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At least 1,027 records · Page 57Linked to original sources
PubMed2006

Open reduction and rigid internal fixation of mandibular condylar fractures by an intraoral approach: a long-term follow-up study of 15 patients.

PURPOSE: To evaluate the long-term results obtained with open reduction and rigid internal fixation of mandibular condylar fractures by an intraoral approach. PATIENTS AND METHODS: Fifteen patients with 24 mandibular condylar fractures were retrospectively examined with an average follow-up of 23 months (range, 6-63 months). Clinical and radiographic examination was conducted according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), including an evaluation of maximum voluntary bite force measurements and facial nerve function. Statistical analysis was performed on maximum voluntary bite force measurements and maximum pressure pain threshold. RESULTS: Two patients fulfilled the criteria for a RDC/TMD diagnosis. Myofacial pain (group I) and bilateral arthralgia (group III), combined with a moderate nonspecific physical symptom score, was diagnosed in 1 patient and 1 patient received a diagnosis of disc displacement with reduction (group II). Satisfying radiographic fracture healing was seen in 12 joints. However, miniplate fracture occurred in 3 patients and severe bone resorption of the condylar head was seen in one patient. Minor adjustment of the postoperative occlusion was necessary in 6 patients. No significant difference between maximum voluntary isometric bite force measurements or maximum pressure pain threshold was found between the fracture side and the opposite side in unilateral cases or between the operated and nonoperated side in bilateral cases. None of the patients showed facial nerve injury or visible facial scars. CONCLUSION: Within the limitations of a retrospective study, the present study emphasized that optimal management of dislocated bilateral condylar injuries combined with other fractures of the facial skeleton constitute a challenging issue in maxillofacial trauma. Moreover, open reduction and rigid internal fixation of mandibular condylar fractures by an intraoral approach is a technically demanding surgical procedure associated with a high risk of postoperative complications in these injuries.

Adolescent↗
PubMed1990

The effect of rigid internal fixation on cranial growth.

As the use of rigid internal fixation of the facial skeleton has become routine in adults, many craniofacial surgeons have expanded its use to the pediatric population. The effects of miniplate and screw fixation on subsequent craniofacial growth, however, have not been examined. Using 6-week-old rabbits as an experimental model, miniplates were placed across the right coronal suture. Calvarial changes were measured by direct osteometry on dry skull preparations. Compared with the control group, a significant reduction in growth was noted across the plated suture and adjacent bones. Because secondary growth disturbances can be produced with the use of these fixation devices, their use in the pediatric population should be viewed cautiously.

Animals↗
PubMedDate not supplied

Immediate open reduction and internal fixation in open ankle fractures.

In this prospective study, 30 patients (28 men and 2 women) with open ankle fractures were treated with early debridement and immediate stable internal fixation after anatomical reduction to achieve better functional results after early mobilization. The procedure was performed an average of 8 hours (range, 6-15 hours) after injury. According to the classification system of Gustilo and Anderson, 11 fractures (37%) were grade I, 12 (40%) were grade II, 5 (17%) were grade IIIA, and 2 (7%) were grade IIIB. Six complications occurred: four patients had superficial skin necrosis and two had loss of reduction, resulting in residual ankle stiffness. Twenty patients had excellent results, eight had good results, and two had fair results according to the modified criteria of Ketenjian and Shelton. We found that immediate debridement, anatomical reduction, and internal fixation of open ankle fractures leads to better functional results, especially in grade I and grade II injuries.

Adult↗
PubMed1982

Effect of internal fixation on the strain environment of the canine femur.

Strain gauge technology and telemetric transmission were utilized to investigate the dynamic strain patterns along the cortical surface of bone and the response to internal fixation, in vivo. Application of a tension band plate resulted in conversion of normal tensile strain into compressive strain which verified the tension band principle of internal fixation. Creation of a transverse osteotomy did not alter this response, provided that the fragments were rigidly fixed. The plate caused an appreciable decrease in normal surface strain measured from the lateral and medial cortices, illustrating the concept of stress protection.

Animals↗
PubMed1992

Rigid internal fixation of mandibular fractures. An analysis of 270 fractures treated using the AO/ASIF method.

The results are reported on 214 patients treated for 270 mandibular fractures, using rigid internal fixation. Of these, 172 fractures (63.7%) in 131 patients had been re-evaluated at final follow-up in connection with plate and screw removal, on average 15.2 months, postoperatively. Although one-third of the patients had a history of alcohol abuse, and 86% were treated with a delay of more than 24 h (mean 3.2 days), good primary bone healing was observed in 93.9% of the patients. Infections, seen in 6.1% of the patients, were related exclusively to inadequate stability of the fracture. Malocclusion, observed in 18.2% of 159 dentate patients, was caused by incorrect plate bending and insufficient fracture reduction. Immediate postoperative dysfunction of the inferior alveolar nerve in 58.1% of the cases, and of the mandibular branch of the facial nerve in 12.7%, was followed by almost total recovery 1 year after operation. It is concluded that rigid internal fixation is a reliable method of treatment, especially indicated for patients with reduced healing capacity and poor co-operation.

Adolescent↗
PubMed2004

Displaced fractures of the proximal humerus in children require open/closed reduction and internal fixation.

Fractures of the proximal humerus in children are rare and constitute only 3% of all epiphyseal injuries. From 1992 to 2002 sixteen patients aged 4 - 15 years with a displaced fracture of the proximal humerus were treated at our level I trauma unit. The mean follow-up of the patients was 23.8 months (8 - 72). Ten children had a metaphyseal fracture and six a Salter and Harris Type II injury. Only one metaphyseal fracture was treated conservatively; the other patients underwent surgery (ORIF [= open reduction internal fixation] in ten patients, CRIF [= closed reduction internal fixation] in five patients). Follow-up examination showed no shortening or major angulation of the humerus in any of the sixteen cases. Fifteen children showed excellent and good results. There was only one average result in a polytraumatized child with additional injuries in both upper extremities. Based on the results of this study we suggest performing ORIF/CRIF in displaced fractures of the proximal humerus in children.

Child↗
PubMed2006

Biomechanical evaluation of different types of rigid internal fixation techniques for subcondylar fractures.

PURPOSE: The aim of this study was to evaluate the biomechanical stability of various internal fixation systems for subcondylar fractures. MATERIALS AND METHODS: Eighteen identical synthetic mandibles were used. Left condylar processes were cut to mimic perpendicular subcondylar fracture and right sides were mimicked oblique subcondylar fracture. The fixation systems used included single 4-hole mini adaptation plate, double fixation with the same plates, single 4-hole mini dynamic compression plate (DCP), Eckelt lag screw system, Wurzburg lag screw plate system and double 4-hole biodegradable miniplates made of poly L-lactide (PLLA). In oblique fractures, one of the screws fixing plates was used bicortically through bone fragments. The loading vector simulated physiologic forces to the condyle on biting with servohydraulic testing machine until failure was reached. Load-displacement curve, maximum load for failure, and stiffness were measured. RESULTS: In perpendicular fracture, double adaptation plate showed the highest level of tolerance load followed by Eckelt lag and double PLLA plate. In stiffness, double adaptation plate and Eckelt lag screw showed higher level of stiffness, whereas double PLLA was almost at the same level of single DCP. In oblique fracture, double adaptation plate showed the highest strength. CONCLUSIONS: In this laboratory setting, double adaptation plates fixation proved to have superior biomechanical stability in both fracture conditions. Eckelt lag screw showed good stability in the perpendicular fracture, however, it was weak in the oblique fracture.

Biomechanical Phenomena↗
PubMed1994

[Single segment internal fixator device in treatment of thoracolumbar vertebral fractures].

Treatment of vertebral fractures by the fixed-angle system of the internal fixator allows fusion over a short area and is the form of treatment now in general use. A bisegmental construction is usual, which means that reduction and relief of the injured vertebral body is achieved indirectly by means of two intact vertebrae immediately adjacent on either side. As a result, both segments stiffen up or are permanently damaged in their function. We report on the possibility of single-segment fixation. The principle is the fusion of the injured segment itself only, i.e., the vertebra actually injured and the vertebra adjacent to the injured segment. Unnecessary fixation of a second healthy segment can thus be avoided. The characteristics of the fracture type in which single-segment stabilization is possible are explained. In a small study of the technique, we used the new AO classification of vertebral fractures of the thoracolumbar spine. The operation technique differs in some details from that applied with a multisegmental internal fixator. For example, the pedicle screws occasionally need to be inserted extremely close to the end-plates if the remaining part of the vertebral body has been destroyed and therefore cannot provide stability. Contraindications are broken pedicles and complete burst fractures of the body. With due consideration for these limitations fractures in all three main groups of the AO classification can, in principle, be stabilized in a single segment. In the years 1988-1990, 14 patients were operated on in this way (12 acute injuries, 2 secondary operations).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Avulsion of the ischial apophysis. The case for open reduction and internal fixation.

We report three cases of avulsion of the ischial tuberosity with marked chronic disability after delay in diagnosis and non-union of the fracture. All were treated by open reduction and internal fixation with return to full function, allowing in one case, athletic performances of Olympic standard. We also report one patient with an acute apophyseal avulsion treated by early reduction and internal fixation with restoration of full function.

Adolescent↗
PubMed2004

Internal fixation of complex fractures of the proximal humerus.

We treated 34 consecutive articular fractures of the proximal humerus in 33 patients with good bone quality by open reduction and internal fixation. Anatomical or nearly anatomical reduction was achieved in 30, at a mean follow-up of 63 months (25 to 131), complete or partial avascular necrosis had occurred in 12 cases (35%). Two patients subsequently underwent arthroplasty and six further patients required additional surgery. The 32 patients who did not require arthroplasty obtained a mean Constant score of 78 points or 89% of an age- and gender-matched normal score (66 points or 76% in the presence and 83 points or 96% in the absence of avascular necrosis (p < 0.0005)); 22 were painfree, and seven had mild pain and three moderate pain. The mean active anterior elevation was 156 degrees. Internal fixation of complex fractures of the proximal humerus restored good shoulder function if avascular necrosis did not develop.

Adult↗
PubMed1992

Resorbable polymers for internal fixation.

Bone fractures are usually fixed with metallic internal and/or external fixation devices. Such devices have to be removed from the implantation site, once the bone fracture is healed. Metallic devices may also corrode in vivo releasing ions into the tissues. An ideal internal fixation device should allow adequate fracture fixation, immediate recovery of mobility of the limb, and be produced from a material which can be safely left at the implantation site when the fracture healing is completed. Resorbable polymers are candidates for construction of such devices.

Animals↗
PubMed2001

The open reduction and internal fixation of humeral diaphysis fracture treatment with a medial approach.

From 1995 to 2000, twenty-three patients with fracture of the humeral shaft were treated by medial approach and internal fixation using AO/ASIF plate and screws. Follow-up was possible for 21 fractures. There were 16 male and 5 females. The ages ranged from 16 to 55 years (mean, 29 years). The average period of follow-up was 4.5 months (range, 3-12 months). There was no evidence of implant failure and nonunion during follow-up. The average lack of complete extension of the elbow was five degrees. There was one case of transient radial nerve palsy. As such, the medial approach to humeral shaft and internal fixation with plate and screws for humeral diaphysis fracture was determined to be a viable technique.

Adolescent↗
PubMed2004

Prediction of resorption rates for composite polylactide/hydroxylapatite internal fixation devices based on initial degradation profiles.

Mechanical and physicochemical outcomes were used to predict the resorption rate of polylactide-based internal fixation devices with and without incorporation of an osteoconductive buffer. Devices were degraded in vitro for 1 year. Addition of an osteoconductive buffer to a resorbable polymer internal fixation device controlled the rate of acid generation resulting from polymer hydrolysis. The pH of the physiological buffer remained neutral when it was exposed to the buffered screw, whereas the pH decreased to approximately 3.0 for the polylactide device. Neutralizaton of the acids generated during polymer hydrolysis increased the projected resorption time of the buffered device to 104 weeks in comparison to 71 weeks for a similar screw made from polylactide. In addition, the buffered device retained a higher percentage of its initial flexural strength throughout the course of degradation than the polylactide screw. The flexural strength of the polylactide screw decreased 20% during the first 4 weeks of polymer degradation, whereas the buffered device maintained its initial mechanical properties through 16 weeks of degradation.

Drug Stability↗
PubMed1991

Biomechanics of cervical spine internal fixation.

Recent advances in the area of cervical spine internal fixation have resulted in important additions to the armamentarium of the spine surgery. However, a sophisticated knowledge of the biomechanics of these devices is important. This article discusses the biomechanics of odontoid screws, anterior cervical plates, posterior cervical plates, and posterior C1-C2 screw arthrodesis. It is hoped that this information will aid in implant selection.

Biomechanical Phenomena↗
PubMed2001

Does the level of an intracapsular femoral fracture influence fracture healing after internal fixation? A study of 411 patients.

The aim of the study was to determine if the level of an intracapsular femoral fracture influences the risk of non-union or avascular necrosis occurring after internal fixation. An observer blinded to the outcome of the treatment (fracture union, non-union or avascular necrosis) reviewed the radiographs of 411 patients with an intracapsular fracture, which had been treated by internal fixation. The level of the fracture was determined by two methods, a direct distance measurement and a ratio method. In addition, the diameter of the femoral head was measured. Results indicated that none of the methods for determining the fracture level had any relationship to the risk of non-union or avascular necrosis occurring. Undisplaced fractures were found to be more proximally located than displaced fractures. We conclude that the level of an intracapsular fracture should not be used as a method of deciding if the femoral head should be preserved or replaced. The level of an intracapsular fracture may determine if the fracture displaces at the time of injury.

Aged↗
PubMed1995

Fracture of the posterior medial tubercle of the talus treated by internal fixation: a report of two cases.

A fracture through the posterior medial tubercle of the talus is quite rare. Although excision of the bone fragments has been reported previously in this fracture, cases of internal fixation of the posterior medial tubercle of the talus have not been reported. Two patients are described who presented with a fracture through the posterior medial tubercle of the talus which was treated with internal fixation. Our patients appeared normal on physical examination and returned to work, with no evidence of avascular necrosis of the fragments.

Adult↗
PubMed1995

Internal fixation of proximal humeral fractures.

Fractures of the proximal humerus are common, especially in elderly individuals, and are usually classified according to Neer into fractures having one, two, three, or four parts with or without an associated dislocation or an injury splitting the humeral head. This article is intended to assist the surgeon in selecting and using techniques for internal fixation of these fractures. The use of open reduction and internal fixation using plates and screws has become less popular because of the extensive dissection required and the tendency for the plate to impinge. Use of multiple percutaneous pins to fix the humeral head to the shaft (surgical neck) and heavy sutures or wires to reattach the tuberosities is often preferable.

Aged↗
PubMed1992

Comminuted intra-articular fracture of the distal radius--results of early open reduction and internal fixation.

Comminuted intra-articular fracture of the distal radius remains a challenging problem. This article reviews the results of 15 consecutive cases which were treated with open reduction and internal fixation with T-plate after failing to achieve articular congruency with closed reduction. The follow-up ranges from 20 months to 28 months. In thirteen cases, articular congruency was restored. However, 4 of these 13 cases later lost some of the articular congruency. This suggests the need for supplementary bone grafting. Reduction of the extra-articular portion of distal radius was generally well maintained. There was an average of 2.4 mm loss in styloid height, an increase of 1.2 mm in ulnar variance and loss of 12.5 degrees of volar tilt. Seven patients (46%) were completely pain-free, with the remaining 8 patients (53%) experiencing mild pain associated with forceful activities involving the wrist. All patients achieved a functional range of motion. Grip strength averaged 81% of the uninjured side. Of the 12 patients who were engaged in active employment, 10 returned to their previous job within 4 months of injury (average 8.5 weeks). The only complication in this series was the development of reflex sympathetic dystrophy in a 68-year-old housewife. We recommend open reduction and internal fixation if closed reduction fails to achieve articular congruency in comminuted distal radius fractures.

Adult↗