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PubMedDate not supplied

[What influence doe the implant have on the perioperative morbidity following internal fixation of proximal femur fracture? Analysis of dynamic hip screw and proximal femoral nailing].

RATIONALE: Proximal femur fracture is a frequent finding in elderly patients. Both the dynamic hip screw (DHS) and the proximal femur nail (PFN) are established implants. The aim of our study was to assess the perioperative morbidity in a sample of 112 patients with proximal femur fracture, operated on with either DHS or PFN. MATERIAL AND METHODS: Data of 112 consecutive patients (59 DHS, 53 PFN), which consisted of 20 variables, were obtained. Nine variables were selected, which were considered to possess a potential impact on the complication rate. These variables were type of implant, sex, age, period between trauma and surgery, ASA classification, fracture classification of the ASIF, duration of surgery, blood loss, and antibiotics. They were transformed into dichotomous data to enable univariate statistical analysis and logistic regression. RESULTS: The ASA classification only was evaluated to have a predictive value as shown by the odds ratio of 2.23 (90 % confidence interval: 1.09 - 4.56). ASA 3 or 4 patients had an expected frequency, which was 2.2-fold increased as compared to patients classified as ASA 1 or 2, to suffer from perioperative complications. Using logistic regression, again the ASA classification only was shown to have a significant impact (p = 0.066, level of significance: p < 0.1) on the perioperative morbidity. CONCLUSION: As suggested by our results, neither the type of implant nor the other variables mentioned above had a significant impact on the resulting complication rate in our study sample. The ASA classification only was found to significantly increase the probability of an adverse event. This finding should be taken into account prior to initiating therapy.

Aged↗
PubMed2000

Internal fixation versus total hip arthroplasty in the treatment of displaced femoral neck fractures: a prospective randomized study of 100 hips.

100 patients 75 years or older, with displaced femoral neck fractures, were randomly assigned to osteosynthesis with two parallel and percutaneously inserted screws (Olmed) or total hip arthroplasty (Lubinus IP). Mean age was 84 (75-101) years, 74% were women and 45% had mental dysfunction. General complications were commoner in the arthroplasty group but the mortality rates did not differ. In the osteosynthesis group, fracture complications were seen in 27/50 hips. In the arthroplasty group, dislocation was the main complication and occurred in 11/50 cases. At 3 months and after 1 year, the Harris Hip Scores were significantly better in the arthroplasty group. When mental dysfunction was present, the dislocation rate after arthroplasty was 32%, whereas the reoperation rate after osteosynthesis was 5%. The opposite pattern of complications was found in patients with normal mental function, 12% versus 60%. The 2-year mortality rate among those with mental dysfunction was 26/45, compared to 7/55 of those with normal function (p < 0.001). We conclude that total hip arthroplasty should be considered for a displaced femoral neck fracture in old patients with normal mental function and high functional demands.

Aged↗
PubMed2004

Internal fixation of proximal humeral fractures with a locking compression plate: a retrospective evaluation of 72 patients followed for a minimum of 1 year.

BACKGROUND: Proximal humeral fractures, particularly in osteoporotic patients, remain an unsolved problem as regards the durability of the osteosynthesis. The AO/ASIF group has developed a new technique which aims to preserve the biological integrity of the humeral head and secures the reduction using multiple locking screws with angular stability (Philos), thus allowing an early mobilization. PATIENTS AND OUTCOME: We retrospectively reviewed the complications and functional outcome after a minimum follow-up of 1 year in 72 patients treated with this new method. 2 fractures failed to unite, and 3 patients developed an avascular necrosis of the humeral head. In addition, 2 implant failures were observed due to a technical error. According to the Constant score, the functional outcome was acceptable even in elderly patients. INTERPRETATION: The Philos method appears to be safe and can be recommended for the treatment of proximal humeral fractures in patients with poor bone quality.

Adult↗
PubMedDate not supplied

The biomechanical evaluation of polyester as a tension band for the internal fixation of patellar fractures.

We use a braided polyester suture in place of cerclage wire in tension band fixations. The objective of this study was to test the biomechanical properties of this technique. Sixteen cadaveric patellae were fractured and repaired by modified tension band fixation. Eight were fixed using eighteen gauge stainless steel wire as a tension band and eight using braided polyester. All specimens were subjected to tensile testing. Polyester was 75.0% as strong as wire. For dynamic testing, the patellae of seven cadaveric knees were fractured and then fixed with polyester tension bands. These were mounted in a device capable of extending the knees from 90 degrees to neutral against an applied force. None of the fixations failed. Three of the specimens fixed using 18 gauge stainless steel wire were compared with three fixed using polyester over 2000 cycles of knee flexion and extension. Polyester performed as well as wire. We conclude that polyester is an acceptable alternative to wire in tension band fixation.

Biomechanical Phenomena↗
PubMed1999

Internal fixation of phalangeal fractures using titanium miniplates.

Although widely utilized in the treatment of metacarpal fractures, plate fixation in phalangeal fractures remains controversial. Increased potential for infection, breakage, and added soft-tissue trauma leading to increased joint stiffness have been cited as important negative factors. A retrospective analysis of titanium plate fixation of phalangeal fractures over a 7-year period is presented. From 1991 to 1998, 16 fractures (13 men, 3 women; age range, 19-70 years) were managed with plate fixation using the Profyle titanium plating system as the primary modality of treatment. All plates were seated dorsally using an extensor tendon-splitting approach. The average follow-up period after surgery was 5 months (range, 3-28 months). Fracture patterns varied: 31% (5 of 16) were open fractures and 69% (11 of 16) were closed. Complications occurred in 25% of patients (4 of 16) and consisted of pain or other trigger that required removal of hardware, flexion contracture at the proximal interphalangeal joint, and extensor lag. There were no instances of hardware failure, infection, or malunion. The quality of recovery of joint motion was assessed using the Total Active Flexion Scale: nine digits were graded excellent, another six were categorized as good, and only one digit was judged as poor. A review of the current literature is presented along with suggested guidelines for the application of miniplate fixation for fractures of the phalanges.

Adult↗
PubMed1992

Rigid internal fixation of a displaced mandibular coronoid fracture.

A report of the open treatment of the extremely rare displaced coronoid fracture of the mandible is presented. The previously predicted but undocumented oblique submuscular fracture from the depth of the mandibular notch to a point immediately behind the distal end of the alveolar process allowed displacement to occur. Use of plate and screw fixation for this exceedingly unusual injury avoided maxillomandibular fixation and was of benefit to this seizure-prone patient.

Adult↗
PubMed1996

Proximity of iliosacral screws to neurovascular structures after internal fixation.

The placement of iliosacral screws for the stabilization of pelvic ring lesions is technically demanding. The postoperative computed tomography scans of 31 patients who had 57 iliosacral screws placed for various indications were studied to determine the proximity of these screws to neurovascular structures. The closest distance of the screws from the S1 foramen averaged 3 mm. (range, 0-10.5 mm); the average closest distance to the anterior cortex of the sacral ala was 4.8 mm (range, 0-15.3 mm). The corridor for the insertion of the screws between the S1 foramen and the anterior cortex of the sacrum averaged 21.7 mm (range, 16.2-28.9 mm). Trigonometric analysis of these dimensions suggests that deviations of the surgeon's hand by as little as 4 degrees may direct iliosacral screws either into the S1 foramina or through the anterior cortex of the sacrum.

Bone Screws↗
PubMed1997

Treatment of tibial plateau fractures by limited internal fixation.

Seventy-five adults who sustained 76 tibial plateau fractures were treated according to a prospective protocol using instability in extension as the principal indication for operative fixation. Patients showing instability underwent closed manipulative reduction under fluoroscopic guidance. If significant joint depression persisted after reduction, elevation of the fracture was performed either from below using bone punches through a cortical window or via limited arthrotomy. Iliac crest bone graft was used to buttress depressed fractures. Fixation was then secured using 7-mm cannulated screws with washers or buttress plates and screws. Postoperatively, 58 of 76 knees were managed in a hinged knee brace, allowing the patient early range of motion and protected weightbearing for 8 weeks. Patients who were found to have a stable knee were treated with Bledsoe braces according to the postoperative protocol. In the 75 patients, 18 of the 76 knees were unsuitable for percutaneous screw fixation because of fracture complexity requiring plates, severe open injuries, or inadequate reductions with limited fixation had been done. A minimum followup of 12 months was obtained in 55 patients (range, 12-59 months). All fractures had healed at the time of followup. Eighty-seven percent of the patients at followup had a successful outcome using Rasmussen's criteria. Fourteen of these patients had arthroscopic assisted reduction or evaluation. All seven patients who had poor outcomes had AO Type C3 fracture patterns. Severely depressed or comminuted fractures or fractures with significant metaphyseal diaphyseal extension may not be suitable for this technique and require the addition of an external fixation device or buttress plate to maintain the reduction and allow for early range of motion.

Adolescent↗
PubMed1988

Regional alterations in long bone produced by internal fixation devices. Part I. 85Sr clearance.

We examined the effect of rigid plate application on the radiostrontium clearance of the intact canine femur at 6 months. We examined each of the component surgical steps. We calculated the clearance both for the whole bone and for each of the five transverse sections of the whole bone. Screw application, but not drilling, increased the clearance in the segment about the screw holes. Plate application produced an increase in the segment beneath the plate as well as around the screws and in the whole bone. These changes are accomplished not only by an absolute increase in clearance to the middle three segments, but by a relative diminution in clearance by the most proximal and distal segments. The histomorphometric changes in long bones following rigid plating may be accompanied by regional increases in bone blood flow.

Animals↗
PubMed1988

Regional alterations in long bone 85Sr clearance produced by internal fixation devices. Part II. Histomorphometry.

The effects of each of the surgical stages involved in compression plating on the development of cortical thinning and porosity were assessed in the intact midshaft, stress-shielded femoral segments of adult mongrel dogs 6 months postoperatively. The data were evaluated in terms of a postsurgical tetracycline-based measure of remodeling and terminal 85Sr clearance (SrC) values for the plated segments of bone. Drilling had no effect on any parameter. Screw application was associated with minimal cortical thinning (p less than 0.05), while plate fixation clearly promoted thinning (p less than 0.01) and porosity (p less than 0.05). The percentage of labeled osteons, a measure of remodeling activity, increased only after plate fixation (p less than 0.05), and the labeling patterns suggested that most osteons had formed during the first 4 postsurgical months. That none of these changes were correlated with the 6-month SrC values suggests that the development of plate-induced osteopenia involves disparate histomorphometric time constants, rather than lack of any association.

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↗
PubMed1990

Internal fixation of the distal humerus: a biomechanical comparison of methods.

Three commonly used configurations of various implants used for fixation of distal humeral fractures were quantitatively compared. The double plate construct, irrespective of plate type (1/3 tubular and/or 3.5 mm reconstruction plate), was significantly stronger, both in rigidity and fatigue testing, than cross screws or the single "Y" plate. If rigid stabilization of supracondylar or bicondylar distal humeral fractures is desired, then two plate constructs, at right angles (the ulna plate medially, the lateral plate posteriorly), are biomechanically optimal.

Biomechanical Phenomena↗