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Fractures of the coronoid process of the ulna.

The coronoid process is critical to elbow stability and is vulnerable during injury. Traumatic elbow injures are relatively uncommon, so it is important for surgeons to be mindful of the importance of specialized treatment of the coronoid for optimal elbow function. Optimal coronoid fracture fixation is determined by fracture morphology, which can usually be predicted based on the overall pattern of injury. There is evidence that improved understanding of coronoid fractures and their management is improving the results of treatment.

Biomechanical Phenomena↗

Fixation of zygomatic fractures with a new biodegradable copolymer osteosynthesis system. Preliminary results.

In a prospective study, a new biodegradable osteosynthesis material for the facial skeleton has been used in 27 patients with zygomatic fractures. In the six-month follow-up period, the first ten patients showed clinically and radiologically uneventful healing of bone. There were no implant-related complications. The main advantages of the new material are its malleability when heated, enabling fast adaptation to the bone surface, and the avoidance of a second operation for implant removal.

Absorbable Implants↗

Self-adapting washer system for lag screw fixation of mandibular fractures. Part II: In vitro mechanical characterization of 2.3 and 2.7 mm lag screw prototypes and in vivo removal torque after healing.

The aim of this study was to mechanically characterize self-tapping 2.3 and 2.7 mm titanium lag screw prototypes which are part of the newly developed 'self-adapting washer' maxillofacial lag screw osteosynthesis system. In vitro in a screw testing machine the insertion torque, maximum locking torque and axial force and the ultimate torsional strength were assessed. In vivo in six miniature pigs using a mandibular symphyseal fracture model, the removal torques after 3 and 6 months of healing were measured. Additionally the bone-metal contact (BMC) of the screws was assessed histometrically. The maximum insertion torque (0.185 Nm) was far below the mechanical limits of the screws (2.3 mm = 0.96 Nm, 2.7 mm = 1.6 Nm). A tightening of the 2.7 mm screw with an axial force of 1000 N and of the 2.3 mm screw with 500-550 N leaves a safety margin of approximately one-third on the ultimate torsional strength. Clinically these values permit the use of two 2.3 mm lag screws or one 2.7 mm lag screw in mandibular symphysis fractures since 1000 N tensile axial force are required in this indication. During screw removal after 6 months healing, torque levels close to the mechanical limits of the screws were recorded and screw failures were observed. This failure rate may have been due to the BMC of 49.8% which was in the range of titanium dental implants. Accordingly the screw heads were reinforced to prevent fractures.

Animals↗

Arthroscopic assisted internal fixation of certain fractures about the knee.

A technique is presented by which single-fragment, major intra-articular fractures about the knee can be reduced anatomically under arthroscopic control and internally fixed with percutaneously placed cancellous screws. A displaced intra-articular fracture of the femoral condyle and a tibial plateau fracture were treated utilizing this technique. Both patients obtained excellent results with rapid return of function of the injured limb.

Adolescent↗

Use of a bioabasorbable bone pin fixation for nasal fractures.

After repairing a nasal fracture, it is customary to provide postoperative support for the nasal bone with intranasal, antibiotic-soaked gauze packing and an external splint. However, in cases of a skull base fracture with liquorrhea, this procedure is generally contraindicated because of the risk of infection. To lessen this risk, the authors used a bioabsorbable pin which is ultimately absorbed by the body through the natural process of hydrolysis. An intranasal support was inserted from outside the skin down to the maxilla. The operative results were satisfactory with no postoperative complications such as an inflammatory reaction or an infection.

Absorbable Implants↗

Biodegradable pin fixation of elbow fractures in children. A randomised trial.

A prospective randomised clinical trial was undertaken to compare biodegradable polyglycolic acid pins with standard Kirschner wires used to fix displaced elbow fractures in children. Twenty-four children were enrolled in the trial; 14 had fractures of the lateral condyle of the humerus, eight of the medial epicondyle and two had olecranon fractures. Eleven fractures were fixed with Kirschner wires and 13 with polyglycolic acid pins. Fracture union with full function occurred in all cases within six months. Kirschner wires caused problems including infection in three cases, soft-tissue ossification in one and they required removal under general anaesthesia in nine cases. No such complications occurred with polyglycolic acid pins but one patient in this group developed avascular necrosis and premature fusion of the medial epicondyle.

Adolescent↗

The Gotfried percutaneous compression plate compared with the conventional classic hip screw for the fixation of intertrochanteric fractures of the hip.

We performed a randomised, prospective trial in 111 patients with intertrochanteric fractures of the hip comparing the use of the Gotfried percutaneous compression plate (PCCP) with that of the classic hip screw (CHS). Blood loss and transfusion requirement were less in the PCCP group but the operating time was significantly longer. The complication rate after operation was similar in both groups, and at a minimum follow-up of six months there was no difference in the rates of fracture healing or implant failure. The PCCP gives results which are similar to those obtained with a conventional device. Its suggested advantages seem to be theoretical rather than practical and, being a fixed-angle implant, it is not universally applicable.

Aged↗