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PubMed1993

Evaluation of rigid internal fixation of mandible fractures performed in the teaching laboratory.

Rigid internal fixation of mandible fractures is advocated as an effective means of providing undisturbed healing and immediate function. However, its application in the clinical setting has resulted in many technique-related failures. To determine the reasons for clinical failure and to help develop improved means of providing successful fixation, the results of plate application in the teaching laboratory were evaluated. Seventy-four surgeons taking the AO/Association for the Study of Internal Fixation (AO/ASIF) maxillofacial course in Davos, Switzerland and 56 surgeons taking the advanced AO/ASIF course in Naples, FL applied rigid internal fixation devices to a mandibular fracture model. Treatment was evaluated for anatomic morbidity and effectiveness. In Davos, 92 of 121 subcondylar, body, symphysis, and ramus fractures (76%) were treated effectively. This included 22 of 34 symphysis fractures (65%). In Naples, 11 of 28 symphyseal fractures (39%) were fixed effectively with lag screws without anatomic morbidity. Technique failure is a frequent event in the application of rigid internal fixation devices to mandible fractures. Lag screw fixation of symphyseal fractures had a particularly high rate of technique-related failure.

Bone Plates↗
PubMed2000

Study of mandibular fracture repair using quantitative radiodensitometry: a comparison between maxillomandibular and rigid internal fixation.

PURPOSE: This prospective study evaluated mandibular fracture repair after either maxillomandibular fixation (MMF) or rigid internal fixation (RIF) using the computer-assisted densitometric image analysis (CADIA) system. PATIENTS AND METHODS: Fifty-two patients, 32 treated by MMF and 20 by RIF, were studied. Five postoperative panoramic radiographs were performed on each patient (immediately postoperatively and at 15, 30, 60, and 90 days) and the changes occurring in the optical density of the bone at and around the fracture line were analyzed. RESULTS: An increase in optic density was observed in both groups at 15 days after treatment. At 30 days, a decrease in optical density was observed in both groups, being significantly greater in the MMF group. In the measurements performed at 60 days, an increased density was found in the RIF group, but the rate of optical density increase was more rapid in the MMF group. During the third month, the rates of optical density increase were similar in the 2 groups. CONCLUSIONS: The use of RIF results in more rapid bone mineralization than the use of MMF.

Absorptiometry, Photon↗
PubMed1999

[Effect of a crosslink or cerclage on the mechanical stability of an internal fixator].

This study was performed to evaluate the effect of a cerclage or a crosslink on internal fixator mechanical stability in an unstable spine injury model. Nine human thoracolumbar spine specimens were instrumented either with an internal fixator alone (T12-L2) or together with a cerclage or a crosslink. Four modes of loading were used: flexion, extension, lateral bending, and axial rotation. Moments itself were generated using a specially designed loading jig and loading system. The maximum moment applied was 10 Nm, three load-unload cycles were performed. The flexibility was measured by a motion tracker and range of motion (ROM), elastic zone (EZ) and neutral zone (NZ) were calculated. Statistical analysis was performed using the paired t-test (p < 0.05). For flexion, extension and lateral bending all devices were significantly more stable (p < 0.01), for axial rotation all devices were significantly less stable compared to the intact specimen (p < 0.01). But the crosslink provided significantly more stability compared to the internal fixator alone (p < 0.001). The complete device, i.e. internal fixator + crosslink, was significantly more stable compared to internal fixator + cerclage (p < 0.05). In this study the use of a cerclage had no additional effect in stabilizing the internal fixator. The operative and financial expenditure using a crosslink seems to be justified in fractures with a high rotationally instability, i.e. in type A-3-, B-, and C-injuries according to Magerl et al. [18].

Bone Plates↗
PubMedDate not supplied

Internal fixation at ECWA Hospital, Egbe, Kogi State, Nigeria.

Forty two (42) cases of fractures treated by internal fixation at Egbe Hospital ECWA, Kogi State, Nigeria were analysed retrospectively. Most of the patients requiring internal fixation were young male patients in their reproductive years 26 patients were under 50 years of age out of which 22 patients were males (84.6%) whilst only 4 patients (15.4%) were females. Internal fixation was found to be commoner in males: 31 patients (73.8%) than in females: 11 patients (26.2%). Fractures requiring internal fixation are commoner in the lower limbs than in the upper limbs (Ratio 6:1). The femur is the commonest site of internal fixation, 22 cases (54.2%) followed by the tibia, 6 cases (14.3%). Majority of the patients, 28 cases (67%) left the hospital under 50 days whereas when treated conservatively most will be in the hospital for up to 100 days. Only about 60% of the cases require blood transfusion and even a more cautious approach could reduce this percentage. 13 (31%) of the cases had fever post-operatively which was not necessarily due to infection. Based on its advantages, internal fixation is therefore encouraged and should only be performed by a surgeon who has adequate experience, equipment, instruments and a good operating theatre setting.

Adult↗
PubMed2006

Treatment for unstable intertrochanteric fractures in elderly patients: internal fixation versus cone hemiarthroplasty.

PURPOSE: To evaluate the effectiveness of internal fixation versus cone hemiarthroplasty for the treatment of unstable intertrochanteric fractures in elderly patients. METHODS: The choice of treatment was based on the year of admission: between 2001 and 2003, 42 patients (mean age, 73 years) underwent cone hemiarthroplasty using a cementless press fit through a posterior approach, whereas between 1999 and 2001, 45 patients (mean age, 75 years) underwent internal fixation using a dynamic hip screw through a lateral approach in a supine position. Patients with stable fractures with intact lesser trochanter, immobility before injury, age younger than 60 years, or with associated injuries (such as another fracture) were excluded. Patients were encouraged active rehabilitation in bed. Bony union was determined by clinical and radiological examinations. Patients were followed up at 6-week intervals in the first sixth months and every 3 months thereafter until bony union was achieved. In the final follow-up, 32 cone hemiarthroplasty patients and 38 internal fixation patients were available for evaluation according to Merle d'Aubigne and Postel criteria. RESULTS: There were no significant differences between the 2 groups in terms of sex, age, fracture type, Singh index, follow-up period, hospital stay, operating time, and receipt of blood transfusions. Clinical results of both groups were similar. Hemiarthroplasty patients were allowed full weight bearing significantly earlier than the internal fixation patients. CONCLUSION: Cone hemiarthroplasty can be an alternative treatment for unstable intertrochanteric fractures in elderly patients so as to achieve earlier mobilisation.

Aged↗
PubMed1989

Reconstruction of the lumbar spine using AO DCP plate internal fixation.

Augmentation of lumbar spine fusion with internal fixation using pedicle screw systems has gained wide currency because it offers rigid stabilization to foster fusion healing. The AO DCP plate has been employed in Europe as a spinal implant with pedicle fixation using 6.5 mm, full-threaded cancellous bone screws with success. This report details the experience of using this device for lumbar spine fusion in a series of 46 North American patients with a mean follow-up of 1.25 years (range 1-2.5 years). Thirty-one patients had had prior lumbar spine surgery with poor outcomes, and 15 had had no prior surgery. All were treated surgically for lumbar degenerative disease with canal decompression, internal fixation with AO plates, and fusion with autologous bone grafting posterolaterally. Complications included two early and one delayed wound infection; five cases of screw loosening; three cases of screw breakage; and three cases of screw impingement upon a nerve. Results of surgery in 17 patients with failed interbody fusion included good to excellent pain relief in 59%, and solid fusion in 76%. In 14 patients with failed posterior surgery the good to excellent pain relief rate was 79%, and the fusion rate was 86%. In 15 patients undergoing primary surgery there was 89% good to excellent pain relief and a solid fusion rate of 87%. The benefits accruing from augmentation of the fusion with internal fixation using AO DCP plates are positive and justify its continued use. Complications encountered in the early experience have been significantly reduced in subsequent series, indicating the existence of a "learning curve" effect which would mandate specific training of spinal surgeons in the technique.

Bone Plates↗
PubMed2001

Treating forearm fractures using an internal fixator: a prospective study.

Some major complications of internal fixation with plates, such as infections and disturbance of healing, have been shown to be related to necrosis of bone and to the soft tissues immediately deep to the plate. This is attributable to plate contact. To deal with this phenomenon, an internal fixator, the Point Contact Fixator, was developed according to a new concept. The Point Contact Fixator resembles a plate but functions like a fixator, that is, the fracture is stabilized using a splint fixed to the bone by monocortical, angularly locked screws that are designed not to exert pressure between the splint and the bone, thereby minimizing implant-to-bone contact. Vascular damage to the osseous blood supply consequently is avoided. The new internal fixator is the first of a new family of implants in addition to nails, plates, and external fixators. To study the potential of the Point Contact Fixator in a prospective study, 79 forearm fractures in 55 patients were treated in a consecutive series by one surgeon using the same technique throughout. Followup to union is reported for 100% of the patients. Handling the fixator was simple; healing was uneventful; and the rate of complication was low.

Adult↗
PubMed2002

[Treatment of lumbar spondylolisthesis by Socon internal fixator: report of 18 cases].

OBJECTIVE: To evaluate the therapeutic effect of Socon transpedicle internal fixators in the treatment of spondylolisthesis in the lumbar spine. METHODS: Fixation with Socon internal fixators along with posterior decompression and fusion was performed in 18 patients with degenerative spondylolisthesis in the lumbar spine. The symptoms, signs and X-ray manifestations observed preoperatively and postoperatively were compared, and a follow-up study of all cases lasting for 6 to 18 month was conducted. RESULTS: Anatomical restoration of the involved vertebrae was achieved in all the cases, of them 15 had out-standing and 2 had fairly good clinical results without incidences of any complications during or after the operation. CONCLUSION: Socon internal fixator is an excellent modality for treatment of lumbar spondylolithesis.

Adult↗
PubMed2007

Rating of internal fixation and clinical outcome in displaced femoral neck fractures: a prospective multicenter study.

The influence of precise surgical technique on the clinical outcome of internal fixation for displaced femoral neck fractures is an under-reported and potential confounding factor in randomized studies involving internal fixation as a treatment modality. Two experienced surgeons blindly rated internal fixation techniques on the perioperative radiographs of 102 patients selected for internal fixation in a prospective multicenter 2-year followup study. Overall technical, fracture reduction, and implant positioning ratings were given according to instruction. One or both raters assigned an inadequate overall rating in 25% of patients. There was a correlation with 2-year clinical internal fixation failure for overall technique and fracture reduction rating. Implant positioning did not correlate with 2-year internal fixation failure. Correlation increased if both raters agreed on inadequate technique. One inadequate rating indicated a problem could arise, whereas two inadequate ratings strengthened this problem likelihood. Adjudication of technique by independent rater(s) is useful, may have clinical implications, and should be performed routinely in future studies involving internal fixation in patients with displaced femoral neck fractures.

Aged↗
PubMed2003

Long-term study of high-strength hydroxyapatite/poly(L-lactide) composite rods for the internal fixation of bone fractures: a 2-4-year follow-up study in rabbits.

Biodegradation of hydroxyapatite (HA)/poly(L-lactide)(PLLA) composite bone implant rods was studied with the use of two types of HA particles as reinforcing fillers: uncalcined HA (u-HA) or calcined HA (c-HA). Composite rods of u-HA/PLLA and c-HA/PLLA containing 30 or 40% (w/w) HA were implanted in the distal femur of 21 rabbits, and specimens were examined by light microscopy, scanning-electron microscopy (SEM), and transmission-electron microscopy (TEM) 2-4 years later. For u-HA/PLLA, trabecular bone bonding directly onto the rod was maintained for up to 2 years. By 3 years, surface collapse had begun, and the implants were shrinking. By 4 years, they had shrunk further, with complete bone encapsulation. The u-HA particles were small and needle shaped in the peripheries, and TEM confirmed their resorption. The cross-sectional area after 4 years decreased by 23.3+/-8.4%. The mean ratio of bony ingrowth to the initial cross-sectional area around the shrunken rods was 6.7+/-1.3 %. The viscosity molecular weight of PLLA reduced from 2 x 10(5) to less than 1 x 10(3). Thus, most of the PLLA had released from the rods. The c-HA/PLLA implants also showed good osteoconductivity, but shrinkage and infiltration of histiocytes were less. No osteolytic or osteoarthritic changes were found.

Absorbable Implants↗
PubMed2005

A 5-7 year in vivo study of high-strength hydroxyapatite/poly(L-lactide) composite rods for the internal fixation of bone fractures.

The biocompatibility and biodegradation of hydroxyapatite (HA)/poly(L-lactide) (PLLA) composite bone implant rods were studied using two types of HA particles as reinforcing fillers, uncalcined-HA (u-HA) or calcined-HA (c-HA). Composite rods of u-HA/PLLA and c-HA/PLLA were implanted into the distal femurs of 25 rabbits. Four of these rabbits lived for more than 5 years after implantation, with one living for 7 years 4 months. Samples were retrieved after the rabbits died naturally and specimens were examined by light microscopy and scanning electron microscopy (SEM). For u-HA/PLLA, the shrinkage of the rods progressed further after 4 years, and some were almost completely resorbed. We could not find traces of the rod in some sections from more than 6 years. Remodeled bone encircled the residual material, and trabecular bone bonded directly to the rod was found toward the center. For u-HA/PLLA 30%, results were similar to u-HA/PLLA 40%, and the cross-sectional area had decreased by 4.0% at over 7 years. Most of the PLLA had been released from the rods. Neither obvious osteolytic nor osteoarthritic changes were found after 4 years.

Animals↗
PubMed2004

Supracondylar fractures of the elbow: open reduction, internal fixation.

This principle-based approach for fixing distal humerus fractures has many advantages. Complex fractures are able to be fixed with sufficient stability to permit immediate intensive rehabilitation. Some fractures believed to be unfixable have been fixed satisfactorily by applying the principles outlined in this article. More straightforward fractures are fixed easily using the same techniques. In the author's experience, the stability achieved with this approach is so much greater than that with traditional methods of fixing distal humerus fractures that bone graft has been required only rarely, despite the severity of injuries so typical of the tertiary referral nature of the author's practice. The key points are that the plates should be placed in parallel configuration medially and laterally and that the screws passing through these plates in the distal fragments should interdigitate and lock together.

Epiphyses↗
PubMed2001

Internal fixation of children's fractures using the Fixclip system.

Thirty five fractures were treated using the Fixclip (Corin medical) system of wires and retaining clips. Union occurred in all instances. In the region of the growth plate, the implant enabled small fragments of bone to be captured and the epiphysis to be secured to the metaphysis without transgression of the physis. In the case of metaphyseal and diaphyseal injuries, the Fixclip allowed stabilisation of fractures with minimal disturbance of the fracture site and soft tissues. This combined with the flexibility inherent in the construct encourages secondary healing with the formation of abundant external callus. On four occasions, a wire escaped from the clip although this led to further intervention in only one instance. In each of these cases, a single retaining clip had been used suggesting that at least two clips should be used for each construct.

Adolescent↗