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PubMedDate not supplied

External dynamic fixation in fractures of the humerus: can it still be considered treatment of second choice?

The authors report 40 patients affected with diaphyseal fracture of the humerus treated by dynamic axial fixator (FAD Orthofix). Minimum follow-up was 2 years. A clinical and radiographic retrospective study was conducted with the purpose of verifying the validity of external fixation as treatment of choice in diaphyseal fractures of the humerus. The results were evaluated considering healing time, extent and type of complications, long-term clinical, radiographic and functional findings. Results were: excellent: 35; good: 2; fair: 2; poor: 1. Complications were: nonunione: 1; reimplantation of FAD screws: 1; 4 infections of the screw holes, 3 realignments due to secondary displacement, 1 re-fracture after removal of the implant. There were no iatrogenic lesions of the radial nerve, or infections of the fracture site. The authors conclude that this semi-invasive, versatile and well-tolerated method, may be considered a valid alternative to conservative treatment, or to internal fixation even in cases of single trauma, despite limits related to the degree of collaboration of the patient, particularly with regard to debridement of the screw holes and periodical clinical and radiographic monitoring.

Adolescent↗
PubMed1988

The displaced femoral neck fracture. Internal fixation versus bipolar endoprosthesis. Results of a prospective, randomized comparison.

The displaced femoral neck fracture poses difficult decision-making issues for the orthopedic surgeon. Young patients frequently require a rapid open reduction and rigid internal fixation in the face of multiple associated injuries. Elderly patients present the typical decision dilemma of internal fixation versus arthroplasty. Consecutive, randomized, prospective series of cases for evaluation of alternatives in the treatment of this difficult fracture are lacking. Between 1982 and 1984, 34 elderly patients with displaced femoral neck fractures were randomized to open reduction or hemiarthroplasty study groups. Although the surgical risks are relatively high, two-year observations showed better functional results in the cemented hemiarthroplasty group.

Aged↗
PubMed1991

Operative fixation of fractures in children.

A total of 39 fractures of the diaphyses of long bones in 31 children were subjected to operative fixation. Indications for surgery included concomitant severe head injury, multiple injuries, patients nearing skeletal maturity, inability to obtain a satisfactory reduction by conservative means, severe soft-tissue injury with or without vascular trauma, long-standing neurological disorder with incapacity and contractures, malunion, and delayed union. Although long-bone diaphyseal fractures in children are generally managed non-operatively, the use of fixation may be indicated in certain cases.

Adolescent↗
PubMed2002

[External fixation of fractures using Dysnastab-S stabilizers for massive ankle fractures of tibial bone epiphyseal articulations ].

Massive ankle fractures lead to joint stiffness and resulting decrease in range of motion. This can be avoided by functional treatment. In cases where severe soft tissue trauma coexists with bone fractures surgical treatment is limited and external fixation is the method of choice. Modern external fixation technique allows for stabilisation and maintaining range of motion in the affected joint. This paper presents the results of application of the Dynastab-S external fixator. The construction of this fixator allows dorsal and plantar, reducing postraumatic joint stiffness. It also allows appropriate insight into soft tissues and debridement of devitalised tissues as well as their forthcoming surgical reconstruction. In our material (27 cases) treated with the Dynastab-S fixator for an average of 16 weeks a satisfactory bone healing process in all cases was noted. Appropriate function of the extremity was maintained, with comparable plantar flexion to the contralateral, not affected joint. Only in one case post operative treatment was complicated by algodystrophy. Our observations showed that implementation of modern external stabilisation techniques leads to appropriate fracture healing with full function of the inferior extremity.

Adult↗
PubMed1979

External fixation of facial fractures.

Although external fixation is not indicated in every type of facial fracture, its use alone or with intermaxillary or internal fixation may be of benefit with problems resulting from avulsed segments, infection, inadequate previous reduction, delayed reduction, severe displacement and comminution, non-union, cerebrospinal fluid leak or where a combination of these factors exists. The judicious application of extraskeletal fixation can save valuable anesthetic time as well as assure accesibility of the pharynx and maintenance of an airway and routes for nutrition when these might otherwise be compromised. Although extraskeletal fixation is not withou problems or contraindications, it must be weighed in view of the patient's physical, mental and neurological status, and the existence of concomitant injuries.

Accidents, Traffic↗
PubMed2005

Fixation of zygomatic fractures with a biodegradable copolymer osteosynthesis system: short- and long-term results.

Biodegradable osteosynthesis devices can be viewed as addition to, not yet replacement for conventional metal osteosynthesis materials. In a series of 65 patients with zygomatic fractures, a short-term complication/sequelae rate of 22.8% and a long-term complication rate of 9.4% were recorded. Lactosorb plates, panels and screws were the only devices used for osteosynthesis. All complications associated with the biodegradable material could be considered minor and were resolved by the use of minor surgical procedures or conservative measures. The results of this study indicate that treatment of zygomatic fractures with biodegradable osteosynthesis material has no major long-term adverse effects beyond the total material resorption time.

Absorbable Implants↗
PubMed1995

Use of an articulated external fixator for fractures of the tibial plafond.

We performed a prospective study of forty-nine displaced fractures of the tibial plafond in forty-eight patients managed, at three centers, with an articulated external fixator placed medially across the ankle joint. Forty ankles had interfragmental screw fixation of a reduced articular fracture, and fourteen ankles had bone-grafting. The average duration of external fixation was twelve weeks. All of the fractures healed (one after delayed bone-grafting). There were no infections in any of the operative or traumatic wounds over the tibia. Two wound infections over the fibula resolved with treatment. Eight patients were managed with antibiotics for a pin-site infection, and two patients had curettage and débridement of a pin site in the hindfoot after removal of the fixator. Thirty patients (thirty-one ankles) completed two-year data sheets at an average of thirty months after the injury. The average ankle score was 67 points. Twenty-one patients had grade-0 or 1 osteoarthrosis and nine had grade-2 or 3. One ankle had been treated with an arthrodesis. These data suggest that the prevalence of early complications associated with severe fractures of the tibial plafond and their treatment can be decreased with use of an articulated external fixator combined with limited internal fixation. We concluded that this technique of external fixation is a satisfactory technique for the treatment of these fractures.

Adolescent↗
PubMed1979

Internal fixation of fractures of the neck of the femur using von Bahr screws and allowing immediated weight bearing: a prospective clinical study.

This article presents the results of von Bahr screw fixation in 103 patients, allowing immediate weight bearing. After a follow-up period of 1 year, a failure rate of 18% was recorded. Analysis of the series shows that the failures are due to inadequate reduction of the displacement during operation, especially when the head is in varus, and to bad positions of the screw. The high failure rate was not related to the initial displacement of the fracture.

Adolescent↗
PubMed2003

Least possible fixation of fractures of the proximal humerus.

The purpose of this study was to assess the clinical outcome of an unreported technique of the least possible fixation for valgus-impacted fractures. Using an open technique without any sharp deep soft tissue dissection, the split between the tuberosities is opened to allow elevation of the impacted humeral head fragment. The tuberosities are reduced and repaired with absorbable sutures between the rotator cuff insertions. No bone grafting, Kirschner wire or other fixation device was used. For 11 patients, with an average age of 55 years, who were operated between 1989 and 1998, the mean follow-up period was 69 months. The patients were assessed radiologically and clinically using the Constant-Murley score. As a percentage of the normal side, the Constant-Murley scores ranged from 55 to 100% (mean 86%); there were eight patients with scores >80%, two patients with scores between 70 and 79% and one patient with score <70%. One patient (9%) showed avascular necrosis (AVN). This fixation allows preservation of the soft tissues in an open approach and avoids the dangers of other fixation methods. There is a low risk of AVN and it allows a good functional result.

Adult↗
PubMed1996

In vitro femoral stiffness after femoral neck osteotomy and osteosynthesis with defined surgical errors.

In our search for an osteosynthesis device that would tolerate the surgical errors of the inexperienced surgeon, we tested in vitro femoral stiffness in 75 human osteoporotic femora after internal fixation of a cervical neck osteotomy using three commonly used devices: two von Bahr screws (A. Ericsson AB, Sweden), two cannulated screws (Uppsala type, Olmed AB, Sweden), and two hookpins (LiH, PSAB, Sweden). The first device has its main grip in the cancellous bone by threads; the second has grip in cancellous and subchondral bone by threads; and the third, which has no threads, has its grip in cancellous bone by a hook pin. The intact specimen was in all instances stiffer (22-63%) than the osteosynthesized specimen (p < 0.001). An osteosynthesized femur with perfectly reduced bone ends was 14-23% stiffer than when reduction of the bone ends was insufficient, irrespective of device malposition (p < 0.001). Insufficient reduction of the osteotomy leaving a 20 degrees dorsal angulation of the femoral head combined with too far ventrally placed screws resulted in the lowest femoral stiffness. If reduction of osteotomy was sufficient, screws placed too far ventrally or converging screws did not result in decreased stiffness compared with optimal screw placement. Irrespective of the quality of reduction, osteosynthesis with the Uppsala screw resulted in all instances in a higher stiffness than using the other devices (p < 0.01). With the Uppsala screw design, femoral stiffness after optimal osteosynthesis was reduced by 22% compared with the intact femur, and in the most unfavorable position with combined malreduction and malpositioning it was reduced by 42%. Corresponding values for the von Bahr screws were 29% and 46%, respectively, and for the LiH screws 47% and 63%, respectively. Use of a device with threads and grip in the subchondral bone is recommended for fixation of femoral neck fractures in osteoporotic bone. Furthermore, the importance of anatomical reduction for fracture fixation is emphasized.

Aged↗
PubMed1988

Fixation of displaced subcapital femoral fractures. Compression screw fixation versus double divergent pins.

One hundred and twenty-seven consecutive patients with displaced subcapital fractures of the femoral neck (Garden Grade III or IV) all under 80 years of age and independently mobile, were randomly allocated to fixation with either double divergent pins or a single sliding screw-plate device. The incidence of non-union and infection in the sliding screw-plate group was significantly higher, and we believe that when internal fixation is considered appropriate multiple pinning should be used. Mobility after treatment was disappointing in about half of the patients, and we feel that internal fixation can only be justified in patients who are physiologically well preserved and who maintain a high level of activity.

Adult↗