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PubMed2004

Subluxation of the hip joint after internal fixation of a trochanteric fracture.

The authors report an unusual case of hip subluxation after internal fixation without associated sepsis. We report one recently treated case in which a 75-year-old female experienced subluxation of her hip joint after open reduction and internal fixation for a trochanteric fracture. In this paper, we describe a case of progressive, spontaneous subluxation of the hip joint over several weeks. Most previously reported cases are associated with cerebral palsy. This entity has not been reported previously. Our patient was treated by hemi-arthroplasty and repair of the disrupted capsule, and achieved a good long-term functional result. The cause of this particular condition is discussed.

Aged↗
PubMed1990

Rigid internal fixation vs. traditional techniques for the treatment of mandible fractures.

Treatment results were compared between mandibular fractures repaired with vitallium miniplates versus intermaxillary fixation (IMF) and wire osteosynthesis in 79 patients treated over a 4-year period. The postoperative courses of 35 patients treated with 46 plates were compared to those of 44 individuals treated with traditional reduction techniques. The plated group contained nine complications (26%) versus ten (23%) in the non-plated group. This difference was not statistically significant, despite the presence of more severe fractures in the plated group. Major complications (nonunions, malocclusions) were noted in only three (8%) of the plated group; there were six complications (14%) in the non-plated group. We conclude that the plating of mandibular fractures incurs no greater overall risk of complications than traditional methods of fixation, and a lower risk of major complications, and that the advantages of plate fixation, including decreased time of intermaxillary fixation and cost effectiveness, make this the method of choice in complex mandibular fractures, even in a high-risk population.

Adult↗
PubMed2002

[Decompression and internal fixation in the treatment of thoracolumbar spine and spinal cord injury: report of 166 cases].

OBJECTIVE: To evaluate the therapeutic effect of several internal fixation methods in the surgical treatment of thoracolumbar spine and spinal cord injury (SSI-TL). METHODS: In the 166 SSI-TL cases included in this retrospective analysis, 37 had vertebral body burst fracture, 109 had vertebral body compression fracture (with compression to a degree over 50%),14 had vertebral body fracture and dislocation and 6 had multilevel vertebral fractures or jumping fracture. In view of the spinal cord injury 59 belonged to Frankel grade A, 46 grade B, 42 grade C and 19 grade D. Posterior decompression, reduction and internal fixation were performed in 122 patients and the other 44 underwent anterior decompression, reduction and ilium bone grafting. RESULTS: Follow-up study for 3 to 18 month was conducted in 123 cases, in which RF screws cracking occurred in 4 cases, Harrington upper hook dislocation in 5 cases and Harrington rod cracking in 6, while the rest cases were free of theses incidents. In terms of the function recovery of the spinal cord, 88 cases showed improvement of the spinal cord and cauda equina of 1 to 3 Frankel grades, leaving only 35 lingering in grade A. CONCLUSION: Decompression should be performed at early stages of SSI-TL, and employment of various internal fixation instrument helps maintain and enhance spinal stability, preventing secondary lesion of the spinal cord and promoting the function recovery of the injured spinal cord.

Adolescent↗
PubMed2005

Intra-articular fractures of the hand: treatment by open reduction and internal fixation.

OBJECTIVE: This study was designed to evaluate the results of open reduction and internal fixation of intra-articular fractures of the hand. DESIGN: Retrospective review. SETTING: Patients were treated at 2 university hospital settings by 2 hand surgeons. PATIENTS/PARTICIPANTS: Twenty-eight patients with displaced intra-articular fractures of the hand treated with mini-screw/plate fixation were identified from databases maintained by two hand surgeons. There were 23 men and 5 women, with an average age of 35 (range, 18-68) years. INTERVENTION: Titanium mini-plate and screw set was used in all cases. MAIN OUTCOME MEASUREMENTS: Total active motion of the digit scored according to the Belsky and Gingrass systems. RESULTS: Twenty-two patients (79%) had excellent or good results, and 6 patients (21%) had poor results. All 5 thumb fractures healed without complication and had excellent results. For the lesser digits, 9 had excellent, 8 had good, and 6 had poor clinical outcomes. Poor outcomes were identified in patients with comminuted (P = 0.01) or open (P < 0.001) fractures. Other complications included superficial infection and hardware prominence, both of which occurred in patients with distal phalanx dorsal lip fractures (P = 0.01). CONCLUSIONS: Open reduction and internal fixation of articular fractures of the joints of the hand seems to be an effective treatment method for these difficult fracture patterns. We identified excellent or good outcomes in 79% of our patient group. Patients with open or comminuted fractures were found to have poor results.

Adult↗
PubMed2006

[Internal fixation with the supporting steel of AO femoral condyles for treatment of complicated distal femoral fractures].

OBJECTIVE: To explore the technique and clinical effects of internal fixation of complicated distal femoral fractures using the supporting steel of AO femoral condyles. METHODS: From October 2001 to February 2004, 23 cases of complicated distal femoral fractures were treated with open reduction and internal fixation using the supporting steel of AO femoral condyles. Of 23 cases, there were 19 males and 4 females, aged 27-55 years. The locations were the right side in 10 cases and the left side in 13 cases. Fracture caused by traffic accident in 16 and by fall in 7, including 14 closed fracture and 9 open fracture, 21 fresh fracture and 2 old fracture. According to AO classification, 6 cases were classified as type A extra-articular fracture and 17 cases as type C intra-articular fracture. The X-ray films before operation showed comminuted fracture of femoral intercondylar and femoral supracondylar. All cases received scientific and rational rehabilitative treatment post-operatively. RESULTS: The postoperative follow-up ranged from 6 months to 20 months, 23 cases achieved fracture healing with an average healing period of 10.3 months (from 7 months to 16 months). According to the criteria of Kolmer and Wulff, the results were excellent in 16 cases, good in 4 cases, fair in 2 case and poor in 1 case. The excellent and good rate was 86.9%. CONCLUSION: Internal fixation with the supporting steel of AO femoral condyles for treatment of complicated distal femoral fractures has advantages of reasonable design, convenient operation, firm fixation and reliable clinical outcome.

Adult↗
PubMed1993

Complete soft-tissue clubfoot release with and without internal fixation.

Two groups of patients who underwent soft-tissue release of clubfoot are compared. In group I, internal fixation (two Kirschner wires) was used for 6 weeks to retain correction of clubfoot. In group II, no internal fixation was used. Patients from the two groups were operated on by one surgeon using the same procedure. Because there was no statistically significant difference in functional result between the two treatment groups (P = .08; Mann-Whitney Test), the authors recommend avoiding internal fixation (with all the associated problems) in cases of uncomplicated clubfoot, and encourage early removal of the cast and frequent manipulations to prevent stiffness of the joints and reduce the recurrence rate.

Bone Wires↗
PubMed1997

Internal fixation sets for use in the hand. A comparison of available instrumentation.

Optimal clinical results of internal fixation in the hand depend on appropriate patient selection criteria, good surgical techniques, and appropriate implant selection. A variety of implant sets with plates and screws from different manufacturers are available for hand bone fixation. Traditionally, such sets have been made of stainless steel, but more recently, implants have been manufactured from titanium. Sizes and configurations vary significantly between manufacturers. In this article, commonly available internal fixation sets are compared. Plate, screw, and instrument design are considered. These comparisons should help the surgeon make an enlightened choice of implant sets.

Fracture Fixation, Internal↗
PubMed1990

Factors predisposing to healing complications after internal fixation of femoral neck fracture. A stepwise logistic regression analysis.

A stepwise logistic regression analysis was made to assess the influence of various factors on the rate of healing complications after femoral neck fracture. A prospective series comprising 101 patients with fresh fractures treated by closed reduction and internal fixation was included in a roentgenographic follow-up study. The single most important factor was the quality of reduction, followed by the type of fracture, and the position of the internal fixation material. Age, gender, and type of internal fixation device (three screws or three nails) were not found to influence the healing complication rate. The predicted probability of a healing complication for different combinations of the three most important factors ranged from 0.05 to 0.99. The highest value was found for the combination Garden Type IV fracture, which had unacceptable reduction and position of the internal fixation material. The results show that failure to achieve adequate reduction should be a strong argument in favor of primary hip arthroplasty.

Adult↗
PubMed1986

Open reduction and internal fixation of humeral shaft fractures. Results using AO plating techniques.

Thirty-six patients with an acute fracture of the humeral shaft were treated by open reduction and internal fixation using AO plating techniques. In thirty-two patients an open fracture or multiple injuries, or both, were the indications for internal fixation. Four patients were treated after non-operative treatment failed to maintain a satisfactory reduction. Follow-up was possible for thirty-four patients and showed that thirty-three fractures united primarily and one failed to unite, necessitating two subsequent procedures. Two superficial wound infections in patients with an open fracture and one transient postoperative radial-nerve palsy were the only complications. A functional range of motion in the elbow and shoulder was regained in all but six patients, and they had severe skeletal or soft-tissue injuries in the same extremity. When indicated, internal fixation using plating techniques can give good results provided the correct principles of fixation are carefully followed.

Adolescent↗
PubMed1996

Internal fixation of displaced fractures of the sacrum.

The results of internal fixation in 30 patients with displaced fractures of the sacrum were retrospectively reviewed. All fractures were displaced at least 1 cm. Neurologic injuries occurred in 40% (12 of 30) patients. In 17 patients who underwent open reduction, the preoperative displacement averaged 24 mm and the postoperative displacement averaged 4 mm. In the 13 patients in whom percutaneous fixation was done, the preoperative displacement averaged 15 mm and the postoperative displacement averaged 5 mm. All 30 fractures united. This review of 30 patients with displaced sacral fractures suggests that open reduction and iliosacral screw fixation leads to better reduction of the fracture site than does closed reduction and percutaneous fixation. Functional assessment indicated that the presence of a neurologic injury is the most important predictor of compromised outcome in patients with displaced sacral fractures.

Activities of Daily Living↗