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Analysis of failed surgical management of fractures of the base of the fifth metatarsal distal to the tuberosity: the Jones fracture.

Failure of surgical management of fractures of the base of the fifth metatarsal distal to the tuberosity is uncommon. Only one such failure has been reported in the literature to date. The purpose of this article is to present the clinical course of 11 patients with failure of surgically managed jones fractures reviewed by the senior author (J.S.T.). Surgical management was complicated by delayed union in three patients, refracture in seven patients, and nonunion in one patient. The 11 procedures were divided between two established techniques: (1) intramedullary screw fixation (N = 6) and (2) inlaid corticocancellous bone graft (N = 5). In the six intramedullary fixation procedures, using other than a 4.5-mm ASIF malleolar screw for internal fixation correlated with failure. In the five inlaid bone graft procedures, undersized corticocancellous grafts and incomplete reaming of the medullary canal correlated with failure. Also, after both procedures, early return to vigorous physical activity is believed to have played a role in delayed union and refracture.

Adolescent↗

Cortical screw support in femoral neck fractures. A radiographic analysis of 87 fractures with a new mensuration technique.

In 87 femoral neck fractures, operated on with 2 von Bahr screws and followed for up to 2 years, the positions of the fixating screws were determined with a new mensuration technique which compensates for the variations in hip rotation in routine radiographs. The union rate of the fractures was related to the position of the screws. A posterior placement of the proximal screw and an inferior placement of the distal screw in both the femoral head and neck improved the outcome substantially.

Aged↗

Internally fixed femoral neck fractures. Early prediction of failure in 203 elderly patients with displaced fractures.

After internal fixation of a femoral neck fracture, 3 months is the critical time for planning rehabilitation of the patient. Most failures in the elderly occur within this time. In a series of 165 patients, we followed 127 women and 38 men with a median age of 81 (63-97) years from an examination at 3 months to reoperation or survival of the hip. 36 patients had radiographic signs of disturbed healing at the 3-month follow-up--change in fracture position by 10 mm, change in screw position by 5%, backing of the screws by 20 mm, or perforation of the femoral head by the screw. These signs had a high association with local complications and need for a later reoperation. High age and male sex increased this association. Signs of impaired healing made nonunion likely, but did not predict late segmental collapse of the femoral head. Patients with signs of disturbed healing and those closest to them should be informed about the value of early check-ups in case of pain and impaired function.

Age Factors↗

Fractures of the femoral neck after healed intertrochanteric fractures: a complication of too short a nail plate fixation. Report of three cases.

Three cases are described in which a femoral neck fracture developed at least 1 year after a healed intertrochanteric fracture of the femur. Trauma via osteoporotic bone is felt to be the cause. To prevent this complication, a nail extending just to the articular cartilage of the hip joint is needed. This can be accomplished by the displacement osteotomy technique or by the use of the sliding nail-plate into the more stable posterior inferior quadrant of the head.

Aged↗

[When does a pediatric fracture become a fracture of the adult? Age and significance of epiphyseal closures].

Surgical treatment of fractures of adolescents is often difficult as the epiphyses are still open or not yet completely closed. The osteosynthesis chosen has to consider the remaining prospective growth of the affected bone and biomechanical needs. Due to high physical maturity with small remaining growth capacity in adolescents, a number of different techniques known from osteosynthesis in adults with minor modifications can be used to treat these fractures.

Adolescent↗

Nancy nailing of diaphyseal forearm fractures. Single bone fixation for fractures of both bones.

We identified 25 children (10 girls and 15 boys) who had been treated with single bone intramedullary fixation for diaphyseal fractures of both forearm bones. Their mean age was 10.75 years (4.6 to 15.9). All had a good functional outcome. We conclude that in selected children, single bone intramedullary nailing is a suitable method of treatment for diaphyseal fractures of both bones of the forearm.

Adolescent↗

[Lateral femoral neck fracture as a fatigue fracture].

We report about a stress fracture of the lateral neck of femur of a 51 years old sportsman which was operated with an angled blade plate 130 degrees. Stressfractures of the femur are very uncommon. Pathogenetic factores are biomechanical changes or reactions of the bone system caused by repeated excessive mechanical stresses which lead to change of microcrystalline structure of the anorganic components of the bone and, if stress continues, to fracture after on initial fissure.

Alanine Transaminase↗

Management of fractures and fracture complications of femoral shaft using the ASIF compression plate.

Nnieteen acute fractures and fourteen fracture complications of the femoral shaft were managed with ASIF plate fixation. Two patients having femoral shortening procedures were similarly managed. Most injuries involved the distal femoral shaft, and were judged unacceptable for intramedullary nailing. Single plate fixation and immediate mobilization of the knee joint were possible in most patients. Technical failure, refracture through an end-screw hole, or nonunion occurred in 20% of the injuries. Plate fixation of the femoral shaft is not the surgical procedure of choice for management of femoral shaft injuries. It is an acceptable alternative to intramedullary nailing but carries a higher risk of complication.

Adolescent↗

Reamed or unreamed nailing for closed tibial fractures. A prospective study in Tscherne C1 fractures.

We performed a prospective, randomised study on 50 patients with Tscherne C1 tibial diaphyseal fractures comparing treatment with reamed and unreamed intramedullary nails. Our results show that reamed nailing is associated with a significantly lower time to union and a reduced requirement for a further operation. Unreamed nailing should not be used in the treatment of the common Tscherne C1 tibial fracture.

Adult↗

Fixation of complex elbow fractures, Part I. General overview and distal humerus fractures.

Complex elbow fractures are those intra-articular injuries which result in displacement or incongruity of one or more of the articulations between the distal humerus, proximal radius, or proximal ulna. The article discusses a system for clinical and radiographic evaluation, operative management, and rehabilitation of distal humerus fractures. This review presents detailed descriptions of skeletal reconstructive techniques for these injuries based on a review of the literature, biomechanic principles, and clinical experience. The importance of rigid internal fixation and early postoperative mobilization is emphasized.

Adult↗

Influence of different posts and cores on marginal adaptation, fracture resistance, and fracture mode of composite resin crowns on human mandibular premolars. An in vitro study.

OBJECTIVE: To evaluate marginal adaptation, fracture modes, and loads to failure of composite crowns with different substructures on root-canal-treated premolars. METHODS: Forty-eight mandibular teeth with single root canals were selected and assigned to six equal groups: group I, untreated; group II, root-canal-treated (RCT), access cavity restored with composite resin; group III, RCT, ferrule (2 mm), no post, standardized composite resin crown (SRCC); group IV, RCT, ferrule, glass fiber post, SRCC; group V, RCT, ferrule, zirconium post, SRCC; group VI, RCT, ferrule, cast gold post, SRCC. All teeth were subjected to thermocycling and mechanical loading (TCML) in a computer-controlled masticator (1,200,000 loads, 49N, 1.7Hz, 3000 temperature cycles of 5-50-5 degrees C). Marginal adaptation was evaluated before and after TCML with scanning electron microscopy at x200 at the tooth-to-luting-composite (IF1) and the luting-composite-to-crown (IF2) interfaces. After TCML, all specimens were loaded to failure in a universal testing machine at 0.5mm/min. RESULTS: A significant decrease in marginal adaptation was found in groups III and IV after TCML at IF1. A significant decrease was observed at IF2 in group V. Mean loads to failure did not differ significantly between the groups with SRCCs. Those of groups II, III, and IV did not differ from that of unrestored teeth. Half the specimens exhibited partial root fractures, independent of the substructures used. No deep or vertical root fractures were observed in any group. CONCLUSION: All studied posts had a positive effect on marginal adaptation at IF1, but not on failure modes or loads to failure of composite resin crowns.

Acrylic Resins↗

[Classification of fractures of the distal distal femur - late results of 31 supracondylar fractures of the femur treated by surgery (author transl)].

At the 20th annual meeting of the Austrian Society of Surgeons in Innsbruck (1979) a new scheme of classification for fractures of the femur was established. The advantages of this scheme are outlined. Own experiences with 31 supra-diacondylar fractures of the femur are reported; the late results after internal fixation are discussed.

Adult↗

Fracture of the atlas associated with fracture of the odontoid process.

A case of burst fracture of the atlas associated with a type II fracture of the odontoid is presented. In this instance no atlanto-axial instability was detected clinically. Treatment consisted of 1 week of rest in bed followed by 3 months in a collar. Management, though conservative, resulted in full recovery.

Adult↗

Biodegradable implants in fracture fixation: early results of treatment of fractures of the ankle.

Biodegradable polylactide-glycolide copolymer implants for fracture fixation were developed and tested in rabbits. In a prospective clinical study 44 patients with a displaced fracture of the ankle were randomly allocated to two groups; one was treated with conventional metallic implants and the other with the biodegradable implants. There were no differences between the two groups in the early results, but the biodegradable fixation method is advantageous because the removal procedure associated with metallic implants is avoided.

Adult↗