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At least 199 records · Page 11Linked to original sources
PubMed1991

Intramedullary wiring for tibial shaft fractures in children before epiphyseal closure. Indications and technique--experience of 36 patients.

Between 1958 and 1987 36 children underwent intramedullary wiring for tibial shaft fractures. Of these, 29 presented with combined tibial and fibular fractures, and 7 showed isolated tibial shaft fractures. Fractures were simple in 22 and compound in 14 patients. Mean patient age was 13 years (4-16 years). Only bending fractures with and without splinters were wired. The wiring technique and the protocol for postoperative care are reviewed. Mean immobilization time in long-leg casts was 12 weeks; intramedullary wires were removed after a mean interval of 17.7 weeks. Patients were selected for intramedullary wiring because of compound fractures of variable severity (14 patients), brain injuries with associated fractures (1), relative separation of the fracture ends with the fibula intact (2), severe dislocation or expected instability following closed reduction (9), and secondary dislocation or unsatisfactory alignment on skeletal traction (9). Complications included infections of 2nd degree compound fractures (2 patients), transitory peroneal palsy (2) and delayed union (2). Non-union and damage related to immobilization were not seen. A total of 19 patients were available for follow-up. Mean follow-up time was 9 years. Posttreatment lateral displacement was found to be irreversible except in infants but had no functional relevance. Malalignment showed a tendency towards spontaneous correction, which decreased with increasing age. Correction surgery proved to be unnecessary. Differential longitudinal growth was not consistently evaluable because of the heterogeneity of the material; reported data on this parameter from the literature were equally inconclusive.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1977

[Corrective osteotomy for malalignment of fractures of the distal radius (author's transl)].

Corrective osteotomy is indicated in young manual workers with significant malalignment after fracture of the distal radius without associated degenerative changes in the wrist joint. Chronic pain, limited motion and impaired power can be avoided and the cosmetic appearance of the hand improved, by restoration of the functional anatomy of the wrist. The operation consists of an opening-wedge osteotomy at the fracture site, sometimes combined with resection of the distal ulna. The approach may be dorsal or volar. A small iliac cortico-cancellous bone graft is inserted at the osteotomy site. Fixation is by an AO-small fragment-T-plate allowing early functional after-treatment.

Adult↗
PubMed1975

[The indication and technique of the arthrodesis by children and adolescents (author's transl)].

The indications and techniques of an arthrodesis procedure, in children and adolescents, differ greatly with that of adults. And this, on account of, the growth of the epiphysis and its circulation during that period, and also, due to the thick cartilage coating the joint's surface. And therefore, only for the rare exceptions, where there are strict indications that the procedure is weeded, should it be performed, and preferably, when possible in late adolescence. It is advised to perform the arthrodesis even earlier, when it will prevent an increase in the static's impairement especially that of the feet. In general, for the seldom splintplastics one should consider autologous material, as primary choice. To conclude, special arthrodesis will be mentioned later.

Adolescent↗
PubMed1985

Early fixation failure in displaced femoral neck fractures.

A study of 76 displaced femoral neck fractures treated by reduction and Knowles pins or AO (ASIF) cancellous bone screws was carried out. Fixation failure within 3 months occurred in 17 cases (22%). Advanced age, inaccurate reduction, a poor mental state of the patient, the number of Knowles pins used, and the preinjury functional ability of the patient are significant risk factors for fixation failure. Neurological disease, the type of fracture according to Garden, delay before operation, and the method of fixation are not significantly related to fixation failure.

Adolescent↗
PubMed1995

Internal fixation of the distal radius. A comparative, experimental study.

In a comparative, experimental examination of 60 human cadaver radii, the stability of various, widely used internal fixation procedures of a distal radius fracture loco typico using a dorsal wedge was determined. The use of 2.5-mm Kirschner wires (K-wires) delivered a 10% greater stability than 1.8-mm K-wires. The 2.7-mm polylactide rods achieved a slightly greater stability than 1.8-mm K-wires under accurate pinning conditions. Polylactide rods (35 mm length, 2 mm diameter) and polyglycolide rods (60 mm length, 2 mm diameter) proved to be 20% less solid than 1.8-mm K-wires and almost 45% less than plate fixation. The short polylactide pins, however, did not have enough hold in the proximal cortical bone. The 2.7-mm polylactide rods (60 mm length) complied with the stability prerequisites necessary for comparable substitution for K-wires in distal radius fractures.

Bone Nails↗
PubMed1995

Fixation of scaphoid delayed union and non-union with absorbable polyglycolide pin or Herbert screw. Consolidation and functional results.

Internal fixation with an absorbable polyglycolide pin or a Herbert screw was used to treat 34 patients with ununited and delayed union of fractures of the carpal scaphoid. The late clinical result could be reviewed in 14 patients in the polyglycolide group and 10 in the Herbert group with an average follow-up time of 68 and 58 months, respectively. The rate of union was 64% in the polyglycolide group and 60% in the Herbert group. The functional outcome was better in the Herbert group than in the polyglycolide group. A transient local abacterial tissue reaction occurred in 5 of 20 (25%) patients in the polyglycolide group. Two Herbert screws were removed due to penetration of the screw into the radial cartilage. The complication rate was relatively high with both methods. The polyglycolide pin results were unsatisfactory in this study, and thus we do not recommend their use in delayed union of and ununited scaphoid fractures.

Adolescent↗
PubMed1985

Pin-hole changes after external fixation of tubular bone.

K-wire-pin-induced changes in cortical bone were studied in the intact rabbit tibiofibular bone. Using a bilateral external fixator two pairs of pins were applied under compression (10 kp), under distraction (10 kp), and in a neutralization sense. After defined intervals the pin-holes were investigated macroscopically and radiologically. Reactive and resorptive changes were present in 101 of 576 (17.5%) pin-holes, infection in 13 (2.3%) pin-holes. Changes were significantly more frequent in the distal pin-holes. The appearance of the pin-holes was not influenced by the type of external fixation used nor did the occurrence depend on the duration of metal implantation.

Animals↗
PubMed1988

Porous surface replacement of the hip with chamfered-cylinder component.

One hundred porous surface replacements (PSR) were performed in 92 patients (63 men and 29 women) with a mean age of 53 (range 17-76). Follow-up times range from 1 to 4 years, with 48 patients having a follow-up of at least 2 years. Preoperative diagnoses were osteoarthritis (OA) 63, osteonecrosis (ON) 13, dysplasia 9, rheumatoid-ankylosing spondylitis 6, and other 9. Seventeen hips had metal-backed acrylic-fixed THARIES acetabular sockets, nine hips had a porous cobalt chrome hemispheric beaded acetabular component with adjuvant fixation screws and externally protruding screw hubs, and 74 hips had a porous chamfered cylinder-design acetabulum. Pain relief had been immediate and more complete than with acrylic-fixed or biologic-ingrowth stem-type replacement with comparable walking and function improvements. There have been no major systemic complications, sepsis, or loosening. There have been two transient peroneal nerve palsies and three trochanteric fibrous unions. There have been three reoperations, one for subluxation, one for "metalosis" due to mesh pad loosening, and one femoral neck fracture. Examination of one removed femoral surface component which has been histologically sectioned revealed excellent (90%) bone in-growth. Circumferential progressive radiolucencies developed at the bone-cement interface by 1 year in all of the 17 acrylic-fixed acetabular components. Reaming or seating defects were noted in 25% of the ingrowth components on postoperative radiographs. Radiographic analysis of immediate postoperative films of the chamfered cylinder design acetabular components frequently demonstrated bone-component interface radiolucencies which represented component seating defects. These initial interface radiolucencies became progressively more narrow over the first six months postoperatively suggesting "healing" of the reamed bone-component interface with trabecular bone around the chamfered cylinder acetabular components. Partial healing of initial interface voids with residual narrow radiolucencies were typical of the nine hemispheric-design acetabula with adjuvant screws and screw hubs. This new porous surface replacement (PSR) of the hip using porous ingrowth fixation avoids the major disadvantages of acrylic-fixed SR: excessive acetabular reaming and difficulty with acetabular revision. (When conversion to stem-type replacement is necessary the modular polyethylene socket liner can be exchanged.) The PSR has the prospect of enhanced fixation and improved longterm durability.

Alloys↗
PubMed1990

Wave plate osteosynthesis as a salvage procedure.

The load axis of the curved proximal femur lies not inside but outside the bone. Therefore, high bending forces are acting, the medial cortex absorbing pressure and the lateral cortex absorbs tension. In a transverse fracture, a laterally applied plate will absorb the tensile stresses and the medial cortex, the pressure forces. When the medial buttress due to a bony defect is missing, the laterally applied plate is subjected to cyclic bending and will undergo fatigue fracture. This dilemma is compensated by a wave plate with bone graft: the compression forces are redirected to the lateral cortex, and the plate is again subjected to tension. Furthermore, since the plate stands away from the bone, it does not disturb the blood supply at the fracture site and thus bone healing.

Adult↗
PubMed1989

Bone grafting in femoral neck fractures: results in 28 cases operated on with multiple pinning and cancellous bone grafting.

Twenty-eight patients with displaced femoral neck fractures were operated on with multiple pinning combined with cancellous bone grafting from the ipsilateral greater trochanter. The bone graft was introduced through a drilled channel in the femoral neck without exposing the fracture. At follow-up after 2 years, seven patients had died. Two patients had been reoperated with prosthetic replacement of the hip. Nineteen fractures were united and one had developed segmental collapse. In femoral neck fractures, complications from non-union and segmental collapse are still a major problem. Even if the impaired vascular supply to the femoral head is responsible for most of the complications, anatomic reduction and a stable fixation are conductive to fracture union. Comminution of the posterior wall of the femoral neck has a negative influence on the security of fixation due to a persisting posterior gap after reduction. In previous reports, bone grafting of the posterior defect in the femoral neck through an open approach has achieved good results. Only a few studies, however, describe a technique of introducing bone chips through a drilled channel in the femoral neck. The use of the ipsilateral greater trochanter as the sole donor site for bone grafting in femoral neck fractures has not been reported previously.

Aged↗
PubMed1989

Instrumentation surgery for primary tumors of the spine.

We performed instrumentation surgery on ten patients with the following rare primary spinal tumors; three solitary plasmacytomas, an aneurysmal bone cyst, a chordoma, a giant-cell tumor, a hemangioma, a solitary bone cyst, a benign osteoblastoma, and a chondrosarcoma. These tumors were found in the cervical spine (one case), thoracic spine (five cases), lumbar spine (two cases), and sacrum (two cases). The patients consisted of five men and five women, and their average age was 43.1 years. Harrington instrumentation was used in six cases, Zielke instrumentation in two, a combination of both in one case, and a Kirshner wire in one. In two cases, iliolumbar fusion was performed with Harrington instrumentation, after total resection of the sacrum. Average duration of the follow-up period was 5 years. This report describes these rare cases and emphasizes the effectiveness of instrumentation surgery in the reconstruction of the spine after extensive surgery.

Adult↗
PubMed1980

How to increase the stability of external fixation units. Mechanical tests and theoretical studies.

From general physical laws simple formulae have been deduced from which the rigidity of an external fixation unit mounted in different ways becomes mathematically calculable. Furthermore, the stability of various mounting systems under bending forces was investigated experimentally. Particular attention was paid to details of operating technique which are of special importance to the stability of the whole construction. The calculated data are consistent with the mechanical test results. The best arrangement of the Steinmann pins and Schanz screws is discussed, and how to mount the frame optimally, depending on the specific type and location of the fracture. Special instructions concerning the mounting of the external fixation unit are given which, depending on the specific circumstances, guarantee optimum stability of the unit.

Biomechanical Phenomena↗
PubMed1975

[Compression osteosynthesis with soft-tissue damage (author's transl)].

The advisability of open reduction with internal fixation by means of compression plates, screws, or tension band is dependant upon the localization and type of fracture, the kind and extent of soft-tissue damage, and also the time factor. Fractures in the vicinity of joints and intra-articular fracture dislocations are practically absolute indications. Its application is less frequent when the metaphysis is involved, except in the case of the forearm. Caution is suggested in the presence of chronic soft-tissue damage subsequent to peripheral circulatory disorders.

Amputation, Traumatic↗