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PubMedDate not supplied

Office removal of tibial external fixators: an evaluation of cost savings and patient satisfaction.

OBJECTIVES: To evaluate the efficacy and patient satisfaction of office removal of tibial external fixators and to compare the cost of this procedure with the cost of removal of fixators in the operating room. DESIGN: A visual analog scale (VAS) and a questionnaire were answered by all patients after office external fixator removal. The treatment, complications, and costs were compared with those of patients having external fixator removal in the operating suite. SETTING: An urban orthopaedic trauma office with a Level I trauma center. PARTICIPANTS: Two similar groups of patients; thirty fixators removed in the office and twenty-nine fixators removed in the operating room. INTERVENTION: Office or operating room removal of tibial external fixators and application of a sterile dressing. A visual analog scale was answered by those patients who had office removal. MAIN OUTCOME MEASUREMENTS: Patient satisfaction and pain rating (VAS) with office removal of external fixators. Comparison of costs, infections, time in fixator, and surgical interventions between the office and operating room groups. RESULTS: Group I had thirty fixators (twenty-nine half-pin fixators) removed in the office. Group II had twenty-nine fixators removed in the operating room. Duration of time in the frame was not statistically different. Antibiotic usage during the fixator treatment period was 69 percent in both groups. On the visual analog scale, twenty-four members (80 percent) of the office fixator removal group rated the pain during removal as less than 25 percent of maximal, including nine (30 percent) who rated the removal as causing no pain. Cost analysis revealed an average cost of $248 for the office group versus $2,160 for the operating room group (p < 0.001). CONCLUSIONS: Due to the cost savings and patient satisfaction, without compromising clinical care, the office is our preferred location for tibial half-pin external fixator removal.

Adolescent↗
PubMed1984

The influence of various fixatives on the immunohistochemical demonstration of a number of plasma proteins and oncofetal proteins in paraffin embedded material.

The influence of different fixatives on the antigenicity of alpha-fetoprotein (AFP), albumin, prealbumin, transferrin, ferritin, human chorionic gonadotropin (HCG), specific pregnancy beta 1-glycoprotein (SP1) and human placental lactogen (HPL) was studied. No single fixative was superior for all the antigens investigated. For intracellular antigens the best all-around fixatives were, however, 10% buffered formalin, 4% buffered paraformaldehyde, 10% formol-calcium and ethanol acetic acid (EA), cold processed. The preferable fixatives were for AFP: Bouińs fixative, B-5 and EA; for albumin: 10% formol-calcium; for prealbumin: Zambonis fixative and B-5; for transferrin: EA; for ferritin: 10% buffered formalin, 4% buffered paraformaldehyde, Lilliés fixative, Zambonis fixative and EA; for HCG: Bouińs fixative and B-5; for SP1: Lilliés fixative and EA; and for HPL: 4% buffered paraformaldehyde and Lilliés fixative. The preservation of extracellular antigens was different from the above mentioned intracellular ones. Thus fixation in 10% buffered formalin gave poor results while the coagulant fixatives such as Bouińs fixative, B-5 and Clelands fixative in general showed good preservation of the antigenicity of the extracellular antigens.

Antigens, Neoplasm↗
PubMed2004

Comparison of two methods of percutaneous pin fixation in displaced supracondylar fractures of the humerus in children.

PURPOSE: To conduct a prospective randomised controlled study to compare the stability and risk of nerve injury between fractures treated by medial-lateral pin fixation and those treated by 2-lateral pin fixation. METHODS: Patients with displaced supracondylar fractures admitted between May 2000 and December 2001 were recruited into the study. They were randomised to treatment either with medial-lateral pin fixation (n=34) or with 2-lateral pin fixation (n=32). RESULTS: 66 children with the mean age of 5.78 years were admitted during the study period. 11 of them were lost to follow-up. The mean follow-up period of the remaining 55 patients was 8.93 months. The difference in the carrying angle between injured and normal elbows was 3.57 degrees and 3.70 degrees in medial-lateral pin fixation and 2-lateral pin fixation, respectively. The extension and flexion loss was 7.14 degrees and 8.68 degrees respectively in medial-lateral pin fixation, and 7.11 degrees and 11.26 degrees respectively in 2-lateral pin fixation. The Baumann angle difference was 5.96 degrees in medial-lateral pin fixation, and 5.30 degrees in 2-lateral pin fixation. The difference in the medial epicondylar epiphyseal angle was 6.07 degrees in medial-lateral pin fixation and 6.92 degrees in 2-lateral pin fixation. Statistical analyses show that these differences are not significant. Five iatrogenic ulnar nerve injuries developed in the group treated by medial-lateral pin fixation, while 2 ulnar nerve and one radial nerve injuries were seen after 2-lateral pin fixation. Again the differences were not statistically significant. CONCLUSION: Both methods of fixation were comparable in terms of stability, duration of bone healing, and risks of injury to the nerve.

Bone Nails↗
PubMed2001

Biomechanical efficacy of an internal fixator for treatment of distal radius fractures.

Despite the effectiveness of external fixation in the treatment of complex wrist fractures, the complication rate for this modality ranges from 20% to 62%. Common complications are related to the use of percutaneous metal pins and result in an average reoperation rate of 16%. In addition, external fixation is unable to prevent dorsal collapse of the radius or maintain the normal palmar tilt of the radiocarpal joint surface. This complication may predispose to posttraumatic wrist instability and arthritis. The problems with external fixation have prompted a search for a better treatment option. An internal fixator placed through limited incisions on the dorsal aspect of the radius and spanning the fracture site can, in theory, provide the benefits of external fixation without the associated morbidity. This study determined the biomechanical efficacy of internal fixators compared with external fixators using a standardized model for an unstable wrist fracture. Two commercially available metal plates were used as internal fixators. Biomechanical testing of the devices was done, and stiffness was determined. Results showed that the internal fixators were significantly stiffer than were the external fixators in axial loading. Failure in axial loading, specifically compression, is a consistent reason for loss of reduction in intraarticular distal radius fractures. The clinical implications of these results suggest that an internal fixator theoretically can prevent loss of reduction in the axial plane and maintain palmar tilt by acting as a rigid dorsal buttress. In addition, the use of an internal fixator potentially decreases the high morbidity associated with external fixation. Additional investigation into the clinical application of internal fixators for distal radius fractures is needed.

Biomechanical Phenomena↗
PubMed1998

Fixation comparison for chevron osteotomies.

A comparison study of temporary K-wire fixation, permanent Herbert Whipple screw fixation, versus no osteotomy fixation was performed on distal chevron osteotomies for hallux valgus deformities. Nineteen chevron osteotomies were performed on 17 patients. Six patients received a Herbert Whipple screw for fixation, seven patients received temporary K-wire fixation, and six patients received no fixation for the chevron osteotomy. The average postoperative hallux valgus (HV) angle improved by 7.1 degrees with no fixation, 6.3 degrees with temporary K-wire fixation, and 9.5 degrees with Herbert Whipple screw fixation. Comparison of the three groups using the Student's t-test revealed no statistical difference between the three groups (P = 0.6). The increased anesthesia time and operative costs for Herbert Whipple screw fixation was found to be statistically significant in comparison with the use of no fixation (P = <0.001). Time and cost studies were not significantly different for the K-wire and no fixation groups. Follow-up averaged 3.3 years. All patients reported satisfaction with the procedure and an improvement of their preoperative complaints. No significant difference in patient satisfaction was found to exist between the groups receiving fixation and those who did not have fixation. The results of this study can find no long-term benefit when comparing costs and patient satisfaction with the use of any temporary or permanent fixation of osteotomy sites when performing chevron osteotomies.

Adult↗
PubMed1994

The pinless external fixator--relevance of experimental results in clinical applications.

The pinless external fixator was intended as a stable, temporary, minimally invasive fixator for severe tibial fractures ensuring safer conversion to an intramedullary nail. An in vitro study showed that the pinless fixator was mechanically not as stiff as the conventional AO tubular device, the main problem being low axial stiffness. This study involving initial clinical trials with the pinless fixator on tibial fractures in St. Gall is based on the experimental work and previous clinical experience of the main author. From June 1992 to June 1994 10 tibial fractures (eight II degrees and III degrees open, one closed with compartment syndrome, one infected non-union) were temporarily stabilized with a pinless fixator. In another patient a calcaneal traction device was applied. The pinless fixator was applied immediately in eight cases and three times as a secondary measure. All patients were scheduled for a secondary change of treatment. The tibiae were stabilized with four clamps and one anterior rod. The clamps were inserted via transverse stab incisions. Intraoperatively the pinless fixator was easy to handle and complications did not occur. Seven different surgeons needed an average of 20 minutes for insertion. Postoperative care was the same as for conventional fixators. Six patients were treated secondarily with an i.m. nail, three with an external fixator on average after 12 days. One patient died on day 1. The pinless fixator failed twice in one patient (incorrect insertion, fall). Reversible pain in the tendons of the foot extensor muscles was noticed. One superficial clamp track infection was seen. All clamps were reused more than three times. The pinless fixator is stable enough for temporary fracture fixation of the tibia in a four clamp one bar construction. A prerequisite for stability is the proper application technique ("grab test", rocking movements). Weight-bearing should be limited to a minimum and needs a compliant patient. The application technique is easy to learn suggesting that the pinless fixator could be an ideal tool for emergency stabilization. The primary application of this fixator leaves all further treatment modalities open (repeated debridements, evaluation of the open fracture). It may also be of particular value to many clinicians working with reamed nails as their only secondary treatment option for open tibial fractures.

Adult↗
PubMed2006

Biomechanical comparison of four C1 to C2 rigid fixative techniques: anterior transarticular, posterior transarticular, C1 to C2 pedicle, and C1 to C2 intralaminar screws.

OBJECTIVE: We performed a biomechanical comparison of several C1 to C2 fixation techniques including crossed laminar (intralaminar) screw fixation, anterior C1 to C2 transarticular screw fixation, C1 to 2 pedicle screw fixation, and posterior C1 to C2 transarticular screw fixation. METHODS: Eight cadaveric cervical spines were tested intact and after dens fracture. Four different C1 to C2 screw fixation techniques were tested. Posterior transarticular and pedicle screw constructs were tested twice, once with supplemental sublaminar cables and once without cables. The specimens were tested in three modes of loading: flexion-extension, lateral bending, and axial rotation. All tests were performed in load and torque control. Pure bending moments of 2 nm were applied in flexion-extension and lateral bending, whereas a 1 nm moment was applied in axial rotation. Linear displacements were recorded from extensometers rigidly affixed to the C1 and C2 vertebrae. Linear displacements were reduced to angular displacements using trigonometry. RESULTS: Adding cable fixation results in a stiffer construct for posterior transarticular screws. The addition of cables did not affect the stiffness of C1 to C2 pedicle screw constructs. There were no significant differences in stiffness between anterior and posterior transarticular screw techniques, unless cable fixation was added to the posterior construct. All three posterior screw constructs with supplemental cable fixation provide equal stiffness with regard to flexion-extension and axial rotation. C1 lateral mass-C2 intralaminar screw fixation restored resistance to lateral bending but not to the same degree as the other screw fixation techniques. CONCLUSION: All four screw fixation techniques limit motion at the C1 to 2 articulation. The addition of cable fixation improves resistance to flexion and extension for posterior transarticular screw fixation.

Aged↗
PubMed1996

[Secondary internal osteosynthesis after external fixation for recent or old open fracture of the lower limb].

PURPOSE: The purpose of our study is to analyse the indications, results and limits of secondary internal fixation after external fixation for open fracture of the lower limb. MATERIAL: Our series covered 21 patients treated between 1991 and 1994. There were 17 men and 4 women. Tibia was affected 17 times and femur 5 times (one bifocal fracture). In Gustilo's classification, we had 1 case of type 1, 12 of type II and 8 of type III. METHODS: We used 15 times the FESSA External Fixator and 6 times a monotube external fixator in emergency. We have done secondary 11 intra medullary nailing and 11 patients were treated by plating (one patient had both) 13 patients had a bone graft (cortico-cancellous graft). In the first group of patients (10 cases), the initial treatment gave us good results for both skin and bone healing. The external fixation was replaced by an internal one in order to accelerate bone consolidation and to allow an early weight-bearing. Removal of the external fixation was made at an average of 4 months postoperative. In the Second group (11 cases) the internal fixation was proposed because of an insufficiency of the external fixation leading to complications as: non union, mal union and bone defects. External fixation was removed in a mean time of 8 months. Internal fixation was completed by local bone autograft. RESULTS: 17 patients have been reviewed. Consolidation occurred with an average of 6 months after internal fixation 1 to 24 months. We had no deep infection but only 2 superficial ones. DISCUSSION: We chose 2 types of indication, and we called them programmed and for necessity. The first group of 10 patients whose stain was moderate and whose initial setting up had permitted a perfect anatomic reduction with a rapid wound healing. Internal fixation was performed after a short duration of external fixator. An early weight bearing was allowed so that the functional recovery could be obtained quickly. The second group is represented by patients whose internal fixation was done for non union, malunion or bone defect. In such a case autogenous cancellous graft was used to fill the defect.

Adolescent↗
PubMed1994

Fixation of bioprosthetic tissues with monofunctional and multifunctional polyepoxy compounds.

Collagen from a native tissue is fixed with a polyepoxy compound (PC) for use as a new biologic prosthetic material. Prior studies have shown that this biomaterial has comparable properties with collagen fixed with glutaraldehyde (GA), and thus has great promise for biomedical applications. A prior kinetic study indicated that the reaction between the functional groups of collagen and the multifunctional epoxy EX-313 is a 2.5th-order reaction. The purpose of this study was to understand the mechanism of the amino acid-PC reactions in a fixation process. Bovine arteries were fixed with a monofunctional PC (EX-131) and a multifunctional PC (EX-313) as a function of fixation time. A sequential fixation with a second fixative was used to identify the available remaining reactive sites from a prior fixation. The denaturation temperature (Td) was measured on each sample. Because the denaturation temperature is a direct indication of crosslinking of individual amino acids with the fixative, the increase in Td of a subsequent fixation may be indicative of the available remaining amino acids. The fixation index was measured on each sample to reflect the increase of fixation completion in a sequential fixation process. The fixation index and crosslink data also revealed that the reactive amino acids for EX-131 and EX-313 may not be exactly the same. The data in this study suggest that a monofunctional fixative can pre-react with the amino acids of collagen to effectively block further fixation of collagen with a second fixative. This amino acid masking may be associated with collagen branching. Collagen branching and its effect on denaturation temperature are described.

Animals↗
PubMed1999

Comparison of polylactide screw and expansion bolt in bioabsorbable fixation with patellar tendon bone graft for anterior cruciate ligament rupture of the knee. A preliminary study.

In a preliminary study, 24 patients with rupture of the anterior cruciate ligament (ACL) were operated on using implants made of self-reinforced poly-l-lactide (SR-PLLA). The operation method was outside-in bone-tendon-bone reconstruction. In 10 patients the fixation was made with an SR-PLLA screw with a diameter of 6.3 mm, in 12 with an SR-PLLA expansion plug with a diameter of 6.0 mm, and in two cases both implants were used, but these cases were excluded from comparison. The purpose of the study was to evaluate and compare the use and fixation results of these two implants. The follow-up time averaged 3.2 years. Twenty patients attended follow-up. On subjective evaluations, seven of the eight patients following SR-PLLA screw fixation and six of the ten after expansion plug fixation regarded their knee as normal or nearly normal. Arthrometric testing showed the side-to-side difference to average 2. 9 mm following SR-PLLA screw fixation and 2.6 mm after expansion plug fixation (NS). Six of the patients had giving-way symptoms (two after screw fixation and four after plug fixation). The pivot shift test was slightly positive in two patients and positive in one patient after SR-PLLA screw fixation, and in three knees slightly positive and in another three knees positive following expansion plug fixation. Radiography showed variation in the location and orientation of the bone channels. Magnetic resonance imaging was performed in seven cases, and in two cases an edema was found in the tendon of the anterior cruciate ligament graft and in six cases the implants were visible. No statistical difference in results between the SR-PLLA screw and SR-PLLA expansion bolt was noted. Fixation with expansion plug seems technically more challenging, with a tendency to inferior results compared to screw fixation. In the absorbable fixation of a bone-tendon-bone graft there are no metallic artifacts on magnetic resonance imaging and no need to remove the fixation material regarding the revision surgery.

Absorbable Implants↗
PubMed2005

Binocular fixation topography in patients with diabetic macular oedema: possible implications for photocoagulation therapy (3rd revision).

BACKGROUND: During retinal photocoagulation for diabetic maculopathy, there is a potential risk of foveal burns, and laser scars may later enlarge to be sight-threatening when involving retinal areas previously used during fixation. Since the retinal area used during binocular steady fixation has been found to vary considerably in the normal test person and central fixation may be even further compromised in patients with diabetic maculopathy, the sight-threatening side effects could possibly be reduced by taking into account the fixation area individually. However, no study has described and quantified the retinal area of fixation binocularly in patients with clinically significant macular oedema (CSME). METHODS: Sixteen diabetic patients with CSME in one or both eyes were examined. Each examination included visual acuity testing (ETDRS charts), a standard eye examination, central retinal thickness assessment by optical coherent tomography, fluorescein angiography and binocular quantification of fixational eye movements using an infrared recording technique. RESULTS: A negative correlation was found between visual acuity and mean microsaccadic amplitude (R=0.48, p=0.009). The maximal retinal extension of the fixation area ranged between 1.0 degrees and 3.0 degrees , and in two eyes with CSME, this area was estimated to exceed 800 mum on the retinal plane. No correlation was found between retinal thickness and visual acuity, retinal area of fixation, maximal extension of the fixation area or mean microsaccadic amplitude. CONCLUSION: Large interindividual differences in quantitative measures of binocular fixational eye movements were found. The mean amplitude of fixational eye movements was not correlated to central retinal thickness, and fixation area could only partly be predicted by visual acuity. Two eyes with CSME had an estimated maximal extension of the fixation area exceeding the central 800 mum on the retinal plane; thus, the possible benefit of individualising central photocoagulation according to precise measures of fixation area needs to be investigated on a larger population.

Adult↗
PubMed1996

Fixation patterns and reading rates in eyes with central scotomas from advanced atrophic age-related macular degeneration and Stargardt disease.

PURPOSE: To study fixation patterns and reading rates in eyes with central scotomas from geographic atrophy (GA) of age-related macular degeneration and to compare fixation patterns with those of patients with Stargardt disease. METHODS: Scanning laser ophthalmoscope analysis of fixation patterns in eyes with 20/80 to 20/200 visual acuity. Included were 41 eyes of 35 patients with GA and 10 eyes of 5 patients with Stargardt disease. The patients with GA also were tested for maximum reading rate, and the size of the areas of atrophy were measured by fundus photograph analysis. RESULTS: Sixty-three percent of GA eyes fixating outside the atrophy placed the scotoma to the right of fixation in visual field space, 22% placed the scotoma above fixation, and 15% placed it to the left, regardless of the laterality of the GA eye. Fixation was stable in subsequent years of testing for scotoma placement to the right of or above fixation. All GA eyes fixated immediately adjacent to the atrophy. In contrast, seven of ten eyes with Stargardt disease fixated at a considerable distance from the scotoma border, with the dense scotoma far above the fixation site in visual field space. For the patients with GA, the maximum reading rate was highly correlated with size of the atrophic area, but not with age or visual acuity within the limited visual acuity range tested. There was a trend to more rapid reading with the scotoma above fixation and slower reading with the scotoma to the left. CONCLUSION: There is a preference for fixation with the scotoma to the right in eyes with GA. Patients with Stargardt disease use different strategies for fixation, perhaps due to subclinical pathology adjacent to the atrophic regions. The size of the atrophic area in GA plays the predominant role in reading rate for eyes that have already lost foveal vision.

Adolescent↗
PubMed1984

Evaluation of nine different fixatives. 1. Preservation of immunoglobulin isotypes, J chain, and secretory component in human tissues.

Eight cross-linking fixatives were tested for their ability to preserve IgG, IgA, IgM and IgD isotypes, J chain, and secretory component (SC) in paraffin-embedded specimens of human tonsils and colonic mucosa. The results were compared with the antigenic preservation afforded by cold 96% ethanol (with or without inclusion of a prefixation 48-hr washing period). A semiquantitative immunofluorescence scoring system was applied. In relation to the cytoplasmic scores of 3.0 assigned to IgG and IgA immunocytes after ethanol fixation, the following median scores were obtained with the other fixatives: routine formalin, 1.3 (IgG and IgA); glutaraldehyde (1%)-formalin, 0.3 (IgG and IgA); Baker's formol calcium, 2.3 (IgG) and 1.5 (IgA); formol sublimate, 1.0 (IgG) and 1.2 (IgA); acetic acid (2%)-formol saline, 2.0 (IgG and IgA); Bouin's fluid and Susa fixative, 0 (IgG) and 1.3 (IgA); and carbodiimide, 2.3 (IgG) and 2.0 (IgA). Most aldehyde-based fixatives afforded poorer result for IgA immunocytes when an anti-alpha-chain reagent of restricted specificity was applied. The result was usually slightly better for IgM cells than for IgG cells, but IgM did not resist fixation in Bouin's fluid and Susa fixative to the same extent as IgA. IgD immunocytes were poorly revealed except after fixation with Baker's formol calcium, carbodiimide, and acetic acid-formol saline, which afforded median fluorescence scores of 1.0-1.8 compared with 3.0 after ethanol fixation. J chain in IgA immunocytes was most intensely stained in sections of ethanol-fixed tissue denatured in acid urea (median score, 3) but was also well revealed after fixation with formalin, acetic acid-formol saline, Bouin's fluid or Susa fixative (median scores, 1.8-2.0). The results with most of the cross-linking fixatives were much less favorable for IgA, IgM, J chain and SC in colonic crypt epithelium than in immunocytes. Only carbodiimide afforded fluorescence scores for IgA and SC approaching those obtained after ethanol fixation (2.0 and 1.5 vs. 3.0 and 2.8). The effect of proteolytic unmasking depended on the fixative - not only for different antigens and locations in the tissue, but also for the same antigen in apparently similar cells.

Colon↗
PubMed1999

Contributions of femoral fixation methods to the stiffness of anterior cruciate ligament replacements at implantation.

One purpose of this study was to determine the stiffness of three femoral fixation methods used commonly in anterior cruciate ligament (ACL) reconstruction to secure a double-looped semitendinosus and gracilis (DLSTG) graft and then assess how the stiffness of these methods affects the stiffness of the young human femur-fixation method-graft complex at the time of reconstruction. A second purpose was to define principles for adjusting the stiffness of the ACL replacement (defined as the femoral fixation method plus DLSTG graft plus tibial fixation method) to match that of the native ACL. The stiffness of a DLSTG graft and the stiffness of the femur-fixation method-DLSTG graft complex for three endoscopic fixation methods were measured. Fixations of the DLSTG graft to a button, anchor, and post, both with and without compaction of bone, were tested in young, human femur. The stiffness of each fixation was calculated by modeling the DLSTG graft and fixation method as a series of springs. The stiffness of the DLSTG graft averaged 954+/-292 N/mm. The stiffness of the DLSTG graft-fixation complex was lowered fourfold to 40-fold by adding fixation. The method of fixation determined the reduction in stiffness. The stiffness of the femur-button-DLSTG graft complex averaged 23+/-2 N/mm, the femur-anchor-DLSTG graft complex averaged 25+/-3 N/mm, and the femur-post with bone graft-DLSTG graft complex averaged 225+/-23 N/mm (P = .0001). The knot in the suture loop was the least stiff component and determined the stiffness when the DLSTG graft was fixed with both the button and anchor. Compaction of bone significantly increased stiffness by an average of 41+/-14 N/mm (P = .027). Because the stiffness of femoral fixation methods are 4 to 40 times less than the stiffness of the graft, increasing the stiffness of an ACL replacement would be best achieved by selecting fixation methods with higher stiffness and not by either shortening the graft or increasing the cross-sectional area of the graft.

Adult↗
PubMed1999

Functional outcome of internal fixation for pelvic ring fractures.

OBJECTIVE: Evaluation of the functional outcome after unstable pelvic ring fractures stabilized with internal fixation. METHODS: Between January 1, 1990, and September 1, 1997, 37 patients were treated with internal fixation for unstable pelvic fracture. Demographic data, type of accident, Hospital Trauma Index-Injury Severity Score, and fracture type according to Tile classification were scored. One patient died the day after the accident from neurologic injury. A Short Form-36 health questionnaire and a form regarding functional result after pelvic trauma, adapted from Majeed et al., were returned by 31 of 36 patients (86%). Twenty-eight patients (78%) were seen for physical and radiologic examination. RESULTS: Twenty-six men and 11 women, with an average age of 34.7 years (range, 15-66 years) were included. The mean Injury Severity Score reached 30.4 (range, 16-66). According to the Tile classification, there were 16 type B fractures and 21 type C fractures. Seven patients were treated with open reduction and internal fixation of the pubic arch, 10 patients were treated with a combination of anterior open reduction and internal fixation with additional external fixation to increase the stability of the posterior ring. Nineteen patients underwent internal fixation of both anterior and posterior arch. In the remaining case, percutaneous posterior screw fixation was combined with anterior external fixation, because of estimated infectious risk. The average follow-up time was 35.6 months. Patients scored 78.6 of 100 on the Majeed score. Remarkable was the reported change in sexual intercourse in 12 patients (40%). Only 12 patients (40%) did not have complaints when sitting. On the SF-36 scales physical and social functioning, role limitations due to physical problems and vitality were limited compared with the averages for the Dutch population. Patients treated with combined anterior and posterior internal fixation scored significantly better on both the Majeed score and on the categories physical functioning, pain, general health and social functioning compared with patients with similar fractures treated with a combination of anterior internal fixation with external fixation. At the physical examination, 11 of 28 patients (39%) did not have any abnormality. Nineteen patients (68%) were back at their original job, which was physically demanding in 9 cases. There was a suspicion of nonunion of the posterior arch in two patients, which could be confirmed with a computed tomographic scan. CONCLUSION: In general, limitations in functioning are reported, even after long-term follow-up. In partially unstable fractures, solitary anterior fixation gives good results. In completely unstable fractures, patients treated with combined internal fixation anterior as well as posterior scored a better outcome compared with combined internal and external fixation. Therefore, this technique is recommended as treatment of first choice in completely unstable fractures.

Activities of Daily Living↗
PubMed2006

Biomechanics of occipitocervical fixation.

STUDY DESIGN: A human cadaveric biomechanical study comparing occipital fixation techniques. OBJECTIVES: To compare ranges of motion between midline and lateral occipital fixation and between rigid and nonrigid occipital fixation of an unstable craniocervical spine. SUMMARY OF BACKGROUND DATA: New fixation techniques using rods and screws increase surgical choice on where fixation is placed onto the occiput. Lateral fixation theoretically gives improved resistance to deformation because of its increased effective moment arm and bilateral purchase. Midline fixation allows significantly longer screw purchase. This study compares these two fixation location. METHODS: Cadaveric occipital cervical spine specimens were tested biomechanically intact and under six different fixation techniques. Range of motion between the skull and C2 at 1.5 N-m and 2 N-m bending moments was measured in flexion-extension, lateral bending, and axial rotation. Mechanical testing of different rod diameters and a reconstruction plate was performed and compared with biomechanical testing. Results were compared between the intact condition and all fixations, between the medial and lateral fixations, and between the rigid and nonrigid fixations by analysis of variance. RESULTS: The range of motion of all constructs was significantly reduced compared with intact. Significant differences between groups were only seen in lateral bending in fixation placed laterally. Mechanical testing demonstrated that construct stiffness was predicted by area moment of inertia of the rod and plate to a greater degree than variation in placement of occipital screws or locking of the implant. CONCLUSION: The choice of location of occipital fixation should be based more on the ease of use and instability pattern. The decreased stiffness of the newer small rod systems should be considered.

Biomechanical Phenomena↗
PubMedDate not supplied

Flexible external fixation for craniodorsal coxofemoral luxations in dogs.

An external fixator consisting of two Ellis pins connected by a flexible band was developed and evaluated as a treatment for craniodorsal coxofemoral luxations in dogs. The technique for closed application of the fixator without injury to the coxofemoral joint or sciatic nerve was developed in six dog cadavers. The coxofemoral joints were then surgically destabilized and the limbs were manipulated through a full range of motion to assess the efficacy of the fixator in maintaining joint reduction. The fixator maintained joint reduction and stability after a surgically created craniodorsal luxation except when the femur was externally rotated 90 degrees. A flexible external fixator was then applied unilaterally in four healthy dogs. The dogs tolerated the fixator well and were bearing weight on the limb within 2 days after surgery; the range of motion was not limited by the fixator. The efficacy of a flexible external fixator in maintaining joint reduction after craniodorsal coxofemoral luxation was then evaluated in eight large dogs. The right coxofemoral joint in each dog was luxated surgically by removal of the dorsal joint capsule and transection of the ligament of the head of the femur and deep gluteal muscle. The joint was reduced and the fixator pins were applied in a closed fashion. In four dogs, a flexible external band was applied to the pins. Luxation did not reccur in these four dogs. The bands were not applied initially in four control dogs. Luxation occurred in three of the four control dogs within 24 hours of surgery. The joints that luxated were reduced and the flexible bands applied. Luxation did not recur after the bands were in place. The dogs tolerated the external fixators well, were bearing weight within 2 days of surgery, and walking with only minimal lameness 5 days after surgery. Luxation of the coxofemoral joints did not occur during the 2-week period in which the fixators were in place. The joints remained stable 1 week after removal of the fixators, at which time the dogs were euthanatized. Necropsy evaluation identified inflammation surrounding the pins and fibrous thickening of the dorsal joint capsule. The flexible external fixators were applied closed, maintained reduction of the coxofemoral joint after replacement of a craniodorsal luxation, and allowed weight bearing and limb usage soon after surgery. The flexible external fixator has several advantages over other methods of treating craniodorsal coxofemoral luxations. Complications noted in this study included pin tract drainage, pin loosening, and disruption of the flexible bands.

Animals↗
PubMedDate not supplied

Fixation techniques for fine needle aspiration biopsy smears prepared off site.

OBJECTIVE: To identify a simple, cost-effective, reliable fixation method for fine needle aspiration biopsy (FNAB) yielding a specimen suitable for mail transport. STUDY DESIGN: Smears prepared from 59 FNABs of surgical specimens were fixed by continuous fixation in 95% ethanol, spray fixation, air drying, ethanol fixation for either 5 minutes or 4 hours followed by spray fixation, or fixation in 95% ethanol for either 30 minutes or 4 hours followed by air drying. Fixation was graded as unsatisfactory, suboptimal, average, good or excellent. RESULTS: Of smears continuously fixed in ethanol, 96.6% were graded as excellent. Of smears fixed in ethanol followed by spray fixation, 93.2% were excellent irrespective of fixation time; 64.4% of spray-fixed smears were excellent and 27.1% good. Of air dried smears, 93.2% were unsatisfactory or suboptimal; 83.0% of smears fixed in ethanol for 30 minutes and 74.6% of smears fixed for 4 hours prior to air drying were unsatisfactory or suboptimal. CONCLUSION: Fixation of smears in 95% ethanol followed by spray fixation produces excellent results, comparable to those with continuous fixation in ethanol. Spray fixation is generally good but not consistently excellent. Air drying or fixation in ethanol followed by air drying yields unsatisfactory or suboptimal results in most cases.

Biopsy, Needle↗