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At least 1,171 records · Page 65Linked to original sources
PubMed1994

Treatment of os calcis fractures by open reduction and internal fixation.

Over a 3-year period, 47 displaced intra-articular fractures of the os calcis in 43 patients underwent open reduction and internal fixation. A significant feature of this series is that computed tomography was used to assess all fractures both before and after surgery. Seventy-seven percent demonstrated a consistent fracture pattern with four major bone fragments. Patients underwent clinical assessment 1 year after injury; thirty-six feet (76.6%) were rated satisfactory and 11 (23.4%) were rated unsatisfactory. An unsatisfactory clinical outcome was significantly correlated with failure to obtain or maintain a satisfactory reduction (P = .004) and also with workers' compensation or liability status (P = .013). The degree of initial comminution, bilateralism, calcaneocuboid joint involvement, patient age, joint depression versus tongue-type fracture pattern, and Bohler's angle at follow-up did not correlate with the final clinical result. Postoperative computed tomography in the coronal plane was found to be mandatory for assessment of joint congruity and restoration of an adequate fibulocalcaneal space.

Adolescent↗
PubMed2006

Subperiosteal elevation of the ulnar nerve during internal fixation for fractures of the distal humerus assessed by intra-operative neurophysiological monitoring.

Ulnar nerve function, during and after open reduction and internal fixation of fractures of the distal humerus with subperiosteal elevation of the nerve, was assessed by intra-operative neurophysiological monitoring. Intermittent recording of the compound muscle action potentials was taken from the hypothenar muscles in 18 neurologically asymptomatic patients. The mean amplitude of the compound muscle action potential after surgery was 98.1% (sd 17.6; -37% to +25%). The amplitude improved in six patients following surgery. Despite unremarkable recordings one patient had progressive paresis. Motor impairment is unlikely if the compound muscle action potential is continuously preserved and not reduced by more than 40% at the end of surgery. Temporary decreases in amplitude by up to 70% were tolerated without clinical consequences. However, repeated clinical examination is obligatory to recognise and treat early post-operative palsy.

Action Potentials↗
PubMed1989

Internal fixation of femoral neck fractures in Parkinson's disease. 32 patients followed for 2 years.

32 patients, suffering from Parkinson's disease, had internal fixation of femoral neck fractures. In 24 displaced fractures, 6 nonunions and 3 segmental collapses were seen; and in 8 undisplaced fractures, 1 case of segmental collapse was diagnosed. Healing complications were thus seen in one third. Total hip replacement for healing complication was performed in 3 of 32 patients. 9 patients died within 2 years. No difference in the rate of healing or mortality was detected compared with hip fracture patients without Parkinson's disease. Our study does not support primary arthroplasty for femoral neck fracture in patients with Parkinson's disease.

Adult↗
PubMed2000

Functional outcome of open reduction and internal fixation of pelvic ring injuries.

Between January 1996 and August 1998, 15 patients with pelvic ring injuries were treated by open reduction and internal fixation. Fractures types included Tile A1 (7%), B1 (33%), C1 (53%) and C3 (7%). The patients were observed for an average of 1 year (range: 5 to 21 months). Thirteen patients (87%) who were operated within 3 weeks after injury had their pelvic disruption healed. One patient with Tile C1 and non-union of the fracture dislocation of sacroiliac joint was operated 11 months after injury and developed implant failure and non-union of the fracture dislocation of sacroiliac joint. Another patient with Tile C1 injury with transforamina sacral fracture was fixed anteriorly only and developed non-union of the sacral fracture and redisplacement of pelvic disruption. Both of them had a poor functional outcome. A 40 points pelvic outcome grading scale (Cole et al 1996) based on physical examination, pain, radiographic analysis and activity/work status was used. Six patients (40%) (1 Tile A1, 5 Tile B1) had an excellent functional outcome. Seven patients (47%) (6 Tile C1, 1 Tile C3) had a good functional outcome.

Adolescent↗
PubMed1981

[A review of 86 fractures of the lower end of the femur treated by internal fixation using A.O. blade-plates (author's transl)].

The authors have treated 86 fractures of the lower end of the femur by internal fixation with an A.O. blade-plate. An adequate follow up was made in 71 cases. A classification of the fractures is given. Half of the fractures were either complex or involved the joint. The technique that was used is described. The authors consider that an immediate cancellous autogenous bone graft is worthwhile. 8 cases of non-union, 7 stiff knees and 31 malunions were seen; 70 per cent of cases achieved satisfactory function.

Adult↗
PubMed1997

A retrospective study on elbow function after internal fixation of intercondylar fracture of adult humerus.

Between 1989 and 1993, 20 intercondylar fractures of the distal humerus were treated by open reduction, internal fixation and early postoperative mobilisation. One patient died on the third postoperative day as a result of multiple injuries, leaving 19 patients for evaluation. The mean follow-up period was 4.1 years (range 2.0 to 6.7 years). According to the Muller system, there were 7 type C1 and 12 type C2 fractures. Using the Jupiter criteria, 6 elbows were rated as excellent, 9 good and 4 fair. Complications included late ulnar neuritis in one patient and wound infection in another patient.

Adolescent↗
PubMed1983

Classification of tibial shaft fractures and correlation with results after rigid internal fixation.

A classification of tibial shaft fractures based on etiology, morphology, and clinical features is documented in a series of 291 fractures treated by AO/ASIF rigid internal fixation. The fractures were placed in nine main fracture groups, each with three subgroups according to location in the proximal, middle, or distal segment of the shaft. Group A includes all simple fractures, and Group B includes fractures with butterfly fragments and cortical contact between the main proximal and distal fragments. In Group C there is no such contact. For all degrees of comminution, Group 1 includes the spiral fractures and Groups 2 and 3 the nonspiral bending fractures. Group C2 contains segmental and Group C3 crush and high-velocity projectile fractures.

Adolescent↗
PubMed2005

[Percutaneous cannulated screws internal fixation for treating the posterior portion of the iliac wing fractures].

OBJECTIVE: To present the technique for percutaneous placement of cannulated screws in the iliac wing, and to describe the surgical technique and the methods, the indication, the time, the key of operation and the clinic outcomes of the technique. METHODS: Through the anatomy study of ilium, a wider columns structure at the posterior ilium was found, which was named "the posterior columns of pelvis", and then measure the parameter of the structure. Twelve patients with the injuries in the iliac wing and the anterior ring of pelvis were treated with percutaneous cannulated screws internal fixation. RESULTS: All of the fractures healed in the followed up period. Vertical replacement were all completely corrected. Two of the cases left behind slight rotary replacement, and no complication were found. CONCLUSIONS: The technique of percutaneous cannulated screws internal fixation for treating the posterior portion of the iliac wing fractures has the advantages of small trauma, less bleeding stiff fixation, which is an ideal and minimally invasive technique.

Adolescent↗
PubMed1998

Reasons for removal of rigid internal fixation devices in craniofacial surgery.

Despite the widespread use of rigid fixation techniques in craniofacial surgery, there is a paucity of studies in the literature that serve to better define the reasons for the subsequent removal of plates and screws. The current study appears to be the first to attempt to assess these issues among a broad range of craniofacial surgery patients. Fifty-five patients who underwent hardware removal following craniofacial surgery at the University of Michigan Medical Center between 1989 and 1995 were retrospectively studied via an in-depth chart review. Common reasons for hardware removal included palpable/prominent hardware in 19 patients (34.5%), loosening of plates and screws in 14 patients (25.5%), pain in 14 patients (25.5%), infection in 13 patients (23.6%), wound dehiscence/exposure of hardware in 11 patients (20%), and removal at the time of secondary procedures in 5 patients (9.1%). It is hoped that this study will serve as a tool to define more completely the risk of needing subsequent hardware removal among craniofacial surgery patients treated with rigid internal fixation.

Adolescent↗
PubMed2000

Surgical approaches and ancillary techniques for internal fixation of intracapsular proximal femoral fractures.

BACKGROUND: In fixation of intracapsular hip fractures, different implants, surgical approaches and ancillary manoeuvres have been employed to improve the reduction, and the stability of the reconstruction, in an attempt to reduce the frequency of non-union and aseptic necrosis of the femoral head. OBJECTIVES: To compare alternative surgical approaches and ancillary techniques in internal fixation of intracapsular hip fractures which have been subjected to randomised trials in elderly people. SEARCH STRATEGY: The Cochrane Musculoskeletal Injuries Group trials register, Medline, and reference lists of relevant articles were searched. Date of the most recent search: June 1998. SELECTION CRITERIA: All randomised and quasi-randomised trials investigating operative technique for the treatment of intracapsular hip fractures. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality, by use of a ten-item checklist, and extracted data. MAIN RESULTS: One study of 94 patients studied the effect of impaction of the fracture at the time of surgery. The only outcome measure was bone scintimetry. There was no difference in scintimetry for the 29 undisplaced fractures but in displaced fractures treated with impaction the scintimetry appearances were significantly reduced implying a reduction of blood flow to the femoral head. One study of 220 patients compared the results of fractures treated with compression against those without compression. Results for 156 patients at one year showed a tendency to a lower incidence of non-union for those fractures treated without compression. One study of 49 patients noted a tendency to a reduced mortality for closed reduction of the fracture as opposed to open reduction. Non-union of the fracture was more common after closed reduction. REVIEWER'S CONCLUSIONS: Insufficient evidence exists from randomised trials to confirm the benefits of open or closed reduction or for intra-operative impaction or compression of an intracapsular fracture treated by internal fixation.

Aged↗
PubMed1978

Secondary treatment of fractures of the middle and lower third of the tibia unsuccessfully treated by primary internal fixation.

The authors present forty six cases, referred to us between 1969 and 1974, of fracture of the middle and lower thirds of the tibia, previously treated elsewhere by primary internal fixation using a plate and screws. The causes of failure are divided into defective indications and defective technique. The methods of treatment used in infected and non-infected lesions are described. They criticise the unnecessary use of plates and explain their reasons. They do not condemn the method outright, since in selected cases IT IS UNDOUBTEDLY A VALID METHod of treatment. They are opposed, however, to its indiscriminate use for lesions that may perfectly well be cured, with the minimum risk, either by conservative methods, or by intramedullary nailing.

Fracture Fixation, Internal↗
PubMed2006

Interference screw technique for arthroscopic reduction and internal fixation of compression fractures of the tibial plateau.

Arthroscopic reduction and internal fixation (ARIF) is recommended as state-of-the-art treatment for patients with pure compression fracture of the tibial plateau. We describe a new technique for ARIF of pure compression tibial plateau fractures that uses a cannulated, bioabsorbable interference screw. After a guide pin is placed in the center of the compressed fragment and a tamp is used to elevate the fracture (with bone grafting as desired), the interference screw is advanced over the guide pin, resulting in both elevation and buttressing of the fracture. As compared with previously described techniques in which percutaneous buttress screws were used, ARIF attained with an interference screw via the tibial metaphyseal window allows substantially improved efficiency of surgical steps, improved preservation of the soft tissue envelope, definitive articular reduction under arthroscopic visualization, use of a bioabsorbable implant, and elimination of the need for fluoroscopy.

Arthroscopy↗
PubMed2005

Surgical approaches and ancillary techniques for internal fixation of intracapsular proximal femoral fractures.

BACKGROUND: In the fixation of intracapsular hip fractures, different implants, surgical approaches and ancillary manoeuvres have been employed to improve the reduction, and the stability of the reconstruction, in an attempt to reduce the frequency of non-union and aseptic necrosis of the femoral head. OBJECTIVES: To compare alternative surgical approaches and ancillary techniques in internal fixation of intracapsular hip fractures which have been subjected to randomised and quasi-randomised trials in adults. SEARCH STRATEGY: The Cochrane Musculoskeletal Injuries Group Specialised Register, MEDLINE, and reference lists of relevant articles were searched. Date of the most recent search: November 2004. SELECTION CRITERIA: All randomised and quasi-randomised trials investigating operative technique for the treatment of intracapsular hip fractures. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality, by use of a 10 item checklist, and extracted data. MAIN RESULTS: One trial with 103 participants studied the effect of impaction of the fracture at the time of surgery. The only outcome measure reported was bone scintimetry. There was some evidence that impaction, particularly of displaced fractures, resulted in a reduction of blood flow to the femoral head as assessed by bone scintimetry. One quasi-randomised trial with 220 participants compared compression of the fracture with no compression. Results for 156 individuals at one year showed a tendency to a lower incidence of non-union for those fractures treated without compression.Two trials, one involving 102 young adults under 50 years old and the other involving 49 older people aged 65 years or over, compared open versus closed reduction of the fracture. Both found open reduction significantly increased length of surgery. None of the other differences between open and closed reduction in the outcomes reported by the two trials were statistically significant. AUTHORS' CONCLUSIONS: Insufficient evidence exists from randomised trials to confirm the relative effects of open versus closed reduction of intracapsular fractures, or the effects of intra-operative impaction or compression of an intracapsular fracture treated by internal fixation.

Aged↗
PubMed2003

Internal fixation of displaced proximal humeral fractures with two one-third tubular plates.

BACKGROUND: Operative treatment of displaced proximal humeral fractures often results in poor functional outcome. We report a technique that provides improved rotational stability of the fracture and thus allows early functional treatment. METHODS: Seventy-one consecutive patients (67 +/- 18 years) with displaced fractures of the proximal humerus (two-part, n = 10; three-part, n = 41; four-part, n = 20) were treated by open reduction and internal fixation using two one-third tubular plates on the anterior and lateral aspects of the proximal humerus. Passive motion was started on the third postoperative day, followed by actively assisted exercises on day 6. RESULTS: Seven patients (12%) had complications (fracture redisplacement, avascular necrosis of the humeral head, frozen shoulder, subacromial impingement, and implant loosening) that required further surgical intervention. Sixty patients (85%) were available for follow-up evaluation 17 +/- 10 months after the injury. Using the Constant score, 34% of the patients had very good results, 29% had good results, 25% had fair results, and 12% had poor results. Age (< 60 years or > or = 60 years) and fracture type had no influence on functional outcome. CONCLUSION: These results demonstrate the high stability of internal fixation with two one-third tubular plates that allowed early mobilization of the shoulder in all patients and emphasize this technique as a preferred treatment option for displaced fractures of the proximal humerus.

Activities of Daily Living↗
PubMed2006

Treatment of anterior fracture-dislocations of the proximal humerus by open reduction and internal fixation.

Over a seven-year period we treated a consecutive series of 58 patients, 20 men and 38 women with a mean age of 66 years (21 to 87) who had an acute complex anterior fracture-dislocation of the proximal humerus. Two patterns of injury are proposed for study based upon a prospective assessment of the pattern of soft-tissue and bony injury and the degree of devascularisation of the humeral head. In 23 patients, the head had retained capsular attachments and arterial back-bleeding (type-I injury), whereas in 35 patients the head was devoid of significant soft-tissue attachments with no active arterial bleeding (type-II injury). Following treatment by open reduction and internal fixation, only two of 23 patients with type-I injuries developed radiological evidence of osteonecrosis of the humeral head, compared with four of seven patients with type-II injuries. A policy of primary treatment by open reduction and internal fixation of type-I injuries is justified, whereas most elderly patients (aged 60 years or over) with type-II injuries are best treated by hemiarthroplasty. The best treatment for younger patients (aged under 60 years) who sustain type-II injuries is controversial and an individualised approach to their management is advocated.

Adult↗
PubMed1994

Prediction of fracture union after internal fixation of intracapsular femoral neck fractures.

This study was based on a series of 470 patients with an intracapsular proximal femoral fracture treated by internal fixation; the characteristics of those patients with non-union were contrasted with those of patients in which union occurred, to determine which variables would predict bony union of the fracture. Radiological factors studied included measurements of fracture displacement, anatomical site and degree of osteoporosis. Patient characteristics studied were age, sex, prefracture mobility and mental state. Patient age and pre-operative fracture displacement were found to be of the greatest value in predicting non-union.

Age Factors↗
PubMed1992

Rigid internal fixation for the treatment of infected mandibular fractures.

A review of the literature is presented that shows that treatment of infected fractures by rigid internal fixation is biologically sound. A protocol for managing infected mandibular fractures with plate and screw fixation was developed and used on 11 patients. All patients had osseous union of the fracture and none required removal of the bone plate. This protocol is recommended as a viable option in the treatment of infected mandibular fractures.

Abscess↗
PubMed1986

The stability of internal fixation in the proximal phalanx.

A biomechanical study was performed to assess quantitative differences in the stability obtained with five commonly used types of internal fixation used in proximal phalangeal fractures. The techniques included dorsal plating, dorsal plating combined with an interfragmentary lag screw, two interfragmentary lag screws, tension-band technique, and crossed Kirschner wires. Rigidity and strength in apex palmar bending were determined after oblique osteotomy and fixation of the proximal phalanx. The failure modes for each fixation technique were also observed and described. The results showed that both of the techniques that used interfragmentary lag screws across the oblique osteotomies provided significantly more rigidity than did dorsal plating alone or the wired configurations but that measurements of strength were similar between all techniques tested. Dorsal plates were at a mechanical disadvantage on the compression surface in our apex palmar bend test and consequently provided no more rigidity and strength than did the wired techniques. The tension band technique represented a combination of stiff and flexible intraosseous wires without strict application of tension band principles and provided intermediate rigidity and strength. Rigidity and strength in intact proximal phalanges in the controls were significantly greater than in all techniques tested.

Biomechanical Phenomena↗