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PubMed2004

[Treatment of tibial plateau fracture with reconstructed bone xenograft plus buttress plate internal fixation].

OBJECTIVE: To investigate the clinical effect of reconstructed bone xenograft plus buttress plate (T or L type) fixation in treating tibial plateau fracture. METHODS: From June 2001 to March 2003, 32 cases of tibial plateau fractures were treated by means of open reduction, reconstructed bone xenograft plus buttress plate (T or L type) fixation. There were 23 cases of bumper fracture, 5 cases of falling injury and 4 cases of crush injury by a weight; 20 males and 12 females, aged from 18 to 69 years with an average of 38 years. All patients had close fracture. RESULTS: All the patients were followed up for 9 months to 23 months, tibial plateau fracture healed satisfactorily without sunken articular surface. According to Pasmussen criterion, the results were excellent in 16 knees, good in 12 knees and moderate in 3 knees. The satisfactory rate was 87.5%. CONCLUSION: Reconstructed bone xenograft plus buttress plate internal fixation has good effect in treating tibial plateau fractures because it can avoid the complication of transplantation of ilium.

Adolescent↗
PubMedDate not supplied

Internal fixation versus traction and casting of adolescent femoral shaft fractures.

We compared the results of traction plus subsequent casting with rigid internal fixation in a large series of adolescent femoral shaft fractures. Of 90 patients with 96 femoral shaft fractures, 49 (52 fractures) underwent rigid internal fixation, whereas 41 (44 fractures) underwent traction and subsequent casting until healing occurred. The traction and casting group had a mean hospital stay of 26 days. The operative group had a mean hospital stay of 9 days and had fewer complications than the nonoperative group. Adolescent femoral shaft fractures can be operatively treated with excellent results and a decreased complication rate. Operation results in shorter hospitalization, which has psychological, social, educational, and economic advantages over conservative treatment.

Adolescent↗
PubMed1987

Transscaphoid fracture/dislocations treated with open reduction and Herbert screw internal fixation.

Six cases of dorsal transscaphoid perilunate fracture/dislocations and two cases of palmar transscaphoid lunate fracture/dislocations were treated by open reduction and internal fixation of the scaphoid with a Herbert screw. Supplemental Kirschner wire stabilization of the carpus was also used in the two cases of palmar transscaphoid lunate fracture/dislocation. All patients were male, with an average age of 23.6 years. The follow-up averaged 18.9 months. A clinical evaluation scoring system assessing pain, ability to function in an occupation, range of motion, grip strength, and radiographic appearance of the wrist was used. Based on this system the scoring of the six cases of dorsal transscaphoid perilunate fracture/dislocations that were treated was three excellent, one good, and one fair result, while the scoring of both palmar transscaphoid lunate fracture/dislocations showed poor results.

Adolescent↗
PubMed1997

Open reduction and internal fixation of displaced intraarticular fractures of the distal radius. 31 patients followed for 3-7 years.

We have used open reduction and internal fixation with a T-plate in 31 displaced, intraarticular fractures of the distal radius which were judged irreducible or in which closed reduction failed. The mean follow-up time was 4 (3-7) years. The dorsal angulation, the radial length, the articular step-off and the intraarticular gap between fragments were substantially improved after surgery. 30 patients had excellent or good extraarticular alignment, and only 1 patient had a postoperative intraarticular step-off of 2 mm. The function was excellent or good in 26 patients at follow-up. Complications occurred in 6 patients: 1 compartment syndrome, 1 postoperative wound infection, 2 ruptures of the extensor pollicis longus tendon, and 2 patients had median nerve paresthesias.

Adolescent↗
PubMed2004

Outcome of infection following internal fixation of closed fractures.

A retrospective study was done in 30 patients with infected closed fractures treated initially by open reduction and internal fixation. Nineteen fractures involved the femur, 8 the tibia, 2 the radius and 1 the ulna. Twenty-five were diaphyseal and 5 metaphyseal. Twenty-two fractures had initially been treated with plating and 8 with intramedullary nailing. Thirteen patients presented in the acute phase and 17 in the subacute phase of infection. Twenty-two patients presented with low grade infection and 8 with florid infection. The commonest organism isolated was Staphylococcus aureus (80%), of which fifty four percent was resistant to Methicillin (MRSA). This study showed that 77% of infected fractures with a stable implant united even in the presence of infection.

Adolescent↗
PubMed1984

Femoral head vitality in femoral neck fracture after hook-pin internal fixation.

Femoral head vitality was evaluated by tetracycline labeling and 99mTc-MDP scintimetry in 317 femoral neck fractures before and after internal fixation with two hook-pins. The preoperative vitality was about the same as that observed by others using comparable methods. The postoperative vitality was reduced in five of 81 undisplaced fractures and in 76 of 236 displaced fractures. These data would predict a rate of avascular healing complications of 7% in undisplaced and 32% in displaced fractures treated with hook-pins.

Adult↗
PubMed1996

Fractures of the distal end of the radius treated by internal fixation and early function. A preliminary report of 20 cases.

Fractures of the distal end of the radius should be treated on the same principles as other fractures involving joints. Displaced articular fractures require open reduction to allow anatomical reconstruction of both the radiocarpal and the radio-ulnar joints. For extra-articular fractures with severe comminution and shortening this enables the radial length to be re-established achieving radio-ulnar congruency. Stable internal fixation can be achieved with two 2.0 AO titanium plates placed on each of the 'lateral' and the 'intermediate' columns of the wrist at an angle of 50 degrees to 70 degrees. This gives good stability despite the tiny dimensions of the plates, and allows early function. We report a series of 20 fractures treated by this method of internal fixation with satisfactory results in all.

Adult↗
PubMedDate not supplied

Fluoroscopically guided closed reduction and internal fixation of fractures of the lateral portion of the humeral condyle: prospective clinical study of the technique and results in ten dogs.

OBJECTIVE: To report a technique for fluoroscopically guided closed reduction with internal fixation of fractures of the lateral portion of the humeral condyle (FLHC) and determine the long-term results in 10 clinical cases. STUDY DESIGN: Prospective clinical case study. ANIMALS: Ten dogs with 11 fractures. METHODS: Fractures of the lateral portion of the humeral condyle were stabilized with transcondylar screws and Kirschner wires. Closed reduction and implant placement were achieved using intraoperative fluoroscopic guidance. After fracture repair, postoperative radiographs were evaluated for articular alignment and implant placement. Dogs were evaluated after surgery by means of lameness scores, elbow range of motion (ROM), radiographic assessment, and owner evaluation of function. RESULTS: Postoperative reduction was considered anatomic in 6 fractures with all other fractures having <1.5 mm of malreduction. Follow-up was available for 9 patients from 9 to 21 months after surgery. All of the fractures had healed. One minor (wire migration) and one major (implant failure) complication occurred. Mean lameness scores were 0 (n = 6), 0.5 (n = 2), and 1 (n = 1) at the time of final follow-up. No significant differences were found in follow-up ROM values between affected and unaffected elbows. All of the dogs in this study regained 90-100% of full function, based on owner assessment. CONCLUSIONS AND CLINICAL RELEVANCE: Fluoroscopic guidance for closed reduction and internal fixation of FLHC in dogs is an effective technique.

Animals↗
PubMed1996

Internal fixation of femoral shaft fractures in children and adolescents: a ten- to twenty-one-year follow-up of 52 fractures.

In a long-term follow-up (mean 16 years) of 52 femoral shaft fractures treated by internal fixation in 50 children and adolescents, we noted a mean overgrowth of 1 mm after plating and a mean undergrowth or relative shortening of 2 and 9 mm after nailing with broad (IMN) and slender (flexible rods: IMR) intramedullary nails, respectively. The mean overgrowth was 8 mm in children, but adolescents had a mean undergrowth of 5 mm (p < 0.01). Excessive overgrowth tended to occur less frequently after intramedullary nailing than after plating (p = 0.1). Undergrowth tended to occur with increasing frequency with increasing age and attained troublesome levels in three patients with severe trauma. Three cases of moderate valgus deformity of the hip and one case of late arthrosis of the hip occurred after intramedullary nailing with IMN introduced through the greater trochanter. We conclude that this method should not be used in patients with open physes.

Adolescent↗
PubMed1990

Internal fixation of proximal radial head fractures.

The treatment of choice for proximal radial head fractures remains controversial. The goal of any treatment for an intra-articular fracture must be the complete restoration of the joint and its function. Nonoperative treatment leads to full motion in cases of less than 1-2 mm of fracture displacement. Resection of the radial head can be recommended only for very comminuted fractures. All other fracture types should be treated by open reduction and internal fixation. Our own personal follow-up observation of 19 patients who had surgical intervention demonstrated restoration of elbow function after an average follow-up time of 11.7 months. Five patients had a slightly restricted range of motion of less than 10 degrees extension and flexion as well as less than 8 degrees pronation and supination, without signs of arthritis. Because complications were minimal, we recommend internal fixation of displaced proximal radial head fractures to restore the anatomic function of the elbow. This is especially true in cases with accompanying proximal ulna fractures and/or ruptured collateral ligaments of the elbow joint and/or disruption of the distal radio-ulnar joint.

Adolescent↗
PubMed2005

Transmasseteric antero-parotid approach for open reduction and internal fixation of condylar fractures.

The morbidity that results from surgical approaches to the condylar neck, and the time-consuming nature of the operation inhibits many surgeons from using open reduction and internal fixation for the treatment of condylar fractures. The many approaches that have been described stand testimony to the disadvantages of the individual techniques. The most common problems are limited access and injury to the facial nerve. We describe the transmasseteric antero-parotid (TMAP) technique, which offers swift access to the condylar neck while substantially reducing the risk to the facial nerve and eliminating the complications associated with transparotid approaches.

Bone Plates↗
PubMed2005

A randomized prospective study on the treatment of intra-articular distal radius fractures: open reduction and internal fixation with dorsal plating versus mini open reduction, percutaneous fixation, and external fixation.

PURPOSE: To compare 2 methods of surgical treatment for displaced intra-articular fractures of the distal radius: open reduction and internal fixation with dorsal plating (Pi Plate; Synthes, Paoli, PA) versus mini open reduction with percutaneous K-wire and external fixation. METHODS: Patients with AO type C intra-articular distal radius fractures were randomized into 2 groups: open reduction and internal fixation and dorsal plating or external fixation and K-wires and mini-open reduction. Patients over the age of 70 years with any associated soft-tissue or skeletal injury to the same limb and pre-existing wrist arthrosis or disability were excluded from the study. Objective, subjective, and radiographic outcomes were assessed at 2 weeks, 4 to 6 weeks, 10 to 12 weeks, 6 months, and 1- and 2-year intervals. The minimum follow-up period was 6 months; the average follow-up period was 18 months. The principal outcome analyzed was the Disabilities of the Arm, Shoulder, and Hand score. Secondary outcomes included grip strength, range of motion, surgical procedure time, complications, and radiographic parameters. The groups were equal with respect to age, gender, fracture subtype, and number of workers' compensation cases. RESULTS: No significant difference was found in the Disabilities of the Arm, Shoulder, and Hand scores, our primary outcome. The dorsal plate group, however, showed a higher complication rate when compared with the external fixator group. The plate group had significantly longer tourniquet times when compared with the external fixator group. The plate group also had higher levels of pain at 1 year when compared with the external fixator group; however, this equalized after hardware removal. The external fixator group showed an average grip strength of 97% compared with the normal side and 86% in the dorsal plate group. CONCLUSIONS: At midterm analysis the dorsal plate group showed a significantly higher complication rate compared with the external fixator group; therefore enrollment in the study was terminated. The dorsal plate group also showed statistically significant higher levels of pain, weaker grip strength, and longer surgical and tourniquet times. Based on these results we cannot recommend the use of dorsal plates in treating complex intra-articular fractures of the distal radius.

Adult↗
PubMed1986

Delayed wound healing, infection, and nonunion following open reduction and internal fixation of tibial plafond fractures.

The literature concerning tibial plafond fractures is briefly reviewed, and a series of 11 tibial plafond fractures of the compressive variety is presented. These fractures fall both prognostically and therapeutically into different categories based upon whether the primary mechanism of injury is rotational or compressive. The severity of the fracture, the degree of contamination, and the severity of concomitant soft-tissue injury in large part appear to determine the morbidity of surgical therapy in these patients. If rigid internal fixation can be performed in those patients with closed injuries that are primarily of the rotational type and performed with a minimum of soft-tissue trauma, this appears to be a reliable alternative in the hands of surgeons experienced with A-O technique and with this type of fracture specifically. In the presence of severe comminution and open wounds, however, the efficacy of rigid internal fixation performed by surgeons without great experience with these types of fracture is dubious.

Fracture Fixation, Internal↗
PubMed1985

Comparison of internal fixation techniques in metacarpal fractures.

A biomechanical study assessed quantitative differences in the stability that was obtained by five commonly used types of internal fixation employed in metacarpal fractures. The techniques included dorsal plating, dorsal plating combined with an interfragmentary lag screw, crossed Kirschner wires, a single intraosseous wire combined with a single oblique Kirschner wire, and a single intraosseous wire alone. Rigidity and strength in torsion and bending were determined after transverse osteotomy and fixation of the metacarpal were performed. The failure modes for each fixation technique were also observed and described. Significant differences in rigidity were found between the plated configurations (with or without an interfragmentary lag screw) and the wired configurations in both apex dorsal bending and axial torsion. The three wired configurations were not significantly different from each other except in torsion. Analysis of the bending moments that were required to produce both yield and failure in apex dorsal bending and also the energy absorbed to yield showed similar disparity between plated and wired techniques. For metacarpal fixation, dorsal plating with or without lag screws provides significantly more stability than do wired techniques and approaches that provided by intact bones.

Biomechanical Phenomena↗
PubMed1996

Arthroscopic subscapularis tenolysis: a technique for treating refractory glenohumeral stiffness following open reduction and internal fixation of a displaced three-part proximal humerus fracture.

This case illustrates the treatment of a stiff shoulder following open reduction and internal fixation of a three-part fracture of the proximal humerus. Motion could not be improved with physical therapy or with manipulation under general anesthesia. Arthroscopic subscapularis tenolysis provided a dramatic increase in range of motion. The unique pathological findings may render such cases refractory to manipulation because of thick unyielding scar tissue. In such cases, arthroscopic subscapularis tenolysis may provide the only means of improving the final range of motion.

Adult↗
PubMedDate not supplied

Radial head and neck fractures: anatomic guidelines for proper placement of internal fixation.

A cadaveric study of the radial head and neck was performed to determine the anterior and posterior limits for safe placement of internal fixation on the surface of the radial head or neck. A "safe zone" of approximately 110 degrees of radial head surface was first identified by cross-sectional anatomic dissections. This "safe zone" was then reproducibly confirmed relative to forearm position when viewed from a standard lateral approach. Because the proximal radioulnar joint cannot be directly visualized through the standard lateral approach, the zone was indirectly identified by making reference marks along the radial head and neck. To determine the position of the "safe zone" reference marks are first made along radial head and neck so as to bisect the bone's anteroposterior distance. Three such marks are made with the forearm in neutral rotation, full supination, and full pronation. Next, the posterior limit of the zone is determined by bisecting the reference marks made with the forearm in neutral rotation and full pronation. The anterior limit is determined by going nearly two thirds of the distance from the neutral mark to that mark made in full supination.

Forearm↗
PubMed2006

Biomechanical evaluation of the less invasive stabilization system and the 95-degree angled blade plate for the internal fixation of distal femur Fractures in human cadaveric bones with high bone mineral density.

BACKGROUND: The less invasive stabilization system (LISS) is an internal fixator that utilizes unicortical locked screws for fixation of distal femur fractures. A question is whether locked unicortical screw fixation is sufficient, when compared with a standard implant such as a blade plate. METHODS: Eight matched pairs of fresh-frozen cadaveric femora were instrumented with either the LISS or a 95-degree blade plate. A 4-cm supracondylar gap fracture model was created and all bone-implant constructs were tested to failure in axial loading. RESULTS: All constructs failed by plastic deformation of the implant. There was no significant difference between the LISS and the blade plate constructs with respect to load to failure. CONCLUSIONS: Despite unicortical fixation axial loading to failure of the LISS did not result in implant/screw pull-out neither proximally nor distally. However, there does not appear to be a biomechanical advantage of using the LISS as opposed to a blade plate in bones with high bone mineral density.

Biomechanical Phenomena↗