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At least 883 records · Page 49Linked to original sources
PubMed1980

Internal fixation of forearm diaphyseal fractures: double plating versus single compression (tension band) plating--a comparative study.

Eighty-four fresh diaphyseal fractures of the forearm in 55 patients were treated by double plates, with bone union occurring in 97.6 per cent. Seventy fresh diaphyseal fractures of the forearm in 48 patients were treated by single compression plates (tension band plates) with bone union occurring in 100 per cent. In both series, other than infection (two in the double plating series and none in the compression plating series), the major complication was synostosis. This matter is being further investigated at this time by one of the authors (JWM) in an attempt to abort this most distressing complication. The other major complication is related to the stress riser effect of the implant, particularly after hardware removal. There still remains some difference of opinion as to whether metal has to be removed, and in general, unless there is a clear-cut indication for its removal, we do not do so. We now believe that double plating and single compression plating (tension band plating) will insure a high rate of union, a generally excellent functional result, and a low complication rate. However, ASIF (AO) plating provides a somewhat shorter operative time and, at least theoretically, less stress protection of bone and possibly less devitalization of tissue because of the need for less soft tissue stripping for exposure. Therefore, in our clinic for the most part we now use single tension band plating for displaced diaphyseal fractures of the forearm in the adult.

Adolescent↗
PubMed1980

A reproducible approach to the internal fixation of adult ankle fractures: rationale, technique, and early results.

1. Open treatment of ankle fractures is discussed. 2. It is our opinion that operative treatment affords the most predictable way to carry out an absolutely anatomic reduction of the fractures. In addition, the joint may be inspected, cartilage damage documented, and loose fragments removed. 3. A logical method of fixation has been discussed. It is stressed that the fibula should be fixed anatomically first and then associated instabilities corrected. 4. A series of cases with a relatively short follow-up period has been presented showing excellent results and a low complication rate when this approach is used. 5. The recommendation for open reduction of S-ER II fractures has been made. 6. It has been suggested that the deltoid ligament does not need to be repaired when fibular reduction is anatomic and fixation is stable. 7. Syndesmosis screws are rarely indicated, except in high C fractures when corrected by indirect methods.

Ankle Injuries↗
PubMed1994

Internal fixation of the unstable anterior pelvic ring: a biomechanical comparison of standard plating techniques and the retrograde medullary superior pubic ramus screw.

The purpose of this study was to evaluate pubic ramus fracture fixation. This biomechanical evaluation compared standard plating techniques with retrograde medullary screw fixation of a superior pubic ramus fracture in a pelvic fracture model. Six fresh-frozen, cadaveric pelvic specimens with a mean age of 79 years were harvested. These specimens were physiologically loaded according to the following modifications and instrumentations: (a) intact; (b) an APC-II unstable pelvic injury, specifically, unilateral superior and inferior rami osteotomies combined with ipsilateral anterior sacroiliac (SI) joint, sacrospinous, and sacrotuberous ligamentous disruptions, without fixation; (c) disrupted as in (b) but fixed anteriorly with a 10-hole 3.5-mm reconstruction plate contoured to the superior ramus and secured with four 3.5-mm cortical screws; (d) disrupted as in (b) but fixed anteriorly with a 10-hole 3.5-mm reconstruction plate contoured to the superior ramus and secured with six 3.5-mm cortical screws; (e) disrupted as in (b) but fixed anteriorly with a 4.5-mm retrograde medullary superior pubic ramus cortical screw 80 mm long (medial to the hip joint); and (f) disrupted as in (b) but fixed anteriorly with a 4.5-mm retrograde medullary superior pubic ramus cortical screw 130 mm long that was extraarticular and engaged the lateral iliac cortex cephalad to the ipsilateral hip joint. The posterior disruptions of the pelvic ring were not fixed. The APC-II injury created in this study resulted in significant (p < 0.05) motion at the disrupted rami and the injured SI joint, compared with the intact pelvic specimen.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

Basicervical fractures of the proximal femur. A biomechanical study of 3 internal fixation techniques.

A biomechanical cadaver study was performed to compare the stability and ultimate strength of 3 standard fixation techniques used for treatment of basicervical hip fractures. Twenty one pairs of mildly osteoporotic femurs were selected, based on a computed tomography bone density reading of 40-50 Hounsfeld units and a Singh index of III. After initial mechanical characterization of intact femurs, basicervical femoral neck fractures were created, reduced, and then instrumented with random assignment to 1 of 3 methods of fixation: (1) 3 parallel 6.5-mm cannulated cancellous screws; (2) a 135 degrees sliding hip screw with a 4 hole side plate; and (3) a 135 degrees sliding hip screw with a 4 hole side plate and a 6.5-mm cannulated cancellous screw placed proximal and parallel to the sliding screw. Nine pairs were tested to failure in axial loading, 6 pairs in lateral bending, and 6 pairs in torsion. The group instrumented with the multiple cancellous screws had a significantly (p < 0.01) lower ultimate axial load to failure than either sliding hip screw group. However, the multiple screws demonstrated significantly (p < 0.01) less fracture displacement. There were no statistically significant differences in lateral bending or torsional testing behavior between the 3 fixation methods. Use of the sliding hip screw is recommended rather than use of multiple cancellous screws for treatment of basicervical femoral neck fractures. Although a superiorly located cancellous screw may provide rotational control during sliding hip screw insertion, it provides no incremental fixation after the sliding hip screw is placed.

Biomechanical Phenomena↗
PubMed1994

Technique of reduction and internal fixation of thoracolumbar fracture-dislocation using pedicle screws and variable screw placement plates.

Spinal column injuries to the thoracolumbar region are common and leave one fifth of patients with neurological deficit. The authors describe a case of complete fracture-dislocation at lumbar 1-2 level with paraplegia. They detail their surgical technique for reduction, stabilization, and fusion using pedicle screws and plates. Surgical management of such injuries allows rapid rehabilitation of patients with spinal column injuries.

Accidents, Traffic↗
PubMed1993

A new approach to the internal fixation of unstable pelvic fractures.

Eighteen patients with horizontally or vertically unstable pelvic fractures were operated on with a new intrapelvic technique. There were 11 horizontally unstable and seven vertically unstable pelvic ring fractures. The fractures were exposed through a low Pfannenstiel or lower midline incision combined with an incision at the iliac crest. This is referred to as the ilioanterior approach. At the operation, all lesions in the symphysis, rami, and in the sacroiliac region were reduced and fixed with reconstruction plates and screws. No intraoperative complications ensued. The average intraoperative blood loss was 930 ml and the operation time averaged two and one-half hours. The obtained reduction was maintained in all but one sacral fracture. All fractures united. The functional recovery was uneventful in all the patients. The good results obtained in this relatively small series encourage further development of operative techniques in unstable pelvic fractures.

Adolescent↗
PubMed1993

Walking ability after internal fixation of trochanteric hip fractures with Ender nails or sliding screw plate. A comparative study of gait.

The influence of several clinical and radiographic parameters on the functional outcome of 92 patients with trochanteric hip fractures treated at random with either Ender nails or a sliding screw plate (SSP) was prospectively investigated. Apart from other clinical variables such as pain, the use of walking aids, and walking distance, the walking ability of patients was assessed by gait analysis performed on an electronic walkway. The parameters investigated were the maximal vertical force (MVF) and single-limb support phase (SLS). Independent of the type of fixation, no differences were observed between stable and unstable fractures in any of the parameters analyzed six months after surgery. In fractures treated with Ender nails, the use of walking aids and MVF were influenced by a satisfactory fracture reduction. Walking distance was the sole factor correlated with the status of fracture healing. In fractures treated with SSP, the pain was the only clinical variable significantly influenced by the outcome of fracture healing. In trochanteric fractures treated with Ender nails, the quality of fracture reduction was the most valuable predictor of patients' recovery of walking ability.

Aged↗