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At least 1,225 records · Page 68Linked to original sources
PubMed2005

Internal fixation of femoral shaft fractures in children by intramedullary Kirschner wires (a prospective study): its significance for developing countries.

BACKGROUND: To evaluate internal fixation by intramedullary Kirschner wires as a surgical technique in the treatment of femoral shaft fractures in children by a prospective study. METHODS: 17 femoral shaft fractures at various levels in 16 children aged 2-15 years were treated by closed intramedullary Kirschner wiring under image intensifier control between May 2000 and October 2003. No external splint was used. RESULTS: Fracture union was achieved in 6-14 weeks. Non-weight bearing crutch walking was started 2-3 days after surgery. Full weight bearing started 6-14 weeks. Average operative time was 40 min (range 20-72 min). Wires were removed after 8-22 weeks. There were no infections, no limb length disparity. One child had pin track ulceration. A big child of 14 years had angulation of the fracture. CONCLUSION: Intramedullary nailing of femoral shaft fractures in children by stainless steel Kirschner wires is an effective method, which compares well with other studies. It is a simple procedure, which can be easily reproduced. Blood loss is minimal, and the operative time short. There is no need pre-bend the wires in a C or S curve. Stainless steel Kirschner wires are cheap, universally available, and can be manufactured locally. The cost of Image intensifiers is affordable in most of the cities of the developing countries. The hospital does not have to maintain a costly inventory. Provides early mobility, return to home and, school. Gives a predictable clinical pathway and reduces occupancy of hospital beds. The technique was successfully applied for internal fixation of other diaphyseal fractures in children and some selected diaphyseal fractures in adults. Based on my experience and a review of the literature, I recommend this technique as a modality for treatment of femoral shaft fractures in children aged 2 to 14 years.

Adolescent↗
PubMed1997

[Ossovenography as a diagnostic criterion of post-traumatic femoral head necrosis in internal fixation devices].

Despite advances in the field of orthopedic surgery, necrosis of the femoral head still remains a serious problem. Under normal conditions magnetic resonance tomography (MRT) is the gold standard for early diagnosis. Because of magnetic interference, this technique is not applicable in the diagnosis of posttraumatic necrosis with internal fixation, however. This seems to be an ideal indication for ossovenography: contrast medium is injected into the femoral head under X-ray control and the venous flow is documented. Furthermore, it is possible to get histological samples from suspicious areas. Ossovenography was performed in 12 patients and the results were compared with histological samples. In every patient in whom necrosis of the femoral head was diagnosed by ossovenography (91.6%), we also found necrosis on histological examination. In one patient in whom physiological flow was found, there was a corresponding absence of necrosis in the histological sample. There were no complications during ossovenography. The results suggest that ossovenography is a promising and reliable method for early diagnosis of necrosis of the femoral head in the presence of internal fixation devices.

Adult↗
PubMed2001

Internal fixation of ankle fractures in the very elderly.

The management of ankle fracture in the elderly remains controversial. A review of the early results of open reduction and internal fixation (ORIF) in 74 patients over the age of 70 years (average 76 years) was undertaken to identify the early complications, length of stay, return to pre-injury mobility and residential status. This revealed 1% deep infection, 9% delayed wound healing, 5% malunion, and 3% mortality. In 12% of patients, soft bone and comminution precluded fixation of one malleolus. The average length of stay for patients who walked with Zimmer frame (116+/-65 days) before injury was significantly longer than those who walked independently or with sticks (19+/-15 days; P<0.01). The inability of the patients to weight-bear early led to lengthy hospital stays and difficult socio-economic problems. However, the majority (85%) of patients regained their pre-injury mobility and residential status. We conclude that ORIF of ankle fractures in the elderly carries a significant risk of wound edge necrosis with delayed wound healing but the incidence of deep infection is relatively low. Poor bone quality presents technical difficulties but the majority of patients can expect good outcome.

Aged↗
PubMed1986

Internal fixation of ununited femoral neck fractures combined with muscle-pedicle bone grafting.

Fifty-six patients with ununited intracapsular fractures of the femoral neck were treated by internal fixation and muscle-pedicle bone grafting. All had some absorption of the femoral neck, and many had avascular necrosis of the femoral head. At operation the sclerosed surfaces of the fractures were freshened, the avascular femoral head was decompressed and the muscle-pedicle graft was fixed with silk thread wrapped around pins. Satisfactory union occurred in 42 patients (75%), and delayed union in seven, of whom four (7%) eventually united without further treatment and three united after osteotomy. Non-union occurred in five patients and technical failure in two.

Adolescent↗
PubMed1999

Outcome and racing performance after internal fixation of third and central tarsal bone slab fractures in horses. A review of 20 cases.

Twenty horses with central and third tarsal bone slab fractures, were treated internal fixation. Eighteen of the 20 cases were Standardbred trotters, one was a Thoroughbred racehorse and one a Swedish Warmblood. The central tarsal bone (CT) was involved in 12 cases and the third tarsal bone (T3) in 8 cases. The fractures were treated by lag screw fixation with one (18 cases) or two (2 cases) 3.5 or 4.5 mm cortical screws. Horses were confined to stall rest for one month and then put on a gradually increasing exercise programme. Convalescence time was 3-8 months until the fracture had healed and training could be resumed. Fifteen of the horses regained athletic soundness. Thirteen of the horses (72%) raced after surgery (12 Standardbreds and 1 Thoroughbred). Nine (69%) of these 13 horses won races after surgery.

Animals↗
PubMed2002

[Observation of body temperature and erythrocyte sedimentation rate in spinal tuberculosis patients with anterior interbody autograft and internal fixation].

This study was designed to observe the changes in the body temperature and erythrocyte sedimentation rate of patients with thoracolumbar tuberculosis who received anterior interbody autograft and internal fixation. The observation conducted in 21 cases establishes the 2 parameters as simple and reliable indicators for post-operative assessment of the patients.

Adolescent↗
PubMed1987

Internal fixation of capitellar fractures using Herbert screws: a report of four cases.

Four patients with displaced fractures of the capitellum (capitulum humeri) were treated by open reduction and internal fixation using Herbert screws. The mean follow-up was 16 months (range from 12 to 21 months). All fractures united without evidence of avascular necrosis. Postoperatively, the range of motion was excellent, except in one patient who had a comminuted open fracture and other injuries. Three cadaveric dissections demonstrated that the Herbert screw could be inserted without detaching the lateral collateral ligament. The Herbert screw is useful in treating displaced capitellar fractures since the jig maintains the reduction and the screw, compressing the fracture site, is buried beneath the articular cartilage and does not have to be removed.

Adult↗
PubMed1993

Internal fixation of open unstable pelvic fractures.

From 1980 through 1990 14 patients with severely complicated unstable fractures of the pelvis were treated. There were 13 men and one women (mean age, 28 years). Eight fractures also involved the acetabulum. The injuries were accompanied by anorectal (nine), urogenital (eight), vascular (three), and nerve (three) injuries. After resuscitation, fractures were stabilized immediately, preferably using internal fixation, notwithstanding fecal contamination in certain cases. Anorectal ruptures were treated with lavage of the distal colon and a divergent stoma. The urogenital lesions also were treated primarily. Two patients died early after treatment of accompanying injuries. Infectious complications were seen seven times. In one patient internal fixation broke down. All fractures healed with good functional results. At last follow-up examination all patients were continent for feces. It is concluded that early internal stabilization of these complex injuries achieves a low mortality rate and good functional results. Immediate repair of urogenital and sphincter lesions, with concomitant divergent stoma and lavage of the distal colon, gives good results notwithstanding the risk of infectious complications.

Adolescent↗
PubMed2000

Robotic-assisted internal fixation of hip fractures: a fluoroscopy-based intraoperative registration technique.

The internal fixation of proximal femoral (hip) fractures is the most frequently performed orthopaedic surgery procedure. When using a sliding compression hip screw, a commonly used fixation device, accurate positioning of the device within the femoral neck-head is achieved by initially drilling a pilot hole. A cannulated component of the hip screw is then inserted over the guide wire (surgical drill bit), which is used to drill the pilot hole. However, in practice, this fluoroscopically controlled drilling process is severely complicated by a depth perception problem and, as such, a surgeon can require several attempts to achieve a satisfactory guide wire placement. A prototype robotic-assisted orthopaedic surgery system has therefore been developed, with a view to achieving accurate right-first-time guide wire insertions. This paper describes the non-invasive digital X-ray photogrammetry-based registration technique which supports the proposed robotic-assisted drilling scenario. Results from preliminary laboratory (in vitro) trials employing this registration technique indicate that the cumulative error associated with the entire X-ray guided robotic system is within acceptable limits for the guide wire insertion process.

Fluoroscopy↗
PubMed1991

Treatment of scaphoid nonunion by radical curettage, trapezoidal iliac crest bone graft, and internal fixation with a Herbert screw.

Ten adult male patients with scaphoid nonunions were treated by radical curettage, trapezoidal iliac crest bone grafting, and internal fixation with a Herbert screw. The mean patient age was 24.7 years, and the mean duration of the nonunion before surgery was 37.3 months. Mean follow-up time was 30.4 months. Nine of the ten nonunions healed, although one patient required a second bone-grafting procedure. The mean postoperative grip strength was 45.0 kg, and the mean postoperative pinch strength was 11.5 kg. The mean postoperative range of motion was volar flexion, 76.1 degrees; dorsiflexion, 74.2 degrees; radial deviation, 22.1 degrees; and ulnar deviation, 40.1 degrees. The scapholunate angle decreased from a mean of 72.8 degrees preoperatively to 60.6 degrees postoperatively (p less than 0.025). The mean carpal index was 0.57 postoperatively. Mean scaphoid length increased postoperatively and was within 0.2 mm of the opposite (normal) scaphoid in every patient except the single patient with a persistent nonunion (p less than 0.025). All patients returned to work (eight as laborers), and nine of ten wrists were subjectively rated as good or excellent. The results of the series suggests that treatment of displaced scaphoid nonunion by radical curettage, trapezoidal iliac crest bone grafting, and internal fixation with a Herbert screw is an effective method of treatment that reconstitutes scaphoid anatomy and promotes excellent wrist function.

Adult↗
PubMed1991

Detection of internal fixation plate loosening by means of an analysis of vibratory responses.

This paper reports an in vitro investigation of a non-invasive method for detecting the loosening of internal fixation plates. The technique involves the electromechanical vibration of the fixation plate and the electromagnetic detection of its vibratory response. Frequency domain analysis of both fixed and loosened plates are compared and spectral artefacts are suggested as a means of classifying the mode and extent of plate loosening. An algorithm for the diagnosis of loose plates using the new approach is included.

Algorithms↗
PubMed1991

Sensory disturbances associated with rigid internal fixation of mandibular fractures.

Sensory status of the inferior alveolar nerve was monitored in 133 patients with 150 fractures in the region of the mandibular canal treated with rigid internal fixation preoperatively and 6 weeks postoperatively. Eighty-five of the patients were reevaluated on final follow-up at an average of 15.9 months. Preoperative sensory disturbance (58.5%) correlated significantly only with the presence of fracture displacement. The occurrence of postoperative paresthesia (76.0% at 6.2 weeks, 46.6% at 15.9 months) correlated significantly with the degree of mandibular edentulousness. Patients with edentulous mandibles, especially when a compression plate was used, suffered significantly more often from nerve injury than fully dentate patients. The results indicated that the sensory disturbance was caused by the surgical procedure. In contrast to previous assumptions, displacement of the fracture and preoperative sensory status did not correlate with postoperative occurrence of paresthesia.

Adolescent↗
PubMed2005

Open reduction and internal fixation of distal radial fractures using the Pi-plate.

The authors reviewed 22 patients with 23 fractures of the distal radius, who were treated by open reduction and internal fixation using the low profile contourable titanium dorsal distal radius AO Pi-plate. There were four men and 18 women with a mean age of 57 years. The mean follow up period was 26 months (range, 12-48 months). The modified Lidstrom's radiographic scoring system and the modified Gartland and Werley' functional scoring systems were used for evaluation of the outcome. An excellent clinical outcome was present in four patients, a good in 10, a fair in seven, and a poor in two. Radiographic results were excellent in 12 patients, good in 10, and fair in one patient. Seven patients required removal of the plate for median nerve compression and tendonitis. The Pi-plate can be used in a wide spectrum of distal radial fractures including complex comminuted intra-articular (AO type C3) fractures with satisfactory functional outcome and low rate of complication.

Adult↗
PubMed1996

Open fractures and internal fixation in a major African hospital.

Between September 1992 and June 1994, 20 patients with 27 open fractures were treated at a major Ethiopian hospital by open reduction and internal fixation. Sixteen fractures were caused by gunshots, eight by road traffic accidents, two by direct blows, and one by a fall. Twenty-one fractures were stabilized with ASIF plates, and six with screws and wires. Five fractures out of 27 (18.5 per cent) developed infection postoperatively. In one case secondary wound infection subsided after wound excision and plate removal. In three others the implants were replaced by external fixators, in two of which the infection subsided and the patients left hospital without infection. The two remaining patients were treated for 4 1/2 months and 18 months respectively for chronic osteitis. Ten of the 15 patients without postoperative infection returned for follow-up. None of them had developed osteitis. The overall functional results were good.

Adolescent↗
PubMed1978

Methylmethacrylate as an adjunct in the internal fixation of intertrochanteric fractures of the femur.

Twenty-eight unstable four-part intertrochanteric fractures in 27 elderly patients with severely osteoporotic femurs were treated by means of internal fixation (commonly the 130 or 95 A.O. blade plate) in combination with methylmethacrylate. Of the 28, ten patients with eleven fractures were recalled and reexamined; 12 had died; five were lost to followup (1 1/2-8 1/2 years) at the time of this review but sufficient documentation existed for their inclusion. There were no deep wound infections. We did not encounter any hypotension during surgery or as a result of the methylmethacrylate. One patient developed a pulmonary embolus 5 days postoperation and responded well to anticoagulant therapy. There were three failures; one femoral shaft fracture at the plate end, one nonunion, both requiring total hip replacemens, and the third failure was due to malreduction of fracture and was later revised. Where bone fragments were in contact, union occurred rapidly and the presence of cement did not interfere with bone union in any way. The patients were pain free and began full weight bearing the day after surgery.

Aged↗
PubMed1998

Biomechanical evaluation of the elbow following radial head fracture. Comparison of open reduction and internal fixation vs. excision, silastic replacement, and non-operative management.

Thirty-six fractures of the radial head were evaluated following treatment with four different techniques: open reduction and internal fixation (ORIF), excision, silastic replacement, and non-operative management. Clinical assessment included calculation of the Clinical Performance Index based on parameters for motion, stability, pain, and daily function, as well as radiographic evaluation for fracture type (Mason) and the development of degenerative changes. Further assessment included isometric strength measurements for elbow flexion, extension, pronation, supination, and grip. Range of motion and strength measurements were similar, except for grip strength, which was significantly better for ORIF patients compared to excision or silastic replacement groups. Patients with ORIF had the best clinical scores with minimal radiographic changes. When possible, ORIF of displaced radial head fractures appears to provide the best functional result.

Adult↗
PubMed1993

[Radiologic determination of bone screw exit site on the femoral condyle. A method of exact imaging and length determination of internal fixation devices (screws, K-wires) in metaphyses of larger tubular bones exemplified by the distal femur].

Distal femur imaging (A-P and lateral X-rays) after internal fixation often give only poor visualization of the exact position. A model with two anteriorly positioned cortex screws was used to show that an additional oblique X-ray, or fluoroscopy of the tip of the screw, allows much more exact determination of its length, so that it can be changed if necessary. This method is considered by the authors as a simple check of screw length measurement in "foyer fermée" procedures.

Adolescent↗
PubMed1987

Delayed internal fixation of femoral shaft fractures--is there an advantage? A review of 320 fractures.

We have reviewed 402 traumatic fractures of the femoral shaft, 320 of which had been treated by operation and had a long follow-up. Of these, 228 closed fractures and 37 open fractures had been stabilised by plating. There was no significant difference in healing between those stabilised early and those having delayed internal fixation. Re-fracture after removal of the implant occurred more often after early operation. All 55 fractures treated by intramedullary nailing healed and there were no re-fractures after nail removal. We found no correlation between delay before operation and the incidence of postoperative infection.

Adolescent↗