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At least 973 records · Page 54Linked to original sources
PubMed2004

Management of intra-articular fractures of the proximal interphalangeal joint by internal fixation and bone grafting.

INTRODUCTION: Intra-articular fractures of the proximal interphalangeal joint are usually treated by one of many methods of external fixation, but this does not restore the articular surface. We describe a procedure where bone grafting and internal fixation are used to restore the articular surface. PATIENTS AND METHODS: A prospective study was conducted in which three patients underwent surgical treatment for this fracture. We describe a surgical procedure where bone graft harvested from the distal radius is packed through a diaphyseal window to restore the articular surface. This is followed by internal fixation with mini-screws. RESULTS: The average follow-up was 61 months. At last follow-up the average arc of movement of the proximal interphalangeal joint was 100 deg and the average Disability of the Arm, Shoulder and Hand (DASH) Score was 2. Postoperative radiographs showed restoration of the articular contour in all three patients. CONCLUSION: The surgical technique described addresses the issues of restoration of the articular surface and permits early mobilisation. The results for our group are excellent and compare favourably with those achieved using external fixators described in the literature.

Adult↗
PubMed1994

Vertical shear fractures of the medial malleolus: a biomechanical study of five internal fixation techniques.

Fifty embalmed human tibias were osteotomized to create a simulated vertical shear (supination-adduction) fracture of the medial malleolus and were stabilized using one of five internal fixation techniques. In offset axial testing, which simulated supination-adduction loading, the fixation strength of tibias stabilized with either cortical or cancellous lag screws placed perpendicular to the osteotomy was over five times greater than the strength of those treated with an antiglide plate and nearly two and a half times greater than those treated with cancellous lag screws placed oblique to the osteotomy. The tibias stabilized with cancellous lag screws placed perpendicular to the osteotomy exhibited twice the fixation strength of the tibias stabilized with an antiglide plate and distal lag screw. The tibias stabilized with an antiglide plate and distal lag screw and perpendicularly placed cortical or cancellous lag screws demonstrated three times greater resistance to displacement to the applied supination-adduction load than those stabilized with an antiglide plate alone. In offset transverse testing, to simulate loading in external rotation, the mean failure load of the tibias stabilized with cancellous lag screws placed perpendicular to the osteotomy was over two and a half times greater than those stabilized with an antiglide plate and distal lag screw. No significant differences were observed in the resistance to displacement for these tests. These results support the use of lag screws placed perpendicular to the fracture surface for stabilization of vertical shear fractures of the medial malleolus and indicate that the use of an antiglide plate, with or without a distal lag screw, does not offer any advantage over lag screw fixation.

Biomechanical Phenomena↗
PubMed2003

Evaluation of the bending strength of rigid internal fixation with absorbable and metallic screws in mandibular ramus sagittal split osteotomy: in vitro study.

The aim of this study was to evaluate, in vitro, the bending strength of internal fixation with absorbable and metallic screws in mandibular ramus sagittal split osteotomy in sheep hemimandibles. The screws were inserted as lag screws, with an inverted "L" configuration, and the set was submitted to bending strength tests. The load and displacement of the peak and final load averages were, respectively, 18.45 kgf, 8.19 mm and 14.38 kgf for Group I, and 16.67 kgf, 6.73 mm and 13.98 kgf for Group II. The results were submitted to statistical analysis by Student s t test and by the Pearson correlation analysis. The groups showed no statistically significant differences, indicating the feasibility of both for osteosynthesis in mandibular ramus sagittal split osteotomies.

Animals↗
PubMed2004

Functional outcome following internal fixation of intraarticular fractures of the distal humerus (AO type C).

The aim of this study was to evaluate the functional outcome following internal fixation of intraarticular fractures of the distal humerus (AO Type C) with a minimum follow-up of two years. A retrospective evaluation with prospective clinical review was carried out. Twenty-six consecutive patients with fractures of the distal humerus were treated over a 31-month period. Their mean age was 56 years (range, 18-82). Six patients were not available for final clinical review. Analysis of the results were based on the medical records, pre-operative and postoperative radiographs of all 26 patients and clinical review of 20 patients at a mean follow-up of 35 months (range, 24-48 months). Twenty-six fractures were fixed using the AO double column plating techniques. Radiographic evaluation of the quality of reduction was carried out using a grading system. Clinical outcome was assessed using the Broberg and Morrey functional rating index. Fourteen patients (70%) had an excellent or good outcome, five patients (25%) a fair outcome and one patient (5%) had a poor result. Three patients (15%) underwent a second procedure for hardware removal. The mean arc of flexion was 112 degrees (range, 85 to 122). Mean pronation was 75 degrees (range, 60-82) and supination was 76 degrees (range, 60-80). No patients had achieved normal grip strength; the mean grip strength was 82% (range, 46-90%) compared to the uninjured side. Fifteen patients (75%) were able to return to their pre-injury level of occupation and activity. Seventeen patients (85%) were satisfied with the final outcome. We conclude that internal fixation of intraarticular fractures of the distal humerus is an effective procedure with an excellent or good functional outcome in most patient age groups. Patients have a high level of satisfaction and the majority return to their previous level of activity.

Adolescent↗
PubMed1998

Use of 3.5-mm acetabular reconstruction plates for internal fixation of flail chest injuries.

The technique of using 3.5-mm acetabular reconstruction plates for multiple rib fractures with cerclage wires has been successful. We modified it by securing the reconstruction plates to the fractured ribs with cortical screws using the standard AO-ASIF (Arbeitsgemeindschaft fur Osteosynthesefragen [Association for the Study of Internal Fixation]) group technique. Our method for the internal fixation of the unstable chest wall is described. It is relatively simple and provides uniform results.

Bone Plates↗
PubMed1992

Open reduction and internal fixation of proximal interphalangeal joint fracture-subluxations.

Proximal interphalangeal (PIP) joint fracture-subluxations represent a small component of hyperextension injuries to the finger. Six unstable PIP fracture-subluxations that were not amenable to nonoperative treatment underwent open reduction and internal fixation. Among the patients, the technique of open reduction and internal fixation with temporary transarticular K-wire fixation and early protected range of motion has been found to result in a good range of motion with minimal complaints on follow-up.

Adult↗
PubMed1998

Patella height after high tibial osteotomy with internal fixation and early motion.

The purpose of this study was to compare the incidence of patella infera in patients after high tibial osteotomy treated with either postoperative immobilization or internal fixation and early range of motion. A retrospective review of 98 patients with high tibial osteotomy was done at the authors' institution. Thirty-three patients who had secondary procedures such as concomitant ligamentous reconstruction with early motion were excluded. Therefore, 69 knees in 65 patients remained in the study cohort. Group A consisted of 32 patients (34 knees) treated with postoperative immobilization, whereas Group B included 33 patients (35 knees) treated with internal fixation and early motion. The preoperative and postoperative Insall-Salvati index, Blackburne-Peel index, and angular alignment were determined for each group. Between Groups A and B, the differences in the Insall-Salvati index and the Blackburne-Peel index were statistically significant, although the difference in angular correction was not significant. With rigid fixation and early motion the Insall-Salvati index showed that there was less postoperative shortening of the patellar tendon. The relationship of the patella to the remainder of the knee was affected less adversely as evidenced by the Blackburne-Peel index. High tibial osteotomy with internal fixation and early range of motion should result in a better knee and ease the subsequent performance of a total knee arthroplasty.

Arthroplasty, Replacement, Knee↗
PubMed1987

Internal fixation of forearm fractures in children.

Fourteen children with severely displaced diaphyseal fractures of both bones of the forearm treated with open reduction and internal fixation were reviewed; these operations represented 9 per cent of all the diaphyseal forearm fractures in children during a 9-year period. The mean age of the patients at the time of the injury was 12 (7-14) years; they were reexamined 8 (5-11) years later, all after cessation of growth. At follow-up, limited prosupination, observed in 8 patients, was associated with a fracture of the proximal third of the forearm; limited motion of the radiocarpal joint, in 2 patients, was associated with shortening of the ulna. Only 4 patients complained of pain or were aware of restricted motion, and the average function was good. Open reduction and internal fixation is indicated in displaced fractures of the forearm even in children.

Adolescent↗
PubMed1983

The influence of timing and rigidity of internal fixation on bony union of fractures of the forearm.

Sixty-one patients with fractures of the shafts of both bones of the forearm treated by internal fixation were studied retrospectively. The importance of the rigidity of the fixation and the time that elapsed before operation was investigated. Eight cases of non-union and one of delayed union were noted after fractures which had been operated on during the first week by non-rigid internal fixation. On the other hand, in the group of rigidly fixed fractures, the time of operation was not found to have a statistically significant effect on the healing process.

Adolescent↗
PubMed1996

The results of open reduction and Internal fixation of distal femur fractures using a biologic (indirect) reduction technique.

The results of 57 A-O type A or C supracondylar femur fractures treated by open reduction and internal fixation using indirect reduction techniques are reported. No bone grafting or dual plating was used. All patients were placed in a continuous passive motion (CPM) machine postoperatively. Patients were followed at 4-week intervals until fracture healing had occurred. All patients were followed for at least 1 year after injury. All fractures were treated by a single surgeon. The average time for fracture healing was 10.7 weeks (range 8-16). Hardware failure did not occur in this series. Outcomes were assessed using a modified Schatzker scoring method. Using the scale, there were 84% good to excellent results, 11% fair results, and 5% poor outcomes. Fair and poor results tended to occur in more severe fractures and were primarily due to limited knee motion. Complications included two broken screws, one deep infection, and one malunion. No fractures failed to unite. In conclusion, holding the surgical skill factor constant, it appeared that biologic reduction techniques, although they provided excellent bone healing capability, did not guarantee universally satisfactory outcomes.

Adolescent↗
PubMed1985

Internal fixation of acute scaphoid fractures: a new approach to treatment.

Thirty-five patients with acute, unstable fractures of the scaphoid were treated by primary internal fixation using the Herbert Bone Screw System. The use of plaster was avoided whenever possible, and operation was carried out as soon as practicable after injury. The average time for return to work after operation was 3.7 weeks. Only one fracture failed to unite, and this was due to avascular necrosis of the proximal fragment of the scaphoid. Internal fixation of the acute scaphoid fracture successfully avoids the morbidity associated with standard methods of treatment in plaster.

Adult↗
PubMed2006

Primary internal fixation and bone grafting for open fractures of the hand.

Primary bone grafting and internal fixation is a reliable option for the treatment of segmental hand defects resulting from high-energy crush or avulsion injuries. Immediate reconstruction can be performed safely if radical debridement and adequate soft tissue coverage of bone can be achieved. When these two criteria cannot be met, staged reconstruction should be performed. The low infection rate (0%), the high union rate (92%), and the return to full, unrestricted, previous employment for all patients in the authors' series supports the use of primary bone grafting in an acute setting. This single-stage approach to fracture management also permits earlier and more aggressive hand therapy that, in turn, can lower the high functional morbidity so often associated with these injuries.

Adult↗
PubMed1991

Open reduction and internal fixation of acetabular fractures: heterotopic ossification and other complications of treatment.

Open reduction and internal fixation was performed on 50 displaced acetabular fractures in 49 patients by nine different attending surgeons over a 10-year period. At an average follow-up of 38 months, poor results were noted clinically in 38% and radiographically in 40%. The incidence of short- and long-term complications was greater than in other studies. Particularly distressing was the 58% incidence of heterotopic ossification (HO). Twenty-four percent had grade III or IV; five hips were autofused and the remainder had 40-60% loss of motion. There was no correlation of HO with age, sex, fracture type, degree of comminution, associated femoral head fracture or dislocation, delay to surgery, or operative time. However, 26 of 28 patients who had a trochanteric osteotomy as part of the operative exposure developed HO. Other complications included wound infection (12%), avascular necrosis of the femoral head (10%), nerve palsy (8%), and deep vein thrombosis/pulmonary embolism (8%). The data suggest formulation of specific treatment protocols, an awareness of surgical risks, and that staff specialization may reduce complications and improve outcome. Avoiding a trochanteric osteotomy at surgery and using prophylactic postoperative irradiation or indomethacin are suggested to reduce HO.

Acetabulum↗
PubMed2004

Locked internal fixator: sensitivity of screw/plate stability to the correct insertion angle of the screw.

OBJECTIVE: Internal fixators with angular stability have been developed to provide high stability without compression of the plate on to the bone. Angular and axial stability of a plate-screw construct can be achieved using a conically threaded screw head undersurface and a corresponding conically threaded plate hole. Furthermore, the insertion angle of the screw must correspond precisely to the axis of the screw hole. This is not always achieved in clinical practice and may result in screw loosening. The objective of this study was to examine the relationship between the stability of the locked screw-plate on the insertion angle of the screw. METHODS: Locking screws were inserted in an isolated (Point Contact Fixator, PC-Fix) or combined (Locking Compression Plate, LCP 4.5) locking hole with the use of an aiming device. The optimal insertion angle for these plates is perpendicular to the plate surface. The screws were inserted with an axis deviation of 0 degrees (optimal condition), 5 degrees , and 10 degrees respective to the optimal angle (variance +/- 1 degrees ). The samples were tested under shear or axial (push out) loading conditions until failure occurred. An Instron materials testing machine was used. RESULTS: Locking screws inserted in the isolated locking hole (PC-Fix) showed a significant decrease of failure load if inserted at 5 degrees and 10 degrees angle. Using an optimal insertion angle (0 degrees ), failure load was 1480 +/- 390 N, with 5 degrees axis deviation 780 +/- 160 N, P = 0.0001, and with 10 degrees axis deviation 550 +/- 110 N, P = 0.0001. Screws inserted in the combined locking hole (LCP) also showed a significant decrease of push-out force of 77% (4960 +/- 1000 N versus 1120 +/- 400 N) with 10 degrees axis deviation. Compared to optimal insertion angle (0 degrees ), bending load to failure did decrease up to 69% (1240 +/- 210 N vs. 390 +/- 100 N) with 10 degrees axis deviation. CONCLUSION: A locking head screw exhibits high stability with a moderate axis deviation in the angle of insertion of up to 5 degrees . However, there is a significant decrease in stability with increasing axis deviation (>5 degrees ). An aiming device is recommended to provide optimal fixation with angular stability.

Bone Screws↗
PubMed1990

Fractures of the adult distal humerus. Elbow function after internal fixation.

We reviewed 57 adult patients at an average of 37 months after early internal fixation for displaced fractures of the distal humerus. Two-thirds had intercondylar (Müller type C) fractures, and one-third had articular comminution (type C3). A chevron olecranon osteotomy was used, with early active movement after fixation. Results were good or excellent in 76% with an average range of movement of 115 degrees. Early stable fixation by an experienced surgeon is recommended for these fractures.

Adolescent↗
PubMed1990

Biodegradable internal fixation. A literature review.

The authors review the properties and podiatric applications of biodegradable internal fixation devices. These devices include sutures, rods, and screws. Fixation of fractures and osteotomies with absorbable materials has been shown to be as effective as fixation with more traditional means, and it also provides several advantages.

Absorption↗
PubMed2000

[Analysis of complication in the spinal pedicle screw internal fixation].

In 1990-1998, five hundred and twenty patients treated with spinal pedicle screw internal fixation were analyzed. The main operative complication was screw misplacement(7.1%), and others such as screw bend and extra-long screw were less seen. The postoperative complications included screw breakage (13.3%) and backache(14.2%). Recently, by making use of RF screw system and X-ray monitor, the complications were significantly decreased.

Adolescent↗