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PubMed2005

Internal fixation for displaced fractures of the femoral neck. Does bone density affect clinical outcome?

The results of meta-analysis show a revision rate of 33% for internal fixation of displaced fractures of the femoral neck, mostly because of nonunion. Osteopenia and osteoporosis are highly prevalent in elderly patients. Bone density has been shown to correlate with the intrinsic stability of the fixation of the fracture in cadaver and retrospective studies. We aimed to confirm or refute this finding in a clinical setting. We performed a prospective, multicentre study of 111 active patients over 60 years of age with a displaced fracture of the femoral neck which was eligible for internal fixation. The bone density of the femoral neck was measured pre-operatively by dual-energy x-ray absorptiometry (DEXA). The patients were divided into two groups namely, those with osteopenia (66%, mean T-score -1.6) and those with osteoporosis (34%, mean T-score -3.0). Age (p = 0.47), gender (p = 0.67), delay to surgery (p = 0.07), the angle of the fracture (p = 0.33) and the type of implant (p = 0.48) were similar in both groups. Revision to arthroplasty was performed in 41% of osteopenic and 42% of osteoporotic patients (p = 0.87). Morbidity (p = 0.60) and mortality were similar in both groups (p = 0.65). Our findings show that the clinical outcome of internal fixation for displaced fractures of the femoral neck does not depend on bone density and that pre-operative DEXA is not useful.

Absorptiometry, Photon↗
PubMedDate not supplied

Powered metaphyseal stapler: an effective and simplified internal fixation system used in multiple types of podiatric surgery.

The multiplicity of types of usage of the powered stapler system in podiatric surgery were explored. The stapler system reduces surgical time and trauma, especially with complex reconstructive and repair procedures. The expedited surgical procedures along with minimized surgical trauma and comfortably implanted staples improved healing rate and less postoperative pain. The important criteria and indications for the usage of powered stapler fixation were reviewed. This relatively new system offers an effective alternative for internal fixation in the foot and ankle.

Foot↗
PubMed2005

Rigid internal fixation with titanium versus bioresorbable miniplates in the repair of mandibular fractures in rabbits.

The purpose of this study was to compare by qualitative histology the efficacy of rigid internal fixation with titanium system and the Lacto Sorb system in mandibular fractures in rabbits. Thirty male adult rabbits Oryctolagus cuniculus were used. Unilateral mandibular osteotomies were performed between the canine and first premolar. The animals were divided into two groups: for Group I-rigid internal fixation was performed with titanium system 1.5 mm (Synthes, Oberdorf, Switzerland), with two screws of 6 mm (bicortical) on each side of the osteotomy. For Group II-rigid internal fixation was performed with PLLA/PGA system 1.5 mm (Lacto Sorb, WLorenz, Jacksonville, FL, USA). The histological analysis evaluated the presence of inflammatory reaction, degree of bone healing and degree of resorption of the Lacto Sorb screws. The results of both fixation systems were similar, only with a small difference after 15 and 30 days. In Group I a faster bony healing was noted. But after 60 days, bony healing was similar in both groups. It is concluded that both PLLA/PGA and titanium plates and screws provide sufficient strength to permit mandibular bone healing. The resorption process of PLLA/PGA osteosynthesis material did not cause acute or chronic inflammatory reaction or foreign body reaction during the studied period.

Absorbable Implants↗
PubMed1993

Immediate internal fixation of low-velocity gunshot-related femoral fractures.

Fractures caused by gunshots are increasingly common in urban hospitals and trauma centers. The rising incidence and complexity of these injuries present difficult management problems and health care burdens. In a 3-year period, from 1989 through 1991, 21 patients with femoral shaft fractures from low-velocity bullets were treated with intramedullary fixation within 15 hours of admission. Eighteen patients were available for follow-up. The fractures had healed in all patients. Average hospitalization for an isolated injury was 7 days. There were no complications related to immediate internal fixation. Immediate internal fixation of femoral shaft fractures caused by low-velocity gunshots can be performed in an efficient and cost effective manner.

Adolescent↗
PubMed2004

Dynamic traction and minimal internal fixation for thumb and digital pilon fractures.

PURPOSE: This study evaluates the use of limited internal fixation and dynamic traction for the treatment of severely displaced digital and thumb pilon fractures. METHODS: Six patients were evaluated both clinically and radiographically at an average of 29 months after surgery (range, 18-36 months) for pain, range of motion, and radiographic signs of joint space narrowing and congruence. Surgery involved the placement of a pin for dynamic traction and an assessment of the adequacy of the articular alignment. A limited incision and supplemental K-wires were often used to improve the position of severely displaced fragments or for the repair of the central tendon. RESULTS: Three patients were pain free, 2 patients experienced pain with prolonged activity, and 1 patient had pain associated with activities of daily living. Average digital arc of motion of the proximal interphalangeal joint was 94 degrees (range, 90 degrees-100 degrees) and thumb interphalangeal motion was 62.5 degrees (range, 60 degrees-65 degrees). The average duration of digital traction was 3.5 weeks. Four patients had greater than 1 mm incongruity of the articular surface immediately after surgery. At final evaluation, all patients had good joint congruency and 2 patients had joint space narrowing but were asymptomatic. There was 1 minor pin tract infection. CONCLUSIONS: Dynamic traction combined with limited internal fixation can be an effective treatment for displaced intra-articular pilon fractures. This technique may allow for earlier removal of traction and simultaneous repair of soft tissue injuries.

Activities of Daily Living↗
PubMed1975

Tibial shaft fractures treated by rigid internal fixation: the early results in a 4-year series.

Ninety-nine fractures of the shaft of the tibia in 98 patients were treated by rigid internal fixation over 4 years. One patient died after operation from myocardial infarction; and one patient went abroad. The healing course of the remaining 97 fractures is described, classified according to the type of fracture and the accuracy of operative reduction. Seventy-five fractures had a normal time to union, defined as the lasting achievement of full weight-bearing within 4 months. In 7 fractures the healing period was moderately delayed (full weight-bearing being achieved in 4-6 months) and in 5 it was seriously delayed, requiring 6-11 months after injury. Nonunion occurred in 4 cases and refracture in 6 cases. Osteitis developed in 2 cases and was successfully treated with antibiotics within 6 weeks. A second internal fixation was necessary in 12 patients. In 5 patients a plaster cast was applied to treat delayed union. Amputation was necessary in a 75-year-old man with senile dementia who developed infection after a second operation for refracture. One patient still has a pseudarthrosis after 2 years and 2 further operations. In the other 95 fractures union was the end-result. Of the 21 comminuted and open fractures only 13 healed within 4 months. We recommend a different approach in the treatment of badly comminuted and open 'high-energy' fractures. With this reservation, we find that the method of rigid internal fixation which we employ has given satisfactory early results. The frequency of both delayed healing and infection is reasonably low compared to the results in similar series.

Adolescent↗
PubMed2002

Quality of life related to fracture displacement among elderly patients with femoral neck fractures treated with internal fixation.

OBJECTIVE: To determine differences in outcome between undisplaced (Garden I and II) and displaced (Garden III and IV) femoral neck fractures in elderly patients treated with internal fixation. SETTING: University hospital. DESIGN: Prospective clinical study. PATIENTS: Ninety patients with an acute femoral neck fracture after a fall. The inclusion criteria were age older than sixty-five years, absence of severe cognitive dysfunction, independent living, and unhindered walking capability preoperatively. The mean follow-up was twenty-six months. INTERVENTION: The patients were treated with closed reduction and percutaneous internal fixation with two cannulated screws. MAIN OUTCOME MEASUREMENTS: Fracture healing complications, pain (visual analogue scale), walking capability, activities of daily living, and quality of life according to EuroQol. RESULTS: The rate of fracture healing complications in displaced femoral neck fractures in patients available at the final follow-up was 36 percent compared with 7 percent in patients with undisplaced fractures. The quality of life, according to EuroQol, of patients with uneventfully healed fractures was significantly lower in patients with primarily displaced fractures (0.51) than in patients with undisplaced ones (0.76). CONCLUSION: There was a major difference in outcome on comparing undisplaced and displaced femoral neck fractures in elderly patients treated with internal fixation. The rate of fracture healing complications in patients with undisplaced fractures was low, and patients with healed fractures regained their prefracture quality of life level. The rate of fracture healing complications and reoperations in patients with displaced fractures was high, and even in patients with uneventfully healed fractures, there was a substantial decrease in the quality of life.

Age Factors↗
PubMed2003

A new internal fixation system using vertebral pedicle screw for unstable lumbar spine: an in vitro biomechanical stability evaluation.

OBJECTIVE: To evaluate the effect of a new internal fixation system utilizing vertebral pedicle screw in fixing unstable lumbar spine in vitro. METHODS: Twelve lumbar spine specimens (L(2 to 5)) obtained from fresh human cadavers were randomly divided into 2 equal groups, namely groups A and B. All intact specimens were subjected to nondestructive testing in 6 loading modalities on a universal testing machine, before complete L(2 to 5) instability was produced by means of a wedge fracture induced by resection of the posterior ligamentous structures. Specimens in group A were fixed with the new internal fixation system, and group B with SOCON pedicle screw. The same nondestructive testing was repeated to determine the structural stability of the spine after fixation in both groups. RESULTS: The injured spines fixed with implants in both groups were significantly more stable than the intact specimens in all modes of tests (P < 0.05), especially in flexion and extension tests, in which a stability increase by 62.8% for flexion and 63.9% for extension was recorded in group A, and 54.9% for flexion and 51.0% for extension in group B. The two fixation systems exhibited similar effect in stabilizing the injured lumbar in all the 6 loading modalities (P < 0.05). CONCLUSION: This internal fixation system with vertebral pedicle screw is capable of providing biomechanical stability for unstable lumbar spine.

Biomechanical Phenomena↗
PubMedDate not supplied

Internal fixation of pilon fractures of the distal radius.

When closed manipulation fails to restore articular congruity in comminuted, displaced fractures of the distal radius, open reduction and internal fixation is required. Results of surgical stabilization and articular reconstruction of these injuries are reviewed in this retrospective study of 49 patients with 52 displaced, intra-articular distal radius fractures. Forty-three patients (87%) with a mean age of 37 years (range of 17 to 79 years) were available for evaluation. The mean follow-up time was 38 months (range 22-69 months). When rated according to the Association for the Study of Internal Fixation (ASIF), 19 were type C2 and 21 were type C3. We devised an Injury Score System based on the initial injury radiographs to classify severely comminuted intra-articular fractures and to identify those associated with carpal injury (3 patients). Post-operative fracture alignment, articular congruity, and radial length were significantly improved following surgery (p < .01). Grip strength averaged 69% +/- 22% of the contralateral side, and the range of motion averaged 75% +/- 18% of the contralateral side post-operatively. A combined outcome rating system that included grip strength, range of motion, and pain relief averaged 76% +/- 19% of the contralateral side. There was a statistically significant decrease in the combined rating with more severe fracture patterns as defined by the ASIF system (p < .01), Malone classification (p < .03), and the Injury Score System (p < .001). The Injury Score System presented here, and in particular the number of fracture fragments, correlated most closely with outcome of all the classification systems studied. Operative treatment of these distal radius fractures with reconstruction of the articular congruity and correction of the articular surface alignment with internal fixation and/or external fixation, can significantly improve the radiographic alignment and functional outcome. Furthermore, the degree to which articular stepoff, gap between fragments, and radial shortening are improved by surgery is strongly correlated with improved outcome, even when the results are corrected for severity of initial injury, whereas correction of radial tilt or dorsal tilt did not correlate with improved outcome.

Adolescent↗
PubMed1989

Displaced subcapital fractures of the femur: a prospective randomized comparison of internal fixation, hemiarthroplasty and total hip replacement.

In a prospective trial of 278 patients aged over 65 years, treatment of displaced subcapital fractures was randomly allocated to closed reduction and internal fixation with a sliding compression screwplate, Moore hemiarthroplasty, or total hip treatment with a Howse semicaptive prosthesis. One year after operation there was little difference between the three groups in mortality (25 per cent) or general complications. The revision rate within the first year was highest for internal fixation (25 per cent), but many of the replacements also required a further anaesthetic for reduction of a dislocation (Moore, 11 per cent; Howse 12.5 per cent). Total hip replacement resulted in the least pain and most mobility at 1 year, while hemiarthroplasty was worst in these respects. We conclude that internal fixation and particularly primary total hip replacement should be given serious consideration in the management of the elderly patient with a displaced subcapital fracture.

Aged↗
PubMed1988

Internal fixation in 50 cases of Galeazzi fracture.

Fifty Galeazzi fracture dislocations were treated by early open reduction, internal fixation, and cancellous bone grafting. After 1 year, 40 cases were good, 8 fair, and 2 poor. We conclude that early open reduction and rigid internal fixation reestablishes the normal relationship of the fractured fragments and the distal radioulnar joint without repair of the ligaments.

Adolescent↗