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PubMed1980

Efficacy of various forms of fixation of transverse fractures of the patella.

To determine whether any of the commonly used wiring techniques are rigid enough to allow early motion in the treatment of transverse fracture of the patella, the patellae of twenty-five fresh cadaver knees were fractured transversely and fixed using the following techniques: circumferential wiring, tension-band wiring, Magnusson wiring, and a modification of tension-band wiring. The knees were mounted in a machine capable of measuring quadriceps force, flexion angle, and fracture separation simultaneously. The knees were extended from 90 to zero degrees by applying tension to the quadriceps tendon with the force of gravity as the only resistance, and separation of the fracture fragments was measured first with the retinaculum unrepaired and then again with the retinaculum repaired. Separation of the fracture fragments was much less with the Magnusson wiring and modified tension-band wiring than with circumferential wiring or standard tension-band wiring. The retinacular repair was found to contribute to stability; however, this seemed most important in the less rigid repairs. We concluded that if early motion is to be used in treating transverse fractures of the patella, techniques in which the wire is anchored directly in bone should be used and the retinaculum should be repaired.

Cadaver↗
PubMed2005

Revision surgery for nonunion after early failure of fixation of fractures of the distal humerus.

Sixteen patients who underwent a revision operation for nonunion of fractures of the distal humerus following previous internal fixation were reviewed at a mean follow-up of 39 months (8 to 69). The Mayo elbow performance score was excellent in 11, good in two, fair in two and poor in one. In 15 patients union was achieved and in one with an infected nonunion a subsequent bone graft was necessary in order to obtain union.Age, gender, a history of smoking, mechanism of the injury and the AO classification of the initial fracture did not correlate with the development of nonunion. In 12 patients (75%), the initial fixation was assessed as being suboptimal. The primary surgery was regarded as adequate in only three patients. Our findings suggest that the most important determinant of nonunion of a distal humeral fracture after surgery is the adequacy of fixation.

Adult↗
PubMed1988

External fixation of fractures of the tibia: clinical experience of a new device.

The performance of a new external fixator was assessed in 50 cases of various types of fractures of the tibia. The fixator comprises an adjustable single outrigger bearing offset pins which offers considerable versatility in its use. The angle at which the pins are offset gives the device considerable torsional and angulatory stability, but its compressive strength is low, allowing axial loading of the fracture during weight bearing. The incidence of complications such as non-union, malunion, and pin-track infection was low. The time to bony union was shorter in cases in which the fixator was applied without exposure of the fracture, compared with those in which the fracture was reduced under direct vision. The time to bony union was also slightly shorter in cases where external fixation was the primary form of treatment, compared with those receiving preliminary os calcis traction.

Adult↗
PubMed2000

Effect of absorbable hydroxyapatite/poly-DL-lactide rods on experimental fracture healing.

In order to investigate the effect of a new institute-designed absorbable hydroxyapatite microparticles/poly-DL-lactide (HA/PDLLA) fracture fixation devices on experimental fracture healing, 25 rabbits with a transverse transcondylar osteotomy of the distal femur were fixed intramedullary by a HA/PDLLA rod (4.5 mm in diameter, 30-40 mm in length). The follow-up time lasted 1, 2, 4, 6 and 12 week(s). Roentgenographic, histological and ultrastructural analyses were conducted. The results showed that all osteotomies united within 6 weeks without delay. No accumulation of inflammatory cells was seen. Ultrastructural studies showed that polymorphonuclear neutrophils and macrophages were observed mainly at the 1st week, but only few were noted at the 2nd week. The inflammatory and debridement stages were not prolonged. Large amount of active fibroblasts and some chondroblasts were observed at the 2nd week, suggesting a fibrous callus stage. The main cellularity at 4th week was osteoblasts and osteocytes. Part of osteocytes had already entered the static stage at the 6th week. Our experiment showed that the HA/PDLLA had good biocompatibility, sufficient mechanical strength and caused no delay to the fracture healing.

Animals↗
PubMed1999

Trans-styloid fixation of fractures of the distal radius. A prospective randomized comparison between 6- and 1-week postoperative immobilization in 60 fractures.

We performed a prospective randomized study on 60 patients with dorsally displaced extra-articular or noncomminuted intraarticular fractures of the distal radius. All 60 fractures were treated by closed reduction and Kirchner wire trans-styloid fixation. 30 patients had 1 weeks' postoperative immobilization and 30 patients had 6 weeks' immobilization. All patients had a clinical and radiographic review at 6 weeks and at 1 year after the operation. Pain, range of movement and grip strength were tested clinically, and changes in dorsal tilt, frontal radial deviation, ulnar variance, and radial shortening were assessed radiographically. Rates of complications were the same in both groups. At follow-up, pain was similar in both groups and range of motion and grip strength were somewhat better after early mobilization--in comparison with the opposite wrist--but this was statistically significant only for ulnar deviation. The postoperative radiographic reductions were similar in both groups, with no differences in loss of reduction after bone healing. Therefore, in Colles' fractures, trans-styloid fixation with two K-wires seems to give a stable osteosynthesis, which does not need additional immobilization with a plaster cast.

Adolescent↗
PubMedDate not supplied

Fluoroscopically guided closed reduction and internal fixation of fractures of the lateral portion of the humeral condyle: prospective clinical study of the technique and results in ten dogs.

OBJECTIVE: To report a technique for fluoroscopically guided closed reduction with internal fixation of fractures of the lateral portion of the humeral condyle (FLHC) and determine the long-term results in 10 clinical cases. STUDY DESIGN: Prospective clinical case study. ANIMALS: Ten dogs with 11 fractures. METHODS: Fractures of the lateral portion of the humeral condyle were stabilized with transcondylar screws and Kirschner wires. Closed reduction and implant placement were achieved using intraoperative fluoroscopic guidance. After fracture repair, postoperative radiographs were evaluated for articular alignment and implant placement. Dogs were evaluated after surgery by means of lameness scores, elbow range of motion (ROM), radiographic assessment, and owner evaluation of function. RESULTS: Postoperative reduction was considered anatomic in 6 fractures with all other fractures having <1.5 mm of malreduction. Follow-up was available for 9 patients from 9 to 21 months after surgery. All of the fractures had healed. One minor (wire migration) and one major (implant failure) complication occurred. Mean lameness scores were 0 (n = 6), 0.5 (n = 2), and 1 (n = 1) at the time of final follow-up. No significant differences were found in follow-up ROM values between affected and unaffected elbows. All of the dogs in this study regained 90-100% of full function, based on owner assessment. CONCLUSIONS AND CLINICAL RELEVANCE: Fluoroscopic guidance for closed reduction and internal fixation of FLHC in dogs is an effective technique.

Animals↗
PubMed1989

Use of the Clyburn External Fixator in fractures of the distal radius.

A study was organized to evaluate the use of a one-plane external fixation device to treat comminuted fractures of the distal radius. Clinical and roentgenographic data were obtained in 20 patients with a followup ranging from 12 to 20 months. The results were graded 14 excellent, 4 good, 2 fair, and none poor. The use of the Clyburn External Fixation Device with supplemental radial styloid Kirschner wire fixation achieved acceptable results in the treatment of comminuted distal radius fractures and proved to be easily applied.

Adult↗
PubMed1990

Healing of osteotomies under different degrees of stability in rats.

In rats, a partial, transverse osteotomy at the midshaft of both femurs was made. In two thirds of the bones, the osteotomy was manually broken and stabilized, either by a tightly fitting or by a loose intramedullary nail. The healing process of the osteotomies was evaluated at 30, 60, and 90 days after the operation. The stable osteotomies healed by direct bone union, and the unstable osteotomies healed by the formation of external callus. At 30 days, the bending moment, rigidity, and energy absorption of the stable osteotomies were significantly greater than those of the unstable osteotomies. At 60 days, however, there were no significant differences in these parameters. During the observation period, no significant differences in mechanical properties were found between the osteotomies nailed with a tightly fitting or a loose intramedullary nail. It is concluded that healing of rigidly fixated fractures is a rather slow, steady process in relation to healing of unstably fixated fractures. Different degrees of instability of intramedullary nailed fractures do not seem to be of significant importance as to the eventual recovery of mechanical properties.

Analysis of Variance↗
PubMed1994

Deformity after internal fixation of fracture separation of the medial epicondyle of the humerus.

We reviewed 24 displaced fractures through the physis of the medial epicondyle of the distal humerus. One was a Salter-Harris type-II fracture-separation of the whole distal humeral epiphysis; the others involved only the medial epicondylar centre of ossification. Two cases had presented as pseudarthroses. One fracture had been treated closed in a plaster slab and 21 had had open reduction and internal fixation with sutures, Kirschner wires or Palmer nails. At 2 to 13 years later we found five types of deformity of the epicondyle: pseudarthrosis, an ulnar sulcus, a double-contoured epicondyle, hypoplasia or hyperplasia. Pseudarthrosis had developed after either no treatment, closed reduction and plaster, or open reduction and suturing. Hypoplasia followed nailing, as did a trend to varus tilting of the joint surface. One very young patient, with fracture-separation of the whole distal epiphysis treated by nailing, developed marked cubitus varus.

Adolescent↗
PubMed2006

Bending stiffness and pull-out strength of tapered, variable pitch screws, and 6.5-mm cancellous screws in acute Jones fractures.

BACKGROUND: Stabilization of fifth metatarsal Jones fractures with intramedullary screws is popular, particularly in athletes, because nonoperative treatment involves prolonged casting and a distinct risk of nonunion or delayed union. Conventional lag screws of various diameters are routinely used for Jones fracture fixation. More recently, tapered, headless, variable pitch screws have become available as an option. These screws have the advantage of not having a protruding screw head, but information regarding their performance in Jones fracture fixation is limited. To determine whether differences exist in the mechanical integrity of fifth metatarsals fixed with each type of screw, this study was designed to compare Jones fracture fixation with 6.5-mm partially-threaded lag screws and headless, tapered, variable pitch compression screws with a 4-mm leading-thread diameter and 5-mm trailing-thread diameter. METHODS: Simulated Jones fractures were created in 20 matched pairs of fresh-frozen fifth metatarsals. One bone from each pair was stabilized with a tapered, variable pitch screw, and the contralateral with a 6.5-mm partially-threaded cancellous lag screw. The stiffness in lateral-to-medial bending of the resulting constructs and the resistance of the screws to pulling out of the distal fragment were quantified. RESULTS: There was no demonstrable difference in bending stiffness between metatarsals fixed with the two types of screws (p = 0.688). The 6.5-mm screw provided significantly higher resistance to pull-out (p = 0.001). CONCLUSIONS: Headless, tapered, variable pitch compression screws of the size tested are not entirely comparable to 6.5-mm lag screws in this application. They are effective in resisting bending but do not offer equivalent resistance to thread pull-out.

Aged↗
PubMed2006

Enhancing the mechanical integrity of the implant-bone interface with BoneWelding technology: determination of quasi-static interfacial strength and fatigue resistance.

The BoneWelding technology is an innovative bonding method, which offers new alternatives in the treatment of fractures and other degenerative disorders of the musculoskeletal system. The BoneWelding process employs ultrasonic energy to liquefy a polymeric interface between orthopaedic implants and the host bone. Polymer penetrates the pores of the surrounding bone and, following a rapid solidification, forms a strong and uniform bond between implant and bone. Biomechanical testing was performed to determine the quasi-static push-out strength and fatigue performance of 3.5-mm-diameter polymeric dowels bonded to a bone surrogate material (Sawbones solid and cellular polyurethane foam) using the BoneWelding process. Fatigue tests were conducted over 100,000 cycles of 20-100 N loading. Mechanical test results were compared with those obtained with a comparably-sized, commercial metallic fracture fixation screw. Tests in surrogate bone material of varying density demonstrated significantly superior mechanical performance of the bonded dowels in comparison to conventional bone screws (p < 0.01), with holding strengths approaching 700 N. Even in extremely porous host material, the performance of the bonded dowels was equivalent to that of the bone screws. For both cellular and solid bone analog materials, failure always occurred within the bone analog material surrounding and distant to the implant; the infiltrated interface was stronger than the surrounding bone analog material. No significant decrease in interfacial strength was observed following conditioning in a physiological saline solution for a period of 1 month prior to testing. Ultrasonically inserted implants migrated, on average, less than 20 microm over, and interfacial stiffness remained constant the full duration of fatigue testing. With further refinement, the BoneWelding technology may offer a quicker, simpler, and more effective method for achieving strong fixation and primary stability for fracture fixation or other orthopaedic and dental implant applications.

Biocompatible Materials↗