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PubMed1975

[Fracture movement and fracture healing in plaster case fixation (author's transl)].

The fixation of a fracture in a plaster cast, or in traction is not absolutely rigid. Experiments were carried out on adaver tibial fractures placed in long leg plaster casts. It was observed that the possible deformity ranged between 4-8 degrees in a well-padded cast and 2-5 degrees in a nonpadded cast. Further observation were conducted while hip osteotomies were compressed by external fixator. These osteotomies are further protected by hip spicas. It was demonstrated that increasing the length of the cast did not increase the degree of fixation. It is suggested that fracture healing in conservatively treated cases is optimal if movement of the fragments remains within the physiological elastic limits of the not fractured bone. Fracture healing can be disturbed not only by extensively denudation and soft tissue disturbance, but also by under-or overstressing the bone and by unphysiological immobilisation.

Biomechanical Phenomena↗
PubMed2002

[Measurement of fracture malrotation after interlocking intramedullary nailing of femoral shaft fracture].

OBJECTIVE: To study the quantitative measurement of the extent of malrotation after interlocking intramedullary nailing of femoral shaft fracture. METHOD: CT scan ("routine method") applied in 36 femoral shaft fractures that had been treated with close reduction and interlocking intramedullary nailing. For the judgement of the extent of malrotation, the anteversion of both fracture side and contralateral side were measured and the difference between the 2 sides was evaluated. The increase of anteversion represented internal rotation of the distal fragment, whereas the decrease of anteversion represented external rotation. RESULTS: The maximum anteversion of the fracture sides, whereas 48 degrees, the minimum anteversion -10 degrees, the mean value, 15.04 degrees, and the standard error is 11.34 degrees. The maximum anteversion of the contralateral side, whereas 31.3 degrees, minimum -4.8 degrees, the mean value was 13.96 degrees and the standard error was 10.20 degrees (P < 0.001). Compared with the contralateral side, half of the 36 cases showed increased anteversion and the other half decreased anteversion. The mean value of internal rotation is 11.56 degrees, and external rotation 9.39 degrees. The maximum internal rotation was 37 degrees, the minimum 0.9 degrees. Eight cases had internal rotation less than 8 degrees, 6 between 10 degrees - 15 degrees, and 4 over 15 degrees. The maximum external rotation was 24.3 degrees, and the minimum 1.8 degrees. Eleven cases had external rotation less than 10 degrees, 4 between 10 degrees - 15 degrees and 3 over 15 degrees. The incidence of malrotation more than 10 degrees was 47% (17/36), and more than 15 degrees 19.4% (7/36). CONCLUSION: The incidence of malrotation after femoral shaft fracture treated with close reduction and interlocking intramedullary nailing is high. Attention should be paid to clinical management and strict control for rotational reduction intra-operatively.

Adolescent↗
PubMed2005

Delayed presentation of ipsilateral femoral neck fractures in diaphyseal femur fractures.

Femoral neck fractures with delayed presentation following ipsilateral femoral diaphyseal fracture stabilization have been described as clandestine, attributed to missed diagnosis, or related to surgical technique. Clandestine fractures are present from time of injury but not detectable. The authors hypothesize that femoral neck fractures with delayed presentation can be clandestine, missed, or caused by surgical technique. A retrospective study and a comprehensive literature review are presented to determine the true incidence and etiology of these fractures.

Diaphyses↗
PubMed1991

[Fracture and dislocation fracture of the os pisiforme].

Four cases of pisiform fracture are presented. In one case the largest fragment of the pisiform bone with the articular surface was dislocated. After open reduction, osteosynthesis with K-wires was performed. Two patients had an isolated fracture without fragment dislocation. They had their lower arms immobilized with a plaster of Paris cast for 4 weeks. In the fourth case the fracture of the pisiform bone was associated with an intraarticular distal radial fracture and wrist dislocation. The typical traumatic cause of pisiform fracture is a fall onto the outstretched hand. Immobilization for 4 weeks results in functional recovery. In cases with dislocation of the pisotriquetral joint open reduction and osteosynthesis are necessary. Excision of the pisiform bone is not indicated in a fresh injury.

Adult↗
PubMed1990

Tibial fracture with or without fibular fracture--clinical studies.

This report investigated 145 cases of closed tibial fractures treated with closed reduction and cast immobilization, and followed up at least for 2 years, from 1981 to 1984, at Chang Gung Memorial Hospital of Taiwan. The total delayed or nonunion rate was 28.3% (41 patients), and the healing period was 4.6 months on average (range, 3-6 months). Among them, the delayed or nonunion rate in the tibial fractures with fibular fracture group was 33.3% (35/105), but in the tibial fractures without fibular fracture group it was only 15% (6/40). The difference between the groups was statistically significant (P less than 0.05). The severity of soft tissue injury may be a very important prognostic factor for bone healing.

Adolescent↗
PubMed1989

[Distal radius fracture. Fracture stabilization with biodegradable osteosynthesis pins (Biofix). Experimental studies and initial clinical experiences].

K-wire stabilization and casting of unstable or intraarticular fractures of the distal radius has proven to be an effective method of treatment since many years. However the need of implant removal after fracture healing is a disadvantage of this method. For this reason we investigated on the use of biodegradable implants in a fracture model of the distal radius. The biomechanical testing with Polydioxanon-(PDS)-pins (Ethipin) showed too small primary stability for the use in vivo. Osteosyntheses with three Polyglycolacid-(PGA)-rods Biofix compared with three K-wires 1.6 mm on the other hand showed 82% initial stability. From May to September 1988 typical distal radius fractures in 11 patients have been stabilized with Biofix-rods. The result of primary reduction could be obtained in all cases. These first experiences suggested, that stabilization of distal radius fractures with Biofix-rods might alternatively be performed instead of K-wire pinning.

Adult↗
PubMed1989

[Anatomoclinical forms of fractures of the sternum. Role and methods of osteosynthesis of unstable fractures].

In general, fractures of the sternum are of little interest. This is unfair since unstable fractures may be the cause of paradoxical respiration and hence respiratory distress. Fractures often result from automobile accidents and occur in passengers wearing seat belts. In these circumstances, the seat belt in fact replaces the steering wheel as the causative agent. With reference to several cases this variety of injury is studied from the anatomo-pathological, clinical and therapeutic viewpoints. Osteosynthesis using a plate and screws limited to the sternum or including neighbouring rib fractures would appear to be the method of choice. Surgical fixation of the fracture site, the methods of which are discussed, is of value for both isolated lesions of the thoracic cage, and also in the context of single stage surgery in certain patients with multiple trauma.

Accidents, Traffic↗
PubMed1988

Subcapital fracture of the hip following an intertrochanteric fracture. A case report and literature review.

A 42-year-old alcoholic man who had a normal femoral head histologically incurred a subcapital fracture four months after surgical treatment of an intertrochanteric fracture of the same hip. Subcapital fracture of the hip following intertrochanteric fracture is an unusual occurrence, with possibly as few as 11 cases documented in the literature. Affected persons are usually elderly females with severe osteoporosis. Though unusual, the fracture is obvious and not difficult to treat.

Adult↗
PubMed1995

Maisonneuve fracture with an associated distal fibular fracture. A case report.

A 46-year-old woman had a severe torsional injury to her left leg. Admission radiographs showed a proximal Maisonneuve-type fibular fracture with an associated distal fibular fracture at the level of the distal tibiofibular syndesmosis. A complete syndesmotic disruption, proximal and distal to the distal fibular fracture, was verified at surgical exploration as was a complete deltoid ligament tear. Management consisted of internal fixation of the distal fibular fracture and placement of a syndesmotic screw. At 1-year followup, the patient reported normal ankle function. This case represents an unusual, and perhaps previously undescribed, variant of the so-called Maisonneuve fracture. The need for careful evaluation of the entire leg in torsional injuries of the ankle is underscored by the injury presented.

Ankle Injuries↗
PubMed1994

[Fracture and dislocation fracture of the os capitatum. Review of the literature and case report].

Capitate fractures are serious and rare carpal injuries. A case of a closed, isolated capitate fracture is presented. The largest fragment of the capitate, which was fractured at its waist, was dislocated with the wrist twisted in an ulnodorsal orientation. The supposed traumatic cause of the capitate fracture was a fall onto the outstretched and ulnar-deviated hand. After open reduction, osteosynthesis with K-wires was performed. Immobilization for 6 weeks in a plaster-of-Paris cast followed. The excellent functional result (according to the modified evaluation scale of Pechlaner/Beck) obtained after 15 months is demonstrated. Diagnosis and subsequent therapy should be as aggressive as in the case of scaphoid fractures. Different modalities and possible complications of an operative treatment are discussed.

Adult↗
PubMed1994

Open reduction and internal fixation of fractures of the acetabulum. Results in 163 fractures.

Management of displaced fractures of the acetabulum represents one of the greatest challenges in fracture surgery. This study reports intermediate term results for a single surgeon of 163 fractures in 161 patients treated by open reduction and internal fixation. The mean length of followup was 3.7 years. The most common fracture patterns treated were both column (67), transverse/posterior wall (32), posterior wall (14), and T shaped (12). The surgical approaches chosen were ilioinguinal (86), Kocher-Langenbeck (58), and extended iliofemoral (26) with 7 patients having sequential or simultaneous dual approaches. Reductions were rated by plain radiography and considered anatomic in 93 (56%) and near anatomic (< 2 mm displacement) in 40 (25%). There were 7 (4%) infections, 2 (1%) vascular injuries, 3 (2%) sciatic injuries, and 1 (1%) obturator nerve injury. Overall outcome was rated as excellent in 23 (14%), good in 101 (61%), fair in 25 (16%), and poor in 14 (9%). Nine patients have undergone hip salvage procedures. These results add to the growing body of clinical data which validates open reduction as the treatment of choice in most displaced fractures of the acetabulum.

Acetabulum↗
PubMed1993

[Locked nailing of fractures of the long bones. 1. Fractures of the leg].

The authors present an account of their initial experience with the use of a method of locked nailing of fractures of the leg, applying the technique described by Grosse and Kempf. They use original implants of Howmedica Co. They indicated for osteosynthesis closed fractures of the leg in the middle three fifths of the bone length, without major damage of soft tissues (grade 0 and 1 of Tscherne's classification). In injuries with imminent compartment syndrome they operated after a delay, in all others they operated early after injury. Using the described method, the authors operated 16 patients. In three instances they used static locking of the nail, in 13 instances dynamic locking. The authors did not observe any delayed healing of the fractures. The only complication was partial paresis of the deep branch of the peroneal nerve. In all instances the patients were allowed to weight-bearing of the operated extremity soon--on average 3.5 weeks after operation. Recovery followed after 8-15 weeks. The authors consider this method with regard to the possible functional treatment, stability for weight-bearing, and rapid recovery of the fracture as the optimal therapeutic procedure for almost all types of closed fractures in the middle three fifths of the leg.

Adolescent↗
PubMed1993

Mechanics of anatomic reduction of thoracolumbar burst fractures. Comparison of distraction versus distraction plus lordosis, in the anatomic reduction of the thoracolumbar burst fracture.

The adequate reduction of vertebral burst fractures is dependent on successful application of distractive forces in combination with the restoration of normal spinal lordosis. However, the optimal sequence of distraction in comparison to distraction plus lordosis in the anatomic restoration of the fractured thoracolumbar spine has not been described. Burst fractures of the L1 vertebra were first created and the reduced in vitro using three differing reduction techniques. In six fresh human cadaver spine specimens, the mean fracture severity based on the degree of canal compromise was 31% (SD +/- 20%) after fracture. Reductions were performed using the AO Fixator Intern, the Reduction Fixation (RF) Device, and the Steffee plate systems following standard clinical techniques. The AO Fixator Intern provided independent but variable control of distraction and lordosis, the RF device provided variable distraction with independent, but preset, correction of lordosis and the Steffee system provided set distraction and stabilization. Both the AO and RF devices restored the lordosis (7.6 degrees +/- 5.2 degrees and 9.7 degrees +/- 4.5 degrees, respectively) better than the Steffee plate system (0 degrees +/- 1.6 degrees). However, the AO device provided poorest restoration of the posterior vertebral body height (92% vs 96% for the RF device and 99% for the Steffee plate). The RF device, which restored both lordosis and posterior vertebral body height to the near anatomic prefracture level, provided significantly better canal clearance (9% +/- 8%) than the other techniques, P < 0.05. The study demonstrates that instrumentation systems that provide independent correction of distraction and lordosis can best restore anatomic alignment, with indirect neurodecompression of the compromised spinal canal.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Tibial fracture stability. Analysis of external fracture immobilization in anatomic specimens in casts and braces.

Plaster casts, custom-fabricated fracture braces, and prefabricated fracture braces were compared in the laboratory for the stability they provided to closed, experimental, diaphyseal fractures of the tibia and fibula on anatomic specimens. The stability was comparable for each type of device tested for the loading conditions of isolated compression, bending, and torsion. Length stability (overriding at the fracture site) was poor, rotation was marginal (by clinical standards), and angulation was very good. Selective removal of portions of each cast and brace demonstrated that the classic patellar-tendon-bearing (PTB) extension proximally and below ankle extensions distally had insignificant effects on stability of these middle-third diaphyseal fractures for the conditions tested. The soft-tissue compression provided by a snug, tapered "cylindrical" sleeve, which encompassed the soft tissues from the tibial tubercle to the flare of the distal tibia and fibula, provided the stabilizing effect for all of the devices tested.

Biomechanical Phenomena↗
PubMed1993

Extensive intraarticular fractures of the foot. Surgical management of calcaneal fractures.

Periodic cycles of enthusiasm for surgical management characterize the history of fractures of the calcaneus of the past century. After each period of advocacy for aggressive surgical therapy, there has been a trend toward nonoperative treatment. Morbidity and disappointing results were reported by those whose early attempts at open reduction were more difficult than expected. With the emergence of a subspecialty within orthopedic surgery devoted to fracture care, the pendulum has again swung toward operative treatment. A clearer understanding of fracture patterns from cross-sectional imaging, concentration of the injuries in the care of experienced fracture surgeons, perioperative antibiotics, rigid internal fixation, and early rehabilitation represent the latest attempts to improve the outcome from this vexing injury. Using an extensile lateral approach, rigid internal fixation, and early motion, more than 100 calcaneal fractures have been treated at the authors' institution between 1985 and 1989. Compared with published reports, the preliminary results demonstrate lower morbidity and improved outcome.

Calcaneus↗
PubMed1998

[Fractures of the tibial pilon. Long-term retrospective study of 51 fractures treated with open reduction and osteosynthesis].

PURPOSE OF THE STUDY: Fracture of the tibial pilon is a rare injury and its treatment remains difficult. The aim of this study was to report the complications and long term results of internal fixation using a technique which respects soft tissues and in which little material was used. MATERIAL: From 1985 to 1990, 48 patients with 51 fractures of the tibial pilon were treated by open reduction and internal fixation. All patients were submitted to a clinical and radiological review. METHODS: Both the Rüedi/Allgöwer and the AO-classification were used and determined by standard X-rays. Surgical procedure was performed with a 2 or 3 1/3 tube AO-plates and the peroneus was always fixed if fractured. Intraoperative reconstruction was analyzed. Subjective and objective scoring were used according to Olerud and Molander and the ankle arthritis was scored according to the classification determined by the SOFCOT in 1992. RESULTS: A minimal follow-up of 1 year for all cases was obtained, based on our own files. Thirty-eight patients (40 fractures) were evaluated after an average period of 88 months (56 to 124 months). Five patients developed cutaneous infection, three developed deep infection and four developed superficial skin necrosis. One aseptic non-union necessitated reoperation after 14 months. Two ankles had joint fusion after 19 and 25 months respectively due to severe arthritis. In six cases infectious and non-infectious complications led to surgical revision. According to the Olerud and Molander score, 15 per cent of the results were excellent, 45 per cent were good, 30 per cent were fair and 10 per cent poor. DISCUSSION: Literature shows a wide range of results following this surgical procedure. This is due to the difference in the type of trauma, classification system used, material used for the internal fixation and method of evaluation. The classification system of Rüedi and Allgöwer is the most commonly used but has a rather subjective tendency, especially between type II and type III. Treatment is difficult, especially for comminutive fractures associated with soft tissue damage. In this case, open reduction and internal fixation could increase iatrogenic lesions. For this reason surgical procedure can be delayed for several days, little material is used and soft tissue manipulation is reduced to minimum. In other study reports, the use of external fixation with or without minimal internal fixation have produced less complications without improving long term results. CONCLUSION: Analysis and comparison of study reports are difficult because of the absence of consensus in classification system and evaluation methods. The AO-classification, apparently the most objective, will probably be more and more used in the future. Treatment must be adapted to the bony lesion and soft tissue damage. Open reduction and internal fixation must be reserved for a specific group of lesion.

Adult↗
PubMed2006

[Fracture of the proximal humerus in children and adolescents. The most overtreated fracture].

BACKGROUND: There is great uncertainty among trauma surgeons regarding the correct treatment of rare proximal humerus fractures in children and adolescents, in spite of the great potential of the proximal humeral epiphysis for self-correction, even in cases of gross malalignment. METHODS: Over a span of 6 years, we treated 52 children and adolescents with closed proximal humerus fractures, 45 of whom had no other injuries. In only three cases did we see an indication for operative treatment at our institution. Operations on another three were performed elsewhere. Forty two patients were available for follow-up exams. RESULTS: They all had good or very good results with regard to fracture healing (constant score) independently of age, sex, fracture morphology, and treatment. CONCLUSIONS: We believe it is particularly important to discuss therapy concepts with parents and the involved outpatient physicians in order to avoid unnecessary and stressful operations.

Adolescent↗
PubMed1999

Subcapital femoral neck fracture after closed reduction and internal fixation of an intertrochanteric hip fracture: a case report and review of the literature.

A subcapital femoral neck fracture in a healed intertrochanteric fracture treated by an open reduction and internal fixation is a rare, but catastrophic, event. We present the case of an 86-year-old woman, a community ambulator, who sustained a displaced right intertrochanteric hip fracture during a fall. She was treated with closed reduction and internal fixation with a dynamic compression hip screw and side plate. Four months later, she was noted to have a displaced subcapital femoral neck fracture and underwent hip screw and side plate hardware removal and cemented bipolar hemiarthroplasty. Both postoperative recoveries were uncomplicated, and she was discharged to a rehabilitation facility able to ambulate with minimal assistance. This devastating complication in patients with osteoporosis may be prevented by deeper placement of the dynamic hip compression lag screw to within 5 mm to 8 mm of the subchondral bone, which may decrease the stress forces in the subcapital femoral neck.

Aged↗