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PubMed2001

Complications of K-wire fixation of fractures and dislocations in the hand and wrist.

Kirschner wire (K-wire) fixation of fractures and dislocations of the hand and wrist is a common procedure. Of the 590 K-wire fixations performed on 236 patients, 36 (15.2%) experienced complications which included osteomyelitis, tendon rupture, nerve lesion, pin tract infection, pin loosening or migration. There were no deep soft-tissue pin infections or pyarthrosis. Technical failure, mainly when the procedure was performed by residents, and poor patient compliance were the major causes of complications. K-wire fixation is a simple but demanding procedure that cannot be left to an inexperienced resident. Elimination of technical failure, supervision in the operating room, close monitoring, prompt treatment upon discovery of a complication, and improvement of patient compliance can reduce the rate of complications.

Bone Nails↗
PubMed1984

Champy plates in mandibular surgery.

Champy plates are becoming more and more accepted for the fixation of simple mandibular fractures, fixation of middle face fractures and fixation after Le Fort osteotomies. This area of indication can be extended by their use in cases of complicated mandibular fractures, fixation of bone graft, and immediate reconstruction following removal of mandibular tumours. Experience shows that Champy plates have the following advantages over other methods: the plates are small, flexible, easily adaptable and the monocortical screws allow a rapid surgical application. Some examples are presented.

Bone Plates↗
PubMedDate not supplied

Absorbable polyglycolide pins in internal fixation of fractures in children.

Absorbable implants made of synthetic biodegradable polymers were recently introduced clinically in internal fixation of fractures. In this prospective study of 71 pediatric patients with a variety of displaced physeal or nonphyseal fractures, self-reinforced polyglycolide pins 1.5 or 2.0 mm in diameter were used instead of Kirschner wires to fix the fragments. The majority of patients (45 children) had a fracture affecting the distal humerus. Mean age of the patients was 9.8 years (range 2-15 years). Follow-up averaged 15.8 months. In 62 patients (87%), an exact reduction of the fracture could be maintained until union. Among the remaining patients, six had minor inaccuracies or redisplacements of the fracture position, but in three patients with supracondylar fractures of the humerus breakage of the pins resulted in a severe redisplacement that necessitated a change in treatment method. With the exception of supracondylar fractures of the humerus, these preliminary results of polyglycolide pin fixation were deemed satisfactory. The fundamental advantage of this method is that no hardware removal procedures are required.

Adolescent↗
PubMedDate not supplied

A comparison of double-plate fixation methods for complex distal humerus fractures.

A modified method of fracture fixation of complex distal humeral fractures with medial and lateral plates and bolts was biomechanically tested and compared with previously described fixation techniques. Compressive stiffness coefficients were determined for three classes of fixation before and after fatigue cycling. This procedure was followed with compressive loading to failure. The results show that in the most unstable fracture type tested this new fixation method provides increased strength and stability. Early clinical follow-up examinations of patients treated with this technique show that this method is a reasonable fixation alternative for the complex distal humerus intercondylar fracture.

Adult↗
PubMed1983

Role of fixation in the treatment of nasal fractures.

Following the reduction of nasal fractures, fixation was performed in 3 ways: 1 Packing for 72 h and plaster cast for 1 week. 2 Packing for 72 h and adhesive tape for 1 week. 3 Adhesive tape for 1 week. At follow-up 3 months after the reduction, these groups were compared with a group of patients with nasal fractures which had not needed treatment and with a group of normals. It was concluded that among the group fixed with packing and plaster cast, significantly fewer patients were dissatisfied than in the other groups, and fewer complained of deformity. The physical examination showed an appreciable number of minor deformities in all groups including the normal group. A significantly higher frequency of nasal obstruction was found in the group of patients operated upon compared to the non-operated group and the normal group by physical examination, but not by the questionnaire. The present study does not support the point of view that a high percentage of cases of nasal fracture have to be operated upon by open reduction. Radiology has no medical or legal value in patients with nasal fractures and should not be used.

Adolescent↗
PubMed2003

An external fixation method and device to study fracture healing in rats.

We wished to establish a reproducible model for fracture fixation to be used in fracture healing research and therefore developed an external fixation construct and surgical procedure adapted to Sprague-Dawley rats. We evaluated the mechanical properties of the construct in brass rods and rat bone, in an Instron test machine with axial and transverse loading, and the in vivo performance. We found that the mechanical properties of the construct in brass rods were predictable and could be repeated in rat femora. In all tests, the axial load was about 10 times the transverse for the same degree of deformation. The stiffness among fixators was uniform. 1 mm pins caused about 50% less stiffness than 1.2 mm pins in axial loading of rat bone (p < 0.001) and brass rods (p < 0.001) as well as in transverse loading of brass rods (p < 0.001). Loosening of 1 or 2 screws that lock the pins to the fixator reduced stiffness by about 50% in axial loading of rat bone (p = 0.009) and brass rods (p = 0.05). A change in the distance between the bone surface and the fixator was linearly related to the stiffness in axial loading of rat bone (p < 0.001) and brass rods (p < 0.001) and in transverse loading of brass rods (p < 0.001). If the bone ends touched each other, the axial stiffness of the construct increased almost 10 times (265 N/mm), as compared to a fracture gap size of 2 mm (31 N/mm). In vivo experiments had a complication rate of less than 10% when we used 1.2 mm pins, 6 mm offset and rats weighing 350-450 g. Our method and device for experimental external fixation of rat femora are reliable and the findings are reproducible. These can be used in bone repair and fracture healing research.

Animals↗
PubMed1992

Fixation of fractures by twisted plates. A new concept of osteosynthesis.

A new twisted plate has been designed for biplane fixation of diaphyseal fractures of long bones. Comparative mechanical testing of the new twisted plate and conventional flat plates showed that the twisted plate was 40% stronger when a bending moment was applied and 132% stronger to a twisting moment. The overall improvement in strength was 90.5%. Clinical trials have been carried out and this paper describes the use of the new plate.

Bone Plates↗
PubMed1981

A new bone-holding clamp for use during internal fixation of fractures.

A new bone-holding clamp for general use during internal fixation of tubular bone fractures is described. The clamp overcomes the common problem of slippage of the reduced position of fracture ends during internal fixation. Further advantages include minimal damage to the periosseous soft tissue and periosteum, which means that the blood vessels are preserved, and the unrestricted working area provided during the operation. Owing to its design the clamp also acts as a self-retaining retractor. The clamp could be described as that 'extra hand' for which the surgeon so often feels the need during the critical stages of osteosynthesis.

Fracture Fixation, Internal↗
PubMed2001

[Analysis and experimental study of reasons for breakage in the bone fracture plate during internal fixation].

Bone fracture plate has been in clinical use for internal fixation of fracture, however, during healing, the steel plate breaks occasionally. This paper applied the static strength theory to imitate the pressed down combination out of shape that was borne by single limb of human body standing. Fracture was made on low limbs of the fresh dead body, fixed with a bone fracture plate. Strain measure was made on a bone fracture plate. Additionally, fatigue experiment and four-point bending experiment were carried out on a bone fracture plate. The reason for a breakage in the bone fracture plate was analyzed with static strength theory and low period fatigue theory.

Bone Plates↗
PubMed1999

Early outcome of hybrid external fixation for fracture of the distal tibia.

OBJECTIVE: To evaluate the early results of treatment when using hybrid external fixation for fractures of the tibial plafond. DESIGN: Retrospective review of patients treated according to protocol. Patients treated with the hybrid fixator were compared with patients treated with open reduction and internal fixation. SETTING: Orthopaedic trauma service of a Level I trauma center, with a single surgeon directing care. PATIENTS/PARTICIPANTS: All patients with fractures of the distal tibia during a five-year period (n = 63) were treated according to protocol, with specific criteria determining method of treatment. Eleven patients were lost to follow-up, and three additional patients were not reviewed for other reasons. Follow-up period averaged twenty months. INTERVENTION: Fracture stabilization was accomplished with the use of a hybrid external fixator (n = 34) or with internal fixation (n = 27), as determined by patient or fracture criteria. Two patients did not receive planned treatment. MAIN OUTCOME MEASUREMENTS: Range of motion, clinical ankle score, and incidence of complications. RESULTS: Patients treated with hybrid fixation had lower clinical scores, slower return to function, a higher rate of complications, more nonunions and malunions, and more infections. CONCLUSIONS: Due to differences in patient populations, the superiority of either treatment method is uncertain; however, hybrid fixation did not seem to solve the problems inherent in severe pilon fractures. The sanguine results reported in the literature did not hold true in this group.

Adolescent↗
PubMed2003

[Innovative implants -- a prerequisite for biological osteosynthesis].

Biological osteosynthesis is a new paradigm in fracture fixation. In contrast to the conservative mechanical operative period, where exact anatomical and rigid fracture fixation was the ultimate ambition, the new perception in fracture management attaches more importance to the conservation of bone perfusion than to the exact anatomical reduction. Because soft tissue condition and local blood circulation are most important for bone reconstruction and healing of fractures, additional damage of soft tissue caused by operation should ideally be avoided. Consequently surgeons aim at minimally invasive operating techniques using no-touch bone implants. This shift in point of view has also been accommodated by a rapid progress in development of innovative bone implants. Solid medullar nails, novel designs and applications of plates, locking screws and biocompatible titanium implants are some of the implantation techniques which pushed the new concept of biological fracture fixation.

Adult↗
PubMed1994

Fixation of thoracolumbar fractures with the Dick fixator: the influence of transpedicular bone grafting.

Fifty patients with thoracolumbar fractures were treated by internal fixation using the Dick fixator. In the first 22 patients (group 1) this was accompanied by posterior intertransverse grafting. The technique was then modified in the following 28 patients (group 2) to include transpedicular elevation of the depressed vertebral end plate and grafting of the vertebral body, in an attempt to reduce the postoperative loss of correction of the kyphotic deformity. The clinical records and X-rays were reviewed to determine whether the change in technique had achieved this objective and whether it affected operative time, blood loss, postoperative recovery and complications. The mean operating time and blood loss in group 1 were 2 h, 38 min and 650 ml, respectively, and in group 2 2 h, 59 min and 783 ml. These differences were not statistically significant. Time from operation to mobilisation and discharge from hospital were related to neurological deficit, but there was no significant difference between group 1 and group 2 in this regard. There was no difference in the complication rate between the two groups and no complication attributable to transpedicular bone grafting. The radiological results postoperatively and at a mean follow-up period of 9 months were assessed by measurement of the kyphosis angle, anterior vertebral height, anterior displacement, scoliosis, and reduction in cross-sectional area of the spinal canal. In group 1 the mean preoperative kyphosis angle and anterior vertebral height were 8 degrees and 21 mm; postoperatively these values were -12 degrees (lordosis) and 27 mm; and at follow-up they were -4 degrees and 24 mm.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2002

Fractures with major vascular injuries from gunshot wounds: implications of surgical sequence.

BACKGROUND: The sequence of surgical repair for penetrating extremity injuries requiring both vascular repair and fracture fixation is controversial. The optimal determination of repair order and its consequences is the purpose of this study. METHODS: A retrospective review was performed of 27 patients over a 10-year period requiring acute revascularization and fracture fixation for isolated gunshot wound injuries. Injuries to the brachial artery and the femoral and popliteal vessels with accompanying fractures requiring operative stabilization were considered. The Mangled Extremity Severity Score, surgical sequence, limb viability, fasciotomy, incidence of iatrogenic vascular repair disruption, and length of hospitalization were analyzed. RESULTS: There were 17 lower and 10 upper extremity injuries, with a mean Mangled Extremity Severity Score of 4.1. Fracture fixation preceded vascular repair in five cases, whereas revascularization preceded bone fixation in 22 cases. A temporary vascular shunt was used in 13 and definitive vascular repair with used in 9 patients. There were no cases of vascular repair, shunt disruption, or amputation after fracture fixation. Four of five (80%) patients with orthopedic fixation before revascularization required fasciotomies, whereas 8 of 22 (36%) patients with revascularization before fixation required fasciotomies, and this difference approached significance (p = 0.10). Patients with fasciotomies had a significantly longer mean length of hospitalization, 18.3 +/- 8.6 days compared with 10.8 +/- 8.1 days (p = 0.03). CONCLUSION For patients with combined injuries, priority should be given to revascularization before orthopedic fixation because of shorter hospitalization and a trend toward lower fasciotomy rates. Revascularization before fracture fixation did not result in iatrogenic disruption of the vascular repair.

Adolescent↗
PubMed2004

Biomechanics of locked plates and screws.

OBJECTIVE: To review the biomechanical principles that guide fracture fixation with plates and screws; specifically to compare and contrast the function and roles of conventional unlocked plates to locked plates in fracture fixation. We review basic plate and screw function, discuss the design rationale for the new implants, and examine the biomechanical evidence that supports the use of such implants. DATA SOURCES: Systematic review of the per reviewed English language orthopaedic literature listed on PubMed (National Library of Medicine online service). STUDY SELECTION: Papers selected for this review were drawn from peer review orthopaedic journals. All selected papers specifically discussed plate and screw biomechanics with regard to fracture fixation. PubMed search terms were: plates and screws, biomechanics, locked plates, PC-Fix, LISS, LCP, MIPO, and fracture fixation. DATA SYNTHESIS: The following topics are discussed: plate and screw function-neutralization plates and buttress plates, bridge plates; fracture stability-specifically how this effects gap strain and fracture union, conventional plate biomechanics, and locking plate biomechanics. CONCLUSIONS: Locked plates and conventional plates rely on completely different mechanical principles to provide fracture fixation and in so doing they provide different biological environments for healing. Locked plates may increasingly be indicated for indirect fracture reduction, diaphyseal/metaphyseal fractures in osteoporotic bone, bridging severely comminuted fractures, and the plating of fractures where anatomical constraints prevent plating on the tension side of the bone. Conventional plates may continue to be the fixation method of choice for periarticular fractures which demand perfect anatomical reduction and to certain types of nonunions which require increased stability for union.

Biomechanical Phenomena↗
PubMed1992

Current techniques for the repair of complex orbital fractures. Miniplate fixation and cranial bone grafts.

BACKGROUND: Computerized imaging of complex fractures of the orbit and facial skeleton have brought about demands for methods of anatomic restoration. In this article, the author outlines techniques for metallic rigid anatomic fixation of facial fractures and the cranial bone graft method of augmentation. METHODS: Clinical results of fracture repair using various types of metallic plates and replacement of missing bone with cranial bone grafts are presented and techniques are described. CONCLUSION: Rigid three-dimensional fixation of the facial skeleton with metallic plate fixation and augmentation with cranial bone grafts has produced more predictable correction of severe fractures of the orbit and facial skeleton.

Bone Plates↗
PubMed1997

Modern trends for external fixation of fractures in children: a critical review.

There is considerable controversy about the use of external fixation to manage children's fractures. The indications for external fixation are examined in the light of the available evidence in the literature. A general overview of surgical considerations, including the type of fixator, pin placement, and duration of treatment, is given with an assessment of possible complications. External fixation offers a safe and effective management option and may perhaps be the subject of randomized controlled trials in the future.

Child↗