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PubMedDate not supplied

A comparison of bicortical and intramedullary screw fixations of Jones' fractures.

Two different fixations for treatment of Jones' fracture were tested in bone models and cadaveric specimens to determine the differences in the stability of the constructs. A bicortical 3.5-mm cannulated cortical screw and an intramedullary 4.0-mm partially threaded cancellous screw were tested using physiologic loads with an Instron 8500 servohydraulic tensiometer (Instron Corporation, Canton, MA). In bone models, the bicortical construct (n = 5, 87+/-23 N) showed superior fixation strength (p = .0009) when compared to the intramedullary screw fixation (n = 5, 25+/-13 N). Cadaveric testing showed similar statistical significance (p = .0124) with the bicortical construct (n = 5, 152+/-71 N) having greater load resistance than the intramedullary screw fixation (n = 4, 29+/-20 N). In bone models, the bicortical constructs (23+/-9 N/mm) showed over twice the elastic modulus than the intramedullary screw fixations (9+/-4 N/mm) with statistical significance (p = .0115). The elastic modulus in the cadaveric group showed a similar pattern between the bicortical (19+/-17 N/mm) and intramedullary (9+/-6 N/mm) screw constructs. Analysis of the bicortical screw failure patterns revealed that screw orientation had a critical impact on fixation stability. The more distal the exit site of the bicortical screw was from the fracture site, the greater the load needed to displace the fixation.

Biomechanical Phenomena↗
PubMed1988

Ogden plate and other fixations for fractures complicating femoral endoprostheses.

Treatment of femoral shaft fractures complicating endoprostheses remains controversial. Nineteen such fractures were treated with open reduction and internal fixation using the Ogden plate. This modified plate allows for proximal fixation with heavy-duty Parham bands and distal fixation with screws. Sixteen of 19 patients healed their fractures in an average of 3.5 months. Two fractures developed delayed unions, one resulted in non-union. At final follow-up examination, results were rated as excellent (12), satisfactory (5), and poor (2). The procedure is not technically difficult. It can be applied to fractures both above and below the prosthetic tip as well as those with and without cement. Use of the Ogden plate provides immediate rigid fixation allowing early mobilization, preventing the complications of traction and/or cast immobilization.

Adult↗
PubMed2000

Successful immediate weight-bearing of internal fixated ankle fractures in a general population.

Several studies on operated ankle fractures have shown that immediate weight-bearing is recommendable. Consequently, we changed our postoperative standard regimen, from 3 weeks of non-weight-bearing followed by 3 weeks of weight-bearing, to full immediate weight-bearing in all 6 weeks. A below-knee walking cast was applied immediately after surgery. Between December 1995 and September 1996, we studied 62 patients (median age, 55 years; range 21-92 years; M/F, 24/38), with ankle fractures who attended our emergency department and were subsequently admitted for open reduction and internal fixation. We excluded patients with distal tibia fracture and patients under 18 years of age. Overall, our elderly population did not have complication rates higher than those reported in similar studies on younger patients. In 1 patient, we observed radiographic widening of the ankle joint, of about 3 mm, 6 weeks postoperatively. No patients required reoperation. Our study indicates that full immediate weight-bearing after open reduction and internal fixation is recommendable, even in an elderly population.

Adult↗
PubMed1997

Total hip arthroplasty for complications of proximal femoral fractures.

OBJECTIVES: To determine problems associated with and to present the results of secondary total hip replacement for complications of proximal femoral fractures. SETTING: An acute care hospital with a prospectively entered database for primary total hip arthroplasty. PATIENTS AND PARTICIPANTS: The prospective database was reviewed to extract all patients undergoing primary total hip replacement for complications of treatment of proximal femoral fractures. These fifty-three patients were then compared with fifty-three patients from the same data bank matched for age, sex, weight, prosthesis type, and length of follow-up but who had not sustained a proximal femoral fracture before total hip replacement. INTERVENTION: Primary total hip arthroplasty for complications of proximal femoral fractures. After the surgical procedure, patients were seen at follow-up intervals of three months and six months and, thereafter, yearly. MAIN OUTCOME MEASUREMENTS: Patients were evaluated using the St. Michael's hip rating scale, which is a scale measuring pain, motion, and function specifically designed for evaluation of total hip arthroplasty. Routine radiographs were obtained at each patient visit. RESULTS: The complications associated with total hip replacement in patients with previous proximal femoral fracture fixation occurred more frequently than in patients who had not had undergone previous fracture fixation; in addition, intraoperative surgical difficulty was significantly greater in those patients who had undergone previous surgery for hip fracture. However, the final hip score at > or = 2 years after total hip arthroplasty was not statistically different between the two patient groups. CONCLUSION: Total hip replacement is a satisfactory salvage procedure for failed fracture treatment despite the increased incidence of operative difficulty and increased incidence of complication.

Aged↗
PubMed1991

[Results of distraction by way of external metacarporadial fixation in fracture of the distal end of the radius. Apropos of 97 cases].

104 fractures cases were treated over 5 years using this method, which is reserved for the most critical cases (less than one fourth the total number of fractures of the distal end of the radius); 97 of those were reviewed by an impartial observer. The technique consists in distractive reduction, maintained by a small external holding device interconnecting two pins inside the radius and two pins in the 2nd metacarpal bone. Usually, the device is removed after 45 days. Subjective results were rated "very good" in 62.8% of cases, while post-mobilization, radiological and overall findings rated likewise in 61.8%, 40.2% and 63.9% of cases, respectively. Half the patients presented secondary displacement, which although usually minimal, did necessitate in 6 cases a new reduction (using the same device). Algodystrophy occurred in 17 cases and constituted the main source of complications. It increased in frequency proportionally to the degree of distraction applied. At long term, important finger stiffness persisted only in 3 cases. Thus, the quality of results obtained makes external fixator distraction a choice therapeutic method in hard-to-manage fractures.

Follow-Up Studies↗
PubMed1986

Salmonella osteomyelitis after internal fixation of fracture.

A patient with Salmonella group D (Salmonella enteritidis) acute osteomyelitis of an operated femur is described. The patient failed to respond to chloramphenicol therapy and aztreonam therapy. The local infection that complicated the presence of a foreign body was eradicated only with the removal of the foreign body, an internal fixation plate.

Aged↗
PubMed1979

Bipolar fixation of fractures of the distal end of the radius.

The frequency fo secondary displacement in fractures of the distal end of the radius is very high and varies from 40 to 60% in various series. This results from the void in the epiphysis after reduction due to crushing of the cancellous bone. Secondary displacement can be easily avoided by the bipolar fixation method. This method is quite simple. Two strong Kirschner wires are driven into the radius and into the first metacarpal, and then incorporated in the cast after the reduction of the fracture. In this study we have followed 102 out of 250 patients treated by this method. The number of secondary displcements has been negligible. The functional results are excellent and we did not find any untoward effects attributable to our technique.

Adult↗
PubMed2001

Major secondary surgery in blunt trauma patients and perioperative cytokine liberation: determination of the clinical relevance of biochemical markers.

BACKGROUND: The aim of this study is to assess the associations between the timing of secondary definitive fracture surgery on inflammatory changes and outcome in the patient with multiple injuries. The study population consists of a series of patients with multiple injuries who were managed using a strategy of primary temporary skeletal stabilization followed by delayed definitive fracture fixation. METHODS: In a prospective cohort study performed at a Level I trauma center, the patients' injuries and operative details as well as immune markers and clinical outcomes were studied. The patients were split into an early secondary surgery group (group ESS, surgery at days 2-4) and a late secondary surgery group (group LSS, surgery at days 5-8). During the posttraumatic course, inflammatory markers (interleukin [IL]-6, tumor necrosis factor-alpha) were determined on a daily basis. Perioperatively, these markers were additionally evaluated at 30 minutes, 7 hours, and 24 hours after initiation of surgery. RESULTS: Secondary surgery on days 2 to 4 was associated with a higher incidence of postoperative organ dysfunction (n = 33 [46.5%]) than secondary surgery on days 5 to 8 (n = 9 [15.7%], p = 0.01). A significant association between the combination of initial IL-6 values > 500 pg/dL plus surgery on days 2 to 4 and the development of multiple organ failure (r = 0.96, p < 0.001) occurred. A correlation between the initial IL-6 values > 500 pg/dL and surgery on days 5 to 8 (r = 0.57, p < 0.07) could not be found. IL-6 also demonstrated a predictive value for the development of multiple organ failure: IL-6 > 500 pg/dL in group ESS, r = 0.96, p < 0.001; IL-6 > 500 pg/dL in group LSS, r = 0.57, p < 0.07. CONCLUSION: According to our data, no distinct clinical advantage in carrying out secondary definitive fracture fixation early could be determined. In contrast, in patients who demonstrated initial IL-6 values above 500 pg/dL, it may be advantageous to delay the interval between primary temporary fracture stabilization and secondary definitive fracture fixation for more than 4 days. In patients with blunt multiple injuries undergoing primary temporary fixation of major fractures, the timing of secondary definitive surgery should be carefully selected, because it may act as a second hit phenomenon and cause a deterioration of the clinical status.

Adolescent↗
PubMed1991

Experimental evaluation of seven different spinal fracture internal fixation devices using nonfailure stability testing. The load-sharing and unstable-mechanism concepts.

Fracture site immobilization capabilities of seven internal spine fixation systems were experimentally evaluated: Harrington double distraction (plain, supplemented with Edwards sleeves, supplemented with sublaminar wires), Luque rectangle, Kaneda device, transfixed Kaneda device, and Steffee plates. Stability evaluation involved comparing the three-dimensional motion that occurred across an experimentally created L1 slice fracture, and the load resistance of the implants when subjected to axial, flexion, extension, lateral bending, and torsional loads. Each implant was tested on 15 different vertebral segments from 200-250-lb calves. All implants load-shared with the fractured vertebral column to varying degrees. All except the Steffee plate system showed an obvious biomechanical weakness in one or more load modes. The unstable 4R-4bar mechanism configuration of bilevel spinal implants was identified. Mechanism configurations allow free movement with little or no resistance to the applied load until load sharing by the spinal column stops the collapse and resists the applied load.

Animals↗
PubMed1977

[Treatment of childhood humeral fractures by wire fixation].

Out of 526 upper limb fractures treated in the Pediatric Surgery Department of the Péterfy Sándor Hospital between 1970-1975, 63 patients were operated on. (11.9%). Fractures in childhood are generally treated by closed methods because healing of the growing bone is favourable. If it is reasonable, fractures of the forearm bones are successfully treated by means of intramedullary wire fixation, fractures of the elbow by means of transfixation. No septic complication occured following operation. Growth disturbancies were not observed in the affected bones after the operative intervention in the course of 1 to 5 years. On this ground the author recommends the adaptational "minimal" osteosynthesis in the treatment of fractures in infancy, if closed methods do not promise optimal results.

Accidents, Traffic↗
PubMed1982

[Plate fixation in fractures of the tibial plateau (author's transl)].

The authors have reviewed 100 cases of fracture of the upper end of the tibia with separation of a tibial plateau with some degree of depression. These cases were treated operatively with reduction of the depression and the use of an iliac bone graft to fill the bone defect and fixation with an epiphyseal plate. The results were satisfactory in 86 cases. The conclusions were that surgery should be avoided in patients with poor general condition or with poor local vitality of the limb. In these cases the possibility of delayed operation should be considered or minimum fixation obtained with an external fixator or conservative treatment using traction.

Adolescent↗
PubMed1988

Recurrence of deformity after removal of Harrington's fixation of spine fracture. Seventy-six cases followed for 2 years.

The radiographic result was assessed in 76 patients with acute unstable fractures of the thoracic or lumbar spine admitted during the years 1977-1984, and who were managed by early reduction and stabilization using Harrington distraction rods and a three-segmental posterolateral fusion. The radiographs were analyzed for anterior and posterior heights plus sagittal and frontal widths of the fractured vertebral body and the angles of kyphosis and scoliosis of the spine. All the measurements were made at admission, immediately postoperatively, and at the latest follow-up at least 3 months after removal of the rods, which was done as a routine procedure 6-12 months after the accident. The mean follow-up was 29 months. The posterior height and sagittal width of the vertebral bodies were best restored, whereas the initially well-reduced anterior height and the angle of kyphosis often had returned to values close to those seen on admission. The best anatomic restoration was obtained in rotation-dislocation injuries of the thoracic and thoracolumbar spine, and was poorest in burst fractures of the lumbar spine.

Adolescent↗
PubMedDate not supplied

Subtrochanteric fracture after fixation of slipped capital femoral epiphysis: a complication of unused drill holes.

Subtrochanteric fracture of the femur has been infrequently reported after in situ fixation of slipped capital femoral epiphysis, and this occurred in only 1.4% of our patients over a 10-year period. As this technique is used more frequently, however, the incidence of this complication is likely to rise. All four subtrochanteric fractures occurred through unused drill holes, and avoiding extraneous screw holes seems to be the best way to prevent postoperative subtrochanteric fracture. Once subtrochanteric fracture occurs, immediate open reduction and internal fixation with a compression hip screw device is the recommended treatment.

Adolescent↗