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PubMed1991

Polyacetal rod fixation of fractures in osteoporotic bone. A preliminary report.

Intramedullary rods manufactured from polyacetal were used to fix diaphyseal fractures in osteoporotic bone. They are pliable and can be introduced without further damage to such bone. Their low elastic modulus induces abundant callus. They can be locked with cortical bone screws without the need of jigs or radiographic control. Nine femoral and five tibial fractures were fixed in 10 patients, all with osteoporosis; 13 united primarily; one required bone grafting. No implant broke; however, no ambulant patient weighed more than 75 kg. The rods offer a promising treatment for diaphyseal fractures in osteoporotic bone.

Acetals↗
PubMed1993

Internal fixation of proximal femur fractures: a biomechanical comparison of the Gamma Locking Nail and the Omega Compression Hip Screw.

The fracture fixation capability of the Gamma Locking Nail was compared with the Omega Compression Hip Screw using cadaver femurs with simulated intertrochanteric and subtrochanteric fractures. Loading of the femurs was done on an Instron machine. Fracture fragment motion was recorded at 100-lb loading increments using standard roentgenograms. Both forms of hardware exhibited sufficient structural integrity to carry loads up to 600 lbs. Fracture motion was generally greater with the Gamma Locking Nail, which appeared to suspend the proximal fragments above a pivot point defined by the distal locking screws. Compression of the fracture site under loading did not occur with the Gamma Locking Nail. The potential for iatrogenic fracture generation appeared greater with the Gamma Locking Nail. Additionally, no clear mechanical advantage was documented in the fracture patterns tested. A limited discretionary use of the Gamma Locking Nail is advised.

Bone Nails↗
PubMed1996

[Fractures of the distal end of the forearm and treatment with external fixation].

Fractures of the distal end of the forearm are common fractures treated at surgical departments with standard equipment. The results, when conservative procedures are used, are not always ideal and redislocation of fragments on the 14th-21st day spoils the satisfaction of the anatomical reposition immediately after the accident. The authors demonstrate the use of external fixation devices in these fractures and the advantages of the method, as compared with the conservative procedure, in particular in unstable fractures. The objective of the submitted paper is not a randomized study as this is beyond the possibilities of the authors department but to demonstrate a more radical "approach" to these fractures. The advantage of this method is the possibility of anatomical reposition and maintenance of this position throughout the time of healing of the fracture, and the possibility of earlier rehabilitation of the wrist.

External Fixators↗
PubMed2003

Fixation of periprosthetic femur fractures: a biomechanical analysis comparing cortical strut allograft plates and conventional metal plates.

This study compared the stability of periprosthetic femur fractures fixed using cortical allograft struts with a metal plate. Cadaveric specimens were loaded in single-leg stance and stair climbiing to 2250 N. Optimum stability in single-leg stance was achieved with two long struts medially and laterally. No clear advantage was noted in using a second strut in stair climbing. Cables rather than wires were useful in single-leg stance, but not in stair climbing. Allograft cortical struts are a biomechanically sound alternative to metal plates fixed with screws and cables for femur fracture fixation below a well-fixed femoral component.

Biomechanical Phenomena↗
PubMed2005

Torsional stiffness in healing fractures: influence of ossification: an experimental study in rats.

BACKGROUND: Different fracture fixation techniques and fracture environment influence bone formation in healing fractures. However, the influence on the development of biomechanical properties has not been clear described. We evaluated the influence of fracture fixation stability and fracture environment on mechanical properties in healing femoral fractures in rats. METHODS: Animals were treated surgically with external fixation: 1 group (27 rats) with 0-mm fracture gap size with bone ends touching, corresponding to an axial stiffness of 265 (SD 34) N/mm, and a second group (27 rats) with 2-mm fracture gap size corresponding to an axial stiffness of 30 (SD 2.1) N/mm. From each group, 6-7 animals were killed at 2, 4, 6 and 12 weeks. Torsional test revealed a delay in torsional stiffness in fractures in group 2 compared to group 1. In group 2, the torsional stiffness of the contralateral femora was found to be greater at 12 weeks than the torsional stiffness in group 1. INTERPRETATION: We found that during fracture healing, the development of torsional stiffness corresponds to the magnitude of endochondral ossification and late response of bone formation. A significantly increased torsional stiffness in the non-fractured leg of rats with delayed fracture healing was also found, possibly indicating a response to loading conditions or a systemic stimulation of bone mass.

Animals↗
PubMed1990

Cemented internal fixation for supracondylar femur fractures in osteoporotic patients.

Seventeen, supracondylar femur fractures in 15 severely osteoporotic patients (average age, 81.9 years) were treated with a 95 degree supracondylar plate and dynamic compression screw supplemented with intramedullary methyl methacrylate and massive cancellous bone graft harvested from the distal femoral metaphysis. Interfragmentary compression and rigid fracture fixation was obtained in all cases with the use of the A-O compression device. Patients were allowed early protected weight bearing without external immobilization. At follow-up observation (average, 2.1 years), bony union was noted in all cases, and knee flexion averaged 100.4 degrees. There were no malunions or cases of implant failure. Complications included two early postoperative deaths and three femur fractures above the plate. This technique was effective in rapidly restoring patient mobility while avoiding the complications of implant failure.

Aged↗
PubMed1999

Salvage of contaminated fractures of the distal humerus with thin wire external fixation.

Fractures and osteotomies of the distal humerus that are contaminated or infected represent a difficult management problem. Stable anatomic fixation with plates and screws, the acknowledged key to a good result in the treatment of bicondylar fractures, may be unwise. A thin wire circular (Ilizarov) external fixator was used as salvage treatment in such complex situations in five patients. The fixator allowed functional mobilization of the elbow while allowing achievement of the primary goal of eradicating the infection or colonization. Two patients required a second operation for fixation of a fibrous union of the lateral condyle. One patient with a vascularized fibular graft later required triple plate fixation for malalignment at the distal host and graft junction. Four of five patients ultimately achieved complete union. The fracture remained ununited in one patient who has declined additional intervention. All five patients achieved at least 85 degrees ulnohumeral motion, two after a secondary elbow capsulectomy performed after healing was achieved. This experience suggested that the Ilizarov construct, although not a panacea, represents a reliable method of skeletal stabilization that allows functional mobilization while elimination of infection or colonization is ensured. If necessary, stiffness and incomplete healing can be addressed with an increased margin of safety at subsequent operations.

Adolescent↗
PubMed1978

The biocompatibility of materials for internal fixation of fractures.

Surgically produced fractures of rabbit tibiae were internally stabilized with intramedullary rods of stainless steel (316LVM), titanium (6A1,4V), polyacetal (Delrin), and polyamide (Nylon 101). Periodic radiographs were taken until sacrifice at 16 weeks after fracture. Structural properties of the tibiae were determined in torsion with the rods in situ, and then the tissue was prepared for histology or microradiography. The results demonstrated that fracture remodeling was adversely affected by the metal rods. New bone was seen to have formed over the ends of the metal rods, and cortical bone resorption was observed in the fracture region, suggestive of transfer of mechanical stress to the rods, resulting in stress shielding of the diaphysis. Negligible osseous response to the polymeric rods was observed; fracture callus remodeling was extensive. The torsional test results demonstrated that fractures with polymeric rods were significantly stronger and tougher than those with metallic rods. With the exception of titanium, the strength of healed fractures was inversely related to the elastic moduli of the implant materials.

Acetals↗
PubMed1988

Operative fixation of fractures of the thoracic and lumbar vertebrae by Williams plates with reference to late kyphosis.

Thirty patients with fractures of the thoracic and lumbar spine, treated by the Williams plating technique (with or without fusion) between 1966 and 1978, were reviewed and followed up for an average of 6.5 years (range 2-14 years). The average degree of primary traumatic kyphosis was 11.4 degrees (range 0-33 degrees), and the average degree of late deformation kyphosis during follow-up was 17.4 degrees (range 0-30 degrees). The average loss of operative correction during follow-up was 9.8 degrees. Technical late complications, such as loosening of screws, occurred in half of the patients, but they did not affect the degree of spinal deformation. The corrective result, with reference to late deformity (kyphosis), largely correlated with the degree of primary traumatic kyphotic deformation and the severity of the neurologic lesion. The best late correction result was achieved with moderate primary kyphosis in patients with bursting fractures. Spinal fusion tended to give better results, especially in anterior wedge fractures, in maintenance of the correction of kyphosis, while laminectomy tended to give poorer results. None of the 15 patients with primary complete paraplegia showed improvement, while 80 per cent of patients with incomplete paraplegia made a moderate recovery.

Adolescent↗
PubMed1976

Percutaneous internal fixation of fractures of the proximal phalanges.

A rational methods for management of the fractures of the proximal phalanges is presented. By this technique fracture healing and recovery of movement take place concurrently rather than consecutively thereby the morbidity is greatly reduced. It leads to early and complete rehabilitation of the patient in a short period.

Adult↗
PubMed1995

Mennen plate fixation for fracture of the femoral shaft with ipsilateral total hip and knee arthroplasties.

A method of treatment for a femoral shaft fracture in a patient with well-functioning ipsilateral total hip and knee arthroplasties is described. Total hip and knee arthroplasties are commonly performed, but ipsilateral femoral shaft fracture is an infrequent and troublesome complication. Management of these fractures is often difficult. Various operative treatments have been described in the literature with varying success.

Aged↗