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PubMed1993

Static fixation of finger fractures.

Static fixation of the fingers by external fixators means external stabilization of a fractured digit or phalanx or preservation of length of the affected segments until bone grafting and bone healing are achieved. During the treatment course, distraction or compression are not applied to the callus. The static fixation does not mean the lack of dynamic influences, it depends on the mechanical characteristics of the device applied. Our mini external stabilizer compared with the former rigid fixators can be considered a semiflexible, and therefore semidynamic, device owing to its metallurgic characteristics, which are proved by the secondary bone healing achieved in our clinical cases.

Bone Transplantation↗
PubMed2006

Cost benefit with early operative fixation of unstable ankle fractures.

INTRODUCTION: Ankle fractures are common and many require surgical intervention. It has been well documented that a delay in fracture fixation results in increased length of hospital stay and increased complication rate. Initial delay can also allow swelling or blistering to develop which may necessitate a further delay in operative fixation for up to 1 week. The aim of the current study was to review the length of hospital in-patient stay for operative ankle fractures over the previous 12-month period at our hospital and compare this to the length of hospital stay following the introduction of a fast-track system for the fixation of these fractures (all fractures fixed within 48 h). PATIENTS AND METHODS: A retrospective review of all ankle fractures managed by open reduction and internal fixation over a 12-month period was undertaken. A protocol was then agreed to openly reduce and fix these fractures at the earliest possible opportunity over the next 6-month period. We then collected the data on all ankle fractures that needed open reduction and internal fixation over this 6-month period. The pre-protocol and post-protocol groups were then compared for total hospital length of stay and complication rate. RESULTS: In the 12-month retrospective review, there were 83 ankle fractures that required surgical intervention. Sixty-two of these had surgery within 48 h (mean length of stay, 5.4 days), and 21 had surgery after 48 h (mean length of stay, 9.5 days). There were 39 ankle fractures in the post-protocol group who all had surgery within 48 h (mean length of stay, 5 days). There was no increase in complication rate after implementation of the fast-track system. CONCLUSIONS: This study shows that early operative intervention for ankle fractures reduces the length of hospital stay. Intensive physiotherapy and co-ordinated discharge planning are also essential ingredients for early discharge. Early operative fixation for unstable ankle fractures has substantial cost-saving implications with no increase in complication rate.

Adult↗
PubMed2006

The olecranon sled--a new device for fixation of fractures of the olecranon: a mechanical comparison of two fixation methods in cadaver elbows.

BACKGROUND: Tension band wiring is the most common surgical procedure for fixation of fractures of the olecranon, but symptomatic hardware prominence and migration of K-wires can cause a high re-operation rate. The olecranon sled has been designed to minimize some of these problems. MATERIAL AND METHODS: Simulated olecranon fractures were created in 6 matched pairs of cadaver arms. Each pair was fixed with tension band wiring used on the one arm and the olecranon sled being used on the other. Mechanical testing was done with the humerus rigidly fixed in a vertical position while the forearm was held at 1 of 3 angles of elbow fixation, 45 degrees , 90 degrees and 135 degrees , respectively. For each angle, the triceps and the brachialis muscles were sequentially loaded with 5 kg (50 N) for 20 cycles and the amount of fracture displacement measured. RESULTS: Loading of the brachialis muscle produced no increase in the fracture gap for either of the two fixation techniques. However, an increase in the fracture gap of up to 0.23 mm was found after cyclic loading of the triceps muscle for both techniques. The amount of increase was not significantly different between the two techniques. INTERPRETATION: The olecranon sled appears to provide as stable fixation as tension band wiring for olecranon fractures.

Adult↗
PubMed1999

The merit of sintered PDLLA/TCP composites in management of bone fracture internal fixation.

Polyesters based on lactic acid have been reported in terms of safety and biodegradation in human beings for 2 decades. The greatest advantage of such material is its degradation conducted only by hydrolysis, whereby the ester backbones are supposed to be unchained in the aqueous condition. The final degradable products are carbon dioxide and water which can be metabolized and digested in the physiological environment. The goal of this study was aimed at developing a composite sintered with poly-DL-lactide (PDLLA) and tricalcium phosphate (TCP) ceramic particles for orthopedic application. The TCP particles in a range of 30-60 wt% with 5 wt% increments were doped into the PDLLA matrix which was prepared by melting and hot pressing techniques for the reinforcement. The basic mechanical strength, biodegradable behavior, and biological response of the composites were investigated in the study. Various techniques such as pH meter, UV, Fourier-transform infrared, and x-ray diffractometer were used to examine and record the degradable process of the composites soaked in saline for 1-16 weeks. The rabbit femur condyle fracture fixation test was used to evaluate tissue compatibility and the effects of bone fracture fixation on the composites. Histological observation and x-ray photography were used for investigating assistance. The mechanical strength of the composites initially increased with TCP additions up to 50wt%, but thereafter they showed no significant difference (p < 0.05). The composite with 50 wt% TCP addition showed greater mechanical strength and had good agreement with cortical bone in terms of its elastic modulus of 30-40 GPa. The weight loss of the pure PDLLA soaked in the saline started at 4 weeks and reached 95% after 16 weeks. The composites compared with pure PDLLA, however, showed no apparent evidence of degradation after soaked for 12 weeks. The possible mechanisms for the delayed degradation of the composites in saline might have been solution penetration retardation by the ceramic particles and chemical bonds formed between the interface of the TCP particles and the PDLLA matrix. In the histological evaluation of the rabbit femur condyle fracture fixation test, the surface of the composite with 50 wt% TCP addition was attached by the newly generated bone without fibrous tissue around 8 weeks after implantation. The fractured bone was gradually healed and the composite firmly and properly fixed on the fracture area during the implanted period, which provided a breeding environment for normal bone remodeling. The developed composite was thought to be an alternative material for orthopedic application in the future, especially for bone screws and bone plates.

Absorption↗
PubMed1989

External fixation of fractures and fracture dislocations of the pelvis.

External fixation of pelvic fracture dislocations is appropriate when reduction must be accomplished by noninvasive methods which are nonetheless capable of precise regulation. The corrective frames described can be applied with minimal trauma and are capable of orientating the necessary corrective forces in the required directions to reduce the wide variety of bony displacements and dislocations encountered in these injuries. The apparatus is flexible and the choice of particular technique and assemblies is determined by evaluating the biomechanics of the mechanism of injury and applying the appropriate antagonist forces. These forces operate in three fundamental planes: anteroposterior, lateral and vertical. The author describes and illustrates how the assembly may be used to operate in these planes and reduce and stabilise a variety of displacements encountered in fractures and fracture dislocations of the pelvis.

Biomechanical Phenomena↗
PubMed1997

The preliminary study and tentative animal study on the sintered PDLLA/TCP composites as bone fracture internal fixation.

Polyesters based on the lactic acid have been reported safety and biodegradation in the human beings for two decades. The greatest advantage of the material is its degradation only conducted by the hydrolysis, where the ester backbones are supposed to be unchained in the aqueous condition. The final degradable products are carbon dioxide and water which can be metabolized and digested in the physiological environment. The goal of this study was aimed to develop a composite sintered with poly-DL-lactide (PDLLA) and tricalcium phosphate (TCP) ceramic particles as orthopedic application. The TCP particles in a range of 30-60 wt% (with 5 wt% increment) were doped into the PDLLA matrix for the reinforcement, which were prepared by the melting and hot pressing techniques. The basic mechanical strength, biodegradable behavior, and biological response of the composites will be investigated in the study. Various techniques, such as pH meter, UV, FTIR, XRD ect., were used to examine and record the degradable process of the composites soaked in the saline for 1-16 weeks. The rabbit femur condyle fracture fixation test was used to evaluate the tissue compatibility and the effects of bone fracture fixation of the composites. The histological observation and x-ray photography were applied for investigating assistance. In the histological evaluation of rabbit femur condyle fracture fixation test, the surface of the composite with 50 wt% TCP addition was attached by the new generated bone without fibrous tissue around after 8 weeks implantation. The fracture bone was gradually healing and the composite always firmly and properly fixed on the fracture area during the implanted period, which provided a breeding environment for normal bone remodeling. The developed composite was thought to be an alternative material for orthopedic application in the future, especially in bone screw and bone plate.

Animals↗
PubMed2000

[The internal fixation of fractures in children].

The internal fixation of fractures of shaft bones was spread out by a group of surgeons working together with Prevot. The principle of this method is a three point load carrying paragraph sign(entry point, height of fracture and cancellous bone of the metaphysis of the opposite fracture part). From 1996 to 1999 86 children with fractures of the humerus, the fore-arm and the femur were operated in the technique of intramedullary nailing. The fractures affected the humerus to 3.5 %, the fore-arm to 65.1 % and the femoral shaft to 31.4 %. The postoperative duration of stay in hospital after internal fixation of the fore-arm in the proximal and middle third lasted 7.2 days, the duration of immobilisation in a cast took 13.7 days. 96 % of the patients showed very good and good results after operation. The average stay in hospital for patients with femoral shaft fractures was 14.4 days. 17 weeks after operation the intramedullary nails were removed. At the time of first full weight bearing the legs showed an average shortening of 1.2 cm. The fractures of the humerus healed without any restriction of movements. Internal fixation is a minimal invasive operation technique with low risks and small operating trauma. Due to the stability a early mobilisation is possible. The reported results in the literature are all good. The only problem can be caused by too long nails irritating the skin.

Biomechanical Phenomena↗
PubMed2004

Displaced fractures of the proximal humerus in children require open/closed reduction and internal fixation.

Fractures of the proximal humerus in children are rare and constitute only 3% of all epiphyseal injuries. From 1992 to 2002 sixteen patients aged 4 - 15 years with a displaced fracture of the proximal humerus were treated at our level I trauma unit. The mean follow-up of the patients was 23.8 months (8 - 72). Ten children had a metaphyseal fracture and six a Salter and Harris Type II injury. Only one metaphyseal fracture was treated conservatively; the other patients underwent surgery (ORIF [= open reduction internal fixation] in ten patients, CRIF [= closed reduction internal fixation] in five patients). Follow-up examination showed no shortening or major angulation of the humerus in any of the sixteen cases. Fifteen children showed excellent and good results. There was only one average result in a polytraumatized child with additional injuries in both upper extremities. Based on the results of this study we suggest performing ORIF/CRIF in displaced fractures of the proximal humerus in children.

Child↗
PubMed1987

Biomechanical evaluation of various forms of fixation of transverse patellar fractures.

A study was undertaken to evaluate the strength and ease of application of four different forms of patellar fracture fixation. Modified tension band, screw fixation, Lotke longitudinal anterior band (LAB), and Magnusson wiring were examined using a Materials Testing System. Using cadaver lower extremities, the tibia was mounted in a fixed base and the tibiofemoral joint was fixed at 36 degrees. Tension was applied to the patella through the quadriceps tendon and fracture displacement was measured with linear motion transducers. Based on the results, we recommend screw fixation for transverse patellar fractures in patients with adequate bone stock. In patients with patellar fractures with comminution and/or osteopenia, modified tension band fixation is recommended. Simple wiring techniques alone may not provide sufficient fixation to allow immediate range of motion.

Biomechanical Phenomena↗
PubMed1997

Biomechanical comparison of fixation methods in transverse olecranon fractures: a cadaveric study.

OBJECTIVES/HYPOTHESIS: Our null hypothesis was that no difference in fracture displacement would be detected between traditional monofilament wire and Kirschner wire placement versus three modified tension-band techniques for transverse olecranon fractures. STUDY DESIGN: A nested form of the repeated measures design with twenty-two paired embalmed elbows (subjects grouped by sex and nested within the fracture method). METHODS: Transverse osteotomies were created at the olecranon and stabilized with four techniques. One hundred cycles of loading were applied to achieve a peak flexion bending moment at the fracture of nine newton-meters. At the onset of testing, the triceps tendon was anchored at an initial elbow flexion angle of 70 degrees. RESULTS: When using a monofilament figure-eight loop, oblique Kirschner wire placement into the anterior ulnar cortex provided greater resistance to tensile force than intramedullary Kirschner wires (p = 0.04). With intramedullary Kirschner wire placement, 1.6-millimeter-diameter braided cable in both figure-eight (p < 0.0001) and circular loop (p < 0.0001) designs allowed less fracture displacement than did the 1.0-millimeter-diameter monofilament wire. There was no difference between figure-eight and circular loop configurations when using braided cable (p = 0.98). CONCLUSIONS: In transverse noncomminuted olecranon fractures, fixation with monofilament wire is superior with Kirschner wire placement into the anterior ulnar cortex. With intramedullary Kirschner wires, fixation using braided cable is significantly improved over that with monofilament wire. When using braided cable, figure-eight and circular loop designs allow similar displacements. Braided cable or anterior cortical Kirschner wire purchase increases the stability of fixation over that achieved with the traditional method.

Adult↗
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↗
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↗
PubMed2006

Fixation of proximal humerus fractures using the PHILOS plate: early experience.

UNLABELLED: Proximal humeral fractures, especially in elderly patients, remain a challenging problem for the surgeon because the complication rate for these fractures still remains high. The internal locked system (PHILOS) plate is a new device used for proximal humerus fracture fixation is designed to decrease the high complication rate. We prospectively evaluated our early experience using this system. Twenty patients with fractures of the proximal humerus were treated with a PHILOS plate from September 2001 to January 2004 at Princess Alexandra Hospital in Harlow, UK. Functional assessment was done using the Constant shoulder score. Two patients who had brachial plexus injury were evaluated only with the visual analogue score because we thought that the Constant objective assessment would be unreliable. Complications were monitored. The mean Constant score was found to be 76.1% (range, 30-100%). The preliminary results seem to be satisfactory. According to our experience, the plate design provides stable fixation with a good functional outcome and eliminates most hardware problems such as failure and impingement syndrome. The PHILOS plate is suitable for the majority of fractures providing that the correct surgical technique is used. LEVEL OF EVIDENCE: Therapeutic study, level IV (case series). See the Guidelines for Authors for a complete description of levels of evidence.

Adult↗
PubMed2000

Displaced intra-articular fractures of distal radius: a comparative evaluation of results following closed reduction, external fixation and open reduction with internal fixation.

Fractures of the distal end of the radius are common injuries and are the commonest bony injury around the wrist. Management of these fractures has remained controversial as far as modality of treatment is concerned. In this study 90 adult cases of acute displaced intra-articular fractures of the lower end of the radius were classified according to Frykman's and AO classifications after obtaining radiographs in antero-posterior and lateral planes. These were randomly treated by one of three methods: (1) closed reduction and plaster immobilisation, (2) external fixation and (3) open reduction and internal fixation, and were followed for an average of 4 yr. In the final functional assessment (Sarmiento) the results were (1) plaster 43% good and excellent, 50% fair and 7% poor, (2) external fixator 80% good and excellent, 20% fair and poor results, (3) open reduction and internal fixation 63% good and excellent, 26% fair, 11% poor. We recommend that displaced severely comminuted intra-articular fractures should be treated with an external fixator.

Adult↗