Tatjana Pastor

Purpose: Chauffeur fractures represent a distinctive subset of distal radius fractures and typically arise from a high-energy axial load or a direct blow to the volar aspect of the wrist. In cases of significant displacement, joint incongruity or functional impairment, surgical intervention becomes crucial. However, up to date there is no consensus about the best osteosynthesis treatment option. Therefore, the aim of this study was to investigate the biomechanical competence of Chauffeur fractures fixed with either one headless cannulated compression screw, two headless cannulated compression screws, or two Kirschner (K-) wires. Methods: Eighteen right synthetic radii with a simulated Chauffeur fracture were assigned to three groups ( n = 6) for fixation with either one headless cannulated compression screw (3.0 mm x 36 mm; Group 1), two K-wires (1.8 mm; Group 2), or two headless cannulated compression screws (2.2 mm x 30 mm and 2.2 mm x 36 mm; Group 3). The specimens underwent non-destructive biomechanical testing in neutral position, flexion, and extension, followed by progressively increasing cyclic loading to failure in neutral position with monitoring via motion tracking. Results: Initial construct stiffness in flexion was significantly lower in Group 3 (202.4 ± 32.8 N/mm) versus both Group 1 (283.6 ± 31.3 N/mm) and Group 2 (275.3 ± 57.8 N/mm), p < 0.05. Cycles to failure and failure load in Group 2 (9214 ± 644; 510.7 ± 32.2 N) and Group 3 (8282 ± 973; 464.1 ± 48.7 N) were both significantly higher versus Group 1 (4678 ± 930; 283.9 ± 46.5 N), p < 0.05. Conclusion: Whereas treatment of Chauffeur fractures with one cannulated compression headless screw is not recommended, using two K-wires is a valid alternative to the fixation of such fractures with two headless cannulated compression screws.

Background: Distal triceps tendon rupture is related to high complication rates with up to 25% failures. Elbow stiffness is another severe complication, as the traditional approach considers prolonged immobilization to ensure tendon healing. Recently, a dynamic tape was designed, implementing a silicone-infused core for braid shortening and preventing repair elongation during mobilization, thus maintaining constant tissue approximation. The aim of this study was to compare biomechanically the novel dynamic tape versus conventional tape in a human cadaveric distal triceps tendon repair model. Methods: Sixteen paired arms from eight donors were split to two groups. Distal triceps tendon tenotomies and repairs were performed via the crossed transosseous locking Krackow stitch technique for anatomic footprint repair. Either conventional (SutureTape) or the novel dynamic tape (DYNATape) were used. A postoperative protocol mimicking intense early rehabilitation was simulated by a 9-day, 300-cycle daily mobilization under 150 N load followed by a final destructive test. Results: Significant differences were identified between the groups regarding the displacement over time at the distal, intermediate, and proximal tendon aspects, p < 0.001. DYNATape demonstrated significantly less displacement compared to SutureTape (4.6 ± 1.2 mm versus 7.8 ± 2.1 mm) and higher load to failure (637 ± 113 N versus 341 ± 230 N), p ≤ 0.037. DYNATape retracted 0.95 ± 1.95 mm after each 24-hour period and withstood the whole cyclic loading sequence without failure. In contrast, SutureTape failed early in three specimens. Conclusion: DYNATape demonstrated improved biomechanical competence compared to SutureTape in a distal triceps tendon repair model, with significantly lower maximal displacement and higher load to failure. These findings indicate that DYNATape may offer a more stable construct under controlled laboratory conditions. Knot slippage and bone-related complications observed in both groups underscore the technical challenges associated with this repair technique and highlight the importance of precise surgical execution.

Purpose: This narrative review systematically compiles and analyzes existing literature on the use of helical plates in orthopaedic trauma surgery. By synthesizing data across various study types, it provides a comprehensive overview of the biomechanical characteristics, clinical outcomes, and anatomical advantages of helical plating. Methods: A systematic search was performed using PubMed and Web of Science databases, employing defined search terms to identify relevant studies. Single case reports were excluded, while structured case series were included. Retrieved studies were categorized into five groups: simulation studies, biomechanical studies, case series, clinical comparative studies, and anatomical studies. Results: The review identified studies from 1992 to 2023, with most of the research focusing on the femur (7 studies) and humerus (6 studies). Biomechanical studies (7) were the most common, followed by clinical case series (7), comparative studies (4), and finite element analyses (3). European institutions contributed to the majority of research, with additional studies from Asia and South America. No randomized controlled trials were found. Helical plates demonstrated comparable stability to straight plates, with distinct biomechanical advantages: superior torsional resistance in femoral fractures and improved neurovascular safety in humeral fractures. Conclusion: Helical plates offer a viable alternative to straight plates in long bone fractures, particularly for protecting neurovascular structures. Optimal designs vary by location, with 45° helical plates recommended for humeral minimally invasive plate osteosynthesis, 180° helical plates for young patients with femoral fractures, and 90° helical plates in geriatric double plating constructs. Further high-quality research is needed to establish definitive clinical guidelines.

Background Digitally Enhanced Hands-on Surgical Training (DEHST) platform was introduced to overcome the lack of training capabilities for the challenging task of freehand distal interlocking of intramedullary nails. It demonstrates high perceived realism for surgeons, and novices perform significantly better after DEHST training. However, characterization of how performance improves remained unexplored. The aim of this study was to evaluate the training progression of novices in freehand distal interlocking during five training rounds with DEHST and to compare their performance in a simulated operation against experienced surgeons. Methods Ten novices (Group 1) underwent five DEHST training sessions (approximately one hour in total) and their performance data was acquired and evaluated. The surgical performance of Group 1 was compared with ten surgical experts (Group 2) by performing distal interlocking of a real tibia nail in an artificial bone model in a simulated operation. Time taken, number of X-rays, accuracy of nail hole roundness, and success rates were compared between the groups. Results Group 1 achieved comparable performance to Group 2 in number of X-rays 26.0 (range 15–40) versus 22.5 (range 16–34), p = 0.281, and accuracy of hole roundness 95.0% (range 91.1–98.0%) versus 93.3% (range 90.7–95.9%), p = 0.087. However, Group 1 needed significantly longer time compared with Group 2, p = 0.001, and furthermore, one participant in Group 1 (10%) failed to hit the nail hole with the drill bit, while 100% of the participants in Group 2 were successful. Conclusions DEHST appears to be a useful tool to gradually improve the proficiency level of novices and to train relevant practical surgical skills needed for distal interlocking of intramedullary nails. However, further investigations are needed to demonstrate the performance under the conditions of a real operation.

Introduction According to current clinical practice, a minimum of 7 knots are required to provide secure hold in high-strength sutures. A new technology featuring a suture tape with a salt-infused silicon core has been recently developed, potentially reducing the number of needed knots. Aims: to (1) assess the influence of number of knots on tape security, (2) evaluate the effect of different ambient conditions on knot security, and (3) compare the biomechanical competence of the novel versus a conventional suture tape. Materials and methods A conventional suture tape (ST, SutureTape^tm) was considered for knot tying together with the novel suture type (DT, Dynatape^tm). Specimens were assigned to receive different number of knots, ranging from 3 to 7, and to be exposed to different media during tying―air (dry), saline solution (wet), and fat (fatty-wet). Seven specimens were considered for each suture type, knot number and ambient condition. With knotted sutures mounted between two roller bearings, quasi-static tensile ramp tests were performed to evaluate knot slippage, ultimate force at rupture, and minimum number of knots preventing suture unraveling for each suture tape and condition. Results Whereas the ST ruptured without unraveling with a minimum of 6 knots in all specimens and ambient conditions, the minimum number of knots for a DT rupture without unraveling was 6 in dry, 4 in wet, and 5 in fatty-wet condition. Ultimate force at rupture with a minimum number of needed knots did not differ significantly between ST and DT (p ≥ 0.067), in contrast to knot slippage that was significantly bigger for ST versus DT in wet and fatty-wet conditions(p ≤ 0.001). Conclusions In fatty-wet conditions―related to open surgery―the novel Dynatape^tm suture tape requires 5 instead of 7 knots to achieve their security. In wet conditions―related to arthroscopic surgery―this number can be reduced to 4 knots. In contrast, the conventional SutureTape^tm needs 6 knots to provide security in all conditions.

Helical plates used for proximal humeral shaft fracture fixation avoid the radial nerve distally as compared to straight plates. To investigate in a human cadaveric model the biomechanical competence of straight lateral plates versus 45° helical plates used for fixation of proximal comminuted humeral shaft fractures, eight pairs of human cadaveric humeri were instrumented using either a long straight PHILOS plate (Group 1) or a 45° helical plate (Group 2) for treatment of an unstable proximal humeral shaft fracture. All specimens were tested under non‐destructive quasi‐static loading in axial compression, internal and external rotation, and bending in four directions. Subsequently, progressively increasing cyclic loading in internal rotation was applied until failure and interfragmentary movements were monitored by motion tracking. Axial displacement (mm) was 3.13 ± 0.31 in Group 1 and 2.60 ± 0.42 in Group 2, p = 0.015. Flexion/extension deformation (°) in Group 1 and Group 2 was 0.56 ± 0.42 and 0.43 ± 0.23, p = 0.551. Varus/valgus deformation (°) was 6.39 ± 0.44 in Group 1 and 5.13 ± 0.87 in Group 2, p = 0.012. Shear (mm) and torsional (°) displacement were 5.36 ± 0.76 and 17.75 ± 1.06 in Group 1, and 5.03 ± 0.46 and 16.79 ± 1.36 in Group 2, p ≥ 0.090. Cycles to catastrophic failure were 10000 ± 1401 in Group 1 and 9082 ± 1933 in Group 2, p = 0.708. From a biomechanical perspective, 45° helical plating is associated with lower axial and varus/valgus displacement under axial loading and demonstrates comparable resistance to failure versus straight plating. Therefore, 45° helical plates can be considered as a valid alternative to straight plates for treatment of proximal humeral shaft fractures.