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PubMedDate not supplied

Plate stabilization with bone rivets: an alternative method for internal fixation of fractures.

OBJECTIVES: Bone rivets were developed as an alternative method to fasten plates during internal fixation of fractures when screw anchorage may be inadequate. This study examined whether such rivets allow proper fracture healing without eliciting adverse bone remodelling and whether they can be removed safely. METHODS: A proximal diaphyseal fracture of the tibia was stabilized with a conventional plate (low-contact dynamic compression plate, Synthes) in 10 sheep. The distal fragment was anchored using bicortical screws, and the proximal fragment (1-2.5 mm thick cortex) with 3 rivets following screw stripping. Postoperative care included immediate weight bearing and biweekly radiographs. After 12 weeks, implants were removed from 6 sheep and the tibial strength measured. Tibiae with empty and filled rivet holes (at 12 and 24 weeks) were examined histologically. RESULTS: In all sheep, secondary bone healing was observed without length and angulation deformities. All fracture gaps were bridged and filled with new bone. The average torsional strength after 12 weeks was 75 +/- 11% of the intact tibia (mean +/- SD), and failure never occurred through an empty rivet hole. After 12 weeks, there was intensive cortical remodelling at the rivets correlating with slight to moderate nonprogressive periosteal radiolucency around 55% of the rivets. However, there was also endosteal appositional bone growth at 85% of the rivets. There was no observable macroscopic or microscopic osseous damage after implant removal. After 24 weeks, remodelling activity had decreased and was noted only sporadically. CONCLUSIONS: In this study, the efficacy of bone rivets for the internal fixation of a fracture with plates, where anchorage of screws may be difficult and/or insufficient, was demonstrated.

Animals↗
PubMed1987

Design considerations in development of a prototype, piezoelectric internal fixation plate: a preliminary report.

The piezoelectric internal fixation plate represents a new concept in orthopaedic implants. The purpose of this device is to provide stable bone fixation while delivering internally generated, microampere direct currents to prevent or treat nonunion of a fracture or osteotomy. Clinically, currents of this type have been effective in treatment of nonunion, but application has required separate, implanted, or external battery or radiofrequency powered circuits. The "piezoplate" being developed contains an integral piezoelectric element that generates current in response to either physiological loading such as weightbearing or to externally applied ultrasound. Currents are processed by a rectifying circuit for delivery to bone by electrodes. Specially designed series/parallel piezoelectric elements and dual processing circuits are required to generate optimum rectified currents from the low-frequency, high-voltage signals generated by weightbearing, as well as the high-frequency, low-voltage signals produced by ultrasound. This paper reports on the current status of development and describes design parameters of this device which combines the modalities of mechanical fixation and electrical stimulation in a single implant.

Animals↗
PubMed1981

A new bone-holding clamp for use during internal fixation of fractures.

A new bone-holding clamp for general use during internal fixation of tubular bone fractures is described. The clamp overcomes the common problem of slippage of the reduced position of fracture ends during internal fixation. Further advantages include minimal damage to the periosseous soft tissue and periosteum, which means that the blood vessels are preserved, and the unrestricted working area provided during the operation. Owing to its design the clamp also acts as a self-retaining retractor. The clamp could be described as that 'extra hand' for which the surgeon so often feels the need during the critical stages of osteosynthesis.

Fracture Fixation, Internal↗
PubMed2004

Distal humerus fractures in elderly patients: results after open reduction and internal fixation.

PROBLEM: Fractures of the distal humerus are difficult to treat. In elderly patients, diminished bone mineral quality and increased trauma-associated joint destruction may make stable joint reconstruction even more problematic. Furthermore, comorbidities and poor tolerance of joint immobilization might be additional factors which influence elbow function negatively. Until now, disagreement has existed on how to treat these fractures in elderly patients. Recommendations range from conservative treatment to primary total elbow replacement. So far, reports in the literature on whether or not open reduction and internal fixation in these patients is justified are very rare. AIM OF THE STUDY: To analyze fracture patterns, surgical approach, complications, and functional results after open reduction and internal fixation in patients of age 60 years and older. PATIENTS AND METHODS: Retrospective clinical study of two university level 1 trauma centers, including 45 patients (median age 73 years; range, 61-92 years) with surgically treated distal humerus fractures. Fracture patterns were recorded according to their AO classification. All patients were treated by open reduction and internal fixation. A clinical and radiological follow-up was obtained after a minimum of 24 months following surgery (median 87 months; range, 24-121 months). Functional results were evaluated according to the Mayo Elbow Score. RESULTS: Fractures with complete joint involvement were seen most often. Taking the fracture type into consideration, functional results deteriorated with degree of joint involvement. Postoperative complication rate was high, predominantly seen as screw loosening and/or implant failure at the lateral column. Neverthless, functional results were preponderating good or excellent. Factors negatively influencing outcome were joint immobilization longer than 14 days and severe joint involvement. DISCUSSION: In elderly patients, distal humerus fractures, which are often considered "osteoporotic fractures," still remain one of the most demanding challenges in trauma surgery. The present study demonstrates that despite diminished bone quality and a high complication rate, open reduction and internal fixation in elderly patients is justified. CONCLUSION: Open reduction and internal fixation of distal humerus fractures in elderly patients should be the main goal, since good elbow function can be achieved in the majority of patients. Elbow immobilization longer than 14 days should be avoided. Stable implant anchorage at the lateral column remains problematic, reflecting a general potential for further implant improvements.

Aged↗
PubMed2002

Open reduction and internal fixation of displaced intra-articular fractures of the calcaneus.

BACKGROUND: Thirty-two displaced intra-articular fractures of the calcaneus in 30 patients were treated with open reduction and internal fixation. Fracture classification was based on Sanders computed tomographic classification. There were 18 type II fractures, 10 type III fractures, and 4 type IV fractures. METHODS: The operations were performed using a standard extended lateral approach, and the fractures were fixed with small-fragment AO T-plates without bone grafting. Average follow-up was 35.4 months (range, 24-53 months). The Creighton-Nebraska Health Foundation Assessment score for fractures of the calcaneus was used for evaluation. RESULTS: The average score was 86.7 for type II, 82.3 for type III, and 59.2 for type IV fractures. There was a clear statistically significant superiority with type II and type III fractures treated with open reduction when compared with type IV fractures (p < 0.0001). CONCLUSION: On the basis of our result, we recommend that type II and type III fractures be treated with open reduction and internal fixation. Despite the results of type IV fractures being significantly worse than that of type II and type III fractures, we recommend open reduction and internal fixation for type IV fractures to restore the hindfoot architecture and the subtalar joint, if possible. When the disrupted subtalar joint is so comminuted that it is beyond the surgeon's ability to reconstruct, primary subtalar arthrodesis should be performed in addition to open reduction and internal fixation.

Adolescent↗
PubMed1999

Intra-articular fractures of the distal aspect of the radius: arthroscopically assisted reduction compared with open reduction and internal fixation.

BACKGROUND: There is no consensus that an arthroscopically guided operation can improve the anatomical and functional results of treatment of intra-articular fractures of the distal aspect of the radius. The purpose of the present prospective study was to determine the usefulness of arthroscopically assisted reduction of displaced intra-articular fractures of the distal aspect of the radius by comparing the results of that procedure with those of conventional open reduction and internal fixation. METHODS: Thirty-four fractures were treated with arthroscopically guided reduction with use of one volar and two dorsal arthroscopic portals. The fractures were pinned, and external fixation was used with or without autogenous bone graft. Intraoperative fluoroscopy was not used. Forty-eight fractures were treated with conventional open reduction and internal fixation with a plate and screws or with pinning, with or without external fixation. The average duration of follow-up for all fractures was thirty-one months. RESULTS: The scores for overall outcome, assessed with use of the system of Gartland and Werley and that of Green and O'Brien as modified by Cooney et al., demonstrated that the group that had had an arthroscopically assisted procedure had better outcomes than the group that had had conventional open reduction and internal fixation. The group that had had an arthroscopically assisted procedure also had significantly better ranges of flexion-extension and radial-ulnar deviation of the wrist and grip strength (p<0.05). We detected an association between the maximum step and gap displacement and evidence of osteoarthritis of the radiocarpal joint (p<0.001), but we did not find a significant association, with the numbers available, between the scores for osteoarthritis, graded according to the scale of Knirk and Jupiter, and the scores for overall outcome, assessed with the scale of Gartland and Werley and the modified system of Green and O'Brien, in either group (p = 0.376). The radiographic results showed that the patients who had had an arthroscopically assisted procedure had better reduction of volar tilt, ulnar variance, and articular (gap) displacement than did those who had been managed with conventional open reduction and internal fixation (p<0.05 for each comparison). CONCLUSIONS: An arthroscopically guided operation achieved an accurate reduction of intra-articular fractures of the distal aspect of the radius. Minimum capsular and adjacent soft-tissue scarring reduced postoperative contracture, which improved the overall functional results. We recommend arthroscopically guided reduction and internal fixation not only for young adults but for all patients who are less than seventy years old and have an intra-articular fracture of the distal part of the radius with more than one millimeter of displacement on plain radiographs.

Adolescent↗
PubMed1996

The role of internal fixation in the treatment of Jones fractures in diabetics.

The purpose of this study was to evaluate the treatment of fractures of the proximal fifth metatarsal at the junction of the metaphysis and diaphysis (i.e., Jones fracture) in diabetics. Open reduction and internal fixation with bone grafting resulted in clinical and radiographic union 8 weeks after surgery in patients treated with either immediate or delayed open reduction and internal fixation. Open reduction and internal fixation with autologous bone grafting is an effective treatment regimen in the diabetic patient with a Jones fracture. An initial trial of casting can be attempted without any apparent deleterious effects on secondary open reduction and internal fixation.

Adult↗
PubMed2000

Open reduction and internal fixation of tibial pilon fractures.

Although it is evident that the fracture of the tibial plafond is a complex, often debilitating injury, its management is not clear. These injuries generally fall into one of two categories. The low-energy, rotational type of fracture has been shown to have excellent clinical and functional results with open reduction and internal fixation. The high-energy, compression type of fracture has had uniformly moderate results and historically high complication rates. Some authors think that bridging external fixation with or without limited internal fixation should be employed in high-energy fractures. Others believe that open reduction and internal fixation to avoid articular incongruence and development of axial malalignment is needed for good long-term outcome. The authors believe the latter. Staging the treatment of the patient can minimize development of soft tissue complications. The authors follow the recommendations of Patterson and Sirkin and believe that high-energy pilon fractures should be temporized with an external fixator with or without fibular plating to restore length. Any open would should be addressed at this time. Definitive fixation should be planned for between 10 and 14 days, by which time the soft tissue envelop is likely to be ready to accept the further insult of surgery. The surgical technique should be well planned for and include the use of meticulous soft tissue techniques and indirect reduction methods. With the proper attention to detail, long-term results will be maximized.

Ankle Injuries↗
PubMed1987

The in vivo performance of 250 internal fixation devices: a follow-up study.

The in vivo performance of 250 retrieved internal fixation plates was evaluated. The corrosion characteristics and metallurgical properties of each implant were assessed and correlated with respective clinical performance. Screw-plate interface corrosion and screw surface corrosion were graded; Rockwell hardness, grain size, thin inclusion content, and heavy inclusion content measurements were made. The devices studied included 169 bone plates, 59 Richards type hip screw-plates and 22 Jewett type hip nail-plates. The devices remained in situ for an average of 26.3 months, with in situ periods ranging from 1 to 192 months. The majority of the plates (50.4%) were removed due to cause-related reasons, while the remaining devices (49.6%) were removed on a routine asymptomatic basis. The primary symptomatic removal reasons consisted of implant related pain, nonunion or malunion, infection, loosening and implant breakage. Upon stereomicroscopic examination, 89% of all plates exhibited some degree of interface crevice corrosion, and 88% of all screws exhibited some degree of surface corrosion. Statistical analysis of corrosion gradings and metallurgical data revealed significant correlations between the two. As was suggested in our previous study of a limited number of implants, this study demonstrates that stricter manufacturing standards for metallurgical properties would serve to enhance corrosion resistance and improve the in vivo performance of stainless steel internal fixation devices. It is also suggested that the routine removal of all internal fixation plates after fracture healing has been achieved would reduce the occurrence of symptomatic complications, such as implant breakage, implant loosening and implant related pain.

Bone Plates↗
PubMed2005

[Evaluation of rigid internal fixation in mandibular reconstruction with autogenous bone].

OBJECTIVE: To investigate the application of rigid internal fixation in mandibular reconstruction with autogenous bone and to evaluate its efficacy. METHODS: From January 1994 to May 2004, 98 patients with mandibular defect received mandibular reconstruction with autogenous bone by using rigid internal fixation. Seventy-two cases of benign tumor and 26 cases of malignant tumor were included. Four hundred and ono rigid fixation plates were inserted. The clinical results and X-ray films were analyzed and the healing processes were evaluated. The functional and aesthetic results of the mandibular reconstruction were also evaluated according to Lopez assessment system. RESULTS: After a follow-up of 1 to 3 years, 95 patients (96.9%)achieved successful effect. The forms and function of the mandibles were resumed. Eighty-one (82.7%) patients were satisfied with the results of operations. Thirteen patients (13.3%) achieved acceptable results. Four patients (4.1%) were dissatisfied with the results of operations. CONCLUSION: The rigid internal fixation is conductive to healing and remodeling of the transplant bone in mandibular reconstruction.

Adolescent↗
PubMed2005

[Treatments of tibial Pilon fractures with a combination of limited internal fixation and external fixation].

OBJECTIVE: To summarize the effect and complication of treatment for Pilon fracture using limited internal fixation combined with external fixation. METHODS: From April 1996 to June 2003, 20 patients with Pilon fracture were treated with limited internal fixation combined with external fixation as the treatment group and 22 patients with Pilon fracture with other methods as the control group. The X-ray films, clinical effect and complication were analyzed and compared between 2 groups. RESULTS: All cases were followed up for 8 to 26 months (15.2 months on average). According to Helfet's criterion for clinical effect, the excellent and good rates were 75% in the treatment group and 72.7% in the control group, being no significant difference (P > 0.05). According to Burwell-charnley criterion for reduction, the X-ray film results showed the excellent and good rates were 90% in the treatment group and 86.4% in the control group, being no significant difference (P > 0.05). But there was significant difference in complications between 2 groups (P < 0.05). CONCLUSION: Limited internal fixation combined with external fixation is better in resuming ankle joint function and remarkably reducing complication, especially in reducing soft tissue complication and collapse of bone joint; it is useful in the treatment of Pilon fracture.

Adult↗
PubMed1992

Complications of high tibial osteotomy and internal fixation with staples.

Osteotomy for osteoarthritis of the knee has established itself well since its first description by Jackson and Waugh [8, 9]. Internal fixation with staples allows early functional treatment with only a minimum of operative intervention. Removal of the metal is optional. In the 5-year period from 1986 to 1990, 182 high tibial osteotomies were performed at the Orthopaedic Department of the University Hospital of Freiburg. In four cases internal fixation was done with plates; in 178 cases two or more staples were used; in 3 cases a screw was additionally inserted for better hold. The staples became loose intraoperatively in eight cases (4.5%); only once did a dislocated staple have to be reoperated on post-operatively. Further complications which are independent of the method of internal fixation are summarized in the article. Complications of surgery on the long bones of the leg are inevitable, but with only one postoperatively dislocated staple and one case of non-infected pseudarthrosis (i.e. a method-related complication rate of 1.1%), internal fixation with staples for high tibial osteotomy presents itself as a reliable and safe procedure.

Adolescent↗
PubMed1995

Robotic-assisted internal fixation of femoral fractures.

Closed surgical techniques for the internal fixation of femoral fractures require orthopaedic surgeons to work in close proximity to X-rays. In addition to the occupational health risk this imposes, inexperienced surgeons often encounter great difficulty in achieving optimal positioning of fracture repair fixtures. A vision-guided robotic system has been proposed as a possible solution to these problems and an initial investigation involving two exemplar orthopaedic procedures has been undertaken. Robotic surgery assistance imposes rigorous safety-related design constraints, since the orthopaedic robot must operate in close proximity to the patient and operating staff. The design and implementation of a purpose-built robotic system for orthopaedic surgery assistance is described in this paper.

Femoral Fractures↗
PubMed2000

Outcome after open reduction and internal fixation of Lisfranc joint injuries.

BACKGROUND: Open reduction and internal fixation has been recommended as the treatment for most unstable injuries of the Lisfranc (tarsometatarsal) joint. It has been thought that purely ligamentous injuries have a poor outcome despite such surgical management. METHODS: We performed a retrospective study of patients who underwent open reduction and screw fixation of a Lisfranc injury in a seven-year period. Among ninety-two adults treated for that injury, forty-eight patients with forty-eight injuries were followed for an average of fifty-two months (range, thirteen to 114 months). Fifteen injuries were purely ligamentous, and thirty-three were combined ligamentous and osseous. Patient outcome was assessed with use of the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score and the long-form Musculoskeletal Function Assessment (MFA) score. RESULTS: The average AOFAS midfoot score was 77 points (on a scale of 0 to 100 points, with 100 points indicating an excellent outcome), with patients losing points for mild pain, decreased recreational function, and orthotic requirements. The average MFA score was 19 points (on a scale of 0 to 100 points, with 0 points indicating an excellent outcome), with patients losing points because of problems with "leisure activities" and difficulties with "life changes and feelings due to the injury." Twelve patients (25 percent) had posttraumatic osteoarthritis of the tarsometatarsal joints, and six of them required arthrodesis. The major determinant of a good result was anatomical reduction (p = 0.05). The subgroup of patients with purely ligamentous injury showed a trend toward poorer outcomes despite anatomical reduction and screw fixation. CONCLUSIONS: Our results support the concept that stable anatomical reduction of fracture-dislocations of the Lisfranc joint leads to the best long-term outcomes as patients so treated have less arthritis as well as better AOFAS midfoot scores.

Adult↗
PubMed1997

Intertrochanteric osteotomy for failed internal fixation of femoral neck fracture.

Thirteen patients with failed internal fixation of the femoral neck were treated with valgus intertrochanteric osteotomy performed by one surgeon from 1987 to 1995. The patients ranged in age from 18 to 59 years. The interval from injury to osteotomy ranged from 4 to 54 weeks. With an average followup of 25 months (range, 9-42 months), the femoral neck fracture healed in all patients. Twelve patients returned to being fully weightbearing without pain. The average limb shortening was improved by 1 cm. Seven of eight patients who were employed before their injuries returned to the same occupations. Femoral head collapse because of avascular necrosis developed in one patient 18 months after surgery and return to full activities and in a second patient shortly after the osteotomy. These two patients now have an arthroplasty. The remainder of the patients have done well without requiring additional surgery. Harris hip scores and Short Form 36 Health Status Survey outcome scoring were available to verify the results in 10 patients.

Adolescent↗
PubMed1979

Internal fixation of fractures of the third phalanx in three horses.

The technique of internal fixation of intra-articular fractures of the third phalanx using lag screw interfragmentary compression is described. Three cases are discussed and the successful treatment of infection and osteomyelitis described in one of them. Despite this potential complication internal fixation offers a better prognosis and also a more rapid return to work than non-operative treatments.

Animals↗
PubMed1990

Indications for use of a microsystem for internal fixation in craniofacial surgery.

The successful use of the newly developed Micro System for internal fixation is discussed. The Micro System provides a firm three-dimensional fixation of segments. Since it cannot withstand extreme muscle or masticatory forces, it should be used selectively. Its usefulness in the fields of craniofacial surgery, neurosurgery, and hand surgery is viewed optimistically.

Adult↗
PubMed1992

[Mechanical efficacy of different internal fixation devices in the treatment of thoracolumbar fractures].

To know the efficacy of different internal fixation devices used in the treatment of thoracolumbar fractures, specimens of 15 adult cadaveric (T-8 to L-4) were prepared and were divided into 5 groups for comparative study. Except the control group, the vertebra of T-12 of every specimen in other 4 groups was artificially fractured, imitating flexion fracture dislocation, with standard technic. Then, they were fixed in each group, with Luque's rod, Dick's screw, pedicle screw plate or Dunn's device respectively. The stress distribution and yielding stress under load and dimensional motions in each group were recorded and compared among the groups and with the control. In the experimental groups, Dunn's device gave the strongest support, against load on the anterior and middle columns. Dick's screw and pedicle screw plate could theoretically fix the anterior, middle and posterior columns rigidly; however, because of the weakness persisted in the connection of their components, their fixation effectiveness was reduced. Luque's rod acted though effectively against bending on every direction, it could not stand much axial load. It is obvious that each of these 4 devices has its own advantages and could be used to prevent horizontal displacement of the fixed fracture, but fail to control torsional stress.

Biomechanical Phenomena↗