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At least 1,495 records · Page 83Linked to original sources
PubMed1999

Triple arthrodesis in adults using rigid internal fixation: an assessment of outcome.

The intermediate outcome of patients who underwent a triple arthrodesis for the treatment of adult foot disorders was evaluated with an outcome tool to determine if their pain and functional status were improved. We evaluated 63 feet in 57 patients who underwent a triple arthrodesis using rigid internal fixation for the treatment of hindfoot deformities associated with symptomatic arthrosis. Twenty-four men and thirty-three women, with an average age of 54 years, were evaluated. The average follow-up was 30 months. Multiple diagnoses contributed to hindfoot deformities with secondary arthrosis. Iliac crest bone graft was used in 56 of 63 cases (89%). Percutaneous heel cord lengthening was done in 53 of 63 cases (84%). Twenty-four of the thirty patients (80%) returned to work. Twenty-five patients were retired and two were unemployed before surgery. All patients except two (97%) were satisfied with the surgery and would have the surgery again. The average American Orthopaedic Foot and Ankle Society Ankle-Hindfoot preoperative score was 28 points, and the average postoperative score was 81 points (P < 0.0001). In the radiographic measurements, there was an average improvement of 12 degrees in the lateral talometatarsal angle, 7 degrees in the lateral talocalcaneal angle, and 10 degrees in the AP talometatarsal angle (P < 0.0001). Complications experienced included two varus malunions, two valgus malunions, two nonunions, two deep vein thromboses, one distal fibula stress fracture, and one wound infection. Of the 26 feet in 22 patients with mortise views available, 10 feet (38%) had evidence of ankle arthrosis and 19 feet (73%) had some degree of talar tilt postoperatively.

Adolescent↗
PubMed2005

Prospective evaluation of a pragmatic treatment rationale: open reduction and internal fixation of displaced and dislocated condyle and condylar head fractures and closed reduction of non-displaced, non-dislocated fractures. Part I: condyle and subcondylar fractures.

This prospective study evaluated outcomes of closed reduction (CR) in non-displaced, non-dislocated condyle and subcondylar fractures (Class I) and open reduction and internal fixation (ORIF) of displaced (Class II) and dislocated (Class IV) fractures. Forty-five patients with 51 fractures (six (13%) with bilateral fractures), 11 (25%) CR and 34 (75%) ORIF, were enrolled in a 1-year follow up that 20 patients with 25 fractures completed. Condylar translation in Class I fractures recovered to 12mm for vertical opening, 9mm for protrusion, 8mm for mediotrusion; in Class II, respectively, 10, 7 and 9mm; and Class IV, respectively, 8, 7 and 7mm. Incisal movements recovered to 46, 8 and 9mm in Class I; 44, 7 and 9mm in Class II; and 43, 5 and 7mm in Class IV. Vertical and angular fragment reduction versus the non-fractured condyle was +0.3 to -1.9mm, +1.1 degrees to +1.8 degrees in Class I; -2.2 to -1.9mm, +0.6 degrees to -1.2 degrees in Class II; +2.9 to -1.1mm, +18.4 degrees to +6 degrees in Class IV. Malocclusion and joint locking were unreliable determinants for a treatment decision, being forged by concomitant fractures. All complications subsided after 6 months; translation and incisal movements returned to within the normal range in proportion to the severity of displacement and dislocation. Vertical opening translation in Class IV fractures remained short-to-normal and was compensated by rotation. Unacceptable clinical function according to predefined standards was not found after 1 year. Angular reposition was better than vertical reduction. This study documents successful evidence-based treatment according to predefined criteria.

Adolescent↗
PubMed1999

Open reduction and internal fixation of fracture of the posterior process of the talus: a case report and review of the literature.

A fracture of the posterior process of the talus is rare. In this report, we present a case of isolated displaced fracture of the posterior process of the talus, which was treated by early open reduction and internal fixation through a posteromedial approach. The fracture healed without evidence of avascular necrosis of either the posterior fragment or the talar body. The purpose of this article is to highlight the importance of early postoperative management of this uncommon type of fracture.

Adult↗
PubMed1984

A method of evaluating possible pin penetration in slipped capital femoral epiphysis using a cannulated internal fixation device.

A technique that utilizes a newly designed cannulated screw with injection of radiographic dye through the screw cannula provides a reliable and practical method for detection and avoidance of pin penetration when operating on slipped capital femoral epiphyses. Adoption of this method minimizes the possibility of poor results occurring as a consequence of internal fixation.

Bone Nails↗
PubMed1995

The unstable shoulder girdle: early functional treatment utilizing open reduction and internal fixation.

The unstable shoulder girdle--a combination of a scapular neck fracture with a clavicular fracture, acromioclavicular dislocation, or sternoclavicular dislocation--represents a rare and often underestimated injury. Sufficient treatment to permit early function is necessary to avoid a frozen shoulder as well as to treat concomitant thoracic injuries. This is possible only by open reduction and internal fixation. In most cases this can be achieved by a sole osteosynthesis of the clavicular injury. We retrospectively analyzed 12 cases and classified the results according to the Constant Score. This analysis showed excellent functional results in nearly all cases.

Acromioclavicular Joint↗
PubMed2002

Enchondromas of the hand: treatment with curettage and cemented internal fixation.

Removal by means of curettage is the mainstay of surgical treatment of enchondromas of the hand. Reconstruction traditionally entails filling the tumor cavity with a bone graft, or it may be decided not to perform a reconstruction. In either case a period of protected activity is needed until the tumor cavity has healed. The current study describes the use of cemented internal fixation for the purpose of reconstruction of these cavities. This technique provides immediate mechanical stability and allows early mobilization. Between 1986 and 1999, we treated 13 patients who were diagnosed as having enchondroma of the hand. Surgery included tumor removal with hand curettes and high-speed burr drilling. The remaining tumor cavity was reconstructed by using bone cement and intramedullary hardware. All patients were followed-up for more than 2 years. There were no postoperative infections or fractures, and all patients returned to their presurgical functional capability within 4 weeks. At the most recent follow-up evaluation, none of the patients had local tumor recurrence. Although 7 patients had a decrease in flexion of the metacarpophalangeal or interphalangeal joints, none reported a functional limitation. Reconstruction of the tumor cavity with cemented hardware provides immediate mechanical stability, allows early mobilization, and is associated with good functional outcome.

Adult↗
PubMed1984

Internal fixation of peritrochanteric fractures of the femur with the Harris condylocephalic nail.

Thirty patients in whom a peritrochanteric fracture of the femur was stabilized with a Harris intramedullary nail were studied retrospectively. The study showed an initially high complication rate and highlighted points of technique and selection which have led to improved results. In appropriate cases, this procedure is a fast, minimally traumatic, and secure method of internal fixation of peritrochanteric fractures.

Age Factors↗
PubMed1982

Correction of post-traumatic wrist deformity in adults by osteotomy, bone-grafting, and internal fixation.

A corrective osteotomy for post-traumatic malalignment of the distal end of the radius was performed in twenty patients who were followed for an average of 3.6 years. The indications for correction were based on age, degree of deformity, limitation of function, pain, and appearance of the wrist. The procedure included an opening-wedge metaphyseal osteotomy combined with insertion of a graft and rigid internal fixation with a plate and screws to permit early motion. Depending on the direction of the angulation, a dorsal or volar approach was employed to guarantee a buttressing effect of the plate. The procedure gave satisfactory results when there were no degenerative changes in the radiocarpal or intercarpal joints and when the preoperative range of motion of the wrist was adequate. The results were graded as excellent in five patients, good in ten, fair in four, and poor in one.

Adult↗
PubMed1976

Subtalar arthrodesis by cancellous grafts and metallic internal fixation.

A technique of subtalar arthrodesis by means of metallic internal stabilisation and autogenous cancellous bone grafting is described. Of forty-eight feet with mobile pes planus treated by this method forty-five gained union after an average of seven and a half weeks in a below-knee weight-bearing plaster, and forty-three had satisfactory correction of the deformity.

Adolescent↗
PubMed1987

Traumatic tarsal luxation repaired without internal fixation in three horses and three ponies.

Three horses and three ponies were treated for traumatic luxation of the proximal intertarsal or tarsometatarsal joint. In each case, there were fractures of one or more tarsal bones. Three of the animals had disruption of one of the collateral ligaments. Five animals were treated by closed reduction and external coaptation. One pony was treated by open curettage, a cancellous bone graft, and cast immobilization. No internal fixation was used in any of these animals. From this series of cases, it would appear that closed reduction and external coaption alone is adequate treatment for most cases of tarsal luxation.

Animals↗
PubMed1978

The biocompatibility of materials for internal fixation of fractures.

Surgically produced fractures of rabbit tibiae were internally stabilized with intramedullary rods of stainless steel (316LVM), titanium (6A1,4V), polyacetal (Delrin), and polyamide (Nylon 101). Periodic radiographs were taken until sacrifice at 16 weeks after fracture. Structural properties of the tibiae were determined in torsion with the rods in situ, and then the tissue was prepared for histology or microradiography. The results demonstrated that fracture remodeling was adversely affected by the metal rods. New bone was seen to have formed over the ends of the metal rods, and cortical bone resorption was observed in the fracture region, suggestive of transfer of mechanical stress to the rods, resulting in stress shielding of the diaphysis. Negligible osseous response to the polymeric rods was observed; fracture callus remodeling was extensive. The torsional test results demonstrated that fractures with polymeric rods were significantly stronger and tougher than those with metallic rods. With the exception of titanium, the strength of healed fractures was inversely related to the elastic moduli of the implant materials.

Acetals↗
PubMed1997

Displaced Fractures of the Radial Head: Internal Fixation or Excision?

Displaced fractures of the radial head in the young active patient should no longer be routinely treated with excision of the radial head. Better techniques of imaging, surgical exposure, and implant placement have improved the likelihood of preserving the head. Associated injuries may make preservation of the radial head important for both acute and long-term stability. In patients with suspected injury to the interosseous ligament of the forearm, saving the radial head may prevent pathologic proximal migration. Rigid internal fixation, permitting early mobilization, can be applied to the radial head and neck in a "safe zone" that does not impede motion. Radial-head excision should be performed in patients with grossly comminuted fractures and in those with low demand on their upper extremities.

Journal Article↗
PubMed1988

Severe spondylolisthesis. Reduction and internal fixation.

The authors have developed and algorithm for management of spondylolysis and spondylolisthesis. Since March 1983, 15 patients with an average age of 20 years and with greater than 50% anterior displacement have been treated. The mean follow-up period is 24 months. Before surgery the average anterior displacement was 72%, the average delta angle at L5-S1 representing kyphosis was 73 degrees, and the average lumbar lordosis from L1 to L5 was 64 degrees. An anterior release and fusion was combined with a posterior reduction and instrumentation using the internal fixator. Correction of the anterior displacement averaged 46%, while the kyphosis was corrected a mean of 20 degrees and the lordosis a mean of 12 degrees. The L4 segment was preserved in 13 cases and the L4-L5 angle was improved by a mean of 7 degrees. Postoperative pain and function were improved in all cases. Neurologic complications occurred in four patients, three permanent and one temporary. Hardware failure occurred in two patients, and reoperation has been required in one. Further follow-up evaluation of this technique is required.

Adolescent↗
PubMed1991

Rigid internal fixation for shoulder arthrodesis.

Fifteen patients underwent a shoulder arthrodesis utilizing standard dynamic compression plate fixation, but with limited postoperative immobilization with only an abduction pillow. In each case, the position of the extremity relative to the scapula and trunk was recorded immediately postoperatively, at regular intervals until fusion, and at follow-up evaluations. Thirteen of 15 shoulders fused without change of intraoperative position after an average postoperative period of 4 months. One patient lost position in the early postoperative period secondary to inadequate fixation, but subsequently fused. Another who demonstrated a persistent non-union at 2 1/2 years was subsequently explored and underwent a bone graft. Four patients complained of residual symptomatic hardware, with two requiring surgical removal of the plate and screws. All but one patient were satisfied with the clinical result at follow up. Only two patients were within 5 degrees of the preoperatively determined position of 30 degrees abduction, 30 degrees forward flexion, and 30 degrees internal rotation. However, almost all were able to function satisfactorily. The authors concluded that shoulder arthrodesis utilizing rigid internal fixation without postoperative cast or brace immobilization maximizes patient comfort without compromising the success of arthrodesis. However, control of arm position remains inexact and additional modifications are needed to ensure fusion position and to minimize disability.

Adolescent↗
PubMedDate not supplied

Internal fixation of acute stable scaphoid fractures in the athlete.

Our study evaluated the results of surgical repair of acute carpal scaphoid fractures in athletes and the time required for the athletes to return to play. Although playing casts are a nonsurgical option, they reduce the effectiveness of the athlete in sports that require maximal manual dexterity; thus, the management of scaphoid fractures is challenging when early return to sports is desired. Twelve athletes with 12 acute midthird scaphoid fractures were treated with Herbert screw fixation. All patients were in-season athletes in sports that precluded the use of a playing cast. Return to sports averaged 5.8 weeks. Nine of the 12 athletes had range of motion equal to the uninjured side. The grip strength was equal to the unaffected side in 10 of the 12 athletes. Clinical and radiographic union was evident in 11 subjects at an average followup of 2.9 years. The healing rates were comparable with other treatment modalities. We concluded that internal fixation of a scaphoid fracture allows safe and early return to sports when a playing cast is not an acceptable option and when an athlete accepts the risks of surgery.

Adolescent↗
PubMed1979

Lumbosacral fusion using internal fixation with a spinous process for the graft: a review of 50 patients with a five-year maximum follow-up.

During a 5 year period 50 patients with chronic low back pain, with or without sciatica due to a proven lumbosacral disk lesion, underwent a spinal fusion using the Boucher method of screw fixation of the facet joints. The L-4 spinous process was excised and fashioned into an H-shape to act as the bone graft between the spinous processes so avoiding an iliac crest incision. Thus blood loss and operating time were substantially diminished. The screws maintain fixation for an 8-week period during which time the graft is "taking." Being inserted with spinous processes distracted about 1 cm the screws and the graft take the load off the painful posterior part of the annulus, and in addition, the distraction of the spinous processes enlarges the intervertebral foramina by about 1 cm thus making subsequent foraminal stenosis unlikely. Loosening of the screws after incorporation of the graft was observed in some cases, but was not considered to be clinically significant. Spinal fusion using screws for internal fixation including indications and contraindications requires careful consideration of operative technique, postoperative management and complications. The clinical evolution of 86% of the patients was rated good or fair from a clinical standpoint; 86% showed a fusion; 14% demonstrated a pseudarthrosis. Three of the 7 pseudarthrotic patients had a good clinical result. The other 4 had only a fair clinical result. Nine of the 14 patients with fair clinical results had a fusion radiologically; all 7 of the clinically unimproved had a fusion. Since the graft is placed at least 1 cm dorsal to the laminae, spinal cancal stenosis is extremely unlikely.

Adult↗
PubMed1996

Internal fixation of the spine using a braided titanium cable: clinical results and postoperative magnetic resonance imaging.

Segmental spinal fixation using sublaminar or interspinous stainless steel wire has been successfully used for many years. Stainless steel cables have been developed that are stronger and more flexible, allowing for shorter operative time and decreased risk of neurological deficit. However, stainless steel implants create significant artifact on magnetic resonance imaging (MRI), reducing the postoperative usefulness of this imaging modality. Titanium instrumentation has the advantage of producing minimal MRI artifact. Recently, a braided titanium cable has been developed that has the advantages of strength and flexibility as well as minimal production of MRI artifact. We present a series of 50 patients who underwent internal fixation of the spine using a braided titanium cable either alone or in combination with supplementary titanium instrumentation. No instrument failures have occurred to date. Postoperative MRI scans have revealed minimal implant-related artifact, allowing for high-resolution, noninvasive postoperative imaging of the neuraxis. We conclude that braided titanium cable has significant advantages over stainless steel cable or monofilament wire and is a valuable instrument for segmental spine fixation.

Adolescent↗
PubMed1991

Long-term results of tibial plafond fractures treated with open reduction and internal fixation.

In this study a series of 41 consecutive cases of operatively treated fractures of the tibial plafond was retrospectively analysed. The fractures were classified into types I (9.75%), II (41.5%) and III (48.75%) as defined by Rüedi. The 10-year average follow-up revealed 66% good and 24% fair objective results overall. The recent literature uniformly reports good results in operatively treated type-I and -II fractures. In this series, these essentially low-velocity injuries resulted in a satisfactory outcome in 86% of cases. Controversy exists in reports of operative treatment of type-III fractures. The incidence of satisfactory results in the present series in type-III fractures was 95% good and fair results, which appears to be better than in other authors' experience. This can be partially explained by the relatively few high-velocity injuries (50% of the type-III fractures) and also by certain technical procedures used in surgery to stabilise these fractures. The initial type of fracture and articular cartilage damage are directly related to late arthrosis. There is clear evidence that the quality of reduction correlates with later development of arthrosis. However, anatomical reduction may still be followed by significant joint arthrosis because of articular cartilage damage. Severe arthrosis present at late follow-up did not correlate with poor subjective or objective results. With adequate open reduction and internal fixation, satisfactory results can be obtained in severe tibial plafond fractures. Meticulous soft tissue care and handling at surgery are important. Various fixation devices may need to be incorporated to ensure optimal soft tissue status for fracture healing.

Adult↗