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PubMed2000

[Osteosynthesis with resorbable hemi-cerclage in metacarpal fractures].

The use and results of biodegradable hemicerclages for metacarpal fracture fixation were reviewed retrospectively. A total of 92 metacarpal fractures in 78 patients were treated with polyglycolic or polydioxanon sutures. Study parameters included time for bony union, duration of immobilisation, total active range of motion, and complications. The hemicerclage achieved rigid fracture fixation and permitted early mobilisation exercises without jeopardizing bony union. Immobilization of metacarpals was performed for a median of 3.4 (1.5 to 6) weeks. There were no complications of wound healing. Adequate bony union was achieved after a median of 4.5 weeks (3.5 to 7 weeks). In one case, premature loading of the fracture led to displacement and delayed union. At the end of treatment (6.1 [4 to 7.5] weeks), total active range of motion was 98 (85 to 100)%. Ideal indications are oblique or torsion fractures of the metacarpals. In these cases, immobilisation up to wound healing is sufficient.

Adolescent↗
PubMed2001

Retrograde fixation of fractures of the neck and shaft of the humerus with the 'Halder humeral nail'.

The Halder humeral nail is a new intramedullary device designed for displaced two part humeral neck and shaft fractures. It is inserted retrograde from the olecranon fossa and a unique trio wire is inserted through the nail to provide good proximal fixation. This avoids the use of proximal screws and damage to the rotator cuff thereby ensuring good rotator cuff function. The results of 100 cases are presented. At 6 weeks, 95 patients could perform the majority of daily tasks. There were four non-unions, one following a deep infection.

Adult↗
PubMed2001

Ilizarov hybrid external fixation for fractures of the distal radius: Part I. Feasibility of transfixion wire placement.

The advantages of Ilizarov external fixation, allowing early motion of adjacent joints during fixation of periarticular fractures, have not yet been applied to distal radius fractures. A magnetic resonance imaging study of 10 normal volunteers evaluated the safety of passing percutaneous transfixion pins across the distal radius in 3 forearm positions. Even in the optimal forearm position, the safe zones between the transfixion pin, vessel, nerve, or tendon was small, suggesting that open placement would be required. A cadaver study in 8 specimens demonstrated that the pins could be placed with an open technique using an aiming device and that the pins could be placed without limiting forearm rotation. The proximity of vital structures to transfixion pins dictates open placement to safely apply Ilizarov fixation to distal radius fractures.

Adult↗
PubMed2000

Rigid internal fixation of fractures of the proximal humerus in older patients.

In 42 elderly patients, 33 women and nine men with a mean age of 72 years, we treated displaced fractures of the proximal humerus (34 three-part, 8 four-part) using a blade plate and a standard deltopectoral approach. Functional treatment was started immediately after surgery. We reviewed 41 patients at one year and 38 at final follow-up at 3.4 years (2.4 to 4.5). At the final review, all the fractures had healed. The clinical results were graded as excellent in 13 patients, good in 17, fair in seven, and poor in one. The median Constant score was 73 +/- 18. Avascular necrosis of the humeral head occurred in two patients (5%). We conclude that rigid fixation of displaced fractures of the proximal humerus with a blade plate in the elderly patient provides sufficient primary stability to allow early functional treatment. The incidence of avascular necrosis and nonunion was low. Restoration of the anatomy and biomechanics may contribute to a good functional outcome when compared with alternative methods of fixation or conservative treatment. Regardless of the age of the patients, we advocate primary open reduction and rigid internal fixation of three- and four-part fractures of the proximal humerus.

Activities of Daily Living↗
PubMed2006

Operative treatment of III grade open fractures of the tibial diaphysis.

UNLABELLED: Open fractures, especially III grade open fractures of the tibial diaphysis, according to the Gustilo classification still remains a serious therapeutic problem. The aim of the study was to evaluate the clinical results after operative treatment of III grade open fractures of diaphysis of the tibia and to promote a new method of fracture fixation. MATERIAL AND METHODS: 48 patients with open fractures of the tibial diaphysis, classified as type III A and B, according to the Gustilo classification, were operatively treated. Patients were divided into two groups depending on the manner of fracture fixation. Patients in group A (30 pts.) were treated with an external fixator and those in group B (18 pts.) with unreamed intramedullary nails. The time of the union of the fracture, problems with the union (malunion and nonunion), infection, different complications and the functional outcome were examined. Late complications and their treatment were not the object of the study. The follow-up period was at least 12 months. The results of the study showed a mean time of union of 38.4 weeks in patients in group A, and 32.8 for those in group B. Malunion was noticed in 5 (16.6%) in group A and 2 (11.1%) in group B, nonunion in 4 (13.35) in group A and in 2 (11.1%) patients in group B. Superficial infection developed in 7 (23.3%) and deep in 6 (20%) of the patients in group A and in group B in 4 (22.2%) and 2 (11.1%) of the patients. Results from the functional examination showed 26.6% excellent and the same percent of fair results in group A. In group B there were 55.5% excellent and 11.1% fair results. Different types of complications were noticed in the patients from both groups. The final results of the examination showed a shorter time of union, a lower percentage of complications and a better functional outcome in the patients in group B. Unreamed intramedullary interlocking nailing of open fractures of the diaphysis of the tibia (grade III A and B according Gustilo classification) is a relatively safe method of operative treatment with fewer complications compared with external fixation.

Adult↗
PubMed1994

A biodegradable expansion plug for the fixation of fractures of the medial malleolus.

In a prospective study, 26 patients with a displaced fracture of the medial malleolus were treated by open reduction and internal fixation using an absorbable self-reinforced poly-L-lactide expansion plug. Twenty-one patients could be followed regularly for at least six months. The follow-up time ranged from six to 18 months. No redisplacements occurred, and the consolidation of the fractures was uneventful. There were no signs of inflammatory foreign-body reactions. This preliminary study showed the potential of the self-reinforced polylactide expansion plug in the internal fixation of cancellous bone fractures. Further clinical applications are being planned.

Adolescent↗
PubMed1996

Metallic or absorbable implants for ankle fractures: a comparative study of infections in 3,111 cases.

Absorbable fracture fixation has been in clinical use since 1984. Our study compares the infection rates and some infection parameters between metallic (2073 patients) and absorbable fracture fixation devices (1012 patients) in displaced ankle fractures. The infection rate associated with metallic fixation was 4.1%, compared with 3.2% absorbable fixation (p 0.3). The patients who had a wound infection were older when metallic fixation was used (p 0.01). They also had a bi- or trimalleolar fracture more often than did patients treated with absorbable fracture fixation, but this difference did not have a significant effect on the wound infection rate (p 0.2). The infections were mostly caused by microorganisms of the Staphylococcus species. Deep infections were equally common with both fixation methods (0.4%), but there was some variation in the bacterial spectrum.

Adolescent↗
PubMed1984

Anterior fixation for fractures of the thoracic and lumbar spine with or without neurologic involvement.

The anterior approach is useful for treatment of early and late thoracic and lumbar spine burst fractures but is especially useful for a post-traumatic kyphosis. The indications for dural decompression include acute neurologic injury in which CT scanning shows evidence of significant canal intrusion of the spinal cord. The use of anterior fixation devices (and, in particular, the anterior Kostuik-Harrington distraction device), supplemented with Dwyer screws and a solid Hall rod, precludes the necessity of any posterior approach. Anterior surgery has been performed in 49 cases for burst injuries of the thoracic and lumbar spine. Dural decompression was performed in 42 cases. A modified Kostuik-Harrington distraction with supplementary fixation was applied in 31 patients; there were no cases of nonunion or instrumentation failure.

Adolescent↗
PubMed1993

The use of cortical allograft struts for fixation of fractures associated with well-fixed total joint prostheses.

Nineteen patients with 19 fractures around or below a well-fixed femoral stem, were treated by open reduction and internal fixation using massive cortical allograft struts and cerclage wires or cables. The first procedure was performed in 1982 and the last in 1990. Follow-up averaged 28 months. Seventeen patients united their fractures and returned to their preoperative functional status at an average time of 41/2 months. Sixteen healed anatomically. There was one mild malunion and there were two nonunions, both requiring further surgery.

Aged↗
PubMed1992

[Absorbable rods and screws: a new method of fixation for fractures of the olecranon].

Between April 1986 and July 1990 fractures of the olecranon in 41 adult patients were treated by fixation with absorbable rods (20 patients) and screws (21 patients) of self-reinforced polyglycolide (SR-PGA), 3.2 mm in diameter and 20-70 mm in length. Patients were followed up for a mean time of 2 years 7 months (range 1 year to 4 years 6 months). After reduction of the fracture, channels were drilled from the proximal fragment through the cortex of the distal fragment and the fractures were fixed with absorbable rods or screws. By one year from follow-up maintenance of an anatomical reduction of the fracture was seen in 34 patients. Failure of fixation requiring a second operation occurred in 2 cases. In all cases functional recovery was at least satisfactory. Sinus formation as a sign of transient tissue reaction was observed in 3 cases, but did not influence the healing of the fractures or the functional recovery. The results in patients treated with rods or screws was similar. Absorbable screws combined with small rods and absorbable sutures allow treatment of +ore severe fractures of the olecranon than do rods alone.

Adult↗
PubMed2005

The effect of early spine fixation on non-neurologic outcome.

INTRODUCTION: It has been shown that spinal fracture fixation within 3 days can reduce the incidence of pneumonia, length of stay, number of ventilator days, and hospital charges. Our institutional protocol calls for surgical stabilization of spinal fractures within 3 days of admission. We hypothesized that compliance with an early spinal fracture fixation protocol (within 3 days of admission) would improve non-neurologic outcome in patients with spinal fractures. METHODS: The trauma registry was queried for the period January 1988 through October 2001 to identify patients with spinal fractures requiring surgical stabilization. Patients were analyzed to determine the compliance with our protocol and to determine whether early spinal fixation can reduce the incidence of pneumonia, reduce length of stay, and reduce mortality. RESULTS: 1,741 patients with spinal fractures were identified. 299 (17.2%) required surgical stabilization. 174 (58.2%) had surgical stabilization within 3 days while 125 (41.8%) had surgical stabilization greater than 3 days from admission. There were no significant differences between the two groups with regards to age (37.9 versus 42.5), admission GCS (14.1 versus 13.9), or ISS (22 versus 20.8). The incidence of pneumonia was similar in both groups (21.8 versus 25.6%). The mortality was higher in the early group as compared with the late group (6.9 versus 2.5%), although it did not reach statistical significance. The hospital length of stay was significantly shorter (14.3 versus 21.1) for patients who had early spine fixation, however there was no statistically significant difference between the two groups with regards to intensive care unit length of stay (7.2 versus 7.9) or number of ventilator days (5.02 versus 1.9). Patients who were severely injured (ISS > 25) also had a significantly shorter hospital length of stay (19.6 versus 29.1) if they underwent early spinal fixation. Patients with thoracic spine injury and associated spinal cord injury had a significantly shorter HLOS (10.1 versus 30.5), ICULOS (2.3 versus 13.1), and lower incidence of pneumonia (6.5 versus 33.3%). CONCLUSIONS: Reasonable compliance with an early spinal fracture fixation protocol produced some outcome improvements in non-neurologic outcome. Early spine stabilization reduced hospital length of stay in all patients. Patients with thoracic spine trauma and a spinal cord injury had the greatest benefit in reduction of morbidity, HLOS and ICULOS from early stabilization. There was a trend toward poorer outcome in some groups with early spine stabilization. A rigid protocol requiring early surgical spine stabilization in all patients does not appear justified. Although early spine stabilization should be performed whenever possible to reduce hospital length of stay, the timing of this procedure should be individualized to allow patients with the most severe physiologic derangements to be optimized preoperatively.

Adult↗
PubMed1995

Role of mini- and microplate fixation in fractures of the midface and mandible.

Le Fort defined the classic weak points of facial fractures. Fractures of the midface and mandible are believed to require management with standard rigid fixation. Recent work has allowed mini- and microplating of multiple fracture fragments into more manageable larger segments for reduction and subsequent plating with rigid fixation to peripheral buttresses. The technique and indications for use are outlined.

Bone Plates↗
PubMed1983

Internal fixation of fractures of the head of the radius.

In a group of 25 patients with a displaced fracture of the head of the radius (which otherwise would have been treated by resection) operative reduction and internal fixation were carried out. The results, after a follow-up ranging from six months to over two years after operation, were excellent in 17 (no pain and no restriction of movement) and fair to good in eight patients (no pain and restriction of less than 20 degrees). None of the patients had a bad result. The advantages of this technique, which conserves the length of the radius, are discussed.

Adult↗
PubMed1989

Combined intramedullary Kirschner wire and intra-osseous wire loop for fixation of finger fractures.

An intramedullary Kirschner wire was combined with an intra-osseous wire loop for fixing finger fractures. The mechanical stability of this technique to resist a bending moment in the sagittal plane was compared with four other conventional methods: single loop, loop and an oblique Kirschner wire, crossed Kirschner wires and dorsal plating. It was found that when the applied force was small, the technique was much more stable than the crossed Kirschner wires and was similar to the others. The ability to withstand mechanical failure was much better than most of the methods except the dorsal plate. This technique is recommended for replantations, transverse fractures and short oblique fractures with little comminution.

Animals↗
PubMed1977

Rush pin intramedullary fixation for fractures of the proximal humerus.

We have treated almost 700 proximal humeral fractures, and selected from them a series of 16 cases which required operative intervention in the form of semiclosed reduction and internal fixation with the Rush pin because of the marked amount of displacement and risk on nonunion. We favor the 3/16 inch Rush pin for this operation. Fractures of the surgical neck comprise the vast majority of cases operated upon in this series. They are the easiest to reduce and fix by the Rush pin technique. Certain comminuted severely displaced fractures involving the anatomic neck of the humerus and/or greater and lesser tuberosities also lend themselves to this operation with comparable results to other methods of treatment. There have been no postoperative motalities and minimal morbidity. The operation can be performed rapidly and requires only a short period of immobilization and hospitalization.

Adolescent↗
PubMed1995

Use of rigid external fixation in fractures of the mandibular condyle.

In this article the use of a rigid external fixation system is proposed for the early treatment of condylar fractures. This method offers the advantage of not damaging the articular structures during reduction and allows early mobilization for a rapid recovery. In our Centre 28 patients have been treated with the rigid external fixation system, with good functional results. Of these 15 men and 13 women, 22 had a monocondylar fracture and 6 had a bicondylar fracture. In all the cases there was complete recovery of the occlusal stituation and of the mouth opening; no patient surgically treated with this method has ever presented problems of a local or general nature. The purpose of this report was to evaluate the use of external fixation for the treatment of extracapsular condylar fractures with luxation of the fragment out of the glenoid cavity.

Adolescent↗