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At least 289 records · Page 16Linked to original sources
PubMed2004

Interlaminar fixation using the atlantoaxial posterior fixation system (3XS system) for atlantoaxial instability: surgical results and biomechanical evaluation.

This study evaluated the surgical results for patients with atlantoaxial instability due to various lesions treated using the atlantoaxial posterior fixation system (3XS system; Kisco DIR, Paris, France), together with a biomechanical study of this system. The strength of the 3XS system during torsion was examined using a biomechanical simulation model. The 3XS system consists of a transverse unit, hooks, and rods. The lower part of the biomechanical simulation machine was rigidly fixed and the upper part was movable, allowing torsion to be applied until the point of failure. The test was started at 1.5 newton-meters, thought to be the maximum load on the upper cervical spine. The 3XS system tolerated torsion of up to 20 newton-meters, but became deformed. The instrument was fractured at 30 newton-meters. Fifteen patients, four with atlantoaxial instability, seven with os odontoideum, and four with odontoid fractures, underwent surgery using the 3XS system and an iliac bone fragment inserted between the C-1 and C-2 laminae. Postoperative rigid fixation of the lesion and optimal cervical alignment was obtained in all patients, and the patients were discharged within 2 weeks after surgery. Follow-up radiography showed bony fusion between C-1 and C-2 in all patients. Posterior fixations between C-1 and C-2 using the 3XS system were easy to perform and no surgical complications were encountered. The biomechanical study showed the 3XS system can tolerate torsions unlikely to occur during rotation movements in the atlantoaxial region in humans. The surgical use of the 3XS system for the treatment of atlantoaxial instability has several advantages.

Adult↗
PubMed1999

Comparison of bone-patellar tendon-bone interference screw fixation and hamstring transfemoral screw fixation in anterior cruciate ligament reconstruction.

While bone-patellar tendon-bone (BPTB) interference screw anterior cruciate ligament (ACL) reconstruction is a biomechanically sound construct, alternative techniques have been developed secondary to potential donor site morbidity. This study evaluates a system designed to address this problem that involves a transfemoral screw fixation device and stapling of hamstring tendons. Seven pairs of cadaveric knees underwent ACL reconstruction using either BPTB interference screw technique or semitendinosus gracilis (STG) transfemoral screw fixation and stapling. Tensile testing was performed. There was no significant difference between the two fixation types with regard to stiffness, maximum load to failure, elongation, energy to failure and yield load, displacement, and energy.

Aged↗
PubMed2004

[Surgery for tympanosclerotic stapes fixation accompanied by malleus fixation at the anterior malleus: report of 2 cases].

Most tympanosclerotic stapes fixation involves fixation or erosion of the malleus and/or incus. This status of the ossicular chain is one reason that ossiculoplasty for tympanosclerotic stapes fixation is more difficult than that for otosclerosis. In some cases, the malleus is fixed only at the anterior, while the incus is intact. In such cases, anterior spinotomy can recover mobilization of the malleus, then a prosthesis can be used for the long process of the incus during ossiculoplasty. We conducted stapedectomy with anterior spinotomy on 3 ears in 2 patients. Over 15 dB of hearing was regained in all 3 ears 6 months after surgery. No significant sensorineural hearing loss was seen in any ear. To adapt this surgical procedure, it is necessary to evaluate preoperative CT findings and the status of the ossicular chain during surgery.

Adult↗
PubMed1991

Comminuted fractures of the basilar joint of the thumb: combined treatment by external fixation, limited internal fixation, and bone grafting.

Displaced, comminuted fractures of the thumb carpometacarpal joint were treated by intermetacarpal external fixation, anatomic reduction of the joint surfaces, bone grafting and adjunctive internal fixation in thirteen patients. Retrospectively, at an average follow-up time of 35 months, nine patients showed a good result and one patient had a fair result. All fractures had united without secondary displacement, but focal irregularities of the joint surface were commonly seen. As compared with the uninvolved side, axial rotation averaged 79%, radial abduction 89%, key pinch 88%, and grip strength 81%.

Adolescent↗
PubMed2004

Prediction of fixation failure after sliding hip screw fixation.

Cut-out of the lag screw is the commonest cause of fixation failure after sliding hip screw fixation of extracapsular hip fracture. A number of technical aspects of surgery have been used to asses the risk of cut-out. This study was to determine which of these indicators was the most reliable predictor of cut-out. The anterior-posterior and lateral post-operative radiographs of 23 cases of cut-out were compared with those of 77 cases of uneventful fracture healing. The tip-apex distance with correction for magnification was found to show the most significant difference between patients with cut-out against those without (P = 0.001), followed by the lag screw position on the lateral radiographs (P = 0.0095 and 0.014), reduction of the fracture on the anterior-posterior radiograph (P = 0.011 and 0.016) and the uncorrected tip-apex distance (P = 0.019). We recommend that for audit and research purposes the corrected tip-apex distance, fracture reduction and implant positioning methods should be used. For routine clinical practice, the uncorrected tip to apex distance, which is sum of the distance from the tip of the lag screw to the apex of the femoral head on anterior-posterior and lateral radiograph, and fracture reduction angle on the anterior-posterior radiograph are recommended.

Aged↗
PubMed2005

Transoral 2.0-mm locking miniplate fixation of mandibular fractures plus 1 week of maxillomandibular fixation: a prospective study.

PURPOSE: In this study, a 2.0-mm locking miniplate (LMP)/screw system was assessed in the treatment of mandibular fractures with a 1-week period of maxillomandibular fixation (MMF). PATIENTS AND METHODS: Fifty mandibular fractures in 34 patients with a mean of 6.97 days of MMF were included in the study. The 2.0-mm LMPs were adapted along Champy's line of ideal osteosynthesis and secured with four 8.0-mm locking monocortical screws. All patients were followed for a minimum of 6 weeks. The incidence of soft tissue infections, nonunion, malunion, malocclusion, osteomyelitis, nerve injury, and tooth damage was prospectively assessed. RESULTS: Primary bone healing was achieved in 98% of cases. Three complications (6%) were observed. Two minor complications of intraoral wound dehiscence and malocclusion were noted. A fibrous nonunion requiring 3 additional weeks of MMF was noted. No evidence of malunion, osteomyelitis, plate fracture, iatrogenic nerve injuries, or dental injuries was noted. CONCLUSIONS: A single 2.0-mm LMP placed along Champy's line of ideal osteosynthesis with four 8-mm monocortical locking screws plus 1 week of MMF fixation is a reliable and effective treatment modality for mandibular fractures.

Adolescent↗
PubMed2000

A financial analysis of maxillomandibular fixation versus rigid internal fixation for treatment of mandibular fractures.

PURPOSE: The aim of this study was to compare the cost-effectiveness of mandibular fracture treatment by closed reduction with maxillomandibular fixation (CRF) with open reduction and rigid internal fixation (ORIF). PATIENTS AND METHODS: This was a retrospective study of 85 patients admitted to the Oral and Maxillofacial Surgery Service at San Francisco General Hospital and treated for mandibular fractures from January 1 to December 31, 1993. The patients were divided into 2 groups: 1) those treated with CRF and 2) those treated with ORIF. The outcome variables were length of hospital stay, duration of anesthesia, and time in operating room. The charge for primary fracture treatment included the fees for the operation and hospitalization without any complications. Within the group of 85 patients treated for mandibular fractures in 1993, 10 patients treated with CRF and 10 patients treated with ORIF were randomly selected, and hospital billing statements were used to estimate the average charge of primary treatment. The average charge to manage a major postoperative infection also was estimated based on the billing statements of 10 randomly selected patients treated in 1992 (5 treated with CRF, 5 with ORIF) who required hospital admission for the management of a complication. The average total charge was computed by using the average charge for primary treatment plus the incidence of postoperative infection multiplied by the average charge for management of that complication. RESULTS: Eighty-five patients were included in the study. The average charge for primary treatment was $10,100 for the CRF group and $28,362 for the ORIF group. The average charge for the inpatient management of a major postoperative infection was $26,671 for the CRF group and $39,213 for the ORIF group. The average total charge for management of a mandible fracture with CRF was $10,927; the total charge for the ORIF group was $34,636. CONCLUSION: The results of this retrospective study suggest that the use of CRF in the management of mandibular fractures at our institution provides considerable savings over treatment by using ORIF. The use of ORIF should be reserved for patients and fracture types with specific indications.

Adult↗
PubMedDate not supplied

Influence of bolt tightening torque, wire size, and component reuse on wire fixation in circular external fixation.

OBJECTIVES: To evaluate the effects of bolt torque, wire size, and component reuse on the ability to maintain wire tension in 3 external skeletal fixation systems. STUDY DESIGN: Biomechanical study. METHODS: Yield strength in tension of 1.0-, 1.2-, 1.5-, and 1.6-mm-diameter wires, and yield strength in torque of Hofmann Small Bone Fixation (SBF) cannulated and slotted bolts and IMEX regular and miniature bolts were determined on a testing machine. The minimum bolt tightening torque needed to prevent wire slippage at clinically recommended wire tensions was determined. Components were tested 10 times, and loads at slippage were recorded. RESULTS: The IMEX system required a mean of 8 Nm of bolt tightening torque to maintain 900 N (1.6-mm wires). The SBF system required a mean of 3 Nm bolt torque to maintain 300 N (1.0-mm wires) and 5 Nm to maintain 600 N (1.2-mm wires). The SBF cannulated bolt required 9 Nm of torque to maintain 900 N (1.5-mm wires). The SBF slotted bolts could only maintain 800 N before yield. The IMEX miniature system required a mean bolt torque of 1.1 Nm to maintain 300 N. The cannulated and slotted bolts from both manufacturers failed to maintain 70% of initial wire tension after 7 and 4 uses, respectively. CONCLUSIONS: The IMEX systems and the SBF system using 1.0- and 1.2-mm wires could maintain clinically recommended wire tension safely. Only the IMEX system could maintain clinically recommended wire tension safely using 1.5- or 1.6-mm wires. CLINICAL RELEVANCE: The SBF system using 1.0- and 1.2-mm wires and the IMEX system using all wire sizes can maintain clinically relevant wire tension. The SBF system using 1.5-mm wires could not. Cannulated and slotted bolts should not be used more than 6 and 3 times, respectively. Nuts should not be reused.

Animals↗
PubMed2005

Intermittent exotropia increasing with near fixation: a "soft" sign of neurological disease.

AIM: To examine the association of distance-near disparity with neurological disease in children with intermittent exotropia. METHODS: A retrospective analysis was performed of the medical records of all children with intermittent exotropia examined at the Arkansas Children's Hospital between 1989 and 2002. The study group consisted of children with intermittent exotropia who had a near deviation that exceeded the deviation at distance by at least 10 prism dioptres. The control group consisted of children with intermittent exotropia who had a distance deviation greater than or equal to the deviation at near. The main outcome measure was the prevalence of neurological abnormalities in the study and control groups. RESULTS: Among the 29 patients in the study group, 19 (66%) had a history of concurrent neurological abnormalities. Associated neurological conditions included developmental delay (10 patients), attention deficit disorder (four patients), cerebral palsy (four patients), history of intracranial haemorrhage (four patients), periventricular leucomalacia (three patients), seizures (two patients), cortical visual impairment (two patients), hydrocephalus (one patient), history of anoxic brain damage (one patient), history of encephalitis (one patient), and autism (one patient). Among the 37 patients in the control group, seven (19%) had a history of concurrent neurological abnormalities. The difference in the prevalence of neurological disease between the study group and the control group was significant (p=0.0002). CONCLUSION: Intermittent exotropia increasing with near fixation is associated with neurological disease in children.

Adolescent↗
PubMed1999

Combined limited internal fixation with circular frame external fixation of intra-articular tibial fractures.

High-energy intra-articular fractures of the tibial plateau and plafond cause ongoing management problems for the orthopedic surgeon. This study retrospectively evaluated 37 such fractures treated with limited internal fixation and circular frame external fixators. Seventeen plateau fractures (5 open) and 20 plafond fractures (9 open) were treated. Time to union, number of procedures, complications, and functional outcomes were evaluated. All tibial plateau fractures healed within an average of 3.8 months. Eighteen of 20 plafond fractures healed at an average of 4.8 months. There was a high complication rate as is common with these injuries, but most of the complications were minor and easily treated.

Adult↗
PubMed1992

Biomechanics of the Ilizarov fixator for fracture fixation.

Compression, distraction, and torsion stiffness of the Ilizarov external fixator was measured in two fracture models in autopsy specimens of tibia and fibula. A transverse model was tested in six frame constructions with the osteotomy site preloaded in four different positions. An oblique model was tested in four frame constructions also with four preloaded positions. Stiffness was more dependent on bone preload than wire number, wire type, or frame design. High stiffness was achieved by bone preloading, by compressing the rings together, by increasing the number of wires, and by using olive wires. The stiffness can be decreased (dynamization) by separating the rings and by removing wires. This data is helpful for frame design of the Ilizarov fixator.

Biomechanical Phenomena↗
PubMed1994

Fixation of thoracolumbar fractures with the Dick fixator: the influence of transpedicular bone grafting.

Fifty patients with thoracolumbar fractures were treated by internal fixation using the Dick fixator. In the first 22 patients (group 1) this was accompanied by posterior intertransverse grafting. The technique was then modified in the following 28 patients (group 2) to include transpedicular elevation of the depressed vertebral end plate and grafting of the vertebral body, in an attempt to reduce the postoperative loss of correction of the kyphotic deformity. The clinical records and X-rays were reviewed to determine whether the change in technique had achieved this objective and whether it affected operative time, blood loss, postoperative recovery and complications. The mean operating time and blood loss in group 1 were 2 h, 38 min and 650 ml, respectively, and in group 2 2 h, 59 min and 783 ml. These differences were not statistically significant. Time from operation to mobilisation and discharge from hospital were related to neurological deficit, but there was no significant difference between group 1 and group 2 in this regard. There was no difference in the complication rate between the two groups and no complication attributable to transpedicular bone grafting. The radiological results postoperatively and at a mean follow-up period of 9 months were assessed by measurement of the kyphosis angle, anterior vertebral height, anterior displacement, scoliosis, and reduction in cross-sectional area of the spinal canal. In group 1 the mean preoperative kyphosis angle and anterior vertebral height were 8 degrees and 21 mm; postoperatively these values were -12 degrees (lordosis) and 27 mm; and at follow-up they were -4 degrees and 24 mm.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2004

[Open valgus alignment osteotomy of the proximal tibia with fixation by medial plate fixator].

High tibial osteotomy (HTO) is an established technique for the treatment of the symptomatic varus malaligned knee. Correction is usually achieved by closed wedge osteotomy from a lateral exposure. This procedure has a certain risk potential regarding peroneal nerve injuries, instability of the osteotomy and secondary loss of correction. We present four technical modifications of HTO which improve safety and reproducibility of this operation. 1) Open wedge osteotomy from a medial exposure avoids lateral muscle detachment, dissection of the peroneal nerve, proximal fibula osteotomy and leg shortening. Only one osteotomy needs to be performed and the correction can be adapted intraoperatively. 2) A biplanar osteotomy provides improved rotational stability of the osteotomy and creates an anterior buttress against sagittal tilting. 3) An incomplete osteotomy with plastic deformation of the intact lateral bone bridge avoids fractures of the lateral cortex and instabilities and promotes bone healing. 4) Rigid fixation with a medial plate-fixator (Tomofix) allows for early mobilisation and avoids loss-of-correction. 262 patients were consecutively operated using the described modified technique until now. No loss-of-correction occurred in this group, two patients with delayed healing received secondary cancellous bone grafts.

Adult↗
PubMed1979

Differential fixation of poly(L-arginine) and poly(L-lysine) by tannic acid and its application to the fixation of collagen in electron microscopy.

A differential fixation of poly(L-arginine) and poly(L-lysine) has been demonstrated by means of cellulose acetate electrophoresis and colorimetric titration. Electrophoresis showed that at pH 3.0 and concentrations between 0.025% and 2% the reagent interacts with poly(L-arginine) but not with poly(L-lysine). At pH 7.5, however, poly(L-lysine) also reacts, although at a higher concentration of tannic acid than was required to fix poly(L-arginine) at this pH. Colorimetric titration revealed that for poly(L-arginine) the reaction with tannic acid commences at pH 3.0 and is complete at pH 4.1 whereas for poly(L-lysine) the reaction commences at pH 3.5 and is complete at pH 4.9. It is suggested that the reaction is predominantly electrostatic. The results are discussed in relation to the use of tannic acid as a protein fixative in electron microscopy.

Animals↗
PubMed2006

Tensioning technique and fixator stability of a circular external fixator with threaded fine wires.

Hybrid external fixators have become more popular over recent years, and although biomechanical tests show varying results from paper to paper, a consistent finding is shear motion occurring at the fracture/osteotomy site during loading. This can be reduced to some extent by frame configuration, and with the use of olive stop wires, but both of these have limitations. We have investigated the use of threaded fine wires in a circular hybrid fixator. A reliable tensioning method is described which minimises movement at the wire-bone interface during tensioning, and threaded wires are seen to offer a significant improvement in fracture site shear stiffness when compared to smooth fine wires.

Animals↗
PubMed1987

Power staple fixation in hand and wrist surgery: new applications of an old fixation device.

After laboratory testing power driven staples were used in metaphyseal type bone 39 times from December 1983 through April 1985 in 33 patients with hand or wrist problems. Applications included arthrodeses, nonunions, and osteotomy fixation. Diagnoses included rheumatoid and degenerative arthritis, scaphoid, and interphalangeal nonunions. There were no infections, and only one staple has broken. There has been little evidence of loosening or inflammation. Shattering of bone has not occurred; osteoporotic bone appears to be ideal tissue in which to use this fixation.

Hand↗
PubMedDate not supplied

Cortical bone pin fixation: a preliminary report on fixation of digital arthrodeses and distal chevron first metatarsal osteotomies.

From 1998 to 1999, the senior author utilized Allofix cortical bone pins for primary fixation of 40 first metatarsal distal chevron osteotomies and 30 digital arthrodeses in 42 patients. Radiographs of each patient were evaluated for the presence of graft incorporation, union of the osteotomy or fusion site, and postoperative migration of the osseous segments. In 70 procedures, the average time for graft incorporation as evaluated by the absence of graft visualization on radiographs was 4 months. Complications included one case of graft displacement. The results indicate that Allofix cortical bone pins are a reliable, safe, and effective method for the fixation of first metatarsal distal chevron osteotomies and phalangeal arthrodeses of the foot.

Absorbable Implants↗