A narrative review synthesizing biomechanical and clinical evidence across five fracture patterns. Covers complex elbow instability, unstable sacral fractures, Vancouver B1 periprosthetic femur fractures, distal femur fractures, and syndesmotic injuries. For each pattern, the review evaluates which fixation construct best balances stability with the motion required for healing.
Two principles collide in distal femur fracture management: locked plates provide strong fixation, but their rigidity suppresses the callus formation needed for healing. The 10-23% nonunion rate with standard locked plating is not bad luck — it is a predictable consequence of overly stiff constructs.
When you fix a distal femur fracture, the construct needs controlled motion, not pure rigidity. FCL screws build dynamization into a locking construct, yielding 157% stronger healing in animal studies and 3% nonunion clinically. This is why dynamization is now a design consideration, not an afterthought.
For terrible triad injuries, resist the urge to fix every coronoid fragment. The threshold is 40-50% of coronoid height. Below that, restore the radial head and repair the ligaments, and the elbow will be stable. The one exception is the anteromedial facet: even small fragments (greater than 5 mm) destabilize the joint and need fixation.
For Vancouver B1 fractures without medial cortical contact, a single locking plate will fail. Add the anterior strut allograft to create 90/90 fixation. The biomechanical data and the systematic review both support it.
A narrative review synthesizing biomechanical and clinical evidence across five fracture patterns. Covers complex elbow instability, unstable sacral fractures, Vancouver B1 periprosthetic femur fractures, distal femur fractures, and syndesmotic injuries. For each pattern, the review evaluates which fixation construct best balances stability with the motion required for healing.
Two principles collide in distal femur fracture management: locked plates provide strong fixation, but their rigidity suppresses the callus formation needed for healing. The 10-23% nonunion rate with standard locked plating is not bad luck — it is a predictable consequence of overly stiff constructs.
When you fix a distal femur fracture, the construct needs controlled motion, not pure rigidity. FCL screws build dynamization into a locking construct, yielding 157% stronger healing in animal studies and 3% nonunion clinically. This is why dynamization is now a design consideration, not an afterthought.
For terrible triad injuries, resist the urge to fix every coronoid fragment. The threshold is 40-50% of coronoid height. Below that, restore the radial head and repair the ligaments, and the elbow will be stable. The one exception is the anteromedial facet: even small fragments (greater than 5 mm) destabilize the joint and need fixation.
For Vancouver B1 fractures without medial cortical contact, a single locking plate will fail. Add the anterior strut allograft to create 90/90 fixation. The biomechanical data and the systematic review both support it.