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PubMedDate not supplied

Open reduction internal fixation of a pelvic malunion through an anterior approach.

Whereas the initial treatment of pelvic fractures and their long-term outcomes have been well researched, little has been written concerning the surgical management of late pelvic malunions and nonunions causing residual pain and deformity. The available literature describes osteotomies usually done in multiple stages. The authors report the case of a progressive lateral compression pelvic disability treated in a unique one-stage procedure. This one-stage anterior approach allowed excellent correction of the deformity. In cases in which the deformity is purely one of internal or external rotation or medial or lateral displacement with no vertical migration, the authors think it is possible to adequately mobilize the pelvis to an anatomic reduction in a single-stage anterior approach. In cases in which vertical migration of the hemipelvis causes symptoms, it is probably necessary to approach the patient posteriorly to safely mobilize and adequately reduce the hemipelvis. With these factors in mind, the authors think a one-stage anterior approach can be an effective treatment for appropriately selected pelvic malunions.

Fracture Fixation, Internal↗
PubMed1997

Internal fixation for small joint arthrodeses in the hand. The interphalangeal joints.

Interphalangeal arthrodeses are performed frequently for disabling pain and deformity in the proximal and distal interphalangeal joints. Such arthrodeses are the gold standard for eliminating pain in arthritic joints of the fingers. Kirschner wire fixation is simple to perform but often leads to nonunion or delayed union. Fixation with tension band wires and Herbert and Accutrak screws is discussed in this article. The techniques are simple and straightforward, and they afford considerably more stability and a higher union rate than Kirschner wires alone.

Arthritis↗
PubMed1998

Cost-effectiveness comparison of three methods of internal fixation for arthrodesis of the first metatarsophalangeal joint.

We used decision-analysis modeling to determine the most cost-effective fixation device among Herbert screws, AO screws, and the Luhr plate for first metatarsophalangeal joint arthrodesis. The model considered patient-reported outcomes at minimum 2-year follow-up, patient charges for the entire course of care, and event and outcome incidences within each fixation group. AO screws had the lowest average cost of utility and, therefore, are the most cost-effective fixation device for first metatarsophalangeal joint arthrodesis even though utility is highest with the Luhr plate. Operating room costs and union rate most strongly influenced cost-effectiveness.

Arthrodesis↗
PubMedDate not supplied

[Biomechanical studies of bisegmental lumbosacral stabilization using the internal fixator or PMMA-simulated fusion].

The implantation of fixation devices increases the primary stability after surgery significantly. Little is known about the comparison of flexibility of instrumented and posterolateral fusions or the lumbosacral distractions spondylodesis (LSDS). The purpose of the study was to compare the flexibility of instrumented and posterolateral fusions or LSDS after simulation with polymethylmethacrylate (PMMA). Dynamic testing from 0-16 Nm in flexion/compression and 0-900 N in compression was performed on 14 lumbosacral spines. The spines were tested intact, after laminectomy, instrumentation with an internal fixateur L5-S1, and simulation of posterolateral fusion L4-S1 or LSDS and thereafter a pseudoarthrosis was simulated. The laminectomy resulted in a significant increase of flexibility and posterior distraction in flexion and compression. The stabilization with an internal fixateur or PMMA simulation for posterolateral fusion or LSDS resulted in a significant decrease of the flexibility. Creation of a unilateral pseudoarthrosis did not effect the flexibility. The instrumented fusion as well as the PMMA simulated bony posterolateral fusion and LSDS resulted in this model in a significant stabilization of the laminectomy. After unilateral fusion the flexibility was not significantly increased.

Aged↗
PubMed2006

Open reduction of irreducible atlantoaxial dislocation by transoral anterior atlantoaxial release and posterior internal fixation.

STUDY DESIGN: A retrospective study of surgical outcome of 33 patients with irreducible atlantoaxial dislocation (IAAD). OBJECTIVE: To evaluate the safety efficacy of one stage anterior release and posterior fixation and fusion to reduce and stabilize IAAD. SUMMARY OF BACKGROUND DATA: The traditional treatment of symptomatic IAAD is ventral decompression by transoral approach. This procedure is accompanied with high morbidity and mortality. It does not correct the swan neck deformity, which could precipitate the degenerative changes in the lower cervical spine. Our hypotheses were that it is the contraction of the muscles, ligaments, and capsules of atlantoaxial joint that prevent reduction, and that most of IAADs might be reduced by anterior atlantoaxial joint release without the odontoid resection, and that further reduction and stabilization might be achieved by special posterior fixation. METHODS: A consecutive series of 33 patients with IAAD were surgically treated. Dislocation or reduction was assessed before surgery, immediately after surgery, and at the final fol5786-up. Etiology, instrumentation, levels fused, and complications were documented. All patients were assessed clinically for neurologic recovery by Odom's method. RESULTS: The mean age was 32 years (range, 7-63 years). The pathology included os odontoideum in 8 patients, occipitalization of C1 in 19 patients, malunion of odontoid fracture in 5, and relaxation of transverse ligament of atlas in 1. Twenty five patients presented neurologic signs and symptoms. Anterior release was performed without odontoid resection in all cases. Four patients underwent transarticular C1-C2 screw fixation, 3 had C1-C2 pedicle screw and plate fixation, and 26 required occipitocervical fixation. Twenty-five cases resulted in an anatomic reduction, 8 had partial reduction. Complication included one dysphagia and two nasal phonations. The mean follow-up period was 33.7 months (range, 24-55 months). There was no pseudarthrosis, and all but 1 of the patients with neurologic deficit showed improvement. CONCLUSION: This series has demonstrated the safety and efficacy of the transoral anterior atlantoaxial release in the reduction of IAAD. Most of the so-called irreducible/fixed AAD could become reducible after anterior release without odontoid resection. The posterior short-segment atlantoaxial or occipitocervical fixation, especially the plate screw instrumentation, could achieve further reduction and provide immediate stabilization. One-stage anterior release and posterior instrumentation and fusion are a safe and reliable operation in experienced hands.

Adolescent↗
PubMed1999

Positive identification of cremains recovered from an automobile based on presence of an internal fixation device.

We report on the use of a surgically implanted device, an EBI osteostimulator, as a means of establishing the identification of a homicide victim. The use of such an appliance for securing positive identification has not been previously reported. Additionally we stress the importance of intensive and accurate excavation at scenes involving intense burning where the potential for non-skeletal contaminants is high.

Adult↗
PubMed1998

Analysis of techniques for video-assisted thoracoscopic internal fixation of the spine.

Between November 1, 1995, and January 31, 1996, four separate thoracoscopic spinal fixation surgeries were performed via extended manipulating channels using the so-called three-portal technique. The diagnoses included three spinal metastases and one T11 burst fracture. All patients had myelopathy at presentation. Using the three-portal technique, the conventional spinal instruments and fixation devices could be passed freely through the extended manipulating channels (usually 3-4 cm) into the chest cavity and manipulated by techniques similar to those used in standard open procedures. A reduction-fixation spinal plate with variable screw and plate anchoring angles was successfully inserted in the procedures. The total length of the operation ranged from 3.5 to 5 h (average 4.3 h), and the total blood loss was 1000-2500 ml (average 1500 ml). There were no intraoperative deaths, and no patient showed neurological deterioration following the procedures. On the basis of these results, we believe that the combination of video-assisted thoracoscopy and conventional spinal instruments presented in this report would be an ideal method for performing these procedures. Throughout the operation, only one trocar was employed for introducing the thoracoscope. The thoracoports were used temporarily during tumor tissue retrievals. This technique makes thoracoscopy-assisted spinal fixation simple and easy. It allows greater control of intraoperative vessel bleeding and reduces the number of portals required during the procedure (on average to 3). In addition, the technique reduced the amount of endoscopic materials required for the procedure, thus reducing the cost of treatment.

Adult↗
PubMed1995

Microsurgical anterior decompression and internal fixation with iliac bone graft and titanium plates for treatment of cervical intervertebral disc herniation.

42 cervical interbody fusions with iliac bone graft and titanium plate fixation were performed between October 1991 and March 1994. The mean follow up period in this study was 10.7 months. In 32 cases fusion was done for 1 and in 10 cases for 2 segments. 2 different types of plates were used. In 25 cases micro-osteosynthesis plates and screws with 2.7 mm diameter were used, and in 17 cases cervical H-plates and screws with 3.5 mm diameter. A favourable outcome was achieved in 31 of 42 cases (74%). Satisfactory pain relief was achieved in 90%. For radicular motor deficit good results were obtained in 84% and for cervical myelopathy in 54%. The 2 different types of plates showed a remarkable difference in the clinical outcome. The results were regarded favourable in 15 of 25 microplate fusions (60%) and in 16 of 17 H-plate fusions (94%). Compression of the bone graft was seen in 5 patients of the micro plate group, however, radiological signs for fusion were present in all 42 cases at follow up. Major surgical complications, damage to neural structures or neurological deterioration did not occur in this study. Plate fixation in cervical interbody fusions seems to be a safe procedure and may reduce graft related complications at the fusion site if the plates and screws are sufficiently well proportioned. A favourable impact upon the results for cervical interbody fusion might be expected and should be further investigated in a long term follow up study.

Adult↗
PubMed2000

Anterior open-bite malocclusion: stability of maxillary repositioning using rigid internal fixation.

A retrospective cephalometric study was performed to investigate the stability of 37 non-growing anterior open-bite cases using mini-plate rigid fixation. The sample was divided into two groups: Group A: maxillary repositioning alone (17 cases) and Group B: bimaxillary surgery (20 cases). Tracings were performed pre-operatively (T1), immediately post-operatively (T2) and at a minimum of one year follow-up (T3) (12-90 months). In Group A, the maxilla was advanced (3.8 +/- 2.8 mm, p < 0.01) and superiorly repositioned at PNS (2.8 +/- 2.3 mm, p < 0.001). In Group B, the maxilla was advanced (3.5 +/- 3.0 mm, p < 0.01) and superiorly repositioned at PNS (3.7 +/- 1.8 mm, p < 0.001); and the mandible (11.7 +/- 3.8 mm, p < 0.001), with no significant change in the vertical plane (p > 0.05). Late relapse due to condylar remodelling or resorption was found as a cause of large horizontal relapse (8.0 < x < 14.0 mm) in three cases (15%), the amount being associated with the amount of operative advancement (r = 0.7, r-sq = 40%, p < 0.01). It was concluded that the correction of anterior open bite by posterior repositioning of the maxilla using rigid fixation is a stable procedure during the follow-up period, and that in bimaxillary cases, post-operative stability depends largely on the stability of the mandibular advancement, which in turn relates to the amounts of advancement, the pre-operative anterior open bite and the mandibular plane angle.

Adolescent↗
PubMed1991

[The value of the Nanković internal fixator in surgical treatment and rehabilitation of spinal fractures].

By fixateur interna light for spine fractures introduced and used by Magerl and Dick, we wanted to estimate fixateur interna validity by Nanković. We considered 37 patients with spine fracture, operated by method previously mentioned. With no patient there was no deformation or fixateur fracture during the rehabilitation. With 3 patients (8%) fixateur was removed according to documentation because of infection. Because of all the things mentioned we consider the fixateur to be good and applied in the case of any indication for it.

Adolescent↗
PubMedDate not supplied

Wilson bunionectomy with internal fixation: a ten-year experience.

One hundred fifteen feet that underwent a Wilson (lateral, transpositional, shortening) osteotomy for the correction of hallux valgus between 1979 and 1989 were retrospectively reviewed. All osteotomies were stabilized either with a single cortical or cancellous screw, or with crossed Kirschner wires. The Wilson procedure is not technically difficult and can allow for tri-plane correction. Of the 115 feet on which this surgical procedure was performed, 92 (80%) were graded in long-term postoperative recovery as excellent or good. Only one complication of hallux varus occurred, which required additional surgery. Survey of the results of the 10-year experience in utilization of this operative procedure has shown a high patient satisfaction with minimum of postoperative complications and a low failure rate.

Follow-Up Studies↗
PubMed1996

Correction of kyphotic deformity of the cervical spine in ankylosing spondylitis using general anesthesia and internal fixation.

Surgical correction of kyphotic deformity of the cervical spine caused by ankylosing spondylitis is usually done using local anesthesia to prevent undue spinal cord compression and paralysis followed by a sudden-extension maneuver. We report a case of kyphotic deformity that was corrected while the patient was under general anesthesia. To prevent cord compression and paralysis and to obtain an accurate and gradual correction, we used a Hartshill rod prebent to the desired angle, and correction was done by tightening sublaminar wires on the rod until the lamina made full contact with it. Somatosensory evoked potential and wake-up tests were also performed. Our successful result shows that correction of kyphotic deformity of the cervical spine in ankylosing spondylitis can be done more accurately and without discomfort using the present method.

Anesthesia↗
PubMed1996

Poly(L-lactide) bone plates and screws for internal fixation of mandibular swing osteotomies.

This study evaluated bone healing after mandibular swing osteotomies fixed with biodegradable poly(L-lactide) (PLLA) bone plates in four patients. A step osteotomy treated with two PLLA bone plates (n=3), and a straight osteotomy treated with one PLLA bone plate (n=1) were performed. Bone healing was uneventful in all patients; only in the patient with the straight osteotomy was callus observed. After 5.5 years, radiologic changes at the site of implantation were observed in the remaining patient. Histologic examination revealed a nonspecific foreign-body reaction on highly crystalline PLLA remnants which were still present. It is concluded that the PLLA bone plates provided enough strength to enable undisturbed bone healing. The long-term degradation results are comparable with those of other studies on as-polymerized PLLA implants.

Biodegradation, Environmental↗
PubMed2004

Wilson osteotomy stabilised by means of internal fixation for the treatment of hallux valgus.

The results achieved in 20 patients (32 feet) who underwent Wilson's osteotomy of the first metatarsal for the treatment of hallux valgus were reviewed. In all cases the osteotomy site was stabilised with one or two cortical screws. The patients' average age was 50.7 years (range: 34-74 years) and they were followed for a mean period of 33.1 months (range 12-63 months). The average AOFAS score was 85.5 (range: 62-100) at the final follow-up and in 84.4% of the cases the final outcome was very satisfactory as far as symptomatic improvement was concerned. Wilson's osteotomy stabilised with cortical screws was found to reliably give satisfactory correction of the hallux valgus and first intermetatarsal angles, while allowing safe patient mobilisation and early weight bearing. This effectively resulted in shorter rehabilitation time, early return to work or normal activities and a very satisfactory functional outcome.

Adult↗
PubMed1992

Mitchell's osteotomy using internal fixation and early mobilisation.

We present the results of a prospective trial of osteotomy of the metatarsal neck for hallux valgus in 31 feet of 23 women, using a new stapling device with no plaster splintage and early weight-bearing. Surgery was performed for pain (29 feet) and difficulty with footwear (nine feet). The average time for return to light work was 3.3 weeks, and to full work 8.3 weeks after operation. Seventeen patients had full recovery within three months and 21 of the 23 patients had complete relief of pain. Shoes were more comfortable in 17 feet and 9 patients could wear narrower shoes. Only two patients were unsatisfied with the appearance of the foot. All the osteotomies united, and the average hallux valgus angle was improved on radiographs from 35 degrees to 23 degrees. The mean first metatarsal angle was reduced from 16 degrees to 11 degrees. The new technique allows more accurate surgery and easier postoperative management.

Adolescent↗
PubMed2000

Clinical biocompatibility of biodegradable orthopaedic implants for internal fixation: a review.

When the polymeric material reaches the final stages of its degradation process, biodegradable orthopaedic fixation devices elicit a local foreign-body reaction. In most cases, the symptoms of this tissue response are subclinical and pass unnoticed, but in some patients a clinically manifest inflammatory foreign-body reaction ensues. Mild clinical reactions consist of a painful erythematous papule, those of medium severity show a sinus discharging polymeric debris for up to 6 months, and in the patients affected by a severe reaction, extensive osteolytic lesions may develop at the implant tracks. The histopathologic picture is that of a non-specific foreign-body reaction. For implants made of polyglycolide, the average incidence of the manifest reactions is 5%. When slow-degrading polymers are used, the incidence is lower. The tissue responses to polyglycolide manifest themselves 11 weeks after surgery, on an average, whereas foreign-body reactions to devices made of poly-L-lactide can emerge as late as 4 or 5 yr after the original fracture fixation operation. A poorly vascularized bone section, use of a quinone dye as an additive in the polymer, and an implant geometry with large surface area each seems to be associated with an increased risk of the occurrence of a foreign-body reaction. Yet in majority of the patients affected, no known individual marker of high risk is present. Some recent laboratory experiments indicate that it may be possible to diminish the risk of an adverse tissue response by incorporating alkaline salts or antibodies to inflammatory mediators in the implants. The results of in vitro and animal experiments, however, cannot always be directly extrapolated to humans. Only large-scale long-term clinical research will ultimately show which physico-chemical characteristics of a biodegradable orthopaedic implant provide the optimal clinical biocompatibility.

Absorbable Implants↗
PubMed1997

Restoration of the spinal canal by the internal fixator and remodeling.

It has been observed that after reduction of an unstable vertebral fracture, treated either conservatively or operatively, the encroachment of the spinal canal remaining after reduction can decrease considerably with time. A series of 31 cases, each with a set of CT scans taken preoperatively, immediately after surgery and after implant removal respectively, was assessed using computer-aided planimetry. The mean initial narrowing of the spinal canal was 44.6%. Through surgery this was decreased by 20.4%, leaving a remaining deficit of 24.2%. After implant removal, 15 months after trauma and surgery, the area of the spinal canal increased a further 17.4%, leaving a remaining deficit of only 6.8%. Comparing the values of the spinal canal for T12-L5 directly after surgery and after implant removal, an almost identical degree of restoration for each level can be seen. This additional and gradual restoration of the spinal canal is termed remodeling. This study demonstrates that a residual postoperative narrowing of the spinal canal of up to 25% can be ignored, provided there is no initial neurologic damage.

Adolescent↗