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At least 415 records · Page 23Linked to original sources
PubMed1993

Late infection in healed fractures after open reduction and internal fixation.

Nine patients with normal fracture healing after open reduction and internal fixation presented with late infection 15 months to 19 years after injury. Eight of the nine patients had a history of pain at the fracture site for 3 weeks or longer. Elevated temperature and white blood cell count were unreliable indicators of infection. Six patients had an elevated erythrocyte sedimentation rate that correlated with osteomyelitis. Roentgenograms showed resorption around the implant in seven patients and a small nidus in two patients. There was a change in position of fixation screws in four patients. Cigarette smoking and alcoholism were the most common systemic risk factors. Local risk factors were open fracture, lower-extremity site, distal femur site, and chronic edema of the lower extremities. Late infection should be included in the differential diagnosis of patients presenting with new-onset pain and a retained orthopaedic implant. Patients who fall into this group may be at increased risk for development of late hematogenous infection of orthopaedic implants.

Adult↗
PubMed1993

Internal fixation of pathologic fractures. A retrospective study.

The records of 44 patients who underwent internal fixation for metastatic fractures between 1970 and 1989 were studied. Excluded were pathologic fractures involving the spine, pelvis, ribs and clavicles. None of the patients was still alive at the time of the study.

Adolescent↗
PubMed2000

Monitoring of somatosensory and motor evoked potentials during open reduction and internal fixation of pelvis and acetabular fractures.

Monitoring of motor and somatosensory evoked potentials provides instantaneous intraoperative assessment of a patient's neurologic status. Monitoring of the sciatic nerve through motor and somatosensory evoked potentials can be used during open reduction and internal fixation of pelvic and acetabular fractures. A review of 12 pelvic and acetabular fractures treated with open reduction and internal fixation was conducted and assessed with a combination of intraoperative motor and somatosensory evoked potential monitoring. Results revealed intraoperative motor evoked potential monitoring was 100% sensitive and 100% specific in predicting postoperative sciatic nerve deficits, whereas somatosensory evoked potentials were not accurate in predicting postoperative sciatic nerve deficits. Combined monitoring of the sciatic nerve with motor and somatosensory evoked potentials is beneficial at predicting postoperative sciatic nerve deficits during open reduction and internal fixation of pelvic and acetabular fractures.

Acetabulum↗
PubMed2004

[The results of open reduction and internal fixation of radial head fractures].

OBJECTIVES: We evaluated the results of radial head fractures treated with open reduction and internal fixation. METHODS: Fifteen patients (9 men, 6 women; mean age 38 years; range 23 to 46 years) underwent open reduction and internal fixation for radial head fractures. According to the Mason classification system, the fractures were type II in seven patients, type III in five patients, and type IV in three patients. Accompanying fractures involved the coronoid process (n=3), olecranon and coronoid process (n=1), scaphoid and coronoid process (n=1), scaphoid with perilunate dislocation (n=1), and the capitellum (n=1). One patient had a Colles' fracture. Osteosynthesis was performed with an AO small plate in nine patients and with a screw in six patients. Bone grafts taken from the distal part of the radius were used in five patients. Clinical and radiographic evaluations were made with the use of a modified Morrey functional evaluation index. The mean follow-up period was 26.4 months (range 14 to 53 months). RESULTS: Functional results were excellent in six elbows, good in three elbows, and moderate in three elbows. Pseudoarthrosis of the radius head was encountered in three patients. Reductions were assessed as anatomic in 12 patients, good in two patients, and poor in one patient. CONCLUSION: In the treatment of radial head fractures, the anatomic integrity of the radius head should be preserved in order to maintain the biomechanics of the elbow. Following a meticulous treatment plan and with preservation of the lateral ligament anatomy, osteosynthesis performed in a safe zone and achievement of a stable elbow may provide successful results in the treatment of radial head fractures.

Adult↗
PubMed2004

[Treatment of old scaphoid fracture with transposition of vascularized periosteal flap and internal fixation].

OBJECTIVE: To introduce an effective method of treating old scaphoid fracture. METHODS: From April 1995 to April 2002, 11 patients with old scaphoid fracture were treated with transposition of vascularized periosteal flap and internal fixation; if necessary, the radial styloid was removed. Out of 11 patients( 8 males and 3 females, aged from 17 to 46 years), the fracture sites were medial scaphoid in 7, the proximal one in 2 and the distal one in 2. The X-ray films showed separated fracture lines. The fracture lines were less than 1 mm in 4 patients and more than 1 mm in 3 patients. Sclerosis of skeleton ends and cystoid degeneration occurred in 2 patients, respectively. RESULTS: After a follow-up of 3 to 24 months, the fracture healing was obtained within 4 months in 9 cases and within 6 to 7 months in 2 cases. Internal fixation was taken out 3 months after bone healing. The carpal joint pain and weakness vanished in all cases. CONCLUSION: Transposition of vascularized periosteal flap and internal fixation have many advantages, such as easy dissection, rich blood supply, quick new bone formation, short time of fracture healing and satisfactory function recovery of carpal joint.

Adolescent↗
PubMed1980

Immediate internal fixation in open fractures.

Open fractures require emergency treatment. Adequate debridement and copious irrigation are essential in their management. The parenteral administration of antibiotics should be started immediately. If the wound is closed primarily, the antibiotics are discontinued after three days. If the wound is closed secondarily, the antibiotics are continued for another three days after this procedure. Most open fractures should be treated without the use of internal fixation techniques. However, we believe that there are reasons for employing immediate internal fixation, particularly in polytraumatized patients and others sustaining type III open fractures, to facilitate care of the soft tissue. When immediate internal fixation techniques are used in open fractures, the wound must not be closed primarily.

Adult↗
PubMedDate not supplied

A new internal fixation technique for fractures of the proximal humerus--the Bilboquet device: a report on 26 cases.

We describe a novel internal fixation device and report on 26 patients (mean age, 70 years) whose proximal humeral fractures were managed with this technique. The 2-part titanium implant consists of a circular staple impacted into the humeral head cancellous bone and a spigoted diaphyseal stem that inserts into the staple "cup." Of the 26 cases reviewed, 16 had 3-part fractures and 10 had 4-part fractures. Mean follow-up was 25.9 months. In the 16 3-part fractures, the mean active forward elevation was 114 degrees and the results were as follows: excellent, 7; good, 5; fair, 3; poor, 1. In the 10 4-part fracture patients, the mean active forward elevation was 101 degrees and the results were as follows: excellent, 2; good, 4; fair, 3; poor, 1. There were 5 cases of avascular necrosis and 1 case of tuberosity nonunion. Only 2 cases needed conversion to hemiarthroplasty. The new technique should simplify the surgery of these fractures and reduce the need for arthroplasty.

Adult↗
PubMed1999

Subcapital femoral neck fracture after closed reduction and internal fixation of an intertrochanteric hip fracture: a case report and review of the literature.

A subcapital femoral neck fracture in a healed intertrochanteric fracture treated by an open reduction and internal fixation is a rare, but catastrophic, event. We present the case of an 86-year-old woman, a community ambulator, who sustained a displaced right intertrochanteric hip fracture during a fall. She was treated with closed reduction and internal fixation with a dynamic compression hip screw and side plate. Four months later, she was noted to have a displaced subcapital femoral neck fracture and underwent hip screw and side plate hardware removal and cemented bipolar hemiarthroplasty. Both postoperative recoveries were uncomplicated, and she was discharged to a rehabilitation facility able to ambulate with minimal assistance. This devastating complication in patients with osteoporosis may be prevented by deeper placement of the dynamic hip compression lag screw to within 5 mm to 8 mm of the subchondral bone, which may decrease the stress forces in the subcapital femoral neck.

Aged↗
PubMed1995

Tarsometatarsal (Lisfranc's) injuries--results of open reduction and internal fixation.

Injuries of the tarsometatarsal (Lisfranc's) joint are uncommon and are potentially associated with chronic disability. The aim of our study was to review retrospectively the results of open reduction with Kirschner wire internal fixation of tarsometatarsal injuries. In this study, 12 patients with Lisfranc's injuries treated between January 1986 and March 1993 were reviewed at an average of 36 months after the injuries. Majority of the patients suffered from type B injuries (Hardcastle's classification, 1982). There were 9 closed and 3 open injuries. All were high energy injuries sustained in motor vehicle accidents, fall from a height or crush force. All were treated with open reduction and internal fixation with Kirschner wires. Anatomical reduction was achieved and maintained. There was no postoperative redisplacement. During follow-up, most patients developed radiological evidence of post-traumatic osteoarthritic changes. However, majority of the patients were pain-free or had very little foot pain, and were able to return to their previous occupation. Our study showed that open reduction with Kirschner wire internal fixation offered satisfactory anatomical and functional results.

Accidental Falls↗
PubMed1987

Delayed posterior internal fixation of unstable pelvic fractures.

Fifteen patients with unstable pelvic fractures were treated with immediate anterior external fixation followed by delayed posterior fixation, including five sacroiliac lag screws, six transiliac rods, and four iliac plates. Initial anterior external fixation aided in resuscitation of hemodynamically unstable patients and allowed early mobilization. Delayed posterior internal fixation avoided infection and hemorrhage but failed to achieve anatomic reduction of disrupted sacroiliac joints and sacral fractures. Followup examination confirmed maintenance of fixation and fracture healing but pain and persistent neurologic deficits were common findings. Lumbosacral nerve plexus injuries occurred in patients with fractures through the sacral foramina. Fixation of these fractures with sacroiliac screws and transiliac rods caused overcompression and the resulting foraminal encroachment may be a factor in the lack of neurologic recovery. In this study, delayed posterior internal fixation was not associated with perioperative morbidity and achieved better reductions than those obtained with external fixation alone. Delaying the fixation, however, increased the difficulty of obtaining anatomic reduction of certain posterior arch disruptions.

Adolescent↗
PubMedDate not supplied

Functional outcomes after open reduction and internal fixation for treatment of displaced distal radius fractures in patients over 60 years of age.

OBJECTIVE: To evaluate the clinical, radiographic, and functional outcomes of patients aged 60 and older treated with open reduction and internal fixation using plates and screws for displaced and comminuted fractures of the distal radius. DESIGN: Retrospective, clinical research. SETTING: Tertiary care center (Level 1 trauma center) located in a large urban area. PATIENTS: Eighteen patients with an average age of 71 years (range 60-86) form the basis of this study. Patients were obtained from a surgical database of 2 hand surgeons in a tertiary care center. INTERVENTION: Open reduction and internal fixation of fractures of the distal radius using metal plates and screws designed for treatment of these injuries. MAIN OUTCOME MEASUREMENTS: Clinical (history and physical examination), plain radiographic, and functional assessments were performed at an average follow-up of 26 months (range 12-40 months). Functional outcomes were assessed using the Gartland and Werley and Disabilities of the Arm, Shoulder, and Hand scoring systems. RESULTS: Satisfactory reduction was achieved in all 18 fractures at the time of operative fixation with no instances of loss of fracture reduction during the study period. There were no cases of malunion, nonunion, or instances of device failure. We identified 4 minor complications. No patients required reoperation. Fifteen patients had an excellent (83%) and 3 had a good (17%) result according to the Gartland and Werley scoring system. The mean Disabilities of the Arm, Shoulder, and Hand score was 4.4 (range 0-14) out of a maximum 100. CONCLUSION: Our findings suggest that open reduction and internal fixation with plates and screws in patients 60 years and older with displaced and comminuted fractures of the distal radius represents a safe and effective treatment alternative.

Adult↗
PubMed1992

Mechanical failures of internal fixation in T and Y fractures of the distal humerus.

To evaluate the factors resulting in mechanical failures of internal fixation of distal T-type and Y-type humeral fractures, we reviewed the clinical course and final results in 61 consecutive cases treated with AO-ASIF internal fixation devices. The patients were followed for at least 2 years (range, 2-11 years). Mechanical failure occurred in 18 cases (29.5%). In 12 patients this resulted from an unstable fixation. Severe osteoporosis was present in four patients. In two patients no specific causative factor could be detected. A second osteosynthesis was undertaken in five patients, and four additional patients were later operated on for nonunion. The functional outcome after these mechanical failures was, unexpectedly, poor in only 6 of the 18 patients. In spite of this comforting finding, the conclusion is that to minimize the failure rate in the management of these demanding fractures strict adherence to the correct technical fixation principles is mandatory, and when the bone is very osteoporotic a nonsurgical approach seems advisable.

Adolescent↗
PubMedDate not supplied

Open reduction and internal fixation of pediatric forearm fractures.

Twenty-six skeletally immature patients with 27 displaced, diaphyseal forearm fractures treated by open reduction and internal fixation were reviewed. The mean age of the patients at the time of injury was 11.5 years (range, 4-15). Indications for surgery included open fractures (10), unacceptable closed reduction (14), and loss of reduction (three). Anatomic or near anatomic fixation was achieved with either compression plates or intramedullary wires. The average time to union was 3.5 months. The average length of follow-up was 39 months (range, 9-98). All but three patients regained full range of motion equal to that of the uninjured extremity. Three complications occurred, including one deep infection resulting in delayed union, one nonunion with failure of hardware, and one proximal radioulnar cross-union. We conclude that open reduction and internal fixation is indicated and can be safely performed in children with open or unstable or both-bone forearm fractures when closed treatment methods have failed. Fixation is reliably achieved with compression plating or intramedullary nailing.

Adolescent↗
PubMed1994

Immediate internal fixation for open fractures of the long bones of the upper and lower extremities.

Immediate open reduction with internal fixation was performed on 66 open fractures (54 patients) of the long bones in the upper or lower extremity, including one clavicle. Using the classification system of Gustilo, there were 13 (20%) type I, 30 (45%) type II, 11 (16%) type IIIA, six (9%) type IIIB, and six (9%) type IIIC soft tissue injuries. Thirty-two patients had associated major multiple trauma. Eighty-eight percent of the patients had good functional results using a modification of Katenjian's criteria. There were three late deep infections (4.5%), all at the sites of type III fractures. The nonunions occurred in four open fractures (6.1%). We conclude that, if a complete and timely debridement can be accomplished, immediate internal fixation of open fractures allows for improvement in ultimate function and a decrease in mortality in patients with multiple trauma. This procedure should be performed in selected patients who have type III open fractures, with careful attention to the general status of the patient and the severity of the soft tissue wound at the fracture site.

Adolescent↗
PubMed2001

Total knee arthroplasty after open reduction and internal fixation of fractures of the tibial plateau: a minimum five-year follow-up study.

BACKGROUND: There is little information in the literature regarding the outcome of total knee arthroplasty following open reduction and internal fixation of fractures of the tibial plateau. The goal of this study was to evaluate the results of such procedures after a minimum of five years of follow-up. METHODS: We retrospectively analyzed the outcomes of fifteen total knee arthroplasties performed at an average of 38.6 months (range, eight months to eleven years) after open reduction and internal fixation of a fracture of the tibial plateau in fifteen consecutive patients. The average duration of follow-up after the total knee arthroplasty procedures was 6.2 years (range, 5.4 to 11.1 years). The average age of the patients was fifty-six years (range, thirty-seven to sixty-eight years) at the time of the arthroplasty. We evaluated the outcomes on the basis of the Hospital for Special Surgery knee score, the Short Form-36 score, and radiographs of the knees. RESULTS: The average Hospital for Special Surgery knee score was 51 points (range, 20 to 74 points) before the arthroplasty, and it increased to 80 points (range, 44 to 91 points) postoperatively. Four knees were scored as excellent, eight had a good result, one was rated as fair, and two had a poor result. The average Short Form-36 scores were 58.0 points for general health, 72.4 points for bodily pain, 72.1 points for mental health, 58.3 points for physical functioning, 84.6 points for physical role functioning, 81.0 points for social functioning, and 57.7 points for vitality. The average active postoperative arc of motion was 105 degrees (range, 70 degrees to 135 degrees ) compared with 87 degrees (range, 20 degrees to 125 degrees ) preoperatively. Incomplete radiolucencies were noted on all of the postoperative radiographs made after the total knee arthroplasties. There was a high rate of infection (three patients), patellar tendon disruption (two patients), and postoperative secondary procedures (three patients required closed manipulation). The patients with infection were considered to have a failure of treatment: two required arthrodesis, and one required a two-stage exchange. CONCLUSION: On the basis of our results, we concluded that total knee arthroplasty after open reduction and internal fixation of a fracture of the tibial plateau decreases pain and improves knee function, but the procedure is technically demanding and is associated with a high failure rate (five of fifteen).

Adult↗