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At least 181 records · Page 10Linked to original sources
PubMed1992

Subtrochanteric fracture: fixation using the AO tibial nail.

We describe an alternative fixation for the pure uncomminuted subtrochanteric fracture by using the AO tibial nail. There were no intraoperative complications in 24 fractures with this method. The fractures healed within 4 months postoperatively in 18 non-pathological fractures that could be followed up. There were minor complications, including 10 degrees external malrotation in one case and varus angulation after nail breakage in another. The nails were removed in seven healed fractures without problems. Two pathological fractures which were stabilized by the AO tibial nail, combined with the use of bone cement to fill the bone defect, were able to have early postoperative ambulation without any problems with the fixing device.

Adolescent↗
PubMed1990

Foreign-body reactions to fracture fixation implants of biodegradable synthetic polymers.

Biodegradable rods of polyglycolide or lactide-glycolide copolymer were used in the internal fixation of a variety of fractures and osteotomies in 516 patients. A clinically manifest foreign-body reaction occurred in 41 patients (7.9%), producing a fluctuant swelling at the implantation site after an average of 12 weeks. Spontaneous sinus formation or surgical drainage yielded a sterile exudate containing liquid remnants of the degrading implants. After prompt drainage this discharge subsided within three weeks. Histological examination showed a typical nonspecific foreign-body reaction with abundant giant cells both in patients with the reaction and in some patients with an uneventful clinical course. The factors determining the nature of the reaction were probably related to the local capacity of the tissues to clear the polymeric debris. The reactions did not influence the clinical or radiographic results, but recognition of the incidence and the features of the reaction is necessary in view of the increasing use of such implants.

Adolescent↗
PubMed2001

Failure of intertrochanteric fracture fixation with a dynamic hip screw in relation to pre-operative fracture stability and osteoporosis.

We have reviewed 178 intertrochanteric fractures treated by dynamic hip screw (DHS) fixation between March 1995 and December 1999 and followed for a minimum of 1 year. We used Singh's classification of the trabecular bone structure in the proximal femur as a measure of osteoporosis and also classified the fractures according to three different systems (Boyd-Griffin, Evans, AO). The postoperative radiographs were examined for loss of reduction, i.e. varus angulation >100, perforation of the femoral head, more than 20-mm extrusion of a lag screw or metal failure. We found 49 cases which showed radiographic failures. Two were stable fractures and 47 unstable fractures (Evans' classification). Unstable fractures with osteoporosis had a failure rate of more than 50%. In such cases DHS should not be the first choice for treatment.

Aged↗
PubMed1992

The tissue-implant interface during degradation of absorbable polyglycolide fracture fixation screws in the rabbit femur.

A transverse transcondylar osteotomy of the distal femur was fixed with an axially placed absorbable fracture fixation screw made of polyglycolide (PGA) in 25 rabbits. Changes at the tissue-implant interface accompanying degradation of the screw were examined histologically, histomorphometrically, and microradiographically seven, 20, 40, 80, and 250 days after implantation. At seven days postimplantation, a layer of fibroblasts was seen surrounding the implant, and new bone formation was discernible in the host tissues adjacent to this membranous structure. At 20 days postimplantation, the geometry of the screw was still intact and the tissue-implant boundary was distinct. The first signs of invasion of vascular granulation tissue into the implant were observed 40 days after implantation, at which time the osteotomies were united. The apparent walling-off response by formation of new trabecular bone outlining the PGA profile continued, with the greatest mean trabecular bone volume fraction at the interface, 23.9%, measured at 40 days. A significant decrease in the new bone volume occurred between 40 and 80 days postimplantation. The intensity of the foreign-body reaction seen was histologically moderate. The giant cell count was highest at 80 days postimplantation, when the migratory activity of phagocytic cells had transported intracellular particulate polymeric debris 400-800 microns away from the original tissue-implant boundary. At 250 days postimplantation, no birefringent polymeric material could be seen in the specimens. No contraindications for the clinical application of PGA implants emerged in this study.

Animals↗
PubMed2004

Anatomical considerations for percutaneous proximal humeral fracture fixation.

PURPOSE: To investigate the hypothesis that percutaneous wire fixation of proximal humeral fractures is prone to regional neurovascular injury. MATERIALS AND METHODS: 40 cadaveric shoulders had percutaneous wires inserted from anterior and lateral humeral shaft entry points into the humeral head. The shoulders were then dissected to identify the neurovascular structures in this area. RESULTS: The axillary nerve trunk and posterior circumflex humeral artery were found to be within the field of dissection. The axillary nerve was damaged on three occasions by the lateral wires, two of which were direct nerve penetrations. The anterior wires caused a single perineural injury of a terminal branch. The main neurovascular leash was 57 mm (range 35-70 mm) from the acromion tip laterally and 51 mm (range 35-85 mm) anteriorly, with a width of 6 mm (range 4-13 mm) laterally, and 12 mm (range 7-15 mm) anteriorly. CONCLUSIONS: Percutaneous wire stabilisation is an attractive fixation option but this study highlights the close proximity of the important neurovasculature. Such fixation should be performed utilising a limited open approach, with dissection to bone under direct vision, with the subsequent use of a drill-sleeve for soft-tissue protection.

Aged↗
PubMedDate not supplied

Intraoperative use of nylon bands in fracture fixation.

Nylon tie bands are introduced as an intraoperative aid in the application of internal fixation. Their use for holding metal plates on reduced fractures is advantageous over metal clamps in that they do not impede access to the fracture site, are easily applied, keep intraoperative injury to soft tissue at a minimum, and reduce manipulatory efforts at the fracture site, decreasing operating time. Scuffing of metal plates is eliminated. A technique for their use is described. Our experience with the nylon tie bands indicates that they are an effective adjunct, as opposed to conventional metal clamps, in open reduction and internal fixation of fractures in our institution.

Bone Plates↗
PubMed1989

Fracture fixation with biodegradable rods. Forty-one cases of severe ankle fractures.

In a prospective study of 41 patients, severe ankle fractures of Lauge-Hansen types SE III-IV, PA III, and PE III-IV were treated by open reduction and internal fixation using biodegradable self-reinforced polyglycolide cylinder-shaped rods. Disruption of the distal tibiofibular syndesmosis and/or fracture of the posterior tibial margin requiring reduction and fixation were the inclusion criteria for the study. The mean follow-up time after operation was 16 (12-32) months. Two failures of fixation necessitated reoperation. A secondary displacement of 1-2 mm of the lateral malleolus occurred in 3 cases. Transient accumulation of soluble polyglycolide mass complicated the course in 3 cases, but did not influence the radiographic or the functional result. Function became good in 30 patients. The advantage of the biodegradable implants is that they do not need to be removed at secondary operations.

Adolescent↗
PubMedDate not supplied

Optimizing stability in distal humeral fracture fixation.

Restoration of painless and satisfactory elbow function after a fracture of the distal humerus requires anatomic reconstruction of the articular surface, restitution of the overall geometry of the distal humerus, and stable fixation of the fracture fragments to allow early and full rehabilitation. Although these goals are now widely accepted by the orthopaedic community, they may be technically difficult to achieve, especially in the presence of substantial osteoporosis or comminution. Failure, when it occurs, typically occurs at the supracondylar level through loss of fixation in the distal fragments. To prevent such failure and thereby maximize the potential for union and full elbow mobility after a severely fractured distal humerus, 2 principles must be satisfied: (1) fixation in the distal fragment must be maximized and (2) all fixation in distal fragments should contribute to stability between the distal fragments and the shaft. There are 8 technical objectives by which these principles are met: (1) every screw in the distal fragments should pass through a plate; (2) engage a fragment on the opposite side that is also fixed to a plate; (3) as many screws as possible should be placed in the distal fragments; (4) each screw should be as long as possible; (5) each screw should engage as many articular fragments as possible; (6) the screws in the distal fragments should lock together by interdigitation, creating a fixed-angle structure; (7) plates should be applied such that compression is achieved at the supracondylar level for both columns; and (8) the plates must be strong enough and stiff enough to resist breaking or bending before union occurs at the supracondylar level. These can be achieved with parallel plating. Severe metaphyseal comminution and bone loss are managed by supracondylar shortening. From the biomechanical data in the literature, 3 conclusions can be reached concerning fixation of distal humeral fractures. First, the concept that plates need to be placed perpendicular (90 degrees /90 degrees orientation) is unsubstantiated and incorrect. Second, parallel placement of 2 plates in the sagittal plane is as strong or stronger than the 90 degrees /90 degrees orientation. Finally, linking the plates together through the bone, thereby creating the architectural equivalent of an arch, offers the greatest biomechanical stability for comminuted distal humeral fractures. This can be done by interdigitating and locking the screws together as they pass through the distal fragments from the medial and lateral plates placed in the sagittal plane.

Bone Screws↗
PubMed1985

The use of short carbon fibre reinforced thermoplastic plates for fracture fixation.

Thermoplastic plates of Nylon 6-10 and Polybutylene terephthalate reinforced with 30% short randomly oriented carbon fibres were tested for internal fixation of canine femoral transverse midshaft fractures. The elastic modulus of the plates was one-half that of bone: however, ultimate strength and strain in bending were comparable to bone. The fractures healed with moderate callus formation which was completely remodelled by 8 to 12 wk post surgery. Although a moderate inflammatory reaction to occasional particulate debris was noted, the materials appeared to possess the proper elastic moduli to allow sufficient support for the healing fracture without protecting the remodelling process.

Animals↗