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PubMed2007

Intramedullary fixation of tibial shaft fractures using an expandable nail.

Interlocking intramedullary nails are the gold standard for treating tibial fractures. We compared the clinical and economic factors associated with tibial fracture fixation using either interlocking intramedullary or expandable nails. From 2000 to 2002, 53 patients with 53 diaphyseal tibial fractures of similar characteristics (AO/OTA 42A1-B3) were randomly and prospectively treated with either interlocking (n = 26) or expandable nails (n = 27). Patients were followed for a minimum of 2 years. The mean surgical duration was 104 minutes with interlocking nails and 52.9 minutes with expandable nails. Rehospitalizations were required in 12 patients (46%) and reoperations were required in nine patients (35%) with interlocking nails. Only one patient (3%) with an expandable nail required rehospitalization and reoperation. Union was achieved after 17 weeks (mean) with interlocking nails and 11.5 weeks with expandable nails. The beneficial economic ramifications of using expandable nails were a 39% reduction in overall surgical and hospital expenses. Expandable nails showed important clinical advantages for tibial fracture fixation, and complications related to lengthy operations, reoperations, and rehospitalizations were substantially reduced. Overall treatment cost was substantially lower with expandable nails. Based on these advantages, simplicity in use, and short surgical time, we recommend an expandable nail for treating tibial (AO Type A, B) shaft fractures.

Bone Nails↗
PubMed1997

Internal fixation of scaphoid fractures.

Scaphoid fracture fixation is indicated in certain acute situations and for scaphoid nonunion. Internal fixation requires an understanding of the distinctive scaphoid anatomy with relation to its shape, blood supply, fracture healing, and radiographic evaluation. The choice of surgical approach varies with the fracture configuration and procedure planned. A variety of innovative implants are available to accomplish internal fixation of the scaphoid. The ultimate goal is to achieve union and restore stability to the carpus.

Carpal Bones↗
PubMed2005

Self-reinforced biodegradable plates and screws for fixation of zygomatic fractures.

PURPOSE: The aim of this retrospective clinical study was to evaluate zygomatic fracture fixation with the BioSorbFX osteosynthesis system by assessing stability of reduction as well as complications in the first postoperative year and by conducting a survey to document surgeons' opinions on biodegradable osteosynthesis for this indication. MATERIAL: From January to September 2003, 25 patients with displaced non-infected unilateral fracture of the zygoma were operated upon (m:f = 20:5; age 17-81 years; mean 39.4 years) using the BioSorbFX 2.0 and/or 1.5 mm osteosynthesis systems. METHODS: A: Clinical and radiographic examinations were carried out immediately postoperatively and after 1, 3, 6, 9 and 12 months. METHODS: B: Surgeons were asked to participate in a survey critically evaluating their experience with biodegradable osteosynthesis systems. RESULTS: A: All fractures of the zygoma healed uneventfully. An excessive soft tissue reaction due to the degradation process was not seen. Three minor complications which resolved after local therapy occurred in the immediate postoperative phase. RESULTS: B: In the survey, the handling of biodegradable plates in general was rated worse than metal plate osteosynthesis. CONCLUSION: Fixation of fractures of the zygoma with the BioSorbFX system was simple and safe. The fixations remained stable and bony healing was uneventful. Postoperative complications were few, of a minor nature and not related to the process of biodegradation.

Absorbable Implants↗
PubMedDate not supplied

Pathophysiology of infections after internal fixation of fractures.

Infection complicating internal fixation of fractures is a serious complication that is difficult to treat. Whenever metallic devices are implanted in vivo, successful biointegration requires that host cells colonize the highly reactive implant surface. Bacteria such as staphylococci can also become adherent to metallic or polymeric implants and will compete with host cells for colonization of the implant surface. Once adherent, these bacteria form a biofilm and undergo phenotypic changes that make them resistant to the normal host immune response as well as to antibiotics. Furthermore, metallic implants themselves cause specific deficits in the function of the local immune system that may render the host response to infection inadequate. Any associated soft-tissue injury causes even greater impairment of local immune function. Despite the potentially detrimental impact of internal fixation, fracture stability is of paramount importance in achieving fracture union and in preventing infection. It has been demonstrated in animal models that contaminated fractures without internal fixation develop clinical infection more commonly than similar fractures treated with internal fixation at the time of colonization. Because of the potential for infection whenever internal fixation is utilized, appropriate prophylactic antibiotic coverage for staphylococci and Gram-negative organisms should be provided. Open wounds and severely damaged soft tissues require aggressive management so that a viable soft-tissue envelope is maintained around the implant. Host factors such as smoking and malnourishment should be corrected. Early diagnosis and aggressive treatment of implant-related infection with antibiotics, debridement, and maintenance of stable internal fixation are essential to successful treatment.

Animals↗
PubMed2001

Mechanical strength of intramedullary pinning and transfragmental Kirschner wire fixation for Colles' fractures.

Four methods of distal radius fracture fixation were tested in this experimental biomechanical study of an unstable Colles' fracture model. Sixty artificial radial bones and seven pairs of cadaveric radii were used. Seven additional pairs of paired cadaveric radial epiphyses were used in separate perforation and cut-out tests. Tests with the artificial bones showed that the rigidity of the four tested fixation methods was comparable, except for proximal intramedullary pinning. The rigidity of the NODE fixation in the cadaveric radii was greater than that of transfragmental pinning. The load at failure was significantly greater for the NODE system than for the Kirschner wire models. Rigidity and failure loads showed a positive correlation with bone mineral density. The current study indicates the NODE system was the strongest of the fixation methods.

Biomechanical Phenomena↗
PubMed1986

Dynamic axial fixation. A rational alternative for the external fixation of fractures.

Conventional external fixation systems neither inhibit motion at the fracture site sufficiently to permit primary bone healing, nor do they allow sufficient motion to encourage adequate external callus formation. Healing with such systems is therefore prolonged. These methods are usually reserved for the most severe fractures when internal fixation may be contraindicated. A unilateral, dynamic axial fixation system (Orthofix - registered trademark) is described which allows for simple conversion from a rigid to a dynamic mode, and so can be readily adapted to the changing physiological patterns of fracture repair. In 288 fresh fractures a success rate of 94% was achieved, with an average time to healing of 4.4 months. The incidence of pin-track infection was only 0.6%. The contribution which the mechanical and design features of the apparatus make to the results obtained is discussed. It is suggested that the system is capable of extending the range of indications for an externally mounted system to include many cases which would formerly have been treated by internal fixation, plaster cast or traction.

Adult↗
PubMed1994

Early exchange intramedullary nailing of distal femoral fractures with vascular injury initially stabilized with external fixation.

Fracture of the femur with accompanying arterial injury represents approximately 1% of all femoral fractures. Controversy exists regarding the choice of fixation and the sequence of fixation and vascular repair. We report on the treatment of six patients with seven distal femoral fractures and angiographically documented arterial injuries treated over a 20-month period. The treatment protocol consisted of angiography followed by provisional external fixation and early primary exchange to an intramedullary nail. Five of the seven fractures were open. Three fractures were caused by blunt trauma, and four were secondary to shotgun blasts. Average follow-up was 12 months (range, 6-25 months). All fractures healed with an average time to union of 25 weeks. There were no complications related to the vascular repair. One case of an acute deep infection resolved after debridement and placement of polymethylmethacrylate cement beads impregnated with antibiotics and a course of intravenous antibiotics. All patients returned to their previous levels of activity. Based on the results of our experience with a small group of patients, we feel that this treatment protocol will prove to be a safe and efficient method of management of these difficult injuries.

Angiography↗
PubMed1993

Rigid skeletal fixation of fractures.

Rigid skeletal fixation of facial fractures has evolved from the principles established in orthopedics. It has taken a long time to develop rigid internal fixation devices that provide stability combined with safety. The application of rigid skeletal fixation to the facial skeleton requires the surgeon to pay strict attention to detail, which may add a small time increment to the procedure. However, the benefits to patients of having early use of the jaws and exact placement of bony segments seem to outweigh the disadvantages. The future of this constantly developing field will almost certainly center around technologic innovations that will make the application of fixation devices easier. It is likely that future research will provide devices that are more biocompatible, and perhaps just over the horizon, devices that are bioresorbable.

Bone Plates↗
PubMed1982

Screw or mini-plate fixation in fractures of the first metacarpal. Experience with thirty-nine cases.

Re-establishing normal osteoarticular anatomy, and early mobilization are the principal elements in the successful treatment of fractures of the base of the first metacarpal. To achieve these goals in thirty-nine fractures rigid fixation was obtained by screw alone, or by a mini-plate. Seven Bennett's fractures have been treated by screw fixation when the size of the fragment has made it possible. Extra-articular fractures have been treated, either by screw alone, in oblique fractures (7 cases). Or by mini-plate, T or L shaped, in transverse fractures (23 cases). The use of these techniques have been extended, to comminuted fractures but is not used in Bennett's fractures when the fragment is too small to allow the screw to be anchored in it without its being shattered.

Adolescent↗
PubMed2000

Biodegradation behavior of ultra-high-strength hydroxyapatite/poly (L-lactide) composite rods for internal fixation of bone fractures.

The purpose of this study was to investigate the biodegradation behavior of the ultra-high-strength hydroxyapatite/poly(L-lactide) (HA/PLLA) composite rods for fracture repair. Two kinds of composite materials were used in this study: u-HA/PLLA. which contained 30% by weight of uncalcined HA as reinforcing particles, and c-HA/PLLA, which contained 30% by weight of calcined HA as reinforcing particles. These composite rods were implanted in the subcutis and in the medullary cavities of rabbits. The specimens were removed at specific intervals between 2 and 52 weeks and the mechanical strength was measured for the rods in the subcutis, and the molecular weight and crystallinity were measured for the rods in both the subcutis and medullary cavities. The rod surfaces were examined using a scanning electron microscope (SEM). The specimens were examined histologically by light microscopy. The bending strength of the composites implanted in the subcutis was maintained at more than 200 M Pa at 25 weeks and at 150 MPa at 52 weeks. The molecular weight dropped to 45% of the initial values at 8 weeks and to approximately 10% at 52 weeks. Significant differences in the molecular weight were seen between c-HA/PLLA and u-HA/PLLA, with u-HA/PLLA showing a faster rate of decrease than c-HA/PLLA after 8 weeks. SEM demonstrated that HA particles disappeared increasingly from the rod surfaces over time and that the spaces left by these HA particles formed many pores in the composite surfaces at 52 weeks. Histologically, a fibrous tissue layer was formed around the composite rod from 4 weeks in the subcutis and in the diaphyseal area of the medullary canal. This became more mature over time. Bony tissue contact to the composites without fibrous tissue layers was seen in the metaphyseal area of the medullary canal. During the experimental period, there were no inflammatory cells such as mono- or multi-nuclear phagocytes. Although further long-term studies for degradation are needed, the composites have promising mechanical strength and no adverse tissue reaction for use as fracture-fixation devices during the experimental periods.

Animals↗
PubMed1999

Absorbable fasteners for the fixation of ankle fractures.

Bioabsorbable materials have been used for the treatment of fractures for more than a century. We reviewed the results of a combined series of 30 ankle fractures from Bad Hersfeld, Germany, and Louisville, Kentucky, using initially polyglycolide and more recently poly-L-lactide screws and rods. The results were comparable to treatment with metal screws. The advantage of bioabsorbable implants is they do not need operations to take them out. There was a low incidence of reaction around the screw heads, which was reduced further with the use of the newer self-reinforced poly-L-lactate screws. The technique for use of plastics is different than the methods for placement of metal screws. Bioabsorbables will have an increasing role in fracture fixation in the future.

Absorbable Implants↗