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At least 775 records · Page 43Linked to original sources
PubMed2005

Anatomical risks of using supra-acetabular screws in percutaneous internal fixation of the acetabulum and pelvis.

We conducted a study to determine whether a lag screw placed percutaneously at the level of the pelvic brim for treatment of iliac fracture risks injury to the lateral femoral cutaneous nerve (LFCN). A 4-mm Kirschner wire (K-wire) was placed percutaneously into each of 8 human cadaveric hemipelvises (4 pelvises) at the level of the pelvic brim to represent the path of screw placement. Under fluoroscopic guidance, each K-wire was advanced from the anteroinferior iliac spine toward the posterior iliac crest. Cadavers were dissected at study end. Proximity of the LFCN to the percutaneously inserted K-wire was the main outcome measured. In 4 of the 8 hemipelvises, the LFCN was disrupted; in 3 hemipelvises, it was within 4 mm of the K-wire; in the last hemipelvis, it was 23 mm away. LFCNs varied anatomically from 1 to 5 branches; disruptions occurred more in LFCNs with multiple branches than in those with 1 branch. The results suggest considerable risk for injury to the LFCN during percutaneous fixation of iliac and acetabular fractures using a percutaneous screw at the level of the pelvic brim.

Acetabulum↗
PubMed2005

[Treatment of humeral pseudarthroses by open reduction and internal fixation].

OBJECTIVES: The effectiveness of open reduction and plate fixation combined with autogenous bone grafting was assessed in the treatment of humeral diaphysis pseudarthrosis. METHODS: Twenty-four patients (16 men, 8 women; mean age 44 years; range 28 to 64 years) were operated on for humeral pseudarthrosis. Of these, 16 patients and eight patients had had previous surgical and conservative treatments, respectively. Surgery was performed after a mean of 10.8 months (range 7 to 21 months) following the initial treatments. Preoperatively, none of the patients had infected nonunion, a bone defect greater than 4 cm, and radial nerve injury. Treatment included open reduction and plate fixation combined with autogenous bone grafting. The plate was secured with at least four screws (8 cortices) both proximally and distally. The mean follow-up was 40 months (range 28 to 60 months). The range of motion of the shoulder and elbow was evaluated according to the criteria by Rommens et al. Functional evaluations were made according to the criteria by Stewart and Hundley. RESULTS: Union was achieved in all the patients after a mean of 19 weeks (range 14 to 26 weeks). Shoulder range of motion was excellent in all the patients. Elbow range of motion was excellent in 22 patients and moderate in two patients. Functional results were excellent in 20 patients and good in four patients. Deep infection, nonunion, malunion, implant failure, or permanent nerve injury did not occur in any of the patients. Two patients had transient radial nerve palsy. CONCLUSION: Treatment with open reduction and plate fixation combined with autogenous bone grafting is a safe and effective option in humeral pseudarthroses, particularly in cases without infection, bony defect, and deformity requiring correction.

Adult↗
PubMed2005

[Treatment of zygomatico-orbital and zygomatico-maxillo-orbital fractures by open reduction and rigid internal fixation].

The zygomatic bone plays an important role in keeping an esthetic and functional balance of the midface. A high number of traumas in the region induces a continuous improvement of diagnostic and therapeutic methods used in fracture management. The material for the studies constituted of 61 patients, treated between 1996 and 2001 at the 1st Department of Maxillofacial Surgery of Silesian Medical University in Zabrze. Zygomatico-orbital and zygomatico-maxillo-orbital fractures were the reasons for hospitalization. All fractures were managed by open reduction and plate fixation. There were 4 women and 57 men aged 14-66 in this group. The analysis was carried out in two stages. Case histories from the hospital and outpatient department were analyzed retrospectively during the first stage. Early therapeutic results were estimated. Prospective analysis was carried out during the second stage of the research. Patients were called for the routine control postoperative examination. Forty three patients came forward. Their subjective ailments after operation were collected. Possible abnormalities were determined in clinical and roentgenological examination. Remote therapeutic results were estimated. On the basis of the analysis it has been found that the use of possibly the least number of plate osteosynthesis, larger than four holed ones, assures the optimal therapeutic result in follow-ups and shortens the time of hospitalization. The place of osteosynthesis application affects the final therapeutic result. High stability of plate osteosynthesis results in fact that bone fragments reduced and fixed with plates do not change the initial location. The efficacy of the method was proved by the results obtained in remote observations.

Adolescent↗
PubMed2005

[Application of restorative laminoplasty combined with spinous process osteotomy and internal fixation for treatment of degenerative scoliosis].

OBJECTIVE: For treatment of mild degenerative scoliosis (DS) complicated with lumbar canal stenosis (LCS), posterior decompression and the spinal canal enlargement with spinous process osteotomy was performed in combination with fusion and pedicle screw instrument fixation. METHODS: Between 1999 and 2003, 18 male and 26 female elderly patients (with mean age of 63 years, ranging from 47 to 72 years) with DS complicated with LCS were treated with the described surgical procedures, including 25 with single segment lesion and 19 with involvement of 2 segments. A posterior medical incision from one vertebra superior to the target fusion area till the vertebral segment below it was made for spinal exposure. Undermining enlargement of the spinal canal was carried out according to the segments of the stenosis; in some cases the intervertebral disc was resected. Osteotomy was subsequently performed at the base of the spinous process, and the bony defect was covered with the spinous processes. Finally Moe fusion and Isola (17 cases) or Diapason (27 cases) instrument fixation were performed. The therapeutic effects were evaluated according to Oswestry scores and postoperative imaging examinations. RESULTS: The average follow-up period was 3 years, ranging from 1 to 4 years. Thirty-three patients were followed up for one year and 93.9% of them had excellent or good outcome; 27 patients were followed up of 2 years and showed a rate for excellent or good results of 88.9%. Both sagittal and transverse diameters of the lumbar spinal canal were increased obviously as found by CT scanning without spinal canal scar. A rate of 92.6% of the ostetomized spinous processes had bony fusions. Successful covering bone healing was achieved in a mean of 4 months after surgery. Compressive vertebral fractures superior to the fixed segments occurred in 2 cases, including 1 with pedicle screw loosening and the other with pedicle screw breakage. Another patient had delayed wound healing. No recurrence of LCS, spondylolisthesis and decompensation, or pseudarthrosis of the spine was observed in these cases. CONCLUSION: The described surgical procedures for DS can decrease the occurrence of spinal canal scar and promote the healing of the covering bone, and can be a satisfactory treatment for mild DS complicated with LCS in the lumbar sagittal curve.

Adult↗
PubMed2005

Pseudoaneurysm of profunda femoris artery following internal fixation of intertrochanteric fracture: two cases report.

The authors report two cases of an uncommon but preventable complication after fixation of intertrochanteric hip fracture, the pseudoaneurysm of the profunda femoris artery. Both cases in the present study presented as proximal thigh mass, and soft tissue sarcoma was suspicious in one case. The diagnosis was confirmed by angiographic study and the feeding vessels were successfully occluded during angiography. Proper placement of the retractors, using a shorter drill or drill guard, accurate screw length and a shorter side-plate DHS were recommended to prevent this problem.

Aged↗
PubMed2006

Delayed osteonecrosis following reduction and internal fixation of a femoral neck fracture.

Osteonecrosis (ON) is a common complication following femoral neck fracture and most studies have reported the incidence of ON after less than 3 years follow-up. Here we report a case of delayed osteonecrosis 7 years after initial treatment for a femoral neck fracture. This example supports the need for continued clinical and radiographic follow-up over an extended period after femoral neck fracture and suggests that 3 years is too short a time to reliably rule out ON as a postoperative complication.

Adult↗
PubMed1991

[Internal fixation for intertrochanteric fracture. Biomechanical study].

A Type IIIa intertrochanteric fracture was made on the preserved femurs of adult cadavers. The fracture was fixed by 4 methods: Percalcar Steinmann's pins, Knowle's pins, Nail plate and Angle plate. The loading limit of the fixations were 150, 140, 70 and 40 kg respectively. In fatigue test the loading ability of the percalcar Steinmann's pins were 4 times greater than that of Nail plate or Angle plate. In Nail plate and Angle plate. The pathological section of the upper femur showed the most bony destruction was at the trabecula beneath the lateral cortex, and in the percalcar Steinmann's, it was at the neck trabecula, where the cal car plays an important role in supporting the loading of the lowest pin. It was found that the level arm was shortened and the loading ability increased. As the direction of the lowest pin was nearly parallel to the loading axis of the hip. The calcar suffered less shearing force. These findings showed that the percalcar Steinmann's pins fixation is the best in these 4 methods.

Biomechanical Phenomena↗
PubMed1991

Early mobilization of ankle fractures after open reduction and internal fixation.

The effect of early mobilization and unrestricted weight bearing on final ankle motion in 51 operatively stabilized ankle fractures was prospectively investigated. Patients were treated with an ankle-foot orthosis (AFO) or a cast. Full weight bearing was unrestricted in both groups. Thirty-two fractures received an AFO and 19 received a cast. The follow-up period ranged from 2.3 to 66 months, with a median of eight months. At the final follow-up examination, the motion in the AFO-treated group was not functionally different from that of the cast-treated group. However, 72% of the patients treated in an AFO compared with 37% of patients treated in a cast had ankle dorsiflexion greater than 15 degrees (p = 0.014). No complications were directly related to the AFO. No loss of reduction occurred in any patient. The results of this series indicate that early motion of a fractured ankle treated operatively does not affect ankle motion. Early motion was not associated with increased morbidity or loss of reduction.

Adult↗
PubMed1991

Internal fixation of femoral neck fractures. A comparative biomechanical study of Knowles pins and 6.5-mm cancellous screws.

In a comparative biomechanical study of the stability of experimentally produced femoral neck fractures fixed with Knowles pins or with 6.5-mm cancellous screws, 12 matched pairs of anatomic specimen femurs were divided into four groups of standardized osteotomies. One member of each matched pair was fixed with three or four 6.5-mm cancellous screws, whereas the other member was fixed with the same number of Knowles pins. Mechanical testing was performed on an Instron testing machine. There was no statistically significant difference in maximum load to failure or in fixed stiffness between the two methods of fixation. When examining maximum load to failure, three of either device provided fixation equivalent to four. Although there was a difference in absolute fixed stiffness between specimens fixed with three Knowles pins compared to four, when stiffness was expressed as a percentage of intact stiffness, there was no difference between any fixation group. From an analysis of the observed modes of failure and from calculations of the flexural rigidity provided by the devices, it is proposed that the quality of the trabecular bone of the femoral neck is a major factor in the experimental fixation of femoral neck fractures.

Biomechanical Phenomena↗