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PubMed1993

[The closed method of intramedullary fixation of forearm fractures].

The authors demonstrate a group of 27 patients subjected to intramedullary osteosynthesis of the forearm by means of Kirschner wires, using closed surgery. They prefer the described method in patients suffering from multiple injuries who have devastated soft parts of the forearm and in unstable fractures in children. The authors draw attention to the fact that they have achieved very good results by the simple surgical method they described.

Adult↗
PubMedDate not supplied

Efficacy of surgical wound drainage in orthopaedic trauma patients: a randomized prospective trial.

OBJECTIVE: To study the efficacy of closed suction drainage in clean nonemergent surgical fracture fixation or bone grafting on the extremities or pelvis. DESIGN: A prospective randomized trial. SETTING: The orthopaedic trauma service of a Level I trauma hospital. PATIENTS: Patients were older than age eighteen years and undergoing clean nonemergent surgical fracture fixation or bone grafting procedures on the extremities (excluding hands and feet) or pelvis. INTERVENTION: The application of a surgical drain. MAIN OUTCOME MEASUREMENTS: Wound drainage, edema, hematoma and erythema, dehiscence, infection, and need for surgery or readmission were followed for six weeks. A univariate analysis with Student's t test for continuous variables and chi-squared analysis for all categorical data were used, with a p value of < or = 0.05 considered statistically significant. RESULTS: A total of 202 patients were randomized to 102 patients with no drain and 100 patients with a drain. There was no significant difference between the groups with regard to injury severity, systemic disease, age, body weight, physical status, or estimated blood loss. There was no significant difference between the drain and no-drain groups in any of the parameters evaluated. CONCLUSION: There is no significant difference between drained and nondrained wounds in clean, nonurgent orthopaedic trauma surgery. It appears that drainage systems can be safely eliminated in this group.

Adolescent↗
PubMed2005

Temporary partial intra-iliac balloon occlusion for the treatment of acetabulum fracture in a Jehovah's Witness: a case report.

Blunt trauma patients with acetabular fractures can lose as much as 2 L of blood after injury, and approximately 40% of these patients require blood transfusions. Fractures involving the anterior and posterior columns may require more than 1 surgery for adequate fracture fixation, increasing the potential for greater blood loss. Although blood transfusions may be medically necessary in these cases, Jehovah's Witnesses often refuse transfusion as a matter of religious conviction. The religious tenets of this faith preclude the use of blood transfusions and certain other blood products, based on an interpretation of Acts 15:29. To treat patients with these beliefs, various techniques have been developed to minimize blood loss as an alternative to transfusion. Temporary arterial balloon occlusion, also known as an "internal tourniquet," was first reported in 1954 for use in severe penetrating abdominal trauma. It was later used to control basilar artery bleeding and to limit blood loss in Jehovah's Witness patients undergoing revision total hip or knee arthroplasty. This case report documents the successful use of temporary balloon occlusion to minimize blood loss during an open reduction internal fixation of a both-column acetabulum fracture in a Jehovah's Witness patient. The method used for achieving this intra-iliac balloon occlusion is described in detail so that others also may implement this technique.

Acetabulum↗
PubMed1979

External fixation devices in fractures of the leg.

External fixation devices, of which there are many types, represent a new and extremely effective method of fixation in fractures of the leg. These are extremely common, frequently severe and often complicated by a variety of other lesions. The usefulness of this method lies in the fact that they can be applied immediately with minimal additional trauma, and the fracture can be immobilised whilst leaving the damaged area uncovered and thus available to carry out repairs and reconstruction of the soft tissues. Mobilisation of the patient is not impeded, and they can be replaced by other more traditional methods as and when these may become more appropriate. The author presents his own views based on some ten years experience with external fixation devices in traumatology, with special reference to fractures of the tibia.

Bone Nails↗
PubMed2000

The management of laryngeal fractures using internal fixation.

BACKGROUND: Laryngeal fracture is a rare injury with the potential to affect all functions of the larynx. Restoration of the laryngeal framework is critical for the rehabilitation of laryngeal function. OBJECTIVE: To ascertain the efficacy of adaptation plate fixation (APF) to repair the laryngeal skeleton. STUDY DESIGN: Retrospective review of the clinical data of all patients who underwent APF of laryngeal fractures from January 1989 to September 1999. RESULTS: Our series consisted of 16 men and 4 women presenting with laryngeal fractures caused by blunt (n = 16) or penetrating (n = 4) trauma. Most of these patients presented with severe fractures classified as category III (n = 6), IV (n = 10), or V (n = 1), according to the Schaefer-Fuhrman classification. All patients who required a tracheotomy (n = 13) were de-cannulated. Nineteen of the 20 patients recovered a social voice. The exception was a patient with aphasia secondary to head trauma No patient had aspiration problems. We encountered no complication associated with the use of APF. CONCLUSION: APF is an effective and well-tolerated method to repair laryngeal fractures.

Adolescent↗
PubMed1993

Suitability of biodegradable polydioxanone materials for the internal fixation of fractures.

A distal femoral osteotomy in 46 rabbits was fixed either with biodegradable polydioxanone (PDS) thread and pins (group A, 31 animals) or with metallic Kirschner wire and pins (group B, 15 animals). Postoperatively, the distal part of each femur was removed and evaluated, and bone sections were evaluated by histology and histomorphometry. Macroscopic studies showed complete PDS absorption in all cases 24 weeks postoperatively. The histologic studies revealed new bone surrounding the area of the implant 3 weeks postoperatively, and at 24 weeks postoperatively, there was thinning or disappearance of the new bone around the implant. On the basis of the present study, PDS thread and pins show promise for the fixation of osteotomies or fractures of cancellous metaphyses of small long bones, such as metacarpals and phalanges.

Animals↗
PubMed1999

A computer study of fracture mobility and strain on biodegradable plates used for fixation of mandibular fractures.

PURPOSE: This computer-based study was done to determine whether a small biodegradable plate system was suitable for internal fixation of mandibular fractures. MATERIALS AND METHODS: In a three-dimensional computer model of the mandible, fracture mobility and plate strain were calculated for bite forces applied on 13 bite points on the dental arch. Simulated solitary angle, body, and symphysis fractures were fixed with one titanium miniplate, one polylactide (PLA) midiplate, one PLA maxiplate, or two PLA midiplates. Fractures with and without interfragmentary bone contact were studied. In the case of fractures with bone contact, the loads were transmitted through the fracture surfaces and the plate; when there was no contact, the loads were transmitted only through the plate. Maximum fracture mobility was set at 150 microm. Maximum plate strain was set at the yield strain of PLA and titanium. RESULTS: For fractures without interfragmentary bone contact, all plate fixations resulted in a fracture mobility and plate strain higher than the limits set, except for the symphysis fracture fixed with two PLA midiplates. Interfragmentary bone contact significantly reduced fracture mobility and plate strain. For the angle fracture with bone contact, all PLA plate fixations resulted in a fracture mobility above the limit, whereas the titanium miniplate fixation had a fracture mobility below the limit. For the body and symphysis fracture with bone contact, only double PLA midiplate fixation resulted in a fracture mobility below the limit. CONCLUSIONS: From a mechanical point of view, based on the computer model, small PLA plates are only suitable for symphysis fractures with and without interfragmentary bone contact and for body fractures with interfragmentary contact. However, fixation with two PLA plates is always necessary to provide sufficient reduction of fracture mobility and plate strain.

Absorbable Implants↗
PubMed1977

8. Self-compressing implants in the management of fractures.

Internal fixation of fractures has become increasingly important since the introduction of self-compressing implants. Rigidity of fixation thus ensured permits primary bone healing. Two types of self-compressing implants are available--screws and plates. The former produces compression between fracture fragments, the latter, along the long axis of the bone. Two common types of plates are the dynamic compression plate and the Osteo self-compressing plate. Use of self-compressing implants requires familiarity with the technique, a definite plan of operation, and strict asepsis and lack of infection in the patient. Indications for the technique include failure or unsuitability of closed reduction of fractures, care of associated serious soft-tissue injuries, and displaced intra-articular fractures. Use of self-compressing plates hastens rehabilitation, lessens joint stiffness and reduces the duration of hospitalization. The incidence of nonunion with self-compression techniques is lower than with traditional methods of fracture management.

Bone Plates↗
PubMedDate not supplied

[An in vitro model for producing femoral fractures and for the study of primary stability of cerclage].

PURPOSE: Intraoperative femoral fracture is a well recognized intraoperative complication of cementless total hip arthroplasty (THA). This study was designed to establish an in-vitro model for initiation of fractures of the femur in cementless THA and to assess the effect of fracture fixation by cerclage wiring using steel wire (Protasul). METHODS: Ten human femur specimens were studied. Longitudinal cracks were created by pressing a well fixed conical stem deeper into the femur in a material testing machine. RESULTS: The force necessary to propagate a longitudinal crack in the femur was 1915 N to 9288 N (median 6531 N). This forces are according to 3 to 15 times (median 11 times) body weight. There was no difference of force between left and right femurs from the same individual (U-test). The femoral cortex fractured in 5 cases ventrally, in 6 cases medially and in 1 case laterally. After monofile cerclage wire application the force required to press prosthesis 5 mm deeper into the medullary canal was 0.3 to 2.7 times body weight. After monofile cerclage wire application pressing in the prosthesis 30 mm needed 1.8 to 8.1 times body weight. CONCLUSIONS: During insertion of a conical stem the orthopaedic surgeon should look for fractures of the medial cortex of the femur which is the most frequent location for fractures. This in-vitro model provides a reproductable method for the initiation and propagation of longitudinal femoral fractures in press-fit noncemented THA system and to assess the effect of fracture fixation in the form of cerclage wiring.

Adult↗
PubMed2004

Principles of metacarpal and phalangeal fracture management: a review of rehabilitation concepts.

Patients with common hand fractures are likely to present in a wide variety of outpatient orthopedic practices. Successful rehabilitation of hand fractures addresses the need to (1) maintain fracture stability for bone healing, (2) introduce soft tissue mobilization for soft tissue integrity, and (3) remodel any restrictive scar from injury or surgery. It is important to recognize the intimate relationship of these 3 tissues (bone, soft tissue, and scar) when treating hand fractures. Fracture terminology precisely defines fracture type, location, and management strategy for hand fractures. These terms are reviewed, with emphasis on their operational definitions, as they relate to the course of therapy. The progression of motion protocols is dependent on the type of fracture healing, either primary or secondary, which in turn is determined by the method of fracture fixation. Current closed- and open-fixation methods for metacarpal and phalangeal fractures are addressed for each fracture location. The potential soft tissue problems that are often associated with each type of fracture are explained, with preventative methods of splinting and treatment. A comprehensive literature review is provided to compare evidence for practice in managing the variety of fracture patterns associated with metacarpal and phalangeal fractures, following closed- and open-fixation techniques. Emphasis is placed on initial hand positioning to protect the fracture reduction, exercise to maintain or regain joint range of motion, and specific tendon-gliding exercises to prevent restrictive adhesions, all of which are necessary to assure return of function post fracture.

Finger Injuries↗
PubMedDate not supplied

Mandibular reconstruction: open reduction and internal fixation of mandibular fractures.

Open reduction and internal fixation of mandibular fractures by intraosseous wiring in conjunction with intermaxillary fixation remains the mainstay of mandibular fracture treatment despite the availability of newer methods. The principles of treatment are reviewed, including indications for use of this technique and its advantages and disadvantages. Various surgical techniques are also reviewed and key points in their application emphasized.

Adult↗
PubMed1991

The role of supplemental lag-screw fixation for open fractures of the tibial shaft treated with external fixation.

Ninety-nine open fractures of the tibial shaft were treated with unilateral external fixation with or without supplemental lag-screw fixation. We compared the results in forty-four fractures in which only external fixation was used (control group) with those in fifty-five fractures that were stabilized with lag-screws and external fixation, and we found no statistically significant differences between the two groups with respect to the time to full weight-bearing, the time to union, or the rates of delayed union, osteomyelitis, malunion, superficial or deep pin-track infection, or loosening of the pins. The limbs in which the fracture was treated with external fixation and supplemental lag-screws had more than twice the rate of refracture of the control limbs (11 compared with 5 per cent), and the percentage of fractures having supplemental lag-screw fixation that needed bone-grafting to achieve union was more than twice that in the group treated with external fixation alone. We concluded that the routine use of supplemental lag-screw fixation is not indicated in patients who have an open fracture of the tibial shaft that has been stabilized with external fixation.

Adolescent↗
PubMed1998

Self-tapping versus standard tapped titanium screw fixation in the upper extremity.

Most screws used in fracture fixation necessitate a separate step for tapping of the screw hole. Titanium screw systems have been developed in which the screws can be inserted directly after a drill hole is made. These self-tapping screws thereby eliminate an operative step. A retrospective study was conducted that evaluated all wrist and hand procedures performed between January 1992 and December 1994 by 1 surgeon using screw fixation. The results of 39 cases treated with standard tapped titanium screws were compared with 28 cases treated with self-tapping titanium screws. Nearly identical union and complication rates were obtained in each group. Comparable results can be obtained with self-tapping screw fixation, which limits the number of instruments needed, eliminates an operative step, and thereby may diminish operative risk and shorten operative time.

Adolescent↗