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The fifth metatarsal metaphyseal diaphyseal stress fracture is a notoriously difficult fracture with a history of delayed healing and prolonged treatment times.
Several other implants have evolved over time to manage this difficult fracture.
In the last decade, the hook plate originally developed by Balser to treat acromioclavicular dislocations has been used as treatment for this difficult fracture [6].
They demonstrated that it was possible to sufficiently fix this difficult fracture due to new developments in the plate screw interface.
In this study, use of the superior clavicle plate with lateral extension yielded excellent results in the treatment of this difficult fracture.
External fixator has been used in difficult fracture dislocations such as: injuries to the "greater arc" with fracture of two or more carpal bones, complete irreducible palmar dislocations associated with intraarticular fractures of the distal radius, and open carpal injuries [12, 27].
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From then on, he began treating the most difficult fractures, which were often referred to him by other specialists.
To review one surgeon's experience with a novel type of "hybrid" locking plate (which has both 3.5 mm and 4.5 mm locking holes) for difficult fractures of the meta-diaphyseal humeral shaft.
Certain technical pearls are pivotal in managing these difficult fractures with nails; these include rotator cuff management, respect of the soft tissues, anatomic tuberosity position, blood supply maintenance, knowledge of the deforming forces on the proximal humerus, fracture reduction, and rehabilitation strategies.
Supracondylar fractures can be one of the most difficult fractures to treat [16].
This treatment method compares well with previous published series and is to be recommended for this group of difficult fractures.
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