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PubMed2005

Functional recovery following pertrochanteric hip fractures fixated with the Dynamic Hip Screw vs. the percutaneous compression plate.

The Dynamic Hip Screw (DHS) is currently the most frequently used implant for the treatment of pertrochanteric hip fractures. The Percutaneous Compression Plate (PCCP) is a recently developed, alternative device that involves minimal invasive surgery. The objective of the present study was to compare functional recovery following these two surgical procedures. A total of 76 consecutive elderly subjects (mean age and standard deviation, 80.6 +/- 5.5) following pertrochanteric hip fracture fixation were evaluated prospectively. Functional recovery was assessed 3 and 12 weeks and 2 years following surgery. Differences between groups 3 weeks postsurgery were found only in pain level during ambulation and in the weight-bearing capability of the operated extremity, which were both in favor of the PCCP. By 3 months, both groups had improved in all measures, but did not reach their preinjury level of independence. However, the PCCP group ambulated with fewer assistive devices and demonstrated better recovery of basic activities of daily living (BADL). While the majority of the subjects from both groups ambulated independently 2 years postsurgery, the PCCP group exhibited less pain during ambulation, was more independent in ADL, and required fewer assistive devices for ambulation. To summarize, the PCCP presents enhanced short- and long-term recovery of functional abilities in comparison to DHS. However, given the limited number of patients, further studies are necessary to substantiate these results.

Aged, 80 and over↗
PubMedDate not supplied

A biomechanical evaluation of methods of distal humerus fracture fixation using locking compression plates versus conventional reconstruction plates.

OBJECTIVES: To examine the biomechanical behavior of 2 techniques of double-plate osteosynthesis for fractures of the adult distal humerus using conventional reconstruction plates and locking compression plates. DESIGN: Basic science study. SETTING: Experimental in vitro study. PATIENTS/PARTICIPANTS: Forty fresh-frozen human distal humeri specimens. INTERVENTION: Four matched groups with 10 humeri each, median age 74 years (46-95), were created using similar bone mineral density values. Two standard configurations of double-plate osteosynthesis (dorsal or 90 degrees configuration) with either conventional reconstruction plates or locking compression plates were studied for biomechanical properties of the constructs. A fracture model with a 5-mm supracondylar osteotomy gap simulating metaphyseal comminution (AO type 13-A3.3) was used. MAIN OUTCOME MEASUREMENT: Stiffness testing of the constructs in anterior/posterior bending, torsion, and axial compression loading. Evaluation of alterations of the bone-implant interface and failure patterns under cyclic loading and strength testing. RESULTS: The study demonstrates that primary stiffness in anterior/posterior bending and torsional loading is significantly increased by using locking compression plates in a 90 degrees configuration (P < 0.05) as compared with dorsally applied plates. The differences between the different plate types are insignificant if applied in the same configuration. It is demonstrated that none of the tested implants failed under cyclic loading within the number of cycles expected for 3 months of use. The bone-implant interface is less likely to fail during strength testing with locking compression plates. CONCLUSION: The biomechanical behavior of the osteosynthesis depends more on plate configuration than plate type. Advantages of locking compression plates are only significant if compared with dorsal plate application techniques. Nevertheless, locking compression plates are helpful supplementary tools for achieving primary stable fracture fixation. This might be of considerable clinical relevance in patients with diminished bone mineral quality or in the presence of metaphyseal comminution.

Aged↗
PubMed1998

Femoral neck fracture fixation: a biomechanical study of two cannulated screw placement techniques.

This biomechanical study evaluated two different methods of femoral neck fracture fixation. Ten pairs of embalmed femora were used. A standardized midcervical osteotomy was performed. One side from each pair was fixed with either conventional (central) or calcar (cortical adjacent) screw placement. The femora pairs then were subjected to cyclic and load to failure biomechanical testing. The results demonstrated significant improved stability, load, stiffness, and displacement in all tested parameters for the group with calcar screw fixation. Grossly, the conventional fixation group tended to fail in an excessively varus position, while the calcar fixation group failed with impaction of the head on the calcar, a potentially stable position.

Aged↗
PubMed1994

Restoration of tissue components after insertion of absorbable fracture fixation devices of polyglycolide through the articular surface: an experimental study in the distal rabbit femur.

Absorbable implants for fracture fixation do not require a secondary removal procedure, a fact that could make them particularly suitable for intra-articular fixation, provided the degree of regeneration of the articular surface is acceptable. To determine the restoration pattern in distal rabbit femurs after the intra-articular insertion of absorbable fixation devices, polyglycolide pins and screws were implanted through the articular surface of the intercondylar portion of the bone in adult animals. The polymer was known to have a degradation time of approximately 20 weeks. At follow-up times of 3-48 weeks, the restoration of the tissue components was examined histomorphometrically and microradiographically. The intact contralateral femur served as an internal control. The first signs of degradation of the implants were seen at 6 weeks. The mean fractional osteoid formation surface of the bone trabeculae within the sample fields showed significantly increased values until 6 weeks but thereafter approached the level of the control femur. In the 36-week and 48-week specimens, the polyglycolide had been absorbed and the intra-articular entrance of the implant channel had become filled either with firm whitish tissue resembling mature articular cartilage or with soft undifferentiated mesenchymal tissue only. Good restoration of the trabecular bone architecture corresponding to the original subchondral bone was a prerequisite for the regeneration of the articular cartilage. The causes of the dichotomous pattern of restoration could not be identified, but possibly it represented a normal biologic variation.(ABSTRACT TRUNCATED AT 250 WORDS)

Absorption↗
PubMed1996

Metallic or absorbable fracture fixation devices. A cost minimization analysis.

Absorbable polyester pins and screws for the internal fixation of small fragment fractures have been commercially available for several years. The main advantage of these devices is that no implant removal procedures are required, which could result in financial savings. The current cost analysis, which included costs of medical care plus costs of lost time from work, was based on 994 fracture patients treated with absorbable internal fixation devices and 1173 patients operated on using conventional metallic devices. The fracture types studied were uni- and trimalleolar fractures of the ankle, fractures of the olecranon, and metacarpal fractures. When the costs for an implant removal procedure after metallic fixation were included, the average cost saved per patient by using absorbable implants varied from $410 in fractures of the olecranon to $903 in unimalleolar fractures. However, hardware removals often are optional. According to the results of this cost analysis, the break even point is attained at a removal rate of 19% for metacarpal fractures, 21% for unimalleolar fractures, 46% for fractures of the olecranon, and 54% for trimalleolar fractures. Only at a higher removal rate would the use of absorbable devices, with their current prices, be a financially more favorable alternative than the use of metallic ones.

Adolescent↗
PubMed2003

Cyclic loading of olecranon fracture fixation constructs.

BACKGROUND: Despite the good results that are usually reported after fixation at the sites of olecranon fractures and osteotomies, problems such as loss of fixation, nonunion, and the need for revision surgery are still encountered. Various types of fixation have been recommended, but few have been evaluated with use of clinically relevant cyclic load testing at appropriate levels of stress. The purpose of the present study was to test multiple olecranon fixation techniques under physiologic cyclic loads. METHODS: We studied ten cadaveric elbows with use of cyclic loading that simulated (1) active range of motion and (2) pushing up from a chair. Each specimen underwent fixation of a simulated 50% transverse olecranon fracture with use of intramedullary and cortically fixed tension band constructs (in randomized order) followed by fixation with a 7.3-mm-diameter cancellous screw with and without a tension band. Displacement transducers were placed posteriorly on the tension side and anteriorly near the articular surface. RESULTS: Both configurations involving the 7.3-mm-diameter cancellous screw provided the most stable fixation-nearly five times better than that provided by the Kirschner-wire techniques. Use of the tension band in conjunction with the intramedullary screw improved the stability of fixation. In none of the constructs did the AO tension band result in compression across the osteotomy gap. CONCLUSIONS AND CLINICAL RELEVANCE: The use of a 7.3-mm screw in conjunction with a tension band provided better fixation of simulated displaced transverse fractures than did the use of Kirschner wires in conjunction with a tension band or the use of a screw only. The AO principle of converting posterior tensile forces to articular compressive forces was not demonstrated in this study. We therefore question the validity of the tension band concept in olecranon fracture fixation and recommend passive rather than active range of motion in the immediate postoperative period to limit fracture distraction.

Analysis of Variance↗
PubMed2003

Development of a robotic navigation and fracture fixation system.

The use of robotics in surgery is nothing new. However, there are areas of surgery, such as in fracture fixation, where robots have yet to be implemented. This paper considers the choice of robot, gripper and ancillary equipment together with navigation systems necessary for their application. Hitherto robots have seen operation in surgery only in cases where relatively low manipulation forces are required. Nothing yet exists with the capability of handling forces in excess of 200 Newton as would be required in the above scenario. Another encumbrance to robots which are already in medical use is the difficulty in programming. Unfortunately most of these robots are programmed by specialists for a particular application. However, there exists a number of robot programming languages, like Unimation VA-LII (recently superceded by Stäubli V+), which do not require specialist knowledge. The application of industrial robots to the "heavier" side of modern surgery is without doubt technically realisable. The remainder of this research project aims to determine exactly which robots and what ancilliary equipment are needed and then to implement them, first on plastic models and later on cadavers. A second phase is expected to deal with type approval and a final third phase with operations on live patients.

Fracture Fixation↗
PubMed1999

Bone tissue response to biodegradable polymers used for intra medullary fracture fixation: a long-term in vivo study in sheep femora.

Since the degradability of the synthetic polymers used for fracture fixation is still unclear, a research project with biodegradable interlocking nails with a longterm implantation period has been started. In 21 female sheep a complete mid-shaft osteotomy of the left femur was performed to mimic a fracture of the femoral shaft. For the fixation, an intramedullary stainless-steel interlocking nail, a PLA rod or a PLA/PGA rod was used. After 30 months of implantation the histological results of these three materials were examined. In contrast to most reports the degradation rate of both polymers was much lower than the suggested ultimate period of two years. Even the tissue response was more pronounced than expected and this reaction can imply certain risks for repulsion. One can conclude that the volume quantity of polymeric implant in the bony tissue must be reduced if possible to avoid severe foreign body responses. The immunologic responses and the clinical consequences need more studies. The degradation behavior of the polymer is still not under control.

Animals↗
PubMed1997

Bioresorbable fracture fixation in orthopedics: a comprehensive review. Part II. Clinical studies.

Bioresorbable materials overcome two major disadvantages of the metal alloys most commonly used in fracture-fixation devices: their extreme stiffness, which causes stress shielding of the underlying bone, and the necessity, in a significant number of cases, of removing metallic implants after fracture healing is complete. The orthopedic surgeon now has the use of polylactic acid, polyglycolic acid, and polydioxanone implants for the fixation of small cancellous bone fractures. The currently available bioresorbable materials lack strength and stiffness and are associated with inflammatory reactions and osteolysis in a significant number of cases. Surgeons should use the available pins and screws with extreme care and attention to the characteristics of each individual injury, particularly its healing characteristics, as well as to the material's initial mechanical properties, degradation rates, and associated complications.

Biocompatible Materials↗
PubMed1996

Metacarpal fracture fixation with absorbable polyglycolide rods and stainless steel K wires: a biomechanical comparison.

Self-reinforced polyglycolide (SR-PGA) rods have been used widely for fracture fixation as an alternative to metallic implants. However, because of its insufficient strength and strength retention, the use of SR-PGA has been restricted to fractures or osteotomies of low stress bearing cancellous bone. To investigate its usefulness in fixing the fractures of cortical bone, the mechanical strength of a human metacarpal fracture fixed with SR-PGA rods was evaluated. The surgical constructs were immersed in buffered saline solution and maintained at body temperature (37 degrees C). The mean initial bending stiffness of the specimens fixed with the SR-PGA rods was 61% of that of the specimens fixed with Kirschner wires. The bending stiffness of the specimens fixed with the SR-PGA rods decreased gradually, and most of the specimens lost their mechanical stability when immersed for 4 weeks. When SR-PGA rods are used to fix the fracture of human cortical bone, such as diaphyseal fracture of the metacarpal bone, it should be protected by additional means.

Absorption↗
PubMed1996

The check X-ray: an unnecessary investigation after hip fracture fixation?

An X-ray-based image intensification system is a necessary operative aid in many orthopaedic procedures. Technological advances have not only increased the resolution of these systems, but allow the production of thermal images. We have compared such images obtained at the time of surgery with postoperative radiographs in 80 patients who underwent closed reduction and internal fixation for proximal femoral fractures. The films were independently assessed with particular reference to fracture reduction and the adequacy of fixation. In no case did the postoperative radiograph provide additional information. We therefore suggest that a postoperative radiograph is only necessary in exceptional circumstances. This is of significance in relation to patient discomfort, morbidity and radiation exposure. It also has important financial and manpower implications.

Bone Screws↗
PubMed1988

Hemarthrosis after femoral neck fracture fixation.

In 34 femoral neck fractures, CT was performed within 1-32 days after internal fixation. All the cases except one showed an increased distance between the femoral neck and the anterior aspect of the joint capsule as compared with the intact side, indicating varying degrees of hip joint effusion and/or synovitis. Hip joint aspiration in 11 patients revealed increased intracapsular pressure varying between 10 and 112 mmHg and volumes of aspirated joint effusion up to 23 ml. Pain relief and increased joint motion after drainage of the intracapsular effusion was observed in 3 patients whose postoperative mobilization was facilitated.

Aged↗
PubMed2005

Review of methods to quantify lag screw placement in hip fracture fixation.

This review considers methods used to quantify lag screw placement within the femoral head following proximal femoral fracture. Implants used for fixation of femoral neck fractures can lead to unwanted outcomes in some patients. Cutting out of the screw within the femoral head has been shown to be the commonest cause of failure and is related to lag screw placement within the femur. Until now, there have been two methods published which quantify lag screw position within the femoral head. These are the concepts of 'Tip Apex Distance' and Parker's ratio method of lag screw placement. We shall discuss each one in turn and their implications in terms of fracture fixation failure.

Bone Screws↗
PubMed2000

Titanium alloys for fracture fixation implants.

This paper is intended to provide an overview of the composition, mechanical properties, biocompatibility, and clinical applications for titanium alloys that are used for fracture fixation implants. A new class of titanium implant alloys has emerged in recent years that exhibits a beta microstructure and a unique combination of mechanical properties. Important information regarding notch sensitivity testing and clinical significance is also discussed. Attributes such as stress corrosion cracking resistance, fatigue strength, and wear characteristics are also essential for specific clinical applications, but are beyond the scope of this presentation.

Alloys↗
PubMedDate not supplied

Mechanical evaluation of two canine iliac fracture fixation systems.

Twenty-three canine pelves were tested bilaterally to determine the stiffness and strength of intact ilium and stabilized oblique iliac osteotomies that simulated a common clinical fracture. Fixation systems tested were three 4.0 mm cancellous screws inserted ventral to dorsal across the osteotomy site and one laterally placed five hole 3.5 mm dynamic compression plate. Specimens were mechanically tested to failure under torsional, axial, or axial plus bending loads. Lag screw fixation was stiffer and stronger than plate fixation in all testing modes. The differences were statistically significant (p less than .05) in the torsional and axial plus bending loading modes. Fatigue testing was performed on implanted specimens with low-level cyclic loading under axial plus bending loading conditions. Physiologic loading conditions failed to produce mechanical failure of either fixation system after 100,000 cycles.

Animals↗