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At least 955 records · Page 53Linked to original sources
PubMed2000

Functional reconstruction of the TM joint in cases of severely displaced fractures and fracture dislocation.

In a clinical and axiographic study the outcome of patients with severely displaced fractures and fracture dislocations of the mandibular condyle was evaluated. Two operation methods were compared one via an intraoral approach without joint revision and another via a preauricular approach with open reduction of the joint. In the group with joint revision, resorbable material was used for osteosynthesis. Twenty-eight patients (32 joints) treated without revision of the joint and 26 patients (29 joints) with open reduction of the joint were evaluated. The mean observation time following surgery was 3 years and 10 months (range 1-7.5 years). Clinical examination utilized the Helkimo-index, while the electronic axiographical results were evaluated by using a five point scheme of joint-mobility. Concerning clinical evaluation, 20 out of 28 patients (71%) without joint revision and 23 out of 26 (89%) patients with joint revision had none or only slight dysfunction of the stomatognathic system. When focusing on arthralgia and pain in motion (part D and E of Helkimo's-index) significantly better results were achieved by open joint revision (Helkimo D: p< or =0.007; Helkimo E: p = 0.0029). No patient exhibited severe dysfunction (group D3). In axiographic evaluation optimal results (group A1) were achieved in seven joints (24%) with revision and four joints (12%) without revision. Twelve out of 29 joints with revision (41%) and six out of 32 joints without revision (19%) were classified as group A2 with a slightly shortened condylar excursion. Revision of joints with disc reduction and reconstruction of ligaments in cases of severely displaced or dislocated fractures resulted in better mobility and less pain. This was seen clinically and in the axiographic results. Looking at the long-term outcome of patients better mobility of the joint without internal derangement due to surgical repair also protects the contralateral (nonoperated) joint. When managing severe TMJ-trauma we suggest that both, bony and soft tissue structures should be reconstructed if there are any signs of internal derangement. However, the limits between bony reconstruction with or without joint revision are still not defined. Our results appear to be promising concerning mobility and absence of pain of the joints after open reduction. Further research comparing the two operative treatment regimes in a randomized controlled clinical trial will be necessary.

Adolescent↗
PubMed2004

Are patients with a nonunion after a femoral neck fracture more osteoporotic than others? BMD measurement before the choice of treatment?: A pilot study of hip BMD and biochemical bone markers in patients with femoral neck fractures.

The incidence of nonunion is high after a femoral neck fracture. If reliable predictors were available, fractures that heal well could be subjected to internal fixation while fractures that do not could undergo an arthroplasty. In this pilot study of 28 patients, those with a low hip BMD on admission had a higher risk of developing non-union.

Absorptiometry, Photon↗
PubMed1992

Fracture healing monitored with strain gauges. External fixation of 7 humeral neck fractures.

We measured healing in 7 cases of surgical neck fracture of the humerus by applying a strain gauge measuring bar between the external fixation pins. Repeated measurements provided a healing curve for the individual cases. The gradual decrease in deflection of the fracture zone reached a plateau of about 50 percent after 2 to 4 weeks in 6 cases. Removal of the frame at this time proved safe, as solid healing occurred. In one fracture no such decrease was seen and nonunion developed.

Aged↗
PubMed2002

Computer-assisted fracture reduction of pelvic ring fractures: an in vitro study.

A newly developed software module for computer-assisted surgery based on a commercially available navigation system allows simultaneous, independent registration of two fragments and real-time navigation of both fragments while reduction occurs. To evaluate the accuracy three fracture models were used: geometric foam blocks, a pelvic ring injury with disruption of the symphysis and the sacroiliac joint, and a pelvic ring fracture with symphysis disruption and a transforaminal sacral fracture. One examiner did visual and navigated reduction and in all experiments the end point was defined as anatomic reduction. Residual displacement was measured with a magnetic motion tracking device. The results revealed a significantly increased residual displacement with navigated reduction compared with visual control. The differences were low, averaging 1 mm for residual translation and 0.7 degrees for the residual rotation, respectively. Residual displacement was small in both set-ups and may not be clinically relevant. Additional development of the software prototype with integration of surface registration may lead to improved handling and facilitated multifragment tracking. Use in the clinical setting should be possible within a short time.

Biomechanical Phenomena↗
PubMed1992

Fracture of the neck of the talus associated with a trimalleolar ankle fracture and ruptured tibialis posterior tendon.

A rare case of a fracture through the neck of the talus with a trimalleolar ankle fracture and ruptured tibialis posterior tendon is presented and the literature reviewed. Management consisted of open-reduction internal fixation of the fractures and repair of the tibialis posterior tendon. At 40 months after injury, the patient had tibiotalar range of motion at 5 degrees of dorsiflexion and 38 degrees of plantar flexion. While avascular necrosis of the talus did not occur, significant degenerative arthritis of the ankle was noted.

Adult↗
PubMedDate not supplied

Multiple fracture of medullary tube during intramedullary nailing of long bone fractures.

Intramedullary nailing is an accepted treatment for the fixation of femoral and tibial shaft fractures. There is a low but significant incidence of intraoperative complications during intramedullary nailing. During this procedure, a medullary tube may be used to exchange the bent olive-tipped reaming guidewire for the straight guidewire. A review of the literature found only one report of a fracture of the medullary tube. Two cases in which the medullary tube fractured into multiple pieces are presented.

Adult↗
PubMed1986

Nonoperative treatment of stress fractures of the proximal shaft of the fifth metatarsal (Jones' fracture).

Early operative fixation of stress fractures of the proximal diaphysis of the fifth metatarsal has been advocated because of the high potential for delayed union, nonunion, and refracture. Case reports are given of three athletes with stress fractures of the proximal shaft of the fifth metatarsal who were treated nonoperatively and who returned to early athletic participation without recurrent symptoms or refracture. Treatment of this injury should be individualized because of the potential for nonunion and the ability of this fracture to heal.

Adult↗
PubMed2005

Postoperative wound complications after internal fixation of closed calcaneal fractures: a retrospective analysis of 126 consecutive patients with 148 fractures.

AIM: The aim of the study was to analyse the number of soft-tissue complications after internal fixation of calcaneal fractures and to evaluate risk factors leading to these complications. MATERIAL: A retrospective analysis of 126 consecutive patients with 148 operatively treated calcaneal fractures was performed. Only primarily closed fractures were included in the study. RESULTS: Wound healing was problematic in 35 cases (24 per cent). The wound was infected in 23 cases (16 per cent) and a wound edge necrosis was observed in 12 cases (8 per cent). The soft tissue complication needed operative treatment in 20 cases (14 per cent). The complications did not lead to amputations in any case. In the end of the follow up all wounds had healed. CONCLUSIONS: The statistical analysis identified a longer delay in surgery and longer operation time to be positive risk factors for wound complications.

Adolescent↗
PubMed1975

Management of fractured scaphoid bone. A prospective study of 100 fractures.

One hundred fractured carpal scaphoids were immobilised alternatively in above-elbow and below-elbow casts. Preventing the pronation and supination of the forearm did not reduce the immobilisation time, which, with either type of cast, averaged 7 weeks, after exclusion of the fractures with delayed union. These eight fractures, which did not unite in 3 months, were operated on using a lag screw fixation, whereafter consolidation was achieved.

Adolescent↗
PubMed1978

Unstable trochanteric fractures treated with the sliding screw-plate system. A biomechanical study of unstable trochanteric fractures. III.

Eighty unstable trochanteric fractures were treated with the sliding screw-plate system. Early weight-bearing was encouraged and mobilization was obtained within the first week in 47 per cent of the cases (37/78). Technical complications were encountered in 5 per cent of the patients (4/76) but none required re-operation. Telescoping of the screw occurred in 49 per cent (37/76). Through this secondary fracture impaction a stable load transmission system was established. Fracture union in the postoperative position was obtained in 49 per cent of the patients (37/76) and non-union did not occur.

Adult↗
PubMed1995

Diagnosis of scaphoid fractures. A prospective multicenter study of 1,052 patients with 160 fractures.

In a prospective multicenter study of 1,052 patients with clinical signs of a scaphoid fracture, mammographic films and fine intensifying screens were used at the radiographic examination. 5 standardized projections including 3 special projections focused on the scaphoid were taken. 150 fractures were diagnosed at the first examination but in 10 cases the fracture was first diagnosed at a second radiographic examination after 10-14 days. The second examination still seems mandatory despite the use of high quality radiographs with optimal spatial resolution and contrast, and the value of supplementary special projections.

Adolescent↗
PubMed1999

Trans-styloid fixation of fractures of the distal radius. A prospective randomized comparison between 6- and 1-week postoperative immobilization in 60 fractures.

We performed a prospective randomized study on 60 patients with dorsally displaced extra-articular or noncomminuted intraarticular fractures of the distal radius. All 60 fractures were treated by closed reduction and Kirchner wire trans-styloid fixation. 30 patients had 1 weeks' postoperative immobilization and 30 patients had 6 weeks' immobilization. All patients had a clinical and radiographic review at 6 weeks and at 1 year after the operation. Pain, range of movement and grip strength were tested clinically, and changes in dorsal tilt, frontal radial deviation, ulnar variance, and radial shortening were assessed radiographically. Rates of complications were the same in both groups. At follow-up, pain was similar in both groups and range of motion and grip strength were somewhat better after early mobilization--in comparison with the opposite wrist--but this was statistically significant only for ulnar deviation. The postoperative radiographic reductions were similar in both groups, with no differences in loss of reduction after bone healing. Therefore, in Colles' fractures, trans-styloid fixation with two K-wires seems to give a stable osteosynthesis, which does not need additional immobilization with a plaster cast.

Adolescent↗
PubMed2002

Vertebral body fracture of the lumbar spine in elderly women: more severe in osteoarthritis of the knee than in femoral neck fracture.

This study investigated bone fragility by comparing fractures of the vertebral body of the spine in elderly women receiving total knee replacement (TKR) (group 1) due to severe osteoarthritis of the knee and those with femoral neck fractures (group 2) attributable to osteoporosis. Forty-two women each were selected retrospectively for group 1 and prospectively for group 2. Patient age ranged from 64-83 years. Vertebral body fractures of the lumbar spine were significantly more severe in group 1 than in group 2 (P<.001). Patients undergoing TKR due to osteoarthritis of the knee had systemic bone fragility, which included the spine.

Absorptiometry, Photon↗
PubMed2000

Controversies in ankle fracture treatment. Indications for fixation of stable Weber type B fractures and indications for syndesmosis stabilization.

Although the treatment of ankle fractures is often straightforward, several controversies remain. This article reviews the need for open reduction and internal fixation of the displaced supination-external rotation fracture, and contrasts the studies that mandate anatomic reduction with clinical results. The many issues surrounding syndesmosis fixation are also reviewed, including the need for fixation of distal fractures and the timing of screw fixation.

Ankle Injuries↗
PubMed2002

[External fixation of fractures using Dysnastab-S stabilizers for massive ankle fractures of tibial bone epiphyseal articulations ].

Massive ankle fractures lead to joint stiffness and resulting decrease in range of motion. This can be avoided by functional treatment. In cases where severe soft tissue trauma coexists with bone fractures surgical treatment is limited and external fixation is the method of choice. Modern external fixation technique allows for stabilisation and maintaining range of motion in the affected joint. This paper presents the results of application of the Dynastab-S external fixator. The construction of this fixator allows dorsal and plantar, reducing postraumatic joint stiffness. It also allows appropriate insight into soft tissues and debridement of devitalised tissues as well as their forthcoming surgical reconstruction. In our material (27 cases) treated with the Dynastab-S fixator for an average of 16 weeks a satisfactory bone healing process in all cases was noted. Appropriate function of the extremity was maintained, with comparable plantar flexion to the contralateral, not affected joint. Only in one case post operative treatment was complicated by algodystrophy. Our observations showed that implementation of modern external stabilisation techniques leads to appropriate fracture healing with full function of the inferior extremity.

Adult↗
PubMed2002

[Fracture of the supracondylar process of the humerus associated with Monteggia fracture].

Fractures of the supracondylar process of the humerus have been rarely described in the medical literature. This is a bony projection that arises from the anteromedial surface of the distal humerus, and present in only one per cent of the population. We present a patient with this rare injury associated with a Monteggia fracture of the forearm. The proximity of neurovascular structures to the process makes them vulnerable to injury associated with this fracture. We present a review of the literature and treatment guidelines.

Adult↗
PubMed2002

Dynamic external fixation of comminuted intra-articular fractures of the distal tibia (type C pilon fractures).

We report 26 patients with 28 type C3, distal intraarticular tibial (pilon) fractures treated by dynamic external fixation. Follow-up was at least two years, and the results (subjective and objective) were classified according to the Ovadia system. The mean to fracture union was 14 weeks (range: 12 to 20 weeks). There were three cases with angulation deformity (from 7 degrees to 20 degrees). There were no cases with nonunion or deep infection. Based on these results, this treatment with closed reduction and dynamic external fixation allowing early motion appears as a suitable method for treatment of comminuted intraarticular tibial pilon fractures.

Adult↗