The use of semi-rigid carbon-fibre-reinforced plastic plates for fixation of human fractures. Results of preliminary trials.
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Adolescent↗
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Comparison of mechanical performance in four types of external fixators.
The Hoffmann-Vidal triangular apparatus for fracture fixation of the femur, the Volkov-Oganesian device with Steinmann pins in tension, the Kronner device with a plastic elliptic frame, and the Roger-Anderson apparatus (both standard and compression-distraction designs) were studied based on loading and analytic methods established previously. The results were compared with those for the standard Hoffmann-Vidal quadrilateral configuration. The Kronner device, with five connecting bars, was the stiffest under most loading modes, closely followed by the Hoffmann-Vidal quadrilateral apparatus. The standard Roger-Anderson device demonstrated average rigidity; its new design with compression-distraction capability was relatively weak. All devices showed an apparent weakness in antero-posterior bending. The Volkov-Oganesian design demonstrated low overall stiffness but was the most effective apparatus in resisting anteroposterior bending. External fixators provide effective compression at the fracture site, and the amount of compression is proportional to the stiffness of the apparatus.
Biomechanical Phenomena↗
[Joint bridging external fixation of fractures of the distal lower leg with severe skin damage].
During the 36 months from April 1989 until April 1992, 34 fractures of the lower end of the leg were treated by joint bridging application of external fixation using the so-called ".. Kugelspannfixateur UNIFIX". They were: 24 intraarticular compression fractures, seven bimalleolar dislocation fractures, two shot fractures and one postoperative empyema. All demanded treatment urgently. Because of severe skin lesions or because of medical reasons, neither osteosynthesis nur conventional conservative methods could be used. With the aid of UNIFIX, good alignment was achieved in all cases and practically always maintained as long as necessary. Reduction of joint-bearing fragments was equally good as with ligamentotaxis. All skin lesions healed during the time of fixation. Only two infections of screw tracks were observed. Additional operations like primary minimal osteosynthesis or later reconstructive surgery could be carried out with the fixateur in place. They have improved the results. No severe damage to the subtalar joint was observed. Therefore this principle of treatment can be recommended providing right indication.
Adult↗
Detection of orthopaedic foot and ankle implants by security screening devices.
BACKGROUND: A common question asked by patients contemplating foot and ankle surgery is whether the implants used will set off security screening devices in airports and elsewhere. Detectability of specific implants may require the orthopaedic surgeon to provide attestation regarding their presence in patients undergoing implantation of these devices. Only two studies have been published since security measures became more stringent in the post-9/11 era. None of these studies specifically focused on the large numbers of orthopaedic foot and ankle implants in use today. This study establishes empiric data on the detectability by security screening devices of some currently used foot and ankle implants. METHODS: A list of foot and ankle procedures was compiled, including procedures frequently used by general orthopaedists as well as those usually performed only by foot and ankle specialists. Implants tested included those used for open reduction and internal fixation, joint fusion, joint arthroplasty, osteotomies, arthroreisis, and internal bone stimulation. A test subject walked through a gate-type security device and was subsequently screened using a wand-type detection device while wearing each construct grouping. The screening was repeated with the implants placed within uncooked steak to simulate subcutaneous and submuscular implantation. RESULTS: None of the implants were detected by the gate-type security device. Specific implants that triggered the wand-type detection device regardless of coverage with the meat were total ankle prostheses, implantable bone stimulators, large metatarsophalangeal hemiarthroplasty, large arthroreisis plugs, medial distal tibial locking construct, supramalleolar osteotomy fixation, stainless steel bimalleolar ankle fracture fixation, calcaneal fracture plate and screw constructs, large fragment blade plate constructs, intramedullary tibiotalocalcaneal fusion constructs, and screw fixation for calcaneal osteotomies, ankle arthrodeses, triple arthrodeses, and stainless steel first metatarsophalangeal joint arthrodeses. The placement of implants in meat prevented the detectability of only the stainless steel Jones fracture implant (stainless steel 6.5-mm cannulated screw) and the stainless steel midfoot fusion construct (four stainless steel 4.0-mm cannulated screws). CONCLUSIONS: These data may help the orthopaedic surgeon in counseling patients as to the detectability of some orthopaedic foot and ankle implants in use today. Specific constructs for which documentation may need to be provided to the patient are identified. As security standards evolve and the environments in which they are practiced change, empiric testing of many of these devices may need to be repeated.
Ankle↗
Biological response to chopped-carbon-fiber-reinforced peek.
Polymer composites are being recognized as important implant materials for fracture fixation plates. The use of a composite material is dependent upon the mechanical properties of the material and its biocompatibility. The primary objective of this project was to evaluate 30% chopped-carbon-fiber-reinforced poly(etheretherketone) (CFRPEEK) as a potential material for use as a fracture fixation plate. A two-phase study was conducted. The first phase analyzed the short-term biocompatibility of CFRPEEK through rabbit muscle implant testing. CFRPEEK exhibited a nonspecific foreign body tissue reaction similar to the response observed with ultra-high-molecular-weight polyethylene (UHMWPE). In the second phase, four-hole CFRPEEK plates were implanted as internal fixation devices for transverse midshaft femoral osteotomies in beagles. The plates were effective in promoting fracture healing. A nonspecific foreign body reaction was observed to the plates and to particulate debris.
Animals↗
Locking compression plating: a new solution for fractures in rheumatoid patients.
Osteoporosis is a well-known phenomenon in rheumatoid arthritis (RA) that is characterized by marked loss of peripheral bone. It was found that the frequency of osteoporosis in RA can be increased significantly compared with the reference population, which implies a higher risk of fracture in this group of patients. Osteoporosis makes the treatment of fracture in RA patients more challenging, including the difficulty of fracture fixation, delayed union, secondary loss of reduction, and fixation failure. The locking compression plate was designed using the concept of "internal fixator," which provides a new solution for the fixation of osteoporotic fractures. The fixed angle between the screw and the plate increases the pull-out strength of the system, so the stability of the fixation no longer depends totally on the quality of the bone. The other benefits of this system include the fact that no accurate contouring is required, it protects the local blood supply, and it supports minimally invasive plate osteosynthesis.
Journal Article↗
Histologic study of the bone adjacent to titanium bone screws used for mandibular fracture treatment.
PURPOSE: Titanium miniplates have been widely used in mandibular fracture fixation because of their strength and excellent biocompatibility. However, the condition of the bone adjacent to titanium bone screws has not been clarified. This study histologically examined the bone-screw interface in patients treated for mandibular fractures. PATIENTS AND MATERIALS: Specimens were obtained from 14 patients, and the undecalcified sections were stained by the toluidine blue and Levai Laczko methods and examined with light microscopy. The mean ratio of direct contact between the bone and the titanium bone screw surface was also analyzed using a computer-aided image analyzer. RESULTS: The formation of new bone was observed around the titanium bone screws in all cases. In areas of cortical bone, partial interposition of soft tissues was rarely observed. However, in areas of cancellous bone, partial interposition of soft tissues was seen, and bone resorption between the bone and soft tissues was noted. The mean ratio of direct contact between all of the adjacent bone and the surface of the titanium bone screws was 64.4%. The mean ratio of direct contact between cortical bone and the titanium bone screws was 82.4%. Black particles were observed in the bone and soft tissues around the titanium bone screws, and multinuclear giant cells resembling macrophages were observed near these particles. CONCLUSION: Titanium bone screws used for mandibular fracture fixation develop almost complete contact with new bone. Some metalosis is present.
Adolescent↗
Technique for internal fixation of capitellum and lateral trochlea fractures.
Internal fixation for fractures of the humeral capitellum is a technically challenging procedure. Controversy exists regarding the optimal surgical approach and fixation technique. The benefit of stable fixation of the capitellum fragment is early mobilization. Our preferred technique involves anatomic reduction of the capitellar fragment and fixation with headless screws placed from anterior to posterior. When possible, the surgical exposure employed preserves the lateral ulnar collateral ligament (LUCL) and minimizes disruption of the soft tissues posterior to the capitellum.
Bone Screws↗
Fixation of fractures of the lower cervical spine using methylmethacrylate and wire: technique and results in 99 patients.
Surgical stabilization of traumatic fracture-dislocations of the lower cervical spine with wire and methylmethacrylate remains a controversial procedure. Yet, the resultant immediate fixation with minimal patient morbidity seems to indicate that this method provides an ideal stabilization construct. We describe and report the outcome of a technique of posterior cervical fixation with methylmethacrylate and wire for stabilization of traumatic fractures of the lower cervical spine. Over a 12-year period, 124 fracture-dislocations of the lower cervical spine in 99 patients (mean age, 32 years; range, 15-76 years) were treated at this institution using a posterior methylmethacrylate and wire technique. Eighty-two patients had a posterior element fracture; 28 had a vertebral compression with posterior ligamentous injury; and 14 had a ligamentous injury alone. Thirty-six patients were neurologically intact upon admission, while the rest had radiculopathy or partial or complete myelopathy. Ninety-one patients were available for follow-up [mean, 18.6 months; range, 1-100 months (8.33 years)]. Eighty-eight patients (97%) had a stable fixation and 77 (85%) had resumed preoperative activity or were working but with a residual deficit. Complications included fixation failure requiring a second operation in 3 patients, nonlethal pulmonary embolism in 2 patients, lethal pulmonary embolism in 1 patient, and a superficial wound infection in 3 patients (none affected the underlying fixation construct). These results indicate that this technique is a safe, simple, and effective method for stabilizing the lower cervical spine that allows rapid patient mobility with minimal morbidity.
Adolescent↗
Displaced fatigue fractures of the femoral shaft.
For this study, all displaced fatigue fractures of the femoral shaft treated during a 20-year period at a national military hospital were analyzed. Ten previously healthy male recruits sustained displaced femoral shaft fatigue fractures, the incidence being 1.5 per 100,000 person-years in military service. The median age of the patients was 19 years (range, 18-20 years). None had any previous fatigue fractures. The median body mass index was normal. Before the fracture displacement, nine recruits experienced thigh or knee pain for 1 to 6 weeks. Six of the 10 fractures were located in the distal third of the diaphysis. Only one fracture occurred in the proximal third. Six fractures showed a noncomminuted, oblique, or oblique-transverse configuration. Five fractures were treated using an intramedullary nail, four fractures with a dynamic compression plate, and one with a dynamic condylar screw-plate. The bone at the site of fracture proved to be abnormally brittle. In six patients this resulted in additional comminution intraoperatively. Two reoperations were necessary to exchange a nail and a screw because of technical faults. The median time to solid bony union was 3.5 months (range, 3-5 months). The recruits returned to light duty military service 6 weeks postoperatively, on the average. Two were exempted from military service for 2 years. Displacement is a rare, highly undesirable consequence of fatigue osteopathy of the femoral shaft among young recruits during basic military training. Preventive methods should focus on early, effective detection of developing fatigue fractures to avoid a displaced fracture, with subsequent prolonged morbidity and possible complications. Gentle handling of the bone during the fracture fixation procedure is imperative because of the extraordinary brittleness of the fracture fragments.
Adolescent↗
[Torque load and types of fractures of threaded holes in cortical bone by lag screw. Mechanic and histological studies (author's transl)].
For the better understanding of fracture fixation by means of screws the torque load and types of fractures from threaded screw holes in cortical bone were studied. The experiments were performed on sheep tibia and femora in vitro and in vivo. We applied the 4.5 mm cortical bone screw (AISF) as lag screw. The screw was threaded in until total destruction of the thread occurred. The process of torque load was registered as a torque-angle of twist curve with 4 typical parts. Histologically in most cases shear fractures with different geometry occurred. In some cases we found conical geometric, and in others cylindrical geometric fragments in the threaded screw holes. The value of the torque at which destruction of a threaded hole occurs is a linear function of the thickness of the cortical bone. The gradient of this linear function is 6.6 kpcm/mm. In practical case, the insertional torque may be estimated by multiplying the cortical bone thickness in mm (if known) by a factor 4.
Animals↗
[The prosthesis nail -- a new stable fixation device for periprosthetic fractures and critical fractures of the proximal femur].
Increasing numbers of total hip arthroplasties in combination with increasing age and growing daily activities of the elderly lead to increasing numbers of periprosthetic fractures and revision arthroplasties in osteoporotic bone. The prosthesis nail is a hybrid of a hip prosthesis and an intramedullary nail allowing immediate full weight bearing and early rehabilitation. The prosthesis nail consists of three self-locking components: a distally locked intramedullary nail, different lengthening modules, and a hip prosthesis module. From 1992 to 1999, 28 prosthesis nails were implanted in 26 patients (40-88 years, mean age: 71 years). The indications were 21 peri- and subprosthetic fractures caused by trauma, 2 fractures of the proximal femur in combination with a fracture of the femoral head or severe degenerative arthritis, and 4 revision arthroplasties associated with poor bone quality. A combination of the prosthesis nail and bone cement was used in one patient suffering from a pathological fracture of the distal femur. Patients were additionally treated with wire cerclage (six patients) and autogenous bone grafting (ten patients). All patients-except those who received a reconstruction of the acetabulum in the same session (four patients)-were mobilized with full weight bearing on the operated side as soon as wound pain diminished. Bone healing was observed in all periprosthetic fractures. In three patients the prosthesis nail had to be revised: one patient suffered from recurrent dislocations and in one patient weighing 350 pounds limb shortening occurred after the distal locking screw broke. Intramedullary infection was observed once after treatment of a periprosthetic fracture. When bone union was achieved the prosthesis nail was removed and the patient was mobilized with a girdlestone situation. The idea of the prosthesis nail is based on the logical consequence of treating femur fractures with the most efficient procedure, which is intramedullary nailing. The prosthesis nail can be applied according to the requirements of the fracture as a reamed or unreamed nail and immediate full weight bearing is possible. Considering the high average age of the patients, low morbidity, short rehabilitation time, and low costs are the major advantages of this new device. Taking into account the unfavorable preoperative conditions associated with elderly and multimorbid patients, the rate of complications is relatively low.
Acetabulum↗
Antibiotic prophylaxis for surgery for proximal femoral and other closed long bone fractures.
BACKGROUND: Antibiotic prophylaxis has been established policy for major surgical operations for many years. In fracture fixation, the effectiveness, and the duration of administration, have been a matter of debate. OBJECTIVES: To assess the effects of the prophylactic administration of antibiotics in patients undergoing surgical management of hip or other long bone fractures. SEARCH STRATEGY: We searched MEDLINE, EMBASE, Current Contents, Dissertation Abstracts, and Index to UK Theses, and bibliographies of identified articles. Trials were also obtained from the Cochrane Musculoskeletal Injuries Group trials register. Date of the most recent search: end of 1997. SELECTION CRITERIA PARTICIPANTS: Any patients with a hip or other closed long bone fracture undergoing surgery for internal fixation or replacement arthroplasty. INTERVENTIONS: Any regimen of systemic antibiotic prophylaxis administered at the time of surgery. OUTCOME MEASURES: Wound infection (deep and superficial), urinary tract infection, respiratory tract infection, adverse effects of prophylaxis, economic evaluations. DATA COLLECTION AND ANALYSIS: Both reviewers independently selected trials for inclusion, and assessed methodological quality and extracted data. Where possible, data were pooled and Peto odds ratios and absolute risk reductions, each with 95% confidence intervals, calculated. MAIN RESULTS: Twenty one randomised trials of only poor or moderate quality were included. The comparisons tested fell within six comparison groups, principally multiple dose or a single dose of antibiotic versus a placebo or no treatment. Antibiotic prophylaxis reduces wound, urinary and respiratory tract infections in patients undergoing surgery for closed fracture fixation. Economic modelling has indicated that this is a cost-effective intervention. There are limited data for the incidence of adverse effects, but as expected they appear to be more common in those receiving antibiotics. REVIEWER'S CONCLUSIONS: Antibiotic prophylaxis should be offered to those undergoing surgery for closed fracture fixation. On ethical grounds, further placebo controlled randomised trials of the effectiveness of antibiotic prophylaxis in closed fracture surgery are unlikely to be justified. Trials addressing the cost-effectiveness of different effective antibiotic regimens would need to be very large and may not be feasible.
Antibiotic Prophylaxis↗
A new method of internal fixation of olecranon fractures.
A new method of internal fixation for fractures of the olecranon is described. An Attenborough spring and hooks, together with a Rush nail, are used. The spring and hooks provide compression across the fracture site. The surgical technique is described and the results in 17 patients treated by this method are discussed. Nine patients had an excellent result and 7 a good result. The method required no special instrumentation and early mobilization is encouraged.
Adolescent↗
External fixation of metacarpal and phalangeal fractures.
External fixation is rarely employed in the treatment of hand fractures, and few reports describing this technique have been published. This is a report on 26 patients with 30 hand fractures (19 metacarpal and 11 phalangeal) treated by closed reduction and external fixation. The fixation consisted of percutaneous and transversely applied Kirschner wires that were fixed externally with methylmethacrylate rods. Active range of motion exercises were started 1 week after reduction with the external fixator in place. Percentage return of total range of motion in phalangeal fractures varied from 66% to 98% (mean, 84%), and in metacarpal fractures it varied from 77% to 100% (mean, 96%).
Adolescent↗
[Biomechanics of femoral interlocking nails at the bone-implant transition].
Today there is a variety of different interlocking intramedullary nail designs available for the femur-each designed with a different approach to achieve stability for fracture fixation. We compared different nail types in the bone-implant complex (BIC) of four unreamed solid nails and a slotted, reamed nail to see if there are major differences in stiffness for axial load, bending and torsion. We simulated comminuted mid-shaft fractures by a 2 cm defect osteotomy in paired human cadaver femora. Each bone was tested intact in a Universal testing machine. The results were recorded, osteotomy and osteosynthesis were performed, and the BIC was tested. Relative stiffness was calculated for each individual bone. For P-values less than 0.01 ('least significance difference test') the difference between groups was considered to be significant. In torque testing the unslotted solid nails showed significantly more stiffness (0.6-1.8 Nm/degree) compared to the slotted nail (0.2 Nm/degree). Compared to intact bone (6.9 Nm/degree), both groups of nails were significantly less stiff (relative stiffness 2-20%). In axial load and bending testing, the large-diameter unreamed nail showed greater higher stiffness (32-68%). This study shows that stiffness of the BIC in interlocking femoral nails is more dependent on nail profile than on the press-fit of nails in the medullary canal. For torque stiffness the absence of a slot is of special importance. According to our study, all of the unslotted nails tested give adequate stability for fracture fixation.
Adult↗
RADIAL NERVE TRANSPLANT AND INTERNAL FIXATION IN CASES OF HUMERUS FRACTURE WITH RADIAL NERVE INJURY.
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Fracture Fixation↗
Anti-infective efficacy of antiseptic-coated intramedullary nails.
The coating of medical devices with antimicrobial agents has recently emerged as a potentially effective method for the prevention of device-related infections. We examined the anti-infective efficacy of intramedullary nails coated with an antiseptic combination of chlorhexidine and chloroxylenol in a rabbit model of device-related infection after fixation of an open tibial fracture. The rabbits were randomized to receive 2.8-by-100-millimeter stainless-steel tibial intramedullary nails that either were uncoated or were coated with antiseptic. After administration of anesthesia and preoperative antibiotic prophylaxis, a tibial fracture was created and then reduced with insertion of the intramedullary nail. A bacterial inoculum of 10(6) colony-forming units of Staphylococcus aureus was injected into the intramedullary canal, and the wound was sutured. Radiographs of the tibiae were made postoperatively, and the rabbits were monitored daily. They were killed at six weeks, or earlier if there was dehiscence of the wound, the fracture became grossly unstable, or the rabbit failed to thrive. The use of the antiseptic-coated nails was associated with a significantly lower rate of device-related osteomyelitis (two of twenty-two; 9 per cent) than the use of the uncoated nails (thirteen of twenty-one; 62 per cent) (p = 0.0003). The radiographic and histopathological findings were generally similar in the two groups of rabbits. Antiseptic agents were not detected in serum. The results suggest that antiseptic-coated fracture-fixation devices provide significant local protection against Staphylococcus aureus, which is the most common cause of infections related to orthopaedic devices.
Animals↗