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PubMed1985

The management of severely comminuted fractures of the femoral shaft, using the external fixator.

Fractures of the femoral shaft are often treated by an established method of internal fixation, such as a medullary nail or a plate and screws, to obviate the many disadvantages of traction and prolonged rest in bed. Fractures of the femoral shaft which are severely comminuted and open are usually unsuitable for internal fixation. Between July 1981 and March 1983 we treated seven patients with severely comminuted fractures of the femoral shaft (of which three were open), using the ASIF tubular external fixator system or the Wagner apparatus. The technique of application of the external fixator is important and is described. When correctly applied, the knee's movement was not restricted and few complications were experienced. All the fractures united within 8 months in a good position without shortening, and none required an additional operation. The use of the external fixator in these patients reduced their time in the hospital and facilitated their postoperative rehabilitation by allowing uncomplicated healing of a complicated fracture.

Adolescent↗
PubMed2003

Open reduction and internal fixation of fractures of the acetabulum--local experience.

INTRODUCTION: It is now widely accepted that open reduction and internal fixation of displaced acetabular fractures should be the standard of care. This paper reports a case series of acetabular fracture fixation performed at the Changi General Hospital by a single trauma surgeon. PATIENTS AND METHODS: A retrospective study was conducted of 15 consecutive cases of displaced acetabular fracture fixation between February 1996 and September 1999. Outcome was assessed radiologically and functionally with the use of a hip scoring system used by Matta. RESULTS: The patients' age had a mean of 34.9 years. All fractures were a result of high energy trauma. The median duration to operation upon admission was eight days. The mean hospital stay was 24.9 days and the mean medical hospitalisation leave was 159 days. Bony union was achieved in all patients. Two patients (13.3%) had a residual displacement of 1 mm. Four patients (26.6%) had a residual displacement of 2 mm. Of these four patients with 2 mm displacement, two eventually developed osteoarthritis. Subsequently, one of the two with OA required revision to a total hip arthroplasty two years post fracture. Other complications include 1 (6%) wound infection and 2 (13%) deep vein thrombosis. There were no complications of heterotopic ossification or sciatic nerve injury. Functional scores with a minimum follow up of one year and a mean of 22.6 months follow-up were excellent in 13.3%, good in 66.7%, fair in 13.3% and poor in 6.7%. CONCLUSION: The number of cases in this paper is insufficient to produce any statisticallly significant outcome predictors but accuracy of reduction is an important factor. A good to excellent result was attained in 80% of the patients which confirms that open reduction and internal fixation is the treatment of choice for displaced and acetabular fractures.

Acetabulum↗
PubMed1986

Internal fixation of a capitellar fracture using Herbert screws. A case report.

Fractures of the capitellum can involve a significant portion of the articular surface, rendering the elbow joint unstable. In this situation it is desirable to reduce and internally fix the capitellar fragment, because this restores the articular surface and augments joint stability. A 35-year-old woman sustained a posterolateral dislocation of the left elbow associated with a capitellar fracture. Fixation of the capitellar fragment with Herbert screws stabilized the joint, allowed anatomic reduction, and gave good fixation. Active motion was possible at three weeks. When the patient was evaluated at one year, the fracture had united and there was no evidence of avascular necrosis.

Adult↗