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At least 343 records · Page 19Linked to original sources
PubMed2006

Biomechanics of cantilever "plow" during anterior thoracic scoliosis correction.

BACKGROUND CONTEXT: Anterior instrumentation is often used for correction of thoracic scoliosis. Loss of spinal correction may occur after failure at the bone-implant interface, and forces on the bone-implant interface during scoliosis correction remain unclear. PURPOSE: Evaluate two different mechanisms of loading associated with anterior scoliosis correction. STUDY SETTING: In vitro biomechanics lab. METHODS: Polyurethane foam and human cadaveric thoracic vertebral bodies were instrumented with transvertebral body screws. Bone-implant interface failure loads were measured during constrained, fixed-angle screw translation, as well as unconstrained translation allowing coronal plane screw rotation. Vertebral body staples were randomly assigned to both conditions. RESULTS: Data were consistent across foam and cadaveric specimens. Failures occurred at significantly lower loads during unconstrained translation (with rotation) compared with constrained translation. Staple usage significantly increased the load to failure in both testing modes. In cadaveric bone, the constrained plowing load to failure was 562N+110N versus 188N+20N in the unconstrained testing. With a staple, these values increased to 694N+53N and 530N+100N, respectively. CONCLUSIONS: The 280% increase in cadaveric failure loads when a staple was added in the unconstrained testing method exceeds previous reports. The unconstrained method of plow simulated anterior scoliosis instrumentation when a rod was cantilevered and compressed into position. Supplemental vertebral body staples may be clinically indicated, particularly at the ends of the construct where residual deforming forces remain the greatest.

Bone Nails↗
PubMed2004

Biomechanical study of a poly-L-lactide (PLLA) sternal pin in sternal closure after cardiothoracic surgery.

BACKGROUND: Stainless steel wiring is currently the standard method of median sternotomy closure but it has been reported that sufficient stiffness is not obtained by the method in anterior-posterior and cranial-caudal directions. A bioabsorbable Poly-L-Lactide (PLLA) sternal pin has been developed as an additive material for sternal closure. We biomechanically examined the effectiveness of a PLLA sternal pin in the two directions by using the sternum of a juvenile pig. METHODS: Juvenile pigs 14-17 kg weight were used. After the sternum was extirpated it was cut into two pieces at the midline. In a wire fixation group the pieces were fixed by two stainless wires. In a wire and intrasternal fixation group a hole was drilled into the bone marrow and a PLLA sternal pin for an infant was set into the hole. Then the both sides of the wired sternum were fixed tightly at the testing machine and the shear stress was forced into the one side. The shear stress was forced in anterior-posterior and cranial-caudal directions. RESULTS: In an anterior-posterior direction, the stiffness was 13.84 +/- 1.84 (N/mm) in a wire and intrasternal fixation group and 7.00 +/- 2.71 (N/mm) in a wire fixation group (p = 0.0002). In a cranial-caudal direction it was 10.61 +/- 4.88 (N/mm) and 4.38 +/- 2.12 (N/mm), respectively (p = 0.03). CONCLUSIONS: The use of a PLLA sternal pin as an additive material to steel wiring was effective in preventing the displacement of the sternum in both directions. Our data showed that closure technique using a sternal pin would provide adequate fixation.

Absorbable Implants↗
PubMed2000

The treatment of isolated ulnar fractures in adults: a systematic review.

The treatment of isolated ulnar fractures remains controversial, with different authors recommending both surgical and non-surgical management. We undertook a systematic review of the current literature in order to assess whether any conclusions can be drawn. A total of 33 series involving 1876 patients were identified as suitable for analysis. Data from these papers were combined by method of treatment. The results of the non-operative treatment of minimally displaced ulnar fractures with a stable configuration were uniformly good. Below elbow plaster cast, functional brace and early mobilisation all produced similar results. An above elbow cast was unnecessarily restrictive. To preserve forearm rotation, widely displaced or unstable fractures are best treated by open reduction and internal fixation. Guidelines based on cadaveric and clinical studies exist to predict fracture stability and the extent of acceptable displacement. However, these have not been verified in clinical studies. Compression plate fixation gave reliable results in these cases. Other methods lacked sufficient published data to be recommended.

Adult↗
PubMed2001

An introduction to the minimally invasive osteosynthesis of intra-articular calcaneal fractures.

The approach to the treatment of intra-articular calcaneal fractures has often been the subject of discussion. The results achieved with both operative and non-operative management remain to some extent unpredictable. Minimally invasive osteosynthesis offers an alternative approach, especially in those cases in which open reduction would be hazardous and non-operative treatment inadequate. This technique requires minimal dissection and preserves subtalar motion almost completely. The authors believe that displaced intra-articular calcaneal fractures are best treated through operative intervention. Restoration of articular congruity is an integral, though not necessarily sufficient, component of a successful long-term outcome following calcaneal fracture. The extra-articular dimensions of the calcaneus must be restored in order to tolerate standard shoe-wear, maintain a functional range of talocalcaneal motion and avoid subsequent tibiotalar arthrosis. However, in certain circumstances open reduction may be associated with an unacceptably high complication rate. In these cases, the authors have found a "minimally invasive" osteosynthesis technique useful in dealing with competing goals. In our experience, this technique can, when used appropriately, result in a functional recovery of the patient suffering a calcaneal fracture.

Aged↗
PubMed2002

Surgical management of the severely displaced supracondylar fracture of the humerus in children.

We reviewed 44 children with a widely displaced supracondylar fracture of the humerus (Gartland grade III) treated with primary open reduction and cross pinning. The average age was 8 years and the mean delay in presentation was 34 h. Comminution of the medial supracondylar pillar was seen in 57% of the cases. After treatment, the range of the elbow motion was restricted in eight patients. Cubitus varus was not seen. There was no deep infection or myositis ossificans. Post-operatively, five children had a temporary nerve palsy. According to Flynns' criteria, 42 patients had a satisfactory outcome.

Adolescent↗
PubMed2003

Displaced supracondylar humeral fractures in children: results of a national survey of paediatric orthopaedic consultants.

Several aspects of the management of displaced supracondylar fractures in children remain controversial. Displaced supracondylar humeral fractures (Type III) in children have traditionally been considered orthopaedic emergencies. Recent studies have suggested that closed Type III supracondylar fractures without vascular compromise may be treated in a delayed manner without compromise to functional and cosmetic outcome. Debate continues over the fixation method of choice in these difficult fractures. A postal questionnaire of 121 practising paediatric orthopaedic consultants in the UK was performed to explore these issues. Seventy-seven replies were obtained (63.6%). The 54.5% of the respondents managed displaced supracondylar fractures without vascular compromise in a delayed manner (more than 8h from presentation). The incidence, initial assessment and factors which influence the timing of surgery of these fractures are discussed. The fixation method of choice reported was closed reduction and the use of smooth Kirshner wires (93.4%). Of these, crossed pin fixation is used by 83.9% of respondents and 9.7% employed laterally placed wires. The majority of consultants (69.7%) considered the operative treatment of these fractures a consultant-led procedure. This survey has established an overview of the current practices of paediatric orthopaedic consultants in the UK in the management of these difficult fractures.

Bone Nails↗
PubMed2004

Unstable trochanteric femoral fractures: extramedullary or intramedullary fixation. Review of literature.

For operative treatment of unstable trochanteric fractures two options exist: extramedullary or intramedullary stabilisation. A review of 18 international papers that compared two different treatment methods for trochanteric fractures, in prospective randomised clinical trials, is presented. In view of the overall results, routine use of intramedullary fixation devices is not to be recommended for stable trochanteric fractures. For these fractures one of the sliding hip screw systems provides a safe and simple alternative. For unstable fractures intramedullary implants are (biomechanically) superior. The review shows that clinical advantages of both treatment methods are suggested and advocated, but still remain to be demonstrated on evidence base.

Analysis of Variance↗
PubMed1979

The Portsmouth method of external fixation of complicated tibial fractures.

A New method of external fixation for complicated fractures of the tibia is described. The use of acrylic cement to secure the tibial transfixing pins to the external bar and the ability to apply compression across the fracture site are the salient features of this technique, which is simple to use and inexpensive.

Bone Nails↗
PubMed1998

The removal of metalwork in children.

The post-operative complications in 57 children under the age of 16 years requiring removal of metalwork during a 12-month period are presented. The grade of surgeon performing the operation is also discussed. The overall complication-rate was 14 per cent. Minor complications such as transiently painful scars and superficial infection occurred in 7 per cent of cases. There was one intermediate complication following removal of Knowles pins of an unacceptable scar requiring revision by a plastic surgeon. The major complication (7 per cent of all cases) involved fracture with retention of the distal part of the screws during attempted removal of Knowles, Crawford-Adams or Moores pins used for the management of slipped upper femoral epiphysis. When considering this sub-group of patients, the actual complication rate for removal of metalwork from the hip was 27 per cent. So significant was this finding that the authors changed their practice to the use of a partially threaded single cannulated screw for the fixation of slipped upper capital epiphyses.

Bone Nails↗
PubMed2000

Is there a place for external fixation in humeral shaft fractures?

There is a good indication for unilateral axial dynamic external fixation in fractures of the humeral shaft when the fracture appears in the distal third or in cases of bilateral fractures. A non-union or a posttraumatic paralysis of the radial nerve may be indications for external fixation as well as fractures associated with multiple injuries. Further indications include osteitis, infected non-union and comminuted fracture. There is maximum protection of the soft tissue with this method of treatment. External fixation combines the advantages of conservative and operative treatment by influencing callus formation by dynamizing, distraction or compression. Minimizing soft tissue damage facilitates the decision for early exploration of the radial nerve in cases of palsy. A safer positioning technique of the distal screws of the fixator is described.

Adult↗