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At least 1,261 records · Page 70Linked to original sources
PubMed1994

An accurate method for open reduction and internal fixation of high and low condylar process fractures.

OBJECTIVE: This study was undertaken to evaluate a protocol for open reduction of both high and low condylar fractures that consistently produces accurate reductions, uses rigid internal fixation, and allows immediate function. MATERIALS AND METHODS: This protocol was retrospectively evaluated in 22 consecutive patients (23 fractures). RESULTS: All patients functioned immediately. There were no inaccurate reductions, malocclusions, wound infections, neurosensory deficits, or reports of chronic pain. No patients required reoperation. CONCLUSION: The results of this study indicate that this protocol consistently produces accurate reduction of condylar process fractures and allows immediate function with a minimum of morbidity.

Adolescent↗
PubMed2000

Open reduction and internal fixation of posterior wall fractures of the acetabulum.

The results of 94 patients with posterior wall fractures of the acetabulum associated with hip instability treated within 3 weeks of injury by open reduction and internal fixation were reviewed. Patients were followed up for an average of 3.5 years (range, 1-13 years). Fracture reductions were graded as anatomic (0-1 mm displacement) in 92 patients and imperfect (2-3 mm displacement) in two patients, as determined by plain radiography. However, postoperative computed tomography scans obtained in 59 patients revealed incongruency of more than 2 mm in six patients and fracture gaps of 2 mm or more in 44 patients. Complications included deep wound infection (one patient), deep vein thrombosis, (seven patients), and revision surgery to redirect an errant screw (one patient). Clinical outcome was graded as excellent in 34 patients (36%), good in 49 (52%), fair in two (2%), and poor in nine (10%). Radiographic results were excellent in 79 hips (84%), good in four (4%), fair in two (2%), and poor in nine (10%). There was a strong association between clinical outcome and radiographic grade. Variables identified as risk factors for an unsatisfactory result included age greater than 55 years, a delay greater than 24 hours from the time of injury for reduction of a hip dislocation, a residual fracture gap greater than 1 cm, and severe intraarticular comminution. The apparent disparity between the accuracy of surgical fracture reduction, as determined by plain radiographs obtained postoperatively, and clinical outcome is explained only partially by the limitations of plain radiography. Other variables are involved, many of which are under the surgeon's control but some are not. As is the case with other acetabular fracture types, the best results are predicated on anatomic fracture reduction.

Acetabulum↗
PubMedDate not supplied

Open reduction and internal fixation for supracondylar humerus fractures in children.

Eight hundred sixty-two supracondylar humerus fractures were treated between January 1984 and July 1997. Sixty-five (8%) patients were managed with open reduction and internal fixation with pins. The remaining 797 patients (92%) were managed with either casting, closed reduction with or without percutaneous pinning, or traction. Of the 65 patients managed with open reduction, 46 (71%) of these fractures were irreducible, 16 (24%) had associated vascular compromise, eight (12%) were open, and one was associated with a postreduction nerve palsy and nonanatomic reduction. According to the criteria of Flynn et al. 18 (55%) elbows were rated excellent, eight (24%) were rated good, three (9%) were rated fair, and four (12%) were rated poor after an average of 5.8 months postinjury. This study indicates that highly satisfactory results can be obtained in severely displaced fractures managed with open reduction in these situations.

Adolescent↗
PubMed2001

The long term results of internal fixation of displaced intra-articular calcaneal fractures.

One hundred and fourteen displaced intra-articular fractures of the calcaneus (47 tongue type and 67 joint depression type) were treated by open reduction and internal fixation with multiple H plate and were followed-up for an average of 6.75 years. All the fractures healed radiographically in 3 months. Average time for bone healing was 2.25 months for the tongue type and 2.42 months for the joint depression type (p > 0.05). Average post operative Bohler tuber angle was 25.05 and 22.71 degrees in the tongue type and joint depression type respectively (p > 0.05). All patients could return to work in 8 months. The average time for returning to work was 3.42 months in the tongue type and 4.16 months in the joint depression type (p < 0.05). Three calcanei (2.6%) had wound infection. There were significant differences between the two types in degree of residual pain, walking activities and range of subtalar joint movement. There were no significant differences in the ability to work, change of footwear and hind foot swelling. The end functional result was rated as excellent in sixty one (53.5%), good in twenty (17.5%), fair in fourteen (12.3%) and poor in nineteen (16.7%) calcanei. There was significant difference in the satisfactory result (excellent to fair) between the tongue type (91.5%) and joint depression type (77.6%).

Adolescent↗
PubMed1997

Internal fixation of experimental intraarticular calcaneal fractures: a biomechanical analysis of two fixation methods.

OBJECTIVE: To evaluate and compare the mechanical stability of two different fixation techniques on experimentally induced calcaneus fractures. METHODS: Thirteen fresh frozen cadaver lower limbs had intraarticular calcaneal fractures produced with an impact loading device. Internal fixation was then performed through lateral and medial approaches using 3.5-mm interfragmentary screws fixed to the posterior facet. Next, either a five-hole 1/3 tubular or five-hole reconstruction plate was placed on the lateral cortex. Radiographs were obtained to confirm reduction. The foot was then cyclically loaded for 500 cycles with a compressive load of 98 N, followed by loading to failure. RESULTS: The displacement at the posterior facet fracture line between the loaded and unloaded foot at the 500th cycle was 0.30 +/- 0.08 mm and 0.39 +/- 0.18 mm for the tubular and reconstruction plates, respectively. These displacements were not statistically significant (Student's t test p > 0.3). The load and displacement at failure for the tubular plate were 2021 +/- 1050 N and 6.10 +/- 1.75 mm, respectively. Those for the reconstruction plate were 1923 +/- 697 N and 4.57 +/- 1.32 mm (p > 0.09). CONCLUSION: This study supports the mechanical viability of using less prominent plates for the fixation of intra-articular calcaneal fractures.

Aged↗
PubMed2006

Spontaneous rapid osteolysis in Paget's disease after internal fixation of subtrochanteric femoral fracture.

Rapidly-progressive spontaneous progression of the osteolysis following internal fixation of pathological fracture in patients with Paget's disease has not been previously reported. We describe two patients, aged 59 and 65 years, respectively, who had pathological subtrochanteric fractures in Pagetic femora fixed internally using an interlocked intramedullary nail, and who developed spontaneous rapid osteolysis. Both patients responded favourably to long-term treatment with alendronate, with resultant fracture union and resolution of osteolysis.

Aged↗
PubMed1984

Closed reduction and internal fixation of proximal phalangeal fractures.

Displaced fractures of the shaft of the proximal phalanx can lead to marked deformity and disability when poor results are obtained. Despite the attention popular concepts of open reduction and internal fixation have received, a less invasive technique has been our standard approach. A prospective study of closed reduction and percutaneous Kirschner wire fixation in 100 consecutive fractures yielded good or excellent results in 90% of cases when treated within 5 days of injury.

Finger Injuries↗
PubMed1997

Internal fixation in postpartum symphysis pubis rupture: report of three cases.

We present three patients with postpartum symphysis pubis rupture whose severe complaints persisted after conservative treatment. All three ruptures were stabilized with open reduction and internal fixation. There were no postoperative problems, and implants were removed after a mean period of six months. Patients were free of complaints after implant removal. In select cases, operative treatment of postpartum symphysiolysis may be indicated.

Adult↗
PubMedDate not supplied

Comminuted trochanteric femoral fractures in geriatric patients: the results of 231 cases treated with internal fixation and acrylic cement.

Instability, osteoporosis and the requirement of early mobilization are the main problems in comminuted trochanteric fractures in elderly patients. Correct reduction and the use of acrylic cement as an adjunct to internal fixation provide the stability for immediate weightbearing and subsequent bone union. In 213 patients there was no evidence of femoral head necrosis or non-union.

Aged↗
PubMedDate not supplied

[The internal fixator in nontraumatic indications in spinal surgery].

This series includes 59 consecutive patients, 51 of whom had a minimum follow up of 2 years. The diagnosis was mechanical instability in 39, deformity in 11, and infection or tumor in 9 patients. The overall clinical results of the total group were good or fair in 88% of the patients. Pseudarthrosis occurred twice. We had on postoperative infection, one persistent and two reversible neurological complications. We found 13 broken screws and one rod breakage which had no clinical relevance. None of these asymptomatic complications required revision. The internal fixator has a great potential of correction in scoliotic and kyphotic deformities of the spine. It has not been shown to have the same potential in spondylolisthesis. A combined anterior and posterior stabilisation is needed in severe spondylolisthesis. We have found the internal fixator to provide satisfactory stability to allow fusion and good clinical results with a low rate of relevant complications.

Adolescent↗
PubMed1983

Internal fixation of supracondylar and bicondylar femoral fractures using a new semielastic device.

Previous reports of failures following surgery of distal femoral fractures prompted the development of a semielastic internal fixation device suitable for the mechanically weak bone of the elderly. The fixation device consists of intramedullary elastic Ender-type nails connected to cancellous screws at each condyle by a special coupling piece. Thus, the intercondylar fracture is rigidly stabilized by screws and adjusted to the supracondylar fracture by connected elastic nails. The device is easily applied through small incisions. During a two-year period 54 fractures of the distal third of the femur were treated. Most patients were elderly and suffered from concurrent diseases or previous ipsilateral fractures. The goal was twofold: to avoid traction in bed and to start early mobilization. Fifteen undisplaced fractures were treated by plaster or cast-brace. Five fractures were treated by traction. Thirty-four displaced supracondylar and bicondylar fractures were operated on using the new fixation device. No deep infections or osteomyelitis occurred. Immediate mobilization was possible in all 34 cases, most with an external support of plaster for two weeks and a hinged cast-brace for eight weeks. Twenty-nine patients were followed up to union; results in these displaced supracondylar and bicondylar femoral fractures were excellent in 12, good in nine, fair in five, and poor in three patients. The semielastic character of the system seemed to prevent the failures observed with the use of rigid internal fixation in osteoporotic bone.

Adolescent↗
PubMed1993

Use of a tourniquet in the internal fixation of fractures of the distal part of the fibula. A prospective, randomized trial.

A prospective, randomized trial was undertaken to determine the rate of complications after the use of a tourniquet during open reduction and internal fixation of simple, closed fractures of the distal part of the fibula. Forty patients were operated on with use of a tourniquet (Group 1) and forty patients, without use of a tourniquet (Group 2). The average duration of the operation was significantly different between the two groups (41 +/- 9 minutes for Group 1 compared with 53 +/- 12 minutes for Group 2 [p = 0.026]). There were more complications in the patients in Group 1, two of whom had an isolated deep-vein thrombosis of the calf. The wound was possibly infected in eleven patients (seven in Group 1 and four in Group 2 [p < 0.05]) and frankly infected in three patients, all in Group 1 (p < 0.05). The plaster-of-Paris cast needed to be changed in three patients from Group 1. The patients in Group 1 returned to work an average of one week later than those in Group 2. The mean duration of follow-up was eighteen months (range, nine to thirty-two months). Given the lower prevalence of postoperative complications and the shorter time to recovery for the patients in Group 2, we believe that it is justified not to use a tourniquet in the operative treatment of simple, isolated fibular fractures.

Adult↗
PubMed1983

Internal fixation of fractures of the head of the radius.

In a group of 25 patients with a displaced fracture of the head of the radius (which otherwise would have been treated by resection) operative reduction and internal fixation were carried out. The results, after a follow-up ranging from six months to over two years after operation, were excellent in 17 (no pain and no restriction of movement) and fair to good in eight patients (no pain and restriction of less than 20 degrees). None of the patients had a bad result. The advantages of this technique, which conserves the length of the radius, are discussed.

Adult↗
PubMed1981

Operative treatment of olecranon fractures. Excision or open reduction with internal fixation.

We reviewed the cases of 107 patients who underwent surgical treatment of an isolated fracture of the olecranon. Fifty-three patients were treated by primary excision and fifty-four, by open reduction and internal fixation by various methods. Static and dynamic strength measurements were obtained from the elbow extensors of twenty-nine patients from these two groups. In the over-all series, the ratings for pain, function, range of motion, elbow stability, and incidence of degenerative joint changes were similar for each group. However, thirteen local complications occurred in the fifty-four patients who had open reduction and two, in the fifty-three who had primary excision. Need for removal of the fixation device led to an additional thirteen procedures in the fixation group. Biomechanical testing demonstrated no significant difference in elbow extensor performance for the two groups.

Adult↗
PubMed1993

Internal fixation of metacarpal and phalangeal fractures with AO minifragment screws and plates: a prospective study.

In a prospective study, 43 patients with 47 metacarpal or phalangeal fractures with significant displacement, rotation, angulation and/or instability were treated with internal fixation using AO minifragment screws and plates. In all fractures an anatomical reduction was achieved. Postoperatively all metacarpal fractures were protected by means of a plaster, in which motion was allowed, whereas all phalangeal fractures were treated by means of a soft bandage. At a review after a mean period of 28 months, 31 patients with 35 fractures out of 34 patients with 38 fractures had regained excellent recovery of total active flexion (92 per cent). Three patients had a poor recovery of total active flexion; one had an infection, the other two were operated on 6 and 14 days after their injury, whereas the mean delay between injury and operation was 3 days. All patients not reviewed had regained good or 100 per cent function.

Adolescent↗
PubMed1992

Open reduction and internal fixation of an acetabular fracture during pregnancy.

Fractures of the pelvis and acetabulum are common injuries in a mechanized society and frequently occur in the younger age groups. Commonly associated injuries such as hemorrhage, urethral tears, gastrointestinal injuries, and major vessel damage are well reported and well known to orthopaedic surgeons. Another less frequently reported complication of pelvic fractures is the potential association with pregnancy and subsequent childbirth. This problem was first described by Malgaigne in 1857 in his classic article on double vertical fractures of the pelvis, in which he described a 34-year-old woman with a pelvic fracture who subsequently died during childbirth. A review of the literature reveals numerous articles addressing potential problems with parturition subsequent to a pelvic fracture and several articles dealing with pelvic fractures occurring during pregnancy. The current literature on pelvic fractures during pregnancy, however, recommends only nonoperative treatment and, to our knowledge, there have been no reports of operative fixation during pregnancy. The purpose of this article is to report a case of an acetabular fracture in a pregnant woman treated with open reduction and internal fixation, who went on to carry a full-term baby and have a normal delivery.

Accidents, Traffic↗
PubMed2001

[Treatment of thoracolumbar spinal fractures using internal fixators (evaluation of 120 cases)].

PURPOSE OF THE STUDY: A group of 120 patients was evaluated with acute injury of Th-L spine who were operated on from posterior approach with the use of Dick AO fixator or USS fixator in the period of 1991-1996. MATERIAL: In the period of 1991-1996, 128 patients were operated on with the acute injury of Th-L spine. Evaluated were 120 patients: 81 men (67.5%) of average age 40.1 years (age range, 16-74 years) and 39 women (32.5%) of average age 35.4 years (age range, 15-66 years). Posterior stabilization using the internal fixator was combined with posterolateral or posterior interarticular fusion. In comminuted fractures of the vertebral body transpedicular cancellous bone grafting was performed and starting for 1995 also intercorporal transpedicular fusion. METHODS: The evaluation covered location and type of fractures, injury of other levels of the spine, other associated injuries, neurological symptomatology prior to the surgery and 3 months after the surgery, duration of surgery and of image intensifier exposure, peroperative and early postoperative complications, radiograph evaluation of the degree of reduction, the loss of correction after 12 months and after the hardware removal. RESULTS: Evaluated were 120 patients. Average interval after the surgery at the time of the evaluation was 43.7 months (range, 24-93 months). The injury was caused in 82 cases (68.3%) by a fall from height, in 26 cases (21.7%) by a car accident and in 12 cases (10%) by another cause. Associated injuries included: calcaneus fracture 18 times, the fracture of ankle 4 times, pelvis fracture 4 times, other fractures 18 times. In 89 cases the injury involved only one vertebra, i.e. one level, 31 cases were multi-level injuries. The angle of the kyphosis of vertebral body was on average 21.8 degrees. Patients with neurological symptoms were on average operated on 2-12 hours after the admission, other patients were operated on in the interval between 5 hours and 7 days. Bilateral transpedicular cancellous bone grafting was performed in 106 affected vertebrae, the canal was revised in 27 injured vertebrae. The surgery took on average 172 minutes (range, 62-430 minutes). Image intensifier exposure lasted on average 2.4 minutes. Average blood loss was peroperatively estimated at 725 ml, postoperatively on average at 815 ml. Postoperative complications: healing of the wound per secundam 6 times, thromboembolic complication in 9 cases--never fatal, pneumonia 3 times, uroinfection 5 times. The total number of these complications was about 8%. Vertebral body was completely restored in 72 cases, incompletely in 34 cases (up to 5 degrees deficit). The correction of kyphosis achieved was on average 6.5 degrees. After 12 months the correction loss with the fixator in place was on average 2.5 degrees. After the removal of the fixator the average correction loss was 5.5 degrees. In 2 cases there occurred a significant re-dislocation which required revision surgery. Transpedicular screws broke 6 times in the total of 4 patients, fixator loosened in 2 cases. DISCUSSION: Surgical treatment of thoracolumbar spine is indicated in unstable injuries and all injuries with neurological lesion and a proved compression of spinal canal. Decompression of the spinal canal is often achieved by reduction, lordotization and distraction. In other cases revision of the canal is indicated. Stabilization is performed by means of a transpedicular internal fixator. Part of the surgery is posterior fusion. The defect in the reduced body is treated by transpedicular cancellous bone grafting. The affected inervertebral disc must be treated by intersomatic fusion. Anterior operation is indicated as a complementary one. CONCLUSIONS: 1. Absolute majority of injuries of thoracolumbar spine may be treated from the posterior approach. In this it is necessary to restore the stability of the anterior column. An indispensable part of the operation is a flawless posterior fusion. 2. Some types of injuries require a complementary anterior approach in the first or second step. This applies mainly to the injuries with a defect of anterior column evaluated on the basis of classification after Gaines. 3. A primary isolated anterior approach to the treatment of the injury of Th-L spine is not in our view suitable as a routine.

Adolescent↗
PubMed2002

Open reduction and internal fixation of fractured mandibular condyles by a retromandibular approach: surgical morbidity and informed consent.

Treatment of fractured mandibular condyles remains controversial. In this paper we present data collected prospectively on 42 fractured condyles treated by open reduction and internal fixation. The central issue, which is sometimes forgotten, is the informed consent of our patients. To this end we have looked at the surgical morbidity related to the retromandibular approach.

Adult↗