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IM pins, cerclage wires, and ILNs are valuable tools for repairing long bone fractures. Successful bone healing is readily achieved with these tools but also requires aseptic technique, attention to preserving soft tissues, and proper application procedures.
Between January 1995 and December 2000 we operated on 1 437 patients with fractures of the proximal femur. In 789 cases an osteosynthesis was performed and in 648 cases a prosthesis was implanted. In the group of patients with primary osteosynthesis we stabilized 89 fractures with screws, in 319 patients a dynamic hip screw (DHS) and in 381 patients a Proximal-Femurnail (PFN) were implanted. Because of major complications we had to reoperate on 42 patients (5.3 %) with primary osteosynthesis. For analysis of this high complication rate we studied the fracture type, the type of complication, the operation time, the primary and secondary implant type and the time of postoperative mobilisation in this group of 42 patients. We saw 27 type A and 15 type B fractures, according to the AO classification. In the patient group with complications 4 times a primary screw stabilisation was done, 22 dynamic hipscrews (DHS) and 16 proximal femurnails (PFN) were implanted. After changing the primary osteosynthesis into 15 hemiprostheses and 26 total prostheses of the hip, we found in over 30 % major complications. A change of the procedure after primary osteosynthesis has to be regarded as a more difficult operation than the primary implantation of a prosthesis.
Five years after an intramedullary nailing of a fractured humerus a fistula developed in a dog. The nail was removed and a gross swelling developed 11 weeks later. Osteosarcoma was diagnosed.
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Lower grade fractures are by definition stable and almost always treated with casting or functional splinting. The best kind of fixation for the higher grade fractures, however, differs between adults and children. Appropriate treatments are discussed, and case-study illustrations are provided. Background on the anatomy of the tibia and femur is included.
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Fracture healing is a repair process of a mechanical discontinuity loss of force transmission, and pathological mobility of bone. Through a sequence of changes of tissue development and geometry, the original structural integrity is restored. The recovery of rigidity and strength is related to tissue differentiation. In unified theory of non-operative and operative stabilized fractures, the mechanics of primary bone healing involves a complex interplay of physical and biological factors. The different patterns of bone repair respond to physical influences including strain tolerance.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
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Open reduction and internal fixation of distal tibia and fibula fractures generally involves two separate incisions: an anteromedial incision to approach the tibia and a lateral incision to approach the fibula. Exposing the distal tibia from the medial side is associated with the risk of wound dehiscence, infection, and discomfort to the patient since the hardware is directly beneath the skin. By using a single incision from the anterolateral side, the fibular fracture can be fixed and the lateral aspect of the distal tibia can be safely approached for internal fixation, thus eliminating the need for two separate incisions.
We reviewed 11 consecutive cases with combined femoral fracture and vascular injury presenting with acute ischemia. 6 cases had ischemia exceeding 8 hours and 4 of them developed massive muscle necrosis in the lower leg. 5 cases with ischemia less than 8 hours had no muscle necrosis. Vascular repair preceded fracture stabilization in 5 cases; there were no vascular complications during the subsequent fracture stabilization. 6 fractures treated with internal fixation had uneventful fracture-healing, whereas the 4 which were treated with external fixation needed later reoperations to obtain fracture-healing. We conclude that the limb must be reperfused within 6-8 hours. Vascular repair should be the first procedure, and fracture fixation by internal fixation is then preferred.
Arthroscopic reduction and internal fixation of tibial plateau fractures has been well documented over the last 15 years. Better visualization, less traumatic surgery, reconstruction of accompanying injuries and early mobilization have encouraged arthroscopic surgeons to use this technique more widely. With experience, surgeons became more comfortable in using arthroscopy-assisted surgery not only in split fractures of the lateral tibial plateau (41-B1) but also in more complex tibial and femoral fractures. In this study, 31 patients with intra-articular fractures of the lateral tibial plateau were operated on between 1991 and 1996. The fractures were classified as follows: x12 AO-type B1, x7 B2, x10 B3, x2 C3. Diagnostic arthroscopy and repair of soft tissue injuries was followed by arthroscopic reduction in all patients and supplemented with internal fixation in 29 patients. Postoperatively, an aggressive physical therapy regimen was performed with immediate mobilization and early partial weight bearing. All patients were examined for follow-up after 15-32 months (mean 25.1). In all cases the fractures were stable and allowed full weight-bearing. At follow-up, 25 patients had anatomic reduction. Anatomical reduction cannot be restored in all cases of open reconstruction because of cartilage defects. Fracture reduction using arthroscopic techniques is a suitable alternative for joint fracture repair because additional soft tissue damage can be minimized.
Percutaneous internal fixation of scaphoid fractures allows for more predictable union and less morbidity than cast treatment or open internal fixation. A headless cannulated compression screw (standard Acutrak) is implanted by way of a dorsal percutaneous approach with the aid of fluoroscopy and arthroscopy to confirm screw position and fracture reduction. This technique is indicated in the correction of acute proximal pole fractures, acute waist fractures, and delayed unions that are not associated with avascular necrosis or collapse. The details of this technique are reviewed. In a consecutive series of twenty-seven fractures (seventeen waist fractures and ten proximal pole fractures) treated with arthroscopically assisted dorsal percutaneous fixation, computed tomographic scanning confirmed 100% union at an average of twelve weeks. Eighteen fractures were treated within one month after the injury, and nine were treated more than one month after the injury. In this series, the fractures that were treated early (less than one month after the injury) healed more quickly than those treated later.