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At least 1,315 records · Page 73Linked to original sources
PubMed2026

Comparative safety and operative efficiency of surgical approaches for open reduction and internal fixation of mandibular condylar fractures: a systematic review and network meta-analysis.

BACKGROUND: The optimal surgical approach for mandibular condyle fractures remains controversial, particularly regarding the trade-off between facial nerve safety and surgical efficiency. METHODS: Our systematic review and frequentist NMA analyzed studies evaluating open reduction and internal fixation (ORIF) for mandibular condyle fractures. The primary safety outcome was transient or persistent (≥6 months) facial nerve weakness. The efficiency outcome was operative exposure time. Surgical approaches were categorized, and random-effects NMAs estimated odds ratios (ORs) and mean differences (MDs). Treatments were ranked using P-scores, and clustered rankings explored safety-efficiency relationships. RESULTS: Overall, 121 studies (n = 6659 patients) were included. For facial nerve safety, endoscope-assisted (EA), preauricular transmasseteric anteroparotid (PATMA), and high submandibular (HSMA) approaches ranked highest, while the retromandibular transparotid (RMTA) approach carried a higher risk. Analyses restricted to persistent weakness yielded consistent results. For exposure time, submandibular (SM), HSMA, and retromandibular transmasseteric anteroparotid (RMTMA) approaches were most efficient. Clustered ranking analysis identified HSMA and RMTMA as achieving the best overall balance between safety and efficiency. Subgroup analyses confirmed the overall hierarchy, though evidence for high-level and intracapsular fractures remains limited. CONCLUSIONS: HSMA and RMTMA offer an optimal compromise between safety and efficiency for extracapsular condylar fractures, while EA may minimize nerve injury risk where technical expertise allows. High-quality comparative trials - particularly for intracapsular fractures - are warranted.

Humans↗
PubMed1996

Arthroscopic internal fixation of fractures of the intercondylar eminence of the tibia.

We treated a 53-year-old man with a fracture of intercondylar eminence of the tibia. He had a nondisplaced (type I) fracture at the first examination and was treated by long leg cast. However, 4 weeks later, it was found that the fracture was displaced, which suggests that nondisplaced fracture of intercondylar eminence may displace later. We recommend primary arthroscopic fixation for type I fractures of the intercendolar eminence of the tibia, because it is difficult to reduce the fragment arthroscopically once it is displaced. This report describes a new technique of arthroscopic reduction and internal fixation for the fractures intercondylar eminence of the tibia.

Adolescent↗
PubMed2002

The use of subtalar arthroscopy in open reduction and internal fixation of intra-articular calcaneal fractures.

Congruency of the subtalar joint is a major predictor of outcome after intra-articular calcaneal fractures. Because of the irregular shape of the posterior joint facet, minor steps may be overlooked with direct vision or intra-operative fluoroscopy during open reduction and internal fixation (ORIF). In a preliminary series of 15 subtalar arthroscopies during hardware removal after ORIF of intra-articular calcaneal fractures, patients with visible steps of 1 mm or more had significantly inferior functional results compared to those with an intact subtalar joint (117 vs. 158 points with the 200-point score, 71.3 vs. 91.2 points with the Maryland Foot Score, P<0.01). Congruency of the posterior facet was controlled arthroscopically in 47 intra-articular calcaneus fractures after open reduction and temporary K-wire-fixation. In 12 cases (25.5%), despite seemingly correct reduction as judged fluoroscopically, incongruencies in the posterior calcaneal facet were detected and reduction was repeated, temporarily removing the K-wires. After anatomical reduction a standard AO calcaneal plate was fixed to the lateral wall. Intra-operative arthroscopy appears to be useful in detecting minor incongruencies after ORIF of intra-articular calcaneus fractures. In the hands of an experienced surgeon it is less time demanding than intra-operative X-rays and more precise than fluoroscopy.

Adult↗
PubMed1989

A review of reduction and internal fixation of adult femoral neck fractures in a county hospital.

Treatment of femoral neck fractures at a county hospital, Parkland Memorial Hospital, Dallas, Texas, from 1978 to 1983 was reviewed. A study of the use of the quadratus femoris muscle-pedicle graft (MPG) as adjunctive treatment to open reduction and internal fixation (ORIF) was in effect during that time. Patients who had primary prosthetic replacement of their femoral head were not included in the study. Two groups of patients were identified, one group that had ORIF without a muscle-pedicle graft (no-MPG) and another group that had ORIF with a muscle-pedicle graft (MPG). There were a similar number of patients in each group (MPG = 25 patients, no-MPG = 24 patients). Although the groups were not exactly similar, the overall outcome was unexpected. The no-MPG group had 76% good-to-excellent results whereas the MPG group had only 24%. A poor result or outright failure of the technique occurred in 68% of the MPG group and in only 16% of the no-MPG group. No accurate assessment of the incidence of avascular necrosis of the femoral head could be made.

Adolescent↗
PubMed2001

Ilizarov hybrid external fixation for fractures of the distal radius: Part II. Internal fixation versus Ilizarov hybrid external fixation: Stability as assessed by cadaveric simulated motion testing.

The in vitro stability of an Ilizarov hybrid external fixator was compared with that of a dorsal 3.5-mm AO T-plate in 8 unpaired, fresh-frozen upper extremities. A specially designed testing device that used computer-controlled pneumatic actuators was used to simulate active finger, wrist, and forearm motions by applying loads to relevant tendons. A comminuted extra-articular distal radius fracture was modelled using a dorsally based wedge osteotomy. Fracture stability was assessed using an electromagnetic tracking device to measure motion across the fracture site after randomized application of the plate and the hybrid fixator. During simulated finger and wrist motions with the forearm pronated or supinated, motion of the distal fragment with the hybrid fixator applied was comparable to or statistically less than with the AO plate applied. During simulated forearm rotation, the stability provided by the 2 fixation types was similar, although the plate allowed statistically less radial-ulnar deviation of the fragment. In this model of a 2-part extra-articular distal radius fracture, the clinically meaningful stability of the Ilizarov hybrid external fixator was comparable to that of the dorsal AO plate.

Aged↗
PubMed1993

The use of primary internal fixation in spondylolisthesis.

A prospective randomized study was designed to examine differences in the primary fusion rate between two surgically treated groups of patients with spondylolisthesis. Twenty-seven patients underwent L5 laminectomy (Gill procedure) and L5 nerve root decompression. Fourteen patients (group I) underwent in-situ posterolateral fusion, thirteen patients (group II) received internal stabilization with the Steffee plate and screw system. All patients were followed for a minimum of two years. Ten of fourteen (72%) patients treated with non-instrumented fusion went on to union. Ten of thirteen (78%) patients treated with internal fixation achieved union. No statistically significant increase in the primary fusion rate occurred with addition of internal fixation compared to non-instrumented posterolateral grafting alone.

Adult↗
PubMed1979

Internal fixation of fractures of the neck of the femur in hemiplegic patients.

There was a history of hemiplegia due to stroke in 97 (6.5 per cent) of 1483 consecutive patients with fresh fractures of the neck of the femur. Both cervical and trochanteric features occurred significantly more often on the hemiplegic side. Internal fixation was technically satisfactory in trochanteric fractures, but failed frequently in cervical fractures.

Adult↗
PubMed1990

Open reduction and internal fixation of comminuted, intraarticular fractures of the distal radius.

Comminuted intraarticular fractures of the distal radius present a difficult problem in management. It is well established that unreduced significant articular incongruency will result in early degenerative osteoarthritis. The technical demands of, and the results to be expected from, formal open reduction and internal fixation of these comminuted articular fractures have not been addressed in the current literature. From 1981 to 1986, 20 patients were treated by open reduction after failure of closed means. Seventeen patients were personally reviewed at an average follow-up of 3.25 years. The results indicate that the procedures are technically demanding and have high early (15%) and late (35%) complication rates. This gives an overall complication rate of 50%, including the need for further operative procedures. However, patient satisfaction is very high, most patients (89%) returning to previous occupations. Function and radiographic results are excellent. Articular congruency was restored in 88%.

Adult↗
PubMed1986

Salmonella osteomyelitis after internal fixation of fracture.

A patient with Salmonella group D (Salmonella enteritidis) acute osteomyelitis of an operated femur is described. The patient failed to respond to chloramphenicol therapy and aztreonam therapy. The local infection that complicated the presence of a foreign body was eradicated only with the removal of the foreign body, an internal fixation plate.

Aged↗
PubMed2002

Internal fixation of valgus-impacted humeral head fractures using the screw-wiring technique.

Between February 1996 and July 2000 eight patients (ages 35-74 years) with nine severely impacted humeral head fractures were operated on with the aim of preserving the humeral heads. Patients were treated surgically with open reduction, autologous bone grafting, and internal fixation with a screw-wiring technique. There were no complications and all patients were satisfied with the results. After 10-63 months there was no evidence of nonunion, arthritis, avascular necrosis, or loosening of implants. The mean Constant score was 83 (66-97) points. Results of this study support the observation that four-part valgus-impacted humeral head fractures without significant lateral displacement have a low incidence of avascular necrosis.

Adult↗
PubMed1989

Operative treatment of intraarticular fractures of the os calcis--the role of rigid internal fixation and primary bone grafting: preliminary results.

The treatment of intraarticular fractures of the os calcis remains controversial. Yet it seems illogical that the subtalar joints should be treated differently from other weight-bearing joints. In this paper, we report the results of treating 64 intraarticular fractures of the os calcis by open reduction, rigid internal fixation with primary bone graft, and early mobilization. Of the 64 fractures, 23.43% were tongue-type fractures, 48.43% were joint depression, and 28.12% were comminuted. All the fractures were operated on with lateral incisions. The average period of follow-up was 10.6 months. The results showed that all the patients had minimal pain, swelling, and deformity. Subtalar joint movement was retained (67.8% of active and 80.7% of passive). Eighty percent of normal Bohler angles and 93.5% of normal crucial angles were regained. Over 80% of patients resumed working within 6 months after the injuries. We therefore concluded that the present method of treating intraarticular fractures of os calcis gives very good results.

Activities of Daily Living↗
PubMed2003

[Open reduction and internal fixation of unstable sacral fractures].

Sacral fractures are frequently misdiagnosed or overlooked, as the majority of the patients are suffering from polytrauma situations. Obvious clinical signs both of the fracture and the associated neurological complications are missing. A poor longterm outcome with pain and urogenital disorders is frequent. Based on clinical and biomechanical studies a new concept for internal fixation of transsacral pelvic instabilities combined with decompression of the central canal is applied. To approach the sacrum, a posterior longitudinal incision is carried out and can be modified according to the fracture pattern. Decompression and anatomic reduction is performed and the fracture stabilized with minimized small fragment implants which are solely fixed in the sacrum. 32 patients were treated according to this protocol between 1989 and 1996. Bony healing occurred in all but one case. A complete anatomical sacral reconstruction was achieved in 80 % of the cases, another 16 % had close to anatomic (< 5 mm) reconstruction. In eight cases a primary neurologic deficit was present, with five complete or partial recoveries directly postoperative. Complications occurred in seven patients with two secondary displacements.

Adolescent↗
PubMed1989

Ankle fractures treated using biodegradable internal fixation.

In order to reduce the resources needed for the removal of metallic fixation devices in fracture treatment, absorbable implants of biodegradable synthetic polymers were developed using self-reinforced lactide-glycolide copolymer and polyglycolide. In a prospective study 102 patients with displaced unimalleolar or bimalleolar fractures of the ankle were managed using internal fixation devices consisting of cylindrical biodegradable implants 3.2 or 4.5 mm in diameter and 50 or 70 mm in length. After open reduction of the fracture a channel was drilled from the tip of the malleolus into the cancellous bone through the fracture surfaces. A biodegradable rod of the same diameter was then tapped into the drill channel to fix the fracture. Postoperatively, the ankle was immobilized by a plaster cast for six weeks. An anatomic initial reduction was achieved in 93 patients (91%). A slight secondary displacement occurred in four patients. In six patients a sinus formation yielding remnants of the degrading implant was seen two to four months after the operation. This minor complication did not influence the union of the fracture or functional recovery. At the one-year follow-up examination there was no change in the ability to participate in sports and other physical activities in 89 patients (87%). The biodegradable fixation method is now the routine approach of the department in treating displaced unimalleolar and bimalleolar ankle fractures. New clinical applications for the implants are under trial.

Adolescent↗
PubMed1997

Open reduction and internal fixation of a glenoid fossa fracture in a child: a case report and review of the literature.

Scapular fractures in children are rare injuries. The indications for the surgical treatment of glenoid fossa fractures in children are not well defined. We report on an eight-year-old child with a displaced glenoid fossa fracture requiring open reduction and internal fixation. A review of the literature and indications for the operative management of glenoid fossa fractures in children are discussed.

Child↗
PubMed1991

Internal fixation of closed tibial fractures for the management of sports injuries.

From 1985 to 1988, 90 closed tibial fractures were prospectively studied to assess the morbidity of such injuries to sports people and how this can be influenced by treatment regimens. All fractures were sustained during rugby or football matches. After random selection, 45 fractures were openly reduced and internally fixed (group A), and 45 fractures were manipulated under general anaesthesia and a long-leg plaster applied (group B). For patients in group A, below-knee plasters were used for 3 to 4 weeks, with immediate weight-bearing when tolerated. A total of 44 (98%) tibiae united clinically and radiologically within 14-18 weeks. Within 4 months of surgery 28 (62%) patients had returned to work and were able to play again by the following season. By 6 months 17 (38%) patients had resumed normal activities. In group B, only 24 (53%) tibiae united in a mean time of 16 weeks (range 12-40 weeks). Six (13%) patients required bone grafting for non-union, and one patient subsequently developed osteomyelitis. Only ten (22%) patients were back to work and playing sport again within 6 months of initial injury. It is concluded that internal fixation of closed tibial fractures as a primary procedure following low velocity sports injuries can be safely performed. It leads to a faster return to normal activities with fewer complications than does conservative treatment in plaster using contemporary methods.

Adolescent↗
PubMed1998

[Comparison of internal fixation methods for the symphysis in multi-directional dynamic gait simulation].

For the stabilization of the ruptured pubic symphysis, rigid forms of fixation such as plate osteosynthesis and flexible fixations such as wire loops or PDS banding have been recommended. All methods have only been tested by static unidirectional loading until failure of the system. By this experimental arrangement Ecke and Hofmann found comparable results for flexible and rigid methods of internal stabilization of the pubic symphysis. They preferred flexible methods to maintain mobility of the symphysis and to prevent symphyseal fusion. We tested dynamic compression plate osteosynthesis, reconstruction plate osteosynthesis, wire loops and PDS banding for internal fixation of injured pubic symphysis in a dynamic multidirectional experimental arrangement simulating gait conditions. The specimens were loaded with 85 N in vertical (y-) direction and 34 N in sagittal (z-) direction, which represent 50% of the forces acting at the pubic symphysis during walking and with a frequency of 1.5 Hz over 55,500 loads simulating the conditions over a 6-week mobilization period. Loading with 100% of the acting forces (corresponding to full weight bearing mobilization) led to early failure of the system. Our experimental analysis showed that neither wire loops nor PDS banding is able to stabilize the ruptured pubic symphysis, even immediately after fixation before loading. During the tests instability increased until failure of the system due to cutting of the bone or breaking of the wires or PDS banding. Success of plate osteosynthesis was dependent on the initial stability of the fixation. Overwinding of the screws, as in osteoporotic bone, lead to increasing loosening during repeated loading, whereas primary stable fixation of the screws was almost completely maintained during the test. In consequence, neither wire loops nor PDS banding should be used for stabilization of injured pubic symphysis if early mobilization with partial weight bearing is desired. Plate osteosynthesis (DC or reconstruction plate) tolerates early half weight bearing in patients with "open-book" injury only if safe screw fixation is guaranteed.

Biomechanical Phenomena↗
PubMed1994

Implants of pure titanium for internal fixation of the peripheral skeleton.

In a multicentre study, a clinical evaluation of the new titanium implants of the sizes 2.7, 2.0 and 1.5 mm was done. In seven centres, 133 patients were operated on and the personal, subjective opinions of the surgeons were recorded. In the opinion of these surgeons experienced in using steel implants, the outcome of the internal fixations was the same for titanium as for steel implants. Three metal-related complications occurred in the smallest size screw type (1.5 mm), namely, one screw broke and two bent. In the cases in which the implant had been removed, good tissue contact with the implant could be seen. Only in one case was there discolouring of the soft tissue due to titanium. It is recommended that surgeons who are used to handling stainless steel screws should be aware of the slightly different behaviour of titanium screws.

Adolescent↗
PubMed1997

Open reduction and internal fixation of combined fourth and fifth carpometacarpal (fracture) dislocations.

BACKGROUND: Traditionally, combined fourth and fifth carpometacarpal fracture dislocations are treated conservatively or by means of Kirschner wire after closed reduction. Since 1983, unstable dislocations have been treated with open reduction and screw fixation or with a temporary plate that bridges the fourth carpometacarpal (CMC) joint to maintain anatomical reduction. METHODS: In a retrospective study, we evaluated the results of this surgical approach in a group of 11 patients and another group of 4 conservatively treated patients. RESULTS: Eleven patients were treated by means of open reduction and rigid screw fixation (n = 6) or plate bridging of the fourth CMC joint (n = 5). Reduction and fixation of the fourth CMC joint always led to spontaneous anatomical reduction of the fifth CMC joint. At long-term follow-up, nine of these patients had full recovery of their hand function without any complaints. CONCLUSION: Open reduction and internal fixation of unstable ulnar CMC dislocations produced excellent results.

Adult↗