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At least 1,351 records · Page 75Linked to original sources
PubMed1985

The Osteoclasp. A dynamic compression device for internal fixation of bone.

The Osteoclasp, a dynamic compression device for internal stainless steel fixation of bone, has been presented. The historical background of its creation and early experimentation for research and development of the Osteoclasp have been reviewed. Physical properties and dimensions of the Osteoclasp, in combination with instrumentation for implantation, has been presented to educate the reader on proper selection and implantation of the Osteoclasp. Specific indications and contraindications for the Osteoclasp have been discussed. Using proper surgical technique, the Osteoclasp will provide constant dynamic compression across an incomplete fracture to enhance bone healing through primary bone repair. Several case histories illustrate the various uses of the Osteoclasp in the lower extremity. Specific illustrations of improper technique will serve to amplify the necessity of appropriate selection of the Osteoclasp for internal fixation and illustration of proper surgical technique. The Osteoclasp has been, and will continue to be, a viable technique for bone fixation. New surgical techniques and bone fixation devices will continue to evolve and further enhance primary bone healing.

Female↗
PubMedDate not supplied

Internal fixation of femoral neck fractures. A follow-up study of 118 cases.

A retrospective study of 118 femoral neck fractures treated with multiple Knowles pins or with AO (ASIF) cancellous bone screws, and followed for at least 22 months, revealed nonunion in 1/33 undisplaced fractures and in 27/85 displaced fractures. Avascular necrosis was radiographically evident in respectively 2/32 and 19/58 united undisplaced and displaced fractures. Four factors were adversely associated with union: inaccurate reduction, mental confusion, age above 80 years and fixation with less than 6 Knowles pins. Late segmental collapse was not significantly related with any of the 9 analyzed factors. It was concluded that displaced femoral neck fractures in confused patients older than 80 years, or fractures one cannot adequately reduce, should be primarily treated with arthroplasty. Following accurate reduction, internal fixation with less than 6 Knowles pins cannot be recommended.

Adolescent↗
PubMed1997

A method for open reduction and internal fixation of the unstable posterior sternoclavicular joint dislocation.

Posterior sternoclavicular joint (SCJ) dislocations are most often stable after reduction but may be associated with significant complications related to the location of the medial head of the clavicle within the mediastinum. In rare instances, a posterior SCJ dislocation is irreducible or redislocates after a closed reduction. Because of the potential hazards related to compression of vital structures within the superior mediastinum, open reduction and internal fixation is usually required. Although open reduction is widely accepted as the method of choice, the best method for achieving stable fixation remains unanswered. We present the case of an unstable SCJ stabilized, in anatomic position, with two large-bore cannulated screws in conjunction with open reduction. We believe that the risk of hardware migration reported with the use of pins and wires and its catastrophic complications are greatly minimized using our technique.

Adult↗
PubMed1999

Susceptibility to local infection in biological internal fixation. Experimental study of open vs minimally invasive plate osteosynthesis in rabbits.

Resistance to local infection after fracture fixation with plate osteosynthesis may be influenced by the implantation technique. It is known that the extent of the surgical approach to the bone can compromise the local defence capacity. We have investigated susceptibility to infection after a local bacterial challenge in rabbit tibiae using either the open surgical approach for 'biological' internal fixation of standard 2.0 dynamic compression plates or the method of minimally invasive plate osteosynthesis (MIPO), a percutaneous, tunnelling insertion technique preserving the integrity of the overlying soft tissue. After the wounds had been closed, various concentrations of Staphylococcus aureus were injected in the direct vicinity of the implants. The infection rate for the open surgical technique was 38.5% and that for the MIPO technique, 25%. This difference is not statistically significant (P > 0.05) suggesting that resistance to local infection associated with the MIPO method is at least equivalent to the open approach for plate osteosynthesis.

Animals↗
PubMed2006

Unexpected high complication rate following internal fixation of unstable proximal humerus fractures with an angled blade plate.

OBJECTIVES: The increasing number of fractures of the proximal humerus, especially in the elderly, carries with it the unsolved problem of the optimal treatment for the displaced or unstable fractures. The authors' goal was to analyze whether fixation with a bent valgus angled blade plate could improve the outcomes reported in the literature to date. DESIGN: Prospective clinical study. SETTING: Urban level 1 university trauma center. PATIENTS: Over a 27-month period, 42 consecutive patients were treated for an unstable or displaced proximal humerus fracture. INTERVENTION: Open reduction and internal fixation with a 90-degree cannulated angled blade plate prebent to 110 degrees. MAIN OUTCOME MEASUREMENTS: Active follow-up for 1 year with assessment of objective and subjective functional results (ie, motion; strength; Constant score; Disabilities of the Arm, Shoulder, and Hand (DASH) score; and visual analog scale (VAS)) and radiographic assessment (reduction, alignment, necrosis, and nonunion). RESULTS: Follow-up was completed for 86% of the patients, who achieved a mean Constant score of 66 points (82% of the contralateral side) with a mean forward flexion of 125 degrees and an average strength of 72% of the contralateral side. Low disability (mean DASH score 22) and pain values (mean VAS 2) were demonstrated after this type of stabilization. The overall complication rate was 33% (12/36), with protrusion of the blade into the glenohumeral articulation as the most frequent problem (8/36, 22%). The negative impact of an adverse event on subjective and objective outcomes was only significant for forward flexion (P = 0.02). Neither clinical outcome nor complication rate was different when compared to patients with regard to fracture type (3 versus 4 parts) or age (younger or older than 70 years). CONCLUSIONS: Fixation of displaced proximal humeral fractures with an angled blade plate provided sufficient stability. Blade perforation into the humeral joint occurred in every fourth patient and was found to be the major reason for a high complication rate. In view of this major problem, the technique described here cannot be recommended, even though the absence of nonunions in our series seems to support the low invasiveness of this surgical approach.

Adult↗
PubMed1994

Deformity after internal fixation of fracture separation of the medial epicondyle of the humerus.

We reviewed 24 displaced fractures through the physis of the medial epicondyle of the distal humerus. One was a Salter-Harris type-II fracture-separation of the whole distal humeral epiphysis; the others involved only the medial epicondylar centre of ossification. Two cases had presented as pseudarthroses. One fracture had been treated closed in a plaster slab and 21 had had open reduction and internal fixation with sutures, Kirschner wires or Palmer nails. At 2 to 13 years later we found five types of deformity of the epicondyle: pseudarthrosis, an ulnar sulcus, a double-contoured epicondyle, hypoplasia or hyperplasia. Pseudarthrosis had developed after either no treatment, closed reduction and plaster, or open reduction and suturing. Hypoplasia followed nailing, as did a trend to varus tilting of the joint surface. One very young patient, with fracture-separation of the whole distal epiphysis treated by nailing, developed marked cubitus varus.

Adolescent↗
PubMed1999

Comminuted Intra-Articular Fracture of the Distal Radius - The Technique of Open Reduction and Internal Fixation With Plating.

The technical details of open reduction and internal fixation with double plating for a patient with comminuted intra-articular fractures of the distal radius were described. The vital steps included the exposure, initial dorsal reduction, ventral reduction and fixation, checking of reduction, return to dorsal surface with final reduction and X-ray check, and wound closure. Special attention and other technical tips were also highlighted, and hopefully will shorten the learning curve of others who would like to use this rather demanding technique for their patients.

Journal Article↗
PubMed1987

Biodegradable internal fixation for malleolar fractures. A prospective randomised trial.

Fifty-six patients with displaced malleolar fractures had open reduction and fixation of the fracture fragments using, by random selection, either biodegradable implants or metal AO plates and screws. The cylindrical biodegradable implants were made of polylactide-glycolide copolymer (polyglactin 910). The complications, radiographic results and functional recovery were studied prospectively. After follow-up of at least one year, no significant differences emerged in the complication rate or in the results of treatment between the two methods of fixation. Because of the advantage of avoiding the need to remove metal fixation after union, we now use biodegradable internal fixation routinely to treat displaced malleolar fractures.

Adult↗
PubMed1991

[Bone remodeling after internal fixation with different stiffness plates: ultrastructural investigation].

Fourty adult New Zealand rabbits were used in this experiment. Four rabbits served as control and the rest 36 divided into 3 groups, each of which was fixed respectively with methylmethacrylate, titanium and strain-less steel plate on left intact tibiae. The cortical bone beneath the plate was harvested at 2, 4, 8 and 12 weeks after operation and observed by means of with transmission electron microscope. The major ultrastructural changes after internal fixation with different stiffness plates were alteration of osteocyte life cycle, perilacunar matrix, and disorder of osteoclast-osteoblast coupling. The greater the stiffness of the plate, the greater the ultrastructural change.

Animals↗
PubMedDate not supplied

Internal fixation of slipped femoral capital epiphyses.

The problems related to internal fixation for the treatment of slipped femoral capital epiphyses were reviewed in 164 cases and by a questionnaire of 59 orthopedic surgeons. Significant problems were reported with all fixation devices. With Trifin nails, the main difficulty was getting them to stay in in place. With threaded pins, there was difficulty removing them. The best fixation was obtained with the cast Vitallium Knowles pin, but it requires additional modification and improvement.

Bone Nails↗
PubMed1998

[Biomechanical evaluation and clinical correlation of 3 methods of internal fixation of metacarpophalangeal arthrodesis of the thumb].

Three methods of internal fixation for MCP arthrodesis of fifteen cadaveric thumbs were used to analyze the biomechanical stability by applying a palmar force, lateral force, and torsion moment. The techniques used included two K-wires 0.045 in parallel (BK), 2 cerclage metallic wires #25 perpendicular to each other (CP), and a 6-holes plate and screws construct from Synthes (PV). The initial rigidity was measured using a Bionix MTS-858. The results after statistical analysis showed: 1) CP was just as rigid as PV for the palmar and lateral tests; 2) CP was, overall, superior to BK in palmar and lateral tests; 3) no difference existed in torsion between the three types of fixation. A comparison was done between the rigidity of the fixation techniques used and the rates of bony nonunion found in the literature. The mean rates of nonunion were reported to be 0-4.0% for the following techniques: CP, tension band wiring (TB), plate and screws, external fixation, compression screw. The rates of nonunion were higher, 7.5-12.5%, for BK, cerclages not perpendicular (CM), bone pegs. According to the results of this biomechanical study and the review of the literature, fixation with BK is the least rigid, and fixation with CP is just as rigid as with PV. The success clinically of CP is yet to be demonstrated. Other studies on the properties of CP for fatigue would be necessary to give a better analysis.

Analysis of Variance↗
PubMed1991

Failure of internal fixation of displaced femoral neck fractures in rheumatoid patients.

We reviewed the records and radiographs from 10 hospitals to identify 50 patients with rheumatoid arthritis (RA) who had sustained 52 femoral neck fractures. Most patients were female (88%), elderly (mean age 66 years) and had had severe polyarticular disease for a mean duration of 16 years. Over half had taken systemic corticosteroids, nearly all were severely osteopenic but few had rheumatoid changes in the hip. Of the 20 fractures treated by internal fixation 12 had complications including nonunion (5), osteonecrosis (5), infection (1), and intertrochanteric fracture (1). Only one of the nine undisplaced fractures required reoperation, but seven of the 11 displaced fractures had revision surgery. Twenty fractures were treated by primary total hip arthroplasty with only one early complication. The other 12 fractures had been treated by hemiarthroplasty (9), hip excision (1) or non-operatively (2). Our results suggest that, in elderly rheumatoid patients, severely displaced femoral neck fractures should be treated by total hip replacement.

Adult↗
PubMed1994

Bone remodelling after internal fixation with different stiffness plates: ultrastructural investigation.

Forty adult New Zealand rabbits were used in this experiment. Four rabbits served as control and the rest 36 being divided into 3 groups, each of which was fixed respectively with methylmethacrylate, titanium alloy and stainless steel plate on the left intact tibiae. The cortical bone beneath the plate was harvested at 2, 4, 8 and 12 weeks after operation and observed by means of using transmission electron microscope. The major ultrastructural changes after internal fixation with different stiffness plates were alteration of osteocyte life cycle, perilacunar matrix and disorder of osteoblast and osteoblast coupling. The greater the stiffness of the plate, the greater the ultrastructural change.

Alloys↗
PubMed1980

Stable trochanteric fractures. A comparative analysis of four methods of internal fixation.

A series of 375 patients with stable trochanteric fractures were treated with the McLaughlin or Jewett nail-plate, the sliding screw-plate or Ender nailing. Technical failure of fixation was encountered in 5% of the cases regardless of the method of fixation used. Re-operations were performed in less than 3% of cases treated with hip implants but in 20% of cases with Ender nailing, mainly because of distal slipping of the nails resulting in knee problems. With an improved technique, however, Ender nailing can be used as successfully as any of the hip implants for the internal fixation of stable trochanteric fractures.

Adult↗
PubMed1996

Internal fixation of unstable pelvic ring injuries.

One hundred and seven unstable pelvic fractures were treated operatively. Reductions were graded by the maximal displacement measured on the 3 standard views of the pelvis. Criteria were: excellent 4 mm or less, good 5 to 10 mm, fair 10 to 20 mm, and poor more than 20 mm. Overall there were 72 excellent, 30 good, 4 fair, and 1 poor reduction. Ninety-five percent of all reductions were excellent or good. Open reduction and internal fixation within 21 days were associated with a higher percentage of excellent reductions than in reductions performed after 21 days (70% versus 55%). These differences were not statistically significant, however. Complications were infrequent using the techniques described.

Fracture Fixation, Internal↗
PubMed2005

Fragment-specific internal fixation of distal radius fractures.

The treatment of complex, intra-articular distal radius fractures can be challenging. Goals of treatment include the restoration of articular congruity and maintenance of a stable reduction to allow for early range-of-motion, prevention of arthrosis, and ultimately return of upper extremity function. Proper understanding of individual fracture patterns is paramount in achieving these goals and avoiding complications. Through the use of limited surgical incisions and low-profile,anatomically contoured implants, fragment-specific internal fixation provides a rational approach to the treatment of these complex injuries.

Biomechanical Phenomena↗
PubMed1984

Immediate internal fixation of open ankle fractures. Report of thirty-eight cases treated with a standard protocol.

We reviewed thirty-eight cases of open ankle fractures that had been treated with a standard protocol: alignment and splinting of the fracture at the scene of injury if possible, antibiotics administered in the emergency room and continued for forty-eight hours, admission of the patient to the operating room as quickly as possible, copious irrigation and thorough débridement of the wound, immediate rigid anatomical internal fixation, and delayed primary closure at five days. All of the fractures united, but three patients required subsequent ankle fusion because of cartilage damage noted at the initial operation. Of the thirty-five ankles with complete follow-up, the functional result was excellent in twenty-six and fair or poor in nine.

Adolescent↗
PubMed2002

Non-union of the humeral shaft treated by internal fixation.

We reviewed 40 cases with non-union of the humeral shaft. There were 31 men and nine women patients with an average age of 38.5 (35-65) years. Thirty-four non-unions were of the atrophic type. Non-union was most often found at the transition of the middle third to the lower third of the humeral shaft. Six fractures were classified as open at the time of the initial injury. All patients were treated by open reduction and internal fixation with a dynamic compression plate (DCP). Cancellous bone graft was used in all atrophic non-unions. In one patient an additional fibular graft was used. The average follow-up was 13 (6-18) months. Final results were available for 34 patients. Thirty-one fractures (91%) healed in an average of 4.5 (3-9) months. Main complications were temporary radial nerve palsy in two patients and deep infection in one.

Adult↗