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At least 1,333 records · Page 74Linked to original sources
PubMed2003

[Open diagonal fracture of metatarsus III/IV and internal fixation in an alpaca].

This report describes the case of a 15-month-old alpaca stallion with an open fracture of metatarsus (MT) III/IV that occurred during transportation. Despite of a guarded prognosis, the animal was operated on request of the owner. The surgical intervention consisted of meticulous lavage and curettage of the wound and affected bone, precise fracture reduction, internal fixation with a 12-hole broad 3.5 mm DCP and implantation of a gentamicin impregnated collagen sponge. Primary wound healing was evident and the implant was removed at 3 months after the initial intervention. At 14 months after surgery, the stallion did not show any signs of lameness and was used for service.

Animals↗
PubMed1997

Rigid internal fixation with lateral mass plates in multilevel anterior and posterior reconstruction of the cervical spine.

STUDY DESIGN: A retrospective clinical and radiographic analysis was performed on 17 patients with multilevel cervical disease who were treated with anterior and posterior reconstruction with a new rigid, segmental, internal fixation system applied to the lateral masses. OBJECTIVES: To determine the applicability, safety, and clinical efficacy of an instrumentation system used as a cervical lateral mass plate in the management of complex spinal disorders. SUMMARY OF BACKGROUND DATA: Cervical disorders involving three or more levels present a difficult reconstruction problem, especially if the posterior elements are deficient. Segmental fixation with lateral mass plating provides an alternative method to situations that would otherwise require a halo. METHODS: Seventeen patients treated by a single surgeon underwent cervical reconstruction surgery involving three or more levels. All patients had anterior decompression and reconstruction and a posterior fusion with rigid internal fixation with a device applied to the lateral masses of the cervical vertebrae. Patients were reviewed clinically and radiographically to determine the efficacy and safety of this method of fixation. RESULTS: Of the 15 patients with adequate follow-up data that were studied, the condition of 13 patients, (87%) was improved, that of one patient (6.7%) was the same, and that of another (6.7%) was worse after surgical intervention. Sagittal alignment was restored to within 5 degrees of the preoperative lordosis in active extension by the modified Cobb method and the Gore method. No patient had radiographic nonunion. One patient had a sensory radiculopathy associated with an overpenetrated lateral mass screw that partially resolved after hardware removal. One patient had asymptomatic loosening of a C7 lateral mass screw. CONCLUSIONS: Segmental posterior fixation with lateral mass plating provides more rigid immobilization than traditional techniques, allows restoration and maintenance of spinal alignment, obviates the need for halo immobilization, and is associated with a low incidence of neurovascular injury.

Adult↗
PubMed2006

Prospective evaluation of a pragmatic treatment rationale: open reduction and internal fixation of displaced and dislocated condyle and condylar head fractures and closed reduction of non-displaced, non-dislocated fractures Part II: high condylar and condylar head fractures.

This study prospectively evaluated closed reduction (CR) outcomes in non-displaced, non-dislocated high-condylar and condylar-head fractures (Class VI after Spiessl and Schroll) and open reduction and internal fixation (ORIF) of displaced (Class III) or dislocated (Class V) fractures. Thirty-eight patients with 54 fractures (16 (42%) with bilateral fractures, 14 (37%) CR, 24 (63%) ORIF) were enrolled in a 1 year follow-up that 18 patients with 33 fractures completed. Condylar translation in Class VI fractures recovered to 11 mm for vertical opening, 8mm for protrusion and 10 mm for mediotrusion; Class III synonymously 8 mm, 8 mm and 6 mm; and Class V 7 mm, 6mm and 7 mm; incisal movements recovered to 38 mm, 8 mm and 8 mm in Class VI; 55 mm, 7 mm and 10 mm in Class III with 1 (8%) malocclusion, 1 (8%) impaired vertical opening and 55 mm, 7 mm and 9 mm in Class V with 2 (18%) malocclusions. Fragment-reduction versus the non-fractured condyle was -0.3 mm to +1.3 mm and +3 degrees to +9 degrees in Class VI, -1 mm to -0.2 mm and +3 degrees to +2 degrees in Class III, -3.3 mm to +3.1 mm and -11.2 degrees to +1 degrees in Class V. Malocclusion and joint locking were unreliable determinants for a treatment decision, being forged by concomitant fractures. Joint movements were within normal range at 1-year follow-up except Classes III and V vertical opening translation. After predefined criteria, 92% successful outcomes were attained. Multiple factor analysis should be used to prospectively evaluate the unacceptable clinical outcomes. Class VI fractures with intact vertical support should prospectively be evaluated whether these benefit from ORIF.

Adolescent↗
PubMed2001

Open reduction and temporary rigid internal fixation of Lisfranc fracture-dislocations.

AIM: To review the results of open reduction and temporary rigid screw fixation of Lisfranc fracture-dislocations performed in Singapore General Hospital (SGH) from 1996 to 1998. METHODS: A retrospective review of II cases of Lisfranc injuries treated with temporary rigid internal screw fixation with a minimum follow up of six months was carried out. Radiological assessment was made at follow up to ascertain the anatomical reduction achieved and complications such as post-traumatic arthritis. In addition, the patients were evaluated with a functional assessment with relation to pain, interference to usual activities and the time to resumption of work. RESULTS: Anatomical reduction was achieved in all cases. None of the cases showed loss of reduction at follow up after the temporary implants were removed. No longitudinal arch collapse or other deformities were seen. All the patients had good or excellent functional outcomes. CONCLUSIONS: Results of treatment of Lisfranc injuries are related to anatomical correction. Temporary screw fixation allows rigid internal fixation with stability to allow anatomical correction. Screws also maintain their stability longer, allowing ligamentous injuries the longer period necessary for healing. In conclusion, temporary rigid screw fixation of Lisfranc fracture maintains anatomical reduction and gives excellent functional outcomes for the patients.

Adolescent↗
PubMed1983

Ankle arthrodesis by chevron fusion with internal fixation and bone-grafting.

We evaluated the results in thirteen patients with disabling tibiotalar arthritis who underwent a new operation for ankle fusion for relief of pain. The procedure in all of these patients was a chevron (pitched-roof) tibiotalar osteotomy and excision of the joint. A bilateral approach to the ankle joint was used and the arthrodesis was supplemented by internal fixation and a tibial onlay graft applied medially. There were few complications, none of them of major importance. The after-care required only immobilization in a short cast. All but one patient had a solid fusion. The final result was a normal-looking ankle with good function.

Adolescent↗
PubMed2002

[Experimental study on the biomechanical stability of different internal fixators for use in the mandible].

BACKGROUND: Comparative studies of different forms of osteosynthesis require that biomechanical and biological criteria be observed. The conditions in experimental studies should be as close as possible to the in vivo situation. The aim of our study was to develop a fracture model that would allow determination of the micromovements in the gap tissue following different forms of internal fixation in fractured human mandibles. METHODS: Micromovements in the gap tissue of five human mandibles treated with different osteosynthetic systems (DCP, EDCP, Miniplates, 3-D systems) following osteotomy or fracture in the region of the corpus and median region were investigated by means of strain gauges. By fitting the human mandibles in plaster according to a method of our own it was possible to create fractures at predictable and comparable localizations. RESULTS: Our investigations show that the micromovements in the gap tissue of osteotomied and fractured mandibles are different and not dependent on the form of osteosynthesis applied. Physiological micromovements in the gap tissue were found under strain for all osteosynthetic systems used in fractured and congruently reset mandibles. DISCUSSION: Our fracture and osteosynthesis model allows the quantitative determination of micromovements in the gap tissue and shows the importance of ideal realignment, which has a decisive influence on micromovements in the gap tissue.

Biomechanical Phenomena↗
PubMed1994

Internal fixation of bilateral mandibular body fractures in a steer.

Bilateral fractures of the mandible were identified in a 9-month-old mixed-breed beef steer, used for show, that had been hit by a car 8 hours prior to admission. The fractures involved the left interdental space and the premolar region of the right hemimandible. For maximal cosmesis, fractures were repaired via internal fixation by use of a medially positioned broad dynamic-compression plate and cerclage wire. A medial approach served to protect more laterally located vascular and nervous structures. The wider intermandibular space in cattle, compared with that in horses, made the medial approach and plate placement feasible.

Accidents, Traffic↗
PubMed1998

[Conversion total hip replacement after failed internal fixation of intertrochantric fracture].

Between 1933-1995, 16 patients underwent conversion-total hip replacement after internal fixation of an intertrochanteric fracture failed. Clinical results were unsatisfactory compared to primary total hip replacement. There was a high incidence of intra- and postoperative complications, including femoral fracture, wound infection, and aseptic loosening. This study should increase the surgeon's awareness of the difficulties encountered in conversion of failed intertrochanteric fractures to total hip replacement.

Aged↗
PubMed2005

Minimal internal fixation augmented by small wire transfixion frames for high-energy tibial plateau fractures.

PURPOSE: To evaluate the outcome of bicondylar tibial plateau fractures treated with minimal internal fixation augmented by small wire external fixation frames and to assess the necessity of bridging the knee joint by extending the external fixation to the distal femur. METHODS: This is a retrospective study of 48 tibial plateau fractures. There were 40 (83.5%) Schatzker type VI fractures, 8 Schatzker type V fractures, and 18 (37.5%) fractures were open. A complex injury according to the Tscherne-Lobenhoffer classification was recorded in 30 (62.5%) patients. All fractures were treated with combined minimally invasive internal and external fixation. Closed reduction was achieved in 32 (66.6%) of the fractures. Extension of the external fixation to the distal femur was done in 30 (62.5%) fractures. Results were assessed according to the criteria of Honkonen-Jarvinen. RESULTS: Follow-up ranged from 28 to 60 months with an average of 38 months. All fractures but 1 united at an average of 13.5 weeks (range 11-18 weeks). One patient developed an infected nonunion of the diaphyseal segment of his fracture. Thirty-nine (81%) patients achieved an excellent or good radiologic result. An excellent or good final clinical result was recorded in 36 patients (76%). Bridging the knee joint did not affect significantly the result (P < 0.418). No significant correlation was found between the type of fracture and the final score (P < 0.458). CONCLUSIONS: Hybrid internal and external fixation combined with tibiofemoral extension of the fixation is an attractive treatment option for complex tibial plateau fractures.

Adolescent↗
PubMed1995

Functional outcome of patients with unstable pelvic ring fractures stabilized with open reduction and internal fixation.

An unstable pelvic ring fracture represents a severe injury and is associated with high morbidity and mortality. Little data are available assessing the long-term functional limitations, including disability, in a patient with an unstable pelvic ring fracture. The purpose of this study was to describe the impairment and functional outcome (disability) for patients with unstable pelvic ring fractures managed with open reduction and internal fixation (ORIF). Disability was measured at a minimum of 1 year postinjury using the Sickness Impact Profile (SIP), a measure of the health-related quality of life as perceived by the patient. Of the 230 consecutive patients with a pelvic ring fracture, 54 had unstable fractures requiring ORIF; 48 patients were available at a 1 year follow-up. The follow-up roentgenograms confirmed an osseous union and an anatomic alignment of the pelvis. Thirty-seven (77%) of the patients had mild disability (total SIP < 10); 11 (23%) of the patients had moderate disability (SIP > 10) at 1 year. Of the patients who were employed preinjury, 76% were employed 1 year postinjury; 62% had returned to full time work and 14% had returned with job modification. Of the 7 patients who had been in school, 6 had returned full time and 1 student returned part time. Mean SIP scores for subcategories were: physical health = 6.8 +/- 9.4, psychosocial health = 7.4 +/- 12.7, work = 17.6 +/- 25.5, home management = 8.3 +/- 13.0, ambulation = 10.7 +/- 13.7, and mobility = 5.3 +/- 13.0. Despite the magnitude of the bony injuries, the majority of patients with unstable pelvic ring fractures managed with ORIF had mild disability 1 year postinjury; the majority of the patients had returned to work.

Activities of Daily Living↗
PubMed1996

Fracture biology, biomechanics, and internal fixation.

The success of orthopedic surgery in ruminants is directly related to the surgeon's knowledge and understanding of bone physiology and mechanics. The relationship of the macro and micro structure and function of bone as it relates to fracture physiology and repair is discussed. A basic review of the biomechanical principles of bone, bone fracture, and fracture repair are presented. The clinical and biomechanical principles of internal fixation are described for fracture repair in ruminants.

Animals↗
PubMed2000

Two-part and three-part fractures: open reduction and internal fixation versus closed reduction and percutaneous pinning.

Surgical management of two-part and three-part proximal humerus fractures is difficult and requires familiarity with more than one method of fixation. Poor bone quality, comminution, and the deforming forces of the rotator cuff on the tuberosities influence the choice of operative approach and fixation techniques. Closed reductions and percutaneous pinning offer the potential advantage of minimal soft-tissue dissection; however, good bone quality and minimal comminution are prerequisites. Selected two-part surgical neck fractures and valgus-impacted fractures lend themselves well to this technique. Open reduction and internal fixation is indicated in two-part surgical neck fractures with poor bone quality or extensive comminution, two-part greater tuberosity or lesser tuberosity fractures, and most three-part fractures. The choice of surgical approach is dictated by the fracture pattern and includes an extended deltopectoral approach and a superior deltoid-splitting approach. Fixation techniques are myriad and are dependent on the fracture pattern. Potential fixation methods include intramedullary rods, interfragmentary sutures or wires, and extramedullary plates and screws or blade plates. Successful results are predicated on obtaining adequate enough fixation to allow early passive motion. Results also are influenced by the quality of the reduction and patient compliance.

Bone Nails↗
PubMed2003

Triplane fractures of the distal tibia requiring open reduction and internal fixation. Pre-operative planning using computed tomography.

Computed tomography (CT) of triplane fractures provides useful information not available on conventional radiographs. Knowledge of the size and position of displaced fragments, the location of the intra-articular fracture and any associated articular incongruency is useful when undertaking pre-operative planning.A postal survey of surgeons revealed only 38% always requested CT scans before undertaking open reduction and internal fixation of displaced triplane fractures. Examples of the usefulness of CT scans in pre-operative planning is presented in two cases.

Fracture Fixation, Internal↗
PubMed1995

Displaced scapular fractures: indication and long-term results of open reduction and internal fixation.

Displaced scapular fractures are often found in polytraumatized patients. In emergency treatment they assume a minor role. Advances in dealing with severely injured patients in most instances allow us to perform an operation on the fractured scapula within the first 2 weeks after injury. A differentiated approach is necessary as exclusively conservative treatment does not always bring about good results. From 1981-1991 we performed open reduction and internal fixation (ORIF) in 25 patients with displaced fractures of the scapula. The long-term results could be assessed in 20 patients after an average of 6.1 years. The different types of fractures were classified according to Habermeyer/Ideberg, and the Constant score was used in the evaluation of results. Some 64% of patients were involved in road accidents, and 64% suffered concomitant injuries. Articular fractures (n = 6) were the most common ones, followed by fractures of the coracoid process (n = 5) and the neck of the scapula (n = 2). There was no early postoperative complication, and follow-up showed a breakage of K-wires in one patient (fracture of the acromion). Thirteen patients obtained a very good, two patients a good, four a fair and one a poor result (according to the Constant score). Fractures of the scapular neck had the best results in terms of pain, daily activity, range of motion, and strength) as compared with fractures of the glenoid and apophyseal fractures.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1998

Displaced avulsion of the ischial apophysis: a hamstring injury requiring internal fixation.

A case is reported of an adolescent sprinter who was chronically disabled by pain after non-operative management for an acute hamstring injury. He had sustained an avulsion fracture of the ischial apophysis with displacement of 2.5 cm. Avulsion fractures of the ischial apophysis with displacement of 2 cm or more are unusual, but they frequently result in a symptomatic non-union, and early diagnosis, open reduction, and internal fixation is to be encouraged.

Acute Disease↗
PubMed2003

Internal fixation compared with total hip replacement for displaced femoral neck fractures in the elderly. A randomised, controlled trial.

The treatment algorithms for displaced fractures of the femoral neck need to be improved if we are to reduce the need for secondary surgery. We have studied 102 patients of mean age 80 years, with an acute displaced fracture of the femoral neck. They were randomly placed into two groups, treated either by internal fixation (IF) with two cannulated screws or total hip replacement (THR). None showed severe cognitive dysfunction, all were able to walk independently, and all lived in their own home. They were reviewed at four, 12 and 24 months after surgery. Outcome measurements included hip complications, revision surgery, hip function according to Charnley and the health-related quality of life (HRQoL) according to EuroQol (EQ-5D). The failure rate after 24 months was higher in the IF group than in the THR group with regard to hip complications (36% and 4%, respectively; p < 0.001), and the number of revision procedures (42% and 4%, p < 0.001). Hip function was significantly better in the THR group at all follow-up reviews regarding pain (p < 0.005), movement (p < 0.05 except at 4 months) and walking (p < 0.05). The reduction in HRQoL (EQ-5D index score) was also significantly lower in the THR group than in the IF group, comparing the pre-fracture situation with that at all follow-up reviews (p < 0.05). The results of our study strongly suggest that THR provides a better outcome than IF for elderly, relatively healthy, lucid patients with a displaced fracture of the femoral neck.

Aged↗
PubMed1984

External and internal fixation of the pelvic ring.

From the basis of this experience an algorithm for the stabilization of virtually all types of pelvic ring disruption is provided which appears to outline suitable options in stabilization for virtually all types of pelvic ring fracture including those with acetabular disruption. Surgical complications have been sufficiently uncommon so that more widespread use of this protocol would appear to be justifiable. Nevertheless, the surgical techniques of internal fixation are formidable operations that should be undertaken only by those surgeons who possess appropriate training and experience.

Biomechanical Phenomena↗
PubMedDate not supplied

[Digital panoramic radiography in patients with rigid internal fixations devices after maxillofacial surgery].

INTRODUCTION: Digital techniques have found promising applications in dental radiology in the recent past, namely with radiovisiography and digital panoramic radiography. These images present some features making them particularly interesting for alveolar bone studies. MATERIAL AND METHODS: Digital panoramic radiography with light-emitting phosphors was performed on 16 patients during postoperative follow-up. The patients were previously submitted to multiple maxillofacial osteosynthesis with rigid internal fixation devices (32 miniplates, 12 microplates, 14 screws). Digital images were always observed and printed with analogic-like and Xeroradiographic-like post-processing. RESULTS: Digital panoramic radiographs yielded clear and effective images of the maxillary and mandibular arches and of surgical osteosynthesis, as demonstrated by a retrospective evaluation performed by three independent observers on a blind basis (score 3: 60.42%), with no major interobserver differences (p = .7286). Xeroradiographic-like images were the most effective in depicting bone structures and osteosynthesis materials, thanks to their better detailing and typically lower overall contrast. Among the drawbacks of the digital technique, reduced cassette size may prevent the full view of the mandibular arch from the symphysis to both condylar regions. The edge effect, which is typical of Xeroradiographic images, may mask useful details within the trabecular bone close to metal implants. This effect was present in some of our cases, but it was seldom disturbing according to our retrospective evaluation (score 3: 53.40%), with good interobserver agreement (p = .1117). CONCLUSION: Digital panoramic radiography proves to be a useful tool to study metal implants after maxillofacial surgery as well as alveolar bone structure. The digital technique markedly reduces the radiation dose to the patient, which is very important for an X-ray examination that must be repeated several times, often in young subjects.

Adult↗