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PubMedDate not supplied

Internal fixation without fusion of a flexion-distraction injury in the lower cervical spine of a three-year-old.

BACKGROUND: Reported surgical treatment of unstable pediatric cervical spine injuries typically involves posterior fusion with internal fixation, usually with posterior wiring. PURPOSE: To discuss management issues in the treatment of an unstable Salter-Harris type I pediatric cervical spine injury and surgical intervention without fusion. STUDY DESIGN: A case report. METHODS: Summary of the management of an unstable flexion-distraction injury in a 3-year-old child is presented with literature review. RESULTS: A rare unstable flexion distraction injury of the pediatric cervical spine was successfully treated with posterior wiring without fusion. The wires underwent fatigue failure and maintenance of motion achieved without instability at 2-year follow-up. CONCLUSIONS: In select physeal injuries of the pediatric cervical spine, internal fixation can provide stability while healing occurs, with avoidance of fusion and maintenance of motion.

Accidents, Traffic↗
PubMed1991

Extra-articular subtalar arthrodesis with cancellous bone graft and internal fixation for children with myelomeningocele.

Extra-articular subtalar arthrodesis with cancellous bone graft and internal fixation was performed on 20 feet of 12 children with myelomeningocele, whose average age at operation was 7.4 years. Indication for surgery was progressive hindfoot valgus deformity causing difficulty in fitting orthoses. At average follow-up of 4.1 years, results were satisfactory in 18 of the 20 feet. Unsatisfactory results were a result of undercorrection at time of surgery. Extra-articular subtalar arthrodesis will correct hindfoot valgus deformity in children with myelomeningocele, and the use of internal fixation and iliac crest bone grafting contributed to the improved success rate in this series.

Arthrodesis↗
PubMedDate not supplied

[An internal fixator for posterior application to short segments of thoracic, lumbar and lumbosacral spine. Design and testing].

The authors present preliminary experiences in spinal instrumentation with internal fixator Socon (Aesculap). The device was introduced into the routine clinical practice in the Department in 1992. Basing on personal experience they confirm the advantages of usage of internal fixators in spinal surgery especially good stabilisation of the spine and possibility of early mobilisation of patients. Analysis of the series of 6 cases operated on in the Department with the longest follow-up of 10 months revealed no neurological or vascular complication related to pedicle screw insertion, no wound infection and no instability of instrumented segment of the spine. The report includes 3 illustrative cases operated on in the Department.

Adult↗
PubMed1980

Effects of fracture stabilization by internal fixation. I. A haemodynamic and blood gas evaluation of the systemic and regional changes.

The effect of internal stabilization of a fracture of the femur on arterial blood oxygen levels, limb flow and oxygen consumption was measured in 24 dogs. Those with stabilized fractures bore weight on their limbs and were much more active. Without fracture stabilization the arterial oxygen tension fell by 10 per cent. With internal fixation this hypoxia did not develop. In fact, there was a 10 per cent increase beginning in the third week. Stabilization of the fracture gave a persistent increase in limb blood flow, but without stabilization this increase was transient and followed by a significant decrease. Over the 7-week observation period, the total oxygen consumption of the uninjured limbs in the stabilized group was twice that in the unstabilized group, an indication of their functional activity. Also with stabilization, the oxygen consumption of the uninjured limb was not significantly different from the opposite limb, whereas without stabilization the consumption was 32 per cent greater, an indication of the energy cost of countering instability.

Animals↗
PubMed2003

[Calcaneus fractures. Open reduction and internal fixation].

AIM OF THIS STUDY: Critical analysis of the medium-term results of open reduction and internal fixation (ORIF) of displaced intra-articular calcaneus fractures with a standardized protocol in a greater patient cohort. METHODS: From October 1993 to December 1999 314 patients (mean age 42.3 years) with 348 calcaneus fractures were seen at the Dresden University Hospital. 41 fractures were open, 4 with 1st degree, 28 with 2nd and 9 with 3rd degree soft tissue damage. 275 displaced intra-articular fractures were treated with ORIF, 262 (95.3 %) with plate osteosynthesis via an extended lateral approach. 169 patients could be evaluated at a mean of 18 months (range 10-47 months) postoperatively with an extended protocol of questionnaire, physical and radiographic examination. RESULTS: The Maryland Foot Score after 18 months follow-up averaged 80.8/100, the mean Zwipp score averaged 146.4/200. The functional result with the Merle d'Aubigné score was judged good to excellent in 86% of cases. Rates of deep infection and superficial wound edge necrosis increased significantly with open fractures and delay in surgery of more than 2 weeks after injury in closed fractures. Clinical results were adversely affected by even minor residual steps in the posterior facet (1-2 mm) as judged by CT or Brodén views (p < 0.001). Böhler's tuberosity-joint-angle had an impact on the final result when falling short compared to the unaffected contralateral side by more than 30% (p < 0.001). CONCLUSIONS: Management of intra-articular calcaneus fractures with a standardized protocol of ORIF and early mobilization leads to reproducible good or excellent clinical results in a majority of patients. New approaches like an interlocking calcaneus plate, the use of subtalar arthroscopy, early soft tissue coverage for complex open injuries and percutaneous screw fixation for selected fractures should further improve prognosis.

Adult↗
PubMed1994

Evaluation of methods of internal fixation of transverse patella fractures: a biomechanical study.

Biomechanical testing was performed to evaluate five techniques of internal fixation of transverse patella fractures. Using cadaveric lower extremities, transverse osteotomies of the patella were performed, and the simulated fractures were fixed with the following techniques: the modified tension band, anterior tension band with a supplemental cerclage wire (the Pyrford technique), tension band with cancellous bone screws, Pyrford technique with cancellous screws, and cancellous screws alone. The fixation techniques were evaluated by measuring the separation of the fracture fragments during loading to produce a physiologic range of motion (90 degrees flexion to full extension). All techniques functioned adequately, with no fracture gap exceeding 1 mm. The tension band with screws technique performed significantly better than did the modified tension band, with an average fracture gap approximately half that of the traditional modified tension band technique. Mechanically, the addition of the screws to the tension band techniques reduces fracture separation by providing compression throughout the range of motion and by resisting the tensile loading during terminal extension.

Aged↗
PubMed1976

The effects of rigidity of internal fixation plates on long bone remodeling. A biomechanical and quantitative histological study.

The effect of rigidity of internal fixation plates on long bone remodeling was studied using two types of plates with considerable differences in stiffness. The plated bones were subjected to bioengineering quantitative histological, and cortical thickness studies after 9 and 12 months. The biomechanical results, together with the quantitative histological measurements of the macroscopic architecture, showed that tissue characteristics of the plated bones were similar. However, because of the larger cortical area, the less regidly plated femora can sustain significantly higher loads and energy before failure. Cortical thickness measurements also showed that rigid plate immobilization results in thinning of the cortex of the underlying bone. The experimental results suggest that cortical bone remodels according to functional stress demands, and the osteoporosis secondary to rigid plate protection is consequent to thinking of its cortex.

Animals↗
PubMed1987

Use of rigid internal fixation in the repair of complex and comminuted mandible fractures.

An overview of the use of rigid internal fixation using the AO method for the repair of complex mandibular injuries is presented. The end result of such an approach is the return of the patient as rapidly as possible to his or her normal status with return to normal alimentation, normal mobility of the mandible, normal airway, and normal access to the oral cavity.

Bone Plates↗
PubMedDate not supplied

Absorbable polyglycolide pins in internal fixation of fractures in children.

Absorbable implants made of synthetic biodegradable polymers were recently introduced clinically in internal fixation of fractures. In this prospective study of 71 pediatric patients with a variety of displaced physeal or nonphyseal fractures, self-reinforced polyglycolide pins 1.5 or 2.0 mm in diameter were used instead of Kirschner wires to fix the fragments. The majority of patients (45 children) had a fracture affecting the distal humerus. Mean age of the patients was 9.8 years (range 2-15 years). Follow-up averaged 15.8 months. In 62 patients (87%), an exact reduction of the fracture could be maintained until union. Among the remaining patients, six had minor inaccuracies or redisplacements of the fracture position, but in three patients with supracondylar fractures of the humerus breakage of the pins resulted in a severe redisplacement that necessitated a change in treatment method. With the exception of supracondylar fractures of the humerus, these preliminary results of polyglycolide pin fixation were deemed satisfactory. The fundamental advantage of this method is that no hardware removal procedures are required.

Adolescent↗
PubMed2006

Open reduction and internal fixation in displaced juvenile Tillaux fractures.

BACKGROUND: Juvenile Tillaux fracture is relatively an uncommon injury for which there appears no established treatment protocol. MATERIALS AND METHODS: Ten patients with juvenile Tillaux fractures were treated by open reduction and internal fixation and the results were evaluated by an objective scoring system. RESULTS: At the latest follow-up (32-75 months) mean score was 99.3 (97-100) by the score of American Orthopaedic Foot and Ankle Society. Radiographically all fractures had healed in anatomical position. CONCLUSION: Treatment of juvenile Tillaux fractures with 2mm or more displacement by internal fixation without any attempt of closed reduction gives excellent results.

Adolescent↗
PubMedDate not supplied

Open reduction internal fixation after displacement of a previously nondisplaced acromial fracture in a multiply injured patient: case report and review of literature.

SUMMARY: A twenty-eight-year-old multiple trauma patient had a nondisplaced acromion fracture that was not detected until after it had displaced. Open reduction internal fixation was performed without complication and the patient achieved excellent shoulder abduction strength. Nondisplaced acromion fractures may displace if not protected. Open reduction internal fixation of displaced acromion fractures should be considered if deltoid muscle strength is important to the patient.

Acetabulum↗
PubMed1995

Mechanical performance of the Dick internal fixator: a clinical study of 75 patients.

A consecutive series of 75 patients with fractures of the thoracolumbar spine, stabilized with the Dick internal fixator, was studied retrospectively. Posttraumatic kyphosis was measured on the preoperative lateral radiograph by the Cobb angle and the wedge angle and the results were compared with angles measured on the radiographs after instrumentation and after removal of the implants. The presence and number of broken Schanz screws was noted. In the whole group, an average correction of kyphosis of 15.5 degrees was obtained, but 7.6 degrees was lost again at follow-up. In comparing the kyphotic angle with the wedge angle, we found that this loss was almost exclusively situated in the upper intervertebral disc space. In the group of patients with transpedicular intravertebral bone grafting, the relative loss of correction in the wedge angle was smaller than in the group without bone grafting, while the relative loss of correction of the kyphotic angle was similar. Schanz screw breakage was present in 13.3% of patients, occurring in 4.6% of inserted screws. In the group of patients with broken Schanz screws, the loss of correction in the wedge angle was somewhat higher, but not markedly different from that of the patient group without breakage of screws. Risk of screw breakage was enhanced by laminectomy and reduced by transpedicular bone grafting. Screw breakage or important loss of correction did not influence the neurological outcome of the patients. The Dick internal fixator is a very reliable implant, even in patients with highly unstable fractures.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2005

Fractures of the distal humerus in the elderly: is internal fixation the treatment of choice?

The incidence of osteoporotic fractures of the distal humerus is increasing, and the treatment of these injuries merits closer review. We assessed the results of 28 elderly patients (29 fractures) with a mean age of 85 years (range, 75-100 years). Open reduction and internal fixation was done on 21 elbows, and eight elbows were treated nonoperatively. Orthopaedic Trauma Association grading showed that the group treated with internal fixation had favorable results (three excellent, nine good, seven fair, and two poor) compared with the nonoperatively treated group (zero excellent, two good, three fair, and three poor). Mean loss of extension and mean flexion were better in the surgically treated patients (23.5 degrees and 99 degrees ) than in the nonoperatively treated patients (33.5 degrees and 71 degrees ). Substantial pain relief (mild or no pain) was achieved in a higher proportion (52%) in the surgically treated group than in the nonoperatively treated group (25%). Anatomic restoration of distal humeral tilt and articular congruity also were better in the surgically treated patients. Rates of complications were observed to be comparable to those described in the literature for younger patients. These findings reflect the relevance of surgical fixation of such fractures in this age group highlighting the need for additional clinical studies.

Aged↗
PubMed1991

Displaced fractures of the head and neck of the radius in children: open reduction and temporary transarticular internal fixation.

This report reviews the results of 36 children surgically treated for fractures of the head and neck of the radius. Indications for operation were: displacement over 2 mm and/or angulation over 45 degrees. Treatment included open reduction and temporary internal fixation with a K-wire transfixing the joint. Eighteen children had a good result, 8 had a fair result, and 10 had a poor result. It appears that when radial head fractures are associated with severe displacement, a high rate of fair and poor results can be expected, despite treatment by open reduction and temporary internal fixation.

Bone Wires↗
PubMed2005

Biomechanical investigation of different internal fixations in medial opening-wedge high tibial osteotomy.

BACKGROUND: The medial opening-wedge osteotomy for treatment of varus gonarthritis has become very popular in recent years. Different implants for internal fixation after the osteotomy have been created. It is still unclear, which principle of internal fixation (angle stable or non-angle-stable plate with or without spacer) has the best biomechanical properties. The aim of this study was to determine the biomechanical properties of different fixation techniques in medial opening-wedge high tibial osteotomy in a porcine bone model. METHODS: A 10-mm high tibial opening-wedge osteotomy was performed and stabilized with plates of similar dimensions but different functional principle (conventional plate, angle stable plate with or without spacer). Biomechanical properties (stiffness, displacement within the osteotomy space and load at failure) were evaluated under axial load. RESULTS: Plates which contain a spacer had a significantly higher stiffness at a load at 1000 N (p < 0.05). This correlates with a significantly reduced deformation within the osteotomy space. The strength at failure was not different between the groups. The use of a spacer in a conventional plate produces fractures of the lateral tibial cortex. In angle stable plates and plates containing spacers, the failure was caused by fractures of the lateral tibia surface, the fibula or by displacement within the tibio-fibular joint. The failure was caused primarily by implant insufficiency in plates without spacers. CONCLUSIONS: In a model with comparable conditions, implants which contain a spacer have superior biomechanical properties. Angle stable plates may prevent fractures of the lateral cortex after opening-wedge osteotomy.

Animals↗
PubMed1976

Methylmethacrylate as an adjunct in internal fixation of pathological fractures. Experience with three hundred and seventy-five cases.

In 323 patients with 375 pathological fractures or impending fractures, local tumor resection and internal fixation supplemented by intramedullary methylmethacrylate proved highly successful. One hundred and thirty-nine patients had metastases from breast carcinoma; 142, metastases from other tumors; and forty-two, myeloma or lymphoma. The mean survival for the 210 patients who had undergone operation two years or more before final evaluation was 15.4 months. Ninety-four per cent of the patients who were ambulatory before fracture regained the ability to walk. Eighty-five per cent had excellent or good pain relief and in only five was pain relief rated poor. There were four failures of fixation and six functionally poor results. Twenty patients died within four weeks of operation, but the remaining patients benefited from the procedure in terms of pain relief, improved mobility, and ease of nursing care.

Acetabulum↗
PubMed2004

[Hip arthroplasty after failed internal fixation of the trochanteric fractures in aged patients with co-existent osteoporosis].

The authors present the results of hip arthroplasty of 67 patients treated after failed internal fixation of the osteoporotic, trochanteric fractures of the femur, which were primary stabilised with angular plate AO in 39 patients and with dynamic hip screw (DHS) in 28 patients. In the discussed material 16 persons were male and 51 female, in the age between 51 and 83 years old. According to the Evans classification in 4 cases we diagnosed type I of fracture, in 10--type II, 31--type III and in 22--type IV. Hip arthroplasty was made from the 3rd to the 39th week after primary fixation of the fracture. In 42 patients we made total hip arthroplasty, in 14 cases Austin-Moore hemiarthroplasty, and in 11 patients bipolar arthroplasty. According to the Postel and Merle d'Aubigne classification there were obtained 29 very good, 21 good and 17 satisfactory results.

Aged↗
PubMed2005

Strength analysis of titanium and resorbable internal fixation in a mandibulotomy model.

PURPOSE: Mandibulotomy is used to access various tumors of the tongue base, posterior oral cavity, pharynx, parapharyngeal space, and cranial base. Internal fixation using titanium plates and screws is the most common method of stabilization. These have the potential for interference with radiotherapy delivery. This in vitro study compares the strength of titanium and resorbable internal fixation in a mandibulotomy model by analyzing the force required for plate and screw breakage. MATERIALS AND METHODS: Red oak wood board was used to simulate the mandible. Titanium and resorbable plates and screws in various configurations were used to stabilize pieces of the wood. They were arranged in 6 different groups. The specimens were individually tested with a vertical load, while the test machine recorded the force-versus-displacement behavior automatically. RESULTS: Plate type and configuration affected the applied load required to induce displacement of the simulated mandibulotomy. Heating and cooling the resorbable plates prior to strength testing also affected the load-versus-displacement curve. CONCLUSIONS: Overall, the titanium system we studied exhibited greater resistance to deformation from a vertical load than did the resorbable plate groups.

Absorbable Implants↗