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At least 181 records · Page 10Linked to original sources
PubMed2006

[Treatment of kyphosis deformity with pedicle subtraction osteotomy and short-segment pedicle screw internal fixation].

OBJECTIVE: To assess the outcomes of pedicle subtraction osteotomy and short-segment pedicle screw internal fixation in kyphosis deformity. METHODS: From June 2001 to November 2003, 16 cases of kyphosis deformity were treated with pedicle subtraction osteotomy and short-segment pedicle screw internal fixation, including 11 males and 5 females and aging 24-51 years. The kyphosis deformity was caused by ankylosing spondylitis in 12 cases, old lumbothoracic fracture-dislocation in 2 cases, and vertebral dysplasia in 2 cases. The disease course was 7-25 years with an average of 12.8 years. The whole spine radiographs were taken pre- and postoperatively. The sagittal balance was assessed by measuring thoracic kyphosis angle, lumbar lordosis angle, sacrohorizontal angle and distance between posterosuperior point of S1 and the vertical line. The clinical outcomes were assessed by Bridwell-Dewald scale for spinal disorders. RESULTS: The mean follow-up period was 25. 6 months. The mean bleeding was 1100 ml. Satisfactory bone graft healing was achieved at final follow-up. Complications were paralytic intestinal obstruction in 1 case, dura laceration in 1 case, and temporary lower limb paralysis in 2 cases. Final follow-up radiograph showed an increase in lumbar lordosis angle from 9.6+/-16.4 degrees to 42.6 14.3 degrees (P<0.05), whereas thoracic kyphosis angle remained relative stable. The distance between posterosuperior point of S1 and the vertical line was decreased from 97.5+/-45.6 mm to 10.7+/-9.6 mm (P < 0.05). Satisfactory clinical outcome was achieved by evaluating the changes of pain, social and working status. CONCLUSION: Pedicle subtraction osteotomy and short-segment pedicle screw internal fixation is effective for correction of kyphosis deformity.

Adult↗
PubMed2004

[Application of two parallel Kirschner wires in internal fixation for digital replantation: experience with 14 cases].

OBJECTIVE: To improve the method for internal fixation in digital replantation. METHOD: In 14 cases of finger fractures (17 fingers) admitted in our hospital between October, 2000 and March, 2003, intramedullary fixation was performed with two-parallel Kirschner wires, and the effects were compared with those of other internal fixations in cases treated within the same period. RESULT: All the digital fractures healed and none of the 10 patients followed up suffered nonunion or delayed healing. The average healing time of the fractures was 5 weeks, and the joint function recovered satisfactorily. CONCLUSION: Internal fixation with two parallel Kirschner wires can achieve more reliable fixation to promote the healing of the bone fractures.

Adolescent↗
PubMed2003

[Treatment of open fracture by vacuum sealing technique and internal fixation].

OBJECTIVE: To investigate the effect of vacuum sealing(VS) technique and emergency internal fixation on the management of limbs open fracture and soft tissue dirty defects. METHODS: Fourteen patients (18 limbs) with open fracture and soft tissue dirty defects were treated by the VS technique and internal fixation after debridement and 14 patients managed by traditional method as control group. Wound surface were covered with polyvinyl alcohol foams with embedded drainage tubes connected with vacuum bottle (negative pressure of 50 to 60 kPa) after wound surface were debrided and fracture were fixed. Wound closure was performed with secondary suturing, or free flap, or loco-regional flap and mesh-grafts after 5 to 7 days. RESULTS: All wound surface healed completely. No complications (systemic and local) were found. After 4-6 months follow-up on average, the fracture healed well. There was significant difference in time of treatment, total cost of treatment and complication rate between 2 groups (P < 0.01). CONCLUSION: The VS procedure can drain the wound surface completely, decrease infection rate and stimulate the proliferation of granulation tissue. A combination of VS with emergency internal fixation is a simple and effective method in treatment of limbs open fracture and soft tissue dirty defects.

Adolescent↗
PubMed2003

Internal fixation for osteomyelitis of cervical spine: the issue of persistence of culture positive infection around the implants.

BACKGROUND: We describe the management of osteomyelitis of the cervical spine, utilizing internal fixation with subsequent removal and culture of the implants. Four out of five patients had evidence of bacterial colonisation in close proximity to the internal fixation device. METHODS: Five consecutive patients (all female, ranging in age from 50 to 74 yrs) presenting with unstable cervical osteomyelitis were treated by surgical decompression, primary internal fixation followed by three months of intravenous antibiotics. The internal fixation was removed in 4 out of 5 cases within a year of stopping the intravenous regime. The remaining patient was deemed medically unfit for further operation. Multiple specimens from the screw sites were taken at the time of metal removal. A final course of oral antibiotics was prescribed based on the results of these specimens. FINDINGS: Four patients, who had removal of the implants, had positive cultures growing different bacteria from the primary infection, at the time of removal of the implant. None of the patients developed instability after removal of the implant. INTERPRETATION: Asymptomatic bacterial colonisation of a metallic implant has profound management implications. We recommend long-term oral antibiotic regimes after insertion of internal fixation devices in the face of infection and eventual removal of these implants and microbiological re-sampling.

Aged↗
PubMed2005

Quantitative comparison of open reduction and internal fixation versus the Gillies method in the treatment of orbitozygomatic complex fractures.

BACKGROUND: Precise repair of orbitozygomatic complex fractures is essential for proper re-establishment of facial symmetry, ocular globe position, and infraorbital nerve function. Controversy regarding the optimal treatment method remains. METHODS: To compare uniform study groups, only patients without previous craniofacial injuries or operations who had sustained moderate-energy orbitozygomatic complex fractures, based on preoperative computed tomography scans, and who were treated using the Gillies repair or open reduction and internal fixation were selected. Quantifiable end-points, including orbitozygomatic complex position, ocular globe projection, and infraorbital nerve function, were measured to objectively compare the accuracy of repair produced by the Gillies procedure and open reduction and internal fixation. Negative sequelae resulting from cutaneous access were tabulated. RESULTS: Overall, 12 patients treated using the Gillies repair and 12 treated with open reduction and internal fixation were examined. The results demonstrated that the open reduction and internal fixation technique produces superior realignment of the orbitozygomatic complex, that is, a smaller difference in the position of the orbitozygomatic complex between the injured and noninjured sides of the face. The differences in orbitozygomatic complex projection, height, and lateral position were 1.4 mm, 1.4 mm, and 1.6 mm, respectively, in the open reduction and internal fixation group and 7.5 mm, 5.6 mm, and 4.1 mm in the Gillies group. The p values were 0.0003, 0.01, and 0.06, respectively. Visible cutaneous scarring was present in four patients and lower lid shortening was seen in three patients treated using open reduction and internal fixation. CONCLUSIONS: To the authors' knowledge, this is the first study to objectively show that the open reduction and internal fixation technique results in superior positioning of the orbitozygomatic complex in moderate-energy orbitozygomatic complex fractures compared with the Gillies repair. Although negative sequelae from surgical access were substantial, recently introduced transconjunctival and upper lid blepharoplasty incisions will minimize these drawbacks.

Adult↗
PubMed1996

[Different techniques of internal fixation applied in lumbosacral fusion: 83 cases analysis].

Posterior lumbosacral fusion using bone graft without internal fixation requires long immobilization and has high rate of pseudoarthrosis. To overcome such limitation technique of spinal internal fixation has been developed and applied in past twenty years. Since 1982, the authors have done lumbosacral fusion with internal fixation and bone graft by using Harrington alar hook (32 cases), luque ring (26 cases), Galveston technique (7 cases), Steffee plate (10 cases), Dick pedicle screw (1 cases), RF instrumentation (3 cases) and CD technique (4 cases). Totally 83 cases have been treated, which include paralytic pelvic tilt (9 cases), spinal fracture (4 cases), lumbosacral tuberculosis (5 cases), degenerative stenosis (21 cases); L5-S1 spondylolisthesis (38 cases), L5-S1 disc protrusion (4 cases); L5 semivertebra (1 cases) and neurofibromatosis (1 cases). Patients have been follow-up for 63.7 months on average. Good fusion has been seen in 82 cases (98.8%). The procedure does not need long immobilization and has less complication.

Female↗
PubMed2001

Is it possible to simulate physiologic loading conditions by applying pure moments? A comparison of in vivo and in vitro load components in an internal fixator.

STUDY DESIGN: Loads acting in an internal fixator measured in vitro under the application of pure moments such as those commonly used for implant testing and basic research were compared with loads measured in 10 patients in vivo. OBJECTIVES: To investigate whether these recommended loading conditions are valid by comparing in vivo measurements and those obtained in an in vitro experiment. SUMMARY OF BACKGROUND DATA: Pure bending moments are often preferred as loading conditions for spinal in vitro testing, either for implant testing or basic research. The advantage of this loading pattern is that the bending moment is uniform along the multisegmental specimen. However, functional loading of the spine by muscles or external loads subjects the spine to a combination of forces and moments. METHODS: In an in vivo experiment, loads acting on an internal spinal fixator in 10 patients were determined before and after anterior interbody fusion during flexion, extension, left and right lateral bending, and left and right axial twisting of the upper body with the patient standing. For comparison, an equivalent in vitro data set was created with 7 human lumbar specimens in which the same type of fixator was used. All specimens were tested under the application of pure bending moments in the three main motion planes in the intact state with fixator, after corpectomy, and with bone graft. RESULTS: Consistent qualitative agreement between in vivo and in vitro measurements for the loads acting in the internal spinal fixator were found for axial rotation and lateral bending. For flexion and extension, reasonable agreement was found only for the intact spines with fixators. After corpectomy and after inserting a bone graft, the median values for axial force and bending moment in the sagittal plane in vitro did not agree with in vivo measurements. An axial preload in the in vitro experiment slightly increased the axial compression force and flexion bending moment in the fixators. CONCLUSIONS: The application of pure moments to intact lumbar spinal specimens in vitro produces forces and moments in implants comparable with loads observed in vivo. During basic research on intact specimens or implant testing involving a removed disc or corpectomy, muscle forces are necessary to simulate realistic conditions.

Humans↗
PubMed2005

Aspects of internal fixation of fractures in porotic bone. Principles, technologies and procedures using locked plate screws.

Fractures of the bones of elderly people occur more often and have a more important effect because of a generally diminished ability to coordinate stance and walking. These fractures occur at a lower level of load because of lack of strength of the porotic bone. Prompt recovery of skeletal support function is essential to avoid respiratory and circulatory complications in the elderly. To prevent elderly people from the risks of being bedridden, demanding internal fixation of fractures is required. The weak porotic bone and the high level of uncontrolled loading after internal fixation pose complex problems. A combination of several technical elements of design, application and aftercare in internal fixation are proposed. Internal fixators with locked screws improve the biology and the mechanics of internal fixation. When such fixators are used as elevated splints they may stimulate early callus formation because of their flexibility, the limit of flexibility being set by the demands of resistance and function of the limb. Our own studies of triangulation of locked screws have demonstrated their beneficial effects and unexpected limitations.

Aged↗
PubMed2006

The anatomical study of transoral atlantoaxial reduction plate internal fixation.

OBJECTIVE: To study relevant anatomical features of the structures involved in transoral atlanto-axial reduction plate (TARP) internal fixation through transoral approach for treating irreducible atlanto-axial dislocation and providing anatomical basis for the clinical application of TARP. METHODS: Ten fresh craniocervical specimens were microsurgically dissected layer by layer through transoral approach. The stratification of the posterior pharyngeal wall, the course of the vertebral artery, anatomical relationships of the adjacent structures of the atlas and axis, and the closely relevant anatomical parameters for TARP internal fixation were measured. RESULTS: The posterior pharyngeal wall consisted of two layers and two interspaces: the mucosa, prevertebral fascia, retropharyngeal space, and prevertebral space. The range from the anterior edge of the foramen magnum to C(3) could be exposed by this approach. The thickness of the posterior pharyngeal wall was (3.6+/-0.3) mm (ranging 2.9-4.3 mm) at the anterior tubercle of C1, (6.1+/-0.4) mm (ranging 5.2-7.1 mm) at the lateral mass of C(1) and (5.5+/-0.4) mm (ranging 4.3-6.5 mm) at the central part of C(2), respectively. The distance from the incisor tooth to the anterior tubercle of C(1), C(1) screw entry point, and C(2)screw entry point was (82.5+/-7.8) mm (ranging 71.4-96.2 mm), (90.1+/-3.8) mm (ranging 82.2-96.3 mm), and (89.0+/-4.1) mm (ranging 81.3-95.3 mm), respectively. The distance between the vertebral artery at the atlas and the midline was (25.2+/- 2.3) mm (ranging 20.4-29.7 mm) and that between the vertebral artery at the axis and the midline was (18.4+/- 2.6) mm (ranging 13.1-23.0 mm). The allowed width of the atlas and axis for exposure was (39.4+/-2.2) mm (ranging 36.2-42.7 mm) and (39.0+/-2.1) mm (ranging 35.8-42.3 mm), respectively. The distance (a) between the two atlas screw insertion points (center of anterior aspect of C(1) lateral mass) was (31.4+/-3.3) mm (ranging 25.4-36.6 mm). The vertical distance (b) between the line connecting the two C(1) screw entry points and that connecting the two C(2) screw entry points (at the central part of the vertebrae, namely 3-4 mm lateral to the midline of C(2) vertebrae) was (21.3+/-2.7) mm (ranging 19.4-24.3 mm), with an a/b ratio of 1.3-1.5. The screws of TARP had a lateral tilt of 12.2 degrees+/-0.4 degrees(ranging 10.2 degrees-14.6 degrees) at C(1) and a medial tilt of 7.3 degrees+/-0.3 degrees (ranging 5.1 degrees-9.4 degrees) at C(2) relative to the coronal plane. CONCLUSIONS: An atlanto-axial surgery through transoral approach is safe and feasible. This approach is suitable for an anterior TARP internal fixation, and the design of the internal fixation system should be based on the above anatomical data.

Atlanto-Axial Joint↗
PubMed1992

Posterolateral lumbar and lumbosacral fusion with and without pedicle screw internal fixation.

Forty-seven patients who had lumbar or lumbosacral fusion with or without pedicle screw internal fixation by one surgeon for treatment of degenerative lumbar disease with clinical instability were retrospectively reviewed by an independent observer. Eighteen of the 21 patients whose fusions were internally fixed with the Variable Spinal Plating (VSP) system were available for review. A control group consisted of 27 patients who had fusion without internal fixation. The rate of pseudarthrosis did not significantly differ between the two groups (VSP group, 22%; versus control group, 26%). Twelve (67%) of the 18 patients treated with fusion and VSP instrumentation were considered to have had a good or excellent outcome, whereas 19 (70%) of the 27 patients treated by fusion without internal fixation had good or excellent results. Two VSP-instrumented patients had postoperative leg dysesthesias, whereas this complication was not observed in the control group. Bilateral posterolateral lumbar or lumbosacral fusion without internal fixation is as effective as and safer than fusion with pedicle screw instrumentation.

Adult↗
PubMed2006

[Endoscopy-assisted internal fixation of ramus and subcondylar fracture].

OBJECTIVE: To investigate clinical application of endoscopy-assisted internal fixation of ramus and subcondylar fractures. METHODS: In 11 patients with mandibular ramus and subcondylar fractures, endoscopy-assisted internal fixations with titanium plates were performed using micro-angular drill and screwdriver. RESULTS: All of the patients showed no visible facial scars. Orthorpantography and three dimensional reconstructions of spiral CT scan demonstrated that all fractures were healed 1 to 15 months after operation. Slight malocclusion existed in 1 case and slight limited mouth openings were found in 2 cases. CONCLUSIONS: Endoscopy-assisted internal fixation of mandibular ramus and subcondylar fracture avoided visible facial scars and the risk of facial nerve damage, it is, therefore, a minimally invasive and effective procedure.

Adult↗
PubMed2004

Undisplaced intracapsular hip fractures: results of internal fixation in 375 patients.

Three hundred seventy-five patients with an undisplaced intracapsular proximal femoral fracture were treated with internal fixation. Nonunion occurred in 24 patients (6.4%) and avascular necrosis occurred in 15 patients (4.0%). Reoperation with an arthroplasty was required in 29 patients (7.7%). The age, walking ability of the patient, and degree of impaction seen on the anteroposterior radiograph or angulation seen on the lateral radiographs were of statistical significance in predicting fracture healing complications. The results for this series of patients were compared with the results in published reports identified by a comprehensive literature search. Summation of the results indicated that the overall risk of redisplacement or nonunion of the fracture was 4.3% (95% confidence interval, 3.4%-5.3%) with internal fixation of an undisplaced intracapsular fracture. For conservative treatment, the failure rate was 19.6% (95% confidence interval, 17.2%-22.1%). The incidence of avascular necrosis with internal fixation at 1 year was 2.2% (95% confidence interval, 1.6%-2.9%) compared with 2.8% (95% confidence interval, 1.9%-4.0%) with nonoperative treatment. Internal fixation is recommended for the treatment of undisplaced intracapsular hip fractures.

Aged↗
PubMed1990

[Use of an internal fixator in the femur and tibia. Clinical and roentgenological course in animals].

The applicability of a new internal fixator was tested in the femur and tibia of sheep. The device was primarily developed for the spinal column by the association for studies of internal fixation (ASIF). For this investigation 12 sheep were subjected to transverse osteotomy and the bones were then stabilized with a internal fixator: The clinical and radiological follow up shows a stable healing process of the osteotomy within 8 weeks despite full load-bearing on all extremities. During the entire study period the sheep had full freedom of movement. Clinical and radiological observations were confirmed by the results of histological examinations. The results allow the following conclusions: in view of the course of recovery the indications for application of a internal fixator can be extended to fractures of the lower extremities. Further studies pertaining to the suitability of the implant for various fracture types are in progress. The great advantage of this fixation technique is that the fixator is mounted without any damage to either the endosteal or the periosteal circulation.

Animals↗
PubMed1998

Use of an internal fixator device to treat comminuted fractures of the distal radius: report of a technique.

An internal fixator technique for stabilizing comminuted Colles fractures has been developed in the anatomy laboratory and used in 35 clinical cases. The Colles Fracture Plate (Biomet, Inc, Warsaw, Indiana) can be used to treat any comminuted Colles fracture for which an external fixator is considered proper management. We have determined, based on our surgical experience with both the internal and external fixator techniques, that internal fixation using the Colles Fracture Plate is technically just as simple as external fixation. In addition to requiring a significantly less expensive device, internal fixation using this technique offers the advantages of better patient acceptance and fewer complications. This report will be followed by a more comprehensive analysis of the technical outcome of this procedure to further substantiate the initial results presented here. The process of compiling and analyzing these data is under way.

Bone Plates↗
PubMed2004

[Treatment results of pseudarthrosis of the humeral shaft by open reduction and internal fixation with dynamic compression plating].

OBJECTIVES: We evaluated the results of open reduction and internal fixation with the use of dynamic compression plating in patients with pseudarthrosis of the humeral shaft. METHODS: Eighteen patients (12 males, 6 females; mean age 41 years; range 22 to 68 years) with aseptic pseudarthrosis of the humeral shaft were treated by open reduction and internal fixation with the use of a dynamic compression plate following unsuccessful treatment with conservative (n=7) or surgical (n=11) methods. The mean interval between the initial and final treatments was 12.2 months (range 5 t 46 months). Exploration of the radial nerve and autogenous corticocancellous grafting were simultaneously performed in all the cases. Functional results were evaluated according to the Stewart-Hundley's criteria. The mean follow-up was 38.8 months (range 12 to 78 months). RESULTS: Union was achieved in all (94.4%) but one patient within a mean duration of 5.5 months (range 3 to 8 months). Functional results were good in fourteen patients (77.8%), fair in three patients (16.7%), and poor in one patient (5.6%). Radial nerve palsy that occurred in two patients during the early postoperative period underwent spontaneous recovery within three and five months, respectively. Mild reflex sympathetic dystrophy developed in two patients. CONCLUSION: In selected patients with pseudarthrosis of the humeral shaft, the results of open reduction and internal fixation with the use of dynamic compression plating are excellent, provided that an appropriate surgical technique is employed.

Adult↗
PubMed1980

A new method of internal fixation of olecranon fractures.

A new method of internal fixation for fractures of the olecranon is described. An Attenborough spring and hooks, together with a Rush nail, are used. The spring and hooks provide compression across the fracture site. The surgical technique is described and the results in 17 patients treated by this method are discussed. Nine patients had an excellent result and 7 a good result. The method required no special instrumentation and early mobilization is encouraged.

Adolescent↗