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At least 1,081 records · Page 60Linked to original sources
PubMed1995

Computed tomographic evaluation of the normal adult odontoid. Implications for internal fixation.

STUDY DESIGN: Computed tomography scans of the dens were performed on patients who had no atlantoaxial pathology. OBJECTIVES: To determine whether one or two screws is optimal for fracture fixation and whether two screws can always negotiate the intramedullary odontoid cavity. SUMMARY OF BACKGROUND DATA: Fixation of Type II dens fractures traditionally has used C1-C2 posterior wiring and fusion. Two screws placed across an odontoid fracture as a method of rigid internal fixation also has been described. However, it is not known whether two screws can always negotiate the odontoid canal. METHODS: Ninety-two consecutive computerized tomography scans of the dens were performed on adults who had no atlantoaxial pathology. Measurements were taken from the scan and compared with the cross-sectional diameter of two odontoid screws. RESULTS: The critical diameter for the placement of two 3.5-mm cortical screws with tapping was 9.0 mm. This dimension was present in 95% of the patients studied. CONCLUSIONS: Correct orientation of the computerized tomography scanner is critical for accurate measurements. Two 3.5-mm screws can be used in internal fixation of Type II dens fractures in 95% of the patients if the inner cortex is tapped.

Adolescent↗
PubMed1998

Open reduction and internal fixation of acetabular fractures.

Between 1982 and 1995, 84 patients with displaced acetabular fractures underwent open reduction and internal fixation in our institution. The mean follow-up was 5.5 years with a minimum of 2 years. There were 33 simple and 51 complex fractures according to the classification of Judet and Letournels. Reduction after operation was anatomical in 49% of the patients, satisfactory in 24%, and unsatisfactory in 27%. Using Merle d'Aubigné's scale, the clinical results were excellent in 39% of the patients, good in 29%, fair in 8%, and poor in 24%. Factors of statistical significance associated with a poor clinical outcome were T-shaped fractures, unsatisfactory reduction (> 3 mm residual displacement), age > 40 years and development of avascular necrosis. Acetabular surgery is demanding, and a high rate of complications can be expected. Trauma centres should designate a group of surgeons who will consistently treat these fractures in order to obtain more experience and better results.

Acetabulum↗
PubMed1990

Internal fixation of pubic symphysis diastasis with a tension banding technique.

We present the details of a method of internally fixing diastasis of the pubic symphysis with stout wires and a tension band which can be employed with speed and ease, through a minimal exposure or minimally extended laparotomy wound. The technique is suitable for those with little experience of internal fixation of the pelvis. Our initial cases are presented.

Adolescent↗
PubMed1992

Canal clearance in burst fractures using the AO internal fixator.

The purpose of this study was to evaluate the ability of posterior distraction delivered by the AO internal fixator to effect a satisfactory reduction of the intraspinal fragments in burst fractures. The overall decompression achieved was from an initial compromise of 54% to a residual encroachment of 40%. Canal clearance proved most effective when carried out in the first 4 days, with an initial canal compromise of between 34 and 66%. The extent of improvement, even in this group, was not dramatic, with an average of 31% encroachment still remaining, with some cases as high as 50%. Therefore, we recommend that when canal clearance is essential, anterior decompression is the treatment of choice.

Fracture Fixation, Internal↗
PubMed2003

Optical plantar pressure analysis following internal fixation for displaced intra-articular os calcis fractures.

Using optical pedobarography, the outcome of open reduction and internal fixation of displaced os calcis fractures was assessed. In 12 patients, well reconstructed heel contact widths and no reduction in heel-ground contact times were found. In conjunction with this, patients showed lateral deviation of the plantar pressures and load bearing, indicating that subtalar and calcaneocuboid joint function remained altered despite reconstruction. These findings could not be linked to the initial fracture severity or clinical outcome score.

Adolescent↗
PubMed1983

Hindfoot disability after a tibial shaft fracture treated by internal fixation.

One hundred patients who had sustained a fracture of the tibial shaft and had been treated by internal fixation were reviewed to obtain information on residual ankle and subtalar disability. This study reinforces the belief that early mobilisation of patients with tibial shaft fractures does help to preserve subtalar movement.

Adult↗
PubMed1991

Internal fixation of femoral neck fractures. Two methods compared.

In a prospective randomised study, the Hansson pin technique for internal fixation of fractures of the femoral neck was compared with the Uppsala screw technique. The series consisted of 115 consecutive patients, 97 women and 18 men, with a mean age of 80 years. There were 56 patients treated with Hansson pins and 59 with Uppsala screws. After one year 22 patients had died, eight in the Hansson pin group and 14 in the Uppsala screw group (p = 0.28). Twenty-four complications had occurred, 18 in the Hansson pin group and six in the Uppsala screw group (p = 0.008). After exclusion of those with complications, the patients in the Hansson pin group had significantly more pain, less mobility, and a smaller proportion were living in their own homes.

Aged↗
PubMed1992

Pseudoaneurysm of the profundus femoris artery resulting from chronic injury of internal fixation screw.

We present an unusual case of pseudoaneurysm of profundus femoris artery which formed after injury from internal fixation screw for intertrochanteric fracture 8 years before. The main clinical manifestation was progressively enlarged pulsating mass and mild intermittent claudication. We resected the pseudoaneurysm after ligating the vessel proximal and distal to the pseudoaneurysm and cut off the excessive tip of the screw. After operation, the recovery was uneventful and no problem of the limb viability was noted.

Aged↗
PubMed1990

Factors influencing the results of open reduction and internal fixation of tibial plateau fractures.

Forty-three displaced tibial plateau fractures were treated with open reduction and internal fixation. The fractures were classified into four groups, and the clinical results were evaluated using a standard 100-point knee rating system. The average follow-up period after surgery was 2.7 years. Overall there were 35 excellent, five good, three fair, and no poor results. In five of eight knees with a less than excellent score, the results were due to the technique of fracture fixation or the absence of a bone graft. There were ten postoperative complications, but only one ultimately affected the clinical result. Fourteen patients required removal of implants. Roentgenographic analysis showed that six knees had mild degenerative changes, two had moderate, and two had severe degenerative changes. There was no statistically significant association between the fracture type and a less than excellent result. The absence of bone grafting, however, was associated with a less than excellent result. Bicondylar fractures had a mean range of motion of 110 degrees, 18 degrees less than that of all other types of fracture combined.

Adolescent↗
PubMed1994

Posterior atlantoaxial fusion. A new internal fixation device.

STUDY DESIGN: Biomechanical and clinical testing of an atlantoaxial posterior fixation device. OBJECTIVES: The authors tested an internal fixation device to maintain the atlas and axis in an anatomic relationship while fusion occurs. The device should also facilitate intraoperative reduction of any residual anterior atlantoaxial subluxation. The device should allow the use of cancellous rather than cortical bone graft. SUMMARY OF BACKGROUND DATA: Previous techniques of atlantoaxial fusion were not universally successful, and the quality of reduction was assessed infrequently. METHODS: Biomechanical testing of the fixator and clinical use in two "problem" patients requiring atlantoaxial fusion. RESULTS: Biomechanical testing indicated the device should be successful. Clinical testing was successful. CONCLUSION: The new fixator facilitates posterior atlantoaxial fusion in an anatomical position.

Atlanto-Axial Joint↗
PubMed2006

Indirect reduction and biological internal fixation of comminuted subtrochanteric fractures of the femur.

BACKGROUND: Surgical treatment of comminuted subtrochanteric fractures may be associated with high incidences of non-union and implant failure. Biological fixation may solve this problem by encouraging rapid callus formation which buttresses the medial cortex. METHODS: In all, 33 patients with comminuted subtrochanteric femur fractures underwent indirect reduction and biological internal fixation. The mean age of the group was 39.12 (19-64) years. RESULTS: Patients were followed up for a mean of 24.6 (12-66) months. Union was achieved within a mean of 15.10 (13-22) weeks, with no cases of delayed union or non-union but with limb-length discrepancy, mean 1.22 (1-2) cm, in nine cases. According to the Traumatic Hip Rating Scale, functional results were excellent in 23 and good in 10 cases. CONCLUSIONS: Indirect reduction and biological internal fixation yield acceptable results in comminuted fractures. These good results can be attributed to early weight-bearing with rapid solid callus formation and early union, which are particularly advantageous in comminuted subtrochanteric fractures, avoiding the implant failure which is not uncommon in these fractures.

Adult↗
PubMed1993

Comparison of CT imaging artifacts from craniomaxillofacial internal fixation devices.

This study compares the artifacts caused by craniomaxillofacial internal fixation devices in CT images. Mandibular reconstruction and "mini" titanium, Vitallium, and stainless steel systems, "micro" titanium and Vitallium systems, and stainless steel wires were evaluated. The hardware was placed on a nylon grid and submerged in water. CT images were obtained with both bone and soft-tissue window settings. All artifacts were compared and graded after a minimum of five observations each. The severity of "starburst" artifact was found to be related to the physical size of the fixation hardware and its composition. Titanium hardware caused the least amount of artifact. Vitallium and stainless steel fixation devices, with the exception of interfragmentary wiring, produced significantly more artifact. These results agree with theoretical predictions. The data indicate that when postoperative imaging is an important clinical consideration, (1) the least amount of implant material necessary to achieve stable fixation should be used, (2) the proximity of implant material to the area of interest should be considered, and (3) titanium implants produce less artifact than Vitallium or stainless steel implants.

Artifacts↗
PubMed2001

Trimalleolar fracture with a double fragment of the posterior malleolus: a case report and modified operative approach to internal fixation.

Fractures of the medial and lateral malleoli are frequently associated with fractures of the posterior malleolus, comprising trimalleolar fractures. The posterior fragment may be posteromedial or posterolateral and its size determines the necessity for surgical or non-surgical treatment. The authors describe a case of trimalleolar fracture with double involvement of the posterior malleolus, both a posteromedial and posterolateral fragment. A modified transmalleolar operative approach for internal fixation is recommended when dealing with such complex trimalleolar fractures of the ankle.

Ankle Injuries↗
PubMed1994

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

Thirty-one patients, ranging in age from 19 to 62 years (average, 55 years), were evaluated an average of six years seven months (range, one to 12 years) after open reduction and internal fixation of a three- or four-part fracture of the proximal humerus. Six patients had an associated dislocation of the humeral head. A modified cloverleaf plate was used in 26 cases and an AO T-plate in five cases. All fractures healed. No avascular necrosis of the humeral head was observed at follow-up examination. Twenty-three patients had an excellent result, two had a good result, and six had a fair result. Open reduction and internal fixation of three- and four-part fractures of the proximal humerus are indicated as initial treatment, even before the use of a prosthetic replacement, which should be recommended only for elderly patients with osteoporotic bones.

Adult↗
PubMed1998

Comminuted fractures of the radial head. Arthroplasty versus internal fixation.

Fractures of the radial head continue to challenge orthopaedic surgeons. Fortunately, most simple uncomplicated fractures treated non-operatively with emphasis on early motion achieve good results. Treatment of more complex fractures remains controversial, however. When simple radial head excision is contraindicated, choosing between open reduction and internal fixation and radial head replacement remains difficult. A review of the literature does not provide definite guidelines, but suggest that fracture complexity and technique are critical for success. This paper is not intended to review the treatment of radial head fractures, but rather to focus on choosing between replacement versus internal fixation when preservation of radial head mechanics is indicated.

Arthroplasty↗
PubMed1998

The nonarticulating portion of the radial head: anatomic and clinical correlations for internal fixation.

The proximal radioulnar joint was dissected in 24 cadaveric elbows to localize the area of the radial head that did not articulate with the lesser sigmoid notch of the ulna. The nonarticulating portion of the radial head was posterolateral in the anatomic position of full supination. Gross observations of the nonarticulating portion of the radial head revealed a thinner band of yellowish cartilage relative to a wider, white, glistening cartilage of the articular portion of the radial head. The nonarticular portion of the radial head did not contain the angled peak, which is most prominent in the middle of the articular portion. The average arc of the nonarticulating radial head was 113 degrees (range, 106 degrees to 120 degrees; standard deviation, 4 degrees). This nonarticulating portion of the radial head (or safe zone for prominent fixation) consistently encompassed a 90 degrees angle localized by palpation of the radial styloid and Lister's tubercle. Using these palpable distal landmarks to localize the safe zone of the radial head, 24 different cadaveric elbows were internally fixed with a plate and screws through 3 different approaches (anterior, lateral, and posterolateral). Regardless of approach, the internal fixation allowed full forearm rotation in all the specimens. Utilization of this method and anatomic landmarks to localize the nonarticular portion of the radial head may assist the surgeon in open reduction and internal fixation of fractures of the radial head and neck.

Cadaver↗
PubMed2003

Acute traumatic lumbosacral dislocation treated by open reduction internal fixation and fusion.

STUDY DESIGN: Case report of a patient with acute traumatic lumbosacral dislocation. OBJECTIVE: To report a case of traumatic lumbosacral dislocation treated with open reduction internal fixation and fusion. SUMMARY OF BACKGROUND DATA: To our knowledge, there are only 49 cases reported in the literature of this exceptional lesion. Complete lumbosacral dislocation is a three-column lesion, and therefore, open reduction internal fixation and fusion is recommended. METHOD: We report the case of a 42-year-old man who had a vehicle accident. In addition to other fractures, he suffered an anterior lumbosacral dislocation. The displacement of L5 on S1 was 35%. The patient was surgically treated with open posterior reduction fixation and fusion with good result. RESULTS: Complete fusion was achieved, and at 5 years follow-up, the patient was asymptomatic, and no further slippage has been observed. CONCLUSIONS: A rare case of acute anterior lumbosacral dislocation treated surgically is reported. We consider the surgical treatment for reduction, decompression, stabilization, and fusion as the method of choice in acute cases of this exceptional condition.

Accidents, Traffic↗
PubMed1978

Internal fixation of fractures.

In recent years close consideration of the biomechanical principles of treatment of mandibular fractures has led to the use of operative as well as conservative methods. Since this combined method of treatment appeared cumbersome, a new kind of osteosynthesis plate was developed for functionally stable internal fixation of mandibular fractures, without the necessity of additional fixation elements. After consideration of the biomechanics of the mandible, an even greater indication for the use of the lag-screw osteosynthesis is found. Use of both the tension band plate and the lag screw makes it possible to perform the operation intraorally. This is a further indication for the use of the operative internal fixation of fractures in the treatment of mandibular fractures, since it has many advantages for the patient.

Bone Plates↗