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PubMed2001

Open reduction and internal fixation of acute displaced scaphoid waist fractures.

Fourteen consecutive patients with acute displaced scaphoid waist fractures were treated with open reduction and internal fixation. The operative technique consisted of anatomic reduction of the displaced scaphoid waist fracture, correction of carpal instability, radial bone grafting for comminution, and internal fixation with K-wires or Herbert screw. The patients were evaluated an average of 26 months (range, 4-48 months) after surgery. Thirteen of the 14 (93%) fractures united. The average time to union was 11.5 weeks (range, 8-20 weeks). Fracture union was confirmed with trispiral tomography. Final radiographic assessment consistently revealed a healed scaphoid fracture, restored intrascaphoid alignment, and no evidence of carpal instability. All patients regained functional wrist range of motion (wrist extension, 57 degrees; wrist flexion, 52 degrees ) and grip strength. Open reduction and internal fixation of acute displaced scaphoid waist fractures restores scaphoid alignment and leads to predictable union. Early operative intervention avoids malunion and carpal instability that often occurs with closed management of these complex fractures.

Adolescent↗
PubMed1983

Intraosseous metastatic breast cancer treatment with internal fixation and study of survival.

The treatment of 31 actual or pending pathologic fractures of the long bones with open reduction and internal fixation with methylmethacrylate in 25 patients with intraosseous metastatic breast cancer is reported. Twenty hips, eight femurs, and three humeri were involved. On the basis of Wilcoxon survival curves, average life expectancy was unaltered by this treatment. However, relief of pain and overall function were significantly improved by rigid internal fixation; 74% of results were rated good (23 cases); 13% fair (four cases); and 13% poor (four cases). Three patients died within three weeks of operation; the fourth poor result was a fixation failure and was repaired with good results. Thus, the efficacy and success of open reduction and internal fixation with methylmethacrylate were confirmed, even in bones with widespread involvement. The procedure is recommended for any patient with fracture or impending fracture of the long bones secondary to metastatic breast cancer, as long as that patient's predicted survival is greater than six weeks after postoperative recovery.

Adult↗
PubMed1986

Internal fixation of femoral neck fractures: a prospective study.

To determine the adequacy of reduction and the soundness of the technique of primary internal fixation, the authors studied prospectively 96 femoral neck fractures over 6 1/2 years. Patients were followed up for an average of 11 months. The mean patient age was 70 years. Both clinical and radiologic data were collected at 3-month intervals for 6 months and then annually. Radiologic indices recorded included the Garden classification and index, shear angle, Western Infirmary Glasgow angle, lateral angle, nail placement, occurrence of bony union and presence of avascular necrosis. The fixation devices included sliding compression screw and side plate, multiple Knowles pins and a 130 degrees AO blade plate. A high rate of varus reduction, excessive ante- or retroversion and poor nail placement were all noted. Twenty-three patients required a total of 36 reoperations. There were six deaths in the first 6 months after operation. Eighty-five patients (mean age 79 years) with femoral neck fractures treated by hemiarthroplasty (71) or total hip replacement (14) during the same period were also reviewed. Follow-up averaged 8 months. Two patients required reoperation. The general morbidity was similar to that of the group treated by internal fixation, but there were eight deaths. Femoral neck fractures, if treated by internal fixation, demand accurate reduction and fixation for optimum results. Primary prosthetic replacement should be reserved for elderly patients with poor bone stock.

Aged↗
PubMed2006

[Comparison of various kinds of internal fixations in unstable intertrochanteric femoral fracture].

OBJECTIVE: To explore the effects of various kinds of internal fixations on unstable intertrochanteric femoral fractures. METHODS: From January 2000 to December 2004, 88 cases of unstable intertrochanteric femoral fractures were treated. There were 52 males and 36 females (aged 19-86 years). Twenty-two cases were caused by fall from height, 36 by motor vehicle accident and 20 by fall and 10 by tumble. They were divided into 4 groups according to 4 kinds of internal fixations: dynamic hip screw (DHS, group A, n=42), anatomical proximal femur bone plate (group B, n = 23), proximal femoral nail (PFN, group C, n = 8)and dynamic condylar screw (DCS, group D, n = 15). According to the modified Evan's classification, fractures were all unstable type and were classified as follow types: group A (15 type III, 8 type IV and 19 type V); group B (12 type III, 5 type IV and 6 type V); group C (3 type III, 2 type IV and 3 type V); and group D (10 type III, 3 type IV and 2 type V). The data of operative time, intra-operative blood loss, intra-operative complications, fluoroscopy exposures, clinical healing time of fracture, post-operative restored function and postoperative complications were recorded and analyzed statistically using the SPSS 12.0 software package. RESULTS: All patients were followed up for 12-48 month (18 months on average). All patients achieved clinical healing. Coxa varus occurred in 3 cases of group A, in 1 case of group C and in 3 cases of group D. The differences were of no statistical significance in operative time and postoperative complications between 4 groups (P>0.05). The difference was of statistical significance in the blood loss between groups A, B and groups C, D (P<0.05) but no statistical significance between group C and group D (P>0.05). The difference was of statistical significance in the fluoroscopy exposures, clinical healing time of fracture and postoperative complications between group B and the other groups (P<0.05). The difference was of statistical significance in the post-operative restored functions between group D and the other groups (P<0.05). CONCLUSION: The anatomical proximal femur bone plate is a useful device in the treatment of unstable intertrochanteric femoral fracture. The operative manipulation is simple and the hip functions recover well.

Adult↗
PubMed2004

[Use of cortical (lag) screws in internal fixation of mental fractures].

PURPOSE: To evaluate the clinical results of cortical (lag) screws in internal fixation of mental fractures. METHODS: 12 patients with single linear mental fracture underwent internal fixation using cortical screws. The patients were followed up for 6 to 9 months after fixation. RESULTS: Of 12 cases, 1 cortical screw was used in 10 cases, and 2 cortical screws were used in 2 cases. The wound healed primarily postoperatively. The patients had normal occlusion and mouth opening. CONCLUSION: Fixation of mental fracture using cortical screw can achieve good stability and appropriate compression. The technique is simple and easily performed, which avoids the bending of the reconstruction plate to adapt to the complex configuration of the mandible, reduce the surgical time, and promote the healing process by producing stress in the fracture lines.

Adolescent↗
PubMed2003

[Primary anterior internal fixation for the surgical management of thoracolumbar spinal tuberculosis].

OBJECTIVE: To discuss the effect of primary anterior debridement, interbody autografting, and anterior internal fixation on the surgical management of thoracolumbar spinal tuberculosis. METHODS: Ninety-one cases of thoracolumbar spinal tuberculosis were treated with primary anterior debridement, interbody autografting, and anterior internal fixation. RESULTS: All cases were treated without any recurrence after follow-up for an average of 13 months. Spinal fusion occurred in 3.7 months on average with 20 degree of kyphosis correction achieved after surgery and 95.5% of the patients obtained good results. CONCLUSION: Primary anterior debridement, interbody autografting, and anterior internal fixation for the surgical management of thoracolumbar spinal tuberculosis are safe and effective and play an important role in reconstruction of spinal stability.

Debridement↗
PubMed2004

Surgical site infection complicating internal fixation of fractures: incidence and risk factors.

BACKGROUND: There is a dearth of data on surgical site infections (SSIs) complicating internal fixation of fractures from Nigeria. AIMS: To determine the incidence and risk factors for SSIs following internal fixation of fracture. METHODS: A cohort of 90 patients with long bone fractures that were stabilized internally with metallic devices was studied prospectively and retrospectively. RESULTS: The incidence of SSI was 12%. The isolated organisms were Staphylococcus aureus in four patients, Pseudomonas spp. in three, and Escherichia coli in one patient. Diabetes mellitus and perioperative transfusion with allogeneic blood were not predictive of SSI. Duration of operation longer than 120 minutes was a strong predictor (OR 2.25, 95% CL 0.48-10.16). Other risk factors were male sex (OR 2.01, 95% CL 0.44-10.45), injury-operation interval less than six months (OR 2.00, 95% CL 0.22-46.08), fracture fixation with plates and screws (OR 1.51, 95% CL 0.36-6.40), white blood cell count (WBC) less than 5,000 per cumm (OR 1.50, 95% CL 0.15-16.37), preoperative urinary catheterization (OR 1.48, 95% CL 0.00-16.19), and postoperative urinary catheterization (OR 1.24, 95% CL 0.29-5.00). CONCLUSION: The incidence of SSI after internal fixation of long bone fractures in our centers is 12%, and this is within the previously reported range. Use of plates and screws, WBC less than 5,000 per cumm, and perioperative urinary catheterization are important risk factors.

Adolescent↗
PubMed2004

Open reduction and internal fixation of volar Barton's fractures: a prospective study.

PURPOSE: To assess the functional and clinical outcomes of open reduction with internal fixation in the treatment of Barton's fracture of the wrist. METHODS: From January 1997 to July 2003, a total of 19 cases of volar Barton's fracture were operated on by open reduction and internal fixation at the Nehru Hospital, Chandigarh, India. Records of 16 cases were available for study. Special care was taken during surgery to achieve articular congruity. The injury was caused by motor vehicle accidents in 13 cases and by a fall in 3. All cases were type-B3 fractures: 10 were of the B3.3 subtype, 4 of the B3.2 subtype, and 2 of the B3.1 subtype. Most (12) cases were operated on within one week of injury, 3 in one to 2 weeks, and one in 2 to 3 weeks. RESULTS: All patients were assessed clinically and radiographically after a mean follow-up duration of 32.4 months (range, 12.0-65.0 months). Fractures healed after 7.0 to 10.0 weeks (mean, 8.8 weeks). Results of evaluations according to functional criteria were excellent in 9 cases, good in 5, and fair in 2. Radiocarpal osteoarthrosis developed secondary to trauma in 2 cases. There was no involvement of the median nerve in any of the 16 cases. CONCLUSION: Open reduction and internal fixation of volar Barton's fracture can restore articular congruity and result in good to excellent function.

Accidental Falls↗
PubMed1992

Internal fixation or arthroplasty for displaced subcapital fractures in the elderly?

A series of 200 patients aged over 69 years admitted to this hospital with a non-pathological displaced subcapital fracture of the femur, have been studied prospectively. Approximately one-half were treated by internal fixation and the remainder by a hemiarthroplasty, the method of treatment being dictated by the preference of the on-call consultant. This has enabled a comparison between the two groups. At 1 year from injury there was no significant difference in the mortality or function of the survivors. Internal fixation resulted in fewer postoperative complications, a shorter hospital stay and a reduced cost of treatment. The reoperation rate for internal fixation was three times that after hemiarthroplasty. Despite the problem of non-union, this study suggests that internal fixation is the treatment of choice for displaced subcapital fractures in the elderly.

Aged↗
PubMed2005

Comparison of internal fixation with total hip replacement for displaced femoral neck fractures. Randomized, controlled trial performed at four years.

BACKGROUND: Recent randomized, controlled trials performed at two years postoperatively have shown that a primary total hip replacement is superior to internal fixation for the treatment of a displaced femoral neck fracture in a relatively healthy, mentally competent, elderly patient. The primary aim of the present study was to evaluate the outcomes at four years. METHODS: One hundred and two patients (mean age, eighty years) who had an acute displaced femoral neck fracture were randomly allocated to be treated with total hip replacement or internal fixation. The inclusion criteria were an age of at least seventy years, absence of severe cognitive dysfunction, an independent living status, and the ability to walk independently. The main outcome measurements were hip complications, reoperations, hip function, and health-related quality of life. RESULTS: The mortality rate was 25% in both groups. At the forty-eight-month follow-up evaluation, the rate of hip complications was 4% in the patients treated with total hip replacement and 42% in those treated with internal fixation (p < 0.001) and the reoperation rates were 4% and 47%, respectively (p < 0.001). The arthroplasty group had no additional hip complications or reoperations between the twenty-four and forty-eight-month follow-up visits. In the fixation group, the percentage of hip complications increased from 36% to 42% and the percentage of reoperations increased from 42% to 47% during the same period. The hip function was significantly better and the decline in health-related quality of life was less pronounced in the arthroplasty group than it was in the fixation group at the four, twelve, and twenty-four-month follow-up evaluations. Ninety-seven percent of the patients in the arthroplasty group and 57% of the patients in the fixation group who were available for follow-up at forty-eight months had no hip complications (p < 0.001). CONCLUSIONS: Compared with internal fixation, primary total hip replacement provides a better outcome for mentally competent elderly patients with a displaced femoral neck fracture. The complication and reoperation rates were significantly lower and hip function and health-related quality of life were at least as good at four years after the surgery.

Aged↗
PubMed2003

Continuous lumbar plexus block for acute postoperative pain management after open reduction and internal fixation of acetabular fractures.

OBJECTIVE: To assess the efficacy of postoperative continuous lumbar plexus blocks for postoperative pain control in patients undergoing open reduction and internal fixation of an acetabular fracture. PATIENTS/PARTICIPANTS: Twenty-six patients who underwent open reduction and internal fixation of an acetabular fracture. DESIGN/PERSPECTIVE: According to a case-control study design, patients were divided into 2 groups: Group 1 (n = 13) received postoperatively a continuous lumbar plexus block with 0.2% ropivacaine (10 mL/hr for 48 hours), and group 2 (n = 13) received postoperatively patient-controlled analgesia with morphine (1 mg; lock-out time, 10 minutes; total 6 mg/hr). MAIN OUTCOME MEASUREMENTS: Postoperative morphine consumption, time to unassisted ambulation, and clinical and radiographic outcomes. RESULTS: No significant differences in demographics, surgical procedure, or duration of surgery were reported between the two groups. The lumbar plexus catheter group showed a lower requirement for morphine in the postanesthesia care unit (6 mg [0-14 mg]) and during the first 2 days (20 mg [6-55 mg] on day 1 and 29 mg [4-56 mg] on day 2) than the control group (51 mg [20-100 mg] on day 1 and 50 mg [10-93 mg] on day 2) (P = 0.001 and P = 0.021). Effective unassisted ambulation was recovered earlier in patients with the lumbar plexus catheter (3 days; range 2-4 days) than in the control group (4 days; range 3-7 days) (P = 0.015). CONCLUSIONS: Continuous lumbar plexus block represents an interesting alternative for postoperative pain control in patients undergoing open reduction and internal fixation of an acetabular fracture.

Acetabulum↗
PubMed2005

[The design of an anti-rotation reduction internal fixator and its applications in spine fracture surgeries].

This article introduces a new-type anti-rotation reduction internal fixator, which can be applied in various spine fractures and dislocations in order to shorten the operation time, to raise reduction effect, and to reduce the complications such as the loss of reduction, broken nail, broken rod etc. Biomechanical tests and clinical applications have proved that the internal fixator has the features of a short operation time, a definite fixation and few complications.

Bone Nails↗
PubMed1984

Posterior spinal fusion using internal fixation with the Daab plate.

The results of posterior spinal fusion, supplemented by internal fixation with the Daab plate in 43 patients, are presented. The Daab plate is a quadruped implant placed longitudinally in the coronal plane and fixed by simply pinching it around the spinous processes. The cause of the instability necessitating fusion was acute trauma in eight patients, late posttraumatic condition in 11, pure degenerative process in seven and spondylolisthesis in nine patients. In addition, there were solitary cases of tuberculous spondylitis, pyogenic spondylitis and metastatic destruction of the vertebral body. The fusion site was cervical in three, thoracic in eight, thoracolumbar in 12 and lumbar or lumbosacral in 20 cases. The mean follow-up time was 19 months. The consolidation of the fused area could, apart from radiographs, ultimately be evaluated at removal of the implant in 39 patients. The fusion was successful in 37 patients. Compared with previous reports, this result must be considered satisfactory when the severity of the cases in this series is noted. Internal fixation in connection with posterior fusion is needed only exceptionally, but in complicated cases the Daab plate seems to afford a simple method of securing the position of the segments for the first postoperative months.

Adolescent↗
PubMed2000

Bone bonding ability of a new biodegradable composite for internal fixation of bone fractures.

Hydroxyapatite particles and poly(L-lactide) composites for internal fixation of bone fractures have been developed based on the hypothesis that incorporation of hydroxyapatite particles in a poly(L-lactide) matrix might enhance bone bonding. This study evaluated the bone bonding ability of these biodegradable composites. Two types of hydroxyapatite and poly(L-lactide) composite were used in this study: calcined hydroxyapatite/poly(L-lactide) and uncalcined hydroxyapatite/poly(L-lactide). Rectangular plates (2 x 10 x 15 mm) of each composite or poly(L-lactide) were implanted into the metaphysis of the tibiae of 33 male rabbits, and the failure load was measured by conducting a detaching test 8, 16, and 25 weeks after implantation. The failure loads of calcined hydroxyapatite/poly(L-lactide), uncalcined hydroxyapatite/poly(L-lactide), and poly(L-lactide), respectively, were 13.60, 13.95, and 0.46 N at 8 weeks; 29.84, 24.09, and 2.86 N at 16 weeks; and 25.50, 29.67, and 2.43 N at 25 weeks. Histologic observation revealed that the composites formed direct contact with the bone. The results in this study indicate that the composites improved the strength of the interface between bone and plate. This improved interfacial strength lead to a substantial decrease in the frequency of implant loosening in the treatment of fractured bones by internal fixation.

Absorbable Implants↗
PubMed1977

The management of secondary neoplastic deposits in long bones by prophylactic internal fixation.

Pathological fracture through a secondary neoplastic deposit is a distressing event. Prevention of such a fracture is clearly of considerable benefit. To determine which secondary deposits are liable to fracture the notes and X-rays of 57 patients with 91 secondary deposits were examined. Fractures are unlikely (2.4%) to develop where the deposit involves less than 50% of the cortex as seen on radiological examination, but 2 out of 3 deposits with over 50% involvement will fracture. As the benefits of internal fixation in those that would otherwise fracture are so great, it is recommended that all deposits involving over 50% of the cortex of a long bone should be treated by prophylactic internal fixation. The results of 26 patients treated by prophylactic internal fixation are summarized. Apart from fracture-prevention, the benefits of such internal fixation were found to be: pain relief, simple operation, rapid postoperative recovery, facilitation of administration of radiotherapy and maintenance of the independance of the patient. The possible effects on local and general tumour spread are not considered to be a contraindication to operation.

Adult↗
PubMed2005

Internal fixation in trapdoor-type orbital blowout fracture.

BACKGROUND: The most common orbital blowout fracture is a trapdoor type. In many cases of trapdoor fracture, the bony segment has a stable hinge consisting of a greenstick fracture and the sinus mucoperiosteum that is attached to the intact orbital wall. If the displaced bony segment opposite the hinge is reduced into the original position and fixed on the unaffected bone, the orbital fracture may be reconstructed by internal fixation of the bony segment itself rather than requiring substitution with alloplastic implants or a bone graft. METHODS: In 20 cases of orbital blowout fracture of a trapdoor type, internal fixation was performed using a cantilever fixation technique (with a piece of titanium micromesh or a titanium microplate plus a microscrew) or a ledge fixation technique (with a piece of micromesh). RESULTS: In all cases, the orbital wall was accurately reconstructed in its normal anatomical position. The associated ocular problems disappeared except for mild diplopia in one patient and there were no surgical complications associated with the internal fixation. CONCLUSIONS: The advantages of internal fixation include anatomical reconstruction of the orbital wall; preservation of the original orbital bone and the mucoperiosteum of the sinus as an osteomucoperiosteal flap resulting in rapid wound healing and normal mucus drainage function of the sinus; the simplicity of the procedure; and consequently, the absence of surgery-related complications. This technique is presented as one of the preferred treatments for trapdoor-type orbital blowout fractures.

Adolescent↗
PubMed1977

The use of bone cement as an adjunct to internal fixation of supracondylar fractures of osteoporotic femurs.

Bone cement was used as an adjunct to internal fixation of 14 supracondylar femoral fractures. The fractures were stabilized with ASIF plates. In all these fractures severe osteoporosis made a stable fixation impossible without the use of bone cement. The average age of the patients was 75 years. Eight of the patients had previously been operated on because of fractures of the same extremity and three suffered from disabling diseases. Twelve fractures healed without complications, despite early mobilization. One fracture needed additional external fixation before it healed and one lead to non-union. No infections were seen. It is concluded that use of bone cement as an adjunct to the internal fixation of supracondylar fractures secures a stable fixation of even the most severe osteoporotic femora, and this aids healing in most cases of such fractures. The method is recommended in selected cases of elderly patients.

Aged↗
PubMed2005

Stanmore total knee replacement versus internal fixation for supracondylar fractures of the distal femur in elderly patients.

BACKGROUND: Supracondylar fractures of the femur in the elderly are difficult to treat. Total knee replacement is often not considered. The aim of this study was to compare the short to medium term outcome of fixation and total knee replacement in medically fit active elderly patients with no pre-existing arthritis in order to determine whether total knee replacement can be an alternative to internal fixation. PATIENTS AND METHODS: In this retrospective study, we included patients who were aged 75 or over with an ASA grade of two or less, walked independently before their injury, and sustained a type A or C supracondylar fracture. Four were treated with internal fixation and six with a cemented Stanmore knee replacement. Patients were reviewed clinically and radiographically a minimum of 6 months after surgery. RESULTS: The advantages of total knee replacement were a greater proportion of patients returned to independent walking, rehabilitation was more rapid, and knee flexion was better. The advantages of internal fixation were a decreased need of blood transfusion, a smaller proportion of patients reported knee pain at follow up, and a better mean Oxford knee score at follow up. Anaesthetic time and level of patient satisfaction at follow up were similar. There were no peri-operative deaths. CONCLUSION: In this preliminary study, total knee replacement was a reasonable alternative to internal fixation for the treatment of supracondylar fractures of the distal femur in elderly.

Aged↗