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PubMed1984

Aseptic diaphyseal pseudarthrosis: treatment by rigid internal fixation.

The authors define their concepts with regard to nonunion of fractures and study the possible causes of aseptic diaphyseal pseudarthrosis in the 182 cases in their casuistics. They have found that the indication for osteosynthesis was incorrect in 34% of the cases and when it was correct, the technique was poor in 58%. The authors conclude that the risk of nonunion in fractures and nonconsolidation of pseudarthrosis can be minimished if there is: (1) correct indication with respect to type and level of fracture or pseudarthrosis; (2) choice of an appropriate internal fixation method; and (3) good achievement of the selected osteosynthesis.

Femoral Fractures↗
PubMed1997

[CT morphology of fractured thoraco-lumbar vertebrae after transpedicular spongiosaplasty and use of internal fixator].

PURPOSE: An analysis of the CT morphology of fractured thoraco-lumbar vertebrae after treatment with internal fixation and transpedicular spongiosaplasty (SP). MATERIAL AND METHOD: 30 patients were examined following trauma and surgery after about 12 and 30 months by means of CT. The following were evaluated: width of the spinal canal; height of the vertebra and intervertebral space; degree of kyphosis; position, size and appearance of the SP and of the vertebral body. RESULTS: The width of the spinal canal was reconstituted in 91%; in 83% the anterior vertebral margin and in 35% the intervertebral space was reduced. A kyphosis of 8.9 degree was found on the followup examination. The SP showed a reduction in size (18/30) or could no longer be defined (6/30). Hypodense areas (28/30) with cavitation (12/30) were found in the vertebral body and the SP could be identified by a sclerotic margin (22/30). CONCLUSION: Treatment by this form of therapy was successful, reaction of the vertebral body against the spongiosaplasty could be identified.

Adolescent↗
PubMed1999

Characteristics of an extended internal fixation system for polysegmental transpedicular reduction and stabilization of the thoracic, lumbar, and lumbosacral spine.

The Kluger internal fixator, with its artificial fulcrum outside the operative site, had to be extended for multisegmental use. Three different prototypes, called Central Bar (CB), Double Bar I (DB I) and Double Bar II (DB II) were designed, which were fully compatible with the existing reduction system. To evaluate the ability of these newly developed systems to provide primary stability in a destabilized spine, their stiffness characteristics and stabilizing effects were investigated in multidirectional biomechanical stability tests and compared with those of the clinically well-known Cotrel-Dubousset (CD) system. The investigations were performed on a spine tester using freshly prepared calf spines. The model tested was that of an intact straight spine followed by a defined three-column lesion simulating the most destabilizing type of injury. Pure moments of up to 7.5 Nm were continuously applied to the top of each specimen in flexion/extension, left/right axial rotation, and left/right lateral bending. Segmental motion was measured using a three-dimensional goniometric linkage system. Range of motion and stiffness within the neutral zone were calculated from obtained load-displacement curves. The DB II attained 112.5% (P = 0.26) of the absolute stiffness of the CD system in flexion and enhanced its stability in extension by up to 144.3% (P = 0.004). In axial rotation of the completely destabilized spine, this system achieved 183.3% of the stiffness of the CD system (P < 0.001), and in lateral bending no motion was measured in the most injured specimens stabilized by the DB II. The DB I, which was the first to be designed and was considered to provide high biomechanical stability, did not attain the stiffness standard set by the CD system in either flexion/extension or axial rotation of the most injured spine. The study confirms that it is worthwhile to evaluate in vitro the biomechanical properties of a newly developed implant before its use in patients, in order to refine weak construction points and help to reduce device-related complications and to better evaluate its efficacy in stabilizing the spine.

Animals↗
PubMedDate not supplied

Osteonecrosis secondary to internal fixation.

Allergies to metals as a cause of failure of joint prostheses has historically been a controversial issue. Loosening of a prosthesis may be due to trauma, infection of the surrounding area, or a faulty implantation of the device. However, cases of loosening of the device do occur without any history of the above criteria. This leads one to consider other explanations for this phenomenon, such as sensitivity of the tissues to one of the metals in the implant. The following presentation demonstrates that metal allergies are a surgical concern when considering joint prostheses, or internal fixation.

Adolescent↗
PubMed2003

[Open reduction and internal fixation of a displaced transverse fracture of the sacrum with a locking compression plate].

Isolated fractures of the distal sacrum are usually caused by direct trauma. Undisplaced fractures are easily missed on conventional X-ray films. CT scans can disclose the full extent of the fracture. Undisplaced, or minimally displaced fractures can be treated conservatively with analgesics and a restriction to seat for six weeks. In cases of major displacement or neurological symptoms, a digital transanal reduction of the fracture under local or regional anaesthesia can be attempted. If this manoeuvre fails, open reduction and internal fixation are required. Stabilisation is challenging because of the thin bone and the complex shape of the sacrum. In a 15 year old girl with major horizontal displacement and comminution of S4, following a snowboard accident, we achieved sufficient and stable fixation with the new LCP (Locking Compression Plate) system. For six weeks after the operation, the patient was not allowed to sit down. Thereafter, she was free of pain and unrestricted in daily activities and sport. The LCP system has a number of advantages in the fixation of fractures in osteoporotic or thin bone, but clinical experience/skill and careful planning of the operation are crucial.

Adolescent↗
PubMed1994

Internal fixation of proximal humerus fractures using the screw-tension band technique.

Many of the current techniques of internal fixation of proximal humerus fractures use tension band wires to achieve secure fixation, allowing immediate postoperative exercise of the affected limb. In addition, the use of a cancellous lag screw placed from the humeral shaft into the humeral head may have several advantages. In particular, this lag screw does not violate the subacromial space and provides initial stability between the head and shaft, which facilitates placement of the tension band wires. This technique was used in 13 patients whose average age was 71 years (range 54-86). Follow-up averaged 20 months. Eight patients had two-part fractures and five patients had three-part fractures. This technique used a deltopectoral approach with manual impaction of the humeral head and shaft. A 6.5-mm AO screw was used for lag screw fixation in addition to two 18-gauge tension band wires: one placed through the tuberosities and one under the rotator cuff tendons. Passive range of motion of the involved shoulder was begun with the first postoperative week, and active range of motion and strengthening were allowed after the fourth postoperative week. At follow-up patients were evaluated for range of motion, function, pain, and radiographic appearance of the fracture. Average forward flexion was 160 degrees, external rotation was 46 degrees, and internal rotation was to the 10th thoracic vertebra. According to the functional scale proposed by Hawkins, 10 of the 13 patients had achieved a good result. Two of the remaining patients had a fair score, and one had a poor outcome.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed1989

Treatment of unstable intertrochanteric and subtrochanteric fractures in elderly patients. Primary bipolar arthroplasty compared with internal fixation.

Thirty-seven consecutive patients who were more than seventy-five years old and had an unstable intertrochanteric or subtrochanteric fracture were treated by primary bipolar arthroplasty from 1983 through 1986. The functional results, according to the rating scale of Merle d'Aubigné, were rated as good or excellent in 75 per cent of the patients and remained almost unchanged with time. Roentgenographic follow-up showed early bone formation around the extramedullary part of the femoral component. The results in this prospective group of patients were compared with those in a similar but retrospective control group of forty-two patients who were treated by internal fixation from 1979 through 1982 and in whom early full weight-bearing was not possible. In the bipolar arthroplasty group, rehabilitation was easier and faster, and the incidences of pressure sores, pulmonary infection, and atelectasis were significantly lower (p less than 0.05). The early walking with full weight-bearing that the bipolar arthroplasty made possible is considered to be a major contributing factor to these results.

Aged↗
PubMed1980

[Internal fixation for fractures of the lateral malleolus with titanium "crown"-plates (author's transl)].

This team of authors constructed a so called "crown"-plate from titanium, suitable for fixation of lateral malleolar fractures. The plate seems to be ideal for Weber-B type fractures, which are level with the joint space, and it can be applied in the more distal (Weber-A) and proximal (Weber-C) fractures too. The titanium plate was used in 166 fractures with good results. On the basis of the follow up assessment of 151 healed cases the authors feel encouraged to suggest the use of the titanium crown plate for internal fixation of lateral malleolar fractures.

Ankle Injuries↗
PubMed1991

Is antibiotic prophylaxis necessary for internal fixation of low-energy fractures?

A series of 54 patients who had low-energy, closed fractures requiring internal fixation were entered into a randomized prospective study comparing prophylactic antibiotics with no treatment. In five patients who did not have antibiotics a superficial wound infection or fever was recorded. In those who received antibiotics, no infection or fever was detected. However, there was no statistical difference between the two groups, and it is concluded that there is no need for prophylactic antibiotics when internally fixing low-energy fractures.

Adolescent↗
PubMed1996

The use of an anterior incision of the meniscus for exposure of tibial plateau fractures requiring open reduction and internal fixation.

The purpose of this study was to examine the use of an anterior incision of the meniscus for exposure of tibial plateau fractures. We studied 27 fractures of the proximal tibia treated with open reduction and internal fixation (ORIF). There were nine unicondylar fractures (five A-O B2; four A-O B3) fixed with plates and screws and 18 bicondylar fractures (seven A-O C1; five A-O C2; six A-O C3) fixed with combination internal and external fixation. Length of follow-up averaged 26 months. All patients were treated with an anterior incision of the meniscus and retraction with the condyle. Of the 18 bicondylar fractures, nine severely displaced fractures were found to have peripherally detached menisci. Unicondylar fractures did not display this finding. After fixation, menisci were repaired at the periphery and sewn to the original anterior insertion. The repair begins posteriorly and advances the cartilage to ensure anatomic placement. There were four medial and 23 lateral menisci in this series. Ten patients underwent knee arthroscopy 6 months to 2 years post-ORIF as a routine procedure during hardware removal. All menisci were found to be healed to the periphery and were stable. There were no gross tears. In one patient, the anterior meniscal incision could be visualized. No patients developed mechanical symptoms either in postoperative rehabilitation or postoperative follow-up at a maximum of 6 years. All patients had > 125 degrees of motion. Less motion when compared with the normal knee was felt to be related to more complex fracture patterns. In conclusion, the anterior meniscal incision allows for excellent exposure of severe proximal tibia fractures. This technique allows for anatomic meniscal repair and early rehabilitation. Arthroscopic examination confirms peripheral meniscal healing. No patient experienced clinical symptoms of meniscal pathology.

Anterior Cruciate Ligament Injuries↗
PubMed1992

Immediate internal fixation of open, complex tibial plateau fractures: treatment by a standard protocol.

A retrospective review of 46 consecutive patients with complex (Schatzker V and VI) tibial plateau fractures treated at Harborview Medical Center between 1984 and 1989, disclosed a subset of 14 grade II or III (Gustilo) open injuries. We wished to determine the incidence of infection, union rate, and the number of operations required to achieve a satisfactory result, based on a treatment protocol: alignment and splinting of fracture at the scene of injury if possible, antibiotics administered in the emergency room (ER) and continued for 48 h, and admission of patient to the operating room as quickly as possible for irrigation and thorough debridement of the wound, immediate rigid internal fixation, and delayed primary closure at 5 days. No acute deep infection or radiographic evidence of implant loosening was noted. The final outcome was graded by Hospital for Special Surgery (HSS) Knee Rating Score at an average follow-up of 2 years 7 months. Radiographs were reviewed for reduction and evidence of postoperative change in reduction. The average HSS Functional Score was 81.5, and Knee Score was 84.6. Of 14 limbs, 10 had an excellent radiographic grade that did not change at follow-up, 2 had a satisfactory grade, and 2 had a poor grade.

Abbreviated Injury Scale↗
PubMed1991

Application and results of the AO internal fixation system in nontraumatic indications.

The AO internal skeletal fixation system (ISFS) permits posterior spine fixation to be restricted to the vertebrae immediately adjacent to the lesion and allows manipulation of each instrumented vertebra in three planes. In a prospective study to assess the value of this fixation for adult spinal disorders, 68 patients were reviewed. The device was used in spondylolisthesis, postlaminectomy instability, post-traumatic kyphosis, degenerative scoliosis, spinal stenosis, tumors, and infections. A total of 322 transpedicular screws have been inserted without neurologic complication. Satisfactory results were achieved in 88% of the patients, and only four pseudarthroses (6%) occurred. The ISFS provides rigid stabilization to enhance bone graft consolidation and to allow rapid postoperative mobilization in a light external orthosis.

Bone Screws↗
PubMed1995

The use of combination internal fixation and hybrid external fixation in severe proximal tibia fractures.

Forty-eight patients with 50 severe fractures of the proximal tibia were followed prospectively for 2-4 years (mean 2.7 years) to evaluate the use of limited internal fixation combined with external fixation in the treatment of these injuries. There were 27 men and 21 women ranging in age from 20 to 74 years. Fractures were classified according to the A0 system (Mast J, Ganz R, Jacob R: Planning and reduction technique in fracture surgery. Berlin, Springer-Verlag, 1989), which included 5 A3, 6 C1, 16 C2, and 23 C3 fractures. All patients in this series healed; 48 fractures healed in an average of 12 weeks without subsequent surgery. There were two (4%) nonunions requiring bone graft. The average hospital special surgery knee score was 90 (68-100). Grading criteria for anatomical outcome revealed there were 17 (34%) excellent results, 24 (48%) good results, 6 (12%) fair results, and 3 (6%) poor results. In conclusion, this treatment method is associated with a high percentage of good and excellent results. Combined internal and external fixation combines the advantages of anatomic, stable fixation with less soft-tissue dissection and eliminates the need for large implants.

Adult↗
PubMed1992

A biomechanical study of two methods of internal fixation of unstable fractures of the femoral neck. A preliminary study.

A model of an unstable femoral neck fracture was used in this study to compare the axial and torsional displacement obtained when the neck was fixed by a compression hip screw (CHS) and side plate, or three Knowles pins. Six paired, embalmed femora were mounted on a special, custom-made jig that grasped the femoral head and shaft securely. A standardized osteotomy was made with an oscillating saw, bisecting the distance between the lower cartilaginous portion of the femoral head and the intertrochanteric line. A 5-mm thick slice of bone was excised from the posteromedial quadrant of the distal fragment. The right or left femur in each pair was then randomly assigned to internal fixation with either three Knowles pins or a keyed CHS plus a 130 degrees four-hole side plate. After potting of the specimens and application of rosette strain gauges, axial displacements were measured during the application of in-plane and out-of-plane compressive loads. The resistance to torsion was also determined. There were no statistical differences between the two devices for compressive or torsional loading using this model.

Biomechanical Phenomena↗
PubMedDate not supplied

Decompression and stable internal fixation of femoral neck fractures in children can affect the outcome.

Pediatric femoral neck fracture is rare and known to be associated with a high complication rate. The effect of early decompression and operative fixation is not frequently reported in the literature. This is a retrospective study of 14 patients younger than 16 years with traumatic fractures of the femoral neck and intertrochanteric region over a 10-year period with a follow-up of 2-11 years (mean, 4.6 years). Road traffic accidents and falls from a height were the main causative factors, and the fractures were subclassified into transcervical, 58%; intertrochanteric, 29%; transepiphyseal, 7%; and cervicotrochanteric, 7%. Of all the fractures, 10 (71%) were displaced. Decompression of the hip by aspiration and closed reduction and internal fixation was performed for all the displaced fractures within 24 h after admission. Three cases required open reduction. Complete fracture healing and functional recovery was achieved in 13 patients with only one delayed union. No patient had radiographic evidence of avascular necrosis. When compared with earlier studies, the current aggressive management protocol for displaced fracture significantly minimized the complications of avascular necrosis, non-union, delayed union, and premature physeal closure.

Adolescent↗
PubMed1993

Experimental physeal fracture-separations treated with rigid internal fixation.

Salter-Harris Type-III and Type-IV epiphyseal injuries were created in the distal aspect of the femur in growing rabbits, and the healing process was analyzed both in the absence of any treatment and after treatment with anatomical reduction and fixation with compression with use of a cortical screw. A sham operation was performed on the left knee, to create a control group. Untreated Type-III injuries led to an angular deformity of the femur that became more severe with time. In the group that had an untreated Type-IV injury, a step-off developed on the articular surface and increased with time. Early vascular anastomoses between the epiphysis and the metaphysis preceded the formation of osseous bridges in these lesions. The healing process in the animals that were treated with anatomical reduction and rigid internal fixation occurred without the formation of osseous callus, and no marked abnormalities were discernible in the physis.

Animals↗
PubMed2002

The role of open reduction and internal fixation in unilateral fractures of the mandibular condyle: a prospective study.

The purpose of this report is to present our experience in the management of unilateral condylar fractures between 1995 and 1998. This prospective study was carried out at a Regional Maxillofacial Unit and Teaching Hospital in the UK, and included 54 patients, of whom 32 attended for review. In all, 42 men and 12 women (age range 17-40 years) entered the study: 28 patients had unilateral fractures of the mandibular condyle alone; the remainder also had another mandibular fracture, invariably at the parasymphysis. Thirty-five of the patients (65%) had allegedly been assaulted. This is at variance with a recent study published by the British Association of Oral and Maxillofacial Surgeons, which showed that only 24% of facial injuries were the result of inter-personal violence. Open reduction and internal fixation of the mandibular condyle seems to carry low morbidity and may be of considerable functional benefit to the patient.

Adolescent↗
PubMed1997

Open reduction and internal fixation with bone grafting of clavicular nonunion.

BACKGROUND: Although clavicular fractures are common, nonunion of the clavicle is a rare complication. However, it can be disabling, presenting mainly with pain, limitation of shoulder movement, and/or compression of the brachial plexus. The technical difficulty in securing adequate skeletal stabilization and the unique anatomic features of the clavicle pose a challenge for the orthopedic surgeon. METHODS: Sixteen patients with symptomatic nonunion of the clavicle were studied. They were nine men and seven women with a median age of 34 years (range, 15-52 years). The average follow-up was 12.9 months (range, 9-24 months). The nonunion was hypertrophic in 11 cases, atrophic in five cases, and showed pseudoarthrosis in one case. The primary indication for performing the operation was pain in all cases. Five of the 16 cases had previous operations. All cases were treated with open reduction and internal fixation using a reconstruction plate or a dynamic compression plate. Double plating was used in three cases. Autogenous bone grafting was applied in 14 cases and corraline hydroxyapatite in one case. RESULTS: Fifteen of the 16 fractures eventually healed with complete resolution of the preoperative pain, except in two cases who had persistent mild pain. The hardware was removed after union in one case. One hardware failure required revision and eventually went on to heal. Another hardware failure required removal because of pain. The pain subsided despite the persistent nonunion. The same patient had hematoma at the site of the bone graft and continued to have pain until the last follow-up. CONCLUSION: Plating and bone grafting of the clavicle is an effective method of management of painful nonunion, and it has minimal complications.

Adolescent↗