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PubMedDate not supplied

Complications associated with internal fixation of high-energy bicondylar tibial plateau fractures utilizing a two-incision technique.

OBJECTIVES: Single incision open reduction and double plate fixation of complex tibial plateau fractures has been associated with high wound complication rates. Minimally invasive methods have been recommended to decrease the wound complication rates as compared with open techniques. Additionally, laterally applied fixed-angle devices appear to minimize late varus deformity without the need for additional medial stabilization. Accurate reduction of comminuted lateral and/or medial articular surfaces, however, often requires visualization through an open reduction. This study reports the complications, infection rate, and radiographic assessment of reduction associated with double plating complex AO/OTA 41-C3 tibial plateau fractures utilizing 2 incisions. DESIGN: Retrospective clinical review. SETTING: Urban level 1 university trauma center. PATIENTS: Over a 77-month period, 83 patients were treated for a complex bicondylar tibial plateau fracture at our institution utilizing a 2-incision technique. INTERVENTION: Dual plating using anterolateral and posteromedial incisions. MAIN OUTCOME MEASURE: Type and incidence of septic and non-septic complications and radiographic assessment of articular reduction and axial alignment. RESULTS: Eleven fractures were open (13.3%) and classified according to Gustilo as type II (1 patient), type III-A (7 patients), type III-B (2 patients), and type III-C (1 patient). Compartment syndrome was diagnosed and treated with fasciotomies in 12 patients (14.5%). The average time interval from injury to definitive surgical treatment was 9 days. Seven patients developed deep wound infections (8.4%). Three of these had an associated septic arthritis (3.6%). Clinical resolution of infection occurred after an average of 3.3 additional procedures. The presence of a dysvascular limb requiring vascular reconstruction was statistically associated with a deep wound infection (P = 0.006). Secondary procedures for complications included 13 patients who required removal of implants secondary to local discomfort, 5 patients who required a knee manipulation, 2 patients that were managed with excision of heterotopic ossification to improve knee motion, 1 patient that required an equinus contracture release, and 1 patient treated for a metadiaphyseal nonunion. Sixteen patients (19.3%) incurred deep venous thromboses. No patient was diagnosed with pulmonary embolism. Sixty-two percent of patients demonstrated satisfactory articular reductions, 91% demonstrated satisfactory coronal alignment, 72% demonstrated satisfactory sagittal alignment, and 98% demonstrated satisfactory condylar width. CONCLUSIONS: Comminuted bicondylar tibial plateau fractures can be successfully treated with open reduction and medial and lateral plate fixation using 2 incisions. Dysvascular limbs requiring vascular repair are at increased risk for deep sepsis. The use of 2 incisions, temporary spanning external fixation, and proper soft-tissue handling may contribute to a lower wound complication rate than previously reported.

Adult↗
PubMed1998

Drill-hole guide for internal fixation of fractures of the mandibular condyle.

We have developed a drill-hole guide valuable in accurately positioning the fracture of the mandibular ramus. It operates by introducing a Kirschner wire through the fracture stump from the mandibular angle to the condyle. A 2.0- to 2.4-mm-diameter Kirschner wire is drilled into the ramus from below and proceeds up to the condylar fragment through the stump of the fracture. With this guide, 15 patients with 23 subcondylar fractures underwent open reduction with Kirschner wire fixation. In each case, wire, by means of a pinning technique, was inserted accurately from the mandibular angle to the repositioned condyle.

Adult↗
PubMed1984

The effects of internal fixation on the articular cartilage of unfused canine facet joint cartilage.

Custom-made distraction instrumentation was placed in the lumbar spine of eight large dogs with care taken to preserve the integrity of two intervening apophyseal joints. Histologic staining of immobilized joint cartilage showed varying degrees of chondrolysis, cloning, invasion of the tide mark, and loss of proteoglycans as early as 2 months postoperatively. Every specimen had significant degenerative changes characteristic of osteoarthritis. The joints one segment caudal to the lower hooks also were examined and were found to have similar histologic evidence of degeneration. Three dogs had the instrumentation removed and were then sacrificed 1.5-3 months later. The degenerative changes were not reversible following instrumentation removal.

Animals↗
PubMed2005

Femoral neck fracture in a child with autosomal-dominant osteopetrosis: failure of spica cast treatment and successful outcome by internal fixation.

A case report of a 6-year-old child with autosomal dominant osteopetrosis who sustained a closed femoral neck fracture initially treated with a spica cast with subsequent fracture displacement is presented. Further treatment included closed reduction and operative fixation, first, with a guide pin placement for a cannulated screw insertion that was abandoned because of the hardness of the bone. Three Kirschner wires were then inserted to maintain the closed reduction, followed by immobilization in a spica cast. At the 2-year follow-up, the child was completely free of any complications resulting from her injury and treatment. Radiographs showed no evidence of avascular necrosis in the affected femoral head. Review of the literature supports evidence for early operative fixation of such cases, whether or not the femoral neck fracture is nondisplaced or displaced.

Casts, Surgical↗