EARLY WEIGHT BEARING AFTER INTERNAL FIXATION OF TRANSCERVICAL FRACTURE OF THE FEMUR; PRELIMINARY REPORT OF A CLINICAL TRIAL.
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Biomedical Research↗
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THE TREATMENT OF FEMORAL NECK FRACTURES BY INTERNAL FIXATION OF PRIMARY PROSTHESIS.
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Femoral Neck Fractures↗
PERCUTANEOUS INTERNAL FIXATION UTILIZING THE X-RAY IMAGE AMPLIFIER.
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Child↗
The results of open reduction and internal fixation in elderly patients with severe fractures of the distal humerus: a critical analysis of the results.
BACKGROUND: We would like to define the results of treatment of open reduction and internal fixation in elderly patients with severe fractures of the distal humerus. METHODS: Between 1988 and 1998, 19 consecutive aged patients (older than 65 years old) with displaced comminuted articular fractures of the distal humerus were treated by open reduction and internal fixation with AO reconstruction plate. The age at the time of injury was 71.9 (65-79) years old. According to the AO classification, 15 patients had type C2 and four had type C3 injury. No patient had inflammatory arthritis of the elbow. The period of follow up is 97.2 (60-174) months. RESULTS: All fractures united with union time of 14.6 (11-20) weeks. No implant failure was found. In final follow up, the average flexion contracture was 16.8 degrees with a range of 0-40 degrees , the average active flexion was 128.4 degrees with a range of 115-140 degrees , the average pronation was 80 degrees with a range of 60-90 degrees , and the average supination was 78 degrees with a range of 60-90 degrees . According to the elbow motion classification of Cassebaum, eight (42.1%) patients were graded as very good elbow motion, eight (42.1%) as good, three (15.8%) as fair, and none as poor. The functional results showed that 15 (79%) patients had excellent results, four (21%) had good results, and none had fair or poor results, according to Mayo elbow performance score. The radiographic evaluation in final follow up showed that four patients (21%) had no osteoarthritic (OA) change, 11 (58%) had grade 1 OA, four (21%) had grade 2 OA, and none had grade 3 OA (the scale of Knirk and Jupiter). Fifteen (79%) patients reported no pain and four (21%) had mild pain. All patients were satisfied with their results. However, There were two early post-operative complications, including one (5.3%) superficial wound infection and one (5.3%) iatrogenic ulnar nerve injury. CONCLUSIONS: Open reduction and internal fixation with appropriate surgical technique is effective in the treatment of displaced fractures of the distal humerus in elderly patients.
Aged↗
Internal fixation of tibial plateau fractures using the AO instrumentation.
Between January 1970 and December 1985, 76 patients (76 fractures) underwent internal fixation for tibial-plateau fractures as recommended by the AO-group (14). Fifty patients were available for follow-up. The long term results of this retrospective study are reported. Subjective results were satisfying. Forty-four percent of the patients were painfree and only 8% had severe postoperative pain, which was clearly related to osteoarthritis. Eight-eight percent of patients had no instability at follow-up. Clinical and radiographic results were evaluated for mobility, laxity and osteoarthritis. Thirty-five patients had a loss of flexion averaging 16.6 degrees. In 12 patients the average decrease in extension amounted to 7.5 degrees. Valgus increase averaged 9.7 degrees in 17 patients, and the average varus increase was 7.5 degrees in 4 patients. Seventy-four percent of patients showed no laxity at follow-up. The finding of osteoarthritis on X-ray was well correlated with the postoperative incongruence of the articular surface. It was also found to develop earlier in patients who underwent (partial) meniscectomy. Some general considerations about tibial condyles fractures are presented, and the technique used by the authors is discussed at length. The indications for internal fixation are also evaluated. The importance of adequate reduction, stable internal fixation and vigorous postoperative rehabilitation is stressed.
Adolescent↗
Internal fixation of fractures in children and adolescents. A comparative analysis.
A retrospective analysis of 4,411 consecutive pediatric fracture patients managed between 1979 and 1983 demonstrated that only 3.6% (170 patients) required internal fixation. Two patient groups with sufficient follow-up study were compared: Group 1-90 skeletally immature children and young adolescents, and Group 2-66 skeletally mature adolescents. Upper-extremity fractures, especially of the distal humerus, and displaced epiphyseal fractures were the major indication for internal fixation in Group 1, while lower-extremity diaphyseal and intra-articular fractures predominated in Group 2. Complication rates were higher than expected but fortunately most were minor-18% in Group 1 and 12% in Group 2. The results of this study demonstrate that internal fixation can be beneficial in selected fractures in children and adolescents in preventing major complications, such as premature epiphyseal closure and malunion, and in restoring and maintaining normal extremity growth and function.
Adolescent↗
Internal fixation in pelvic fractures and primary repairs of associated genitourinary disruptions: a team approach.
Associated urological and orthopedic injuries of the pelvic ring are complex with numerous potential complications. These patients are treated optimally using a team approach. The combined expertise is not only helpful initially when managing these difficult patients, but also later as problems develop. This study describes a treatment protocol and reports the early results of 23 patients with unstable pelvic fractures and associated bladder or urethral disruptions, or both, treated surgically with open reduction and internal fixation of the anterior pelvic ring injuries at the same anesthetic and using the same surgical exposure as the urethral realignments or bladder repairs or both. Early complications occurred in four patients (17%): one patient sustained a fifth lumbar nerve injury caused by the pelvic reduction procedure, and three patients had anterior pelvic internal fixation failures. Late complications occurred in eight patients (35%). There was one deep wound infection (4.3%) that presented 6 weeks after injury. Late urological complications occurred in seven patients (30%). Four of the nine male patients with urethral disruptions had urethral stricture after their primary urethral realignments (44%). Three of the 18 male patients admitted to impotence (16.7%). One of the three had a residual thoracic paraplegia caused by a burst fracture. One of the five female patients had urinary incontinence and required a bladder suspension operation to restore normal function (20%). A low infection rate can be expected despite the use of internal fixation. Early urethral "indirect" realignments avoid more difficult delayed open repairs; however, late urological complication rates are still high. Early "direct" bladder repairs are easily performed at the time of anterior pelvic open reduction and internal fixation. Suprapubic tubes are not necessary to adequately divert the urine when large diameter urethral catheters are used in these patients.
Adolescent↗
Single-stage autogenous bone grafting and internal fixation in the surgical management of pyogenic discitis and vertebral osteomyelitis.
OBJECT: Patients with deep wound infections complicating previously placed internal instrumentation have been successfully treated by debridement and prolonged postoperative antibiotic therapy, which avoided removal of the hardware. Comparatively fewer patients with pyogenic discitis and vertebral osteomyelitis (PDVO) have undergone single-stage debridement, arthrodesis, and internal fixation. The purpose of this study was to determine the efficacy of combining debridement, arthrodesis in which iliac autograft is used, and segmental internal fixation in a single-stage procedure for patients in whom nonoperative management of PDVO has failed. METHODS: A retrospective analysis of 17 consecutive patients with PDVO treated between July 1996 and September 1999 was performed. Follow-up data (mean 30 months) included office examinations and telephone interviews, and patients were grouped according to the duration of preoperative antibiotic therapy. All patients experienced significant postoperative reduction in pain, and those with neurological deficits improved. Eleven patients were independently ambulatory, and three required a walker; only five had been ambulating independently preoperatively. Two patients died during the 1st postoperative week of medical complications; another developed a wound dehiscence that was managed with debridement, prolonged antibiotic administration, and removal of the hardware 1 year later. In no case was pseudarthrosis demonstrated on dynamic radiography. Most patients received only a 6-week course of intravenous antibiotics postoperatively. CONCLUSIONS: The authors conclude that single-stage debridement, arthrodesis, and internal fixation can be effective in the treatment of PDVO. A 6-week course of postoperative intravenous antibiotics may be sufficient in patients with few risk factors. The harvesting of iliac autograft through the same operative exposure may not increase the risk of secondary infection.
Adult↗
Immediate internal fixation of open ankle fractures.
Seventy-six consecutive displaced open ankle fractures were treated by immediate internal fixation between 1983 and 1986 at Los Angeles County University of Southern California Medical Center. Sixty-two patients were available for clinical and radiological examination at an average of 16.4 months post-fixation. Seventy-two percent of the patients had a satisfactory result. Poor results (20%) were most commonly due to non-anatomic reductions, articular surface damage, or deep infection. Deep infection occurred in 5% of the patients while 8% required late ankle arthrodesis. We believe immediate internal fixation is the treatment of choice for displaced open ankle fractures, but this form of treatment does have a significant rate of complications.
Adolescent↗
THE USE OF POLYURETHANE FOAM AS AN ADJUNCT TO INTERNAL FIXATION OF PATHOLOGIC FRACTURES.
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Breast Neoplasms↗
The value of internal fixation and radiotherapy in the management of upper and lower limb bone metastases.
Fifty-four consecutive patients underwent 61 orthopaedic operations for metastatic bone disease affecting the upper and lower limbs. These patients were subsequently managed using a consistent postoperative radiotherapy (RT) policy. There were 27 prophylactic internal fixations and 34 internal fixations of pathological fractures. There was a marked difference in survival between these groups. The median postoperative survival of the prophylactic (P) group was 15 months whereas that of the fracture (F) group was 2 months (P less than 0.0001). Ninety-three per cent of the P group and 59% of the F group were able to be discharged home following treatment. Subsequent local fracture requiring further surgical intervention occurred in 11% of the P group and in none of the F group. Seventy-eight per cent of the P group and 62% of the F group did not suffer any further sequelae at the operation site until the time of death or last follow-up. Patient mobility following surgery and RT for metastatic lesions occurring in the lower limb was significantly improved in both the P group (P less than 0.05) and in the F group (P less than 0.0001) such that 91% and 58%, respectively, of these patients were subsequently able to walk.
Adult↗
Open reduction and internal fixation of delayed unions and nonunions of fractures of the distal part of the humerus.
BACKGROUND: The purpose of the present retrospective study was to evaluate the results of open reduction and internal fixation of delayed unions and nonunions of fractures of the distal part of the humerus. METHODS: Between 1976 and 2001, fifty-two patients with a delayed union (thirteen patients) or nonunion (thirty-nine patients) of the distal part of the humerus were treated with open reduction and internal fixation along with selective elbow joint arthrolysis and bone-grafting. The average time to presentation was eighteen months (range, two to 192 months) after the injury. Thirty-nine of the fifty-two patients had undergone an average of 1.6 previous operations. There were twenty-seven supracondylar, six transcondylar, thirteen intercondylar, two lateral condylar, and four medial condylar delayed unions or nonunions. The average duration of follow-up was thirty-three months (range, three to 198 months). RESULTS: Fifty-one of the fifty-two patients had healing of the delayed union or nonunion after the index operation; the average time to union was six months (range, two to twenty-four months). The average range of elbow motion increased from 71 degrees preoperatively to 94 degrees postoperatively. Complications included two superficial infections, two deep infections, and five cases of ulnar neuropathy. Fifteen patients (29%) needed additional surgery after the index procedure. Specifically, seven patients underwent removal of prominent hardware; six underwent hardware removal along with excision of heterotopic bone, ulnar neurolysis, and/or manipulation under anesthesia; one underwent irrigation and débridement; and one underwent compartment release. CONCLUSIONS: Open reduction through an extensile exposure and rigid internal fixation consistently results in healing of a delayed union or nonunion of the distal part of the humerus. An improved range of motion of the elbow can be achieved by securing the site of the nonunion and performing aggressive elbow joint arthrolysis and soft-tissue releases in patients with severe contractures. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series [no, or historical, control group]). See p. 2 for complete description of levels of evidence.
Adolescent↗
Biomechanical comparison of a unique locking plate versus a standard plate for internal fixation of proximal humerus fractures in a cadaveric model.
BACKGROUND: Newer internal fixation devices with a locking mechanism between the plate and the screw have recently been released. The efficacy of these plates in the proximal humerus has yet to be fully described. There is a need to compare the biomechanical properties of efficacy of plate fixation with or without locking screws for surgery of two-part proximal humerus fractures. Multiple-plane locking plate and cloverleaf plate designs were tested to determine their ability to maintain fixation on the humeral head. METHODS: Eight matched pairs of cadaveric shoulders with 7-millimeter osteotomy defects at the surgical neck simulating two-part fractures of the proximal humerus were loaded to failure in thirty degrees of glenohumeral abduction. One side was repaired with a proximal humerus locking plate and the other with a cloverleaf plate. The rotator cuff musculature was then loaded via a servo-hydraulic testing machine under displacement control to simulate the deforming forces present in vivo. FINDINGS: The average maximum load to failure was greater in proximal humerus locking plates than in cloverleaf plates (876 versus 712; P=0.04). INTERPRETATION: In the cadaveric, two-part proximal humerus fracture model that was created, the locking plate displayed significantly greater holding power of the humeral head. Clinical relevance is unproven but may be manifested in vivo as improved early range of motion exercises and functional outcome.
Aged↗
Biomechanical analysis of structural stability of internal fixation in fractures of the thoracolumbar spine.
Three different methods of internal fixation for the flexion-rotation thoracolumbar spinal fractures were tested biomechanically in a cadaver model for strength, mode of failure and ease of application. The compression rod system was clearly superior in strength and rotational stability to the spring device, but it was more difficult to apply than springs. The distraction rod system exhibited an intermediate level of strength with adequate rotational stability. Technically, the method is exacting and requires a clear understanding of its principle of 3 point fixation.
Biomechanical Phenomena↗
Internal fixation of malar fractures: an experimental biophysical study.
Open reduction and internal fixation of displaced zygoma fractures are necessary to avoid immediate and delayed facial disfigurement. Interosseous wires, Kirschner wires, and more recently, rigid metallic miniplates have been recommended for fixation of these and other midfacial fractures. However, the precise physical stability of the zygoma with respect to wire versus miniplate fixation methods and with respect to the number and location of miniplates applied is not known. Noncomminuted zygoma fractures were simulated by saw osteotomy in eight fresh human cadaver heads (16 zygoma "fractures"). Each zygoma was sequentially fixated with three miniplates, two miniplates, one miniplate, and three interosseous wires across the orbital rim and arch "fractures". Static and oscillating loads simulating maximal physiologic masticatory stresses were applied to the fixated zygoma along the lines of action of the masseter muscle by means of a tensometer. The stability and adequacy of each pattern of fixation were recorded. Double-miniplate fixation across the orbital rim of simulated noncomminuted zygoma "fractures" is sufficient to withstand static and oscillating loading similar to physiologic masticatory forces. Neither single-miniplate fixation nor triple-wire fixation are sufficient to stabilize the zygoma against similar forces.
Biophysical Phenomena↗
Bi- and trimalleolar ankle fractures operated with nonrigid internal fixation.
The results of bi- and trimalleolar fractures treated with nonrigid internal fixation were analyzed in 134 patients. The fractures were of both pronation and supination type. The operative success was evaluated in terms of congruency as seen on the post-operative radiographs. The congruency was classified as either congruent, small, or grave displacement respectively. At follow-up evaluation, four variables were recorded: a linear analogue scale, an ankle score, range of motion, and presence of osteoarthritis. Fifty percent had congruent joints, 20% had small, and 30% had grave displacements. At follow-up examination those with congruent joints had significantly better function than those with displacements in all four variables. There were only minor differences between the two displacement groups. The nonrigid technique seems inadequate in retaining congruency of the unstable bi- and trimalleolar fractures. Congruency is the key to good prognosis. Even minor displacement significantly increases the risk of impending disability.
Adolescent↗
A permanent internal fixation technique for the Austin osteotomy.
A new method of permanent internal fixation is described with a discussion of applicability to the Austin procedure for the surgical correction of hallux abducto valgus deformity. The contention of this article is that an easily performed wire fixation method provides superior stabilization of the Austin osteotomy site. Preliminary investigation of this method shows consistently fewer complications secondary to instability of the Austin osteotomy, with union of the osseous fragments proceeding more rapidly as compared to nonfixated osteotomies.
Fracture Fixation, Internal↗
Absorbable plugs of self-reinforced poly-L-lactic acid in the internal fixation of rabbit distal femoral osteotomies.
An absorbable plug for the internal fixation of fractures and osteotomies, measuring 4.5 mm in diameter and 30 mm in length, was constructed of poly-L-lactide using a self-reinforcing fibers-in-matrix manufacturing technique. To increase the rotational stability and grip of the device, the plug has deployable distal fins. The plug was used in the fixation of a transverse distal femoral osteotomy in 20 rabbits. The consolidation of the osteotomy was investigated histologically, histomorphometrically, and microradiographically in groups of five rabbits observed for three, six, 12, or 24 weeks. Fifteen osteotomies showed bony union. In five rabbits, no bridging trabeculae across the osteotomy had developed, but these rabbits belonged to the groups with the shortest follow-up times of three or six weeks. No mechanical failures of the plugs were encountered, and the short-term biocompatibility of the implant was excellent. Future clinical applications are planned.
Animals↗