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PubMedDate not supplied

Clinical outcome of pediatric calcaneal fractures treated with open reduction and internal fixation.

The results of displaced intra-articular calcaneal fractures treated with open reduction and internal fixation in skeletally immature children at one institution were reviewed. Six children with seven displaced intra-articular calcaneal fractures treated with open reduction and internal fixation were reviewed at an average of 30 months after surgery (range 18-48 months). All children were treated by one of two surgeons and followed by the same surgeon. The preoperative workup included computed tomography scans, which showed that all had displaced intra-articular fractures and five had comminuted fractures. At follow-up all children were pain-free with normal activities. All were able to return to full activities at an average of 10 months after surgery. All had normal ankle range of motion, but five had decreased subtalar range of motion. There were no postoperative complications, shoe wear problems, or peroneal tendinitis. This study demonstrates that open reduction and internal fixation for displaced intra-articular fractures in children yields encouraging results.

Adolescent↗

PubMed1986

Early open reduction and internal fixation of the disrupted pelvic ring.

Early open reduction and internal fixation (ORIF) of extremity fractures in patients with multiple injuries has been demonstrated to be safe, improve survival, and decrease the incidence of respiratory failure. Complications leading to abandonment of planned operative fixation and death in several patients with pelvic fractures led us to initiate a policy of early ORIF of the disrupted pelvic ring. Early ORIF of the pelvis was performed in 15 multiply injured patients between May 1984 and August 1985. Patients ranged in age from 13 to 79 years, their Hospital Trauma Index-ISS scores ranged from 14 to 68, and number of preoperative transfusions ranged from 0 to 42. Types of fractures were A-P compression, two, lateral compression, one, vertical shear, seven, complex, two, and acetabulum with ring disruption, three. All patients were resuscitated, transported in pneumatic antishock garments, and evaluated by abdominal and pelvic CT scan (in two patients following celiotomy). Preoperative angiograms to assess retroperitoneal hemorrhage in eight patients resulted in identification and control of significant bleeding in five. The mean time from injury to pelvic stabilization was 38 hours. Seven patients underwent ORIF within the first 24 hours. In most cases simultaneous anterior and posterior internal fixation was performed with the patient in the lateral decubitus position. Excluding associated procedures, operative time averaged 5.1 hours. Intra-operative transfusions averaged 4 units (range, 0-11). Rigid fixation was achieved in all patients. Most patients were out of bed by the third postoperative day. No patient developed respiratory failure. Two patients developed wound infections. Modification of our technique has avoided this complication in the latter part of this series.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed2001

Internal fixation implants for intracapsular proximal femoral fractures in adults.

BACKGROUND: Numerous different implants with screws, pins and side plates have been used for the internal fixation of intracapsular hip fractures. OBJECTIVES: To determine from randomised trials which implant is superior for the internal fixation of intracapsular proximal femoral fractures. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group specialised register. The date of the most recent search was December 2000. SELECTION CRITERIA: Randomised and quasi-randomised trials comparing different implants for the internal fixation of intracapsular hip fractures in adults. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality, by use of a ten item scale, and extracted data. Additional information was sought from trialists. After grouping by implant type, comparable groups of trials were subgrouped and where appropriate, data were pooled using the fixed effects model. MAIN RESULTS: Twenty-seven studies involving 5269 participants (5274 fractures) were included in the study. Considerable variation in the quality of methodology between studies was found and biases due to familiarity with some of the implants were noted. None of the implants tested were found to be significantly superior for any of the outcome measures related to fracture healing complications or mortality. The sliding hip screw was found to take longer to insert and to have an increased operative blood loss compared with multiple screws or pins. REVIEWER'S CONCLUSIONS: No clear conclusions can be made on the choice of implant for internal fixation of intracapsular fractures from the available evidence within randomised trials.

Bone Nails↗

PubMed2002

[Orthopaedic applications for biodegradable and absorbable internal fixation of fractures].

OBJECTIVE: To illustrate the effect and complication of orthopedic applications for biodegradable and absorbable internal fixation of fractures, and to indicate the existent problem and research aspect currently. METHODS: The recent literatures on orthopedic applications and study of biodegradable and absorbable internal fixation for fractures were reviewed. The effect of biodegradable materials on bone healing was summarized. RESULTS: It is good for the stability of fracture fixation and result of treatment. The biodegradable and absorbable internal fixation fractures had no adverse effect on bone healing. CONCLUSION: There will be more widespread application for biodegradable and absorbable materials in orthopedics, but the intensive research should be carried out to prevent its complication.

Absorbable Implants↗

PubMed1995

Management of flail chest injury: internal fixation versus endotracheal intubation and ventilation.

A total of 427 patients with major chest trauma were treated in two major hospitals in Abu Dhabi, United Arab Emirates, during a 10-year period. In 64 of 426 patients, flail chest injury was the dominant factor among other injuries that were insignificant. Among 64 cases of flail chest injury, 25 were managed by internal fixation of ribs, whereas the remaining 38 were managed by endotracheal intubation and intermittent positive-pressure ventilation alone. Of the patients treated by internal fixation 80% (21/26) were weaned from the ventilator within an average of 1.3 days, whereas the remaining 20% (5/26) continued to need assisted ventilation for a longer duration; the total average duration of assisted ventilation for the whole group was 3.9 days. In comparison, among 38 patients with flail chest injury treated by endotracheal intubation and ventilation alone, the average duration of assisted ventilation was 15 days. In the group treated by internal fixation 11% (3/26) of the patients ultimately required a tracheotomy, whereas in the patients treated by intubation and ventilation alone tracheostomy was required in 37% (14/38) of the cases. In the group treated by internal fixation, chest infection was documented in 15% (4/26), septicemia in 4% (1/26), and barotrauma in 0%; in the other group these complications occurred in 50% (19/38), 24% (9/38), and 8% (3/38) of the cases, respectively. The mortality rate was 8% (2/26) in the surgically treated patients, whereas it was 29% (11/38) in the other group. All the deaths in both groups were ascribed to adult respiratory distress syndrome. Average stay in the intensive care unit was 9 days for the patients treated by internal fixation, whereas it was 21 days in the group treated by intubation and ventilation alone. The treatment of flail chest injury in our series by internal fixation resulted in speedy recovery, decreased complications, and better ultimate cosmetic and functional results and proved to be cost effective.

Adolescent↗

PubMed2005

[The clinic study of internal-fixation of mandibular fracture with endoscope].

OBJECTIVE: To investigate effectiveness of internal-fixation in mandibular fracture through endoscope. METHODS: Use puncture internal-fixation under endoscope to treat 28 patients of fracture of mandibular angle, ramus and condyle. RESULTS: The 28 patients were restorated with occluding relation in good apposition. The healing of mandibular fracture was very good. CONCLUSIONS: The interal-fixation under endoscope is an effective way of treating fracture of mandibular angle, ramus and condyle, without facial scar and complication of facial nerve injury.

Adolescent↗

PubMed2004

[Surgical anatomy of transoral atlantoaxial reduction plate internal fixation].

OBJECTIVE: To provide anatomical data for transoral atlantoaxial reduction plate internal fixation. METHOD: Microsurgical dissecting was performed on 10 fresh craniocervical specimens layer by layer according to transoral approach. Stratification of posterior pharyngeal wall, course of vertebral artery, adjacent relationships of atlas and axis and correlative anatomical parameters of internal fixation to atlantoaxial joint were observed. RESULT: (1) Posterior pharyngeal wall consisted of 2 layers and 2 interspace: mucosa, anterior fascia of vertebrae, posterior interspace of pharynx and anterior interspace of vertebrae. (2) The range from anterior rim of foramen magnum to C3 could be exposed by this approach. (3) The distance between the vertebral artery at atlas and midline was (25.2 +/- 2.3) mm and that between the vertebral artery at axis and midline was (18.4 +/- 2.6) mm. (4) The width of atlas and that of axis could be exposed respectively to (39.4 +/- 2.2) mm and (39.0 +/- 2.1) mm. The distance (a) between 2 atlas screw inserting points (center of anterior aspect of C-1 lateral mass) was (31.4 +/- 3.3) mm. The vertical distance (b) between the connecting line of 2 atlas screw inserting points and that of 2 axis screw inserting points (at the central part of the vertebrae which was 3 - 4 mm lateral to the midline of C-2 vertebrae) was (18.7 +/- 2.7) mm. The odds of a/b was 1.5 approximately 1.7. CONCLUSIONS: Anterior atlantoaxial plate internal fixation through transoral approach is suitable and feasible. The design of the plate should be based on the above data.

Atlanto-Occipital Joint↗

PubMed1990

Biological internal fixation of fractures.

Trauma centers treat more and more patients who have sustained multiple injuries during high energy accidents. The techniques of internal fixation of such fractures may be dictated by the concomitant soft tissue trauma, rather than by the bony injury. Three stages of soft tissue injuries are recognised: Stage I delineates compromised soft tissues which may be treated with standard techniques of internal fixation, provided that further devialization by surgery is avoided. Stage II implies partial, non-circumferential destruction of soft tissues, requiring alternative techniques of internal fixation to prevent (mainly septic) complications. In stage III, the soft tissues about the fracture site are destroyed and need early, specific soft tissue reconstruction. Indirect reduction without further devascularization of bone, aiming at perfect alignment rather than anatomical reduction of extraarticular fractures, optimal rather than maximal internal fixation as well as the inclusion of soft tissue reconstructive procedures into the armamentarium of the orthopaedic surgeon, require an intellectual and technical reorientation but can be shown to improve the results of the treatment of fractures with concomitant soft tissue injury.

Bone Plates↗

PubMed2004

[The minimally invasive stabilization of the dorsal pelvic ring with the transiliacal internal fixator (TIFI)--surgical technique and first clinical findings].

The Trans Iliacal Internal Fixator (TIFI) is a minimally invasive technique for the stabilization of sacro-iliac joint ruptures and fractures lateral to the sacral ala or through the sacral foramen. In this study, 7.0 mm pedicle screws of the Universal-Spine-System (USS, Synthes) were inserted 1-2 cm on the cranial side of the posterior superior iliac spine and parallel to the superior gluteal line. The connecting bar was inserted subfascially and fixed with the locking head pedicle screws to form an fixed-angle construction. In a prospective study 31 patients with vertical shear injuries of the pelvis were treated with the TIFI. There were two wound infections and one loosening of a pedicle screw. None of the screws were incorrectly positioned and no neuro-vascular lesions were caused by the implant. 2 years postoperatively we found 50% good and excellent results for type C pelvic ring injuries. Early findings show that the TIFI is well suited to stabilization of sacro-iliac joint ruptures and fractures of the lateral sacrum. Closed reduction and minimally invasive insertion technique are possible. The implant leads to sufficient biomechanical stability but there is a very low intraoperative risk of neuro-vascular lesion.

Adolescent↗

PubMed2005

[Value of multislice spiral CT scanning and three-dimensional reconstruction in selecting optimal length and shape of mandible internal fixation material].

OBJECTIVE: To investigate the value of multislice spiral CT (MSCT) scanning and three-dimensional reconstruction in selecting optimal length and shape of mandible internal fixation material. METHODS: Three-dimensional reconstruction of the mandible was performed in 5 cases by MSCT scanning and the length of the mandible for operation was measured. Some isometric points were chosen on the mandibular curve and the distance from these points to the two ends of the curve was measured to depict the mandibular curve using a self-designed skeletal curve-depicting software. The optimal length and shape of the material for internal fixation was then determined. RESULTS: After removal of the soft tissues and other irrelevant bones from the reconstructed three-dimensional mandible with clear view from any directions, the length of the mandible was accurately measured with the software. The physiological curve of the mandible was generated after determination of the distances from the chosen points on the mandibular curve and to the two ends of the curve for precise determination of the length and shape of the material for internal fixation. CONCLUSION: Three-dimensional mandible reconstruction with MSCT and measurement facilitates the determination of the optimal length and shape of the internal fixation material to enhance the attachment between the material and the bone surface and consequently the therapeutic effects.

Adolescent↗

PubMed2000

Pediatric occipitocervical arthrodesis. A review of current options and early evaluation of rigid internal fixation techniques.

OBJECT: Few reports exist on the options and effectiveness of craniocervical stabilization in the pediatric population compared with the adult literature. Traditional options in children include onlay grafting and semi-rigid occipitocervical wiring. Recently, reports on the use of rigid internal fixation devices such as occipitocervical plates and contoured loops have provided excellent results in adults, and their use has often obviated the need for external orthosis. The purpose of this article is to report our experience with both traditional and newer rigid internal fixation methods for occipitocervical fusion in children. METHODS: During the past 4.5 years, 14 children (ages 4 months to 16 years) have undergone occipitocervical fusion. Indications for fusion included trauma (n = 4), congenital instability/stenosis (n = 6), postinfectious instability (n = 1) and basilar invagination (n = 3). Techniques using onlay grafting (n = 3) as well as rigid internal fixation using plates (n = 1) and contoured craniocervical titanium loops (n = 10) were used. Postoperative orthosis included halo vests (n = 7), minerva jackets (n = 3), sterno-occipital mandibular immobilizer (n = 1), and a cervical collar (n = 3). Long-term follow-up (range 13-58 months) was available for 13 of the 14 children. CONCLUSIONS: While each occipitocervical fusion in pediatric patients requires a customized treatment plan, we believe children older than 12 months of age should be considered candidates for rigid internal fixation methods. The rigidity afforded by this method may eliminate the need for rigid external orthotic support in selected individuals. In our experience, anatomic constraints in children less than 1 year old usually require fusion with more traditional onlay techniques. Long-term follow-up studies are still required to assess the effects of rigid internal fixation in the skeletally immature spine.

Adolescent↗

PubMed1996

Internal fixation of oblique metacarpal fractures. A biomechanical evaluation by impact loading.

Internal fixation of oblique metacarpal fractures was studied in a cadaver model by impact loading. One hundred twenty fresh-frozen human metacarpals underwent compressive and bending impacts after oblique osteotomy and internal fixation. Dorsal plating with lag screws, 2 dorsal lag screws (2-screws), crossed Kirschner wire tension band (crossed K-wire), 5 stacked intramedullary Kirschner wire (5-rod), and paired intramedullary Kirschner wire (2-rod) were used. The failure occurred within 6 msec in the compressive impact and was almost immediate in the bending impact. The dorsal plate and the intramedullary rod fixations were the strongest and were not significantly different from the intact specimens in compressive impact; they were, however, 19% weaker in bending impact. The 2-screws was the weakest fixation in this group. This fixation was 59% weaker in compressive impact and 47% weaker in bending impact compared with the dorsal plating.

Biomechanical Phenomena↗

PubMed1990

Degradable polyglycolide rods for the internal fixation of displaced bimalleolar fractures.

Cylindrical biodegradable rods of self-reinforced polyglycolide were constructed for internal fixation of fractures in cancellous bone. The self-reinforced texture was achieved by embedding polyglycolide fibres in a polyglycolide matrix. In a prospective clinical study, 62 patients with displaced bimalleolar fractures were managed by open reduction and internal fixation using these rods. The results were assessed between 1.1 and 3.4 years from implantation. One wound infection occurred (1.6%). Five patients (8.1%) developed a sterile accumulation of fluid at the site of operation which required drainage: the final outcome was not affected. Minor displacement of the fracture (1-2 mm) occurred in nine patients (14.5%) but did not need further operation. The functional result was excellent in 39 patients (63%). This was considered acceptable given the severity of the fractures. Consequently, at our hospital, when a displaced malleolar fracture needs internal fixation biodegradable rods are now the treatment of choice. The psychological and financial advantages of avoiding implant removal are considerable.

Adult↗

PubMed2003

Costs of internal fixation and arthroplasty for displaced femoral neck fractures: a randomized study of 68 patients.

We included in a prospective, randomized study 68 patients aged 70 years or older, with displaced cervical hip fractures. The patients were randomized to internal fixation with hook-pins (36) or primary arthroplasty (32) (total or hemiarthroplasty due to their prefracture status) and followed for 2 years. Patients with rheumatoid arthritis, mental confusion and/or residence in an institution were excluded. The postoperative stay in hospital, rehabilitation wards or nursing homes were recorded as well as complications and the costs of surgery. The aim of this study was to compare the accumulated costs of each method, during the first 2 years after the fracture. In the internal fixation group, 15/36 were considered failures, as compared to 1/32 in the arthroplasty group. As regards primary treatment of the fracture, the durations of surgery and hospital stay were shorter after internal fixation, but the total need for hospitalization/institutionalization was somewhat longer in these patients. The mean 2-year cost for a patient with internal fixation was USD 21,000 and of one with primary arthroplasty USD 15,000. We conclude that primary arthroplasty is a cost-efficient treatment. Considering the very much higher failure rate after internal fixation--leading to increased suffering for these patients--primary arthroplasty stands out as the best method for displaced fractures of the femoral neck.

Aged↗

PubMed1993

Arthroscopic assisted internal fixation of volar intraarticular wrist fractures.

Open reduction internal fixation of displaced volar intraarticular distal radius fractures traditionally require sacrificing the volar ligaments to visualize the articular surface. We present a modification of standard arthroscopy that facilitates visualization of the radiocarpal joint while preserving these ligaments.

Arthroscopy↗

PubMed2002

Internal fixation of intracapsular fractures.

The main indications for internal fixation of intracapsular fractures are undisplaced and minimally displaced fractures and displaced intracapsular fractures in those aged less than about 70 years. For displaced fractures, closed reduction is to be preferred to open reduction. Numerous different implants may have to be used; with current practice favouring two or three parallel cannulated cancellous screws. These may be inserted either percutaneously or with minimal surgical exposure. Attention to surgical details of fracture reduction and implant positioning will minimise the risk of fracture healing complications. Post-operative care should generally be unrestricted mobilization with weight bearing as tolerated.

Bone Screws↗

PubMed2002

Open reduction and internal fixation of fractures of the radial head.

BACKGROUND: The purpose of this retrospective study was to analyze the functional results following open reduction and internal fixation of fractures of the radial head and to determine which fracture patterns are most amenable to this treatment. METHODS: Fifty-six patients in whom an intra-articular fracture of the radial head had been treated with open reduction and internal fixation were evaluated at an average of forty-eight months after injury. Thirty patients had a Mason Type-2 (partial articular) fracture, and twenty-six had a Mason Type-3 (complete articular) fracture. Twenty-seven of the fifty-six fractures were associated with a fracture-dislocation of the forearm or elbow or an injury of the medial collateral ligament. Fifteen of the thirty Type-2 fractures were comminuted. Fourteen of the twenty-six Type-3 fractures consisted of more than three fragments, and twelve consisted of two or three fragments. The result at the final evaluation was judged to be unsatisfactory when there was early failure of fixation or nonunion requiring a second operation to excise the radial head, <100 degrees of forearm rotation, or a fair or poor rating according to the system of Broberg and Morrey. RESULTS: The result was unsatisfactory for four of the fifteen patients with a comminuted Mason Type-2 fracture of the radial head; all four fractures had been associated with a fracture-dislocation of the forearm or elbow, and all four patients recovered <100 degrees of forearm rotation. Thirteen of the fourteen patients with a Mason Type-3 comminuted fracture with more than three articular fragments had an unsatisfactory result. In contrast, all fifteen patients with an isolated, noncomminuted Type-2 fracture had a satisfactory result. Of the twelve patients with a Type-3 fracture that split the radial head into two or three simple fragments, none had early failure, one had nonunion, and all had an arc of forearm rotation of > or =100 degrees. CONCLUSIONS: Although current implants and techniques for internal fixation of small articular fractures have made it possible to repair most fractures of the radial head, our data suggest that open reduction and internal fixation is best reserved for minimally comminuted fractures with three or fewer articular fragments. Associated fracture-dislocation of the elbow or forearm may also compromise the long-term result of radial head repair, especially with regard to restoration of forearm rotation.

Adolescent↗

PubMed2005

The total costs of a displaced femoral neck fracture: comparison of internal fixation and total hip replacement. A randomised study of 146 hips.

We randomised 143 patients--age 75 years or older--with displaced femoral neck fracture to either internal fixation or total hip replacement (THR) and compared the socio-economic consequences. In the internal fixation group, 34 of 78 hips underwent secondary surgery. In the THR group, 12 of 68 hips dislocated, the majority in mentally impaired patients. We calculated the total hospital costs for two years after operation. When secondary surgery was included, there was no difference in costs between the internal fixation and THR groups, or between the mentally impaired and lucid subgroups. The costs to the community were calculated comparing the baseline cost before surgery with the average cost per month during the first postoperative year. No difference was found between the treatment groups. The Harris hip scores were higher in the THR group, and pain was more common in the internal fixation group. In lucid patients, THR gives a better clinical result at the same cost.

Aged↗