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At least 1,135 records · Page 63Linked to original sources
PubMed1998

Palatal fractures: classification, patterns, and treatment with rigid internal fixation.

A classification of palatal fracture types is developed from patterns observed on CT scans, and success with open reduction techniques is correlated with fracture pattern. The six palatal fracture types are as follows: I, anterior and posterolateral alveolar; II, sagittal; III, parasagittal; IV, para-alveolar; V, complex; and VI, transverse. Associated fractures were LeFort I (100 percent), LeFort II and III (55 percent), mandible (48 percent), and dental (55 percent). Large segment, sagittally oriented palatal fractures could be stabilized with rigid internal fixation. Complete rigid fixation of the palate consists of (1) roof of mouth, (2) pyriform or alveolar, and (3) four LeFort I buttress stabilization. Comminuted palatal fractures were managed by standard LeFort I and alveolar buttress fixation, palatal splinting, and intermaxillary, fixation. If complete rigid fixation was employed in the palate in type II, III, and IV fractures, a palatal splint was avoided in 60 percent of these cases. Rigid internal fixation is therefore concluded to facilitate the treatment of certain types of palatal fractures by reduced length of intermaxillary fixation and avoidance of palatal splinting.

Alveolar Process↗
PubMed1994

Hip arthroplasty for failed internal fixation of intertrochanteric and subtrochanteric fractures in the elderly patient.

Nine elderly patients were treated by salvage hip arthroplasty following failed internal fixation of an intertrochanteric or subtrochanteric hip fracture. The mean age at time of fracture was 79 years (range 67-94 years). The mean interval from initial fracture fixation to conversion arthroplasty was 7 months (range 5 days to 19 months). One 84-year-old patient died 6 weeks postoperatively from a pulmonary infection. The remaining eight patients were assessed clinically and roentgenographically after a mean follow-up period of 41 months (range 4-85 months). The functional results, rated according to the Merle d'Aubigné hip rating scale, were excellent in one patient, very good in four patients, good in two patients, and fair in one patient. Serial roentgenographic analysis showed new bone formation around the extramedullary part of the femoral component in all these patients and bone remodelling of the diaphyseal part of the femur in all patients. The preservation of the functional continuity of the abduction apparatus during surgery and the early walking with full unrestricted weight-bearing made possible by the arthroplasty are considered to be the major contributing factors to these results.

Aged↗
PubMed1991

The early results of internal fixation of displaced acetabular fractures.

The treatment of choice today for displaced acetabular fractures is anatomical reconstruction by open reduction and internal fixation. Nineteen patients with 20 displaced acetabular fractures treated by this method have been reviewed. A satisfactory outcome was obtained in all but one patient. The surgery is amongst the most demanding in orthopaedics. Specialised radiographic techniques are essential in defining the personality of the fracture and in planning the reconstructive surgery.

Acetabulum↗
PubMed1983

Internal fixation in patients with multiple injuries.

The hypothesis is advanced that there are additional and exceptional indications for the use of internal fixation in the patient with multiple injuries. Eleven case studies of patients who sustained major injuries support this hypothesis.

Accidents, Traffic↗
PubMed1992

Acute open reduction and rigid internal fixation of proximal interphalangeal joint fracture dislocation.

We report the application and results of a technique of open reduction and rigid internal fixation of dorsal fracture/dislocation of the proximal interphalangeal joint with an interfragmentary screw in two cases. Articular congruity was restored, and the proximal interphalangeal joint was stabilized. This technique permitted immediate range-of-motion exercises. Excellent results were obtained in both cases. Previous descriptions have not detailed the indications, the surgical approach, or the results of this technique.

Adolescent↗
PubMed1978

The comparison of steel and titanium dynamic compression plates used for internal fixation of 256 fractures of the tibia.

A consecutive series of 256 fractures of the shaft of the tibia treated by internal fixation with a narrow dynamic compression plate (DCP) is presented. In 123 cases the plates were made of titanium and in 133 cases they were made of stainless-steel. In both groups the age distribution of the patients, the period between operation and the final review and the time of removal of the metal were comparable. All these fractures resulted from skiing accidents. Eighty-six per cent of the 256 fractures were reviewed between 1 and 2 years after the operation. Ninety-one per cent of the titanium group and 93 per cent of the stainless-steel group showed full recovery without any loss of movement in the joints. In both groups there was the same number of refractures, which were chiefly due to subsequent accidents. There were no cases of local wound infection, osteitis or non-union. Furthermore, there was no difference to be seen between the radiological patterns of fracture healing in the two groups. In this series stainless-steel and titanium plates gave the same excellent results.

Adult↗
PubMed1996

Evaluation of new plate designs for symphysis pubis internal fixation.

The purpose of this study was to evaluate and compare biplanar and other newly designed plates used for pubic symphysis internal fixation to other standard plates. Our data demonstrate that neither of the newly designed symphyseal plates, curved (Zimmer four-hole plate with either two or four 4.5-mm cortical screws) nor the biplanar (Zimmer six-hole plate with four 4.5-mm cortical screws in one plane and two 4.5-mm cortical screws in another) significantly reduce motion more than the other plates tested (Synthes two-hole 4.5-mm dynamic compression plate with two 6.5-mm cancellous screws and six-hole 3.5-mm reconstruction plate with four 3.5-mm cortical screws). All of the plate constructs were able to restore motion to nearly that of the intact symphysis pubis and sacroiliac joint. In summary, using the anteroposterior compression disruption pattern and model, the disrupted symphysis does gap under load but has no effect on sacroiliac joint gapping. It does permit increase in relative flexion angles between the wings of the pelvis. All of the plate systems tested restore normal gap motion at the symphysis and normal sacroiliac joint flexion.

Bone Density↗
PubMed1988

Internal fixation of femoral neck fracture. No difference between the Rydell four-flanged nail and Gouffon's pins.

Two methods of internal fixation of femoral neck fractures were compared in a prospective randomized study of 223 patients. Radiographic evidence of early redisplacement, nonunion, or late segmental collapse occurred in 45 of 122 patients operated on with the Rydell four-flanged hook nail and in 33 of 101 patients operated on with Gouffon pins. According to the actuarial method of follow-up, the failure rates after 2 years were respectively 41 and 35 percent in the nail and pin groups, which is a nonsignificant difference.

Actuarial Analysis↗
PubMed2005

[Related factor analysis of avascular necrosis of the femoral head after internal fixation with cannulated screws in femoral neck fractures].

OBJECTIVE: To observe the accident of avascular necrosis of the femoral head after internal fixation with cannulated screws in femoral neck fractures and analysis of the related factors. METHODS: 212 cases of femoral neck fracture treated with cannulated screws between Sep. 1989 and Dec. 1999 were reviewed retrospectively. The average age was 45.2 years old, ranging from 13 to 70 years. Among the fractures, 3 were Garden stage I, 32 were Garden stage II, 107 were Garden stage III, 53 were Garden stage IV, and 17 unclassified. Average duration of follow-up was 32.7 months, ranging from 12 to 101 months. RESULTS: Fracture healing occurred in 203 cases (95.8%). Avascular necrosis of the femoral head occurred in 70 cases (33.0%) and late collapse developed in 30 cases (14.3%). The rate of the avascular necrosis and late collapse of the femoral head according to the Garden stage was 0/0, Garden stage I; 6.3%/0, Garden stage II; 33.6%/15.9%, Garden stage III; 49.1%/20.8%, Garden stage IV. Avascular necroses of the femoral head were observed within 3 years in most cases (95.7%). Correlation analysis shows Garden stage of the fracture was the major factor contributed to the accident of avascular necrosis and late collapse of the femoral head. It also shows the low risk of avascular necrosis and late collapse of the femoral head was related to the patient's age over 60; time of surgery within 14 days and Garden's reduction index within 155-180 degrees on both AP and Lateral views. CONCLUSION: Garden stage of the fracture is the major factor contributed to the accident of avascular necrosis and late collapse of the femoral head, emergency operation and good reduction is beneficial to reduce the accident of avascular necrosis of femoral head.

Adolescent↗
PubMed1991

Total hip arthroplasty following failed internal fixation of hip fractures.

A retrospective review was performed on 27 consecutive patients with total hip arthroplasty (THA) following failure of internal fixation of fractures of the proximal femur. The results were comparable to primary THA in femoral neck fractures. Considerably less satisfactory results were obtained in THA in intertrochanteric fractures. Bone loss and medial displacement of the femoral shaft led to high incidence of intraoperative complications and postoperative dislocations. Extreme care must be taken to avoid fracture and penetration of the femoral shaft. Autograft, allograft, or head and neck replacement components should be available for reconstruction of the difficult cases.

Adult↗
PubMedDate not supplied

Internal fixation of intertrochanteric hip fractures: a clinical and biomechanical study.

One hundred seventy-three cases of intertrochanteric fractures treated by internal fixation are reviewed: 72 treated with the Jewett nail and 101 with the Richards compression hip screw. Both devices maintained adequate reduction in the majority of cases. Treatment failure: loss of fixation, symptomatic joint penetration, aseptic necrosis, malunion and nonunion occurred in 25% of the Jewett nail cases and 6% of the Richards screw cases. In vitro biomechanical studies demonstrate that the compression screw is subjected to less bending stress by acting as a lateral "tension band" in stable reductions and by allowing sliding, thus shortening the bending movement lever arm in unstable reductions. The compression hip screw is valuable in the treatment of intertrochanteric hip fractures. In stable conditions, it acts as a tension band producing more force transmission through the medial cortex, stressing the implant more in tension and less in bending. In unstable conditions with higher shearing forces, the device will shorten the lever arm, decreasing the bending moment, as well as avoiding penetration of the femoral head.

Biomechanical Phenomena↗
PubMed1994

Biomechanical evaluation of methods of internal fixation of the distal humerus.

The best results following fractures of the distal humerus are provided by anatomic reduction and rigid internal fixation. Plates of two designs placed in five different fixation configurations were used to determine the construct that would maximize rigidity of fixation of the distal humerus. Using a cadaver distal humerus osteotomy, with and then without cortical contact, motion of the distal fragment was measured with respect to the proximal fragment in axial and torsional loading, anterior to posterior and posterior to anterior bending, and lateral to medial and medial to lateral bending. With cortical contact, two plates when placed medial and lateral or at 90 degrees to each other provided equivalent rigidity. However, with a cortical gap, the combination of a specially designed anatomic lateral buttress "J" plate and a medial reconstruction plate gave the greatest rigidity (ANOVA, p < 0.05). Two-plate constructs do not require placement at 90 degrees to obtain sufficient rigidity, but do require placement on separate bony pillars and different surfaces.

Biomechanical Phenomena↗
PubMed2006

Posteromedial approach of gastrocnemius for reduction and internal fixation of avulsed tibial attachment of posterior cruciate ligament.

OBJECTIVE: To introduce a posteromedial approach through the medial border of the medial head of gastrocnemius for reduction and reattachment of bony avulsion of the posterior cruciate ligament (PCL) from the tibia. METHODS: Eleven patients with avulsed tibial attachment of the PCL underwent an operative reduction and internal fixation through the posteromedial approach of the gastrocnemius in our department from February 1998 to March 2000. The skin incision was reversed L-shaped along the medial border of the medial head of the gastrocnemius and the posterior capsule was exposed by dissecting the medial border and lateral retraction, avoiding the damage of the popliteal neurovascular structures. After that, the posterior capsule was vertically dissected a little medially to the posterior intercondylar sulcus and just on the posterior medial tibial eminence positioned by finger palpation. Then the PCL and its tibial attachment were easily accessible. In the delayed cases, PCL peripheral releasing was necessary to overcome the ligament retraction and to refresh the fracture bed for optimal reduction and bony healing. At last, one or two biodegradable screws were used to fix the avulsed bone segment and 30 flexion knee plaster cast immobilization was regularly applied after the wound was closed. The evaluation included X-ray, posterior sag sign and posterior drawer test compared with the contralateral side. The functional assessment of the low limbs was not available because of concomitant injuries. RESULTS: The posteromedial approach of the gastrocnemius used in repair of tibial attachment avulsed injury of the PCL could provide benefit of clear anatomical exposure, few blood loss (20 ml on average), no need for detachment or reattachment of any structure. The patients were followed up for 11 months on an average (ranging from 6 months to 2 years). It demonstrated that bony healing was achieved within 4-6 weeks in cases of fresh injury and 7-9 weeks in cases of delayed injury. Six out of 8 fresh cases showed totally negative posterior sag sign or posterior drawer test but 2 had extra laxity for 1-2 mm. In 3 delayed cases, extra laxity for 3-4 mm was presented compared with the contralateral knee. CONCLUSIONS: The posteromedial approach of the gastrocnemius is ideal for internal fixation of avulsed tibial attachment of the PCL. It is fairly easy, safe, time-saving, applicable alternatives, in addition, the morbidity is rare and can also be used in management of posteromedial fracture of the medial femoral condyle and tibial plateau.

Adolescent↗
PubMed2006

Closed reduction and internal fixation for acute midshaft clavicular fractures using cannulated screws.

BACKGROUND: Although most acute midshaft clavicular fractures can be successfully treated nonsurgically, surgery is more appropriate for cases with severe displaced fractures, skin tenting, initial shortening of fracture ends, and associated with multiple injuries. However, methods of surgical treatment for such fractures remain controversial. This study discusses a closed reduction and internal fixation technique for midshaft clavicular fracture. METHODS: Between 2000 through 2003, 34 acute midshaft clavicular fractures were operatively treated with cannulated screws using closed reduction technique by one surgeon. The follow-up and clinical evaluation was performed by another surgeon. RESULTS: Thirty-one patients were followed for an average of 27.4 months (range, 24-37 months). Thirty (96.8%) fractures healed within 12 weeks, and one fracture healed at 18 weeks. No major surgical complications occurred, although superficial wound infection occurred in one patient. No implants needed to be removed. The final union rate was 100%. CONCLUSIONS: Closed reduction and internal fixation with cannulated screw is an alternative choice for treating acute midshaft clavicular fracture in selected cases where surgery is indicated and should be done cautiously.

Adolescent↗
PubMed2004

Causes and effects of zygomatico-orbital and zygomatico-maxillo-orbital fractures managed by open reduction and rigid internal fixation.

Progressive violence, the quickening pace of life and transport facilities' development have as a consequence an increased number of traumas. Midface fractures involving zygomatic bone fractures take one of the leading positions in the total number of traumas. It seems appropriate to study the causes and the effects of zygomatico-orbital and zygomatico-maxillo-orbital fractures managed by open reduction and rigid internal fixation at the present time of the medical service being reformed and economic rules being included in the treatment. The analysis of the economic consequences of midface traumas and their causes as well as the search for the influence of social and cultural changes on fracture management was the aim of the study. Histories of 61 injured patients treated by open reduction and rigid internal fixation in 1st Department of Maxillofacial Surgery of the Silesian Medical University in Zabrze between 1996 and 2001 were studied. Patients' sex, the most frequent trauma causes and their disposition in different age groups were taken into consideration. It was observed that certain symptoms of the fracture tend to coexist with high energy traumas (traffic accidents, violent assaults). The influence of injury's extension on the prolongation of hospitalization time was emphasized. It was concluded that assaults and traffic accidents are the most frequent and devastating causes of zygomatico-orbital and zygomatico-maxillo-orbital fractures. The fractures usually involve men aged from 21 to 40 years. The rapid growth of violence and the pace of life have in recent times necessitated the general use of advanced and expensive operating techniques in injured patients recently. The break in social and professional activity of injured individuals and the scale of the problem indicate the necessity of change in medical service financing.

Adolescent↗
PubMed1981

Open reduction and internal fixation of clavicular fractures.

Extensive clinical studies reported in the literature have indicated that non-operative treatment is the treatment of choice for clavicular fractures. It has also been suggested by some that open reduction may contribute to the development of non-union. From 1970 to 1978, twenty-five of approximately 800 patients with a fracture of the clavicle were treated by open reduction and internal fixation with a threaded intramedullary wire or pin or with cerclage suture (one case). The patients' ages ranged from thirteen to fifty-nine years. All fractures healed without infection or migration of the pin. Based on this experience and a review of the English-language literature, we concluded that the indications for open reduction and internal fixation should be: (1) neurovascular compromise due to posterior displacement and impingement of the bone fragments on the brachial plexus, subclavian vessels, and even the common carotid artery; (2) fracture of the distal third of the clavicle with disruption of the coracoclavicular ligament; (3) severe angulation or comminution of a fracture in the middle third of the clavicle; (4) the patient's inability to tolerate prolonged immobilization (required by closed treatment) because of Parkinson's disease, a seizure disorder, or other neuromuscular disease; and (5) symptomatic non-union following treatment by closed methods.

Adolescent↗
PubMed1994

Comparison of artifact from craniomaxillofacial internal fixation devices: magnetic resonance imaging.

This study compares artifact from craniomaxillofacial internal fixation devices in magnetic resonance images and examines heating and magnetic deflection effects on these devices. Stainless steel wires, microfixation plates of vitallium and titanium, and minifixation and mandibular reconstruction plates of stainless steel, vitallium, and titanium were evaluated. The plates were mounted on a dry skull and submerged in dilute copper sulfate solution. All images were obtained in duplicate by two independent, nonblinded teams of observers with a 1.5-T Signa magnetic resonance system. Each team ranked artifact size for each material by computerized measurement. The rank order of artifact size for each material within each fixation system group and between fixation groups was identical between the two teams. Bath and plate temperatures were recorded before and after imaging. Artifact production was related to hardware size and composition. Titanium hardware caused the least amount of "black-hole" artifact. Vitallium and stainless steel fixation devices of similar size produced significantly more artifact. No significant heating or magnetic deflection effects were seen with any of the fixation devices.

Artifacts↗