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PubMed1991

Subtrochanteric femur fractures: a comparison of the Zickel nail, 95 degrees blade plate, and interlocking nail.

Seventy-nine nonconsecutive patients with subtrochanteric femur fractures were divided into three groups based on the method of fracture fixation. Group I consisted of 21 patients treated with a Zickel nail, Group II comprised 25 patients treated with a 95 degrees blade plate, and Group III included 33 patients treated with an interlocking nail. All patients in Group I and Group II had open reduction and internal fixation of their fractures. Ninety-four percent of the patients in Group III were treated by closed intramedullary nailing. The average operating times for Groups I, II, and III were 212, 272, and 181 min, respectively, while blood loss averaged 900, 1,500, and 600 ml for each group, respectively. Group I had one infection, ten malunions, and one nonunion. Group II had one infection, six malunions, and two nonunions. Group III had no infections, two malunions, and one nonunion. We conclude that closed interlocking nailing is the treatment of choice for acute nonpathologic subtrochanteric femur fractures in adults. There is decreased blood loss, reduced operating time, and fewer complications than with either the Zickel nail or the 95 degrees blade plate regardless of the fracture pattern or the degree of fracture comminution.

Adult↗
PubMed1993

[Injuries with severe soft tissue damage. Osseous defects--septic complications; plastic surgery management to osseous reconstruction].

Most of the severe soft tissue problems following open or closed fractures can be treated successfully by means of local or microvascular muscle flaps. Thus open fractures can be changed to closed fractures, or cases of high grade osteomyelitis can be transformed into non-infected or low-grade infected ones as a prerequisite for successful internal fracture fixation or bony reconstruction. Follow-up of 319 muscle flaps shows a low flap loosening rate (4%) and low overall complication rate (8%). The results demonstrate the high value and benefit of soft tissue reconstruction in trauma and reconstructive surgery.

Adolescent↗
PubMed1991

[Screw fixation of fractures of the odontoid process].

In the year 1981, J. Böhler completed for the first time a screw fixation for unstable fractures of the odontoid process of the axis. This surgical technique preserves the anatomy and the physiology of the articulation between the atlas and the axis, as a guarantee for a good functional recovery. It is not a very difficult technique when performed by a trained surgeon with a very good X-ray image intensification for the per-operative control. We have treated 32 unstable fractures of the odontoid process without any neurological complication per- or post-operatively. We had a follow-up on only 29 cases. In 19 cases the fracture healed in leading to a good bone union, complete mobility and no residual pain. Seven patients complained of residual pain or a limitation in cervical movement, because of the association with other cervical fractures, an age superior of 70 years, or a major initial instability. In 2 cases the authors noted a non-union and a secondary displacement because of technical faults at the beginning of their experience. These good results determined the authors to prefer the direct screw fixation for the unstable fractures of the odontoid process, to the posterior arthrodesis which leads to functional limitations.

Adolescent↗
PubMed2000

External fixation in forearm shaft fractures.

External fixation for uncomplicated forearm fractures is rarely performed. The situation is different in a multiply injured patient or in a fracture with considerable soft tissue damage. In these cases the external fixator confers quick and efficient stabilisation which meets the requirements of adequate nursing and aids recovery of the general and local condition. Later change to an appropriate internal fixation procedure for definitive fracture treatment is recommended.

Adolescent↗
PubMed1990

Internal fixation for fractures of the patella. A comparison of two methods.

Cadaveric experiments in 10 knees were used to study the strength of two methods of internal fixation for a fractured patella. A modified AO tension band technique was compared with the combination of cerclage wiring and a tension band used at Pyrford. The repairs were stressed to failure; the combination of cerclage and tension band wiring proved to be significantly stronger and is recommended.

Adolescent↗
PubMed2002

[Two-pin L fixation of fractures of the fifth metacarpal neck].

The authors present a retrospective review of 48 fractures of the fifth metacarpal neck in 48 patients, who underwent internal fixation using the two-pin L procedure. These fractures were treated between 1994 and 2000, in 5 female and 43 male patients with an average age of 27 years (range 14 to 58). Fighting and sporting accidents were the main etiology of injury. The indication for surgical treatment was volar displacement of over 30 degrees. The two-pin L procedure consists of stabilizing the fragments after reduction using one intra-medullary pin 2 mm in diameter introduced through a proximal approach, and a transverse distal pin 1.2 mm in diameter from the fifth toward the fourth metacarpal. All treatments were performed under nerve block. Early mobilization was authorized. Patients did not need any physiotherapy. Activity was resumed after three weeks, and the average time to the removal of pins was five weeks. In eight cases, it was necessary to remove the transverse distal pin around 21 days after surgery because of displacement of the pin causing pain under the skin. At three months follow-up, bone union was obtained in all cases, with a perfect range of motion of all finger joints, without any pain or reflex sympathetic dystrophy. The two-pin L procedure appears to be a reliable technique, which provided union in an anatomic position in all our cases, and also allowed early mobilization and provided good functional results.

Adolescent↗
PubMed1993

Polyglyconate plates and screws to stabilize zygomatic osteotomies in a rabbit model.

Rigid internal fixation with miniplates and screws continues to be widely used in the correction of both congenital and acquired craniomaxillofacial deformities. This technique allows precise three-dimensional stabilization of bony segments. A number of recent reports have detailed some disadvantages, including potential growth restriction in developing children, bone resorption, infection, extrusion, and palpability. These problems have often necessitated secondary surgery for hardware removal. A biodegradable plate and screw system would eliminate these potential and real problems. Over the last 2 decades, there has been an escalating interest in developing satisfactory biodegradable materials for bony fixation. We have previously reported the initial phases of a long-term evaluation of various biomaterials currently available. The purpose of this study is to examine a biodegradable plate and screw system fabricated from a faster resorbing material--polyglyconate. This system would be applicable to pediatric reconstructive problems. Earlier studies have shown its tissue compatibility and feasibility for multiple surgical uses. Osteotomies were created at the midpoint of each zygomatic arch of 42 adult male white New Zealand rabbits. The animals were then divided into two equal groups. The first group served as a control and the bony segments were permitted to heal without stabilization, whereas in the experimental group, the bony segments were stabilized with biodegradable plates and screws made from polyglyconate. Animals were then sacrificed at 2, 4, 6, 8, 12, and 16 weeks, at which time radiographs were obtained. Zygomatic complexes were then removed en bloc, and routine hematoxylin and eosin slides were made for light microscopy. Without fixation, fracture segments became significantly displaced.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2001

Total knee arthroplasty after open reduction and internal fixation of fractures of the tibial plateau: a minimum five-year follow-up study.

BACKGROUND: There is little information in the literature regarding the outcome of total knee arthroplasty following open reduction and internal fixation of fractures of the tibial plateau. The goal of this study was to evaluate the results of such procedures after a minimum of five years of follow-up. METHODS: We retrospectively analyzed the outcomes of fifteen total knee arthroplasties performed at an average of 38.6 months (range, eight months to eleven years) after open reduction and internal fixation of a fracture of the tibial plateau in fifteen consecutive patients. The average duration of follow-up after the total knee arthroplasty procedures was 6.2 years (range, 5.4 to 11.1 years). The average age of the patients was fifty-six years (range, thirty-seven to sixty-eight years) at the time of the arthroplasty. We evaluated the outcomes on the basis of the Hospital for Special Surgery knee score, the Short Form-36 score, and radiographs of the knees. RESULTS: The average Hospital for Special Surgery knee score was 51 points (range, 20 to 74 points) before the arthroplasty, and it increased to 80 points (range, 44 to 91 points) postoperatively. Four knees were scored as excellent, eight had a good result, one was rated as fair, and two had a poor result. The average Short Form-36 scores were 58.0 points for general health, 72.4 points for bodily pain, 72.1 points for mental health, 58.3 points for physical functioning, 84.6 points for physical role functioning, 81.0 points for social functioning, and 57.7 points for vitality. The average active postoperative arc of motion was 105 degrees (range, 70 degrees to 135 degrees ) compared with 87 degrees (range, 20 degrees to 125 degrees ) preoperatively. Incomplete radiolucencies were noted on all of the postoperative radiographs made after the total knee arthroplasties. There was a high rate of infection (three patients), patellar tendon disruption (two patients), and postoperative secondary procedures (three patients required closed manipulation). The patients with infection were considered to have a failure of treatment: two required arthrodesis, and one required a two-stage exchange. CONCLUSION: On the basis of our results, we concluded that total knee arthroplasty after open reduction and internal fixation of a fracture of the tibial plateau decreases pain and improves knee function, but the procedure is technically demanding and is associated with a high failure rate (five of fifteen).

Adult↗
PubMed2002

Percutaneous Herbert screw fixation for fractures of the scaphoid: review of 30 cases.

INTRODUCTION: The purpose of this study was to evaluate the results of percutaneous fixation of undisplaced or minimally displaced fractures of the scaphoid using the first generation Herbert screw in terms of union, functional results and scaphoid mobility. METHODS: 30 of the 50 patients operated on in our department between 1995 and 2000 were available for evaluation by an independent observer. Wrist mobility, grip strength and key pinch were measured. Scaphoid mobility was evaluated by measuring radioscaphoid angles in flexed and extended positions on dynamic X-rays. RESULTS: The union rate was comparable to that achieved by non-operative management (90%). Resumption of professional activities was possible long before bony union because immobilization was short. Grip strength, wrist and scaphoid mobilities were comparable to the controlateral sides except for scaphoid flexion. Persistent symptoms were found in 30% of the patients despite union of their fracture. DISCUSSION: Our results demonstrate that percutaneous stabilization of undisplaced or minimally displaced fractures of the scaphoid preserves the mobility of the wrist and minimally alters the normal dynamics of the carpus. The duration of work inability is short.

Adult↗
PubMed1999

Internal fixation of phalangeal fractures using titanium miniplates.

Although widely utilized in the treatment of metacarpal fractures, plate fixation in phalangeal fractures remains controversial. Increased potential for infection, breakage, and added soft-tissue trauma leading to increased joint stiffness have been cited as important negative factors. A retrospective analysis of titanium plate fixation of phalangeal fractures over a 7-year period is presented. From 1991 to 1998, 16 fractures (13 men, 3 women; age range, 19-70 years) were managed with plate fixation using the Profyle titanium plating system as the primary modality of treatment. All plates were seated dorsally using an extensor tendon-splitting approach. The average follow-up period after surgery was 5 months (range, 3-28 months). Fracture patterns varied: 31% (5 of 16) were open fractures and 69% (11 of 16) were closed. Complications occurred in 25% of patients (4 of 16) and consisted of pain or other trigger that required removal of hardware, flexion contracture at the proximal interphalangeal joint, and extensor lag. There were no instances of hardware failure, infection, or malunion. The quality of recovery of joint motion was assessed using the Total Active Flexion Scale: nine digits were graded excellent, another six were categorized as good, and only one digit was judged as poor. A review of the current literature is presented along with suggested guidelines for the application of miniplate fixation for fractures of the phalanges.

Adult↗
PubMed1999

Risk factors for ankle fracture requiring operative fixation.

BACKGROUND: Ankle fractures are common and expensive injuries, particularly the injuries that require operative intervention. However, epidemiological research on the causative factors is sparse. This study aims to identify the groups at risk of ankle fracture requiring operative fixation, and to suggest directions for further study. METHODS: The clinical data on 336 patients with ankle fractures admitted to an urban hospital in New Zealand in 1994 were reviewed. Statistical analysis was carried out on the 252 patients with ankle fractures requiring operative fixation. RESULTS: Those at highest risk of ankle fracture are young male rugby players and middle-aged women who sustain injury while walking. Young males have a similar incidence of AO Type B and C fractures, while Type B fractures predominate strongly in older women. CONCLUSIONS: The groups at risk of ankle fracture requiring operative fixation, and the activities predisposing these groups to injury have been identified. More work is required to define the specific risk factors and biomechanical mechanisms that lead to these debilitating injuries.

Adolescent↗
PubMed2004

Percutaneous plate fixation of fractures of the distal tibia.

Minimally invasive plate osteosynthesis (MIPO) of the distal tibia offers several theoretical advantages compared to classic open reduction and internal fixation. A mechanically stable fracture-bridging osteosynthesis can be obtained without significant dissection and surgical trauma to the bone and surrounding soft tissues. In this retrospective study we looked at the results and complications in ten consecutive patients treated with percutaneous plating for fractures of the distal tibia and plafond with a minimum follow-up period of one year. No significant soft tissue problems occurred. The need for bone grafting should be carefully evaluated in every case as we encountered two delayed unions. All fractures healed within one year; there was no fracture malunion. The use of indirect reduction techniques and small incisions to insert hardware is technically more demanding and requires strict radioscopic control throughout the procedure, but it considerably decreases surgical trauma to the soft tissues.

Adult↗
PubMed1992

Compression-staple fixation for fractures, non-unions, and delayed unions of the carpal scaphoid.

We used the Richards scaphoid compression staple for operative fixation in a total of twenty-five patients who had a fracture of the carpal scaphoid: sixteen whom we reported on previously and nine whom we are reporting on for the first time here. In the current series, we extended the application of the method to fresh, unstable fractures (two patients) and treated an additional seven patients who had a non-union or delayed union. The procedure was simple, and no operative complications were encountered. Both patients who had a fresh fracture had a satisfactory result. Of the other twenty-three patients, only two had a result that was not satisfactory. One patient had a persistent non-union. Three patients had doubtful radiographic evidence of a persistent non-union; however, all three had a good result clinically, and only one had moderate loss of function. Although the over-all results were good, there was some worsening of the clinical results on long-term follow-up compared with those that we reported earlier. This deterioration probably was due to secondary degenerative changes in the articular surfaces.

Adult↗
PubMed1991

[Ventral direct screw fixation in dens fractures].

Direct anterior screw fixation of odontoid fractures is indicated in type II and occasionally type III fractures according to the Anderson and d'Alonzo classification. This fracture treatment follows the generally accepted concepts of surgical treatment of limb fractures. It is direct osteosynthesis of a fracture by screw fixation with interfragmentary compression and differs fundamentally from all other treatment methods in spinal fractures, where the treatment is combined with fusion and definite immobilization of a motion segment. The iatrogenic trauma is minimal by using an anterior surgical approach and no supplemental bone grafting is required. The postoperative care is very simple, and the fusionless fracture fixation has a better functional outcome. With the introduction of cannulated screws, which can be inserted over K-wires, the surgical procedure has been further simplified and minimizes the peroperative risks. After initial complications in the first series of 17 patients, the most recent 15 cases were without complications. This stresses the fact that this surgical procedure should only be done by spine surgeons who are familiar with the upper cervical spine and osteosynthesis techniques.

Adolescent↗
PubMed1993

Rigid internal fixation of fractures in the angular region of the mandible: an analysis of factors contributing to different complications.

Data relating to 113 patients with 121 mandibular angle fractures treated according to the principles of rigid internal fixation were analyzed to determine which clinical factors are associated with different complications. Certain clinical characteristics were found to be associated with major complications. The use of compression plates seemed to entail disadvantages resulting in some complications. Because of the relatively small cross section of bone surface and particular anatomic features of the angular region, well-adjusted interfragmentary compression is often not possible. A neutral reconstruction plate is considered optimal for rigid osteosynthesis. If a molar tooth in the fracture line has to be extracted, this should be done after fracture stabilization. In most cases, an extraoral approach could not be avoided, but complications associated with this approach were infrequent and well tolerated by patients.

Adult↗
PubMed1996

Arthroscopic internal fixation of fractures of the intercondylar eminence of the tibia.

We treated a 53-year-old man with a fracture of intercondylar eminence of the tibia. He had a nondisplaced (type I) fracture at the first examination and was treated by long leg cast. However, 4 weeks later, it was found that the fracture was displaced, which suggests that nondisplaced fracture of intercondylar eminence may displace later. We recommend primary arthroscopic fixation for type I fractures of the intercendolar eminence of the tibia, because it is difficult to reduce the fragment arthroscopically once it is displaced. This report describes a new technique of arthroscopic reduction and internal fixation for the fractures intercondylar eminence of the tibia.

Adolescent↗
PubMed1993

Use of a tourniquet in the internal fixation of fractures of the distal part of the fibula. A prospective, randomized trial.

A prospective, randomized trial was undertaken to determine the rate of complications after the use of a tourniquet during open reduction and internal fixation of simple, closed fractures of the distal part of the fibula. Forty patients were operated on with use of a tourniquet (Group 1) and forty patients, without use of a tourniquet (Group 2). The average duration of the operation was significantly different between the two groups (41 +/- 9 minutes for Group 1 compared with 53 +/- 12 minutes for Group 2 [p = 0.026]). There were more complications in the patients in Group 1, two of whom had an isolated deep-vein thrombosis of the calf. The wound was possibly infected in eleven patients (seven in Group 1 and four in Group 2 [p < 0.05]) and frankly infected in three patients, all in Group 1 (p < 0.05). The plaster-of-Paris cast needed to be changed in three patients from Group 1. The patients in Group 1 returned to work an average of one week later than those in Group 2. The mean duration of follow-up was eighteen months (range, nine to thirty-two months). Given the lower prevalence of postoperative complications and the shorter time to recovery for the patients in Group 2, we believe that it is justified not to use a tourniquet in the operative treatment of simple, isolated fibular fractures.

Adult↗