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PubMed1993

Internal fixation of proximal femur fractures: a biomechanical comparison of the Gamma Locking Nail and the Omega Compression Hip Screw.

The fracture fixation capability of the Gamma Locking Nail was compared with the Omega Compression Hip Screw using cadaver femurs with simulated intertrochanteric and subtrochanteric fractures. Loading of the femurs was done on an Instron machine. Fracture fragment motion was recorded at 100-lb loading increments using standard roentgenograms. Both forms of hardware exhibited sufficient structural integrity to carry loads up to 600 lbs. Fracture motion was generally greater with the Gamma Locking Nail, which appeared to suspend the proximal fragments above a pivot point defined by the distal locking screws. Compression of the fracture site under loading did not occur with the Gamma Locking Nail. The potential for iatrogenic fracture generation appeared greater with the Gamma Locking Nail. Additionally, no clear mechanical advantage was documented in the fracture patterns tested. A limited discretionary use of the Gamma Locking Nail is advised.

Bone Nails↗
PubMed1993

Combined percutaneous and "minimal" internal fixation for displaced articular fractures of the calcaneus.

Forty-one displaced intraarticular fractures of the calcaneus in 38 patients were treated with open reduction and screw fixation of the posterior facet, bone grafting, and percutaneous pinning of the body. A single extensile posterolateral approach was used in all but two cases in which an additional medial incision was needed. Using early functional aftercare, all fractures healed without secondary displacement in an average of eight weeks. Follow-up periods averaged 4.2 years. Results were graded as excellent in 14 patients, good in 16, fair in three, and poor in five. There was a strict correlation between the clinical results and the severity of the articular comminution. A satisfactory outcome depended on the restoration of articular congruency and extraarticular alignment of the os calcis.

Adolescent↗
PubMed1993

Subcapital femoral neck fracture following open reduction and internal fixation of an intertrochanteric hip fracture using a sliding screw and side plate.

This case report illustrates a subcapital femoral neck fracture following application of a compression screw and side plate to treat an intertrochanteric hip fracture. This is an uncommon complication in the management of intertrochanteric hip fractures. The authors describe steps in this surgical technique that minimize the possibility of this complication.

Aged↗
PubMed1996

Postoperative radiographs or thermal prints after internal fixation of fractures? A study of DHS fixation of hip fractures.

Immediate postoperative radiographs confirm the quality of reduction and fixation of fractures. This information is already available from the image intensifier and can be saved as hard copy thermal prints. If thermal prints give the surgeon the necessary patient and clinical information them immediate postoperative radiography should not be required. In this retrospective study of 20 hip fractures treated by dynamic hip screw (DHS) fixation, plain radiographs and thermal prints were compared for the patient and clinical information they contained. Thermal prints were found to be deficient in some areas but, nevertheless, can potentially replace postoperative radiographs in many orthopaedic procedures saving time, money and radiation exposure.

Aged↗
PubMed1997

A rare case of hip dislocation after internal fixation of a femoral neck fracture without infection.

Hip dislocation after hip pinning has been reported in association with sepsis, but in this paper the authors describe a case of gradual, spontaneous dislocation of the hip over several weeks, without sepsis, in a 36-year-old man who had undergone screw-plate fixation of a displaced basi-cervical fracture. This is only the second reported case of spontaneous dislocation after hip pinning not associated with infection.

Adult↗
PubMed1998

Internal fixation of multiple fractures in patients with polytrauma.

Within the last decade understanding of the pathogenetic consequences of trauma has been improved significantly. An additional reduction of lethality has been achieved that in part is related to increasing discrimination of complex injury patterns. Accordingly, additional staging in fracture management of these injuries has been developed. An overview of the current status of fracture management in polytrauma is given and certain regimens that are still controversially are discussed. The principles determined are based on the treatment experience of 4003 multiply injured patients within the past 23 years. The most important principles within the first hours after trauma represent adequate hemorrhage control. In fracture treatment the primary goal remains to perform primary stable osteosynthesis. In severe polytrauma with severe injuries to the extremities, the first decision is whether limb salvage can be achieved without risk of deterioration of the patient's condition. If this is the case, open fractures Grades III b and c usually can be stabilized primarily by unreamed intramedullary nailing or percutaneous plating. The priority pattern in multiple closed fractures is as follows: (1) tibia; (2) femur; (3) pelvis; (4) spine; and (5) upper extremity. Exceptions may ensue if severe head or thoracic trauma is present. Delayed treatment is performed for complex joint reconstruction, definitive treatment of maxillofacial injuries, and soft tissue reconstruction.

Algorithms↗
PubMed1998

Displaced fractures of the glenoid fossa. Results of open reduction and internal fixation.

Displaced fractures of the glenoid fossa are an uncommon and anatomically diverse group of injuries. Failure to restore anatomy in these fractures results in poor outcome in most cases. The success of a treatment protocol that encompasses appropriate preoperative imaging, injury pattern assessment, prudent approach choice, and a comprehensive reduction and fixation tactic was evaluated. Twenty-seven patients were assessed clinically and radiographically at a mean followup interval of 43 months from surgery. Anatomic reconstruction was achieved in 24 (89%) patients. Three patients had residual joint incongruities measuring 2 mm or less. The only perioperative complication was a partial superficial wound dehiscence. Two additional patients had infraspinatus palsies of indeterminate origin. Functional rating revealed six (22%) excellent, 16 (60%) good, three (11%) fair, and two (7%) poor outcomes. The fair and poor outcomes largely were related to associated injuries. These findings show that anatomic surgical reconstruction with a low complication rate and good functional outcome can be obtained for most patients with glenoid fossa fractures.

Adolescent↗
PubMed1997

The preliminary study and tentative animal study on the sintered PDLLA/TCP composites as bone fracture internal fixation.

Polyesters based on the lactic acid have been reported safety and biodegradation in the human beings for two decades. The greatest advantage of the material is its degradation only conducted by the hydrolysis, where the ester backbones are supposed to be unchained in the aqueous condition. The final degradable products are carbon dioxide and water which can be metabolized and digested in the physiological environment. The goal of this study was aimed to develop a composite sintered with poly-DL-lactide (PDLLA) and tricalcium phosphate (TCP) ceramic particles as orthopedic application. The TCP particles in a range of 30-60 wt% (with 5 wt% increment) were doped into the PDLLA matrix for the reinforcement, which were prepared by the melting and hot pressing techniques. The basic mechanical strength, biodegradable behavior, and biological response of the composites will be investigated in the study. Various techniques, such as pH meter, UV, FTIR, XRD ect., were used to examine and record the degradable process of the composites soaked in the saline for 1-16 weeks. The rabbit femur condyle fracture fixation test was used to evaluate the tissue compatibility and the effects of bone fracture fixation of the composites. The histological observation and x-ray photography were applied for investigating assistance. In the histological evaluation of rabbit femur condyle fracture fixation test, the surface of the composite with 50 wt% TCP addition was attached by the new generated bone without fibrous tissue around after 8 weeks implantation. The fracture bone was gradually healing and the composite always firmly and properly fixed on the fracture area during the implanted period, which provided a breeding environment for normal bone remodeling. The developed composite was thought to be an alternative material for orthopedic application in the future, especially in bone screw and bone plate.

Animals↗
PubMed1997

[Internal fixation with U-shaped pin in the treatment of fracture-dislocation of the cervical spine].

Twenty cases with fracture-dislocation of the cervical spine were treated by U-shaped pin fixation. The U-shaped pin made of Steiman pin was used to hold sublaminar fixation of two segments above and below the vertebra of fracture. When atlas or axis was injured, a pair of small holes were drilled on the occipitale. The closed end of the U-Shaped pin was wired through the holes. Early postoperative ambulation was allowed without external fixation. 18 cases were followed up for 8-35 months. 5 cases of six patients with neurologic deficits recovered completely. The remaining one improved, no failure or loosening of the U-Shaped pin or wires was observed. Sound union of the bone grafts was obtained in all the patients. The results suggest that the operative procedure is simple, with sound fixation and satisfactory reduction and union of the fractures.

Adolescent↗
PubMed2002

A prospective randomised trial of internal fixation versus arthroplasty for displaced fractures of the neck of the femur. Functional outcome for 450 patients at two years.

It remains a matter of debate whether displaced fractures of the neck of the femur should be treated by internal fixation or arthroplasty. We have compared the two methods with regard to complications, mortality and functional outcome. We studied 409 patients, aged 70 years and over, with subcapital fractures graded as Garden 3 or 4, in a two-year prospective multicentre study from 12 Swedish hospitals. They were randomised to internal fixation or arthroplasty. Patients who were mentally confused, bedridden or in a nursing-home were excluded from the survey. After two years the rate of failure was 43% in the internal fixation (IF) and 6% in the arthroplasty group (p < 0.001). In the IF group 36% had impaired walking and 6% had severe pain compared with 25% and 1.5%, respectively, in the arthroplasty group (both p < 0.05). There was no difference in mortality. With a high rate of failure and poor functional outcome after IF, we recommend primary arthroplasty for displaced fractures of the neck of the femur in patients over 70 years of age.

Aged↗
PubMed1989

Treatment of mandibular fractures. Need for rigid internal fixation.

The treatment of 200 mandibular fractures was evaluated retrospectively with special reference to the need for rigid internal fixation (AO-plating), as indicated by the ASIF organization. It was shown that the treatment was most typically intermaxillary fixation (50%) followed by Gunning-type splints (17%), wire (16%) and plate (6%) osteosynthesis, while 11% received no active treatment. Complications during splinting were most common among patients treated by osteosynthesis via an extra-oral approach. Most of the fractures (73%) were estimated to be anatomically suitable for AO-plating. One fifth (22%) had relative indications for the use of rigid internal fixation, and 59% had absolute indications, mostly due to simultaneous condylar and corpus (body) fractures or due to fractures in the angle region.

Adolescent↗
PubMed2006

[Treatment of comminuted inferior femoral fractures with combination of supracondylar locked intramedullary nail and shape memory block hoop internal fixator under arthroscopy].

OBJECTIVE: To investigate the advantages and the clinical outcomes of the treatment of comminuted inferior femoral fractures with combination of supracondylar locked intramedullary nail and shape memory block hoop internal fixator under arthroscopy. METHODS: From June 2002 to December 2004, 12 cases of comminuted inferior femoral fractures were treated (9 males, 3 females). Of them, 5 cases were classified as type B and 7 cases as type C according to AO classification. All cases were treated with combination of supracondylar locked intramedullary nail and shape memory block hoop internal fixator under arthroscopy. In 12 cases of one-stage bone grafting, there 5 of autologous cancellous bone grafting and 7 allo-freeze drying bone grafting. RESULTS: With a follow-up of 6 to 18 months, all fractures healed within 3 to 6 months. There were no infection and nonunion. The function of all the knees joint was excellent. According to Noye's criterion for knee scoring, the results were excellent in 9 cases and good in 3 cases; the excellent and good rate was 100%. CONCLUSION: It is a good method to treat comminuted inferior femoral fractures with combination of supracondylar locked intramedullary nail and shape memory block hoop internal fixator under arthroscopy. It has many advantages of less injury to knee joint, good anatomic reduction and reliable fixation.

Adult↗