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At least 1,207 records · Page 67Linked to original sources
PubMed2000

Rigid internal fixation of fractures of the proximal humerus in older patients.

In 42 elderly patients, 33 women and nine men with a mean age of 72 years, we treated displaced fractures of the proximal humerus (34 three-part, 8 four-part) using a blade plate and a standard deltopectoral approach. Functional treatment was started immediately after surgery. We reviewed 41 patients at one year and 38 at final follow-up at 3.4 years (2.4 to 4.5). At the final review, all the fractures had healed. The clinical results were graded as excellent in 13 patients, good in 17, fair in seven, and poor in one. The median Constant score was 73 +/- 18. Avascular necrosis of the humeral head occurred in two patients (5%). We conclude that rigid fixation of displaced fractures of the proximal humerus with a blade plate in the elderly patient provides sufficient primary stability to allow early functional treatment. The incidence of avascular necrosis and nonunion was low. Restoration of the anatomy and biomechanics may contribute to a good functional outcome when compared with alternative methods of fixation or conservative treatment. Regardless of the age of the patients, we advocate primary open reduction and rigid internal fixation of three- and four-part fractures of the proximal humerus.

Activities of Daily Living↗
PubMed2000

Open reduction and internal fixation of intra articular and unstable fractures of the distal radius using the AO distal radius plate.

This study reports the results of open reduction and internal fixation of 25 dorsally displaced distal radial fractures using a specifically designed plate for the distal radius, the AO pi plate (Synthes Ltd, Paoli, USA). Twenty-one of these fractures were complex and intra-articular (AO Type 'C'). Measurement of range of motion of the affected wrist at an average follow-up of 16 months revealed a median return of 60 degrees of wrist extension, 40 degrees of wrist flexion, 90 degrees of pronation and 90 degrees of supination. Radiographic assessment revealed restoration of normal radial length, inclination and palmar tilt in all but six cases. The final outcome, as assessed by the Gartland and Werley scale, was excellent in four cases, good in 11, and fair in ten cases. Complications were seen in five patients.

Adolescent↗
PubMed2003

A comparison of open reduction and internal fixation and primary total elbow arthroplasty in the treatment of intraarticular distal humerus fractures in women older than age 65.

OBJECTIVE: To compare open reduction and internal fixation (ORIF) with total elbow arthroplasty (TEA) for intraarticular distal humerus fractures in women older than 65 years of age. DESIGN: Retrospective review. SETTING: Information was obtained from a Level 1 trauma center with fellowship-trained traumatologists and a tertiary care center with fellowship-trained shoulder and elbow surgeons. PATIENTS: Patients were 24 women older than age 65 who sustained distal humerus fractures that required surgical treatment with clinical follow-up at a minimum of 2 years. All fractures were OTA classification 13.C2 or 13.C3. No patients were lost to follow-up. INTERVENTION: ORIF or TEA was the treatment method. MAIN OUTCOME MEASUREMENTS: The Mayo Elbow Performance score and the need for revision surgery were established as the means of patient evaluation. RESULTS AND CONCLUSIONS: Using the Mayo Elbow Performance score, the outcomes of the 12 patients treated with ORIF were as follows: 4 excellent, 4 good, 1 fair, and 3 poor (cases that required conversion to TEA). Outcomes of the 12 patients treated with TEA were as follows: 11 excellent and 1 good. There were no fair or poor outcomes in the TEA group. No patients treated with TEA required revision surgery. We believe TEA to be a viable treatment option for distal intraarticular humerus fractures in women older than age 65. This is particularly true for women with associated comorbidities, such as rheumatoid arthritis, osteoporosis, and conditions requiring the use of systemic steroids.

Age Factors↗
PubMed1990

Internal fixation for fractures of the patella. A comparison of two methods.

Cadaveric experiments in 10 knees were used to study the strength of two methods of internal fixation for a fractured patella. A modified AO tension band technique was compared with the combination of cerclage wiring and a tension band used at Pyrford. The repairs were stressed to failure; the combination of cerclage and tension band wiring proved to be significantly stronger and is recommended.

Adolescent↗
PubMedDate not supplied

Rigid internal fixation of the Mitchell-Hawkins osteotomy/bunionectomy with the Herbert Bone Screw.

The author reports on his use of the Herbert Bone Screw to obtain rigid internal fixation of the Mitchell-Hawkins osteotomy-bunionectomy procedure (distal metatarsal osteotomy). A pilot drill with a built-in stop to prevent overpenetration is used first and then the screw can be inserted with jig, or it may be inserted manually if the osteotomy is stablized temporarily with a Kirschner wire. The screw is an excellent fixation device and does not have to be removed because it is made of inert materials and has no protrusive head.

Adult↗
PubMed1987

Treatment of displaced intra-articular fractures of the calcaneus using medial and lateral approaches, internal fixation, and early motion.

Twenty-two displaced intra-articular fractures of the calcaneus (in twenty-two patients) were treated by open reduction and internal fixation with a screw and one or two staples using a lateral and, when needed, a medial approach, followed by early motion. Despite the early motion, a nearly normal anatomical reduction was achieved and maintained in nineteen feet. After follow-up that ranged in duration from sixteen to seventy-two months, the clinical and radiographic result was rated as good in seventeen patients and fair in one, and there were four failures. Twenty-one of the twenty-two patients returned to work within six months. The average subtalar motion at follow-up was 75 per cent of normal.

Adult↗
PubMed1993

Open reduction and internal fixation of tibial plafond fractures. Variables contributing to poor results and complications.

In a retrospective study, 58 patients with 60 tibial plafond fractures were treated by internal fixation and reviewed over an average follow-up period of 2.5 years. There were three Reudi Type I, 27 Reudi Type II, and 30 Reudi Type III fractures. Twelve fractures were open, and 60% of the fractures were the result of high-energy trauma. Results were evaluated based on a subjective and objective rating system. There were 15 good and excellent (25%), 15 fair (25%), and 30 poor results (50%). The deep infection rate in Reudi Types I and II fractures was 0%, and in Type III fractures it was 37%. The deep infection rate statistically correlated with the presence of a postoperative wound dehiscence or skin slough but not with the presence of an open fracture. Overall clinical rating correlated with the Reudi classification, quality of reduction, and the presence of a postoperative wound infection. The ankle fusion rate for Reudi Types I and II fractures was 10%, whereas that in Reudi Type III fractures was 26%. The results of this study show that operative treatment of complex intraarticular fractures of the distal tibia remain fraught with difficulty and that the complication rates and need for further reconstructive surgery remains high. If anatomic reduction without soft-tissue complications cannot be predicted preoperatively, consideration should be given to alternative types of treatment.

Adolescent↗
PubMed1995

Internal fixation of high tracheal stents.

A technique for internal fixation of a silicone elastomer tracheal stent is described. This technique allows the use of a short stent in situations where complex stent placement otherwise would be necessary. The procedure was used successfully to manage a postresection stricture in the subglottic trachea.

Adult↗
PubMed1989

Internal fixation of unstable spinal fractures: the Hartshill system.

The first 69 cases with a minimum of 1 year follow-up using the Hartshill system for the internal fixation of unstable spinal fractures (cervical 11, thoracic 8, thoracolumbar 42 and lumbar 8 are reported. The instrumentation is uncomplicated but attention to detail in technique is important. The system allows secure stabilization of the spine and early mobilization, irrespective of any neurological damage incurred in the primary injury.

Fracture Fixation, Internal↗
PubMed1990

Internal fixation of a capitate fracture with Herbert screws.

A case of an isolated, displaced fracture of the capitate is described. This rare carpal injury was treated by internal fixation with two Herbert screws. The fracture united and the patient achieved an excellent range of wrist motion. The Herbert screw is useful in the treatment of displaced fractures of the capitate since the screw maintains reduction, compresses the fracture site, and allows early wrist motion.

Adult↗
PubMed2003

Complications following management of displaced intra-articular calcaneal fractures: a prospective randomized trial comparing open reduction internal fixation with nonoperative management.

OBJECTIVE: To report on all complications experienced by patients with displaced intra-articular calcaneal fractures (DIACFs) following nonoperative management or open reduction internal fixation (ORIF). DESIGN: Prospective, randomized, multicenter study. SETTING: Four level I trauma centers. PATIENTS: The patient population consisted of consecutive patients, age 17 to 65 at the time of injury, presenting to 1 of the centers with DIACFs between April 1991 and December 1998. INTERVENTIONS: Patients were randomized to the nonoperative treatment group or to operative reduction using a lateral approach to the calcaneus. MAIN OUTCOME MEASUREMENTS: Follow-up for patients was at 2 weeks, 6 weeks, 3 months, 12 months, 24 months, and once greater than 24 months following injury. At each follow-up interval, patients were assessed for the development of major and minor complications. After a minimum of 2-year follow-up, patients were asked to fill out a validated visual analogue scale questionnaire (VAS) and a general health review (SF-36). RESULTS: There were 226 DIACFs (206 patients) in the ORIF group with 57 of 226 (25%) fractures (57 of 206 patients [28%]) having at least 1 major complication. Of 233 fractures (218 patients) nonoperatively managed, 42 (18%) (42 of 218 patients [19%]) developed at least 1 major complication (indirectly resulting in surgery). CONCLUSION: Complications occur regardless of the management strategy chosen for DIACFs and despite management by experienced surgeons. Complications are a cause of significant morbidity for patients. Outcome scores in this study tend to support ORIF for calcaneal fractures. However, ORIF patients are more likely to develop complications. Certain patient populations (WCB and Sanders type IV) developed a high incidence of complications regardless of the management strategy chosen.

Adolescent↗
PubMed2002

Functional outcome of patients following open reduction internal fixation for bilateral calcaneus fractures.

Treatment of displaced intra-articular calcaneus fractures has historically been controversial, but recent developments have led to resurgence in open reduction internal fixation (ORIF) for displaced calcaneus fractures. Recent functional outcome studies comparing operative to nonoperative treatment of unilateral calcaneus fractures has shown a trend towards improved function with ORIF. No studies have investigated the functional outcome of patients who have required operative treatment of bilateral displaced calcaneus fractures. The purpose of this study was to review our operative experience with bilateral displaced intra-articular calcaneal fractures. A retrospective review of medical charts indicated 13 patients had undergone ORIF for bilateral calcaneus fractures. Nine patients could be contacted and brought to the clinic for functional evaluation and radiographic CT studies. Functional outcome was assessed by the Musculoskeletal Functional Assessment Score (MFA) and the American Orthopaedic Foot and Ankle Hindfoot Score (AOFAS). The average follow-up was 56 months. Over half of the patients required additional surgeries. The average MFA and AOFAS scores were 31.1 and 71.8, respectively. Functional outcome decreased for patients with multiple traumatic fractures and surgical procedures of the calcaneus. Our results show a diminished functional outcome for patients sustaining bilateral calcaneus fractures treated with ORIF when compared to patients managed surgically for unilateral calcaneus fractures, but better functional outcomes than patients who do not undergo ORIF for unilateral calcaneus fractures. This diminished function limits work capacity and ability to perform daily activities that require standing.

Adult↗
PubMed1987

A new method of occipitocervical fusion using internal fixation.

We describe a method for decompression and fusion of the occipitocervical junction in cases of atlantoaxial subluxation. Use of an implanted steel rectangle provides immediate rigid internal fixation, permitting early mobilization with minimal external support.

Adolescent↗
PubMed2003

Minimal internal fixation and calcium-phosphate cement in the treatment of fractures of the tibial plateau. A pilot study.

We used calcium-phosphate cement combined with minimal internal fixation to treat 49 fractures of the lateral tibial plateau. There were 25 split depression fractures, 22 pure depression fractures and two bicondylar fractures. Anatomical reduction was obtained in 38 fractures, satisfactory reduction in nine and imperfect reduction in two. Of 44 patients reviewed at one year, 33 were rated as having an excellent reduction. Functional outcome as measured by the Rasmussen score was good or excellent at six months in 92% (44/48) of patients and in 95% (42/44) at one year. Eight (16%) showed some loss of reduction of the plateau. In seven of these the loss of reduction was slight (<3 mm) and no action was taken. One patient with a deep infection had gross loss of reduction and a poor functional outcome. Calcium-phosphate cement is a useful alternative to bone grafting for the treatment of fractures of the tibial plateau.

Adult↗
PubMed2005

[Complications of internal fixation by a short proximal femoral nail].

PURPOSE OF THE STUDY: The article presents analysis of complications of the treatment of unstable fractures of the proximal femur by the proximal femoral nail (PFN Synthes). MATERIAL: Between October 1997 and October 2003, 239 patients were treated for unstable fractures of the proximal femur, 89 men and 150 women, average age 71 years. The minimum follow-up was 12 months. Unstable was considered a fracture in which it was impossible to restore by reduction the medial support -- the Adams' arch, i. e. the region below the lesser trochanter in subtrochanteric fractures. Prevailing in the group of patients were unstable pertrochanteric fractures (AO 31 A2.1, A2.2) that occurred in 55 % of patients, per-subtrochanteric fractures (AO 31 A2.3) accounted only for 26 % and subtrochanteric fractures (AO 31 A3.3) for 19 %. RESULTS: The fracture healed in 95 % of patients within 6 months and in 98 % of patients within 9 months. There were 29 intraoperative complications recorded in 19 patients (12 %). This category included also intraoperative technical difficulties. Only 9 patients (4 %) were reoperated on. Early postoperative complications occurred in 16 patients (8 %) requiring reoperation in 7 cases. Six late postoperative complications occurred in 3 patients. DISCUSSION: Intramedullary implants for internal fixation of the proximal femur tolerate higher static and several times higher cyclical loading as compared to DHS types of implant. As a result the fracture heals even without the primary restoration of the medial support. The implant temporarily compensates the function of the medial column. When this function is not restored in a limited period of time, the internal fixation, although correctly performed, fails. The main cause of complications are technical mistakes or failure to observe the proper surgical technique. CONCLUSION: The most frequent mistake is reduction with the persisting varus position or distraction in the fracture line, incorrect placement of the screw in the femoral neck or the nail in the femoral shaft, wrong choice of the length of the screws, unnecessary hesitation in solving the defect in the course of the treatment. Forced insertion of the implant may cause additional damages to the skeleton. PFN is a quality implant for the treatment of unstable pertrochanteric and subtrochanteric fractures of the femur. The number and severity of complications may be reduced by the observance of proper principles of reduction and exact surgical technique.

Adult↗
PubMed1994

Results of the AO spinal internal fixator in the surgical treatment of thoracolumbar burst fractures.

The potential for clinical instability following thoracolumbar fractures has evoked a progressive increase in interest in the surgical treatment of unstable thoracolumbar fractures. From September 1988 to October 1991, 44 thoracolumbar burst fractures were treated surgically by the AO Spinal Internal Fixator at the Orthopaedics and Traumatology Clinics of Ankara Social Security Hospital. Mean follow-up period was 28.8 (range 12-48) months. Fourteen (31.8%) of the patients were female, and 30 (68.2%) were male. Postoperatively, the mean anterior vertebral height loss and spinal canal compromise were corrected by 36.5% and 39.9%, respectively. Also, postoperatively 15.9% of improvement was obtained in the mean kyphosis angle. The mean compression angle, which was 19.5 degrees preoperatively, was corrected by 12.3 degrees and came to an average of 7.1 degrees postoperatively. In light of these data, it is suggested that the AO Spinal Internal Fixator effectively restores three-dimensional alignment of the spine and provides a rigid fixation.

Adolescent↗
PubMedDate not supplied

Anterior spinal cord decompression for lesions of the thoracic and lumbar spine, techniques, new methods of internal fixation results.

Seventy-nine patients, 51 with a fresh neurologic deficit, underwent anterior spinal cord decompression, block bone grafting and anterior internal fixation. AO plates were used in nine patients. Dwyer cables in 15, anterior Harrington systems in 20, and solid Hall rods with Dwyer screws in 23. Cases included 13 tumors (six metastatic, five primary malignant, two benign), 15 late kyphotics (13 congenital and two old tuberculosis), 15 pyogenic (nontuberculous) infections, 32 fractures and four thoracic discs. Levels of decompression were from T5 to L5 with the majority (23) at L1. The neurologic deficit improved in 100% of those with incomplete paraplegia, and was graded according to the Frankel classification. None was made worse. Surgical indications were: progressive neurologic deficit in 51 patients, tumors in 13, correction of deformity in 55, failure of infection to respond to conservative measures in 15, cachexia in nine, (many patients had more than one indication). Bone grafts included 11 rib grafts, 24 block iliac grafts with ribs and 44 iliac block grafts. Complications included three nonunions, two common iliac vein lacerations, one death (pulmonary) and two post-thoractomy syndrome. The more recent use of an anterior Harrington distraction system allows for greater correction of kyphotic deformities and more rigid internal fixation which in time allows for early ambulation in a brace. Supplementary posterior fixation is generally no longer necessary except where more than one vertebral body is resected.

Adolescent↗
PubMed2001

[Applied researches on polylactide internal fixation devices].

Nowadays, more and more basic and clinical researches on polylactide internal fixators were carried out in China. In this paper are reviewed the researches of polylactide acid(PLA), including its physical and chemical characters, biodegradation, absorption and mechanical properties, effects on fracture healing, and clinical application. Some problems that have not been solved are high-lighted and discussed. Also dealt with are some researches of PLA in future.

Fracture Healing↗