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At least 1,099 records · Page 61Linked to original sources
PubMed2003

Quantitative anatomic characterisation of the pelvic brim to facilitate internal fixation through an anterior approach.

PURPOSE: To define the centre of the hip joint and the bone stock around the hip joint from the supra-acetabular portion or pelvic brim so as to avoid penetration of guidewire into the hip joint when performing internal fixation using the anterior approach. METHODS: A total of 42 cadavers were utilised. Measurements were completed before and after cutting the pelvis into 4 pieces. Before cutting the pelvis, the centre of the hip joint was measured on the pelvic brim. After cutting the pelvis, the bone stock around the hip joint was measured in each section. The pelvic brim and the anteroinferior iliac spine were utilised as guide points in the measurements, because these parameters could be determined during an anterior surgical procedure. RESULTS: On the pelvic brim, the reflected centre of the hip joint centre was located approximately 3.2 mm anterior to the distal edge of the anteroinferior iliac spine. The mean minimum bone stock of the pelvic brim was 14.0 mm in the centre of the hip joint section. CONCLUSION: This study described the anatomical reference points around the hip joint, and the ways in which they can be utilised to increase the safety of the anterior approach for internal fixation. It is important to define the centre of the hip joint from the supra-acetabular portion or pelvic brim, given that it is not visualised during surgery using an anterior approach.

Body Weights and Measures↗
PubMed2001

[Internal fixation of subcapsular fractures of the femoral neck].

Beside of modern surgical and implant techniques and basic pathophysiological knowledge, internal fixation of subcapsular fractures of the neck of the femur is still known to be connected with a high rate of complications. Implant failure, the typical early complication arising within the first 3 months, non-union, avascular necrosis of the femoral head and late segmental collapse are the typical complications. The type of fracture, timing of operation (emergency operation), quality of reduction and implant positioning have all been shown to predict outcome significantly. However, it is also suggested that further therapeutical interventions like intra-articular pressure decrease by evacuation of hematoma, the kind and technique of reduction, special surgical techniques and postoperative treatment can influence outcome, as well as patient-associated factors like age, degree of osteoporosis, neurological disease, and alcoholism. The superiority of one of the 100 different existing implants have not been proved either by clinical or by biomechanical trials. However, besides screw osteosynthesis, the sliding screw plate and less often sliding nail plate implants are commonly used. Because of the very different biomechanical principles it is of great importance to adhere to the special operative techniques to avoid intraoperative complications that might cause treatment failure. To reduce the frequency of these almost always fatal and in special circumstances lethal complications, we need some more detailed information from good clinical trials and sufficient external quality assurance.

Femoral Neck Fractures↗
PubMed2000

[3-dimensional movement analysis after internal fixation of pelvic ring fractures. A computer simulation].

Several studies exist describing the biomechanical behavior of several external or internal fixation techniques of the posterior and anterior pelvic ring. Recently, the traditional models using isolated anatomical sections or fixed pelvic ring specimens for evaluation of linear or two-dimensional data have been replaced by three-dimensional measurement systems and simulations of muscle forces. These studies have contributed important information to the understanding of the biomechanics of the intact and injured pelvic ring, however, a consequent movement analysis is still missing. In the present study, 3-D data acquired during several series of testing implants for stabilization of the posterior pelvic ring (sacrum: sacral bars, sacral plates, transiliosacral lag screws; Sl joint: anterior plates, transiliosacral lag screws), using a complete pelvic ring model with single leg stance and static abductor muscle simulation, were converted into a commercially available 3-D animation package. By use of simple graphical representation of anatomical elements of the posterior pelvic ring, reproducible and reliable movement patterns for different types of stabilization could be identified, which demonstrated potential "weakness" of the fixation before failure occurred. These movements were analyzed by "replay functions" and were comparable to observations during the original experiment. The following movements were observed. Sacral fracture, transforaminal: (1) rotation of the transiliosacral lag screws around its axis, even with a second screw into S1; (2) Sacral bars: shearing with compression of the cranial-posterior fracture zone; (3) Sacral plates: minimal translation in the proximal fracture zone and distraction in the distal fracture line, effectively compensated by an additional plate at the S3 level. Sl joint disruption: (1) anterior plating (two plates), minimal translation in the plane of the Sl joint; (2) transiliosacral lag screws, rotational movement around the axis of the screws with only minimal movement at the S1 level. The provided information confirmed the observations and allowed a more detailed and comfortable examination of movement patterns. A better understanding of potential "failure zones" might be useful to optimize the dimensions, design, and the positioning of implants for the pelvic girdle. For further studies, more complex computer models including finite element technology might be useful to add accessory information and could result in a decreased need of living specimen testing.

Biomechanical Phenomena↗
PubMed2001

Incidence of hardware-related pain and its effect on functional outcomes after open reduction and internal fixation of ankle fractures.

OBJECTIVES: To document the incidence of late pain and hardware removal after open reduction and internal fixation (ORIF) of ankle fractures. To test the hypothesis that late pain overlying the distal tibial and fibular hardware is associated with poorer functional outcomes. DESIGN: Retrospective review. SETTING: Level II trauma center. PATIENTS: One hundred twenty-six skeletally mature patients undergoing ORIF of unstable malleolar fractures who were followed up for at least six months from injury were included. MAIN OUTCOME MEASUREMENTS: Analog pain score, Short Form-36 Health Survey (SF-36), and Short Form Musculoskeletal Functional Assessment (SMFA). RESULTS: Thirty-nine (31 percent) of the 126 patients had lateral pain overlying their fracture hardware. Twenty-nine patients (23 percent) had had their hardware removed or desired to have it removed. Of the twenty-two patients with hardware-related pain who had undergone hardware removal, only eleven had improvement in their lateral ankle pain; the mean analog pain score decreased from 6 +/- 3.16 (mean +/- standard deviation) before hardware removal to 3 +/- 2.9 after hardware removal (p = 0.008). In general, SF-36 and SMFA scores at final follow-up were significantly lower for patients who had pain overlying their lateral hardware than for those who had no pain. For the group of patients who had lateral ankle pain, no significant difference was noted in SMFA or SF-36 scores for patients who had and who had not had their lateral hardware removed (p > 0.5). CONCLUSION: The incidence of late pain overlying the distal tibial and fibular plate or screws is not insignificant. Although pain is generally decreased after hardware removal, nearly half of patients continue to have pain even after hardware removal. Functional outcome scores are poorer for patients with pain overlying lateral ankle hardware than in those with no pain at this location; this poorer outcome seems to be independent of whether the hardware was removed. Although the results of this study do not support or condemn the routine removal of fracture hardware after healing of unstable ankle fractures, they give orthopaedic surgeons some information that may assist them in counseling patients as to the expected functional outcome after ORIF of ankle fractures and the likelihood of relief of pain after removal of fracture hardware from the distal tibia and fibula.

Adolescent↗
PubMed2005

"Smile" incision: an approach for open reduction and internal fixation of calcaneal fractures.

MATERIALS: A consecutive group of 73 patients (77 calcaneal fractures) treated with open reduction and internal fixation through a smile-shaped lateral approach to the hindfoot were reviewed retrospectively. Inclusion criteria were a closed displaced intra-articular fracture of the calcaneus, no compartment syndrome, and adequate followup. Followup ranged from 4 months to 4 years. RESULTS: One patient had a deep wound infection that required removal of hardware and intravenous antibiotics. No deep dehiscence or flap necrosis occurred. Superficial dehiscence occurred in three patients (4%) and superficial necrosis was seen in nine patients (12%); all resolved with continued casting to protect the wound. Six patients (8%) complained of numbness or pain in the sural nerve distribution. No symptomatic neuromas were seen. Reflex sympathetic dystrophy occurred in three patients (4%); all resolved with sympathetic blocks. Only one patient required an additional procedure for treatment of a wound-related problem or infection. CONCLUSION: The "smile" incision provides good fracture exposure for reduction without added morbidity.

Calcaneus↗
PubMed2003

Treatment of supracondylar femur nonunions with open reduction and internal fixation.

We reviewed a consecutive series of 22 adults with 22 supracondylar femoral nonunions treated with open reduction and internal fixation (ORIF) to determine the results and complications associated with the procedure. Twenty-one of 22 nonunions (95%) healed. Knee Society pain scores improved from 18 to 88 (P < 0.001). Mean Knee Society functional scores improved from 4 to 55 (P < 0.001). Mean range of motion at follow-up was 1 degree to 96 degrees. ORIF and bone grafting of properly selected patients with nonunions of the distal femur resulted in high rate of union with few associated complications. All patients had improvement in pain scores and the great majority had improvements in functional scores.

Femoral Fractures↗
PubMed2005

[Application of temporal anterior hairline incision in internal fixation of zygomatic complex fracture].

PURPOSE: To investigate the methods, merits and effects of temporal anterior hairline incision in internal fixation of zygomatic complex fracture (ZCF). METHODS: 99 cases of ZCF were treated via vertical incision in temporal anterior hairline. During dissection, the zygomatic branch and the frontal branch of the facial nerve, which crossed over the zygomatic arch, were protected. The deep fascia superficial to the zygomatic arch was horizontally incised, the periosteum was elevated at the fracture sites. Cases of type A1 were treated through the above approach; while minor periorbital and oral vestibule incisions were also used in cases of type B and C. The fracture segments were reduced accurately and fixed with titanium microplates. Coronal incision was not applied in all cases. RESULTS: The clinical results were good in 99 cases (86.0%). All the temporal anterior hairline incisions healed primarily. The rate of temporary facial paralysis, due to injury of the zygomatic and frontal branch of the facial nerve, was 24.3%; but all recovered six months later, without any permanent paralysis. CONCLUSION: The temporal anterior hairline incision has many merits including clear field of operation, convenient manipulation, minimal trauma, less bleeding, high accuracy of reduction and inconspicuous scar.

Dissection↗
PubMed2004

Biomechanical evaluation of the less invasive stabilization system, angled blade plate, and retrograde intramedullary nail for the internal fixation of distal femur fractures.

OBJECTIVE: To evaluate the stability of the retrograde intramedullary nail (IMN), angled blade plate (ABP), and a locked internal fixator (Less Invasive Stabilization System [LISS], Synthes, Paoli, PA) for internal fixation of distal femur fractures. DESIGN: Destructive biomechanical testing of matched pairs of fresh-frozen human cadaveric bone-implant constructs. SETTING: Biomechanical laboratory. METHODS: A fracture model was created to simulate an AO/OTA33-A3 fracture. Forty-eight matched pairs of specimens were used. Six groups of 8 pairs each were tested to failure: LISS versus ABP and LISS versus IMN (axial, torsional, and cyclical axial). MAIN OUTCOME MEASUREMENT: Load to failure, mode of failure, energy to failure, displacement at the load to failure, and stiffness. RESULTS: Fixation strength (load/moment to failure) of the LISS constructs was 34% greater in axial loading (P = 0.01) and 32% less in torsional loading (P = 0.05) compared with ABP constructs and 13% greater in axial loading (P = 0.35) and 45% less in torsional loading (P < 0.01) compared with IMN constructs. Loss of distal fixation in axial loading occurred in 1 of 16 cases with the LISS, in 3 of 8 cases with the ABP, and in 8 of 8 cases with the IMN. Cyclical axial loading demonstrated significantly less plastic deformation for the LISS construct compared with ABP constructs (P < 0.01) and similar plastic deformation compared with IMN constructs (P = 0.98). CONCLUSIONS: All 3 fixation devices (LISS, ABP, and IMN) offer sufficient torsional stability and sufficient proximal fixation that withstands axial loading without failing. The LISS provides improved distal fixation, especially in osteoporotic bone, at the expense of more displacement at the fracture site.

Aged↗
PubMed1991

Open reduction and internal fixation of two-part displaced fractures of the greater tuberosity of the proximal part of the humerus.

Twelve patients, ranging in age from thirty-four to seventy-two years (average, fifty-three years), were evaluated an average of five years (range, two to eight years) after open reduction and internal fixation of a two-part displaced fracture of the greater tuberosity of the proximal part of the humerus. The indication for operative reduction was one centimeter or more of displacement of the fracture as seen on the diagnostic radiographs. The anterosuperior deltoid-splitting approach, combined with rotation of the humerus, allowed adequate exposure of the retracted tuberosity. Internal fixation of the greater tuberosity with heavy, non-absorbable sutures and careful repair of the rotator cuff permitted early passive motion. All fractures healed without postoperative displacement. Six patients had an excellent result and six had a good result; active elevation averaged 170 degrees. There was one partial, transient palsy of the axillary nerve.

Adult↗
PubMed2003

[Biological internal fixation -- guidelines for the rehabilitation].

The process of fracture healing restores the biological and mechanical state of the bone tissue. In contrast to other tissues, bone has the unique capacity to heal through a real repair process resulting not in a scar but in a regular reconstitution of its original tissue structure. During the last two decades, the understanding of bone biology continuously evolved leading to the new concept that preservation of the viability of the bone fragments is the key to unimpaired fracture healing. The biological fracture management provides environmental conditions that allow the natural healing process to occur as quickly and undisturbed as possible. In comminuted diaphyseal and metaphyseal fractures, the reduction process strives for restoration of proper length and axial and torsional alignment. Thereby, the reduction technique is mainly indirect, i.e. without direct visualization of the fracture area. The primary stability of an osteosynthesis seems to be of secondary importance for achieving sound bone healing. Stabilization can either be performed with an intramedullary nail or a bridging plate. The new biological plating technique imitates the concept of intramedullary fixation. It requires the use of a long implant working with improved leverage. This reduces both, the loading of the screws and the loading of the plate. The good healing capacity of viable fragments and their integration into the fracture callus protects the implant (especially a plate) from fatigue failure. To help to accomplish this new concept of biological plate fixation, new implants such as the Locking Compression Plate (LCP) have been introduced. The mechanical efficiency of this new plate generation is enhanced due to its possibility for angular stability screw insertion; load transfer by friction can be replaced by a load transfer by interlocking (internal fixator), reducing the biological interference of this implant (no contact implant). Functional rehabilitation with painfree mobilization needs to be performed carefully because the loading capacity of the biological plate osteosynthesis is low until radiological signs of bone healing via callus formation is visible. Clinical signs of overload and radiological indicators of potential mechanical failure of the fixation have to be identified by the general practitioners, and the compliance of the patient has to be controlled during the rehabilitation phase to avoid complications after biological internal fixation.

Bone Plates↗
PubMed2000

Displaced scaphoid fractures treated with open reduction and internal fixation with a cannulated screw.

BACKGROUND: This study was performed to determine if the accuracy of screw placement was improved with use of the Herbert-Whipple cannulated screw compared with use of the AO/ASIF cannulated screw and also to evaluate the functional results in patients with an acute displaced fracture of the waist of the scaphoid treated with open reduction and internal fixation with a cannulated screw. METHODS: We retrospectively reviewed the results for thirty-five patients in whom an acute displaced fracture of the waist of the scaphoid had been treated with internal fixation with use of a cannulated screw. The patients were divided into two groups; Group 1 consisted of nineteen patients managed with a 3.5-millimeter cannulated AO/ASIF screw from 1990 through 1997, and Group 2 consisted of sixteen patients managed with a Herbert-Whipple screw from 1993 through 1997. RESULTS: There were no clinical or radiographic differences between the two groups. The average time to union (and standard deviation), confirmed with tomography, was 4.2 +/- 1.2 months for Group 1 and 4.0 +/- 1.2 months for Group 2. Both screws significantly improved the alignment of the scaphoid and decreased carpal collapse (p < 0.01). Importantly, the use of either cannulated screw improved the height-to-length ratio and the lateral intrascaphoid angle, which were correlated with an increase in the range of motion of the wrist (r = 0.584 and 0.625). In addition, both screws allowed for accurate placement in the central portion of the proximal pole. Regardless of the type of screw used, the time to union increased with increasing age of the patient (r = 0.665) and with increasing initial displacement of the fracture (r = 0.541). Within both groups, the time to union was longer for the patients who smoked (p < 0.01). CONCLUSIONS: Within both groups, cannulated screw fixation maintained the corrected fracture alignment and promoted healing and return of function. Our study shows cannulated screws to be a safe and effective method of treatment.

Adult↗
PubMed1992

Osteosynthesis of pathologic fractures and prophylactic internal fixation of metastases in long bones.

Osteosynthesis was performed in 36 pathologic fractures, and in 21 metastases prophylactic internal fixation was carried out. The principles of the operative technique consist of a rigid osteosynthesis with removal of metastatic tissue and filling up of the bone defect with allograft or methylmethacrylate. The indications and benefits of prophylactic internal fixation are discussed.

Adult↗
PubMed2001

Osteosynthesis of diaphyseal fractures of the radius and ulna using an internal fixator (PC-Fix). A prospective study.

Over a five year period, 121 forearm shaft fractures in 82 patients including nine non unions were fixed using the PC-Fix. Two patients died early; of the remaining 80 patients (119 bones) 96% were followed until bone healing. No non unions or late infections were observed in spite of the fact that no primary bone grafts were used except when treating non unions. In this clinical study with a high follow up rate using a newly developed internal fixator, encouraging overall results were achieved and the technology of monocortical locked screws was proven to be valid.

Adolescent↗
PubMed2001

Retrosternal displacement after physeal fracture of the medial clavicle in children treatment by open reduction and internal fixation.

Retrosternal displacement of the medial aspect of the clavicle after physeal fracture is rare. We treated six patients with this injury between 1995 and 1998, all as an emergency in order to avoid complications associated with compression of adjacent mediastinal structures. Attempted closed reduction was undertaken, but all required open reduction and internal fixation using a wire suture. There were no associated complications. Five were reviewed clinically and radiologically at a minimum of one year after operation. All had regained full use of the affected arm without pain and had resumed their preinjury level of activity including sports. Follow-up radiographs showed union in the anatomical position in all patients. We recommend attempted closed reduction in the operating room, followed, if necessary, by open reduction. Internal fixation after open reduction gives stable fixation with minimal morbidity.

Adolescent↗
PubMed1994

Complications of internal fixation of tibial plateau fractures.

All cases of displaced tibial plateau fractures treated by open reduction and internal fixation at two university hospitals over a 3-year period were retrospectively reviewed. There were 47 fractures in 45 patients. Rigid fixation to allow early motion was the goal in all cases. There were 3 AO type I (wedge) fractures, 20 AO type III (wedge/depression) fractures, and 24 AO type IV (comminuted/bicondylar) fractures. Cases were classified into three groups depending on the amount of hardware used to obtain fixation (a single buttress plate, group 1; a buttress plate and interfragmentary lag screws, group 2; or medial and lateral buttress plates with or without lag screws, group 3). In group 1, there were 20 fractures and no instances of deep-wound infection or postoperative ankylosis. In group 2, infection occurred in 6 of 19 fractures (32%), all of which also developed significant ankylosis including 1 patient who underwent arthrodesis. In group 3, 7 of 8 (87.5%) knees became infected, and the patients experienced other devastating complications, including ankylosis (n = 3), arthrodesis (n = 2), knee disarticulation (n = 1), and above-knee amputation (n = 1). Patients whose knees became infected underwent an average of five subsequent surgical procedures. These results suggest that patients with comminuted tibial plateau fractures requiring either two buttress plates or a single plate with additional interfragmentary lag screws would probably be better managed by either non-operative treatment or limited internal fixation.

Adult↗
PubMed1991

Surgical orthodontic treatment of anterior skeletal open bite using small plate internal fixation. One to five year follow-up.

Thirty-eight patients with skeletal open bite were studied retrospectively to assess stability of surgical-orthodontic treatment when small plate internal fixation was used. 86% of the sample population showed stable clinical results. Follow-up was from 1-5 years. Only 1 patient experienced skeletal relapse (3%) and 5 patients (13%) dento-alveolar relapse. Fifty percent of relapses were due to transverse relapse of orthodontically expanded maxillary arches. No relapse was seen with surgically assisted orthodontic expansion or surgical expansion at the time of osteotomy. Stable results can be achieved in treating skeletal open bite when small plate internal fixation is used and proper consideration given to the cause of skeletal open bite when planning treatment.

Adolescent↗
PubMed2001

[Angle- and rotation-stable internal fixation of proximal humerus fractures with the humerus fixator plate. Early clinical experience with a newly developed implant].

INTRODUCTION: The Humerus Fixator Plate is presented as a new implant for angle- and rotation-stable internal fixation for the operative treatment of proximal humerus fractures at the surgical neck. METHODS: In an ongoing two-centre study, 47 patients were treated with the new implant. To date, 31 patients had clinical and radiological postoperative follow-up examinations with a mean interval of 10 months (range: 6-14 months). RESULTS: In 46 patients (97.9%), complete angle and rotational stability was achieved without limiting the range of motion or requiring immobilization. Good pain relief was obtained in 43 patients (91.5 %), and 3 patients (6.4%) showed moderate pain relief following surgery. There was one implant failure. Utilizing the Constant-Raw score (without any correction factors), a mean result of 82.8 points (range: 46-100 points) was ascertained. The majority of the patients (87.1%) achieved "excellent" or "good" clinical results. X-ray analysis revealed no non-union nor humerus head necrosis. In 4 cases (12.9%), protrusion of a humerus head screw was observed which mandated removal of the implant. CONCLUSION: The first clinical investigations of the novel Humerus Fixator Plate are encouraging and provide essential advances in the treatment of unstable proximal humerus fractures.

Adult↗