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At least 811 records · Page 45Linked to original sources
PubMed2004

Nonbridging external fixation for fractures of the distal radius.

OBJECTIVE: To assess the feasibility of using standard components from the small AO external fixator set to support fractures of the distal radius with a construct incorporating distal fixation in the periarticular radius fragment that would allow for primary mobilization of the wrist joint during fracture healing. METHODS: In a prospective pilot study of a nonbridging external fixator in early 2001, 6 consecutive cases of fracture in the distal radius presenting at a tertiary care centre, the Hamilton General Division of Hamilton Health Sciences, were compared with 6 historical controls treated with a standard bridging construct immobilizing the wrist. Both groups were or had been treated with closed reduction and external fixation of the distal radius under fluoroscopic control. Fracture alignment was measured on radiographs after healing and removal of the fixation devices; additional (secondary) outcome measures were pin-tract sepsis and implant loosening (treatment failure). RESULTS: Compared radiographically with controls, alignments after fracture healing were improved (and virtually anatomic) with use of the nonbridging external fixator. The incidence of pin-tract sepsis was similar in the 2 groups, neither of which included any treatment failures. CONCLUSIONS: Nonbridging external fixation of comminuted distal radius fractures can be accomplished safely and effectively. The results of this pilot study suggest that improved radiographic alignment may be achieved with this technique.

Early Ambulation↗
PubMed2005

Current therapy: complications associated with rigid internal fixation of facial fractures.

Rigid internal fixation (RIF) is commonly used for the anatomical reduction and fixation of facial fractures. This technique has many advantages over more traditional methods, such as wire osteosynthesis and maxillomandibular fixation. Properly placed RIF ensures a stable anatomical reduction and allows for immediate or early restoration of function. RIF has a number of complications associated with its use in facial trauma surgery including metal sensitivity, infection, neurologic injury, dental trauma, stress shielding, and malocclusion. Complication rates appear to be inversely proportional with operator skill and experience when using RIF.

Dental Stress Analysis↗
PubMed1997

Sliding osteotomy of the greater trochanter.

Trochanteric osteotomy is commonly used to facilitate surgical exposure in difficult cases of total hip arthroplasty or acetabular fracture fixation. In this paper, we report our experiences using the sliding trochanteric osteotomy performed in 3 patients for acetabular fracture fixation and in 2 patients with total hip arthroplasty. Using the sliding trochanteric osteotomy technique facilitates improved exposure, reduction, and internal fixation of acetabular fractures, especially those involving the dome and the posterior wall. Sliding osteotomy of the trochanter also permits trochanteric advancement when the abductors are weak or the prosthesis is unstable during total hip arthroplasty. No significant complications occurred from this technique, and the postoperative clinical course was satisfactory in all patients.

Acetabulum↗
PubMed2002

Transoral 2.0-mm miniplate fixation of mandibular fractures plus 2 weeks' maxillomandibular fixation: a prospective study.

PURPOSE: We conducted a study to assess the efficacy of intraoral treatment of mandibular fractures using a 2.0-mm miniplate and 2 weeks of maxillomandibular fixation (MMF). PATIENTS AND METHODS: Forty-four mandible fractures in 31 patients with a mean of 15 days of MMF were included in this study. A 2.0-mm miniplate was adapted along Champy's lines of ideal osteosynthesis and secured with four 8.0-mm monocortical screws. All patients were followed for at least 8 weeks after surgery. The incidences of bone or soft tissue infections, wound dehiscence, nonunion, malunion, malocclusion, plate fractures, and iatrogenic neurosensory deficits were prospectively evaluated. RESULTS: Primary bone healing was achieved in 100% of cases. No soft or hard tissue infection, malocclusion, malunion, nonunion, dental injuries, plate fracture, or iatrogenic nerve injuries were observed. Two (4.52%) minor complications-intraoral wound dehiscences-were noted. CONCLUSIONS: The use of a single 2.0-mm miniplate adapted along Champy's line of ideal osteosynthesis and stabilized with 4 monocortical screws plus 2 weeks of MMF was a viable treatment modality for mandibular fractures.

Adolescent↗
PubMed1990

Fixation of mandibular fractures: a comparative analysis of rigid internal fixation and standard fixation techniques.

This study used a prospective design to compare standard therapy (closed or open reduction with 4 weeks of maxillomandibular fixation) to rigid internal fixation (RIF) for the treatment of mandibular fractures. Ninety-two patients with 143 fractures were evaluated and treated. There was no statistically significant difference in the treatment results between the two groups, despite a bias in the distribution of study variables that favored the standard therapy.

Adult↗
PubMed1997

Suppression of natural killer cell activity in patients with fracture/soft tissue injury.

BACKGROUND: Natural killer cells (NKCs) participate in "innate" cell-mediated immunity. Fracture/soft tissue injuries are cytokine rich and may influence cell-mediated immunity. OBJECTIVE: To study the effects of fracture cytokines on NKC function. DESIGN: A case-control study. SETTING: A level I trauma center and laboratory in a university medical center. PARTICIPANTS: Patients requiring open fracture fixation and healthy volunteers. INTERVENTIONS: Fracture supernatants and peripheral plasma were collected during open fracture fixation. Volunteer mononuclear cells were used as effector (NKC) sources. Mononuclear cells were preincubated with fracture supernatants, paired peripheral plasma, or normal plasma under various conditions. MAIN OUTCOME MEASURES: Natural killer cell lysis of K562 target cells was assessed by chromium 51 release. RESULTS: Fracture supernatants suppressed NKC function more rapidly than peripheral plasma. Fracture supernatants from 1 to 4 days after injury were most suppressive. Inactivation of complement and reactive oxygen species failed to restore lysis. Neutralizing antibodies to interleukin 4 and interleukin 10 further suppressed lysis. Antibodies to transforming growth factor beta1 failed to restore lysis. The addition of interferon gamma did not restore lysis but the addition of interleukin 12 did. CONCLUSIONS: Fracture supernatants and peripheral plasma from patients with fractures suppress NKCs. The responsible mediators may be concentrated in fracture/soft tissue injuries. Responses to manipulation of the cytokine environment suggest that fracture cytokines may impair cooperation between NKCs and accessory cells.

Adult↗
PubMed1990

Cast or external fixation for fracture of the distal radius. A prospective study of 126 cases.

In a prospective 4-year study, 126 consecutive patients with a fracture of the distal radius were followed. Functional, anatomic, and radiographic final results of fixation with above-the-elbow cast immobilization were compared with the results obtained with external fixation. The results following external fixation of comminuted intraarticular fractures were better than those of similar fractures treated in a cast. Aged osteoporotic patients tolerated better residual deformities, and the clinical results had a relatively low correlation with the final anatomic alignment. We suggest that extraarticular fractures of the distal radius should be treated with cast immobilization. Comminuted intraarticular fractures of the distal radius should be treated with external fixation, which maintains accurate anatomic position until solid fracture healing is achieved.

Adult↗
PubMed1987

Mouth opening after release of maxillomandibular fixation in fracture patients.

Three hundred eleven patients with mandibular fractures were studied prospectively to ascertain the influence of jaw immobilization on mouth opening. Maxillomandibular fixation caused a significant reduction in mouth opening whereas open reduction did not. Furthermore, there appeared to be a relationship between the duration of immobilization and the degree of reduction of mouth opening such that the shorter the duration of fixation, the less the reduction.

Adult↗
PubMed1998

[Biological osteosynthesis].

A historic review distinguishes three periods in the treatment of fractures: The conservative period (approximate reduction and immobilization in traction or plaster cast), the mechanical and operative period (exact anatomical reduction and stable--even rigid--fracture fixation), and the biological and mechanical period (stability with strict attention to the biological environment of the bone circulation). Biological fracture fixation means: conservation of bone perfusion, protection of the soft tissue envelope and reduction of systemic stress by strengthening the host-defense mechanism. For preoperative planning, the following points have to be considered: choice of fixation method, reduction technique (open, closed, additional aids), surgical tactics (approach), and intra- and postoperative adjuvant therapy.

Combined Modality Therapy↗
PubMed1999

The mechanics of internal fixation of fractures of the distal femur: a comparison of the condylar screw (DCS) with the condylar plate (CP).

Distal femoral fractures are rare and usually complex. Mostly, they are fixed with the Dynamic Condylar Screw (DCS) or the 95 degrees condylar plate (CP). The simplicity of applying the DCS compared with the CP led us to investigate whether any possible mechanical deficiencies of the CP would detract from its technical advantages, thus limiting the indications for its use in the treatment of fractures of the distal femur. An in vitro investigation was carried out to measure the stability of a Y-osteotomy (with and without medial metaphyseal bone defect) stabilized either with the CP or the DCS. 8 pairs of human cadaveric femora classified according to their bone density were used. CP and DCS were applied to 1 bone in each pair by means of three lag screws (anterior, posterior and through the plate). Physiological loading was simulated and measurements were taken at the level of the osteotomy in the frontal and sagittal planes in order to assess rotational instability and the amount of gap opening in the vertical branch of the osteotomy. There was no relevant difference in the mechanical properties of the two fixations for fractures without medial defect, even if the stability of the fixation was reduced by removing the distal screw. Furthermore, interfragmental movement was minimal. In the frontal plane, simulated closure resulted in closure of the medial branch of the osteotomy in every case without any opening of the vertical branch of the osteotomy. In the sagittal plane, the closure of all branches of the osteotomy was confirmed for 11 bones and a rotation of the condyle was observed in 5 bones (3 CP, 2 DCS). Removing the distal lag screw did not increase the instability. Even in osteoporotic bones, the DCS provided the same stability as the CP. For simple Y-osteotomies, the CP did not offer any technical or mechanical advantages. The stability in the frontal plane however was significantly reduced in osteotomies with medial defect. The amplitude of interfragmental movement on all bones fixed by the CP, except for 1 pair, was greater than those fixed by the DCS. The absence of the anterior lag screw did not reduce stability. However, the absence of the lag screw within the implant considerably weakend the fixation--more so for the CP than for the DCS. Instability reached a maximum without any lag screw at all, which again was more pronounced for the CP than for the DCS. The Dynamic Condylar Screw (DCS) must be regarded as the implant of choice both technically and mechanically even in osteoporotic bones, but the distal condylar block must be at least 4 cm in length.

Biomechanical Phenomena↗
PubMed1979

Internal fixation of fractures of the neck of the femur in hemiplegic patients.

There was a history of hemiplegia due to stroke in 97 (6.5 per cent) of 1483 consecutive patients with fresh fractures of the neck of the femur. Both cervical and trochanteric features occurred significantly more often on the hemiplegic side. Internal fixation was technically satisfactory in trochanteric fractures, but failed frequently in cervical fractures.

Adult↗
PubMed1996

Cerclage fixation for fracture dislocation of the proximal interphalangeal joint.

Dorsal fracture dislocations of the proximal interphalangeal joint remain 1 of the most difficult problems in which to obtain an excellent functional outcome. The use of minimally invasive internal fixation techniques improving the biologic healing response and yet providing fracture fragment stabilization has met with greater popularity in recent years. The results of 12 patients treated by the volar cerclage wiring technique are described. At average followup examination of 2.1 years, 11 of 12 patients were noted to have no degenerative joint changes with only 1 patient having evidence of early volar articular surface beaking. Average final active arc of motion at the proximal interphalangeal joint was 89 degrees (range, 72 degrees - 109 degrees). The average degree of extension loss at the proximal interphalangeal joint was 8 degrees (range, 0 degrees - 16 degrees). There were no complications involving implant failure, irritation, or infection. A description of the volar cerclage wire technique is presented. This technique provides the advantage of avoiding fracture fragment stripping, stable restoration of the articular surface, and palmar buttress of the middle phalanx at the proximal interphalangeal joint.

Adolescent↗
PubMed1994

Bite forces in patients treated for mandibular angle fractures: implications for fixation recommendations.

Voluntary bite forces were recorded at varying periods in 35 males treated with rigid internal fixation for fractures of the mandibular angle. Bite forces were also obtained in 29 male controls for comparison. It was found that molar bite forces in patients were significantly less than in controls for several weeks after surgery. Further, molar bite forces on the side of the fracture were significantly less than on the nonfractured side. The results of this study indicate that recommendations for the amount of fixation required for a given fracture may be reduced.

Adolescent↗
PubMed2001

[Anterior screw fixation of fractures of the dens axis].

INTRODUCTION: The aim of the present study was to evaluate the results of anterior screw fixation in the treatment of odontoid fracture. MATERIALS AND METHODS: The clinical and radiographic records of the first 14 patients treated with anterior screw fixation for odontoid fracture were reviewed retrospectively. RESULTS: Satisfying stabilisation of the fracture was achieved in 10 patients (71%). In four patients, two of whom had severe osteoporosis, additional posterior C1/C2 fusion, owing to failure of screw treatment was needed. Two patients developed small occipital bedsores caused by preoperative treatment, but no further complications were observed. CONCLUSION: Although only a few patients were entered in the study, the results justify the use of anterior screw fixation as the treatment of odontoid fracture in selected patients.

Adolescent↗
PubMed1991

Biomechanical evaluation of a biodegradable composite as an adjunct to internal fixation of proximal femur fractures.

Internal fixation of comminuted unstable fractures of the severely osteoporotic proximal femur is sometimes supplemented with polymethyl-methacrylate (PMMA). We here report an in vitro biomechanical evaluation of a biodegradable particulate composite that might be used for similar purposes. The composite includes a matrix phase consisting of a hydrolyzable prepolymer [polypropylene fumarate (PPF)] cross-linked with methacrylate monomer, and a particulate phase consisting of tricalcium phosphate and calcium carbonate. We implanted dynamic hip screws in 22 cadaveric proximal femora and measured the yield load for an oblique force applied to the femoral head. The hip screws were then reinforced with either PMMA or the PPF composite and tested again. On the basis of analysis of variance, the average increases in yield load for PMMA and PPF reinforcement of 1,750 and 1,130 N were statistically significant (p less than 0.00005), suggesting that both materials enhance congruence between implant and bone and thereby increase the projected load-bearing area of the implant. The increase in yield force with PMMA was slightly higher than the increase with PPF (p less than 0.05), but both values after reinforcement were close (3,790 +/- 561 N for PMMA vs. 3,240 +/- 669 N for PPF). If we can demonstrate that appropriate rates of degradation, bony ingrowth, and static and fatigue properties can be achieved in vivo with this system, our data suggest that this PPF composite may have potential as an adjunct to the internal fixation of unstable fractures of the osteoporotic hip.

Aged↗