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At least 1,027 records · Page 57Linked to original sources
PubMed1981

Osteosynthesis of closed femoral shaft fractures by plate fixation: indications and results.

Osteosynthesis of fractures of the shaft of the femur by plating is not so widely used as intramedullary nailing. It does, however, have precise indications in certain situations that preclude the use of nails or render them inadvisable. The purpose of the present paper is to make a contribution to this aspect of the problem, the literature on which is by no means extensive. The results of forty-seven cases, performed on the basis of the writers' indications, are reported after a long term follow up period.

Adolescent↗
PubMed1991

The dynamic axial fixator in fractures of the tibia and femur. A retrospective study in 98 patients.

In a retrospective study involving 98 patients the results achieved with the dynamic axial fixator (Orthofix) in closed or open fractures of the tibia or femur treated in two district hospitals in the southwest of England during the period 1986-1988 were evaluated. Fifteen patients were vacationers and, as a result, were lost to followup. The operation and subsequent management was performed by more than 15 different members of the staff, of different levels of seniority and experience. The present survey in this group of surgeons has demonstrated that the dynamic axial fixator is a reliable means of treating open fractures of the tibia following an initial good reduction. It does, however, highlight the importance of the strict adherence to simple guidelines for application, pin care and dynamization if best results are to be obtained.

Adolescent↗
PubMed1996

Routine implant removal after fracture surgery: a potentially reducible consumer of hospital resources in trauma units.

OBJECTIVE: Assess the workload caused by elective routine removals of internal fracture fixation devices in a large university orthopedic and trauma unit when no premeditated departmental removal policy existed. MATERIALS AND METHODS: Data on all operations performed during a 7-year period were retrieved. Routine removals of internal fracture fixation implants were analyzed for demographic data and clinical details. Patients requiring additional procedures to manage the fracture besides simple hardware removal were excluded. Nationwide data were included for comparison. RESULTS: A total of 5,095 routine implant removal operations were performed after uneventful fracture union. The mean age of the patients was 42 years. The five most common fracture types were fractures of the ankle, the proximal femur, the tibial shaft, the femoral shaft, and the thoracolumbar spine. In 63% of the procedures, a medium-size or large implant was removed. The mean operation time was 37 minutes. The removals accounted for 29% of all elective operations and for 15% of all operations at the department. The corresponding nationwide figure was 6.3% of all orthopedic operations, the number of implant removals in the whole country being 90 operations per 100,000 person-years. CONCLUSIONS: Without a strict departmental removal policy, a remarkable portion of the resources allocated for elective orthopedic operations was spent on routine hardware removal procedures. A more rational and selective attitude toward implant removals is desirable. Further research on the disadvantages of retained hardware and the complications of implant removals is required.

Adult↗
PubMed1989

Reduction and fixation of jaw fractures using acrylic splints.

This paper proposes the criteria for application of acrylic splints in the treatment of various types of maxillofacial fractures. These were based mainly on the number of remaining teeth that are important for the restoration of occlusion. The acrylic splints studied consisted of intermaxillary, lingual and labiolingual types that hold a dental arch and a cap type that covers a dental arch. It was found that the intermaxillary type was best indicated for the loss of multiple teeth, the lingual type for the predicted intraversion of bone fragments and the labiolingual as well as cap types for the deciduous or mixed dentition. Clinical application based on the above standard, which was attempted in our 60 patients, produced successful results. In addition, the usefulness of these acrylic splints as an intraoral apparatus was discussed.

Acrylic Resins↗
PubMed2000

Percutaneous intramedullary fixation of trochanteric fractures of the femur. Clinical trial of a new hip nail.

Since 1992, we have developed an implant which can be inserted percutaneously without reaming the femoral shaft. In the final design, the intramedullary nail is 13 mm diameter proximally and 11 mm distally. The femoral head is fixed with two screws of 6.5 mm diameter, and there is a single 4.5 mm distal screw. The nail and screws are constructed from coldworked ISO 5832-9 stainless steel. From July 1994 to June 1997, 159 patients aged over 60 years with acute trochanteric femoral fractures were treated with these implants. Results were assessed on a functional basis of walking mobility and level of dependency. After three months, 89 patients (56%) had regained their previous level of mobility and 22 patients (16%) had died from unrelated causes. Average operating time for the first 50 patients was 38 min. Complications include screw cutout in two patients, prominent screws in four, one non-union and two persistent low grade infections. The complication rate is comparable with that of other methods of treatment.

Aged↗
PubMedDate not supplied

Synthetic casting tapes: benefits and uses of Delta-Cast Conformable.

Casting is a traditional practice that has changed relatively little over thousands of years. Today, however, with the emphasis on evidence-based medicine, health professionals are examining the practice and investigating ways of improving it for the benefit of both patients and those who perform it. Most fractures and many soft tissue injuries are usually managed in a rigid cast, which brings with it complications and disadvantages. The ideal form of fracture fixation would stabilize the fracture while allowing some movement of the fracture site and soft tissue compression. This article explores the use of Delta-Cast Conformable (Johnson and Johnson), a synthetic casting tape, in both primary and secondary casting. The role of Delta-Cast Conformable with regard to focused rigidity casting, a new philosophy in fracture management, is discussed.

Casts, Surgical↗
PubMed1997

Awareness of tip-apex distance reduces failure of fixation of trochanteric fractures of the hip.

We compared the results of the surgical treatment of trochanteric hip fractures before and after surgeons had been introduced to the tip-apex distance (TAD) as a method of evaluating screw position. There were 198 fractures evaluated retrospectively and 118 after instruction. The TAD is the sum of the distance from the tip of the screw to the apex of the femoral head on anteroposterior and lateral views. This decreased from a mean of 25 mm in the control group to 20 mm in the study group (p = 0.0001). The number of mechanical failures by cut-out of the screw from the head decreased from 16 (8%) in the control group at a mean of 13 months to none in the study group at a mean of eight months (p = 0.0015). There were significantly fewer poor reductions in the study group. Our study confirms the importance of good surgical technique in the treatment of trochanteric fractures and supports the concept of the TAD as a clinically useful way of describing the position of the screw.

Aged↗
PubMed1993

Antibiotic prophylaxis with two doses of cephalosporin in patients managed with internal fixation for a fracture of the hip.

A prospective, randomized, double-blind study was performed to evaluate the effects of antibiotic prophylaxis on the development of a wound infection in 239 patients who had immediate stabilization of a fracture of the proximal part of the femur with a dynamic hip screw. The effects of two perioperative doses of cefotiam, given twelve hours apart, were compared with those of two doses of a placebo. Sixteen perioperative risk factors were evaluated to determine whether it was possible to identify patients who were at risk for a wound infection. All patients were followed for a minimum of six weeks. Antibiotic prophylaxis significantly reduced the prevalence of wound infection (p < 0.05): the rate of major wound infection decreased from 5 to 1 per cent and the rate of minor wound infection, from 11 to 4 per cent. The most powerful predictors of major wound infection were the duration of the operation, the interval between the accident and admission to the hospital, and the duration of postoperative urinary catheterization. The preoperative level of serum albumin and the absolute lymphocyte count were significant predictors (p < 0.05) of minor wound infection and systemic infection, respectively.

Aged↗