Case Studies

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Case #1

F.C. is a 68-year-old female with rheumatoid arthritis with severe osteoporosis who presented with an ununited 1-MTP fusion after a forefoot reconstruction. The patient’s continued problems were secondary to deformity and pain at the nonunion site. Figure 1 shows the fractured plate and the relatively small proximal phalanx fragment that remain.

The challenge, after removing the old hardware, was to get stable fixation of the severely shortened osteoporotic, proximal phalanx. The goal was to get as many screws into the distal fragment as possible in multiple planes of fixation for stability. The MaxLock plate, shown in figure 2 one week post-op, was ideal for this situation. The three screws were placed into the proximal phalanx with excellent hold. The patient went on to a solid union in six weeks post-op.

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Case #2

A.A. is a 68-year-old man who fractured his left distal fibula in a pronation, external rotation-type injury. The deltoid ligament was also ruptured leaving him with an unstable ankle. Figure 1 shows the challenge of getting stable fixation on the relatively small fragment distally.

The goal of surgery was to get anatomic, stable fixation of the distal fibular fracture to allow for a stable mortise and allow early post-op mobilization. The standard 1/3 tubular plate would only allow uniplanar fixation with one or two screws in the distal fragment. The MaxLock Plate afforded three screw fixations in multiple planes to optimize fixation rigidity and allowed early mobilization of the ankle at two weeks post-op (Figure 2).

At four weeks post-op the patient was full weight bearing in a CAM walker, and at seven weeks in a supportive shoe. Because of the stability of the fracture fixation, the patients rehab was accelerated without compromise of the fracture healing and position of the ankle mortise.

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Case # 3

D.H. is a 56-year-old male who suffered a comminuted bimalleolar ankle fracture after falling off a ladder. The severely comminuted nature of the distal fibular component made internal fixation a challenge (Figure 1).

Through a medial longitudinal incision, the ankle joint was inspected for osteocartilagenous debris. The medial malleolus was internally fixed in compression with 3.5 MaxLock screws. The fibula fracture was found to be markedly comminuted and distal. With the standard 1/3 tubular plate, the very distal fragment had room for only one screw. The MaxLock Plate, however, because of its unique design and hole placement, allowed for biplanar, two-screw fixation in the most distal fragment (Figure 2).

At four weeks post-op, the patient was placed in a CAM walker and allowed to start active ankle range of motion exercises. At eight weeks post-op, the patient was full weight bearing in a supportive shoe. The MaxLock fixation system allowed accelerated rehabilitation for this patient because of the superior stability of fixation compared to standard 1/3 tubular plates.