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PubMed1998

The effect of ongoing litigation on outcome scores following open reduction and internal fixation of the calcaneum.

All sixteen patients who had undergone open reduction and internal fixation (ORIF) of the calcaneum by the senior author between April 1993 and August 1996 were included in the study. Two had died from unrelated illnesses and one had failed to attend any follow-up following discharge. The remaining 13 were reviewed by the main author. As part of a complete clinical, radiological and functional assessment, Buckley and Meek (B&M) and Kerr and Atkins (K&A) outcome scores were calculated as well as a satisfaction score obtained by a visual analogue scale (VAS). Statistical analysis of the results using Wilcoxen's paired and unpaired ranking scores showed that the initial grade of the fracture, degree of operative reduction, correction of width of the heel and post-operative ranges of motion had no significant correlation to either B&M or K&A outcome scores or to the VAS score. However, the presence of ongoing litigation was significantly correlated to the scores (VAS < 0.01, B&M < 0.05, K&A < 0.05). These findings cast doubt on the validity of post operative scoring for fracture of the calcaneum in the presence of ongoing litigation.

Calcaneus↗
PubMed1996

A comparative review of 266 mandibular fractures with internal fixation using rigid (AO/ASIF) plates or mini-plates.

This study compares the internal fixation of mandibular fractures using either rigid 2.7 mm AO/ASIF plates or mini-plates. In the rigid plate group, 88 fractures were fixed with 88 plates. In the mini-plate group, 116 fractures were fixed with 170 plates. All the cases were consecutive and were treated in two South Wales hospitals during a 3-year period from 1988 to 1991. The aetiology of injury, timing of surgery, site of fracture, antibiotic policy and demographic features were evenly distributed between the two groups but there was a higher incidence of females in the mini-plate group. Both plating systems were successful in restoring functional occlusion. Rigid plates avoided the use of postoperative elastics better than mini-plates but the difference was not significant. There was a significantly higher incidence (P = 0.013) of infection in the mini-plate (12.9%) compared with the rigid plate (2.3%) group but 7.9% of the rigid group developed facial nerve weakness. A significantly higher proportion of mini-plates needed to be removed (P = 0.00019). A better treatment outcome for angle and comminuted fractures was noted with rigid plates.

Adolescent↗
PubMed2003

Complications of open reduction and internal fixation of ankle fractures.

This article discusses the complications after open reduction and internal fixation of ankle fractures. Complications are classified as perioperative (malreduction, inadequate fixation, and intra-articular penetration of hardware), early postoperative (wound edge dehiscence, necrosis, infection and compartment syndrome), and late (stiffness, distal tibiofibular synostosis, degenerative osteoarthritis, and hardware related complications). Emphasis is placed on preventive measures to avoid such complications.

Age Factors↗
PubMed1975

A simple technique for internal fixation of the clavicle. A long term evaluation.

A simple, effective technique for internal fixation of the clavicle with Knowles threaded pins is described in 11 patients with 1 to 21 year results. The method is applicable to fresh fractures of non-union and provides secure compression-fixation. The threads prevent migration of the pin, reduce the period of external immobilization, and obviate the need for removal of the pin.

Adult↗
PubMed1996

Internal fixation for the transforaminal sacral fracture.

The mechanical stability of alternate forms of internal fixation of the transforaminal sacral fracture were compared. A transforaminal sacral fracture was made in each of 6 fresh-frozen cadaveric pelvic specimens. Implants compared for fixation included: a single and 2 fully threaded iliosacral screws inserted through the posterior ilium and anchored into the first sacral vertebral body both with and without the addition of a posterior tension band plate; and 2 transiliac bars inserted through the posterior tubercles. The femora of each specimen were potted and fixed to the table of a materials tester. The pelvis was restrained only from flexing and extending, and a compressive load was applied through the lumbar spine, representing a standing loading condition. Flexion of the sacrum and displacement at the fracture site were measured during loading. Although creation of the injury increased motion considerably, there was no measurable increase in stability provided by any of the implants or combination of implants in this model when an anatomic reduction was obtained.

Aged↗
PubMed1982

The early management of thoracolumbar fractures by open reduction and internal fixation.

Twenty-eight patients with thoracolumbar fractures treated by open reduction and internal fixation with Harrington instrumentation are reviewed. An unresolved problem is the selection of patients for surgical management. It is a major operation requiring a surgeon experienced in both the care of spinal cord injuries and the use of spinal instrumentation. The technique permits more rapid mobilization, retraining and rehabilitation than nonoperative management.

Adolescent↗
PubMed1988

Tissue reaction to implant corrosion in 38 internal fixation devices.

The corrosion characteristics, metallurgical properties, and clinical performance of 38 retrieved internal fixation devices were correlated with the tissue reaction to these devices. Metallurgical parameters included thin and heavy inclusion content, Rockwell hardness, and grain size. The excised fibrous tissue strip was directly overlying each plate at removal and sectioned between screw-hole sites. The material studied from the 38 plates consisted of 201 screw-hole junctions with associated tissue biopsy sites. Clinical histories were obtained on all 38 patients with hardware removal. The average age at the time of plate insertion was 35.6 years (range, 4 to 75 years). Insertion diagnoses included acute trauma (35 patients), joint dislocations (two patients), and fracture nonunion (one patient). The devices included seven upper extremity bone plates, 19 lower extremity bone plates, and 12 hip screw plates. The devices remained in situ an average of 20.4 months (range, 3 to 60 months). Routine asymptomatic removals were performed on 17 of the patients, while the remaining 21 patients were symptomatic at the time of removal. Included in the reasons for symptomatic removal were pain associated with the implant (eight patients), nonunion (four patients), bursae prominence (three patients), and implant breakage (two patients). Significant correlations were found between average tissue reaction scores and average crevice corrosion scores; a trend of increasing average tissue reaction scores with increasing average screw surface corrosion scores also was observed for the 38 devices, although this relationship was not significant. Average crevice corrosion scores and average screw surface corrosion scores were highly correlated for all removals, and for the asymptomatic and symptomatic removal groups. The metallurgical parameters of thin inclusion content and heavy inclusion content also were significantly correlated for all removals, as well as for symptomatic removals. Similarly, significant correlations were found between the individual tissue reaction scores and crevice corrosion scores from the 201 individual sites, again for all devices and for the asymptomatic and symptomatic removal groups. Tissue reaction scores and time in situ showed significant correlation, with tissue reaction decreasing over time. Crevice corrosion and screw surface corrosion scores were not significantly related to time in situ. The results of this study indicate that there is considerable tissue reaction to the corrosion products of this material.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed2002

[Internal fixation in the treatment of radial head fractures].

The authors give indications for internal fixation of the radial head fractures. The results in 20 patients, age 18-69 (average 38 years), 12 male and 8 female have been reported. The authors conclude that fixation is a better method of treatment than resection of the radial head. The authors suggest that good fixation is also possible in the case of comminuted fracture. Fracture-dislocation of the elbow joint is not an indication for ligaments repair if the elbow is stable after radial head osteosynthesis.

Adult↗
PubMed2005

Stabilisation of periprosthetic fractures with angular stable internal fixation: a report of 13 cases.

INTRODUCTION: Periprosthetic fractures of the femur present a challenging surgical problem. The aim of this study was to retrospectively evaluate the outcome of periprosthetic fractures stabilised with an angular stable, less invasive stabilisation system (LISS). PATIENTS AND METHODS: Thirteen patients (ten total hip-, two total knee-, one total hip- and knee-arthroplasty) with periprosthetic fractures were treated with the LISS internal fixator (in ten cases minimal invasive). Six patients had previous operations due to periprosthetic fractures. The average follow-up period was 20 months, follow-up rate 85%. RESULTS: All fractures showed radiographic fracture healing without implant loosening. Except one patient, all patients had returned to their pre-operative activity level. No early post-operative complications were seen. There was one implant failure after 4 months and two cases of malunion. CONCLUSION: The cases showed the internal fixator to be effective for the stabilisation of periprosthetic fractures, even in cases of poor bone quality with good functional outcomes. The internal fixator, with the option of minimal invasive application, is the preferred method of osteosynthesis in periprosthetic fractures.

Accidental Falls↗
PubMed1983

A new approach to the design of internal fixation plates.

Mathematical analysis by finite element modeling methods was used in conjunction with laboratory bench experiments in selecting appropriate stiffness parameters for internal fixation plate designs. Bench experiments performed included tests of an idealized plated magnesium tube and of a plated canine femur. Finite element modeling of the plate-tube and plate-bone structures was also performed, and the computed results were compared with those obtained experimentally. Three types of internal fixation plates--one "rigid" control plate and two less rigid experimental plates--were examined using both the finite element and experimental models. These plates were further examined by finite element modeling of a plated human femur during single stance loading. In all cases, the "rigid" control plate was found to shield the underlying bone from stress, while both experimental plates were found to have significantly less bone stress shielding. Our findings suggest that an improved plate design should have a low axial stiffness but moderate bending and torsional stiffnesses to facilitate fracture healing and bone remodeling without causing osteopenia.

Animals↗
PubMed1995

Recurrent kyphosis after posterior stabilization of thoracolumbar fractures. 24 cases treated with a Dick internal fixator followed for 1.5-4 years.

24 patients with Th12-L1 fractures treated with a Dick internal fixator were analyzed to assess predictors of poor outcome. 4 patients had fixation without bone transplantation, 20 patients had a posterior fusion, and 12 of them had additional transpedicular spongioplasty. There were fractures of the transpedicular screws in 4 and screw migration in 2 cases. The increase in the local kyphosis angle was greater than the increase in the anterior compression angle and this did not correlate with spongioplasty or fusion. Fixation failure was in all cases related to a disproportionate increase in the local kyphosis angle. There was no difference between the patients with transpedicular spongioplasty and posterior fusion and the other patients with respect to results and complications. Bony collapse was not the major cause of failure and consequently there was no measureable contribution of transpedicular spongioplasty. We found that the Dick internal fixator for unstable fractures was associated with a higher complication rate than earlier reported.

Adolescent↗
PubMed2005

[Internal fixation of proximal humerus fractures].

BACKGROUND: Intramedullary nails and angle-fixed plates have recently been used in proximal humerus fractures. Rigid implants might be associated with an increased risk of failure in osteoporotic conditions. METHODS: Unstable fractures of the surgical neck were created in 24 pairs of human humeri. The biomechanical properties of four implants were analysed. These were a nail with conventional interlocking (PHN-K), a nail with spiral blade interlocking (PHN-S), the T-plate, and an internal fixator with elastic screw properties (reference). The specimens were subjected to axial loading and torque. Stiffness, plastic deformity, and load to failure were assessed. RESULTS: The PHN-S was stiffer than the internal fixator. The PHN-K and T-plate were stiffer only during torque. Less subsidence was observed for the PHN-S. This implant failed at higher loads than the other implants. CONCLUSIONS: The PHN-S offers biomechanical advantages in unstable fractures of the surgical neck of the humerus. Elastic implant properties, however, are disadvantageous.

Aged↗
PubMed1990

Mechanical properties of biodegradable polymers and composites proposed for internal fixation of bone.

The mechanical properties of biodegradable polymers and composites proposed for use in internal fixation (in place of stainless steel) are crucial to the performance of devices made from them for support of healing bone. To assess the reported range of properties and degradation rates, we searched and reviewed papers and abstracts published in English from 1980 through 1988. Mechanical property data were found for poly(lactic acid), poly(glycolic acid), poly(epsilon-caprolactone), polydioxanone, poly(ortho ester), poly(ethylene oxide), and/or their copolymers. Reports of composites based on several of these materials, reinforced with nondegradable and degradable fibers, were also found. The largest group of studies involved poly(lactic acid). Mechanical test methods varied widely, and studies of the degradation of mechanical properties were performed under a variety of conditions, mostly in vitro rather than in vivo. Compared to annealed stainless steel, unreinforced biodegradable polymers were initially up to 36% as strong in tension and 54% in bending, but only about 3% as stiff in either test mode. With fiber reinforcement, reported highest initial strengths exceeded that of stainless steel. Stiffness reached 62% of stainless steel with nondegradable carbon fibers, 15% with degradable inorganic fibers, but only 5% with degradable polymeric fibers. The slowest-degrading unreinforced biodegradable polymers were poly(L-lactic acid) and poly(ortho ester). Biodegradable composites with carbon or inorganic fibers generally lost strength rapidly, with a slower loss of stiffness, suggesting the difficulty of fiber-matrix coupling in these systems. The strength of composites reinforced with (lower modulus) degradable polymeric fibers decreased more slowly. Low implant stiffness might be expected to allow too much bone motion for satisfactory healing. However, unreinforced or degradable polymeric fiber reinforced materials have been used successfully clinically. The key has been careful selection of applications, plus use of designs and fixation methods distinctly different from those appropriate for stainless steel devices.

Biocompatible Materials↗
PubMed1993

Open ankle fractures. The indications for immediate open reduction and internal fixation.

Twenty-two patients with open ankle fractures or fracture-dislocations were treated with irrigation and debridement, reduction, and immediate stable internal fixation at an average of six hours from initial evaluation. There were 13 women (59%) and nine men (41%), having an average follow-up period of 32 months (range, five to 111 months). There were six Grade I (27%), 15 Grade II (68%), and one Grade III (5%) injuries. Fractures also were classified according to the Danis-Weber scheme (Type A [three cases]; Type B [eight]; Type C [11]). Excellent results were achieved in 14 patients (64%); good results in five (23%), and poor results in three (13%). There were four minor complications: two superficial would ulcerations, one loss of reduction requiring revision stabilization, and one distal tibiofibular synostosis. There were no deep infections or nonunions. Immediate debridement, irrigation, reduction, and internal fixation of open ankle fractures is clearly indicated in Grade I and clean Grade II open injuries.

Adult↗
PubMed1992

Soft-tissue alterations associated with acute, extended open reduction and internal fixation or orbital fractures.

Soft-tissue alterations associated with radical degloving of the overlying soft tissues during extended open reduction and rigid internal fixation of facial fractures involving 51 orbits in 36 patients were studied. In all patients, the blepharoplasty skin muscle flap incision was employed in conjunction with, as necessary, a gingivobuccal sulcus and coronary incisions. Patients were evaluated between 6 and 20 months after surgery. Physical examination and standardized photographs were used for assessment. Ectropion developed in 2 lids (4%), and 10 lids (20%) had increased scleral show. Thirteen of the 51 lids (25%) revealed lateral canthal displacement; all 13 lids underwent canthal stripping. Cheek pad displacement developed in 8 patients (22%), all of whom had complete maxillary degloving without soft-tissue resuspension. No patient had frontal nerve palsy. Depression in the temporal area was noted in all patients in whom the temporalis was mobilized. Remote incisions and soft-tissue degloving used for extended open reduction and internal fixation are associated with morbidity that can be minimized by meticulous technique and soft-tissue repositioning at closure.

Adolescent↗
PubMed1996

Occipital morphology. An anatomic guide to internal fixation.

STUDY DESIGN: The authors present the results of an anatomic study of the human occiput to delineate appropriate screw placement sites. OBJECTIVES: Occipital bone morphologic characteristics were evaluated to determine whether significant variability exists and to determine the position of greatest bone thickness for safe and effective internal fixation. SUMMARY OF BACKGROUND DATA: New instrumentation and techniques for occipital fixation are being developed in response to concerns about occipital bone variability. Thirty cadaveric occiputs were evaluated to determine if such variability exists and the location of greatest bone thickness. Radial thickness, occipital locations, and gender differences, were determined. METHODS: Twenty-six skulls were sectioned sagittally to determine the contributions of the inner, middle, and outer tables to overall occipital thickness. The angle required to gain maximal cortical purchase was determined. Mean values and variance were analyzed statistically to determine variability and thickness. Data was plotted in three dimensions. Variability in morphologic features was minimal. RESULTS: The internal occipital protuberance-external occipital protuberance was thickest at 17.55 mm (SD = 3.18 mm) and was consistently located on the superior nuchal line 43 degrees from the horizontal skull base line. Bone thickness decreased radially from the central internal occipital protuberance position. Bone thickness above the superior nuchal line exceeded that below by 2.74 mm (P < 0.05) vertically and at the oblique positions (P < 0.05). Bone to the right of the midline was only 1 mm thicker than that to the left. Gender differences were minimal. The inner table contributed only 10% to overall occipital thickness. As occipital thickness decreased, the optimal purchase angle increased. CONCLUSIONS: Unicortical purchase at and above the superior nuchal line is warranted with a low risk of intracranial venous penetration. Internal fixation devices developed in response to occipital bone variability should be considered with respect to occipital bone thickness distributions. Attention to cervical morphologic characteristics should result in higher success rates in occipitocervical arthrodesis.

Bone Plates↗