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PubMed1986

Segmental spine plates with pedicle screw fixation. A new internal fixation device for disorders of the lumbar and thoracolumbar spine.

A new segmental spine plate fixation system, utilizing a posterior approach and screw fixation, has been developed for disorders of the lower thoracic or lumbar spine. The indications are significant instability and severe pain relieved by immobilization. This new system uses multiple segmental fixation points through the pedicle "force nucleus" of the vertebral body. The spine plates can be contoured for anatomic positioning, reduction, and rigid stabilization to enhance graft consolidation and fusion. The surgical fixation technique is demonstrated in five case presentations illustrating the application and versatility of the method.

Adult↗
PubMed2003

Removal of internal fixation in pediatric patients.

OBJECTIVE: Internal fixation devices are commonly used in the surgical treatment of many orthopedic conditions. Their prolonged presence, however, has been associated with potential complications. Many surgeons advocate the routine removal of internal fixation in the pediatric age group. In this report we present our experience with removal of internal fixation in pediatric patients and evaluate the benefits and difficulties of doing so. METHODS: A retrospective analysis of 304 pediatric patients who underwent removal of internal fixation implants for various indications at the Armed Forces Hospital, Riyadh, Kingdom of Saudi Arabia between January 1985 and December 1999, was carried out. RESULTS: A total of 176 males and 128 females were included. Their mean age at time of removal of internal fixation was 11 years (range 2-18). The fixation device was removed at an average of 16.3 months (range 10-40) after implantation. One hundred and twenty (39.5%) patients had the initial fixation for the treatment of fractures. For all 304 patients, late removal of the implant was found to be more difficult than early removal. Implants around the hip and pelvis were more difficult to remove than other locations. CONCLUSION: Our experience supports the indication for timely removal of internal fixation devices in the pediatric population. When carried out on a routine basis it can avoid the difficulties associated with the late removal of implants.

Adolescent↗
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↗
PubMed2006

Comminuted fractures of the radial head: comparison of resection and internal fixation. Surgical technique.

BACKGROUND: Satisfactory internal fixation of comminuted radial head fractures is often difficult to achieve, and radial head resection has been the accepted treatment. In this study, we compared the results of radial head resection with those of open reduction and internal fixation in patients with a comminuted radial head fracture. METHODS: Twenty-eight patients with a Mason type-III radial head fracture (some with associated injuries) were enrolled in the study. Fifteen patients underwent radial head resection as the initial treatment (Group I), and thirteen patients underwent open reduction and internal fixation (Group II). The age at the operation averaged 41.1 and 38.2 years, respectively, and the duration of follow-up averaged ten and three years, respectively. The outcomes were assessed on the basis of pain, motion, radiographic findings, and strength measured with Cybex testing. The overall outcome was rated with the functional rating score described by Broberg and Morrey and with the American Shoulder and Elbow Surgeons Elbow Assessment Form. RESULTS: Elbow motion averaged 15.5 degrees (extension loss) to 131.4 degrees (flexion) in Group I and 7.1 degrees to 133.8 degrees in Group II. The carrying angle and ulnar variance averaged 8.2 degrees and 1.9 mm in Group I and 1.5 degrees and 0.5 mm in Group II. Compared with Group II, Group I had a loss of strength in extension, pronation, and supination (p < 0.01). The Broberg and Morrey functional rating score averaged 81.4 points in Group I and 90.7 points in Group II (p = 0.0034). The score on the American Shoulder and Elbow Surgeons Elbow Assessment Form averaged 87.3 points in Group I and 94.6 points in Group II (p = 0.0031). CONCLUSIONS: The patients in whom the comminuted radial head fracture was treated with open reduction and internal fixation had satisfactory joint motion, with greater strength and better function than the patients who had undergone radial head resection. These results support a recommendation for open reduction and internal fixation in the treatment of this fracture.

Adult↗
PubMed1980

Principles of stable internal fixation.

The results of internal fixation can be adversely affected by implant failure before union takes place. The survival of an internal fixation device depends upon load transfer from fragment to fragment. Techniques that do not provide such a load sharing between implant and bone will lead to failure of the implant. For example, absence of contact between cortices opposite the plate will increase the forces acting on the device which will either pull out, shear or break. This review focuses on the methods of applying implant to bone to achieve stable fixation and thus restore early function without sacrificing reduction and union.

Biomechanical Phenomena↗
PubMed1980

The use of immediate internal fixation in open fractures.

Internal fixation of open fractures can be carried out according to the same indications employed in closed fractures in the presence of a type I wound. In type II and type III wounds early internal fixation may be indicated in victims of multiple trauma, in the elderly, in intra-articular fractures, in mutilated limbs, and in some fractures with associated vascular injuries. In these cases the higher risk of infection should be justified by the salvage of limb, life, or joint function. The risk of infection can be minimized by meticulous irrigation and debridement of the fractures, atraumatic surgical technique, and rigid fixation and by leaving the wound open.

Adolescent↗
PubMed2002

Treatment of displaced intracapsular hip fractures with total hip arthroplasty: comparison of primary arthroplasty with early salvage arthroplasty after failed internal fixation.

BACKGROUND: Closed reduction and internal fixation is the preferred initial treatment for young active patients who sustain a displaced intracapsular hip fracture. However, there is a paucity of information on the outcome in patients in whom this procedure fails and who subsequently require revision to a total hip arthroplasty. The purpose of this study was to compare a group of patients with a displaced intracapsular fracture who required early salvage total hip arthroplasty following failure of internal fixation within the first year after fracture with a group treated with primary total joint replacement for treatment of the same type of fracture. METHODS: With use of a matched-pairs case-control design, a group of 107 patients, between the ages of sixty and eighty years, who required an early salvage total hip arthroplasty with cement following failed reduction and internal fixation of a displaced intracapsular hip fracture (Group I) was compared with an age and gender-matched group of patients who had undergone total hip arthroplasty with cement as the primary procedure for the treatment of such a fracture (Group II). RESULTS: During the first year after the arthroplasty, there were fifty-two early complications in thirty-nine patients in Group I and twenty-two complications in fourteen patients in Group II (p < 0.05). There were significantly more superficial infections and dislocations in Group I (p < 0.05). The rate of revision beyond one year was greater and the overall prosthetic survival rate at both five and ten years postoperatively was significantly worse in Group I (log-rank test, p < 0.05). The functional outcomes at one year and at the time of final follow-up were also significantly worse in Group I. CONCLUSIONS: Reduction and internal fixation will continue to be used as the primary treatment of displaced intracapsular fractures in many younger patients because of the benefits of preservation of the normal hip joint. However, patients should be counseled that if this method of treatment is unsuccessful and requires revision to a total hip arthroplasty with cement, the risk of early complications is higher and hip function may be poorer than if the arthroplasty had been performed as a primary procedure.

Aged↗
PubMed1988

Rigid internal fixation for fractures involving tooth-bearing maxillary segments.

Fracture dislocations of the middle third of the face usually involve a complex combination of the three types of fractures initially described by LeFort. Treatment of these injuries requires a six- to eight-week period of intermaxillary fixation, unless rigid internal fixation devices (plates and screws) are used to stabilize the fractures. However, rigid fixation carries the risk of producing a malunion and serious malocclusion if not performed correctly. A review of 22 patients with complex LeFort fractures treated with rigid fixation revealed that the only absolute contraindication to its use is difficulty in interdigitating the maxillary and mandibular teeth in a passive fashion at the time of fracture reduction. Rigid internal fixation should therefore be considered as an alternative treatment for most fractures of the middle third of the face.

Fracture Fixation, Internal↗
PubMed1989

Update-1988. Current status of internal fixation of thoracolumbar fractures.

Rigid internal fixation has become the preferred method of treatment for unstable thoracolumbar fractures in most American spine centers. In most cases, posterior instrumentation alone is adequate, but occasionally an anterior procedure is necessary. A number of internal fixation devices are now available to the orthopaedic surgeon. Controversy exists regarding the number of levels that need to instrumented and the optimal form of internal fixation.

Adult↗
PubMed1989

The AO spinal internal fixator.

The AO spinal internal fixation system uses 5.0 mm diameter transpedicular Schanz screws with 7.0 mm diameter fully threaded stainless steel rods. Originally developed for the treatment of thoracolumbar and lumbar spine fractures, it can be used for a variety of spinal disorders. A prospective study has been carried out, and the first 48 patients have been reviewed. The results for those patients with fractures are excellent. In burst fractures, it has been possible to decompress the canal and restore lordosis. In only half of the cases of spondylolisthesis has it been possible to improve the degree of slip. The fixator has provided rigid stabilization for a variety of other spinal problems.

Adolescent↗
PubMed1977

Mechanical stability and post-traumatic osteitis: an experimental evaluation of the relation between infection of bone and internal fixation.

Stable and unstable internal fixation of fractures was performed in rabbits. After inoculation with Staphylococcus aureus, clinically manifest osteitis occurred only in the very unstable fractures. Abscesses, sinuses and sequestra developed in 45 per cent of the unstable fractures, whereas clinically manifest osteitis did not occur after rigid fixation. With rigid fixation there was no significant difference in the time to bony union between the infected and uninfected fractures. It seems that the development of osteitis and the healing of a fracture are both related to the degree of rigidity, but remain independent of each other. The significance of these findings in the management of posttraumatic osteitis is discussed.

Animals↗
PubMed1981

Use of a dynamic mini-compression plate for the internal fixation of mandibular fractures.

Internal fixation for mandibular fractures can be simplified using dynamic mini-compression bone plates, frequently employed by orthopedic surgeons. These enable fragment immobilization without the usual intermaxillary fixations--arch bars, splints, and so on. They also allow better oral hygiene, early feedings, and short hospitalization. Complications and risk of infection appear to be minimal. The intraoperative steps are described.

Biomechanical Phenomena↗
PubMed2003

Salvage of failed internal fixation of intertrochanteric hip fractures.

Most intertrochanteric hip fractures treated with internal fixation heal. If nonunion or early loss of fracture fixation occurs, treatment options include prosthetic replacement and revision internal fixation. The purpose of the current study was to evaluate the results of revision internal fixation and bone grafting for salvage of failed internal fixation of intertrochanteric hip fractures. Between 1981 and 2000, 20 patients with 20 intertrochanteric fractures who had initial internal fixation that failed were treated with revision open reduction and internal fixation and bone grafting. The mean age of the patients was 58 years (range, 21-86 years). The mean clinical followup was 27 months (range, 3-120 months), and mean radiographic followup was 22 months (range, 3-120 months). Eleven patients were treated with an angled blade plate (seven, 95 degrees; two, 90 degrees; one, 110 degrees; and one, Harris blade plate), five with a dynamic hip screw, three with a dynamic condylar screw, and one with a Zickel nail. Autograft bone was used in 17 patients and allograft bone was used in three patients. Nineteen of 20 nonunions healed (95%). Sixteen of the 19 patients who achieved healing reported no pain and three had mild pain (related to retained hardware); all were ambulatory. Two patients had perioperative complications (10%): one wound dehiscence, and one severe hyponatremia. In properly selected patients, revision internal fixation with bone grafting for failed open reduction and internal fixation of intertrochanteric hip fractures can provide a high rate of union and good clinical results with a low rate of complications.

Adult↗
PubMed2005

Implant retention and removal after internal fixation of the symphysis pubis.

Although internal fixation of diastasis of the symphysis pubis is commonly performed, there are no clear guidelines regarding the indications for removal of these implants. The long-term physiologic effects of retaining these internal fixation devices are not well described. We surveyed the literature to assess the current thinking and recommendations regarding implant retention and removal. Twenty-four case series and two case reports were found, for a total of 482 cases. Complications arose as a result of implant retention in 7.5% of patients, with infection the most common complication. There is no consensus in the literature regarding implant retention and removal after internal fixation of diastasis of the symphysis pubis.

Device Removal↗
PubMed1986

Management of mandibular trauma with rigid internal fixation.

The use of rigid internal fixation has become an acceptable method for the treatment of fractures and continuity defects of the mandible. This technique has a wide variety of applications, including stabilization of mandibular segments for the application of bone grafts. The primary advantage of rigid fixation is that it obviates the need for maxillomandibular fixation associated with the treatment of mandibular trauma by traditional methods. This article reviews twenty cases in which rigid internal fixation was used for the treatment of fractures and continuity defects of the mandible. In only one case was early removal of the implant necessary as a result of infection.

Adult↗
PubMed1988

[Cross stabilization of the internal fixator of the spine].

The "Internal Fixator" for stabilizing the dorso-lumbar spine represents an effective and meanwhile established device to neutralize flexion-bending and sagittal shearing forces. Because of the possible movement of the Schanz' screws in the bone and within the connection clamps, this device does not withstand torsional and frontal plane shearing forces after postinjury or postlaminectomy instability. Therefore, a cross-link device, adaptable to the "Internal Fixator" has been developed. Biomechanical testing against torsion and frontal plane bending moments have shown very low stability resulting in lateral displacement of the fixation device without cross-linking. The diagonal bracing with two wire cerclages does not significantly increase the stability. The recently developed cantilever cross-link device completes the two longitudinal bars to a frame construction and increases therefore the torsional and frontal plane stability for over 70%. This supplementary device is easy to apply to the "Internal Fixator" and has been successful in clinical practise.

Biomechanical Phenomena↗
PubMed2006

Replacement arthroplasty versus internal fixation for extracapsular hip fractures in adults.

BACKGROUND: Internal fixation, commonly used for extracapsular hip fractures, may fail particularly in unstable fractures. Replacement of the hip using arthroplasty, often used for intracapsular fractures, has been used as an alternative. OBJECTIVES: To compare replacement arthroplasty with internal fixation for the treatment of extracapsular hip fractures in adults. SEARCH STRATEGY: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (December 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 4, 2005), MEDLINE, EMBASE, the UK National Research Register, several orthopaedic journals, conference proceedings and reference lists of articles. SELECTION CRITERIA: Randomised and quasi-randomised trials comparing replacement arthroplasty with an internal fixation implant for adults with an extracapsular hip fracture. DATA COLLECTION AND ANALYSIS: Both review authors independently assessed 10 aspects of trial quality and extracted data. We requested additional information from trial investigators. Where appropriate, limited pooling of data was performed. MAIN RESULTS: Two randomised controlled trials including a total of 148 people aged 70 years or over with unstable extracapsular hip fractures in the trochanteric region were identified and included in this review. Both had methodological limitations, including inadequate assessment of longer-term outcome. One trial compared a cemented arthroplasty with a sliding hip screw. This found no significant differences between the two methods of treatment for operating time, local wound complications, mechanical complications, reoperation, mortality or loss of independence of previously independent patients at one year. There was, however, a higher blood transfusion need in the arthroplasty group. The other trial compared a cementless arthroplasty versus a proximal femoral nail. It also found a higher blood transfusion need in the arthroplasty group, together with a greater operative blood loss, and a longer length of surgery. There were no significant differences between the two interventions for mechanical complications, local wound complications, reoperation, general complications, mortality at one year or long-term function. None of the pooled outcome data yielded statistically significant differences between the arthroplasty and internal fixation, with the exception of the significantly higher numbers of participants in the arthroplasty group requiring blood transfusion (relative risk 1.71, 95% confidence interval 1.05 to 2.77). AUTHORS' CONCLUSIONS: There is insufficient evidence from randomised trials to determine whether replacement arthroplasty has any advantage over internal fixation for extracapsular hip fractures. Further larger well-designed randomised trials comparing arthroplasty versus internal fixation for the treatment of unstable fractures are required.

Fracture Fixation, Internal↗
PubMed2000

Replacement arthroplasty versus internal fixation for extracapsular hip fractures.

BACKGROUND: Internal fixation, commonly used for extracapsular hip fractures, may fail particularly in unstable fractures. Replacement of the hip using arthroplasty, often used for intracapsular fractures, has been used as an alternative. OBJECTIVES: To compare replacement arthroplasty with internal fixation for the treatment of extracapsular hip fractures in adults. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group's trials register and bibliographies of published papers, and contacted colleagues. Date of the most recent search: August 1999. SELECTION CRITERIA: Randomised and quasi-randomised trials comparing replacement arthroplasty with an internal fixation implant for skeletally mature patients with an extracapsular hip fracture. DATA COLLECTION AND ANALYSIS: Both reviewers independently assessed trial quality, using a ten item scale, and extracted data. Additional information was sought from trialists. Odds ratios and 99% confidence intervals were calculated for relevant dichotomous outcomes and presented graphically. MAIN RESULTS: Only one randomised trial of 90 patients with unstable extracapsular hip femoral fractures in the trochanteric region was identified and included in this review. This compared arthroplasty with a sliding hip screw and was of poor methodological quality. From the limited data available for this trial, there were no significant differences between the two methods of treatment for operating time, local wound complications, mortality rate or mobility of previously independent patients. There was however a reportedly higher blood transfusion need in the arthroplasty group. REVIEWER'S CONCLUSIONS: There is insufficient evidence from randomised trials to determine whether replacement arthroplasty has any advantage over the sliding hip screw for extracapsular hip fractures. Further well designed randomised trials for the treatment of these fractures for this comparison are required.

Fracture Fixation, Internal↗