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PubMed1989

Computerized tomography after internal fixation of the spine.

32 patients with internal fixation of the spine were postoperatively examined by computerized tomography. Details of metallic osteosynthetic material were demonstrated in all our cases. Bony structures were well defined in 27 patients, whereas soft tissue imaging was degraded by scattering artifacts in 14 of 20 examinations. Application of intrathecal contrast medium, however, was helpful for the evaluation of intraspinal soft tissues. Involvement of extraspinal soft tissues could be interpreted on the basis extent of vertebral osseous destruction.

Fracture Fixation, Internal↗
PubMed1997

Cost advantages of two-level anterior cervical fusion with rigid internal fixation for radiculopathy and degenerative disease.

BACKGROUND: Conventional anterior cervical discectomy with fusion is thought to require postoperative neck immobilization for the promotion of bony fusion. Rigid internal fixation with anterior cervical plates may decrease graft-related complications and provide immediate stability. This stability may obviate postoperative external immobilization. METHODS: This report reviews one surgeon's experience with the use of rigid internal fixation for two-level anterior cervical discectomy and fusion for radiculopathy to promote early mobilization without external bracing. It compares outcomes and costs with a similar population of patients treated with anterior cervical discectomy and fusion who did not undergo rigid internal fixation. We compared patients who underwent two-level allograft anterior cervical discectomy and fusion with or without rigid internal fixation between 1989 and 1994 performed by a single surgeon (FJP) to evaluate the cost advantages and outcome of each procedure. All patients had clinical evidence of cervical radiculopathy unresponsive to medical therapy with magnetic resonance imaging confirmation of the appropriate nerve root impingement. Thirty-nine patients underwent two-level Cloward allograft fusion using Synthes anterior cervical locking plates, 25 underwent identical fusion without plating. Follow-up was 6 months to 4 years (mean, 31 months). RESULTS: Twenty-three of 25 patients in the nonplated group and 36 of 39 patients in the plated group achieved excellent or good outcomes using the Odom criteria. There were six complications (two major and four minor) in each group. Patients who underwent plating returned to light activities (mean, 17 vs. 29 days), driving (28 vs. 57 days), and unrestricted work (66 vs. 136 days) sooner than non-plated patients (p < 0.05, paired t test). No patient with plates was given external immobilization. CONCLUSIONS: Two-level anterior cervical discectomy and fusion with anterior plating for radiculopathy is safe, effective, and seems to provide shorter convalescence compared with conventional anterior cervical discectomy and fusion. Patients returned to unrestricted work sooner, thus reducing short-term disability. Rigid internal fixation may provide cost advantages to patients and insurance disability providers. The authors conclude that the increased cost of treatment for rigid internal fixation is more than offset by the benefits of earlier mobilization.

Bone Plates↗
PubMed2003

Internal fixation versus arthroplasty for intracapsular proximal femoral fractures in adults.

BACKGROUND: Displaced intracapsular fractures may be treated by either reduction and internal fixation which preserves the femoral head, or by replacement of the femoral head with an arthroplasty. OBJECTIVES: To review all randomised trials that have compared internal fixation and arthroplasty. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group specialised register (January 2002), MEDLINE (1966 to January 2002), EMBASE (1988 to 2002, Week 2), Current Contents (1993 to 2002, Week 4), PREMEDLINE (January 2002) and selected orthopaedic journals and conference proceedings, and reference lists of relevant articles. We contacted trialists where possible. SELECTION CRITERIA: All randomised and quasi-randomised trials comparing internal fixation with arthroplasty for intracapsular hip fractures in adults. DATA COLLECTION AND ANALYSIS: Trial quality was assessed by use of a 10 item scale. Data from the majority of trials were independently extracted by three reviewers with the remaining extracted by two. Additional information was sought from trialists. After grouping into three broad categories, comparable groups of trials were subgrouped and where appropriate, data were pooled using the fixed effects model. MAIN RESULTS: Thirteen trials involving 2091 patients were included. Internal fixation had a reduced length of surgery, operative blood loss, need for blood transfusion and risk of deep wound infection. Arthroplasty had a lower re-operation rate in comparison with fixation. No definite differences for hospital stay, mortality, degree of residual pain, regain of mobility or regain of same residential state were found. REVIEWER'S CONCLUSIONS: Internal fixation is associated with less initial operative trauma but has an increased risk of re-operation on the hip. Definite conclusions cannot be made for differences in pain and residual disability between the two groups. Future studies should concentrate on better reporting of final outcome measures and there is still a need for studies to define which patient groups are better served by the different treatment methods.

Adult↗
PubMed2005

[Large variation in indications for internal fixation or arthroplasty in displaced femoral neck fracture; results of a questionnaire distributed among general surgeons in 20 hospitals].

OBJECTIVE: To describe the treatment protocols for displaced femoral neck fractures in all 8 university hospitals (UH) and 12 general hospitals (GH). DESIGN: Descriptive; questionnaire. METHOD: Questionnaires were distributed to general surgeons who also perform traumatology surgery. They were requested to give succinct answers to questions about local protocol for the maximum permissible time interval between hip trauma and operation, indications for internal fixation and arthroplasty, operative technique and postoperative degree of weight-bearing in patients over 60 years of age with a displaced femoral neck fracture. RESULTS: Internal fixation and arthroplasty were performed within 24 and 48 hours respectively in 95% of all hospitals. A biological upper age limit of between 65 and 80 years old was the most commonly quoted indication for internal fixation in 70% of all hospitals. In 83% of GH dementia was considered an indication for arthroplasty as opposed to 0% in UH. Poor bone quality, immobility, comminution and inadequate reduction were incidentally quoted indications for arthroplasty. Rheumatoid arthritis, arthrosis and pathological fracture were contra-indications for internal fixation in all hospitals. Operative techniques for internal fixation and arthroplasty were similar in both UH and GH. After internal fixation, full weight-bearing was recommended in all UH and partial weight-bearing in 7 (58%) of GH. Following arthroplasty all protocols prescribed full weight-bearing. CONCLUSION: The variation in indications for internal fixation or arthroplasty reflects the lack of studies that demonstrate clearly which patient can be treated optimally with which treatment modality. There were few differences in the operative techniques of internal fixation and arthroplasty between the hospitals.

Age Factors↗
PubMed1979

Methylmethacrylate as an adjunct in the internal fixation of pathologic fractures.

The authors evaluated methylmethacrylate as an adjunct to internal fixation of 47 pathologic fractures of long bones (10 of the humerus and 37 of the femur) in 43 patients with metastatic disease. In their experience this method proved to be vastly superior to other methods of internal fixation. All patients were relieved of pain and, if able to walk, could do so almost immediately after fixation of the fracture. In the others comfort was enhanced and nursing greatly facilitated. The surgical technique of internal fixation is described in detail. Correct selection of the metal implant, meticulous attention to the biomechanical considerations and restoration of bone continuity by means of methylmethacrylate are most important if a gratifying result is to be obtained.

Adult↗
PubMed1989

Treatment of open ankle fractures. Immediate internal fixation versus closed immobilization and delayed fixation.

Thirty-one open ankle fractures were treated over a period of 11 years and retrospectively reviewed with an average follow-up period of 61 months. Fifteen were managed by closed immobilization and delayed internal fixation. Sixteen were treated with immediate open reduction and internal fixation. One case in each group became infected. Functional scores at follow-up examination were the same for both groups. The fractures treated with immediate open reduction and internal fixation showed less impairment of range of motion but had a greater incidence of chronic ankle swelling. The hospitalization time was significantly shorter for the patients treated by open reduction and internal fixation. Immediate open reduction and internal fixation of open ankle fractures speed recovery with no greater incidence of infection than encountered with conservative treatment.

Adolescent↗
PubMed1988

Custom titanium plating for failed nonunion or delayed internal fixation of femoral fractures.

Eight patients with either failed internal fixation of nonunions of the femur (six) or delayed treatment of extensively comminuted femoral fractures (two) were treated with customized titanium plates for internal fixation. All eight patients had fixation problems that surpassed treatment by intramedullary nailing or standard plate osteosynthesis. Custom titanium plates were individually designed from roentgenograms and/or computed axial tomographic (CAT) scans. Plate dimensions were altered to increase strength, height, length, and placement of screw holes to enhance stabilization of the individual femoral anatomy. At an average follow-up period of 33 months, all fractures united; there were no complications, including fatigue or loosening of the custom implants. The implants were well tolerated and provided excellent fixation of difficult fracture problems.

Adult↗
PubMed2005

[Ultrastructure of intervertebral disk in the corresponding area after internal fixation of spinal column].

OBJECTIVE: To observe ultrastructural changes of the intervertebral disk in the corresponding area after internal fixation of spinal column. METHODS: Twenty-four Japanese big ear rabbits were divided into internal fixation of spinal column group (n=12) and control group (n=12). The internal fixation model was made as follows: The spinous processes and erector spinal muscle were exposed and the T10-L3 spinous processes and the relevant two-side articular processes under the periosteum were isolated. With the help of L-shaped Kirschner wires, the steel wire was threaded through the articular of T11, T12, LI and L2, and were connected with L-shaped Kirschner wires. After 6 months of operation, the following intervertebral disk tissues were observed with transmission electron microscope: nucleus pulposus, internal anulus fibrosus and external anulus fibrosus of L1 intervertebral disk. The T12 and L2 intervertebral disk surface structure was observed horizontally and longitudinally with scanning electron microscope, respectively. RESULTS: After internal fixation of spinal column, the structural changes of cells in nucleus pulposus and internal annulus fibrosus occurred earlier than that in the external annulus fibrosus. Proteoglycan and special structure were found in nucleus pulposus and matrix of annulus fibrosus. However, the forms of special structure in nucleus pulposus and internal layer of annulus fibrosus were different. In the degeneration matrix of intervertebral disc, the proteoglycan particles and special structure were obviously decreased. CONCLUSION: Abnormal stress environment can result in the degeneration of intervertebral disk. There is a regular distribution of the special structure in nucleus pulposus and matrix of annulus fibrosus, which is related to biology behaviour of proteoglycan particles in the degeneration of intervertebral disk.

Animals↗
PubMed2001

High energy plafond fractures treated by a spanning external fixator initially and followed by a second stage open reduction internal fixation of the articular surface--preliminary report.

UNLABELLED: Early open reduction and internal fixation (ORIF) with plates and screws for plafond injuries caused by skiing initially reported by Ruedi and Allgower proved inadequate for the treatment of high-energy motor vehicle accident type injuries. The purpose of our study was to review our treatment protocol using a spanning external fixator placed semi-emergently medially across the joint and a later staged ORIF of just the articular surface to achieve and maintain anatomic reduction. METHODS: We preformed a retrospective study of 35 patients with 37 highly comminuted severe (OTA 43-B3 and -C3 or Ruedi type II or III) tibial plafond fractures treated by a single surgeon. All patients were treated with an initial spanning unilateral external fixator and subsequent ORIF. Radiographs were examined for: classification, number of pieces of the tibial dome, evidence of ground-glass comminution (more than three pieces <2mm in size on CT), anatomic reduction, alignment, and presence/absence of arthritis. RESULTS: Evidence of ground glass comminution existed in 26/37 patients (70%). Following ORIF, articular reduction was perfect (0-1mm displacement) in 29/36 (81%), imperfect (1-3mm) in 6/36 (17%) and poor (>3mm) in 1/36 (3%) cases. Joint alignment was anatomical in 35/37 (96%), with 15 degree anterior angulation in one patient and 5 degree valgus angulation in another patient. Radiographic arthritis was present in 10/36 patients (28%) at latest follow-up. Joint distraction at time of reduction was present in 27/37 patients (73%). A total of 25/37 patients (65%) had no post-operative complications, while 3/37 (8%) had a joint infection requiring one patient to have hardware removed. A total of 4/37 (11%) showed loss of reduction at latest follow-up. A total of 3/37 (8%) had a secondary arthrodesis; A total of 1 (3%) had a primary arthrodesis; 1 (3%) diabetic man had a below-knee amputation after a failed arthrodesis. DISCUSSION AND CONCLUSION: We treat severe tibial plafond fractures with a spanning external fixator at the time of injury, wait between 10 and 21 days to allow for soft tissue healing, and then perform a limited ORIF of the articular surface with canulated screws. In a group of high-energy plafond fractures, we achieved 81% good to excellent results with this protocol. We conclude that use of a spanning external fixator with delayed ORIF compares favorably with the literature.

Adult↗
PubMed1999

Two-staged delayed open reduction and internal fixation of severe pilon fractures.

OBJECTIVE: To evaluate the use of a two-staged technique for the treatment of C3 pilon fractures. DESIGN: Retrospective. SETTING: Level I trauma center. PATIENTS/PARTICIPANTS: Twenty-one consecutive patients with twenty-two C3 pilon fractures. Patients with C1 or C2 fractures and patients with open growth plates were excluded. INTERVENTION: All patients underwent immediate fibular fixation and placement of a medial spanning external fixator. After, on average, twenty-four days, patients underwent removal of the external fixator and formal open reduction and internal fixation of the pilon fractures. MAIN OUTCOME MEASUREMENTS: At average follow-up of twenty-two months, all patients were evaluated by using subjective, objective, and radiographic measurements as described by Burwell and Chamley (J Bone Joint Surg 1965;47B:634-659). Range of motion and postoperative complications were also recorded. RESULTS: Twenty-one of the twenty-two fractures healed within an average of 4.2 months. Average range of motion was 7 degrees of dorsiflexion, 33 degrees of plantar flexion, 17 degrees of eversion, and 11 degrees of inversion. Subjective and objective measurements showed 77 percent good results, 14 percent fair results, and 9 percent poor results. Radiographic reduction showed 73 percent anatomic and 27 percent fair reductions. There were no infections or soft tissue complications. The arthrodesis rate was 9 percent. CONCLUSIONS: A two-staged approach offers acceptable results for the treatment of severe pilon fractures. These results compare favorably with those of primary open reduction and of internal fixation and external fixation techniques. The major advantages include limited soft tissue complications and improved articular reconstruction.

Adult↗
PubMed1999

[Comparison of internal fixation with mini-titanium plate and wire osteosynthesis in midface fractures].

OBJECTIVE: To compare clinical results of the internal fixation with wire and the internal fixation with mini-titanium plate in midface fractures. METHODS: By the coronal approach and supplementary incisions, forty patients with midface fractures were treated with wire osteosynthesis or rigid internal fixation (RIF) with mini-titanium plate. RESULTS: A good stability can not he obtained with wire osteosynthesis in the treatment of midface fractures. The supporting bony structure of midface can be reconstructed with mini-titanium plate RIF, which results in a sufficient three-dimensional stability of the fractured segments and an ideal facial configuration Mini-titanium plate RIF is more convenient and reliable than wire osteosynthesis in the difficult operation fields of the infraorbital margin and zygomaticomaxillary suture. CONCLUSION: Mini-titanium plate RIF is the best method for treatment of midface fractures.

Adult↗
PubMed1993

Arthrodesis of the first metatarsophalangeal joint: a biomechanical study of internal fixation techniques.

This study compares the strength and rigidity of four methods of internal fixation for arthrodesis of the first metatarsophalangeal joint. Ten matched pairs of cadaveric first rays were harvested and arthrodesis performed by one of four techniques: (1) planar excision of joint surfaces and fixation with crossed Kirschner wires, (2) planar excision of joint surfaces and internal fixation with a dorsal plate and screws, (3) planar excision of joint surfaces and internal fixation with an interfragmentary screw, or (4) excision of the joint surfaces using powered conical reamers and fixation with an interfragmentary lag screw. Biomechanical testing with a Bionix 858 materials testing machine was carried out, applying a plantar force utilizing principles of cantilever loading. Force applied and displacement of the arthrodesis were recorded. Of the four methods tested, bony preparation with power conical reamers and supplementary interfragmentary screw fixation was the most stable.

Arthrodesis↗
PubMed1987

Internal fixation vs. conventional therapy in midface fractures.

The purpose of this review is to evaluate internal fixation by means of AO miniplates compared to conventional therapy for the treatment of complicated midface fractures. A more precise division of midface fractures into functional units than that afforded by the Le Fort classification was employed to categorize the complexity of injury. The criteria of evaluation were ease of functional rehabilitation, incidence of complications, and results of surgery. The classification system was helpful in surgical planning and in subsequent analysis of results. Forty-nine of the 92 midface fractures treated by open repair between July 1980 and January 1986 were malar fractures, and 41 of these had associated orbital fractures. The remaining 43 had Le Fort II or more complicated midface fractures, only 15 of which could be adequately categorized by the Le Fort classification. Twenty-two of the 43 patients with complicated midface fractures were surgically treated with internal fixation utilizing 67 AO miniplates. The remaining 21 patients were treated with conventional therapy utilizing a combination of intermaxillary fixation (IMF), and/or interosseous wiring, and/or primary bone grafting. Among the problems encountered were a nonunion of the midface in a delayed repair of a severely comminuted midface fracture, which required secondary split rib grafting. Three plates were removed because of intraoral extrusion. There were no plate-related infections. One of the advantages of internal fixation is that the need for primary bone grafting and external fixation is eliminated. Another is that intermaxillary fixation is needed less frequently, allowing immediate access to the oral cavity for control of airway, care of intraoral wounds, and rapid return to normal alimentation with full mandibular function. Most patients with no associated GI problems tolerated a soft diet within 6 days. Tracheostomy tubes were removed within 3 days if no pulmonary failure was present. We can conclude that internal fixation provides excellent stabilization and repair of complicated midface injuries with minimal complications and rapid return to function for most patients.

Bone Plates↗
PubMed1996

Arthroscopic reduction and internal fixation of a displaced intraarticular lateral femoral condyle fracture of the knee.

Anatomic reduction, typically obtained by direct visualization through an arthrotomy and internal fixation (open reduction and internal fixation), is the traditional treatment method for displaced intraarticular condylar fractures of the distal femur. We present a case report describing an alternative treatment method, namely, arthroscopic reduction and internal fixation, of a displaced, malrotated intraarticular lateral femoral condyle fracture of the knee. The potential benefits of decreased blood loss, shortened operative time, excellent intraarticular visualization, decreased soft tissue dissection, and shortened postoperative recovery are outlined.

Adult↗
PubMed2002

Hemiarthroplasty versus internal fixation for displaced intracapsular hip fractures in the elderly. A randomised trial of 455 patients.

A total of 455 patients aged over 70 years with a displaced intracapsular fracture of the proximal femur was randomised to be treated either by hemiarthroplasty or internal fixation. The preoperative characteristics of the patients in both groups were similar. Internal fixation has a shorter length of anaesthesia (36 minutes versus 57 minutes, p < 0.0001), lower operative blood loss (28 ml versus 177 ml, p < 0.0001) and lower transfusion requirements (0.04 units versus 0.39 units, p < 0.0001). In the internal fixation group 90 patients required 111 additional surgical procedures while only 15 additional operations on the hip were needed in 12 patients in the arthroplasty group. There was no statistically significant difference in mortality between the groups at one year (61/226 versus 63/229, p = 0.91), but there was a tendency for an improved survival in the older less mobile patients treated by internal fixation. For the survivors assessed at one, two and three years from injury there were no differences with regard to the outcome for pain and mobility. Limb shortening was more common after internal fixation (7.0 mm versus 3.6 mm, p = 0.004). We recommend that displaced intracapsular fractures in the elderly should generally be treated by arthroplasty but that internal fixation may be appropriate for those who are very frail.

Aged↗
PubMed2004

[Treatment of multi-segmental spinal tuberculosis by using focal debridement and internal fixation with CD rod].

OBJECTIVE: To study the clinical results of focal debridement and primary internal fixation with CD rod in treatment of multi-segmental spinal tuberculosis. METHODS: From July 1999 to November 2002, 16 patients with multi-segmental spinal tuberculosis were given focal debridement and primary internal fixation with CD rod trans sick vertebra. There were 9 males and 7 females, aging from 21 to 59 years. The course of disease was 2 to 11 months. The locations of lesion were T6-T11 in 11 patients and T10-L2 in 5 patients. The involved vertebral bodies were 3 segments in 13 patients, 4 or more than 4 segments in 3 patients. There were 5 cases of Pott's paralysis (according to Frankel classification system: 3 cases of degree C, 2 cases of degree D) and 4 cases of kyphosis and 2 cases of collapse. Focal debridement and internal fixation was performed in 1 or 2 incisions according to concrete conditions. RESULTS: All patients were followed up 11 months (6 months-3 years), spinal tuberculosis was completely cured and the grafted bones were fused in all 16 patients. All patients obtained primary healing of the incision. Postoperative complication met with cerebrospinal fluid leakage in 1 case. After 6 months, 5 cases of paraplegia recovered. The kyphosis was corrected partly. No loose and dislocation of the nails and rods was found. CONCLUSION: Focal debridement and primary internal fixation with CD rod can stabilize involved spinal segments, prevent and correct local deformity, and improve its curative ratio and fused ratio of grafted bone.

Adult↗
PubMed1999

[Comparative biomechanical study of 3 types of osteosynthesis of the Duparc grade IV fractures of the calcaneus: value of triangular internal fixation].

PURPOSE OF THE STUDY: We present an in vitro biomechanical study performed to evaluate and compare, for an experimentally produced fracture of the calcaneum (Duparc grade IV), the reaction of 3 standard models of internal fixation commonly used in these fractures and which occupy different volumes. MATERIALS AND METHODS: We compared different methods of fixation using fresh human calcanei. In two experimental series, we compared triangular internal fixation (3 1/4 tube AO plates Saragaglia), Y internal fixation (2 1/3 tube AO plates Bezes), isolated screw technique (three 3.5 diameter screws, two 4.5 diameter screws). The plates and screws were made of identical material (316L). Both series used 8 pairs of bone (talo-calcaneum system) with the same fracture submitted to a 200N to 1000N load. Stiffness and movement were analyzed using 8 references on the calcaneum. RESULTS: The stiffness and movement analysis with 8 references points demonstrated the superior resistance to bending with the triangular internal fixation. Fixation stability was significantly better than with the Y or screw technique. DISCUSSION: This study underlined the importance of triangular trabecular organization of cancellous bone on calcaneum biomechanics. We showed that the 3 (anterior, posterior and inferior) trabeculae must be repaired in calcaneum fractures to achieve horizontal and vertical stability of the talar joint. CONCLUSION: In our hands, restoration of the triangular architecture of calcaneum fractures, to resemble a roof truss, where the talus is fixed to the triangle vertex, is fundamental to obtain a rigid and stable internal fixation.

Biomechanical Phenomena↗
PubMed1979

Clinical study on internal fixation of femoral neck fractures.

A clinical study on the results of internal fixation of femoral neck fractures treated by multiple Knowles pinning was undertaken and correlated with the results of an experimental study. Experimentally, failures were produced by downwards migration of the Knowles pins. This phenomenon accounts for the settling of the femoral head on the neck and the frequency of non-union or malunion in patients with subcapital fractures. The type of fracture, type of reduction and age correlate with failure rate. This has to be explained by biomechanical considerations based upon the mode of failure of the internal fixation. A Garden stage III and IV, a varus or anatomical reduction of the fracture and an old age predispose to failure of the internal fixation and consequent non-union.

Age Factors↗