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PubMed1987

Herbert screw fixation of fracture of the head of the radius.

Herbert screw fixation of simple displaced fractures of the radial head involving up to one-half the articular surface is a reliable and effective technique. Following accurate reduction, the fracture surfaces are compressed with the Herbert scaphoid clamp and internally fixed with a Herbert screw, which is appropriately buried beneath the articular cartilage. Preliminary observations on two cases demonstrate rapid union and return of function occurring with anatomic reduction and sound fixation.

Adult↗
PubMed2004

Delayed internal fixation of fractures of the neck of the femur in young adults. A prospective, randomised study comparing closed and open reduction.

We have compared the results and complications after closed and open reduction with ternal fixation in young adults with displaced intracapsular fractures (Garden grades III and IV) of the neck of the femur. We also studied the risk factors which influenced nonunion and the development of avascular necrosis (AVN). A total of 102 patients aged between 15 and 50 years was randomised to receive either closed or open reduction. Both groups were compared for age, gender, time to surgery and posterior comminution as well as for union and complications. Using univariate and multivariate analysis the factors influencing nonunion and AVN were assessed. Of the 102 patients, 92 were available for review. There was no significant difference between the groups in terms of union (p = 0.93) and AVN at two years (p = 0.85). Posterior comminution, poor reduction and improper placement of the screws were the major factors contributing to nonunion. The overall incidence of AVN was 16.3% (15 of 92 patients) and it was not influenced by these factors. A delay of more than 48 hours before surgery did not influence the rate of union or the development of AVN when compared with operation within 48 hours of injury.

Adolescent↗
PubMed1997

Resorbable polymeric inserts as a means of enhancing fixation of fractures of porotic bones. I. Stability of mechanical properties and viscoelasticity of the inserts aged in vitro.

A titanium screw-poly(L-lactide) medullary insert system intended for use in the fixation of porotic bone fractures was subjected to in vitro ageing at 37 degrees C and pH = 7.4 for up to 6 months. The pull-out force of the screw from the insert and the viscoelastic properties of the insert were measured. The pull-out force did not change up to 6 months of ageing, indicating that the polymeric insert provides a good purchase for the screws. The viscoelastic properties of the insert provides of bone and did not change substantially with temperatures up to 52 degrees C. This indicates that the medullary insert would maintain its properties in vivo even if the body temperature was increased. The molecular weight of the insert at 6 months was reduced by 60%, but the molecular weight reduction did not affect the mechanical properties of the insert.

Bone Screws↗
PubMed1998

Fixation of fractures of the midshaft of the clavicle with Kirschner wires. Results in 108 patients.

We treated 110 fractures of the middle third of the clavicle in 108 patients aged between 14 and 66 years, by fixation with 2 mm Kirschner wires. The wire was introduced, using an air drill and a telescoping guide, from the medial into the lateral fragment. The medial end of the wire which perforated the anterior cortex of the medial fragment was bent backwards to prevent migration into the lung or mediastinum. In cases of nonunion and acute fracture in which a bone gap was present, bone graft was laid around the fracture site after internal fixation. All the fractures united. No wires broke but in three patients one migrated before union was achieved. Twenty-one patients failed to return for removal of the wire; nine of them had radiological evidence of union before they were lost to follow-up.

Accidents, Traffic↗
PubMed2000

The posterolateral approach to the distal humerus for open reduction and internal fixation of fractures of the lateral condyle in children.

Our study describes a posterolateral approach to the distal humerus for open reduction and internal fixation of displaced fractures of the lateral condyle. A total of 20 patients had open reduction and internal fixation over a four-year period using this approach, and at a mean follow-up of 12 months had full union, range of movement and no complications, either clinical or radiological. This approach is well suited to the exact visualisation and accurate reduction of this difficult fracture with minimal dissection of tissues.

Adolescent↗
PubMed1977

[Minimal internal fixation of fractures in elder children (author's transl)].

The fractures in elder children (9--17 years) need a special treatment. Regarding the exact reposition they have to be handled like the fractures of adults. Regarding localisation, morphology of the bone and the way of internal fixation they have to be treated like those of smaller children. The "Minimal-Osteosynthesis" primarily means adaptation, refixation and continuous retention. The procedure is less traumatizing, however the indication should be as strictly as in other cases. The minimal osteosynthesis is giving more respect to the growing bone. The material of internal fixation may be removed much earlier than in adults. Stability for early physical exercises is rarely necessary in children. Even different types of minimal internal fixation are possible. A number of cases are demonstrated.

Accidents, Home↗
PubMed2006

Comparison of plate and screw fixation and screw fixation alone in a comminuted talar neck fracture model.

BACKGROUND: Talar neck fracture fixation has been studied in noncomminuted fracture models, but no large clinical series of comminuted fracture patterns have been published and no biomechanical studies have compared plate fixation with screw fixation in comminuted talar neck fractures. METHODS: Nine matched pairs of fresh frozen talar specimens were stripped of soft tissue and mounted in a cylindrical jig. The talar neck was fractured using a dorsally directed shear force at a rate of 200 mm/min, and dorsal comminution was simulated by removing a 2-mm section of bone from the distal fracture fragment. One specimen from each pair was fixed with either two solid 4.0-mm partially threaded cancellous screws posterior-to-anterior just lateral to the posterior process of the talus or with a four-hole 2.0-mm minifragment plate contoured to the lateral surface of the talar neck and secured with 2.7-mm screws. A 2.7-mm fully threaded cortical screw was placed medially using a lag technique. The specimens were then loaded to failure with a dorsally directed force at a rate of 200 mm/min. Failure was defined as the load producing 2 mm of displacement. A Student's t-test analysis was used with significance set at p < or = 0.05. RESULTS: Posterior-to-anterior screw fixation had a statistically significant higher load to failure than plate fixation (p < 0.05). Mean load to failure for the screw group was 120.7 +/- 68.5 N and 89.7 +/- 46.6 N for the plating group. CONCLUSIONS: Plate fixation may offer substantial advantages in the ability to control the anatomic alignment of comminuted talar neck fractures, but it does not provide any biomechanical advantage compared with axial screw fixation. Further, the fixation strength of both methods was an order of magnitude lower than those found in previous studies of noncomminuted fractures.

Bone Plates↗
PubMed1999

Rigid or sliding plate. A mechanical evaluation of osteotomy fixation in sheep.

Fracture fixation using rigid plates leads to direct bone union, but it also may lead to complications because of stress protection osteopenia. This study aims to compare the mechanical characteristics restored during the callus formation after an osteotomy is fixed with two types of internal plate fixation. Twenty-four adult female sheep were divided randomly into three groups of eight each, which were euthanized at 2, 4, and 6 months after operation. Half of them had their osteotomized radius fixed with a seven hole dynamic compression plate, whereas in the remainder a sliding plate was used. The sliding plate consists of two halves connected together in such a way as to permit axial sliding of the one within the other, thus allowing cyclic axial load transfer at the fracture site. Bone strips obtained from the healthy (control) and the surgically treated side were subjected to four-point bending tests. The effective modulus of elasticity, ultimate bending strength, and energy absorption to fracture (toughness) were calculated. All parameters were restored more quickly in the sliding plate group, but there was no statistically significant difference observed at 6 months when all the osteotomies were united completely. Thus, the sliding plate, by allowing axial loading at the fracture site, led to a faster callus maturation and hence bony union, which, hopefully, will permit earlier full weightbearing and functional recovery of the injured limb.

Animals↗
PubMed1990

Biological internal fixation of fractures.

Trauma centers treat more and more patients who have sustained multiple injuries during high energy accidents. The techniques of internal fixation of such fractures may be dictated by the concomitant soft tissue trauma, rather than by the bony injury. Three stages of soft tissue injuries are recognised: Stage I delineates compromised soft tissues which may be treated with standard techniques of internal fixation, provided that further devialization by surgery is avoided. Stage II implies partial, non-circumferential destruction of soft tissues, requiring alternative techniques of internal fixation to prevent (mainly septic) complications. In stage III, the soft tissues about the fracture site are destroyed and need early, specific soft tissue reconstruction. Indirect reduction without further devascularization of bone, aiming at perfect alignment rather than anatomical reduction of extraarticular fractures, optimal rather than maximal internal fixation as well as the inclusion of soft tissue reconstructive procedures into the armamentarium of the orthopaedic surgeon, require an intellectual and technical reorientation but can be shown to improve the results of the treatment of fractures with concomitant soft tissue injury.

Bone Plates↗
PubMed2006

Acetabular fractures in the UK. What are the numbers?

We have established a nationwide directory of the specialist surgical units and their Lead Consultants with expertise in acetabular fracture surgery throughout the UK. Our directory has facilitated an estimation of the total numbers of operative acetabular fracture cases managed annually in the UK, as reported by those actually providing this specialist service. Previously the total number of acetabular injuries admitted and operated on in the UK was not known and there was no directory of acetabular surgeons in the UK. The introduction and accuracy of the OPCS codings will have massive financial implications for the DoH at a local and national level in the planning and provision of adequate health care resources. We have performed a questionnaire study to validate the DoH data for acetabular fracture surgery. Data was compiled using the ICD-10 for diagnosis of fracture of the acetabulum, and the OPCS-4 codes for the surgical procedures used for fracture fixation for the year 2003-2004. The Department of Health (DoH) data identified 44 units that had OPCS-4 coding for acetabular fracture fixation. We had a 95% (42 out of 44 units) response to our questionnaire. A total of 9 units contacted had actually performed no surgery, whereas the DoH coded these as having performed a maximum of 35 cases. The DoH data showed a total of 1825 admissions to 311 NHS hospitals for acetabular fractures, including 258 operative cases performed in 44 NHS hospitals in the UK. Our study has found that 748 acetabular fracture fixation cases were performed at 33 NHS hospitals in the UK in this study period. The total difference between the DoH operated cases and those confirmed by our study was 490. The hospital care for an operative acetabular fracture case may cost approximately 14,830, pounds if the actual numbers are under-reported to or by the DoH are 490, then approximately 7,266,700 pounds has been lost by these centres due to incorrect proportioning of resources.

Acetabulum↗
PubMed1999

Application of minimal-access techniques in lag screw fixation of fractures of the anterior mandible.

A modification of the traditional open methods for the surgical management of anterior mandibular fractures using the principles of minimal-access surgery is presented; it was successfully performed in five patients. This technique incorporates the use of lag screws introduced through small incisions transmucosally or percutaneously after anatomic reduction of the fracture, and it relies on accurate preoperative radiologic assessment of the fracture pattern and location. This technique is indicated for any favorable fracture in the anterior mandibular arch that could achieve osteosynthesis with lag screw fixation, and it depends on the use of a dental arch bar as a tension band. Contraindications include unfavorable fracture patterns (long oblique, comminuted, or flat mandibular plane), inadequate dental support to maintain an arch bar due to missing or loose teeth, the inability to determine the fracture pattern preoperatively, and operator inexperience. Potential advantages include a shorter operative time, economic savings, decreased patient morbidity (swelling, scarring, and mental nerve and lower-lip muscle dysfunction), and improvement in functional rehabilitation.

Adult↗
PubMed1980

[Internal fixation for fractures of the lateral malleolus with titanium "crown"-plates (author's transl)].

This team of authors constructed a so called "crown"-plate from titanium, suitable for fixation of lateral malleolar fractures. The plate seems to be ideal for Weber-B type fractures, which are level with the joint space, and it can be applied in the more distal (Weber-A) and proximal (Weber-C) fractures too. The titanium plate was used in 166 fractures with good results. On the basis of the follow up assessment of 151 healed cases the authors feel encouraged to suggest the use of the titanium crown plate for internal fixation of lateral malleolar fractures.

Ankle Injuries↗
PubMedDate not supplied

Radial and tibial fracture repair with external skeletal fixation. Effects of fracture type, reduction, and complications on healing.

Twenty-eight consecutive fractures of the canine radius and tibia were treated with external skeletal fixation as the primary method of stabilization. The time of fixation removal (T1) and the time to unsupported weight-bearing (T2) were correlated with: (1) bone involved; (2) communication of the fracture with the external environment; (3) severity of the fracture; (4) proximity of the fracture to the nutrient artery; (5) method of reduction; (6) diaphyseal displacement after reduction; and (7) gap between cortical fragments after reduction. The Kruskal-Wallis one-way analysis of variance was used to test the correlation with p less than .05 set as the criterion for significance. The median T1 was 10 weeks and the median T2 was 11 weeks. None of the variables correlated significantly with either of the healing times; however, there was a strong trend toward longer healing times associated with open fractures and shorter healing times associated with closed reduction. Periosteal and endosteal callus uniting the fragments were observed radiographically in comminuted fractures, with primary bone union observed in six fractures in which anatomic reduction was achieved. Complications observed in the treatment of these fractures included: bone lysis around pins (27 fractures), pin track drainage (27 fractures), pin track hemorrhage (1 fracture), periosteal reaction around pins (27 fractures), radiographic signs consistent with osteomyelitis (12 fractures), degenerative joint disease (2 dogs), and nonunion (1 fracture). Valgus or rotational malalignment resulted in 16 malunions of fractures. One external fixation device was replaced and four loose pins were removed before the fractures healed. One dog was treated with antibiotics during the postoperative period because clinical signs of osteomyelitis appeared.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗
PubMed2001

Interventions for treating proximal humeral fractures in adults.

BACKGROUND: Proximal humeral fractures are common yet management varies widely. In particular, the role and timing of any surgical intervention have not been clearly defined. OBJECTIVES: To collate and evaluate the scientific evidence supporting the various methods used for treating proximal humeral fractures. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group trials register, MEDLINE, PubMed, the Cochrane Controlled Trials Register, CINAHL, the National Research Register and bibliographies of trial reports. The search was completed in July 2000. SELECTION CRITERIA: All randomised studies pertinent to the treatment of proximal humeral fractures were selected. DATA COLLECTION AND ANALYSIS: Independent quality assessment and data extraction were performed by two reviewers. Although quantitative data from trials are presented, trial heterogeneity prevented pooling of results. MAIN RESULTS: Nine randomised trials were included. All were small trials; the largest study involved only 85 patients. Bias in these trials could not be ruled out. Six trials evaluated conservative treatment, two compared surgery with conservative treatment and one compared two surgical techniques. In the 'conservative' group there was very limited evidence indicating that the type of bandage used made any difference in terms of time to fracture union and the functional end result. However, an arm sling was generally more comfortable than a body bandage. There was some evidence that mobilisation at one week instead of three weeks alleviated pain in the short term without compromising long term outcome. Two trials provided some evidence that patients, when given sufficient instruction to pursue an adequate physiotherapy programme, could generally achieve a satisfactory outcome if allowed to exercise without supervision. Operative reduction improved fracture alignment in two trials. However, in one trial, surgery was associated with a greater risk of complication, and did not result in improved shoulder function. Fracture fixation of severe injuries was associated with a high rate of re-operation in one trial, comparing tension-band wiring fixation with hemi-arthroplasty. REVIEWER'S CONCLUSIONS: Only tentative conclusions can be drawn from the available randomised trials, which do not provide robust evidence for many of the decisions which need to be made in contemporary fracture management. It is unclear whether operative intervention, even for specific fracture types, will produce consistently better long term outcomes. There is a need for good quality evidence for the management of these fractures.

Adult↗