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PubMed1980

Principles of less rigid internal fixation with plates.

The paradox of internal fixation for treating fractures is that fixation is required to achieve union, while flexibility is necessary to restore normal mechanical properties of bone after union. Three series of experiments were performed to investigate the role of plate rigidity on fracture repair and changes in bone mass. Using plates with tenfold differences in axial and bending rigidities, the authors were able to show some advantages in fracture healing and bone remodelling with less rigid plates.

Animals↗
PubMed1996

Internal fixation of pelvic ring disruptions.

The internal fixation of pelvic ring fractures and dislocations has become more popular recently. Aggressive resuscitation of the injured patient includes pelvic stabilization and improves survival rates. Pelvic surgical exposures as well as the skeletal anatomy become more familiar as the orthopaedic surgeon gains experience in treating these difficult patients. Recent radiographic techniques for pelvic imaging facilitate comprehensive preoperative planning and intraoperative decision-making for pelvic injuries. Improved outcomes are expected as treatment is individualized for each patient.

Adolescent↗
PubMed1995

Comparison of the morbidity associated with maxillary fractures treated by maxillomandibular and rigid internal fixation.

OBJECTIVE: To compare the type and incidence of morbidity encountered by two groups of patients with maxillary fractures, one treated by closed reduction and maxillomandibular fixation and the other by open reduction and rigid internal fixation. STUDY DESIGN: This was a retrospective review of records for all patients with maxillary fractures treated over a 10-year period. Age, sex, mechanism of injury, anatomic location of fracture, treatment modality, and complications were identified. Two populations of patients, those treated with closed reduction and maxillomandibular fixation and those treated with open reduction and rigid internal fixation, that were similar in size (n = 50), age, sex, and anatomic distribution of fractures were compared. RESULTS AND CONCLUSIONS: This study indicates that patients with maxillary fractures treated with either closed reduction and maxillomandibular fixation or open reduction and rigid internal fixation will encounter postoperative problems with a near equal frequency (60% to 64%). Regardless of the technique used, no relationship could be established between age, sex, or cause of injury. The more superior the level of the fracture, the higher the rate of adverse sequelae.

Adolescent↗
PubMed2006

Applied anatomy of transoral atlantoaxial reduction plate internal fixation.

STUDY DESIGN: A C1-C2 operation by the transoral approach was simulated to study the anatomic stratification, various structures, and adjacent relationships. The anatomic parameters in relation to transoral atlantoaxial reduction plate (TARP) internal fixation were measured. OBJECTIVES: To study relevant anatomic features of the structures involved in TARP internal fixation through transoral approach for treating irreducible atlantoaxial dislocation, so as to provide anatomic basis for the clinical application of TARP. SUMMARY AND BACKGROUND DATA: Irreducible anterior atlantoaxial dislocation (IAAD) with ventral spinal cord compression is difficult for surgical correction. Despite previous description of direct plate internal fixations through the transoral approach, the problem has not been fully resolved: the Harms' plate lacked a locking mechanism while the other plates unable to achieve immediate reduction of the atlantoaxial joint. We therefore designed the TARP system with which the decompression, reduction, internal fixation, and fusion procedures could be completed in the same transoral approach. The anatomic structures and stratification involved in the transoral approach, which were seldom addressed in previous anatomic studies, need to be clarified for internal fixation with TARP system. METHODS: Twenty fresh craniocervical specimens were microsurgically dissected layer by layer according to a transoral approach. Stratification of the posterior pharyngeal wall, course of the vertebral artery, anatomic relationships of the adjacent structures of the atlas and axis, and closely relevant anatomic parameters for TARP internal fixation were measured. RESULTS: The posterior pharyngeal wall consisted of two layers and two interspaces: the mucosa, prevertebral fascia, retropharyngeal space, and prevertebral space. The range from the anterior edge of the foramen magnum to C3 could be exposed by this approach. The thickness of the posterior pharyngeal wall was 3.6 +/- 0.3 mm (range, 2.9-4.3 mm) at the anterior tubercle of C1, 6.1 +/- 0.4 mm (range, 5.2-7.1 mm) at lateral mass of C1 and 5.5 +/- 0.4 (range, 4.3-6.5 mm) at the central part of C2, respectively. The distance from the incisor tooth to the anterior tubercle of C1, C1 screw entry point, and C2screw entry point was 82.5 +/- 7.8 mm (range, 71.4-96.2 mm), 90.1 +/- 3.8 mm (range, 82.2-96.3 mm), and 89.0 +/- 4.1 mm (range, 81.3-95.3 mm), respectively. The distance between the vertebral artery at atlas and the midline was 25.2 +/- 2.3 mm (range, 20.4-29.7 mm) and that between the vertebral artery at the axis and the midline was 18.4 +/- 2.6 mm (range, 13.1-23.0 mm). The allowed width of the atlas and axis for exposure was 39.4 +/- 2.2 mm (range, 36.2-42.7 mm) and 39.0 +/- 2.1 mm (range, 35.8-42.3 mm), respectively. The distance (a) between the two atlas screw insertion points (center of anterior aspect of C1 lateral mass) was 31.4 +/- 3.3 mm (range, 25.4-36.6 mm). The vertical distance (b) between the line connecting the two C1 screw entry points and that connecting the two C2 screw entry points (at the central part of the vertebrae, namely, 3 to 4 mm lateral to the midline of C2 vertebrae) was 21.3 +/- 2.7 mm (range, 19.4-24.3 mm), with an a/b ratio of 1.3 to 1.5. The screws of TARP had a lateral tilt of 12.2 degrees +/- 0.4 degrees (range, 10.2 degrees -14.6 degrees ) at C1 and a medial tilt of 7.3 degrees +/- 0.3 degrees (range, 5.1 degrees -9.4 degrees ) at C2 relative to the coronal plane. CONCLUSION: An atlantoaxial surgery through transoral approach is safe and feasible. This approach is suitable for an anterior TARP internal fixation, and the design of the internal fixation system should be based on the above anatomic data.

Atlanto-Axial Joint↗
PubMed2003

Internal fixation compared with arthroplasty for displaced fractures of the femoral neck. A meta-analysis.

BACKGROUND: The optimal choice for the stabilization of displaced femoral neck fractures remains controversial, with alternatives including arthroplasty and internal fixation. Our objective was to determine the effect of arthroplasty (hemiarthroplasty, bipolar arthroplasty, and total hip arthroplasty), compared with that of internal fixation, on rates of mortality, revision, pain, function, operating time, and wound infection in patients with a displaced femoral neck fracture. METHODS: We searched computerized databases for randomized clinical trials published between 1969 and 2002, and we identified additional studies through hand searches of major orthopaedic journals, bibliographies of major orthopaedic textbooks, and personal files. Of 140 citations initially identified, fourteen met all eligibility criteria. Three investigators independently graded study quality and abstracted relevant data, including information on revision and mortality rates. RESULTS: Nine trials, which included a total of 1162 patients, provided detailed information on mortality rates over the first four postoperative months, which ranged from 0% to 20%. We found a trend toward an increase in the relative risk of death in the first four months after arthroplasty compared with the risk in the first four months after internal fixation (relative risk, 1.27). At one year, the relative risk of death was 1.04. The risk of death after arthroplasty appeared to be higher than that after fixation with a compression screw and side-plate but not higher than that after internal fixation with use of screws only (relative risk = 1.75 and 0.86, respectively; p < 0.05). Fourteen trials that included a total of 1901 patients provided data on revision surgery. The relative risk of revision surgery after arthroplasty compared with the risk after internal fixation was 0.23 (p = 0.0003). Pain relief and the attainment of overall good function were similar in patients treated with arthroplasty and those treated with internal fixation (relative risk, 1.12 for pain relief and 0.99 for function). Infection rates ranged from 0% to 18%, and arthroplasty significantly increased the risk of infection (relative risk, 1.81; p = 0.009). In addition, patients who underwent arthroplasty had greater blood loss and longer operative times than those who were treated with internal fixation. CONCLUSIONS: In comparison with internal fixation, arthroplasty for the treatment of a displaced femoral neck fracture significantly reduces the risk of revision surgery, at the cost of greater infection rates, blood loss, and operative time and possibly an increase in early mortality rates. Only larger trials will resolve the critical question of the impact on early mortality.

Arthroplasty↗
PubMed2001

Arthroscopic reduction and internal fixation of tibial plateau fractures in skiing.

Arthroscopic reduction and internal fixation of tibial plateau fractures can facilitate restoration of articular congruity while permitting rigid fracture stabilization. Twenty-five patients who underwent arthroscpoic reduction and internal fixation of a tibial plateau fracture were reviewed. The average age of the patients was 45. At a mean followup of 24 months, 76% of patients rated their result as excellent and 16% as good. Eighty-four percent returned to full sporting activity. There were no episodes of nonunion, failure of fixation, wound infection, deep venous thrombosis, compartment syndrome, or arthrofibrosis. Preoperative fracture depression averaged 7.7 mm (range, 1-18 mm). Fracture depression at final followup averaged 0.8 mm (range, 0-5 mm). Sixty-four percent of patients had associated intraarticular injury diagnosed and treated at the time of arthroscopy. Arthroscopic reduction and internal fixation provides an accurate assessment of, and allows definitive treatment for, intraarticular injuries associated with tibial plateau fractures. The technique allows less soft tissue stripping than with traditional arthrotomy, better visualization of the articular surface, early return to physical activities, and obviates the need for meniscal detachment and repair.

Adolescent↗
PubMed1975

Primary internal fixation of femoral neck fractures.

The principles in treatment of femoral neck fractures by primary internal fixation have been reviewed. In the rare, undisplaced stress or fatigue fracture, early internal fixation with threaded pins is recommended. Impacted fractures should be treated by primary internal fixation in patients who do not follow orders and patients whose general condition is poor and would require early weight bearing. Displaced fractures may be treated by primary internal fixation at any age and regardless of the patient's general condition. The following principles are emphasized: early operation, anatomical reduction and slight valgus in some cases, compression and impaction of fragments, and firm immobilization of fragments with a device that has a sliding mechanism and provides lateral cortical fixation.

Bone Nails↗
PubMed1986

Nine-year functional nonunion of a femoral neck stress fracture: treatment with internal fixation and fibular graft. A case report.

Open reduction and internal fixation utilizing a full thickness fibular graft was performed on a patient who presented with a 9-year-old functional nonunion of a femoral neck stress fracture. During this period, the patient had remained fully ambulatory, with intermittent episodes of hip pain. Our experience indicates that the treatment of old, nonunited stress fractures of the femoral neck with a fibular bone graft and internal fixation contributes to a successful result, lending support while stimulating osteogenesis as the nonunion heals. Use of rigid internal fixation will eliminate motion at the site of the fracture, enhancing incorporation of the bone graft and, thereby, speeding the patient's recovery.

Adult↗
PubMed1996

Complications of rigid internal fixation for mandibular fractures.

The application of rigid internal fixation to maxillofacial trauma is among the truly great advances that have been made in the field. The use of rigid internal fixation techniques has resulted in many advantages for the patient. Unfortunately, complications have occurred with this technology that are often devastating in their consequences for treatment outcomes. This article addresses some of the problems that stem from the use/misuse of rigid fixation devices in the treatment of mandibular fractures. It presents the most common complications and their management, including malunion, fibrous union, infection/osteitis, and impalement of the tooth roots and/or inferior alveolar canal.

Alveolar Process↗
PubMed2006

Treatment of displaced radial head fractures by internal fixation with absorbable pins.

OBJECTIVE: To study the effect of internal fixation with absorbable pins on treatment of displaced radial head fractures. METHODS: From May 1999 to May 2004, 16 patients with displaced radial head fractures (Mason types II and III) were treated with internal fixation by absorbable pins. The duration of follow-up averaged 22.6 months (12-58 months). The outcome was assessed on the basis of elbow motion, radiographic findings and the functional rating score delineated by Broberg and Morrey. RESULTS: All fractures healed within 10 months without avascular necrosis of radial head. The mean elbow flexion loss was 15 degrees (0 degrees-35 degrees), and pronation and supination decreased by 10 degrees (0 degrees-30 degrees) on average compared with those of the contralateral elbow. Five patients had an excellent result, 6 a good result, and 3 a fair result according to the criteria of Borberg and Morrey. CONCLUSIONS: Internal fixation with absorbable pins is an effective method in treating displaced radial head fractures. It can maintain the biomechanical stability of forearm, improve the elbow function and avoid second operation.

Adult↗
PubMed2005

Perioperative morbidity and 30-day mortality after intertrochanteric hip fractures treated by internal fixation or arthroplasty.

The conventional treatment for intertrochanteric hip fracture is open reduction and internal fixation. However, hip arthroplasty is occasionally performed. The objective of this study was to determine the 30-day mortality for patients with intertrochanteric hip fracture treated with open reduction, internal fixation, or hip arthroplasty. The mortality rate for patients treated with arthroplasty at 4.8% (23/478) was slightly, but not significantly, higher than that for patients treated with open reduction and internal fixation at 4.5% (62/1395). However, more of the patients in the arthroplasty group exhibited serious intraoperative cardiorespiratory disturbances (62% vs 22%) and died in the hospital (77% vs 35%) when compared with the patients in the open reduction and internal fixation group. Although the incidence of 30-day mortality in these groups was not significantly different, the patients in the arthroplasty group were more likely to have a complicated intraoperative course and die in the hospital.

Adult↗
PubMed2006

Internal fixation versus arthroplasty for intracapsular proximal femoral fractures in adults.

BACKGROUND: Displaced intracapsular fractures may be treated by either reduction and internal fixation, which preserves the femoral head, or by replacement of the femoral head with an arthroplasty. OBJECTIVES: To review all randomised controlled trials that have compared internal fixation with arthroplasty for intracapsular femoral fractures in adults. SEARCH STRATEGY: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (December 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2005, Issue 4), MEDLINE, EMBASE, the UK National Research Register, several orthopaedic journals, conference proceedings and reference lists of articles. We contacted trialists where possible. SELECTION CRITERIA: All randomised and quasi-randomised controlled trials comparing internal fixation with arthroplasty for intracapsular hip fractures in adults. DATA COLLECTION AND ANALYSIS: Trial quality was assessed by use of a 10 item scale. At least two review authors independently assessed trial quality and extracted data. Additional information was sought from trialists. After grouping into three broad categories, comparable groups of trials were subgrouped and where appropriate, data were pooled using the fixed-effect model. MAIN RESULTS: Seventeen trials involving 2694 participants were included. Length of surgery, operative blood loss, need for blood transfusion and risk of deep wound infection were significantly less for internal fixation compared with arthroplasty. Arthroplasty had a significantly lower re-operation rate in comparison with fixation. No definite differences for hospital stay, mortality, or regain of same residential state were found. Limited information from some studies suggested pain was less and function was better for a cemented arthroplasty in comparison to fixation. AUTHORS' CONCLUSIONS: Internal fixation is associated with less initial operative trauma but has an increased risk of re-operation on the hip. Definite conclusions cannot be made for differences in pain and residual disability between the two groups. Future studies should concentrate on better reporting of final outcome measures and there is still a need for studies to define which patient groups are better served by the different treatment methods.

Adult↗
PubMed1991

Open reduction and internal fixation of radial head fractures.

Open reduction and internal fixation of displaced fractures of the radial head were reviewed in 14 elbows. Follow-up averaged 32 months. The average elbow score for Mason type II fractures was 96.8 points, corresponding to 100% good or excellent results. Average flexion was 142.5 degrees, and the mean fixed flexion deformity was 3.9 degrees. There was no loss in grip strength. An almost normal elbow was the expected result. Good or excellent results were achieved in only 33% of Mason type III fractures treated with open reduction and internal fixation. The average elbow score was 72.9 points, and this was statistically significantly different than the Mason type II fractures (p less than 0.05). An associated elbow dislocation did not affect the results significantly, but was associated with a slightly increased fixed flexion deformity. Fractures may be more comminuted than suggested by plain radiographs, and intraoperative decision making is required in deciding between reconstruction or excision of the radial head. Excellent results were obtained provided an anatomical reduction with stable fixation and early range of motion were achieved. If a stable anatomic reduction cannot be obtained, then alternative treatment methods should be considered.

Adult↗
PubMed2003

In-hospital mortality after femoral neck fracture: do internal fixation and hemiarthroplasty differ?

In this article, we examine rates of in-hospital mortality of elderly patients with femoral neck fracture treated with internal fixation or hemiarthroplasty. Data were analyzed for 51,003 patients (> or = 65 years old) admitted with femoral neck fractures to New York state hospitals between 1985 and 1996. The primary outcome examined was in-hospital mortality. Associations between type of surgical procedure and outcome were assessed using a multiple logistic regression model, adjusting for patient age, sex, race, number of comorbidities, and residence in a nursing facility before hip fracture. Approximately 30% of the study group had undergone open or closed reduction and internal fixation; the other 70% had undergone hemiarthroplasty. Forty-six percent of the internal fixation group and 56% of the hemiarthroplasty group were 85 years old or older (P < .001). Median hospital stays were 13 days for the internal fixation group and 15 days for the hemiarthroplasty group (P < 001). In-hospital mortality was 5.1% overall, 3.9% for the internal fixation group, and 5.6% for the hemiarthroplasty group (P < .001). The association between type of procedure and mortality held after adjusting for patient age, sex, and number of comorbidities (odds ratio, 1.42; 95% confidence interval, 1.29-1.56; P < .001). After controlling for potential confounding variables, we found that elderly patients who had undergone hemiarthroplasty after femoral neck fracture were more likely to die during hospitalization than those who had undergone internal fixation.

Aged↗
PubMed1987

The predictive value of bone scintigraphy after internal fixation of femoral neck fractures.

Persisting pain of the hip following internal fixation of fracture of the neck of the femur is often caused by capital necrosis or non-union. In a randomized trial 35 patients had 99mTc-MDP bone scintigraphy performed 6 weeks, 3, 6, and 12 months after internal fixation of their subcapital fractures with a sliding screw-plate or a sliding nail-plate. The purpose was to find out whether bone scintigraphy could predict capital necrosis or non-union before it shows up on plain radiographs, which happens later. The patients were followed up for an average of 44 months (range 12-64). Radiologically, capital necrosis occurred in five patients and non-union in six. Bone scintigraphy showed decreasing activity in the 1st year after operation in uncomplicated cases (P less than 0.03). However, it was impossible to distinguish patients with capital necrosis or non union from those with uneventful healing. There were no significant differences in the scintigraphic appearance between groups at most risk, e.g. Garden stage 3 and 4 fractures versus Garden stage 1 and 2, and fixation by sliding nail versus fixation by sliding screw-plate. In conclusion, bone scintigrams during the first 6 months after operation do not reliably predict failure of internal fixation of fractures of the neck of the femur.

Adult↗
PubMed1987

Duration of fracture healing after early versus delayed internal fixation of fractures of the femoral shaft.

The effect of delayed internal fixation in closed uncomplicated fractures of the femoral shaft was studied by comparing 40 patients from a hospital where this fracture was principally treated within 24 hours of the injury, with 46 patients from another hospital where this type of fracture was principally treated after a mean period of 13 days in skeletal traction. The two groups of patients were similar with regard to age, level of fracture, type of fracture and incidence of comminution. All fractures were treated by stable internal fixation. In the group treated by early operation considerably longer AO plates were used. Although delayed fixation resulted in more callus and although secondary bone healing was more frequent than in the group with early internal fixation, no difference in the rate of union of the fractures could be demonstrated.

Adolescent↗
PubMed1994

[An experimental study and preliminary clinical report of shape-memory sawtooth-arm embracing internal fixator].

The sawtooth-arm internal embracing fixator is made of Nickel-Titanium shape memory alloy and consists of 3 components: body, arms and sawteeth. In cross section a 2/3 circumference is constructed by body and arms of the fixator. The free ends of the arms which exceed the semi-circle are bent more medially so that it can match the requirement of fixation of long tubular bone whose cross section is not a regular circle. The embracing fixator has two types: the cylinder type is for use in the middle part and the cone type is either for the proximal or distal 1/3 of the shaft of long tubular bone. The animal experimental studies and in vitro mechanical tests demonstrated that the embracing fixator possesses good anti-bending and anti-torsion effects, and its resisting compression effect was much lower than that of bone plate. These characteristics are beneficial for enhancing fracture healing, reducing post fixation osteoporosis and providing a new, simple and effective method for the treatment of long tubular bone fracture. The fixator has already been used in the treatment of fractures of femur, humerus, radius and ulna with good results.

Adolescent↗
PubMed2002

[Treatment of calcaneal interarticular fracture by open reduction and internal fixation].

OBJECTIVE: To investigate the clinical outcome of open reduction and internal fixation of calcaneal interarticular fractures. METHODS: From August 1998, 38 calcanneal interarticular fractures in 35 cases, including 8 of type II, 14 of type III and 16 of type IV according to Sander's classification, were treated by open reduction to restore the posterior articular facet, subtalar facet, Bohler angle and Gissane's angle, following internal fixation by plastic titanic alloy plate. Thirty-three calcanneal interarticular fractures were followed up for 6 to 22 months, 12.3 months on average; and the healing time and joint function were evaluated according to Maryland Foot Score System. RESULTS: The average healing time of fracture was 7.1 weeks, ranging from 5 to 12 weeks; and the joint function was excellent in 18 calcanneus, good in 13 calcanneus, and the satisfactory rate was 93.9%. CONCLUSION: Open reduction and internal fixation with plastic titanium plate is a good choice for calcanel interarticular fractures.

Adult↗