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At least 991 records · Page 55Linked to original sources
PubMed2003

[Clinical results of tibial pilon fractures treated by open reduction and internal fixation].

OBJECTIVES: We evaluated the results of pilon fractures treated by open reduction and internal fixation. METHODS: The study included 18 patients (mean age 36 years; range 19 to 56 years) with pilon fractures. According to the Ruedi and Allgower's classification, there were three type I, nine type II, and six type III fractures. Five fractures were open including three of Gustilo-Anderson type II, and two fractures of type III. The results were assessed using the Burwell-Charnley criteria. The mean follow-up was 54 months (range 9 to 86 months). RESULTS: According to the Burwell-Charnley criteria, the results were good in 12 patients (66%), fair in three patients (17%), and poor in three patients (17%). The most common complication was posttraumatic degenerative arthritis, followed by wound infection (22%), Sudeck atrophy (22%), delayed union (17%), and angulation (11%). CONCLUSION: Early anatomical reduction, a stable fixation, early mobilization, and delayed weight-bearing seem to improve long-term results of treatment in pilon fractures caused by high energy trauma.

Adult↗
PubMed1992

The computed tomographic evaluation of patellofemoral joint in patellar fractures treated with open reduction and internal fixation.

In this study, we examined 97 patella fractures in which open reduction and internal fixation had been performed at the 1st Orthopaedics and Trauma Clinic of Social Security Ankara Hospital between January 1983 and December 1988. After 24 to 96 months, on an average of 48.4 months follow-up period, the cases were evaluated clinically for knee function complaints and by CT and roentgenography for patellofemoral articulation. In 11 of the patients (11.5) there was patellar displacement, 2 of the patients had patellar tilt (2.1%) and in 14 patients (14.5%) there was malalignment in which 1 patient (1.1%) had both patellar tilt and displacement. This data was obtained by measuring femoral trochlear angle (FTA) and patellar tilt angle (PTA) by CT at various degrees of knee flexion. Thirty-three patients (34%) had slight and 19 patients (19.6%) had severe degenerative changes in the patellofemoral articulation. It is found that there is close relation between the variability of the pain complaints of the patients and the type of the fracture and the time of management and the postoperative rehabilitation.

Adult↗
PubMedDate not supplied

Open reduction and internal fixation of displaced supracondylar fractures of the humerus.

The results of open reduction and internal fixation were analysed in 200 displaced supracondylar fractures of the humerus in children. Overall, excellent results were obtained in 65% of cases, good in 15% and unsatisfactory in 20%. Delay in surgery was found to lead to unsatisfactory results. The operation was performed within 48 hours of injury in 140 cases and gave an excellent result in 120 cases, whereas delayed surgery, in 60 cases, gave an excellent result in only 10 cases. Open reduction provides an accurate, stable reduction, is easy to perform and has been found to give consistently good results.

Adolescent↗
PubMed1996

Internal fixation of the spine in traumatic and scoliotic cases. The potential of pedicle screws.

Internal fixation techniques are in common used to stabilize vertebral fractures and correct severe scoliosis. Consolidation of injured vertebrae with neighbouring intact vertebra is the goal in the former case whilst fusion of the vertebrae in a corrected position is aimed at in the latter case. Degenerative spine diseases are not considered in this paper. Classical instrumentation consists of rods (e.g., Cotrel-Dubousset, Harrington, Luque-Galveston) attached to the bone by means of hooks or wires. More recently, transpedicular screws are introduced as an alternative bone/implant interface. Comparing the results of several studies, the posterior pedicle screw based devices demonstrate the ability to produce the most rigid constructs. However, the insertion of pedicle screws implicates a relatively high complication risk and its success strongly depends on the experience of the surgeon. Incorrect drilled holes or malplacement of the screws can result in nerve root injuries and fracture of the pedicle. Studies reported complication ratios up to 30% with substantial neurological implications. A certain degree of automation of the critical actions may be necessary to enhance the safety of pedicle screw insertion. Two techniques of computer assisted spine surgery are compared. Both techniques permit a computer assisted surgical planning based on CT images. During operation the first system permanently observes the position of the drill relative to the spine and informs the surgeon on the deviation of the actual drill path to the planned drill path. The second system uses a pre-operative surgical planning to design and construct a mechanical drill guide, fitting perfectly on the patient's spine.

Bone Screws↗
PubMed1989

Titanium mesh rigid internal fixation of the modified LeFort III osteotomy.

Surgical techniques for correcting midfacial deformities have used bone grafting with direct wire fixation, occlusal overcorrection, and maxillomandibular fixation for 6 to 8 weeks. With the advent of rigid internal fixation, the need for occlusal overcorrection and maxillomandibular fixation has been reduced or eliminated. A technique of rigid internal fixation using titanium mesh is presented. Two representative cases and their 18-month followups are described.

Humans↗
PubMed2004

Stability of skeletal class III malocclusion after combined maxillary and mandibular procedures: rigid internal fixation versus wire osteosynthesis of the mandible.

PURPOSE: The aim of this study was to evaluate skeletal stability after double-jaw surgery for correction of skeletal Class III malocclusion to assess whether there were any differences between wire and rigid fixation of the mandible. PATIENTS AND METHODS: Thirty-seven Class III patients had Le Fort I osteotomy stabilized with plate and screws for maxillary advancement. Bilateral sagittal split osteotomy for mandibular setback was stabilized with wire osteosynthesis and maxillomandibular fixation for 6 weeks in 20 patients (group 1) and with rigid internal fixation in 17 patients (group 2). Lateral cephalograms were taken before surgery, immediately after surgery, 8 weeks after surgery, and 1 year after surgery. RESULTS: Before surgery, both groups were balanced with respect to linear and angular measurements of craniofacial morphology. One year after surgery, maxillary sagittal stability was excellent in both groups, and bilateral sagittal split osteotomy accounted for most of the total horizontal relapse observed. In group 1, significant correlations were found between maxillary advancement and relapse at the posterior maxilla and between mandibular setback and postoperative counterclockwise rotation of the ramus and mandibular relapse. In group 2, significant correlations were found between mandibular setback and intraoperative clockwise rotation of the ramus and between mandibular setback and postoperative counterclockwise rotation of the ramus and mandibular relapse. No significant differences in postoperative skeletal and dental stability between groups were observed except for maxillary posterior vertical position. CONCLUSIONS: Surgical correction of Class III malocclusion after combined maxillary and mandibular procedures appears to be a fairly stable procedure independent of the type of fixation used to stabilize the mandible.

Adolescent↗
PubMed1981

[When is rigid internal fixation indicate din multiple injuries with head trauma? (author's transl)].

Operative fracture treatment is an important therapeutic measure in patients with cranial and other multiple injuries. If signs of reversible brain stem injury are present, the operative fixation of the long tubular bone fractures is indicated, whereas it contraindicated with irreversible damages to the brain stem. Nursing of the patients in coma is much more feasible after rigid internal fixation. Loss of consciousness alone is no contraindication of internal fixation.

Arm Injuries↗
PubMed1995

Fracture line stability as a function of the internal fixation system: an in vitro comparison using a mandibular angle fracture model.

PURPOSE: This study was conducted to determine and compare the initial mechanical stability and functional capability of six contemporary internal fixation systems used to fix mandibular angle fractures. MATERIALS AND METHODS: An iterative analog of a mandibular angle fracture was developed to ensure replicability of material properties and fracture configuration across the test constructs. Each of six sets of mandible analog (1 set = 3 mandibles) was reduced according to prescribed technique by a variety of compressive and adaptive fixation systems. The compressive systems included the 1) eccentric dynamic compression plate, 2) Würzburg plate, 3) Luhr plate, and 4) solitary lag screw technique. The Champy miniplate and the Mennen clamp plate represented the adaptive fixation systems. The reduced analogs were placed in a straining frame, and simulated masticatory loads were applied to predetermined occlusal sites. Fracture line displacements were acquired and registered by displacement transducers attached to a computer-based data acquisition program. A coordinate transformation procedure was used to convert the generalized displacements at the fracture line into the individual rotations of the segments. An "instability factor" computed from the force-displacement data recorded at various loading conditions for each test construct was used to characterize a particular system's ability to restrain relative motion at the fracture surfaces. RESULTS: There were minimal variations in the stability profiles of the individual compressive fixation systems. However, the fixation stability provided by the compressive and adaptive systems differed significantly (P < or = .0001). A large initial setting and a susceptibility to variations in loading patterns characterized the functional stability provided by the adaptive systems. Even at low masticatory loads (2 DaN), the adaptive systems had an instability that was two to three times as much as that of the compressive systems. Post-hoc comparisons between pairs of devices showed that angle fractures fixed by compressive systems provided significantly greater stability (P < or = .05) than those fixed by the Champy and Mennen systems. Between the adaptive systems tested, fracture fixation with Mennen plates was more stable than reduction by Champy miniplates (P < or = .05) when averaged over loads. CONCLUSIONS: Compressive fixation systems are biomechanically superior to adaptive systems and provide good immediate functional stability to reduced mandibular angle fractures. The Champy and Mennen systems permit significantly higher motion at the fracture site, even at the attenuated masticatory forces encountered in the early postoperative period. Because the functional stability afforded by these adaptive systems is influenced by variations in the biting patterns, the risk of infection and complicated healing is correspondingly increased. Also, the low displacement resistance of the adaptive systems may not protect the alignment of the mandibular segments through the healing period and may manifest as occlusal discrepancies in the dentate patient. The biomechanical test system developed for this study allows an equitable comparison of fixation stability and appears to be a promising tool for investigating a variety of fixation systems and optimizing device design on a rational basis.

Analysis of Variance↗
PubMed2000

CT-guided internal fixation of a hangman's fracture.

Most hangman's fractures are treated conservatively. If surgery is indicated, an anterior approach using a C2/C3 graft and plate fusion is usually preferred. Another surgical method according to Judet is direct transpedicular osteosynthesis by the dorsal approach. This surgery is frequently rejected because of the high risk of spinal cord damage or vertebral artery tear. Direct transpedicular osteosynthesis of hangman's fracture according to Judet is a "physiological operation" that does not cause fusion and creates anatomical conditions. This procedure enables appropriate reduction, compression of fragments and immediate stabilization of the C2 segment. A new aspect of Judet's method of internal fixation of a hangman's fracture is now proposed. Computed tomographic (CT) guidance is used to ensure safe and exact introduction of two screws from the posterior approach. This method of CT-guided internal fixation of hangman's fracture allows, preoperatively, for an accurate assessment of the pattern and course of fracture line, selection of the anatomically safest screw path and determination of an appropriate screw length. The procedure also allows for accurate intraoperative control of instrument and implant placement, screw tightening, fracture reduction and anchoring of the screw tip in the contralateral cortex, using repeated CT scans. The procedure is performed in a CT unit under sterile conditions. This method was used in the treatment of eight male and two female patients aged 21-71 years. All treated patients were without neurological deficit. Follow-up ranged from 12 to 57 months (mean 33.3 months). No intraoperative or early or late postoperative complications were apparent. This new aspect of the surgical procedure ensures highly accurate screw placement and minimal risks, and fully achieves the "physiological" internal fixation.

Adult↗
PubMed1993

Pediatric mandibular fractures treated by rigid internal fixation.

Mandibular fractures in the pediatric patient population are relatively uncommon. These patients present with their own unique treatment requirements. Most fractures have been treated conservatively by dental splints. Closed reduction techniques with maxillomandibular fixation (MMF) in very young children can pose several concerns, including cooperation, compliance and adequate nutritional intake. Rigid internal fixation of unstable mandibular fractures using miniplates and screws circumvents the need for MMF and allows immediate jaw mobilization. At major pediatric trauma institutions, there has been an increasing trend toward the use of this treatment when open reduction is necessary. This article presents a report of a five-year-old child who presented with bilateral mandibular fractures and was treated by rigid internal fixation and immediate mandibular mobilization.

Bone Plates↗
PubMed1994

Biomechanical effects of internal fixation of the distal tibiofibular syndesmotic joint: comparison of two fixation techniques.

This biomechanical study compares two methods of internal fixation of the tibiofibular syndesmosis used in Weber type C malleolar fractures of the ankle. The transverse syndesmotic 3.5-mm screw was compared with two 1.5-mm Kirschner wires introduced obliquely across the distal tibiofibular syndesmosis. The influence of implants on distal tibiofibular joint motion and contact characteristics of the intact ankle joint were determined. Up to 1.25 mm of lateral displacement and 2 degrees of external rotation of the lateral malleolus during uninjured ankle dorsiflexion was recorded. Both techniques stabilized the injured syndesmotic joint and limited its normal motion during flexion and extension of the ankle. Pressure distribution displaced laterally in internally stabilized ankles compared with intact specimens, regardless of the type of fixation used. Therefore, both techniques alter joint biomechanics equivalently compared with the intact ankle.

Ankle Injuries↗
PubMedDate not supplied

Internal fixation of fractures: evolution of concepts.

The recognized goal of any fracture treatment is the restoration of normal function to the injured part(s). Historically, this was first achieved with non-operative techniques and more recently with operative fixation of fractures. Newer systems utilizing the principles of rigid internal fixation and a sophisticated armamentarium have proved useful in fractures of both bones of the forearm, major intra-articular joint fractures and the multiply injured patient. With these methods "fracture disease" (i.e. muscle atrophy, joint stiffness and bony demineralization) is decreased by early mobilization without external support. The penalties for inadequate surgery are nonrigid fixation and/or infection, emphasizing that the operative treatment of fractures is a technique to be mastered.

Europe↗
PubMed2000

The vascularized pig fibula bone flap model: effect of segmental osteotomies and internal fixation on blood flow.

The free fibular flap is the flap of choice for reconstruction of complex mandibular defects, although two or more osteotomies may be required to recreate the normal mandibular contour. The effect of these surgical manipulations on the fibula has not been adequately investigated. This study was designed to study the effect of multiple segmental osteotomies and internal fixation techniques on blood flow in the vascularized pig fibula bone flap model. The hindlimbs of 15 Yorkshire pigs were randomized into 1 of 5 groups (n = 6 fibulae per group) consisting of: (1) a nonoperated, in situ fibula; (2) an elevated fibula flap; (3) an elevated fibula flap with two segmental osteotomies; (4) an elevated fibula with two segmental closing osteotomies rigidly fixed with 2-mm miniplates; (5) an elevated fibula with two segmental closing osteotomies rigidly fixed with 2-mm lag screws. Total and gradient blood flow was measured in the bone and soft-tissue components of these flaps using the 15-microm radioactive microsphere technique. The creation of two segmental osteotomies in the vascularized pig fibula bone flap model resulted in a significant decrease (p<0.05) in the gradient blood flow in the segment of bone distal to the second osteotomy. Application of miniplates or lag screws across closing osteotomies resulted in a significant decrease (p<0.05) in total and gradient blood flow to the bone component of the fibulae, as compared with the elevated and osteotomized fibulae groups. An increase in blood flow suggesting a hyperemic response was noted in the bone and soft tissue in the elevated and osteotomized flap groups as compared with the in situ, nonoperated controls. This study established the validity of the pig fibula as a suitable model for investigating the pathophysiology of blood flow changes in the face of standard surgical maneuvers necessary for the restoration of mandibular form and function. The results demonstrated that the creation of multiple segmental osteotomies and the application of internal fixation significantly decreases (p<0.05) blood flow to the distal portion of the flap. The effects of segmental osteotomies and internal fixation on healing and growth of the pig fibula bone flap model are investigated in a separate study.

Animals↗
PubMed1997

Rigid internal fixation of the jaws in an adult patient with facio-scapulo-humeral muscular dystrophy: report of a case.

This study shows the advantages of rigid internal fixation in the surgical management of a facial deformity in a 29-year-old patient with facio-scapulo-humeral dystrophy (FSHD). After presurgical orthodontic treatment, surgery consisted of a Le Fort I maxillary osteotomy, with 5 mm of anterior movement, and fixation with miniplates. After mandibular sagittal split set-back osteotomy, internal fixation was applied on each side using two bicortical screws; no postoperative intermaxillary fixation was utilized. At the 2-year follow-up, the patient was satisfied with the surgical results; lip competence and occlusion were good. The advantages of using internal rigid fixation are: immediate osseous stability which does not require intermaxillary fixation, improved perioperative airway management (no preoperative tracheostomy) and earlier functional recovery.

Adult↗
PubMed2003

Internal fixation versus arthroplasty of comminuted fractures of the distal humerus.

BACKGROUND: A comminuted distal humerus fracture in an older patient is a difficult clinical problem. Open reduction internal fixation (ORIF) carries the risks of nonunion, loss of fixation, infection, and stiffness. Arthroplasty carries the risks of loosening, infection, and periprosthetic fracture. Both procedures are technically challenging, and complications following these procedures are frequent. OBJECTIVE: To evaluate best available evidence to assist in guiding clinical decision making for ORIF versus arthroplasty of intraarticular distal humeral fractures in elderly patients. HIGHEST AVAILABLE EVIDENCE: 1. Case series of internal fixation or arthroplasty of acute interarticular distal humerus fractures in the elderly (level IV). 2. Review of expert opinion without explicit critical appraisal or controlled research (level V). STUDY IDENTIFICATION: 1. Computerized data search 1969-2003, Cochrane Database, OVID Search Engine. 2. Reviews of bibliographies of selected articles.

Aged↗
PubMed1975

[Local traumatic injury of the soft tissue and internal fixation (author's transl)].

The influence of local traumatic injury of the soft tissue on the decision as to whether surgical therapy is indicated and on the method of internal fixation selected for a fresh, closed fracture is discussed. General descriptions of injuries to the soft tissue are followed by a critical discussion of the possibilities of closed and open methods of internal fixation with some examples.

Fracture Fixation↗
PubMed2004

Internal fixation for osteochondritis dissecans of the knee.

Eight knees of seven patients with osteochondritis dissecans of the knee underwent internal fixation of the fragments. The affected location was the medial femoral condyle in four knees, the lateral femoral condyle in one knee and the patellar groove in three knees. At the time of surgery, patient age ranged from 13 to 20 years (mean 16.9 years). Open reduction and internal fixation of the unstable fragments was performed with autologous bone pegs in one knee. In the other seven knees, the procedures were carried out with biodegradable poly-L-lactide pins. At a mean follow-up of 5 years (range 4-6.8 years), seven fragments were united, whereas one knee required arthroscopic removal of the loose fragment. Neither effusion nor synovitis was noticed in any of the patients treated with biodegradable pins. The technique is simple and provides satisfactory results, suggesting a valid option for the treatment of osteochondral defects where possible.

Absorbable Implants↗
PubMed1989

Stability following combined maxillary and mandibular osteotomies treated with rigid internal fixation.

Skeletal stability was examined in 16 patients following combined maxillary and mandibular osteotomies using rigid internal fixation. Postoperative changes (T2 to T3) were generally less than 1.0 mm for linear measurements and less than 2.0 degrees for angular measurements. The removal of maxillomandibular fixation (MMF) splints accounted for 85% to 95% of the counterclockwise rotation in the proximal and distal mandibular segments from T2 to T3. Maxillary inferior repositioning and large mandibular advancements exhibited the greatest tendency for relapse; however, the changes were less than with comparable procedures using nonrigid methods for stabilization. Except for large mandibular advancements, relapse was essentially unrelated to the magnitude of the surgical repositioning. Although the use of skeletal, maxillomandibular, and transosseous wire fixation have traditionally provided satisfactory clinical results, the use of rigid internal fixation in combined osteotomy procedures provides better stabilization of dentosseous segments when compared with these nonrigid methods, and may be particularly indicated in complex surgical procedures.

Adolescent↗