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At least 1,477 records · Page 82Linked to original sources
PubMed1988

Primary reconstruction of the mandible in cancer surgery. A report of 13 reconstructions according to the principles of rigid internal fixation.

This study comprises 30 patients with extensive oral cancer invading the mandibular bone. In each case, large segmental composite resections were performed and the mandibles primarily reconstructed, according to the principles of rigid internal fixation. All but one of the reconstructions were successful and the functional and cosmetic results were excellent or good in 12 patients. The results indicate that primary reconstruction can be performed without major complications. Bone transplantation may be omitted or postponed to a later date. The fact that tracheostomy and intermaxillary fixation can be avoided, is a major advantage for these patients.

Adult↗
PubMed1985

Pelvic ring disruptions with symphysis pubis diastasis. Indications, technique, and limitations of anterior internal fixation.

The management of disruption of the pelvic ring is both complex and controversial. Twenty-four injuries associated with symphysis pubis diastasis were reviewed to evaluate a two-hole plate technique of anterior internal fixation as compared to four-hole plate anterior fixation. The two-hole plate technique appears to be quite acceptable for maintaining reduction of the diastasis and therefore can be used to manage most anteroposterior compression injuries (those without complete posterior disruption). Vertical shear injuries, all of which are grossly unstable, can also be managed with anterior two-hole plates. However, this fixation method must be supplemented with some form of posterior stabilization to maintain pelvic ring reduction.

Adolescent↗
PubMed1979

Resistant congenital club foot--one-stage posteromedial release with internal fixation. A follow-up report of a fifteen-year experience.

I have reviewed my personal experience with 240 resistant congenital club feet (176 patients) treated surgically by one-stage posteromedial release with internal fixation. The end results in the 149 feet that had a follow-up of two to fifteen years were: excellent or good, 83.8 per cent; fair, 10.7 per cent; and failures, 5.3 per cent. The best results with the least complications were in children who were operated on between the ages of one and two years. A statistical analysis of fifty-three feet with a follow-up of less than two years is reported for comparison with the results after longer follow-up to allow analysis of all the known failures and complications that have been encountered with the operation. Possible causes and prevention of fair and poor results are discussed. Modifications of the technique, which originally was reported in 1971, are described.

Achilles Tendon↗
PubMed2000

High tibial osteotomy without internal fixation for medial unicompartmental osteoarthrosis.

Between 1982 and 1993, a total of 35 patients underwent high tibial osteotomy for medial unicompartmental osteoarthrosis. The osteotomy was performed high in the tibia without the use of jigs, and internal fixation devices were avoided. Patients were assessed using the British Association for Surgery of the Knee score, and satisfactory results with minimal complications were obtained. Our results indicate that in a select group of patients, high tibial osteotomy preserves bone stock and is performed near the deformity so that excellent correction is achieved and recurrence of varus deformity is avoided.

Adult↗
PubMedDate not supplied

Metatarsal osteotomy using internal fixation with compression screws.

Forty-six metatarsal osteotomies in 25 feet were performed in order to treat forefoot deformity. The authors used an exacting operative procedure based on oblique osteotomies of the metatarsal and rigid internal fixation. All osteotomies healed and only one patient was not satisfied with the operation. This technique provided predictable long-term results in the authors' hands, and also involved an easier postoperative course than conventional methods.

Adolescent↗
PubMed1999

Split coronal fractures of the lumbar spine. Treatment by posterior internal fixation and transpedicular bone grafting.

The clinical and radiological results of 12 patients with a split coronal vertebral fracture were analysed with minimum follow-up of 24 months. All patients were treated operatively with an AO internal spinal fixator and transpedicular bone grafting. The operation was supplemented with posterior bone grafts in 4 patients. All fractures healed without marked deformity. There were no vertebral body pseudarthroses. There were no neurological or vascular injuries due to the placement of pedicle screws or to transpedicular bone grafting. 10 patients, had excellent or good results.

Adult↗
PubMedDate not supplied

Physeal remodeling after internal fixation of slipped capital femoral epiphyses.

Rounding off the femoral neck metaphysis helps improve hip function in slipped capital femoral epiphysis (SCFE). Remodeling by physeal growth, not previously reported, may also contribute. By studing the changes in physeal-shaft angle after internal fixation (IF), we found evidence of physeal remodeling in one of 21 mild, five of 23 moderate, and in all of 11 severe slips. Although the amount of remodeling averaged 11.7 degrees, it occurred in 100% of severe slips (p less than 0.001). This support the use of initial pin fixation and a wait of at least 2 years before realignment femoral neck osteotomies are considered.

Adolescent↗
PubMed1990

Distal metaphyseal tibial nonunion. Deformity and bone loss treated by open reduction, internal fixation, and human bone morphogenetic protein (hBMP).

Four patients with severely deformed nonunions of the distal end of the tibia failed to respond to standard surgical methods and were successfully treated as follows: debridement of fibrous tissue, sequestrectomy, correction of angulatory deformities, internal stabilization, and implantation of human bone morphogenetic protein (hBMP). After resection of the sequestra, all four patients had significant bone defects of the anterior tibial cortex extending to the ankle joint. The average number of failed previous surgical procedures was 5.8. The average patient age was 35.3 years. The intervals of nonunion averaged 24.8 months. In two patients, the hBMP, including other low molecular weight bone matrix noncollagenous proteins (hBMP/NCP), was implanted across the fracture site in polylactic-polyglycollic acid strips (1 X 13 cm) as an onlay graft. In one patient, the BMP was implanted in the fracture gap in absorbable gelatin (No. 5 capsules). In another patient, the BMP/NCP was also implanted in the form of a composite of cortical allogeneic bone in addition to a capsule of BMP/NCP. In all four cases, alignment was restored and the bone ends were stabilized with internal fixation. Preoperatively, the ankle joints were ankylosed and painful. Healed fractures and functional ankle joints were observed in three of four patients at an average of 4.4 months. In one patient, the fracture healed but the joint remained ankylosed. Although a randomized double-blind consecutive series of matched cases is necessary to prove the efficacy of hBMP, implants of hBMP combined with skillful surgical treatment are under investigation in the interim as an alternative to amputation.

Adult↗
PubMed1987

Lumbar laminectomy for herniated disc: a prospective controlled comparison with internal fixation fusion.

This is a controlled prospective study on a matched set of patients with herniated lumbar discs. Both groups received the same bilateral lumbar laminectomy and disc excision by the same surgeon. One group had the addition of an intertransverse fusion with internal fixation. Both groups were studied by an independent examiner at an average of 3 years postoperatively for success rate as determined by activity level, medication, subjective and objective evaluation. Both groups had similar age, sex, and occupational characteristics. No patient had prior surgical treatment or chemonucleolysis. Patients with associated lumbar spine problems such as stenosis, instability, or spondylolisthesis were excluded. Each patient had a positive clinical picture for a herniated lumbar disc, as well as a positive myelogram, venogram or computerized tomographic scan. Most had positive electromyograms. All patients received at least 3 months of conservative care. The 38 patients with fusion had a significantly longer mean time to return to work after surgery versus the 31 patients without fusion. Although the general success rate of both groups was 87%, the best results were in the nonfusion group. A total of 29% of nonfusions had excellent results whereas only 11% of the fusion group had excellent results. The conclusion is that fusions are not necessary and give less excellent results in simple laminectomy cases for herniated lumbar disc.

Adult↗
PubMedDate not supplied

Internal fixation by bundle nailing in the elderly patient.

Between November 1992 and July 1999, a total of 27 fractures and 1 non-union, including 15 tibias, 8 femurs, and 5 humeri in geriatric patients were treated using Marchetti-Vicenzi bundle nail internal fixation. Reaming of the medullary canal was never used in any of the fractures, while it was used in the case of non-union. The results suggest that flexible intramedullary nailing provides adequate stability and is responsible for earlier weight-bearing, facilitating bone healing and early functional recovery in the elderly patient. Automatic distal locking allows for a reduction in the amount of time required for surgery.

Age Factors↗
PubMed1990

Hazards of internal fixation in the treatment of slipped capital femoral epiphysis.

We reviewed the records of 202 patients (308 hips) in whom a slipped capital femoral epiphysis had been fixed with pins or screws. A serious complication that was directly related to the use of internal fixation developed in eighty hips (26 per cent). The rate of complications in the 202 patients was 40 per cent. In thirty-six (18 per cent) of the 202 patients, an additional procedure was done to correct a pin-related complication. Forty-one hip joints had been penetrated by a pin. Other complications included avascular necrosis (fourteen hips), chondrolysis (nine), fracture (one), infection (one), further slippage (one), sciatic-nerve injury (one), and breakage of a screw (eight). Ways of decreasing the incidence of complications of fixation were explored.

Bone Nails↗
PubMed1988

Spondylolysis and spondylolisthesis. Treatment by internal fixation and bone-grafting of the defect.

Eighteen patients who had symptomatic spondylolysis or Grade-I spondylolisthesis, and whose symptoms had not been relieved by non-operative treatment, were operated on using the Buck method for bone-grafting and internal fixation of the defect of the pars interarticularis with screws. There were six male and twelve female patients and the average age was twenty years (range, fourteen to thirty-eight years). The amount of slipping ranged from zero to ten millimeters. After an average period of follow-up of forty-one months (range, twenty-four to seventy-two months), the result was excellent in ten, good in five, and poor in three patients. Thus, a satisfactory result was obtained in 83 per cent of the patients.

Adolescent↗
PubMed1987

Internal fixation for atlanto-axial instability in children.

A new and simple method for the operative treatment of atlanto-axial instability in children is described. The technique involves a metal rectangle wired in place between the occiput and cervical spine to act as an internal fixation device. Onlay bone grafts subsequently produce bony fusion. A synchronous decompression of the cervical canal can be performed and there is no need for complex or prolonged external fixation.

Adolescent↗
PubMed1996

Magnetic resonance imaging to detect avascular necrosis after open reduction and internal fixation of talar neck fractures.

Twenty-one consecutive patients with displaced talar neck fractures (12 Hawkins type II, 9 Hawkins type III) were prospectively evaluated with magnetic resonance (MR) scans performed between 3 days and 12 months after surgery. All patients underwent open reduction and internal fixation with titanium screws, except two who underwent fixation with stainless steel implants that were subsequently removed. All patients had plain radiographs. We classified the scans as follows: type A, no abnormal signal changes in the body of the talus; type B, signal changes in less than 25% of the body; type C, signal changes in 25% to 50% of the body; and type D, signal changes in greater than 50% of the body. Plain anteroposterior radiographs correlated well with MR scans in patients with type D scans, but an inconsistent correlation was noted with lesser degrees of signal changes (types A-C), with the MR scans being more accurate in displaying the volume of avascular bone. Scans obtained less than 3 weeks after injury were not helpful in assessing for avascular necrosis. We found that high-quality MR images of the talus were consistently obtained in the presence of titanium screws in contrast to images obtained with stainless steel implants. We use titanium screws in all talar neck fracture repairs, because they permit high-quality MR images. We believe that further study of patients with Hawkins type III fractures and Hawkins type II fractures with equivocal radiographic evidence of avascular necrosis is warranted to try to identify those patients at risk for collapse and perhaps to guide weightbearing recommendations.

Adult↗
PubMed1993

Triple arthrodesis using internal fixation in treatment of adult foot disorders.

Forty adult patients with 44 fused feet were evaluated at an average of 4.9 years after triple arthrodesis. The average age of the patients at operation was 41 years. All operations were performed by a specific technique using rigid internal fixation with screws. Outcome was graded using the clinical criteria of Hallgrimsson as modified by Angus and Cowell. Function was evaluated according to modified Arthritis Impact Measurement Scales (AIMS). Radiographic evaluation included measurement of lateral talocalcaneal angle, lateral talometatarsal angle, and anteroposterior (AP) talometatarsal angle on standing or simulated weight-bearing radiographs. Thirty-four feet had good results, six had fair results, and there were four failures. The average patient could function painlessly on flat surfaces in nonstrenuous activities and had only occasional mild pain with more vigorous activities. In roentgenographic parameters, there was an average improvement of 17 degrees in the lateral talometatarsal angle, 11 degrees improvement in the lateral talocalcaneal angle, and an improvement of 18 degrees in the AP talometatarsal angle. There were two pseudarthroses, no recurrences, and two unsatisfactory corrections. When carefully done, triple arthrodesis can restore an adult patient with a disabling foot disorder to normal function and minimal pain.

Adolescent↗
PubMed1996

Wrist arthrodesis in rheumatoid arthritis. A new technique using internal fixation.

Arthrodesis of the wrist is a standard operation which is indicated for severe rheumatoid arthritis in which destruction is too advanced for more conservative procedures, or after failure of previous surgery. We have developed an L-shaped plate designed for this purpose. It provides rigid internal fixation with the wrist in the neutral position and utilises bone grafts obtained from the distal ulna and the carpal bones. We have carried out 29 successful fusions between 1992 and 1995. In all 29 patients synovectomy and resection of the head of the ulna were performed; 11 also had reconstruction of ruptured extensor tendons. All the patients obtained bony union, pain relief and improved function.

Adult↗
PubMed1989

Distal metaphyseal tibial nonunions associated with significant bowing deformity and cortical bone loss: treatment with human bone morphogenetic protein (h-BMP) and internal fixation.

Distal tibial metaphyseal nonunions with significant posterior bowing deformities are extremely difficult to manage and may require the use of additional healing factors to achieve union. Four patients with complex multiple failed surgically treated distal metaphyseal nonunions were treated with debridement of the nonunion, correction of deformities, internal stabilization, and augmentation with human bone morphogenetic protein implants (h-BMP). All patients had, following resection of the anterior cortical sequestrum, a significant cortical defect extending from a level proximal to the ankle joint to the distal tibial metaphysis. The average number of failed previous surgical procedures were 5.8 and average age was 35.3 years. Symptomatic nonunion averaged 24.8 months. All patients received h-BMP combined with insoluble noncollagenous proteins (iNCP) either in a delivery form of coated polylactic polyglycolic acid strips (1 x 13 cm.) or in gelatin capsules. The h-BMP/iNCP implants were placed within the anterior cortical defects in contact with the residual distal metaphyseal bone. All nonunions were stabilized with internal fixation. Ankle motion was difficult to record preoperatively but good to very good ankle function was obtained at final follow-up evaluation in three of four patients. All fractures healed without further surgical treatment at an average of 4.4 months. h-BMP/iNCP protein implants were felt to be of benefit in the healing of these difficult fracture problems.

Adult↗
PubMedDate not supplied

Results of hip arthrodesis in adolescents by using the cobra-head plate for internal fixation.

A retrospective study was conducted to examine the efficacy and potential morbidity of hip fusion using the Cobra-head plate in adolescents. A heterogeneous group of 11 adolescents, with recalcitrant hip pain and an average age of 14.6 years, underwent unilateral hip arthrodesis with the Cobra-head plate for internal fixation. Seven (64%) patients achieved an uneventful clinical and radiographic arthrodesis after a mean postoperative interval of 7.4 months. Four index operations (36%) were complicated by pseudarthrosis. All patients who developed a postoperative pseudarthrosis ranked at or above the 90th percentile for their age-determined weight. The relationship between the percentile-weight-for-age and the incidence of pseudarthrosis was statistically significant (p < or = 0.001). Hip-arthrodesis procedures with the Cobra-head plate in adolescents at or above the 90th percentile weight-for-age are associated with an unacceptably high rate of pseudarthrosis. In this subset of patients, alternate or supplementary stabilization methods should be considered.

Adolescent↗