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PubMed2002

Biomechanical failure of metacarpal fracture resorbable plate fixation.

Metacarpal fractures are a relatively common hand injury that may require operative intervention to ensure adequate reduction and stabilization. The use of permanent hardware, although acceptable, may lead to complications and an increased number of surgical procedures. The use of resorbable hardware such as poly-L-lactic acid and polyglycolic acid copolymer plates and screws may circumvent some of these complications. In vitro studies have demonstrated that the biomechanical characteristics of these resorbable plates may provide the rigid fixation necessary to allow for union of metacarpal fractures in vivo. However, limited clinical data are available regarding the success of their use in this application. The authors present what they believe is the first reported case of the failure of a poly-L-lactic acid and polyglycolic acid copolymer miniplate after use in the fixation of a metacarpal shaft fracture.

Absorbable Implants↗
PubMed2001

Tangential views of the articular surface of the distal radius-aid to open reduction and internal fixation of fractures.

Open reduction and internal fixation of comminuted, displaced intra-articular or potentially unstable fractures of the distal radius with plate and screws has increasingly become a favoured treatment. Intra-operative assessment of fixation with the help of an image intensifier has always been difficult because of the anatomy of the distal radius. Imaging of the implants placed as distal as possible to achieve satisfactory fixation often shows the screws to be penetrating the joint. We describe two new radiographic views of the wrist joint, which we used intra-operatively in ten patients undergoing open reduction and internal fixation of distal radius fractures. Screws were thought to have been penetrating the joint in the standard lateral views of all of them and in the standard antero-posterior views of eight of them.However, no screw was seen penetrating the joint in these new views. It was hence possible to place the plate distal enough to enable the screws to engage the sub-chondral bone. We recommend the use of these views in the open reduction and internal fixation of distal radius fractures.

Bone Plates↗
PubMed1980

External fixation of fractures: a simple method.

A simple and versatile method for external fixation of fractures of long bones is described. The method was first used in 1976 in a successful attempt to save a limb which had sustained a severe comminuted fracture of the tibia with vascular impairment.

Femoral Fractures↗
PubMed2002

Percutaneous screw fixation of fractures of the iliac wing and fracture-dislocations of the sacro-iliac joint (OTA Types 61-B2.2 and 61-B2.3, or Young-Burgess "lateral compression type II" pelvic fractures).

A technique for closed reduction and percutaneous screw fixation of fractures of the iliac wing and fracture-dislocations of the sacro-iliac joint is presented. Twenty-seven pelvic fractures were treated with attempted closed reduction followed by percutaneous screw fixation. Closed reduction failed in two patients. In the other twenty-five, closed reduction to within one centimeter of residual displacement was obtained, and was followed by stabilization with percutaneously placed cannulated screws. Complications included dislodgment of a screw from the superior pubic ramus in one patient, and partial cut-out of a screw along the inner cortex of the iliac wing in another. Two patients were lost to follow-up before fracture union occurred. The remaining twenty-three patients were followed-up for an average of twenty-seven months (range, 18-48 months). All of the fractures healed in the twenty-three patients who were not lost to follow-up. All but two of the patients who were working before injury returned to work. All but one of the patients was satisfied with the outcome of their pelvic fracture treatment. Closed reduction and percutaneous screw fixation of fractures of the posterior portion of the iliac wing yields acceptable reductions, with minimal blood loss and limited damage to the surrounding soft tissues.

Adolescent↗
PubMed2000

Fixation of periprosthetic femoral shaft fractures occurring at the tip of the stem: a biomechanical study of 5 techniques.

This study evaluated 5 currently used periprosthetic femoral shaft fracture fixation techniques to determine which technique provided the greatest fixation stability. Periprosthetic fractures in 30 synthetic femurs were fixed with a plate with cables, plate with proximal cables and distal bicortical screws (Ogden concept), plate with proximal unicortical screws and distal bicortical screws, plate with proximal unicortical screws and cables and distal bicortical screws, or 2 allograft cortical strut grafts with cables. These specimens were then tested in 3 physiologic loading modes. The plate constructs with proximal unicortical screws and distal bicortical screws or with proximal unicortical screws, proximal cables, and distal bicortical screws were significantly more stable in axial compression, lateral bending, and torsional loading than the other fixation constructs studied.

Biomechanical Phenomena↗
PubMed2001

Ilizarov hybrid external fixation for fractures of the distal radius: Part II. Internal fixation versus Ilizarov hybrid external fixation: Stability as assessed by cadaveric simulated motion testing.

The in vitro stability of an Ilizarov hybrid external fixator was compared with that of a dorsal 3.5-mm AO T-plate in 8 unpaired, fresh-frozen upper extremities. A specially designed testing device that used computer-controlled pneumatic actuators was used to simulate active finger, wrist, and forearm motions by applying loads to relevant tendons. A comminuted extra-articular distal radius fracture was modelled using a dorsally based wedge osteotomy. Fracture stability was assessed using an electromagnetic tracking device to measure motion across the fracture site after randomized application of the plate and the hybrid fixator. During simulated finger and wrist motions with the forearm pronated or supinated, motion of the distal fragment with the hybrid fixator applied was comparable to or statistically less than with the AO plate applied. During simulated forearm rotation, the stability provided by the 2 fixation types was similar, although the plate allowed statistically less radial-ulnar deviation of the fragment. In this model of a 2-part extra-articular distal radius fracture, the clinically meaningful stability of the Ilizarov hybrid external fixator was comparable to that of the dorsal AO plate.

Aged↗
PubMed2006

Current concepts in volar fixed-angle fixation of unstable distal radius fractures.

UNLABELLED: We present new developments in the volar treatment of unstable distal radius fractures in adults. New perspectives on the anatomy of the wrist, the watershed line on the volar radius and the usefulness of the pronator fossa are presented and these help to avoid flexor and extensor tendon disturbance when using a volar approach. Other new insights on the bony anatomy of the distal end of the radius are discussed, which are important in improving the quality of fracture fixation, including the benefits of constructing a precise fixed-angle scaffold underneath the articular surface in order to stabilize it. A volar fixed-angle plate must support the dorsal, central and volar aspects of the subchondral bone in order to stabilize the most complex fractures. Awareness of the anatomy of blood supply to the distal radius: the dorsal retinaculum that feeds the distal fragments and the blood supply to the diaphysis through branches of the anterior interosseous artery is necessary to maximize healing potential and avoid complications. Volar fixed-angle plates need to withstand very high forces during rehabilitation, the magnitude of these forces are up to five times the loads applied on the hand. LEVEL OF EVIDENCE: Level V (expert opinion).

Biomechanical Phenomena↗
PubMed1991

[Internal fixation of fractured ribs with Kirschner wires for serious traumatic chest instability].

Internal fixation of fractured ribs with kirschner wires was done in 14 patients with serious traumatic chest wall instability. Four of these patients had fracture of prothorax ribs, and 10 fracture of lateral thorax ribs. This method can not only stabilize the chest wall but also reduce the fractured ribs. It is an ideal treatment for serious traumatic chest wall instability. In this paper, operative opportunity, indication and the main technical points of surgery are discussed.

Adult↗
PubMedDate not supplied

Fixation of fractures of the proximal humerus with the PlantTan Humerus Fixator Plate: early experience with a new implant.

The majority of fractures of the proximal humerus can be managed nonoperatively. However, displaced fractures generally require operative repair, and in the young patient with good bone quality, the results are usually satisfactory. In contrast, the osteoporosis found in the elderly patient makes internal fixation problematic and frequently contributes to failure of fixation and poor results. We report our early experience with a new plate that locks two humeral head cancellous screws to the plate. In 3 of 7 patients, all under 65 years of age, the results were good. However, in the remaining 4 patients, all over the age of 75 years, there was a 100% failure rate, with screw penetration of the head in 3 patients and secondary displacement of the fracture at 7 days postoperatively in another. We conclude that this implant is unsatisfactory for patients with osteopenic bone in the humeral head.

Adult↗
PubMed2000

Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures.

BACKGROUND: Cephalocondylic intramedullary nails which are inserted proximally to distally (cephalocondylic) have been used for the surgical treatment of extracapsular hip fractures. OBJECTIVES: To update and expand our review comparing the Gamma nail with the sliding hip screw (SHS) by comparing all cephalocondylic intramedullary nails with extramedullary implants for the surgical treatment of extracapsular hip fractures in adults. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group trials register, Medline, select orthopaedic journals and conference proceedings, and reference lists of relevant articles. We contacted trialists, colleagues and implant manufacturers. Date of the most recent search: June 1998. SELECTION CRITERIA: All randomised and quasi-randomised trials comparing cephalocondylic nails with extramedullary implants for extracapsular hip fractures. DATA COLLECTION AND ANALYSIS: Both reviewers independently assessed trial quality and extracted data. Additional information was sought from all trialists. Wherever appropriate and possible, results were pooled. MAIN RESULTS: The one trial of 230 patients comparing the Kuntscher-Y nail with the SHS, reported no major difference the outcome aside from a significantly increased number of patients with leg shortening, and a tendency for poorer recovery of mobility in the Kuntscher-Y nail group. Fourteen trials comparing the Gamma nail with the SHS were included, with data available for 1977 patients. The Gamma nail was associated with an increased risk of operative and later fracture of the femur and an increased re-operation rate. There were no major differences in the incidence of wound infection, mortality or medical complications between implants. Data were inadequate to determine if there were differences for other outcomes. Two trials involving 231 patients compared the intramedullary hip screw (IMHS) with the SHS. Fracture fixation complications were more common in the IMHS group: all cases of operative and later fracture of the femur and haematoma occurred in this group. Results for post-operative complications, mortality and functional outcomes were similar in the two groups. REVIEWER'S CONCLUSIONS: Further evidence is required before any conclusions can be drawn on the relative merits of the Kuntscher-Y nail and the SHS. Given the lower complication rate of the SHS in comparison with the Gamma nail, it appears that for trochanteric fractures the SHS is superior. Further evidence is still required to confirm this, as well as to determine if the Gamma nail, or modifications of the Gamma nail, have advantages for selected fracture types (for example, subtrochanteric fractures). From the limited evidence available, IMHS appears to have the same problems as the Gamma nail, but other theoretical advantages of the IHMS can not be ruled out.

Bone Nails↗
PubMed1992

Biodegradable implants in orthopaedic surgery--a review on the state-of-the-art.

Until recently, internal fixation of fractured bones and joints has been managed by metal implants. Certain disadvantages of the metal implants are: the properties of the materials are stiffer than those of cortical bone and removal of the implants requires a second operation. About 40 different biodegradable polymers, copolymers and composites have been developed in order to substitute the metal implants for internal fracture fixation. First experimental and clinical results demonstrate the limitations of these new methods. The main problem of the material is the loss of mechanical strength within a time interval not long enough to guarantee bone healing. The development of sterile sinus at the site of implantation is also a problem reported by various groups. Despite some drawbacks, there are indications for the isolated or the adjuvant implantation of biodegradable materials.

Biocompatible Materials↗
PubMed2003

[Principles and new methods of flexible fixation of fractures of long bones].

The modern developments in orthopedic traumatology brought various modifications of modes and principles in operative fixation of fractures. Contrastingly to previous concept of rigid fixation as a priori necessary element for complete fracture union, a principle of flexible or elastic fixation took an equal place in contemporary professional doctrine. The results of these changes were technological innovations of fixation implants, with their mechanical characteristics as a base for their biological application that promoted essential advancements in fracture treatment and full functional recovery of injured patients. We review in this paper the modern principles and some new implant generations in flexible fracture fixation.

Fracture Fixation, Internal↗
PubMedDate not supplied

[Displaced femoral neck fractures: internal fixation or arthroplasty?].

Femoral neck fractures are a challenge for orthopedic surgeon due to the high rate of complication for such fractures. The aim of this study was to propose a treatment algorithm based on author's current concept in management of femoral neck fractures. Fractures were classified according Garden in four types but, for practical reasons, fractures were considered undisplaced (Garden I and II) and displaced (Garden III and IV). Treatment method was chosen based on next criteria: patient's age, associated pathology, patient's mental status and expectations, quality of the bone (osteoporosis), type and age of fracture, quality of reduction. Based on this criteria, the proposal algorithm may led to close reduction and internal fixation, open reduction and internal fixation or arthroplasty.

Aged↗
PubMed1990

Healing of physeal fracture after fixation with biodegradable self-reinforced polyglycolic acid pins. An experimental study on growing rabbits.

Physeal fractures occur at a frequency of 15% of all long bone fractures in children. Undisturbed continued bone growth is the main goal of the treatment of these fractures. After the operative reduction and fixation, whenever needed, a second operation for the removal of the pins is inevitable. The purpose of this study was to develop a biodegradable fixation device for transphyseal fracture fixation, abolishing the need of removal operation. Epiphyseal separation of the distal femoral physis was made on the right side in 18 five-week-old rabbits. The fixation of the physeal fracture was made with two self-reinforced polyglycolic acid (SR-PGA) pins 1mm in nominal diameter and 25mm in length. The follow-up times were 3, 6, 12, 24, and 28 weeks. The distal femoral growth-plate of both femurs was analyzed by radiographic, microradiographic, oxytetracycline-fluorescence, histological and histomorphometric studies. Histomorphometric studies showed normal features of growth. Two growth-plate-penetrating transcondylar SR-PGA implants, of 1mm in diameter, provided sufficient stability for the fixation of a distal femoral physeal fracture in a growing rabbit, and did not cause any growth disturbance.

Animals↗