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Results for “FRACTURE FIXATION”

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At least 253 records · Page 14Linked to original sources
PubMed2004

Use of a synthetic bone void filler to augment screws in osteopenic ankle fracture fixation.

INTRODUCTION: Sufficiently stable constructs may be difficult to obtain with ankle fractures in patients with severe osteopenic bone. Augmentation of the osteosynthesis with a new synthetic bone void filler may help to solve this problem, and it can improve the clinical outcome. MATERIALS AND METHODS: A prospective, open-label study was performed in two surgical clinics in Norway. In 37 of 42 selected patients with Weber type B ankle fractures showing clinical and radiologic signs of osteopenic bone, at least one screw was found to be stripping during open reduction and internal fixation (ORIF). All the stripped screws were augmented with the bone void filler, and tightness was assessed clinically afterwards. All patients were followed up for 2 years. Successful healing of the fracture after 3 months and absence of radiographic movement of the augmented screws were assessed relative to the plate and the bone. Safety was assessed by recording adverse events and abnormal haematology findings. RESULTS: All 86 augmented screws were clinically tight after augmentation. After 3 months, all fractures healed, and 1 augmented and 1 non-augmented screw appeared to be radiographically loose. After 2 and 6 months, respectively, deep wound infections occurred in 2 patients (5%), necessitating antibiotic treatment, revision surgery and implant removal. After 2 years, all patients had resumed their normal daily activities, and none of the augmented screws showed signs of loosening. CONCLUSIONS: Augmentation of bone screws with this new synthetic bone void filler was an effective means of gaining screw anchorage. Screw stabilisation with the new synthetic bone void filler proved to be safe and effective in the ORIF of ankle fractures in patients with osteopenic bone.

Aged↗
PubMed1998

A method to determine the 3-D stiffness of fracture fixation devices and its application to predict inter-fragmentary movement.

Inter-fragmentary movement considerably influences the fracture healing process. Large shear movement delays while moderate axial movement stimulates the healing process. To be able to control the mechanical situation at a fracture site and to achieve optimal bony healing it is essential to understand the relationship between inter-fragmentary movement, bony loading and fixation stiffness. A 6 x 6 stiffness matrix is introduced which completely describes the linear relationship between the 6 inter-fragmentary movements and the resulting bony loading (3 forces and 3 moments). Further, it is illustrated that even in relatively stiff external fixateur constructs simple axial loading of the bony fragments leads to complex inter-fragmentary movement. When the 3-D stiffness description is multiplied by the load state in sheep tibiae, movements similar to those measured in vivo are calculated. The relationship between axial compression and medio-lateral or dorso-ventral shear varies depending on the mounting plane of the external fixateur. The authors conclude that a single value is not sufficient to describe the mechanical relationship between inter-fragmentary movement and bony loading. Only a complete description of fixation stiffness allows prediction of inter-fragmentary movement and differentiation between various configurations of fixation devices and their potential for mechanically promoting bony healing.

Animals↗
PubMed2006

The history of fracture fixation of the hand and wrist.

UNLABELLED: The treatment of fractures of the hand and wrist has evolved over the centuries from one of rest and immobilization to internal fixation and early motion. Although today's technology (anesthesia, antibiotics, metal implants) has allowed us more freedom in treating these injuries, a number of our patients continue to experience stiffness, nonunion, malunion, and chronic pain. We explore the techniques used to treat hand and wrist fractures throughout the centuries and determine what beneficial aspects of fracture care have been maintained and those that have changed as a result of new technology. We are now realizing that rigid immobilization of fractures at the expense of the soft tissues can be just as damaging as the ancient physician's techniques of prolonged immobilization with frequent dressing changes. New implants and lighter cast materials have allowed improved digital motion and early functional use of the extremity. This has become especially important in the treatment of the aging population, which demands improved function and a quicker return to activities. The optimal treatment of these fractures for each patient remains elusive, however, and there remains a tendency to rely on technology at the expense of sound clinical care. We must not loose sight of the goals of fracture treatment and should heed the lessons learned throughout centuries of treating these injuries. LEVEL OF EVIDENCE: Level V (expert opinion).

Casts, Surgical↗
PubMed2002

Gluteus minimus necrotic muscle debridement diminishes heterotopic ossification after acetabular fracture fixation.

OBJECTIVE: The aetiology and pathogenesis of heterotopic ossification (HO) are still obscure. We evaluated the impact of necrotic gluteus minimus muscle (GMM) debridement on the formation of HO after operative treatment of posterior wall (PW) and associated transverse-posterior wall acetabular fracture (Tr/PW) fixations utilizing a Kocher-Langenbeck surgical exposure. METHODS: Thirty-one consecutive patients with displaced PW or associated Tr/PW acetabular fracture-dislocations were operatively treated by a single surgeon using a Kocher-Langenbeck surgical exposure. Strict soft tissue technique was observed and self-retaining retractors were not used. Necrotic GMM was debrided in an attempt to diminish ectopic bone formation. RESULTS: Twenty-nine patients were available for post-operative clinical and radiographic evaluations. HO occurred in 12 patients. Significant HO (Brooker class III or IV) was noted in only three patients (10%). There were no complications associated with debridement of necrotic GMM. CONCLUSIONS: Necrotic GMM resection diminishes HO formation comparably to other reported series in which non-steroidal anti-inflammatory medications were used. Resection of the necrotic GMM from the zone of injury has proved to be an efficient and safe method of preventing significant HO in patients after operative fixation of PW and associated Tr/PW acetabular fractures treated through a Kocher-Langenbeck approach.

Acetabulum↗
PubMed1985

Biomechanics of intramedullary fracture fixation.

Intramedullary rodding allows excellent control of bending forces on long bone fractures when adequate sized rods are used. This is made possible by reaming when necessary. Torsional stability is poor if adequate bone nail contact is not obtained and there is little bone fragment interdigitation. This can be optimized with the interlocking system, especially with proximal and distal fractures. Intramedullary rods allow transmission of compressive load so there must be adequate bone to bone contact without comminution to prevent shortening. If a great deal of comminution is present, an interlocking system must be used to resist compressive loads. The interlocked devices have not been proven to be a detriment to union and indeed are a semi-rigid fixation system when used in comminuted shaft fractures. The strength of an osteosynthesis with an intramedullary rod depends on the geometry of the rod and the geometry of the fracture complex. Both locked and nonlocked intramedullary rods perform extremely well when one understands the mechanical principles involved in intramedullary rodding and pays close attention to detail.

Biomechanical Phenomena↗
PubMed2002

Effects of intramedullary femoral fracture fixation: what is the impact of experimental studies in regards to the clinical knowledge?

This review manuscript summarizes the available literature on animal studies dealing with the local and systemic effects of intramedullary (IM) reamed and unreamed nailing. It focuses on the question of whether the large numbers of studies have contributed to our clinical knowledge about its impact on perfusion, fracture healing, and about the clinical relevance of systemic side effects. The effects of IM contents that are squeezed out of the medullary canal into the venous and the systemic circulation due to reaming and nailing has been a major issue. In addition, the impact of the surgical procedure and the timing of such a major operation as femoral fractures surgery has been a major source of debate within the last decade. The compilation of relevant studies investigating the degree of impact of a surgical procedure and the influence of concomitant injuries depends on the design and the type of the animal model. If this fact is considered and if a model is selected that reflects the systemic impact comparable with the clinical situation, animal studies represent a valuable source of information. In this respect, fat embolization represents an additive surgical impact and can cause clinically relevant side effects if cofactors (e.g., thoracic trauma, severe shock, and polytrauma) are present that set the individual up for postoperative complications.

Animals↗
PubMed1987

Warping of cross sections in the torsion of long bones with internal fracture fixation plates.

Torsion of noncircular beams results in warping of each cross section. When noncircular cross sections are constrained to remain plane, the resulting shear stress distribution is different from what Saint Venant torsion (with warping) would predict. This has practical implications to the stress analysis of plated long bones subjected to torsional loadings. Analyses in which warping is not allowed predict incorrect stress fields in the plate and bone and overpredict the amount of stress shielding associated with fracture plate fixation.

Biomechanical Phenomena↗