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A comparative review of 266 mandibular fractures with internal fixation using rigid (AO/ASIF) plates or mini-plates.

This study compares the internal fixation of mandibular fractures using either rigid 2.7 mm AO/ASIF plates or mini-plates. In the rigid plate group, 88 fractures were fixed with 88 plates. In the mini-plate group, 116 fractures were fixed with 170 plates. All the cases were consecutive and were treated in two South Wales hospitals during a 3-year period from 1988 to 1991. The aetiology of injury, timing of surgery, site of fracture, antibiotic policy and demographic features were evenly distributed between the two groups but there was a higher incidence of females in the mini-plate group. Both plating systems were successful in restoring functional occlusion. Rigid plates avoided the use of postoperative elastics better than mini-plates but the difference was not significant. There was a significantly higher incidence (P = 0.013) of infection in the mini-plate (12.9%) compared with the rigid plate (2.3%) group but 7.9% of the rigid group developed facial nerve weakness. A significantly higher proportion of mini-plates needed to be removed (P = 0.00019). A better treatment outcome for angle and comminuted fractures was noted with rigid plates.

Adolescent↗

A transparotid transcutaneous approach for internal rigid fixation in condylar fractures.

Closed versus open reduction in condyle fractures is a dilemma that may torment the plastic surgeon. Although at present it is accepted that there are fractures that must be open reduced as when the middle cranial fossa or temporal fossa are involucrated, foreign body are in the joint capsule, lateral extracapsular deviation of condylar deviation, and open fractures. Risdon or retromandibular approaches are used for the treatment of fractures in the condyle neck and superior third of the lower ramus.When both approaches are used the correct placement of screws is very difficult for the following reasons: 1. Both drill and screwdrivers must be placed in an oblique direction to the bone surface; as a result, screws do not press the plate toward the bone and therefore a deficient stabilization results; 2. A distraction of too much soft tissue entrapped between the skin and mandibular bone is necessary for a good visual to surgical field and 3. The parotid tissue, the masseter muscle, and the facial nerve must be strongly distracted facilitating the nerve injury.A transcutaneous transparotid approach is the most appropriate for screws placement. By means of transbuccal set it is possible to reach the mandibular bone going through both the parotid tissue and the masseter muscle avoiding the injury the branches of the facial nerve.A case report illustrates the practical application of the above technique and it shows that as the lesion of branches of the facial nerve can be avoided.

Aged↗

[Recent fractures of the scapula. Apropos of 43 cases].

The authors have studied a series of 43 fractures of the scapula. They confirm the results are generally good. However, 12 displaced fractures of the neck of the scapula have been seen. All were treated conservatively with only one good result, the other results being fair or poor. These results are explained by the fact that displaced fractures of the neck disorganize the coraco-acromial arch. This type of fracture should be surgically treated as an articular fracture by open reduction and plate fixation. Fractures of the glenoid should also be treated surgically.

Adolescent↗

The antiglide plate for the Danis-Weber type-B fibular fracture: a review of 71 cases.

The authors present a retrospective study of 71 fractures seen in 70 patients who had sustained the Danis-Weber type-B fibular fracture. All patients had the fractures fixated with the posterior antiglide plate. Of the 71 cases studied, 2 developed peroneal tendonitis. No other type of complication related specifically to the antiglide plate was noted. Because of the very low incidence of complications and good biomechanical strength, the authors recommend the antiglide plate for the fixation of type-B fibular fracture.

Adolescent↗

The use of the Zuelzer hook plate in fixation of olecranon fractures.

Twenty-five cases of fracture of the olecranon process were treated using a modification of the Zuelzer hook plate, and uniformly excellent or good results were obtained in all cases in which there were no other associated traumatic lesions about the elbow joint. Regardless of the degree of comminution of the fracture, obliquity of the fracture line, or age of the patient, almost a full range of motion was obtained in every case. No failure of the appliance or loss of position occurred in any case despite the fact that active motion was usually instituted in one to two weeks.

Adolescent↗

The locked flexible intramedullary humerus nail in pediatric femur and tibia shaft fractures: a feasibility study.

There are several options for the treatment of long bone fractures in skeletally immature patients. Surgeon experience, type of fracture, and the possibility of damage to the physeal area dictate individual fracture management patterns. Notably, nail devices have not gained popularity in this patient group. Intramedullary locking nails have become the standard of care in adult patients due to decreased morbidity and mortality. A novel nail has been developed for humeral shaft fractures that uses a lateral starting position to avoid damage to the rotator cuff in humeral fracture fixation. This is possible because of the nail's transient flexibility during insertion. This study illustrates that it is feasible to insert this type of nail through multiple entry portals for both tibial and femoral fracture fixation, without damaging the physeal blood supply or growth areas.

Adolescent↗

[Treatment of mandibular fractures with different fixation techniques--results of a prospective fracture study].

In a prospective study 150 adult patients with mandible fractures were analysed. Criteria for entry into the study were fractures of the mandibular body with and without associated condylar fractures. The fractures must fit to the Spiessl-classes F1 and F2, L1 to L4, W0 to W3 and the patients must have had a sufficient dentition to judge their occlusion. Not included were patients with combinations of mandible and Le Fort fractures, comminuted and defect fractures and patients who could not communicate preoperatively in order to have a full preoperative examination. The patients were equally distributed among 3 different treatment groups. Group 1 was treated conservatively with MMF, only displaced fractures which needed open reduction were internally fixed with wire osteosynthesis. Group 2 received rigid internal fixation with AO 2.7-plates from an intraoral approach, group 3 internal fixation with miniadaption-plates also from an intraoral approach. Using a standardized treatment protocol the patients were followed in defined intervals up to a maximum of 2 years after therapy. Group 1 presented with the lowest complication rate, group 2 with the highest rate of overall complications as far as disturbances of the occlusion and sensory disturbances were concerned. Except one plate fracture in group 3 with subsequent pseudarthrosis, which required a reosteosynthesis with a rigid plate, no major complications in bone healing were observed.

Adult↗

Staged reconstruction of pelvic ring disruption: differences in morbidity, mortality, radiologic results, and functional outcomes between B1, B2/B3, and C-type lesions.

OBJECTIVE: To analyze injury pattern, surgical therapy, radiologic results, and functional outcome in unstable B-type and C-type pelvic ring fractures. DESIGN: Retrospective study. SETTING: Level I University Trauma Center. PATIENTS: Two-hundred-twenty-two consecutive patients, admitted during a nine-year period with unstable B-type (n = 100) and C-type (n = 122) pelvic ring injuries, of whom 122 (61.3 percent of surviving patients) were eligible for evaluation with a minimum follow-up of one year. INTERVENTIONS: Staged reconstruction dependent upon injury pattern. Emergency external compression of the pelvic ring in case of hemodynamic instability. Management of associated lesions. Secondary open reduction and internal fracture fixation. MAIN OUTCOME MEASURES: Assessment of perioperative and postoperative mortality and morbidity depending on fracture pattern. Fifty-five B-type and sixty-seven C-type lesions were evaluated clinically and radiologically an average of 21.6 months after trauma. RESULTS: Perioperative mortality was 5 percent in B-type and 15 percent in C-type fractures. External fixation was part of the definitive treatment in 52 percent of B-type and in 38 percent of C-type lesions. Planned secondary operative procedures were performed in 15 percent of B-type and in 26.2 percent of C-type fractures. Radiologic results were anatomic in 93.5 percent of B1, 75 percent of B2/B3, and 62.7 percent of C-type lesions. Functional results were excellent or good in 74 percent of the B1, 92 percent of the B2/B3, and in 71 percent of the C-type fractures. CONCLUSIONS: Unstable pelvic ring fractures require a staged approach. Mortality is higher in C-type than in B-type lesions. Functional outcome is worse in C-type than in B-type lesions. Within the B-type group, B1 lesions have a worse functional end result than B2/B3 fractures. These findings are not only related to the stability and symmetry of the pelvic ring, as seen in the radiologic picture, but also depend on the severity and amount of damage to the soft tissues around the pelvis.

Adolescent↗

Tension-band fixation of olecranon fractures. A cadaver study of elbow extension.

The loss of extension produced by tension-band wiring was studied using cadaveric elbows. Extension loss was found to be due to impingement of the longitudinal wires against the humerus independent of the tension band. Reducing the size of the bent end of the longitudinal wire is recommended, and bending the wire into a loop achieves this. In addition, passing the tension band through the loops prevents the wire from backing out.

Bone Wires↗