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PubMed2004

Obturator nerve injury associated with femur fracture fixation detected during gracilis muscle harvesting for functioning free muscle transfer.

A rare case is reported in which injury of the motor nerve of the gracilis (obturator nerve) was detected during its harvesting for functioning free muscle transfer. The probable cause of this rare injury was considered to be accidental penetration while drilling for a proximal locking screw in intramedullary nailing during previous femur fracture surgery.

Adult↗
PubMed2001

Mechanical testing of bioresorbable implants for use in metacarpal fracture fixation.

The purpose of this study was to evaluate the mechanical properties of a bioresorbable plate and screw system that was developed for the treatment of unstable metacarpal fractures and to compare the strength and stiffness of this system with those of conventional titanium plates and screws. Using a 4-point bending test, we measured the strength and stiffness of these implants over a 12-week period of in vitro degradation. Our data suggest that these implants provide stable bending strength and stiffness for 8 weeks and gradually lose their strength over a period of 12 weeks. Further research is necessary to determine whether this level of fixation is adequate to stabilize unstable metacarpal fractures.

Absorbable Implants↗
PubMed1996

Foreign-body reaction and the course of osteolysis after polyglycolide implants for fracture fixation: experimental study in sheep.

Foreign-body reaction to polyglycolide (PGA) implants has been described in man. Many animal experiments have verified the mechanical properties of fixation devices made from PGA, but a significant foreign-body reaction has not been described. We studied the effect of PGA rods in 12 sheep with standardised osteochondral fractures of the medial femoral condyle fixed with uncoloured, self-reinforced PGA rods (Biofix). Radiographs were taken at intervals ranging from two weeks to two years, and the sheep were killed at intervals ranging from six to 24 months. All knees were examined histologically. Eleven of the 12 fractures healed radiologically and histologically. Moderate to severe osteolysis was seen at four to six weeks with maximum changes at 12 weeks in ten animals. Six knees showed fistula-like connections between the implant site and the joint space. Three developed synovitis, one with inflammatory changes involving the whole cartilage and one with destruction of the medial condyle. Although in our study osteochondral fractures fixed with PGA rods healed reliably, there were frequent, significant foreign-body reactions. Caution is needed when considering the use of PGA fixation devices in vulnerable regions such as the knee.

Animals↗
PubMed1992

Biodegradable implant materials in fracture fixation.

Based on our experiences in paediatric traumatology treated conservatively or with metallic implants, we looked for alternative fixation possibilities in the field of biodegradables. We designed a new driving system for screws consisting of an indwelling screw driver which transduces the torque force over the whole length of the thread. With this technical approach, the head and the neck of the screw as the most friable point for the fracture of the implant could be avoided. In 48 calves aged 6 weeks we performed a comparative study with either conservative treatment (repositioning and casting) or osteosynthesis with biodegradable screws made from polylactate acid or metallic screws (AO type) after an oblique osteotomy at a 45 degrees angle to the axis of the right metacarpal bone. Results from 1 to 6 weeks postoperatively were compared and good to excellent results obtained in equal amounts for PLA and steel screw osteosynthesis, whereas conservative treatment was only successful in one third of the cases. Clinical, radiological and histological follow-up proved the feasibility of biodegradable osteosynthesis in the growing skeleton. For clinical evaluation in children, the resorption time of biodegradable materials has to be lowered to 3 to 6 months.

Animals↗
PubMed1997

Postoperative magnetic resonance imaging evaluation of Pipkin fractures fixated with titanium implants: a report of two cases.

Previous studies have documented the effectiveness of magnetic resonance imaging for evaluating and following up the development of avascular necrosis of the femoral head. One of the limitations of this technique, however, is the distortion that is encountered with ferromagnetic screws. A traumatic fracture to the femoral head is a risk factor for avascular necrosis. The addition of internal fixation, which is often required in Pipkin-type fractures of the femoral head, creates significant image distortion on magnetic resonance scans used for postoperative follow-up. The artifact and field distortion present in magnetic resonance imaging when ferromagnetic screw fixation is used has been avoided at our institution by the use of titanium hardware. The authors, therefore, recommend the use of titanium screws in the fixation of Pipkin-type fractures in the hip joint.

Adult↗
PubMed1980

[Problems of fracture fixation in replantation surgery].

Our management of bone fixation in replantation surgery is reported. The use of Kirschner-wires in phalanges and plates with screws in the region of the metacarpal bones proved to be satisfactory. In the presence of infection we experienced good results with Gentamycin pearls.

Amputation, Traumatic↗
PubMed1987

Strength of femoral neck fracture fixation. Comparison of six techniques in cadavers.

A neck osteotomy parallel to the femoral shaft was made on 36 cadaveric femora using the contralateral intact femur as a control. The osteotomies were fixed using a Thornton nail, two von Bahr screws, three Gouffon screws, three Knowles pins, a Haukebø compression screw, or an AO compression screw. The femora were then tested for bending strength using the load ratio test/control at 2- and 5-mm displacement as an expression of the relative strength of the osteosynthesis. There was no difference between the von Bahr, Haukebø, and the AO screws. These implants gave stronger fixation than the Thornton nail, Gouffon screws, and Knowles pins. The Thornton nail was stronger than three Gouffon screws or Knowles pins. The relatively stronger compression hip screws were thus not superior to two optimally placed 5-mm screws.

Aged↗
PubMedDate not supplied

[A makeshift miniature fracture-fixation device: the "domino" apparatus].

The fixation of an external synthetic apparatus on fingers or metacarpals is often relevant to an emergency. In such a condition, particularly overseas, the surgeon does not get all the time and adequate apparatus. So, several expedient measures may be utilized. The authors describe a makeshift apparatus, simple and cheap, giving satisfactory stability when more sophisticated apparatus is not available.

Finger Injuries↗
PubMed1990

Effect of fracture fixation on cortical bone blood flow.

Because internal and external fixation devices alter blood flow, and thus the transport of nutrients to the cortical bone of a healing fracture, we studied the effects of a fluted intramedullary rod (IMR), a half-frame external fixator (EF), and a compression plate (PL) on the cortical bone directly adjacent to the fracture site at 4 and 48 h and 14 and 90 days after fixation. Three specific areas of cortical bone were studied: endosteal cortex, periosteal cortex, and subplate cortex (cortical bone under the compression plate). The fractures fixed with IMR had the lowest blood flow at all time periods studied. At 4 h, the difference between IMR and PL or EF was statistically significant in the endosteal cortex (p less than 0.01 or p less than 0.05, respectively); also, the difference between the IMR and EF in the subplate cortical bone region was significant (p less than 0.05). At 14 days, the blood flow to the endosteal cortex was still significantly lower with IMR than with EF (p less than 0.025). At 90 days, the blood flow to the subplate region of cortical bone was significantly (p less than 0.02) higher with PL than with IMR but there was no significant difference in bone remodeling with the different fixation devices.

Animals↗
PubMed1980

Mechanical properties of some fibre reinforced polymer composites after implantation as fracture fixation plates.

Continuous fibre reinforced composite bone plates made from graphite/polysulphone and glass/epoxy laminates were implanted for 16 weeks on osteotomized canine femurs and for 12 months on intact femurs. After sacrifice, the plates were removed and tested in four point bending for stiffness and strength. There were no significant differences in properties between control and implanted plates in the 16 week study. Both the glass/epoxy and the graphite/polysulphone systems showed deterioration after implantation for 12 months.

Animals↗
PubMed1983

Quantitative microradiography of cortical bone in disuse osteoporosis following fracture fixation.

Stainless steel (elastic modulus 210 GN/m2) and carbon fibre reinforced epoxy resin (elastic modulus 65 GN/m2) plates have been attached to intact femora in cats and the development of disuse osteoporosis assessed by microdensitometric methods after 8 months. The bone adjacent to the stainless steel plate showed evidence of considerable demineralization, both uniformly throughout a section and especially at certain focal points. A noticeable, but much smaller amount of osteoporosis developed adjacent to the composite plate. Various methods of presenting quantitative micro-densitometric data are used.

Animals↗
PubMed1979

Bone ingrowth and stress shielding with a porous surface coated fracture fixation plate.

The extent of bone remodelling under metal fixation plates attached to bone by (i) normal screw fixation and (ii) bone ingrowth into a porous metallic surface underlayer sintered to the metal plate was investigated. Extensive bone remodelling was observed under the integrally bonded porous surface layered plate. This remodelling could be attributed to the more extensive stress transfer from bone to metal plate because of the good bone-to-implant bonding. The importance of stress shielding with high stiffness implants is demonstrated.

Alloys↗
PubMed2006

Trochanteric flip osteotomy for cranial extension and muscle protection in acetabular fracture fixation using a Kocher-Langenbeck approach.

OBJECTIVE: To describe the advantages and surgical technique of a trochanteric flip osteotomy in combination with a Kocher-Langenbeck approach for the treatment of selected acetabular fractures. DESIGN: Consecutive series, teaching hospital. METHODS: Through mobilization of the vastus lateralis muscle, a slice of the greater trochanter with the attached gluteus medius muscle can be flipped anteriorly. The gluteus minimus muscle can then be easily mobilized, giving free access to the posterosuperior and superior acetabular wall area. Damage to the abductor muscles by vigorous retraction can be avoided, potentially resulting in less ectopic ossification. Ten consecutive cases of acetabular fractures treated with this approach are reported. In eight cases, an anatomic reduction was achieved; in the remaining two cases with severe comminution, the reduction was within one to three millimeters. The trochanteric fragment was fixed with two 3.5-millimeter cortical screws. RESULTS: All osteotomies healed in anatomic position within six to eight weeks postoperatively. Abductor strength was symmetric in eight patients and mildly reduced in two patients. Heterotopic ossification was limited to Brooker classes 1 and 2 without functional impairment at an average follow-up of twenty months. No femoral head necrosis was observed. CONCLUSION: This technique allows better visualization, more accurate reduction, and easier fixation of cranial acetabular fragments. Cranial migration of the greater trochanter after fixation with two screws is unlikely to occur because of the distal pull of the vastus lateralis muscle, balancing the cranial pull of the gluteus medius muscle.

Acetabulum↗
PubMed1998

Trochanteric flip osteotomy for cranial extension and muscle protection in acetabular fracture fixation using a Kocher-Langenbeck approach.

OBJECTIVE: To describe the advantages and surgical technique of a trochanteric flip osteotomy in combination with a Kocher-Langenbeck approach for the treatment of selected acetabular fractures. DESIGN: Consecutive series, teaching hospital. METHODS: Through mobilization of the vastus lateralis muscle, a slice of the greater trochanter with the attached gluteus medius muscle can be flipped anteriorly. The gluteus minimus muscle can then be easily mobilized, giving free access to the posterosuperior and superior acetabular wall area. Damage to the abductor muscles by vigorous retraction can be avoided, potentially resulting in less ectopic ossification. Ten consecutive cases of acetabular fractures treated with this approach are reported. In eight cases, an anatomic reduction was achieved; in the remaining two cases with severe comminution, the reduction was within one to three millimeters. The trochanteric fragment was fixed with two 3.5-millimeter cortical screws. RESULTS: All osteotomies healed in anatomic position within six to eight weeks postoperatively. Abductor strength was symmetric in eight patients and mildly reduced in two patients. Heterotopic ossification was limited to Brooker classes 1 and 2 without functional impairment at an average follow-up of twenty months. No femoral head necrosis was observed. CONCLUSION: This technique allows better visualization, more accurate reduction, and easier fixation of cranial acetabular fragments. Cranial migration of the greater trochanter after fixation with two screws is unlikely to occur because of the distal pull of the vastus lateralis muscle, balancing the cranial pull of the gluteus medius muscle.

Acetabulum↗
PubMed1991

Partially biodegradable polyacrylic-polyester composites for internal bone fracture fixation.

New partially resorbable composite formulations based on components used in surgery were synthesized in rod form (length 15-20 mm, diameter 4 mm). The biostable components were poly(methyl methacrylate) in hydrophobic implants and poly(2-hydroxy ethyl methacrylate) in hydrophilic ones. The biodegradable components were commercially available suture yarn made from poly (alpha-hydroxy esters): polyglycolide, a polyester derived from glycolic acid; and a copolyester of glycolic and lactic acids, polyglactin 910. Biodegradation in phosphate-buffered solution at pH 7.0 and 37 +/- 0.5 degrees C was analysed gravimetrically. There was no measurable loss of mass after treatment for 20-25 d. Composite microstructure was examined by phase-contrast, cross-polarized light microscopy.

Biocompatible Materials↗
PubMed1996

Trochanteric hip fractures. Fixation failure commoner with femoral medialization, a comparison of 101 cases.

The radiographic characteristics of 27 patients with a trochanteric fracture treated with a sliding hip screw in which fixation failure occurred, were compared with 74 cases having uneventful fracture union. Femoral medialization was commoner in specific fracture types, particularly if there was comminution of the lateral femoral cortex at the site of insertion of the lag screw. Femoral medialization was strongly associated with fixation failure, with a 7-fold increase in the risk of failure if medialization at more than one third occurred. These observations indicate that the value of implants preventing femoral medialization in specific types of trochanteric fracture merit further evaluation.

Bone Screws↗
PubMed1987

Strength and strength retention in vitro, of absorbable, self-reinforced polyglycolide (PGA) rods for fracture fixation.

The initial shear strength and changes in flexural strength of self-reinforced, absorbable polyglycolide (PGA) composite rods, submerged in distilled water (at 37 degrees C) for a period of 6 wk, were investigated. The recently developed self-reinforced absorbable material consists of an absorbable polymeric matrix reinforced with fibres of the same polymer. The initial shear strength of self-reinforced cylindrical PGA rods with a diameter of 3.2 mm was 250 MPa and the initial flexural strength of the rods was 370 MPa. During the first week of immersion the level of flexural strength decreased very little i.e. to 320 MPa. The loss of flexural strength increased after 1 wk immersion. However, after 3 wk it was 90 MPa. After 5 wk the flexural strength decreased to the level of strength of cancellous bone i.e. 10-20 MPa. The gamma-irradiation of the PGA rods (total dosage 2.5 Mrad) decreased the initial bending strength to 300 MPa but the hydrolytic behaviour of the rods was not changed. The in vitro strength and the strength retention of self-reinforced PGA rods are clearly better than the corresponding values for self-reinforced glycolide/lactide copolymer rods which we developed recently. Self-reinforced PGA rods are now used routinely in Helsinki University Central Hospital in the treatment of certain types of cancellous bone fracture.

Benzenesulfonates↗
PubMed2002

Optimizing the biomechanical compatibility of orthopedic screws for bone fracture fixation.

Progressive loosening of bone fixation screws is a well-documented phenomenon, induced by stress shielding and subsequent adaptive bone remodeling which results in bone loss around the screw. A set of two-dimensional computational (finite element) models was developed in order to test the effect of various engineering designs of fixation screws on the predicted screw-bone stress transfer, and consequently, on the biomechanical conditions for osteosynthesis. A dimensionless set of stress-transfer parameters (STP) was developed to quantify the screw-bone load sharing, enabling a convenient rating to be given of the biomechanical compatibility of practically any given screw design according to the nature of the simulated mechanical interaction. The results indicated that newly proposed screw designs, i.e. a "graded-stiffness" composite screw with a reduced-stiffness-titanium core and outer polymeric threads and an "active-compression" hollow screw which generates compressive stresses on the surrounding bone, are expected to provide significantly better biomechanical performances in terms of the STP criteria, compared with conservative screw designs. Accordingly, the present work demonstrates that finite element computer simulations can be used as a powerful tool for design and evaluation of bone screws, including geometrical features, material characteristics and even coatings.

Biocompatible Materials↗