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At least 235 records · Page 13Linked to original sources
PubMed1993

Comparative fatigue strengths and stabilities of metacarpal internal fixation techniques.

To study quantitative differences in the fatigue strength and stability obtained with 5 types of internal fixation of metacarpal fractures, 105 preserved human metacarpals were cyclically tested in bending, torsion, and axial loading after oblique osteotomies of the metacarpal and internal fixation. The dorsal plate with lag screw was superior in all modes, followed by the two dorsal lag screws, crossed Kirschner wire tension banding, and intramedullary Kirschner wire fixation. The five intramedullary and the paired intramedullary Kirschner wire fixations were not statistically different. The fatigue life of the plate fixation was significantly larger in bending (1.5 times), torsion (1.6 times), and axial loading (2.5 times) than the second strongest fixation, two dorsal lag screws. Its initial rigidity was significantly higher in axial loading (1.5 times) but was not statistically different in bending and torsion.

Fracture Fixation, Internal↗
PubMed2000

Internal fixation or arthroplasty for displaced cervical hip fractures in the elderly: a randomised controlled trial of 208 patients.

208 patients aged over 70 years with a displaced cervical hip fracture were admitted to a prospective randomised trial of internal fixation using 3 parallel cannulated screws or an uncemented Austin Moore hemiarthroplasty. All surviving patients were followed for a minimum of 3 years. Functional assessment of survivors at 1, 2 and 3 years from injury showed no significant difference between groups. Patients treated by the fixation had a marginally lower mortality rate. Other outcomes which favoured internal fixation were a lower risk of wound infection, reduced length of surgery (22 minutes versus 47 minutes), lower operative blood loss (23 mL versus 172 mL), and lower transfusion requirements (4/102 patients versus 18/106). However, internal fixation had a significantly greater re-admission rate (24/102 versus 7/106) and re-operation rate. Following internal fixation, 44 re-operations were required in 36 patients, while re-operation was required in only 4 patients treated with arthroplasty. The results of this randomised trial indicate that both procedures produce comparable final functional outcomes for the survivors.

Aged↗
PubMed1994

Hip arthroplasty for failed internal fixation of intertrochanteric and subtrochanteric fractures in the elderly patient.

Failure of internal fixation in hip fractures can lead to difficult problems, especially in elderly patients. At the intertrochanteric or subtrochanteric level a prosthesis with diaphyseal support is one of the solutions to this problem. In 12 patients an endoprosthesis was performed for failed internal fixation. The mean age at the time of initial fracture fixation was 79 years (range: 61 to 94 years). The mean time from initial fracture fixation to failure and salvage by an endoprosthesis was 6 months (range: 5 days to 19 months). Eleven patients could be reviewed clinically and radiographically after a mean follow-up time of 32 months (range: 4 months to 7 years). The functional results were satisfactory considering the age of the patients. The current series shows that endoprosthesis might be considered as a valuable method in the salvage treatment of failed internal fixation of a subtrochanteric or intertrochanteric hip fracture.

Aged↗
PubMed2006

[Triple arthrodesis in rigid foot deformities and the effect of internal fixation on clinical and radiographic results].

OBJECTIVES: We evaluated the results of triple arthrodesis in rigid foot deformities and assessed the effect of internal fixation on clinical and radiographic results. METHODS: Thirty feet of 26 patients (12 females, 14 males; mean age 27 years; range 13 to 55 years) were treated with classic triple arthrodesis. Ten patients (12 feet) underwent temporary internal fixation with one or more Kirschner wires. Clinical evaluations were made with the use of both AOFAS (American Orthopaedic Foot and Ankle Society) and Angus-Cowell ankle-hindfoot scoring systems. Anteroposterior and lateral talocalcaneal and talus-first metatarsal angles were used as radiographic parameters. The mean follow-up period was 80.3 months (range 30 to 140 months). RESULTS: The mean AOFAS score increased from a preoperative 39.3 (range 16 to 59) to postoperative 90.8 (range 71 to 94). According to the Angus-Cowell criteria, the results were good in 19 feet (63.3%), fair in eight feet (26.7%), and poor in three feet (10%). Clinical improvement was statistically significant according to both scoring systems (p<0.05). Radiographically, all the angular values were within normal limits both in the early postoperative period and at the last follow-up (p<0.05). Pseudoarthrosis was detected in four feet (13.3%) and degeneration of the ankle and naviculocuneiform joints was detected in 12 feet (40%) and 17 feet (56.7%), respectively. Internal fixation had no significant effect on pseudoarthrosis, residual or recurrent deformity, and the degree of degeneration (p>0.05). CONCLUSION: Triple arthrodesis is a good alternative for functional and cosmetic improvement in foot deformities. Although internal fixation seems to have no significant effect, the use of a temporary fixation material may contribute to maintenance of reduction and surface contact.

Adolescent↗
PubMed2006

The initial safe range of motion of the ankle joint after three methods of internal fixation of simulated fractures of the medial malleolus.

BACKGROUND: Previous studies have demonstrated the safe passive range of ankle motion for inter-bone stiffness after internal fixation under load but there is a lack of information about the safe range of ankle motion for early rehabilitation in the absence of loading. The present study was designed to assess the effect of ankle movement on inter-bone displacement characteristics of medial malleolus fractures following three types of internal fixation to determine the safe range of motion. METHODS: Five lower legs obtained during autopsy were used to assess three types of internal fixation (two with Kirschner-wires alone; two with Kirschner-wires plus tension band wiring; and, one with an AO/ASIF malleolar screw alone). Following a simulated fracture by sawing through the medial malleolus the displacement between the fractured bone ends was measured during a passive range of movement with continuous monitoring using omega (Omega) shaped transducers and a biaxial flexible goniometer. Statistical analysis was performed with repeated measures analysis of variance. FINDINGS: Inter-bone displacement was not proportional to the magnitude of movement throughout the range of ankle motion as, when separation exceeded 25 microm, there was increasingly wide separation as plantar-flexion or dorsal-flexion was increased. There was no statistical significant difference between the small amount of inter-bone displacement observed with three types of fixation within the safe range of dorsal-flexion and plantar-flexion for early rehabilitation. However the inter-bone separation when fixation utilized two Kirschner-wires alone tended to be greater than when using the other two types of fixation during dorsal-flexion and eversion. INTERPRETATION: The present study revealed a reproducible range of ankle motion for early rehabilitation which was estimated to be within the range of 20 degrees of dorsal-flexion and 10 degrees of plantar-flexion without eversion. Also, internal fixation with two Kirschner-wires alone does not seem to provide stability achieved by the other two forms of fixation.

Ankle Injuries↗
PubMed1979

Subcapital fractures of the femur. Re-operations with internal fixation.

Over a period of 5 years, 55 re-operations with internal fixation were performed on 51 patients. The re-operations constituted 9.2 per cent of all operations employing internal fixation for subcapital fractures of the femur during that period. The indications for re-nailing were penetration of the nail through the femoral head, or slipping of the nail, with or without dislocation of the fracture. Only 26 per cent of the re-nailed fractures healed. Seventy-three per cent showed avascular necrosis and 61 per cent non-union.

Adult↗
PubMed1995

The internal fixation of ankle fracture repair.

A descriptive overview of the type of internal fixation, the biomechanical principles of this fixation technique, and the methods of application are outlined. Clinical illustrations demonstrate some of the more commonly used internal fixation techniques.

Ankle Injuries↗
PubMedDate not supplied

Radial forearm free flap for coverage of postoperative lateral heel wounds after open reduction and internal fixation of the calcaneus.

For intraarticular calcaneus fractures, open reduction and internal fixation has become commonplace for the reduction of morbidity of postinjury arthritis. Despite adequate surgical results, there are often associated postoperative wound complications. The purpose of this study was to describe a unique application of the radial forearm free flap for coverage of lateral postoperative heel defects seen after calcaneal fixation. Seven lateral heel wounds after open reduction of calcaneal fractures in 6 patients were covered with radial forearm free flaps. The technique used involved passage of the pedicle of the laterally placed flap anteriorly to the Achilles tendon so that it can be anastomosed to the posterior tibial artery. Flap application was 100% successful, with good functional and cosmetic results in all patients. The radial forearm free flap provides a quick, reliable, and easily harvested source of coverage for lateral heel wounds seen after open reduction and internal fixation of the calcaneus. Tunneling of the flap pedicle anterior to the Achilles tendon is simple and provides the additional advantages of access to reliable vessels, reduced scarring, and avoidance of further wound problems often seen with incisions used to access the anterior tibial artery.

Adult↗
PubMedDate not supplied

Deep, late infections associated with internal fixation in children.

Deep, late infection associated with internal fixation is well known in adults, but has not been previously reported in children. We report here six cases of deep, late infection in children associated with internal fixation of the proximal femur. All patients had cerebral palsy and had undergone a proximal femoral osteotomy for hip subluxation or dislocation. The patients presented with infection between 7 and 24 months after a period of total recovery. The clinical presentation was variable, although many patients had increasing hip pain. Radiographs showed radiolucency around the lag screw. The bacteriologic finding was usually Staphylococcus aureus, and patients responded to wound debridement, hardware removal, and intravenous antibiotics. In light of these cases of deep, late infection, we strongly urge routine removal of metallic implants as soon as bony healing will allow.

Bone Plates↗
PubMed2006

Infection rate in closed fractures after internal fixations in a municipal hospital in Ghana.

This prospective study conducted in the Holy Family Municipal Hospital in Techiman, Ghana aimed to determine the incidence of wound infection following internal fixation of closed fractures in a municipal hospital in a developing country. Between May 2000 and February 2005, 194 patients were treated for closed fractures, implanting a total of 215 internal fixations. Patients were reviewed 10, 30 and 120 days after operation. In 141 (73%) patients, a follow-up of four months was achieved. Of all patients, six developed an infection, two deep and four superficial. The cumulative incidence of wound infection after internal fixation was 3.3%. This study demonstrates that the incidence of wound infection following internal fixation is comparable with hospitals in a temperate climate in industrialized countries. We therefore conclude that specific tropical risk factors play a minimal role in the development of wound infection.

Adolescent↗
PubMed2004

Internal fixation of nonunions.

We review the two major types of internal fixation of nonunions (plating and intramedullary nailing), and analyze nonunions in different locations (upper and lower extremities). Depending on the type and the location of the nonunion, plating or intramedullary nailing may be selected. Both have advantages and disadvantages: plating requires opening the nonunion site, which entails some damage to the soft tissues, and carries with it a risk of secondary infection. With plating, it often is impossible to do a real decortication because the periosteum may be thin and poorly adherent to bone, and the quality of bone may prove insufficient to achieve good fixation with most of the screws. However, plating still is used in metaphyseal nonunions, and angular deformities may be corrected by applying a plate under tension on the convex side of the bone. Nailing can be done percutaneously in numerous cases; it has a smaller risk of infection but, should an infection be present, there is a risk that it may spread over the entire length of the medullary cavity. Nailing stimulates bone formation, but noninterlocking nails may cause shortening and rotational instability of the nonunion site. Plate fixation was popular approximately 20 years ago, but now has been largely superseded by intramedullary nailing except for proximal or distal nonunions. Dynamic locking nails are preferable. Successful treatment of nonunions often requires several consecutive surgical actions and a global strategy must be established from the beginning, taking care not to interfere with the successive steps.

Arm Injuries↗
PubMed2005

Internal fixation versus hemiarthroplasty for displaced fractures of the femoral neck in elderly patients with severe cognitive impairment.

We studied 60 patients with an acute displaced fracture of the femoral neck and with a mean age of 84 years. They were randomly allocated to treatment by either internal fixation with cannulated screws or hemiarthroplasty using an uncemented Austin Moore prosthesis. All patients had severe cognitive impairment, but all were able to walk independently before the fracture. They were reviewed at four, 12 and 24 months after surgery. Outcome assessments included complications, revision surgery, the status of activities of daily living (ADL), hip function according to the Charnley score and the health-related quality of life (HRQOL) according to the Euroqol (EQ-5D) (proxy report). General complications and the rate of mortality at two years (42%) did not differ between the groups. The rate of hip complications was 30% in the internal fixation group and 23% in the hemiarthroplasty group; this was not significant. There was a trend towards an increased number of re-operated patients in the internal fixation group compared with the hemiarthroplasty group, 33% and 13%, respectively (p = 0.067), but the total number of surgical procedures which were required did not differ between the groups. Of the survivors at two years, 54% were totally dependent in ADL functions and 60% were bedridden or wheelchair-bound regardless of the surgical procedure. There was a trend towards decreased mobility in the hemiarthroplasty group (p = 0.066). All patients had a very low HRQOL even before the fracture. The EQ-5D(index) score was significantly worse in the hemiarthroplasty group compared with the internal fixation group at the final follow-up (p < 0.001). In our opinion, there is little to recommend hemiarthroplasty with an uncemented Austin Moore prosthesis compared with internal fixation, in patients with severe cognitive dysfunction.

Activities of Daily Living↗
PubMed1987

Influence of internal fixation on wound infections.

With increasing frequency trauma surgeons are advocating early internal fixation in open fractures. The effect of the fixation devices on the infection rate in contaminated wounds remains a concern as our clinical experience in this area has been mixed. To study the effects of internal fixation on bone infections a 3.5-mm stainless steel screw was inserted into rabbit femurs and the wounds contaminated with Staphylococcus aureus. The controls had the screw hole drilled and taped but the screw was not inserted. Thirty of 49 rabbits receiving the screw subsequently became infected whereas 19 of 56 control animals developed an infection. The difference was significant at the 0.05 confidence level.

Animals↗
PubMed1997

Internal fixation of scaphoid fractures.

Scaphoid fracture fixation is indicated in certain acute situations and for scaphoid nonunion. Internal fixation requires an understanding of the distinctive scaphoid anatomy with relation to its shape, blood supply, fracture healing, and radiographic evaluation. The choice of surgical approach varies with the fracture configuration and procedure planned. A variety of innovative implants are available to accomplish internal fixation of the scaphoid. The ultimate goal is to achieve union and restore stability to the carpus.

Carpal Bones↗
PubMed1996

[Reconstruction of open width of the spinal canal by internal fixator instrumentation and remodeling].

In 106 cases of unstable vertebral fractures treated with the ASIF internal fixator, the degree of restoration of the spinal canal could be studied in detail. Computer-aided planimetry was used to measure the area of the spinal canal. Three series could be studied, where the postoperative CT scans had been performed at different times. The first series of 58 cases had the CT scans taken immediately after surgery; the initial mean traumatic narrowing of the spinal canal had been 42.8%, but after surgery it was only 25.2%. The second series consisted of 74 CT scans performed after implant removal. At this time, a residual defect of only 3.7% was observed. In a third series 31 cases could be analysed where CT scans obtained both directly after surgery and after implant removal were available. This confirmed the first two series insofar as it demonstrated the existence of a further mechanism, i.e. remodeling, that served to increase the degree of restoration of the spinal canal. This biological-functional process operates to approximately the same degree at each fracture level, demonstrated by the almost parallel course of the graph showing reduction plus internal fixation and remodeling. In summary, the remaining deficit of 25% after surgery is restored almost to normal through remodeling and can be neglected, provided there is no neurologic damage.

Adolescent↗
PubMed1991

Effects of rigidity of an internal fixation device. A comprehensive biomechanical investigation.

Internal fixation with instrumentation often accompanies surgical fusion to augment spinal stability, provide temporary fixation while the surgical fusion mass unites, and enhance postoperative mobilization of a patient. Some surgeons, however, feel that the existing plate-screw designs are too rigid and are the primary cause of "iatrogenic" adverse effects clinically observed. A three-part study, involving in vitro experimental protocol, analytical finite-element-based models, and an in vivo canine investigation, was undertaken to study the role of decreasing rigidity of a device on the biomechanical response of the stabilized segments. Two alternatives--the use of one variable screw placement (Steffee plate [unilateral, 1VSP model]) as opposed to two VSP plates (bilateral, 2VSP model) and two VSP plates with polymer washers placed in between the integral nut and plate (2MVSP model)--were considered for achieving a reduction in the rigidity of the conventional VSP system. The load-displacement data obtained from the in vitro experiments and the stress distributions within the stabilized and intact models predicted by the finite-element models revealed that the unilateral VSP system is less rigid and is likely to reduce stress shielding of the vertebral bodies compared with the 2VSP model. The undesirable effects associated with the use of the 1VSP plate system are the presence of coupled motions due to the inherent asymmetry and the likely inability to provide enough rigidity for decompression procedures requiring a complete excision of the disc. The use of two MVSP plates overcomes these deficiencies.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1990

Rigid internal fixation with miniplates and screws: a cost-effective technique for treating mandible fractures?

Traditional methods of fixation for stabilization of mandible fractures primarily center around intermaxillary fixation with or without open reduction. During the past decade, rigid internal fixation with miniplates and screws has attained widespread acceptance in the management of acute traumatic injuries to the mandible. With continuing emphasis on cost containment in health care delivery, plastic surgeons will be expected to justify their therapeutic methods as beneficial as well as cost-effective. This is particularly important when a number of acceptable procedures are readily available. The purpose of our investigation was retrospectively to compare treatment with intermaxillary fixation alone, interosseous wire osteosynthesis, and rigid internal fixation with miniplates and screws. We analyzed the hospital records of three such treatment groups, each consisting of 25 patients. Despite initial purchase costs, increased operating time, and the need to develop the skills required to apply the hardware, our study clearly demonstrated that miniplates and screws remain a cost-effective approach to caring for fractures of the mandible. Associated advantages include a quicker return to a preinjury life-style, decreased weight loss, improved oral hygiene and wound care, and protection of the airway, thereby eliminating monitored intensive care unit admissions.

Adolescent↗
PubMed2006

[Comparison of primary arthroplasty with early salvage arthroplasty after failed internal fixation for displaced femoral neck fractures in elderly patients].

OBJECTIVES: We compared the results of primary total hip arthroplasty (THA) with those of early salvage THA following failure of internal fixation for acute displaced femoral neck fractures in elderly patients. METHODS: Patients with displaced femoral neck fractures (Garden type III, IV) were treated with either early salvage arthroplasty following failure of internal fixation (n=34; mean age 68 years) or THA (n=34; mean age 67.5 years). Both groups consisted of 8 men and 26 women with the same age range (60 to 75 years). Uncemented THA was performed in both groups. All patients were physiologically and socially active before the initial trauma. The hips were evaluated with the use of the Merle D'Aubigne scoring system. Prognostic risk factors were determined on radiographs obtained before or shortly after internal fixation. The mean follow-up was 5.2 years in the secondary and 5 years in the primary THA groups. RESULTS: During the first year of THA, there were 21 complications in 16 patients and nine complications in six patients in the secondary and primary THA groups, respectively (p<0.05). The results with respect to pain were worse and reoperation rate was higher in the revision group (p<0.05). The mean Merle D'Aubigne hip scores for pain, mobility, and walking were higher in the primary THA group. Radiographs taken before or after internal fixation showed prognostic risk factors in 32 patients (94.1%). CONCLUSION: Primary THA is a good choice of treatment for femoral neck fractures in physiologically and socially active elderly patients with a high life expectancy and cognition level.

Aged↗