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PubMed1988

The displaced femoral neck fracture. Internal fixation versus bipolar endoprosthesis. Results of a prospective, randomized comparison.

The displaced femoral neck fracture poses difficult decision-making issues for the orthopedic surgeon. Young patients frequently require a rapid open reduction and rigid internal fixation in the face of multiple associated injuries. Elderly patients present the typical decision dilemma of internal fixation versus arthroplasty. Consecutive, randomized, prospective series of cases for evaluation of alternatives in the treatment of this difficult fracture are lacking. Between 1982 and 1984, 34 elderly patients with displaced femoral neck fractures were randomized to open reduction or hemiarthroplasty study groups. Although the surgical risks are relatively high, two-year observations showed better functional results in the cemented hemiarthroplasty group.

Aged↗
PubMed1993

Open reduction and internal fixation of displaced intra-articular fractures of the glenoid fossa.

Ten displaced intra-articular fractures of the glenoid fossa were treated with open reduction and internal fixation between 1980 and 1987. Nine patients were available for evaluation at an average of four years (range, two to ten years) after the operation. Eight patients had mild or no symptoms and little or no restriction of the motion of the shoulder. There were no infections or malunions. The only complication was heterotopic ossification in one patient. Radiographic evaluation showed no evidence of traumatic osteoarthrosis in any patient. Open reduction and internal fixation is a useful and safe technique for the treatment of selected, displaced fractures of the glenoid fossa, and it can restore excellent function of the shoulder.

Adult↗
PubMed1992

Rigid internal fixation and the effects on the temporomandibular joint and masticatory system: a prospective study.

A prospective study of 22 patients who underwent a bilateral sagittal osteotomy to advance the mandible and subsequent rigid internal fixation, were examined for signs and symptoms of temporomandibular joint (TMJ) pain and masticatory dysfunction. A modified Helkimo index was used to analyze the anamnestic, clinical, and occlusal data. In addition, 12 of the cases chosen at random were mounted on a semiadjustable (SAM2) articulator and analyzed with the mandibular position indicator (MPI) to determine the amount and the direction of condylar displacement postoperatively. Anamnestic dysfunction decreased because of a reported decrease in muscular pain, joint noise, headache frequency, and parafunctional habits postoperatively. Clinical dysfunction remained unchanged, with a decrease in muscular soreness but with an increased incidence of joint clicking of 7%. The increased incidence of temporomandibular joint pain postoperatively was 4%. Increase in clinical dysfunction was most often seen in women and older patients. Occlusal dysfunction decreased, with the majority of interferences remaining after surgery as a result of insufficient lingual crown torque of the maxillary buccal segments. Occlusion is thought to have played only a minor role in temporomandibular joint and masticatory dysfunction. Reduction in range of motion was 10%, indicating the added benefit of early mobilization with rigid internal fixation procedures. The MPI study found the condyles inferiorly or inferoposteriorly displaced less than 1 mm from their preoperative position. These findings suggest that rigid internal fixation had no adverse effects on the temporomandibular and masticatory system. The variable responses and results can be attributed, at least in part, to the heterogenous population of patients studied and the variations in surgical techniques employed.

Adolescent↗
PubMed1998

Strength of internal fixation for calcaneal fractures.

OBJECTIVE: To compare the strength of two types of fixation method for calcaneal fractures. DESIGN: A biomechanical testing examined the stability of 12 fractured calcaneal specimens fixed with two different methods. BACKGROUND: Though anatomic reduction and internal fixation for the treatment of intra-articular fractures of the calcaneus has become popular, biomechanical data on the fixation strength is lacking. METHODS: Twenty fresh frozen specimens of amputated human legs were impacted by a 20 kg weight dropped from a 155 cm height to create calcaneal fractures. Twelve specimens which demonstrated a longitudinal and a transverse primary fracture lines were selected for open reduction and internal fixation. Group 1: a lateral buttress plate and parallel screws placed in the latero-medial direction were used. Group 2: a longitudinal screw was added in addition to the fixation used in group 1. Biomechanical testing was performed by applying a tibial shank load until the internal fixation failed. RESULTS: All mechanical failures of the reconstructed calcaneus occurred through the transverse primary fracture line. The average failure load was 805+/-356 N in group 1 and 2905+/-910 N in group 2 (Wilcoxon p<0.05). CONCLUSIONS: A longitudinal transfixing screw could significantly improve the stability of the transverse primary fracture line in calcaneal fractures.

Journal Article↗
PubMed1992

Open reduction and internal fixation for distal radius fractures.

From a series of 650 dorsally angulated fractures of the distal radius, 32 intra-articular fractures were treated by open reduction and internal fixation. The 32 fractures were classified according to the Frykman criteria as type VII (5) or type VIII (27). On the basis of the location of intra-articular involvement, the fractures were further subdivided into Mayo type II (4), type III (18), and type IV (10). Results were analyzed by the methods of Gartland and Werley (functional) and Lidström (radiographic). After open reduction and internal fixation, 90% of the patients had satisfactory results on the basis of the subjective criteria of minimal deformity, absence of pain, and good strength. Objective assessment demonstrated that the patients had 80% of normal motion and 73% of normal grip strength at a minimum of 2 years after the operation. On the basis of radiographic and functional evaluation, results were good to excellent in 87%. When intra-articular step-off exceeded 2 mm or the radius was shortened more than 5 mm, the results were only fair and posttraumatic arthritis was evident.

Adolescent↗
PubMed1989

Open reduction and internal fixation of three-part fractures of the proximal humerus.

Eleven patients with 12 three-part fractures of the proximal humerus were treated by open reduction and internal fixation using AO/ASIF buttress plating. All of the fractures healed. There were no failures of fixation. Nine of these patients returned for a follow up of more than 2 years and had a satisfactory rating using Neer's shoulder rating system. Five patients who had an acromioplasty at the time of their initial surgery had slightly better function and range of motion than the remaining patients. Successful operative treatment requires accurate definition of the fracture pattern, careful attention to the details of internal fixation, and supervised postoperative rehabilitation.

Adult↗
PubMedDate not supplied

Open reduction and internal fixation of forearm fractures in children.

We retrospectively reviewed 16 children younger than 13 years with 17 fractures of the shafts of the radius or ulna or both who had undergone an open reduction-internal fixation (ORIF). ORIF was performed when a closed reduction was deemed unacceptable in 14 radius fractures and for three unstable open fractures of the radius. The average age was 9.4 +/- 2.3 years (range, 5.0-12.5). Of the 14 fractures with an unacceptable closed reduction, soft-tissue interposition was encountered in seven. Fixation was secured by plates and screws, percutaneous Steinmann pins, or intramedullary Steinmann pins. There were no delayed unions or nonunions, no infections, and no neurovascular injuries. The average follow-up was 12.3 months; all 17 fractures had excellent results (forearm rotation loss of < 10 degrees). Our study indicates that excellent results can be expected with no increased risk of complications if the treating physician elects to proceed with an ORIF in a pediatric forearm fracture with proper indications.

Adolescent↗
PubMed1993

Rigid internal fixation of fractures in the angular region of the mandible: an analysis of factors contributing to different complications.

Data relating to 113 patients with 121 mandibular angle fractures treated according to the principles of rigid internal fixation were analyzed to determine which clinical factors are associated with different complications. Certain clinical characteristics were found to be associated with major complications. The use of compression plates seemed to entail disadvantages resulting in some complications. Because of the relatively small cross section of bone surface and particular anatomic features of the angular region, well-adjusted interfragmentary compression is often not possible. A neutral reconstruction plate is considered optimal for rigid osteosynthesis. If a molar tooth in the fracture line has to be extracted, this should be done after fracture stabilization. In most cases, an extraoral approach could not be avoided, but complications associated with this approach were infrequent and well tolerated by patients.

Adult↗
PubMed2004

Biomechanical evaluation of contemporary posterior spinal internal fixation configurations in an unstable burst-fracture calf spine model: special references of hook configurations and pedicle screws.

STUDY DESIGN: This study attempts to determine the most biomechanically rigid posterior spinal instrumentation configuration in a burst-fracture calf spine model. OBJECTIVES: To compare the biomechanical stability of contemporary posterior spinal instrumentation in various hook and screw configurations in an unstable calf spine model. SUMMARY OF BACKGROUND DATA: Burst-fractures are relatively common injuries seen in the setting of spinal trauma. The use of posterior-only configurations in the treatment of this deformity has become a much more popular approach because of the relative ease of applying the instrumentation. METHODS: Fresh frozen in vitro study using 10 calf spines involving the T11-S1 vertebral segments. Pure moment forces including flexion, extension, axial rotation, and lateral bending were applied to the top of the spinal column at T11. Testing was first performed on all intact specimens. A corpectomy was then performed at L2. Testing was then repeated on each of the ten specimens after internal fixation with different posterior spinal configurations using ISOLA instrumentation (DePuy AcroMed Inc., Raynham, MA). RESULTS: With regards to flexion-extension and lateral bending, all configurations except for distraction hook-rod construct provided stability greater than the intact spine. The distraction hook-rod configuration failed to control extension (P > 0.05) above the intact specimen. All pedicle screw constructs were more rigid than the hook-rod constructs in axial rotation at the level of injury (P < 0.001). CONCLUSIONS: The motion segment at the corpectomy site is adequately stabilized by contemporary spinal internal fixation configurations tested except for the distraction-hook stabilization. Axial rotation is generally poorly controlled by posterior-only internal fixation. Pedicle screw instrumentation was the most rigid compared with other forms of stabilization in stabilizing a burst-corpectomy defect. Based on this study, pedicle screw configurations are preferred over hook-rod strategies in the posterior stabilization of a burst-corpectomy anterior defect. Among hook-rod configurations, the distraction hook-rod strategy provided the least stability.

Animals↗
PubMed1975

Minimal internal fixation of tibial fractures.

Flexible wire and small pins cause minimal disturbance of osseous blood supply, and introduce minimal foreign material into the wound. Supplemental support by a plaster cast or by traction is required, but the external support can generally be discontinued early for joint mobilization. Several simple auxillary fixation devices extend the usefulness of wire fixation. Removal of metal is not required. Many common fractures of the tibia are amenable to this method of minimal internal fixation. In the diaphysis, long oblique fractures are the most suitable for this application; the firmness of their fixation by cerclage is augmented by muscle pull. Rotation is effectively controlled by a plate which is L-shaped in cross section, and is held in position by cerclage. In the metaphysis, articular fractures of the knee and ankle are securely fixed by a flattened loop of wire and two washers (wire-washer set), supplemented sometimes by pins or hand-made staples. Two pins alone provide excellent fixation of the medial malleolus. A single pin, or a single wire loop through drill holes, may be sufficient to impart stability to an unstable tibial fracture. A key-type graft of iliac bone, maintained by crossed wire loops through cortical drill holes, is effective in the tibial diaphysis. Autogenous iliac cancellous chips provide minimal and effective internal fixation for an infected ununited fracture of the tibia. The surgical instrument most important for making wire fixation highly successful is a tightener-twister which protects wire loops from excessive strain during application, and permits twisting at a predetermined and therefore reproducible tension. Other special and ordinary instruments are valuable assets.

Adult↗
PubMed1979

Internal fixation of fractures of the proximal end of the radius in adults.

Eight cases of internal fixation for fractures of the proximal end of the radius in adults are discussed. The reasons for this procedure, after considering the patient's age and activity and the type of fracture, was to avoid the sequelae of resection of the radial head. By following an appropriate technique, and provided that there are no compications, the results obtained have been excellent.

Adult↗
PubMed1996

Infection after open reduction and internal fixation with dynamic compression plates--clinical and experimental data.

Infection rates for open reduction and internal fixation (ORIF) with the DCP in clinical studies are based on heterogeneous data on general risk factors and do not take into account the direct effect of the implant (material, design, surface, technique). The initial degree of bacterial contamination is generally unknown and the applied definition of the term infection is not mentioned. In our own prospective randomized clinical study including 281 cases of ORIF with the DCP (154 steel vs 127 titanium), the influence of the implant material on susceptibility to local infection was examined in relation to initial bacteria contamination (109 non-contaminated / 172 contaminated). Although in the group of contaminated DCPs the difference in the infection rates for stainless steel (sSt) and commercially pure titanium (cpTi) showed no statistical significance, a tendency was apparent. In an animal experiment, the lower rates of infection for c.p.Ti-DCP compared to sSt-DCP in the presence of a local bacterial challenge could be demonstrated with statistical significance. The need for further experimental research in the field of implant related local infection after ORIF will be discussed and strategies for further investigations proposed.

Animals↗
PubMedDate not supplied

Mechanical characteristics of the new BONE-LOK bi-cortical internal fixation device.

The purpose of this study was to evaluate the mechanical characteristics of a new and unique titanium compression anchor with BONE-LOK (Triage Medical, Inc, Irvine, CA) technology for compressive, bi-cortical internal fixation of bone. This device provides fixation through the use of a distal grasping anchor and an adjustable proximal collar that are joined by an axially movable pin and guide wire. The titanium compression anchor, in 2.0-, 2.7-, and 3.5-mm diameters, were compared with cortex screws (Synthes USA, Paoli, PA) of the same diameter and material for pullout strength in 20 lb/cu ft and 30 lb/cu ft solid rigid polyurethane foam; and for compression strength in 20 lb/cu ft foam. Retention strength of the collar was tested independently. The results showed significantly greater pullout strength of the 2.7-mm and 3.5-mm titanium compression anchor as compared with the 2.7-mm and 3.5-mm cortex screws in these test models. Pullout strength of the 2.0-mm titanium compression anchor was not statistically different in comparison with the 2.0-mm cortical screws. Compression strength of the titanium compression anchor was significantly greater than the cortical screws for all diameters tested. These differences represent a distinct advantage with the new device, which warrants further in vivo testing. Collar retention strength testing values were obtained for reference only and have no comparative significance.

Bone Screws↗
PubMed1988

Anterior interosseous nerve palsy following internal fixation of the proximal radius.

Three cases of anterior interosseous nerve palsy were diagnosed after internal fixation of fractures of the proximal radius. The suggestion that the nerve was injured at operation by bone-holding forceps was supported by operations on 12 cadaver forearms, in which the nerve was frequently trapped. Care should be taken to place such forceps in a subperiosteal plane.

Adolescent↗
PubMed1978

Atrophy of cortical bone caused by rigid internal fixation plates. An experimental study in the dog.

The cortical atrophy induced by a rigid internal fixation plate on diaphyseal bone was studied on the femora of seven dogs. When the plate, which had been in position for 7 months without previous osteotomy, was removed, a pronounced reduction of the cortical bone was observed in the previously plated section of the diaphyseal bone. The atrophy took the form of loss of cortical bone mainly caused by endosteal resorption with enlargement of the medullary cavity. Neither periosteal resorption nor formation of woven bone under the site of the plate were observed. The process of adaption to the changed stress and strain conditions, caused by the mechanical joint, i.e., implants and bone, was studied by means of a histological technique, and was still in progress after a period of seven months.

Animals↗
PubMedDate not supplied

Slipped upper femoral epiphysis: internal fixation using single central pins.

Eighteen patients with slipped upper femoral epiphyses were treated by internal fixation using single pins in the centre of the femoral head. In 15 patients, prophylactic pinning of the unaffected side was performed; therefore, 33 hips were pinned. Results were encouraging in that no slip progressed following fixation, no pins broke, and no late reslips occurred. The optimum position for a pin is in the centre of the femoral head, with subsequent pins in suboptimal sites. The method of single pinning is simple and, theoretically, minimizes the risk of joint penetration.

Adolescent↗
PubMed1976

Influence of a rigid plate for internal fixation on the maximum torque capacity of long bones.

The unfavourable effect of the rigid internal fixation plate on the strength (measured as maximum torque capacity) of the diaphyseal bone, with due attention to the importance of the screw holes, has been studied on the femora of 7 dogs. When the plates that had been applied for 7 months without previous osteotomy were removed, a significantly reduced maximum torque capacity was observed, as also a significantly reduced maximum angle of torsion, and a significantly changed distribution of the amount of bone mineral.

Animals↗
PubMed1998

Surgical treatment for pilon fracture of the ankle-open reduction and internal fixation.

From 1991 to 1994, 39 ankles of 38 patients underwent surgical open reduction and internal fixation for pilon fractures. These patients included 29 males and 9 females with an average age of 38.6 y/o (range 28 y/o-58 y/o). The follow up and evaluation period averaged 31.7 months (range 22Ms-44Ms), during which time a standing x-ray for arthrosis grading and functional scale was used for clinical evaluation. Complications included 1 case of infection, 1 case of loss reduction, 2 cases of partial skin necrosis and 2 cases of delayed union. Post-traumatic arthritis occurred in 23 ankles (59%) but only 4 ankles of grade 4 arthrosis resulted in poor functional scale and the overall satisfactory rate was 82%. It was found that anatomic reduction, rigid fixation and early motion exercise are important to successful treatment of ankle fractures. Regarding pilon fracture, specifically the severity of fracture pattern and delay of reduction are important problems to overcome to ensure successful results. Therefore, adequate surgical approach for entire view of ankle joint, reduction and fixation of fibula, sufficient bone graft for articular support, intraoperative x-ray check and postoperative immobilization are essential for the achievement of better clinical results.

Adult↗