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PubMed1986

Rigid internal fixation in the hand: 104 cases.

One-hundred and four patients with fractures of the metacarpals and phalanges have been treated with rigid internal fixation over a 6-year period. Patients with both open and closed injuries had their fractures fixed by tension band wires, interosseous compression screws (lag screws), or plates and screws. The concepts of primary bone healing and its variations, methods of fixation, and the importance of interfragmentary compression are defined and stressed. Illustrative cases of each technique are described and the applicable principles are enunciated.

Accidents, Occupational↗
PubMed2003

Open reduction and internal fixation of calcaneal fractures with a low profile titanium calcaneal perimeter plate.

Forty-two intra-articular calcaneus fractures underwent open reduction and internal fixation with a low profile, titanium plate with a shape similar to the lateral aspect of the calcaneus. All 42 fractures healed without complication. There were no cases of hardware breakage. None of the patients were noted to have a loss of reduction. The plates were applied without bending and molded to the side of the calcaneus with tightening of the screws. No patient complained of symptomatic hardware during the follow-up period. With postoperative plain radiographs, the reduction was judged as anatomic in 35 patients, less than a 2 mm step off in six patients, and one patient with greater than 2 mm step off. Use of this new plate allows for easy application as it does not require contouring, is well tolerated without complaints of hardware prominence, and none of the hardware broke prior to fracture union.

Adolescent↗
PubMed2006

The usefulness of computed tomography following open reduction and internal fixation of acetabular fractures.

PURPOSE: To investigate the role of a supplemental imaging modality in postoperative assessment of acetabular fractures following open reduction and internal fixation. METHODS: Postoperative axial computed tomographic (CT) scans were compared with plain radiographs of 20 patients with regard to their sensitivity for detecting articular fracture reduction in terms of gap displacement and step deformity or offset. Three observers independently reviewed the plain radiographs and CT scans at 2 separate time points and categorised the outcome as either anatomical or non-anatomical. The inter-observer reliability and intra-observer reproducibility of these measurements was expressed as a kappa statistic. The radiological result was correlated with the clinical outcome measures using the Merle D'Aubigne scale, the Harris Hip Score, and the SF-36 score. RESULTS: Plain radiography was less effective in the detection of postoperative articular displacement (mean, 75.1% sensitive). The inter-observer and intra-observer agreement between reviewers was good to excellent in detecting reduction quality between the 2 modalities. Patient management was not altered by the findings of the CT scans. CONCLUSIONS: Although postoperative CT scanning of acetabular fractures in selective cases may be useful, issues such as higher cost, less effective allocation of resources, and excessive radiation doses do not support its routine use.

Acetabulum↗
PubMed2002

Arthroscopically assisted reduction and internal fixation of tibial plateau fractures: report of twenty cases.

The purpose of this study was to evaluate the results of arthroscopically assisted reduction and internal fixation of tibial plateau fractures. We report on 20 patients with 20 fractures with a mean follow-up time of 39 months (27-64 months). All fractures were evaluated according to the Schatzker classification. Under arthroscopic guidance, the fractures were reduced and associated intra-articular lesions were addressed appropriately. For split fractures a limited lateral approach, or the joystick technique, was used. Depression fractures were reduced with the aid of an anterior cruciate ligament (ACL) tibial guide. Postoperatively, immediate mobilisation and continuous passive motion was encouraged. A hinged brace provided stability and the patients were not allowed to bear weight for at least six weeks. According to the Rasmussen grading system, 18 out of 20 patients scored an excellent (15 patients), or a good (3 patients) result. One patient had a fair result. The only poor result we noted was caused by the fact that we were unable to reduce the fracture arthroscopically and had to perform an arthrotomy. We experienced no complications due to the arthroscopic procedure.

Adolescent↗
PubMed2004

[The use of self-reinforced P(L/D)LA bioabsorbable internal fixation system in oral maxillofacial fractures].

PURPOSE: The purpose of this study was to evaluate the effectiveness of self-reinforced P(L/D)LA internal fixation system for oral maxillofacial fractures. METHODS: The system was used in 43 patients. The reduction situation during and after operation, postoperative complications and degradation time were recorded. RESULTS: The postoperative complications were one case with postoperative infection and one case with late noninfectious inflammatory tissue response, but these were controlled by routine treatment. Bone healing was satisfactory in all cases, without delay of bone union or obvious displacement of fracture segments after surgery. The degradation time ranged from one and half years to three years, the system remained in orbital and zygomatic areas and cannot be degraded completely. CONCLUSIONS: The SR-P(L/D)LA system provided effective and stable fixation for maxillofacial fractures. The system has some defaults: the screws are broken easily, different degradation time in different individuals and incomplete degradation in some patients exist.

Adolescent↗
PubMed1991

Internal fixation of the odontoid: a newer approach to an old problem.

A surgical approach to cervical spine instability associated with odontoid fracture is described. Internal fixation of the odontoid (IFO) has advantages over traditional posterior surgical treatments currently employed. This approach to the odontoid process is easier for the surgeon comfortable with anterior discectomy to perform than other techniques described in the spine literature.

Adolescent↗
PubMed2000

Successful immediate weight-bearing of internal fixated ankle fractures in a general population.

Several studies on operated ankle fractures have shown that immediate weight-bearing is recommendable. Consequently, we changed our postoperative standard regimen, from 3 weeks of non-weight-bearing followed by 3 weeks of weight-bearing, to full immediate weight-bearing in all 6 weeks. A below-knee walking cast was applied immediately after surgery. Between December 1995 and September 1996, we studied 62 patients (median age, 55 years; range 21-92 years; M/F, 24/38), with ankle fractures who attended our emergency department and were subsequently admitted for open reduction and internal fixation. We excluded patients with distal tibia fracture and patients under 18 years of age. Overall, our elderly population did not have complication rates higher than those reported in similar studies on younger patients. In 1 patient, we observed radiographic widening of the ankle joint, of about 3 mm, 6 weeks postoperatively. No patients required reoperation. Our study indicates that full immediate weight-bearing after open reduction and internal fixation is recommendable, even in an elderly population.

Adult↗
PubMed2006

Conversion of failed proximal femoral internal fixation to total hip arthroplasty in osteopetrotic bone.

Osteopetrosis is a rare disease. When fractures are encountered, fixation is extremely difficult. A 38-year-old man with osteopetrosis who sustained a displaced Pauwels type IV fracture with 3 failed internal fixations required total hip arthroplasty. Two main problems were perceived during preoperative planning: the removal of failed and broken metalwork and reaming of the tight intramedullary canal to allow seating of the femoral stem. We present technical solutions to aid the surgeon in the management of this difficult type of case using custom-made tungsten carbide instrumentation.

Adult↗
PubMed1992

Survivorship analysis of pedicular fixation systems in the treatment of degenerative disorders of the lumbar spine: a comparison of Cotrel-Dubousset instrumentation and the AO internal fixator.

We retrospectively analyzed the frequency and clinical consequences of pedicular fixation system failure in 50 patients who underwent Cotrel-Dubousset transpedicular instrumentation (CDI), and 46 patients who underwent AO internal fixator (IF) instrumentation for similar indications. After 2 years, 14 implants in the CDI group and 13 in the IF group had failed. The overall probability of implant survival was similar in both groups (CDI, 71.9% versus IF, 71.7%). However, more implant failures were associated with nonunion, loss of reduction, and nerve-root compromise in the IF group (four versus none) than in the CDI group. Implant failure usually occurred after solid fusion, and did not significantly affect the short-term clinical results. Therefore, implant failure does not a priori indicate failure of the operation.

Adolescent↗
PubMedDate not supplied

Open reduction and augmentation of internal fixation with an injectable skeletal cement for the treatment of complex calcaneal fractures.

OBJECTIVES: To describe the surgical handling, potential complications, and remodeling of an injectable, osteoconductive calcium phosphate cement (Norian SRS) for joint depression-type calcaneal fractures in humans, and to illustrate the clinical efficacy of this cement with special reference to early postoperative full weight bearing. DESIGN: Prospective cohort study. SETTING: Level I trauma centers in Bochum and Leipzig, Germany. INTERVENTION: Thirty-six joint depression type calcaneal fractures in thirty-two patients were augmented with the calcium phosphate cement after standard open reduction with internal fixation. Postoperative full weight bearing was allowed progressively earlier, and as the study progressed, the last patients were bearing full weight as early as three weeks postoperatively. Biopsies for histologic analysis were performed at time of hardware removal after one year (seven biopsies) or in case of infection at time of debridement (five biopsies). MAIN OUTCOME MEASURES: Clinical outcome was evaluated according to a calcaneal scoring system. Data were compared and statistically analyzed between patients with postoperative full weight bearing after eight to twelve weeks and three to six weeks, respectively. Histologic findings are described. RESULTS: Cement injection averaged ten cubic centimeters and could easily be performed under fluoroscopic control. Progressively earlier full weight-bearing was achieved without loss of reduction. There was no statistical difference in clinical outcome scores in patients with full weight bearing before or after six weeks postoperatively. The infection rate was 11 percent, possibly related to the skin incisions. The biopsies from clinically satisfactory cases showed nearly complete bone apposition, areas of vascular penetration, and reversal lines illustrating progressive cycles of resorption and new bone formation. Biopsy specimens from infected cases showed bone and cement surrounded by either fibrous tissue or acute inflammation without extensive bone apposition. CONCLUSIONS: Calcium phosphate cement augmentation of standard open reduction with internal fixation in joint-depression type calcaneal fractures allows postoperative full weight bearing as early as three weeks postoperatively. The injectable bone cement can easily be handled surgically under fluoroscopic control and has proved to be remodelable.

Adult↗
PubMed1995

Internal fixation of the distal radius. A comparative, experimental study.

In a comparative, experimental examination of 60 human cadaver radii, the stability of various, widely used internal fixation procedures of a distal radius fracture loco typico using a dorsal wedge was determined. The use of 2.5-mm Kirschner wires (K-wires) delivered a 10% greater stability than 1.8-mm K-wires. The 2.7-mm polylactide rods achieved a slightly greater stability than 1.8-mm K-wires under accurate pinning conditions. Polylactide rods (35 mm length, 2 mm diameter) and polyglycolide rods (60 mm length, 2 mm diameter) proved to be 20% less solid than 1.8-mm K-wires and almost 45% less than plate fixation. The short polylactide pins, however, did not have enough hold in the proximal cortical bone. The 2.7-mm polylactide rods (60 mm length) complied with the stability prerequisites necessary for comparable substitution for K-wires in distal radius fractures.

Bone Nails↗
PubMed2005

Total knee arthroplasty for salvage of failed internal fixation or nonunion of the distal femur.

Seventeen patients with a mean age of 66 years had total knee arthroplasty (TKA) performed to salvage failed internal fixation or nonunion of the distal femur. Two patients died at less than 2 years, both of whom were unrevised. The remaining 15 were followed for a mean of 5 years. Three arthroplasties failed, 1 by infection and 2 by mechanical failure. The 5-year survivorship free of revision for aseptic failure was 91% (72%-100%). There were 5 intraoperative complications (29%) and 5 postoperative complications (29%). The mean Knee Society pain score improved from 2 (range, 0-10) to 89 (range, 63-97), and the mean functional score improved from 2 (range, 0-25) to 45 (range, 10-90). TKA provided reliable pain relief and functional improvement for the great majority of patients. Functional scores and prosthesis survivorship, however, were inferior to those reported for primary TKA. The surgeries were difficult, and intraoperative and postoperative complications were common.

Adult↗
PubMed2000

Image analysis for computer-assisted internal fixation of hip fractures.

This paper focuses on the task of automatic feature detection for intra-operative drilling trajectory planning for computer-assisted internal fixation of hip fractures. The features of interest are the lateral cortex line of the femoral shaft, the femoral neck centre and the femoral head centre, the latter being the most challenging of all. Since the object is known, the detection process is regarded as a localisation task rather than a recognition one. Simple anatomical relationships between bone parts provide a naturally hierarchical approach to searching, allowing refinement of image-derived information based on a priori constraints. Use of knowledge and an unconventional "divide-and-conquer" approach produce more reliable and faster results than the standard global image processing routine. Analysis of summed 1D grey level profiles is used as a main segmentation tool to carry out the above strategy.

Artificial Intelligence↗
PubMed1997

Fractures of the calcaneus: open reduction and internal fixation from the medial side a 21-year prospective study.

Since 1974, 61 displaced fractures of the calcaneus have been treated by open reduction and internal fixation by a modified medial approach technique. Surgery was performed through a 5-cm incision posterior to the neurovascular bundle. A single threaded pin was passed longitudinally through the tuberosity and into the sustentacular fragment, giving stable fixation. Reduction of the depressed posterior facet fragments was accomplished from the medial side in 77% of cases, occasionally assisted by fluoroscopy. Postoperatively all fractures were immobilized in a cast for 4 weeks. At the end of 4 weeks the pin was removed, and full weight bearing in a walking cast was started and continued for 4 weeks. At 8 weeks after surgery, the walking cast was removed, and the patient began walking in a shoe. These cases were evaluated at a mean follow-up of 4.4 years. There were 49 successful cases (80.3%) and 12 unsuccessful cases (19.7%). A high number of superior results was found in the successful group as shown by the mean score of 94.7 (American Orthopaedic Foot & Ankle Society Scoring System). Time to return to work was a mean of 4.9 months.

Adult↗
PubMed2000

[Early results of short segment internal fixation of the thoracic and lumbo-sacral spine after trauma].

The aim of this paper was to assess the results of short-segment internal fixation of the spine in posttraumatic instability. A group of 53 cases of spinal trauma was analysed using both Magerl's and Frankel's classifications. Spinal instability was assessed according the Sagittal Index (SI). The metaanalysis of the clinical material demonstrated that early decompression of the spinal cord and the spinal roots following trauma allows either total or partial restitution of their physiological functions.

Adolescent↗
PubMed1987

Internal fixation of a proximal metatarsal fracture in a calf.

An open proximal metatarsal fracture was identified in a 9-month-old calf. Open reduction, internal fixation, and external coaptation were used to repair the fracture. The calf recovered without complications and was reported to be sound 6 months after surgery.

Animals↗
PubMed1981

Internal fixation versus hemiarthroplasty for the displaced subcapital fracture of the femur. A prospective randomised study.

A prospective randomised trial of surgical treatment for the displaced subcapital femoral fracture in patients of 70 years or more is presented. Two hundred and eighteen patients were randomly allocated into one of three treatment groups: manipulative reduction and internal fixation using Garden screws; Thompson hemiarthroplasty through a posterior (Moore) approach; and Thompson hemiarthroplasty through an anterolateral (McKee) approach. There is no significant difference in the mortality of the internal fixation and posterior arthroplasty groups. Both groups showed a significantly higher mortality than patients operated on through the anterior approach. The technical results of operation were worse in the internally fixed group, with only 40 per cent being satisfactory. Mobilisation was best achieved after the posterior approach. It is concluded that Thompson hemiarthroplasty, using an anterolateral approach, is the safest operation in this group of patients.

Aged↗