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PubMedDate not supplied

Operative treatment of clavicle fractures in children: a review of 21 years.

Between 1980 and 2000, 15 children (14 boys and 1 girl) underwent surgical treatment of a fractured clavicle at the authors' hospital. Eight patients were treated for midshaft fracture, two had medial fractures, and five had fractures to the lateral end, one of which occurred in combination with true disruption of the acromioclavicular joint. The indications for operative treatment of clavicle fractures are rare, in some cases debatable, and surgery is usually necessary only in older children. If surgically treated, the results are satisfactory without major complications. In the authors' experience intramedullary stabilization with elastic nails is the method of choice in most cases.

Adolescent↗
PubMed1994

Acute lengthening of shortened lower extremities after malunion or non-union of a fracture.

Forty-nine skeletally mature patients who had either a non-union or a malunion of a fracture of the tibia or the femur had correction of the deformity and acute axial lengthening of the fractured bone. Distraction was provided by the short AO/ASIF fracture distractor applied directly to the site of the osteotomy or non-union. At an average of sixty-three months (range, twenty-six to 105 months), the average increase in the tibial and femoral length was 1.7 and 3.2 centimeters, respectively. There were no compartment syndromes or ischemia secondary to any of the procedures. One patient had a transient sensory-nerve loss. Fatigue fractures were seen in two tibial plates, two femoral plates, and one femoral intramedullary nail used for osteosynthesis. A non-union developed after four other femoral intramedullary nailing procedures. One infection developed after lengthening of a tibia. Restoration of normal length by acute lengthening and internal fixation was achieved in twenty-seven patients. One patient had overlengthening of one centimeter. Fifteen patients had residual shortening of approximately one centimeter, three had shortening of more than one to 2.5 centimeters, and three patients had more than 2.5 centimeters of shortening. The patients in this series had acute restoration of limb length after traumatic shortening with a low prevalence of complications of neurovascular compromise. Three of the thirty tibial lengthenings and seven of the nineteen femoral lengthenings had to be followed by at least one additional procedure to obtain union.

Adult↗
PubMed2006

Two-part surgical neck fractures of the proximal part of the humerus. A biomechanical evaluation of two fixation techniques.

BACKGROUND: Successful internal fixation of fractures of the surgical neck of the humerus can be difficult to achieve because of osteopenia of the proximal aspect of the humerus. The purpose of this study was to compare the biomechanical stability of a proximal humeral intramedullary nail and a locking plate for the treatment of a comminuted two-part fracture of the surgical neck in a human cadaver model. METHODS: Twenty-four cadaveric humeri were instrumented with use of either a titanium proximal humeral nail (PHN) or a 3.5-mm locking compression plate for the proximal part of the humerus (LCP-PH). The specimens were matched by bone mineral density and were separated into four experimental groups with six humeri in each: PHN bending, LCP-PH bending, PHN torsion, or LCP-PH torsion. Comminuted fractures of the surgical neck were simulated by excising a 10-mm wedge of bone. Bending specimens were cyclically loaded from 0 to 7.5 Nm of varus bending moment at the fracture site. Torsion specimens were cyclically loaded to +/-2 Nm of axial torque. The mean and maximum displacement in bending, mean and maximum angular rotation in torsion, and stiffness of the bone-implant constructs were compared. RESULTS: In bending, the LCP-PH group demonstrated significantly less mean displacement of the distal fragment than did the PHN group over 5000 cycles (p = 0.002). In torsion, the LCP-PH group demonstrated significantly less mean angular rotation than did the PHN group over 5000 cycles (p = 0.04). A significant number of specimens in the PHN group failed prior to reaching 5000 cycles (p = 0.04). The LCP-PH implant created a significantly stiffer bone-implant construct than did the PHN implant (p = 0.007). CONCLUSIONS: The LCP proximal humeral plate demonstrated superior biomechanical characteristics compared with the proximal humeral nail when tested cyclically in both cantilevered varus bending and torsion. The rate of early failure of the proximal humeral nail could reflect the high moment transmitted to the locking proximal screw-bone interface in this implant. CLINICAL RELEVANCE: The high failure rate in torsion of the proximal humeral nail-bone construct is concerning, and, with relatively osteoporotic bone and early motion, the results could be poor.

Adult↗
PubMed1997

[Pediatric forearm fractures. Diagnosis, therapy and possible complications].

Nonoperative management of forearm fractures in children has a good outcome in over 90% of all cases. In our own series (n = 102) there were only six children (6.1%) with significant limitation (> 25 degrees) of forearm rotation. In these cases two out of four (50%) were located in the proximal third but only two out of 68 in the distal third. Indications for operative stabilization are the following: compound fractures, fractures associated with vessel and nerve injuries, joint fractures, dislocated fractures of the middle and proximal third, and Monteggia/Galeazzi injuries. As implants intramedullary devices are preferred. Twenty children were managed with elastic IM rods between 1994 and 1995 at our institution. At final follow-up all had a free ROM and a maximal axial malalignment of less than 5 degrees. In the region of the distal forearm K-wires are useful. Plates play a dominant role for corrections and nonunions; external skeletal stabilization is indicated for temporary fixation in compound fractures.

Bone Plates↗
PubMedDate not supplied

Seidel locked nailing for the treatment of unstable fractures and nonunion of the humerus.

The results of treatment by Seidel locked nailing in 13 recent fractures and 4 nonunions of the humerus are reported. The feature common to all of the fractures was instability consequent to comminution or in the site of the fracture center. The 4 nonunions were originally fractures synthesized by Rush intramedullary nailing. The surgical method used an entry approximately 1 cm from the greater tuberosity through a well-vascularized area of the rotator cuff. All of the cases achieved consolidation and in 70% of the patients results were excellent with complete recovery of range of movement of the shoulder. Thus, the Seidel nail appears to be an intramedullary means of synthesis particularly suited to the treatment of unstable fractures and nonunion of the humerus because it guarantees stability, especially in rotation, superior to any other intramedullary means of synthesis.

Adult↗
PubMed2002

[Retrograde locking nail osteosynthesis of distal femoral fractures with the distal femoral nail (DFN)].

Non-operative treatment with immobilization or isometric traction has been abandoned as treatment for fractures of the distal femur at the end of the 1960ies. The technique of open reduction and internal fixation with a condylar plate as suggested by the AO has been the golden standard since the 1970ies. However, anatomic reconstruction of the condylar region with interfragmentary screw fixation and axial realignment of the femur shaft with a plate are challenging procedures especially in the presence of severely compromised soft tissues and put periosteal blood supply at risk. Soft tissue complications, axial malalignment and delayed fracture healing times led to the consideration of alternative techniques, such as intramedullary nailing which has been practiced with success since the 1940ies by Gerhard Küntscher and colleagues for femoral shaft fractures with minimal complication rates and improved results after closed reduction. The era of retrograde femoral nailing began with the systematic approach through the intercondylar notch by Green. This paper reviews the biomechanical properties, indication, technique as well as potential hazards and pitfalls of fracture management with the AO "distal femoral nail" (DFN). With appropriate application this technique is suitable for all fractures of the distal third of the femoral shaft including highly instable bicondylar fractures without damage to the soft tissues and the knee joint.

Biomechanical Phenomena↗
PubMed2000

Surgical salvage from comminuted metatarsal fracture using a weight-bearing pin-putty apparatus in a dog.

Comminuted metatarsal fractures in a dog were treated using intramedullary pins externally connected and stabilized by epoxy resin putty and application of a fibreglass cast. Two weeks later the cast was removed. After further 2 weeks application of a Robert-Jones bandage the dog could stand and walk with the pin-putty apparatus in position. The pin-putty apparatus was removed 3 months postoperatively, and the dog resumed normal activity. This fixation method could be an easy, economical and effective alternative treatment for managing comminuted fractures of the metatarsal and possibly metacarpal bones in selected cases.

Animals↗