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PubMed1998

Posterior fixation suture and convergence excess esotropia.

The present study investigates the results of Cuppers' 'Fadenoperation' in patients with non-accommodative convergence excess esotropia. Particular attention is given to postoperative eye alignment at distance fixation. Group 1 (n=96) included patients with a 'normal' convergence excess. The manifest near angles (mean ET 16.73 degrees +/- 6.33 degrees, range 4 degrees -33 degrees ) were roughly twice the size of the distance angles (mean ET 6.50 degrees +/- 3.62 degrees, range 0 degrees -14 degrees ). These patients were treated with a bilateral fadenoperation of the medial recti without additional eye muscle surgery. Three months after surgery, the mean postoperative angles were XT 0.5 degrees +/- 3.3 degrees (range XT 11 degrees -ET 5 degrees ) for distance fixation, and ET 2.7 degrees +/- 3.6 degrees (range XT 5 degrees -ET 14 degrees ) for near fixation, respectively. Postoperative convergent angles at near fixation >ET 10 degrees were present in two patients (1.9%). Group 2 (n=21) included patients with a mean preoperative distance angle of ET 9.2 degrees +/- 3.7 degrees (range 6 degrees -16 degrees ) and a mean preoperative near angle of ET 23.4 degrees +/- 3.1 degrees (range 16 degrees -31 degrees ). These patients were operated on with a bilateral fadenoperation of the medial recti and a simultaneous recession of one or both medial rectus muscles. Mean postoperative angles were XT 0.5 degrees +/- 4.6 degrees (range XT 12 degrees -ET 7 degrees ) for distance fixation and ET 1.4 degrees +/- 4.5 degrees (range XT 8 degrees -ET 13 degrees ) for near fixation, respectively. In this group, 2 patients (10.6%) had a postoperative exotropia >XT 5 degrees at distance fixation, and two patients had residual esotropia>ET 10 degrees at near fixation. Group 3 (n=17) included patients with a pronounced non-accommodative convergence excess. Near angle values (mean of 17.8 degrees +/- 5.3 degrees, range ET 7 degrees -26 degrees ) were several times higher than the distance angle values (mean ET 1.9 degrees +/- 4.2 degrees, range XT 3 degrees -ET 6 degrees ). These patients were treated with a bilateral fadenoperation of the medial recti and a simultaneous resection of one or both medial rectus muscles. Mean postoperative angles were ET 0.2 degrees +/- 4.7 degrees (range XT 8 degrees -ET 6 degrees ) for distance fixation and 5.3 degrees +/- 6.1 degrees (range XT 3 degrees -ET 12 degrees ) for near fixation, respectively. One patient had a postoperative distance angle >XT 5 degrees, whereas two patients displayed postoperative convergent angles >ET 5 degrees at near fixation.

Journal Article↗
PubMed2000

Biomechanical comparison of five different atlantoaxial posterior fixation techniques.

STUDY DESIGN: Five different reconstructions of the atlantoaxial complex were biomechanically compared in vitro in a nondestructive test. OBJECTIVES: To determine whether non-bone graft-dependent one-point fixation affords stability levels equivalent to three-point reconstructions. SUMMARY OF BACKGROUND DATA: Previous investigations have demonstrated that three-point fixation, using bilateral transarticular screws in combination with posterior wiring, provide the most effective resistance to minimize motion around C1-C2. However, placement of transarticular screws is technically demanding. Posterior wiring techniques affording one-point fixation have failure rates of approximately 15%, with failure considered to be secondary to structural bone graft failures. One-point, non-bone graft-dependent fixations have not been tested. METHODS: Eight human cervical specimens, C0-C3 were loaded nondestructively. Unconstrained three-dimensional segmental motion was measured. The reconstructions tested were two one-point fixations, one two-point fixation, and two three-point fixations. RESULTS: Under axial rotation two and three-point reconstructions provided better stiffness than the one-point reconstructions (P < 0.05). During flexion-extension, higher stiffness levels were observed in one- and three-point fixations when compared with the intact spine (P < 0.05). In lateral bending no significant differences were observed among the six groups, although the trend was that reconstructions including transarticular screws provided greater stability than one-point fixations. CONCLUSION: The current findings substantiate the use of three-point fixation as the treatment of choice for C1-C2 instability. [l: atlantoaxial fixation, biomechanics, cervical spine, instability, spinal instrumentation, transarticular screws]

Aged↗
PubMed2005

Biomechanical analysis of unilateral fixation with interbody cages.

STUDY DESIGN: An in vitro biomechanical study of the stabilizing effects of a different combination of cages and transpedicular instrumentation on experimental degenerative disc disease. OBJECTIVES: To evaluate the biomechanical efficacy of the interbody fusion cage and unilateral posterior instrumentation on the stability of the spine-device construct. SUMMARY OF BACKGROUND DATA: Posterior lumbar interbody fusion (PLIF) has become a clinically established and increasingly popular procedure since its introduction and subsequent modification. Recently, unilateral fixation was reported to have comparable efficacy to bilateral fixation in two- to three-segment posterior instrumentation. This study has been designed to compare biomechanical properties among various spinal fixations, including bilateral versus unilateral fixation with PLIF and cages. METHODS: Thirty porcine L3-L6 spines were separated into six groups. The utilization of one or two cages and unilateral or bilateral instrumentations were reciprocally combined to stabilize the spine with the L4-L5 discectomy, simulating degenerative disc disease. A serial of biomechanical tests, including flexion (5 N-m), extension (5 N-m), compression (250 N), lateral bending (5 N-m), and axial rotation (5 N-m, 25 mm/min), were conducted at the displacement rate of 25 mm/min in five cycles. Stiffness values were derived from loading curves for comparison of spinal stability. RESULTS.: In axial compression, the stiffness of bilateral fixation (BF) and unilateral fixation with two-cage (UF2C) groups were almost identical and only less than that of the bilateral fixation with two cages (BF2C) group. In the flexion, the BF, UF2C, and unilateral fixation with one cage (UF1C) group incurred comparable stiffness to that of the Intact group. In extension, the UF2C group had a comparable stiffness to the BF2C group. In lateral bending, the BF2C group and the UF2C group were the constructs incurring most stiffness. In torsion, the BF group and the UF2C group were less stiff than the BF2C group, but that was statistically insignificant CONCLUSIONS: In the group of unilateral fixation combining PLIF with two cages, the anterior support of cages enabled unilateral instrumentation to restore torsional stiffness and other spinal stability indexes. Considering the initial stability and the load-sharing effect, this study showed that the unilateral fixation combining PLIF and two cages might be a good alternative to spinal fixation.

Animals↗
PubMed2005

Experimental and clinical studies of malleus fixation.

OBJECTIVES/HYPOTHESIS: Preoperative clinical diagnosis of malleus fixation can be difficult. "Fixation" of the malleus can be caused by various disorders or diseases: fibrous tissue, bony spurs, and neo-osteogenesis around the malleus head or stiffening of the anterior malleal ligament. The conductive hearing loss produced by these disorders or diseases has not been well characterized. The study goals were 1) to determine the effects of various types of malleus fixation using a cadaveric temporal bone preparation and 2) to assess the clinical utility of umbo velocity measurements in preoperative differential diagnosis of malleus fixation and stapes fixation. METHODS: Umbo and stapes velocity were measured in 18 fresh cadaveric human temporal bones with laser vibrometry before and after controlled application of adhesives to the malleus, stapes, or both ossicles. RESULTS: Each simulated pathological condition produced a specific degree of loss in stapes velocity: stiffening of anterior malleal ligament, 0 to 8 dB; fibrous tissue around malleus head, less than 10 dB; bony bar to malleus head, 10 to 30 dB; and extensive neo-osteogenesis around malleus head, greater than 35 dB. Simulated malleus fixations generally produced similar reductions in both umbo and stapes velocity. Stapes fixation reduced stapes velocity with little change in umbo velocity. Because the change in stapes velocity would be similar to conductive hearing loss, experimental results were directly compared with clinical measurements of umbo velocity in surgically confirmed cases of malleus or stapes fixation. The effects of malleus and stapes fixations between the clinical and experimental data were similar. CONCLUSION: The study showed that measurements of umbo velocity and air-bone gap can enable one to diagnose malleus fixation and specifies how to differentiate malleus from stapes fixation.

Aged↗
PubMed2006

Transrenal fixation of aortic stent-grafts: short- to midterm effects on renal function--a systematic review.

PURPOSE: To perform a systematic review of the short- to midterm effects of transrenal fixation of aortic stent-grafts on renal function in patients with abdominal aortic aneurysms. MATERIALS AND METHODS: A search of the PubMed, MEDLINE, and EMBASE databases for English-language literature was performed. Studies with at least 10 patients were included for data analysis. Only studies on transrenal fixation of aortic stent-grafts that included follow-up results for renal function were included. A log-linear model was used for meta-analysis to compare transrenal fixation with infrarenal fixation. RESULTS: Twenty-two studies met the inclusion criteria. Because two studies analyzed the same group of patients, one was excluded, for a total of 21 studies. Comparisons between transrenal fixation and infrarenal fixation were found in seven studies. For transrenal versus infrarenal fixation, the combined odds ratio, 95% confidence interval, and P value were found to be statistically significant with respect to postprocedural renal infarction only (combined odds ratio, 5.189; 95% confidence interval: 3.198, 8.420; P < .001). No significant difference was found between transrenal and infrarenal fixation with respect to renal dysfunction, renal artery occlusion, or endoleaks (P > .05). CONCLUSION: Transrenal fixation of aortic stent-grafts seems to be a relatively safe alternative compared with infrarenal fixation in terms of short- to midterm follow-up. Postprocedural renal infarction, however, was significantly higher for transrenal fixation.

Aged↗
PubMed1981

Importance of fixation in immunohistochemistry: use of formaldehyde solutions at variable pH for the localization of tyrosine hydroxylase.

Adequate fixative in immunohistochemistry requires not only a rapid and total immobilization of the antigen, but also a sufficient preservation of its immunoreactivity and maintenance of its accessibility to the immunochemical reagents for localization. Thus, the optimal fixation condition for a specific antigen necessitates a compromise between these opposing variables and can be determined by the preparation of a series of tissues with a progressively increasing degree of fixation. Unless the results of localization using such a series is available, one must be satisfied with adequate but less than optimal results. In the present study, this principle is demonstrated using the localization of tyrosine hydroxylase in the dopaminergic system with formaldehyde as the fixative. The rate and degree of fixation with formaldehyde was shown to be highly pH dependent. By perfusing the tissue with formaldehyde at pH 6.5 (where the rate of fixation is extremely slow) it is possible to rapidly distribute the fixative homogeneously into the tissue. By suddenly changing to a formaldehyde perfusate of higher pH, the cross-linking reaction is rapidly increased. This two-step fixation procedure provides a means of obtaining a rapid and uniform immobilization of the antigen, so that its translocation can be avoided. The final degree of fixation is controlled by the duration and pH of the second fixative solution. The results obtained by increasing the pH of the second solution demonstrated that complete fixation of tyrosine hydroxylase in the dopaminergic system with formaldehyde maybe obtained using a very basic formaldehyde solution (pH 11) while still retaining immunoreactivity of the enzyme. The localization that was achieved at lower pH appeared adequate until it was compared to the results obtained by perfusion at pH 11 in the second step.

Animals↗
PubMed2001

Methodology and validity of assessing kinematics of the thoracolumbar vertebral column in horses on the basis of skin-fixated markers.

OBJECTIVE: To determine the validity of using skin-fixated markers to assess kinematics of the thoracolumbar vertebral column in horses. ANIMALS: 5 Dutch Warmblood horses without abnormalities of the vertebral column. PROCEDURE: Kinematics of T6, T10, T13, T17, L1, L3, L5, S3, and both tuber coxae were determined by use of bone-fixated and skin-fixated markers. Three-dimensional coordinate data were collected while horses were walking and trotting on a treadmill. Angular motion patterns were calculated and compared on the basis of 2-dimensional analysis of data from skin-fixated markers and 3-dimensional analysis of data from bone-fixated markers. RESULTS: Flexion-extension of thoracolumbar vertebrae and axial rotation of the sacrum were satisfactorily determined at both the walk and trot, using skin-fixated markers. Data from skin-fixated markers were accurate for determining lateral bending at the walk in the midthoracic and lower lumbar portion of the vertebral column only. However, at the trot, data from skin-fixated markers were valid for determining lateral bending for all thoracolumbar vertebrae. CONCLUSIONS AND CLINICAL RELEVANCE: Caution should be taken when interpreting data obtained by use of skin-fixated markers on lateral bending motions during the walk in horses. For determination of other rotations at the walk and all rotations at the trot, use of skin-fixated markers allows valid calculations of kinematics of the vertebral column. Understanding to what extent movements of skin-fixated markers reflect true vertebral motion is a compulsory step in developing noninvasive methods for diagnosing abnormalities of the vertebral column and related musculature in horses.

Animals↗
PubMed2000

[Screws versus screw-plate fixation of type 2 Schatzker fractures of the lateral tibial plateau. Cadaver biomechanical study. Arthroscopy French Society].

PURPOSE OF THE STUDY: We compared in vitro the efficacy of screw-plate fixation versus double screw fixation on a model of type 2 Schatzker fracture of the lateral tibial plateau. MATERIALS AND METHODS: Ten screw-plate fixations using a lateral prebent plate and 10 double-screw fixations (6.5 mm screws) were made on 10 pairs of non-embalmed cadaver knees after simulation of type 2 Schatzker fractures. The strength of each fixation was tested with a compression device. Criteria indicating failure were displacements greater than 2 mm of one or more fracture lines. The force applied at rupture and the stiffness of each type of fixation were compared. Wilcoxon's test was used for statistical analysis. RESULTS: Force at rupture and stiffness of the fixation were similar for the two types of fixation. There was no statistical difference (p > 0.05) between the screw-plate and the double-screw fixations. DISCUSSION: Our findings on a model of type 2 Schatzker fractures are in agreement with previous data obtained by other authors working on models of type 1 Schatsker fractures. The biomechanical stability of the double-screw fixation is as good as that obtained with screw-plate fixation for the treatment of fractures of the lateral tibial plateau.

Aged↗
PubMed2006

Vertically unstable pelvic fractures fixed with percutaneous iliosacral screws: does posterior injury pattern predict fixation failure?

OBJECTIVE: To measure the failure rate of percutaneous iliosacral screw fixation of vertically unstable pelvic fractures and particularly to test the hypothesis that fixations in which the posterior injury is a vertical fracture of the sacrum are more likely to fail than fixations with dislocations or fracture-dislocations of the sacroiliac joint. DESIGN: Retrospective review. SETTING: Level 1 trauma center. METHODS: All patients with pelvic fractures admitted between January 1, 1993, and December 31, 1998, were identified from the trauma registry. Hospital records were used to identify patients treated with iliosacral screws. Radiologic studies were examined to identify patients who had unequivocally vertically unstable pelvic fractures. Immediate postoperative and follow- up anteroposterior, inlet, and outlet radiographs from a minimum of 12 months postinjury were examined. Position, length, and numbers of iliosacral screws and any evidence of screw failure (eg, bending or breakage) were recorded. Residual postoperative displacement and late displacement of the posterior pelvis were measured. The main outcome measure was failure, defined as at least 1cm of combined vertical displacement of the posterior pelvis compared with immediate postoperative position. The main analysis was for association between fracture pattern and failure. Patient demographic data, iliosacral screw position, and anterior pelvic fixation method also were studied. RESULTS: The study group comprised 62 patients with unequivocally vertically unstable pelvic fractures in whom the posterior injury was treated with closed reduction and percutaneous iliosacral screw fixation. Of patients, 32 had dislocations or fracture-dislocations of the sacroiliac joint, and 30 had vertical fractures of the sacrum. Fixation failed in four patients, all with vertical sacral fractures and all within the first 3 weeks after surgery. These four patients required revision fixation. In two further cases with vertical sacral fractures, there was evidence that the fracture had only barely been held by the fixation, but these fractures healed, and followup radiographs did not meet the displacement criteria for failure. A vertical sacral fracture pattern was associated significantly with failure (Fisher exact test, P = 0.04); the excess risk of failure compared with sacroiliac joint injury was 13% (95% confidence interval 1% to 25%). There was no significant association between failure and anterior fixation method, iliosacral screw arrangement or length, or any demographic or injury variable. CONCLUSIONS: Percutaneous iliosacral screw fixation is a useful technique in the management of vertically unstable pelvic fractures, but a vertical sacral fracture should make the surgeon more wary of fixation failure and loss of reduction.

Acetabulum↗
PubMed2000

[Dorsal oblique pelvic fixator: development and biomechanical testing].

In haemodynamically unstable patients with an unstable pelvic ring injury the primary stabilisation of the pelvis and thus reduction of pelvic volume is important for the success of the treatment. The pelvic C-clamp is an approved emergency device for these unstable pelvic ring injuries. A secondary procedure though is necessary in most of the cases with a hig rate of wound problems in already traumatized soft tissue areas. The ventrally placed external fixator is a simple and quick procedure with little soft tissue damage. Though primary stability is sufficient even for C-type injuries, biomechanic stability of the posterior pelvic ring is often insufficient for mobilization. Based on biomechanic considerations, a new dorsal oblique pelvic external fixator was developed for pelvic C-type injuries. With the advantages of the supraacetabular fixator and two additional Schanz screws the ventral fixator should stabilize the posterior pelvic ring with comparable stability to the pelvic C-clamp. A primary and already definitive minimal invasive stabilization of the posterior pelvic ring was the aim. In the first series several variations of this asymmetric fixator with two different Schanz screw applications were tested biomechanically. In a second series the favorite version was tested versus the supraacetabular fixator and the pelvic C-clamp. Both of the biomechanic test series were performed with artificial pelves in the one leg stance model in the material testing machine. SI disruption and sacral fracture were the posterior instability types in 6 pelves each. There was no statistically significant difference between the dorsal oblique fixator and the pelvic C-clamp. But the new fixator was significantly more stable than the supraacetabular fixator or the new fixator without pretension.

Biomechanical Phenomena↗
PubMed2006

Fixation methods can produce misleading artifacts in sperm cell ultrastructure of diploid and tetraploid Pacific oysters, Crassostrea gigas.

Spermatozoa from diploid and tetraploid Pacific oysters (Crassostrea gigas) were examined after anisotonic fixation. Morphological anomalies, such as membrane rupture, detached tails, and the formation of tail vesicles (typically associated with damage attributable to procedures such as cryopreservation) were observed; the Mantel-Haenszel Chi-square test indicated a strong association between the anomalies and fixative osmolality (P<0.001). The present study also indicated that media in a range of 800 to 1,086 mOsm/kg could be assumed to be functionally isotonic to Pacific oysters, and osmolalities below or above this caused severe cell damage. For example, the maximum volume of flagella obtained after hypotonic fixation was approximately twice the volume of the flagella in isotonic fixation. Sperm cell flagellar volumes after hypertonic fixation (1,110 mOsm/kg) were 32% smaller than those in isotonic fixation, and sperm heads were 25% smaller. Although the damage associated with anisotonic fixation was evident in all parts of the sperm cells, the most vulnerable locations were the plasma membrane and flagellum motor apparatus. The formation of tail vesicles after hypotonic fixation was also examined. Because of water uptake, oyster sperm became swollen in hypotonic fixative, and bending or coiling of the axoneme within the tail vesicles led to the appearance of multiple axonemal structures in cross sections when observed by transmission electron microscopy. This phenomenon might be generally misinterpreted as the presence of double tails. This and other fixation artifacts can lead to the misinterpretation of damage caused by cryopreservation in ultrastructure studies of sperm of aquatic species, especially those in marine species.

Animals↗
PubMed2005

Mechanical analysis of fixation methods for anterior cruciate ligament reconstruction with hamstring tendon graft. An experimental study in sheep knees.

This study evaluates the structural properties of the femur-anterior cruciate ligament (ACL) graft-tibia complex, comparing different graft fixation techniques in sheep knees. Four fixation devices were tested both for femoral fixation (Transfix, absorbable screw, RCI screw and Linx-HT) and tibial fixation (bone plug with metal screw, absorbable screw with staple, RCI screw and cancellous screw with spiked washer). The graft used for ACL reconstruction was fresh ovine doubled Achilles tendon (DAT). Femurs and tibias were tested separately. Two mechanical test series were performed on the specimens: a load-to-failure test and a cyclic loading test. On the femoral side, transcondylar screw showed the greatest fixation strength and stiffness and the lowest elongation at cyclic loading. Tibial fixation complexes seemed to have poorer structural properties in comparison to femoral fixation. Among the tibial fixation devices, absorbable screw with staple fixation showed the greatest strength and stiffness. Spiked washer fixation showed the greatest elongation under cyclic loading.

Animals↗
PubMed2003

Pin tract infection with contemporary external fixation: how much of a problem?

OBJECTIVE: To determine the incidence of pin tract infection.DESIGN Retrospective chart review. SETTING: Level 1 trauma center in an urban community. PATIENTS: A total of 285 patients with 285 fractures over a 4-year period (1997-2001). INTERVENTION: External fixation. MAIN OUTCOME MEASUREMENT: Incidence of pin tract infection. RESULTS: Of 285 fractures, 32 (11.2%) were complicated by infection. The incidence of infection according to montage was 3.9% (3/77) for ring fixators, which was significantly different (P < 0.04) from the 12.9% incidence (23/178) for unilateral fixators and the 20.0% incidence (6/30) for hybrid fixators (P = 0.004). The incidences of pin tract infection for the unilateral fixator group and the hybrid fixator group were not significantly different. CONCLUSIONS: Patients with hybrid external fixators had a similar risk of pin tract infection as patients who had unilateral fixators. The infection rate in the ring fixator group was significantly lower than the hybrid external and unilateral fixator groups.

Adolescent↗
PubMed2000

Simple anterior pelvic external fixation.

BACKGROUND: Unstable pelvic ring disruptions are often associated with significant morbidity and mortality, especially in patients with multiple injuries. Early pelvic fixation provides stability and should diminish ongoing hemorrhage. A simple anterior single-pin pelvic external fixator can be applied rapidly and accurately to stabilize pelvic ring injuries as a part of the initial patient resuscitation of such patients. Simple anterior pelvic external fixation (SAPEF) frames can be used as either temporary, definitive, or supplementary fixation depending on the pelvic injury pattern. METHODS: Over a 32-month period, 41 patients with unstable pelvic ring disruptions were stabilized using a simple anterior pelvic external fixator. Eight patients had open pelvic ring injuries and 13 others had genitourinary system disruptions. Fluoroscopic imaging was used to insert all of the fixation pins into the iliac crest between the iliac cortical tables to a depth of at least 5 cm. Each patient had closed manipulative reduction of the pelvic ring using external methods before SAPEF application. RESULTS: One patient died less than 24 hours after injury because of torrential hemorrhage. Clinical evaluations and serial radiographs, including postoperative computed tomographic scans, were available for the other 40 patients postoperatively. Seventy-five of the 80 (94%) pins were completely contained between the iliac cortical tables, according to the computed tomographic scans. The initial pelvic closed reductions were maintained until the fixators were removed in 37 of 40 patients (93%). Only one deep pin track infection developed, mandating early frame removal and intravenous antibiotic therapy. CONCLUSION: Simple anterior pelvic external fixation can be applied rapidly using fluoroscopic guidance to direct accurate pin insertion and closed manipulative reduction of the pelvis. Depending on the specific pelvic ring injury pattern and clinical scenario, SAPEF can serve as a resuscitative temporary fixation device, as definitive pelvic treatment, or as a supplement for pelvic internal fixation implants.

Adolescent↗
PubMedDate not supplied

Mechanical comparison of two external fixator clamp designs.

OBJECTIVE: To compare two external fixation clamp designs for their ability to resist movement of a fixation pin in relation to the connecting rod. STUDY DESIGN: Two designs of external fixator clamps were attached to connecting rods mounted on a jig for mechanical testing. Fixator pins were placed perpendicular to the connecting rod. A mechanical testing machine was used to deflect each 3.2-mm pin at a distance that was 25 mm from the center of the clamp bolt. Both clamp designs were tightened to 4.4, 6.1, and 7.8 newton-meters (N x m) torque, and loads were applied in a position ramp through 4 mm and resisting loads were measured. Two clamp orientations were used during load application, such that the deflection of the pin tended to tighten the clamp bolt or tended to loosen the clamp bolt. The tests were videotaped to determine mode of failure. Comparisons of the load/displacement curves for the two external fixator clamp designs were made using nonlinear equational curve fitting methods. The resultant plateau and rise coefficients were compared using analysis of variance. RESULTS: Slippage of the pin in relation to the clamp occurred with the Kirschner-Ehmer clamp tightened to 4.4, 6.1, and 7.8 N x m, and slipping of the pin in relation to the clamp occurred with the experimental clamp design tightened to 4.4 and 6.1 N x m but not to 7.8 N m. At 7.8 N x m, the 3.2-mm pin deformed plastically with the experimental clamp design. Increasing the torque of the clamp bolt resulted in superior plateau coefficients for both clamp designs. At each level of tightness and in each clamp orientation to applied pin load, the experimental clamp design provided greater plateau coefficients than did the Kirschner-Ehmer clamp design. At 7.8 N x m of tightness, the Kirschner-Ehmer clamp and bolt bent, whereas only slight plastic deformation of the experimental clamp design occurred. CONCLUSIONS: The experimental external fixator clamp was more secure in resisting fixator pin movement at all levels of tightening compared with the Kirschner-Ehmer-type external fixator clamp. At 7.8 N x m of tightening, the new clamp design did not allow slippage of the pin within the clamp. CLINICAL SIGNIFICANCE: The experimental external fixator clamp should result in greater rigidity of fixator configurations, in addition to providing design features that allow addition of a clamp between two installed clamps, sleeved predrilling of pilot holes for all pins, measurement of pin depth, and placement of positive profile pins at all sites.

Animals↗
PubMed1994

A comparison of heating modes in rapid fixation techniques for electron microscopy.

Recent studies have established that microwave irradiation during aldehyde fixation of electron microscopy specimens can reduce fixation times substantially. Similar reductions in duration of histochemical and light microscopy procedures have been reported. Both thermal and non-thermal effects of microwaves have been proposed to explain these dramatic decreases in processing time. Possible thermal effects include increases in fixative diffusion and reaction rates and increased formation of glutaraldehyde monomers. Proposed non-thermal effects include preferential orientation of fixative molecules by the microwave field and other more speculative direct microwave effects. Several reported attempts to produce rapid fixation without temperature increase by cooling specimens during irradiation have produced conflicting results. If rapid fixation is a thermal effect, other heating modes in addition to microwave exposure should produce similar effects. We show that for mouse liver samples (< or = 1 mm3) comparable fixation can be obtained with microwave irradiation, conductive and convective heating in a waterbath, and resistive heating with a low-frequency (1 kHz) current passed through the fixative solution. We also show that using an efficient convective cooling method to prevent temperature increase during microwave exposure produces unsatisfactory fixation. These results are consistent with thermal mechanisms for rapid fixation.

Animals↗
PubMed2003

Cyclic loading of olecranon fracture fixation constructs.

BACKGROUND: Despite the good results that are usually reported after fixation at the sites of olecranon fractures and osteotomies, problems such as loss of fixation, nonunion, and the need for revision surgery are still encountered. Various types of fixation have been recommended, but few have been evaluated with use of clinically relevant cyclic load testing at appropriate levels of stress. The purpose of the present study was to test multiple olecranon fixation techniques under physiologic cyclic loads. METHODS: We studied ten cadaveric elbows with use of cyclic loading that simulated (1) active range of motion and (2) pushing up from a chair. Each specimen underwent fixation of a simulated 50% transverse olecranon fracture with use of intramedullary and cortically fixed tension band constructs (in randomized order) followed by fixation with a 7.3-mm-diameter cancellous screw with and without a tension band. Displacement transducers were placed posteriorly on the tension side and anteriorly near the articular surface. RESULTS: Both configurations involving the 7.3-mm-diameter cancellous screw provided the most stable fixation-nearly five times better than that provided by the Kirschner-wire techniques. Use of the tension band in conjunction with the intramedullary screw improved the stability of fixation. In none of the constructs did the AO tension band result in compression across the osteotomy gap. CONCLUSIONS AND CLINICAL RELEVANCE: The use of a 7.3-mm screw in conjunction with a tension band provided better fixation of simulated displaced transverse fractures than did the use of Kirschner wires in conjunction with a tension band or the use of a screw only. The AO principle of converting posterior tensile forces to articular compressive forces was not demonstrated in this study. We therefore question the validity of the tension band concept in olecranon fracture fixation and recommend passive rather than active range of motion in the immediate postoperative period to limit fracture distraction.

Analysis of Variance↗
PubMed2001

Influence of an interdental full pin on stability of an acrylic external fixator for rostral mandibular fractures in dogs.

OBJECTIVE: To determine total stiffness and gap stiffness of an external fixation system in a canine mandibular fracture gap model incorporating a full interdental pin as the only point of rostral fixation in a bilateral type-I external fixator. SAMPLE POPULATION: 10 canine mandibles. PROCEDURE: Bilateral mandibular ostectomies were performed between premolars 3 and 4. A type-I external fixator incorporating a full interdental pin was placed to stabilize a 0.5-cm fracture gap. Four pin configurations (intact mandibular bodies with fixator; ostectomized mandibular bodies and complete fixator; ostectomized mandibular bodies with caudal pins of rostral fragment cut; ostectomized mandibular bodies with all pins of rostral fragment cut) were tested in dorsoventral bending 5 times on each mandible. The full interdental pin remained intact in all configurations. Total stiffness and gap stiffness were determined for each configuration on a materials testing machine. RESULTS: Total stiffness of intact mandibles was significantly greater than that of ostectomized mandibles, regardless of external fixator configuration. However, total stiffness and gap stiffness were not significantly different among different external fixator configurations applied to ostectomized mandibles. CONCLUSION AND CLINICAL RELEVANCE: External fixator configurations with only the full interdental pin engaging the rostral fragment were as stiff as configurations that had 2 or 4 additional pins in the rostral fragment for the applied loads. External fixators for rostral mandibular fractures may be rigidly secured with rostral fragment implants applied extracortically, avoiding iatrogenic trauma to teeth and tooth roots.

Animals↗