinical & radiographic data of all Ludloff osteotomies performed between 2010 and 2015. Preoperative and postoperative data included Foot Function Index, intermetatarsal & hallux valgus angles, complications, callus formation & clinical outcomes. 395 feet in 350 patients were examined. 6 patients (2.1%) were male. 43 feet were excluded due to incomplete films and 21 were excluded due to screw fixation only; requiring restricted post- operative weightbearing protocols. Three surgeons performed the surgeries and review/analyses conducted by a senior orthopedic resident, uninvolved with the care of any of the patients. Indications included symptomatic hallux valgus deformities (intramedullary angle greater than 10°), failure of conservative treatment and normal preoperative range of motion. Exclusion criteria included 1st tarsometatarsal joint arthritis/instability, peripheral neuropathy, vascular disease and 1st metatarsophalangeal joint arthritis. Preoperative and postoperative radiographs were weightbearing. Patients discharged when comfortable in normal shoes. Results: At an average of 8 months postop (2 - 43 months), there was an average hallux valgus (HVA) correction angle correction of 7.6° (p<.0001) and intermetatarsal angle (IMA) correction of 21° from initial to final radiographs. Patients were discharged when comfortable in normal shoes. In the 15 feet (4.6%) who formed hypertrophic callus, there was loss of IMA of 2.3° (p<.0001) and HVA of 4.6° (p<.0001). Superficial wound infection or mild cellulitis was noted in 16 feet (4.9°); no deep infections. 15 (4.6%) feet had hardware removal due to prominent and/or broken screws. These were in older women with thin feet. There was only 1 nonunion & 8 mal-unions. An average foot function index (in 70 patients) of 9.5/100 indicated low pain and disability. Conclusion: The data from this large series of patients (395 osteotomies) supports the use of an immediate weight-bearing protocol for Ludloff osteotomies fixed with anatomic locking plates, including patients with osteopenic bone. All patients were allowed activities and weight bearing as tolerated during the post-operative period. There were relatively few complications including loss of correction or nonunion. Patients and surgeons can expect healing and complication rates similar to osteotomies fixed with screws and a non-weight-bearing post-operative protocol. Furthermore, because of the increased stability imparted by the anatomic locking plate, it would be a good option for revision bunion surgery.