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At least 163 records · Page 9Linked to original sources
PubMed1986

[Use of external fixation in pediatric fractures].

Conservative treatment is usually applied to fractures in childhood. However, stabilisation of such fractures is necessary for certain indications. Indications for stabilisation are specified, and a new technique for stabilisation is described. Fractures were stabilised in 40 children, using a clamp-type fixator. In this context, Hoffmann's external fixator is recommended for cases of closed resetting, since additional and corrective resetting would then be possible even after application of bone nails and apparatus. The following advantages are likely to be provided by the above approach: reduced time of hospitalisation, very early possibility of mobilisation and exposure to loading, minor traumatisation in the course of stabilisation of such fractures. No blood transfusion has ever been necessary for blood supply to patients with femoral fractures. Absence from school has been minimized. This surgical approach has proved to be simple and of low-risk nature, as compared to plate osteosynthesis.

Athletic Injuries↗
PubMed1993

Experimental mandibular regrowth by distraction osteogenesis. Long-term results.

The use of gradual distraction to grow bone (distraction osteogenesis) has gained widespread orthopedic acceptance, but has only recently been applied to craniofacial skeletal defects. The use of bifocal distraction osteogenesis to fill experimental segmental mandibular defects with regenerate bone was recently reported. Though all canines in that study demonstrated normal oromandibular function, they were observed for only 4 weeks following defect closure. The study that is now reported describes the long-term (12-month) functional, morphologic, and biomechanical results when bifocal distraction osteogenesis was applied to the same model. In this long-term study, three canines had 2.5-cm unilateral segmental mandibular body defects filled with structurally stable bone using bifocal distraction osteogenesis. These dogs exhibited normal oromandibular function for 1 year following segment regrowth and external fixator removal. Macroscopic and histologic evaluation of the regrown segments revealed a re-formation of the cortical and medullary architecture. Stress testing demonstrated the average ultimate strength of the regrown segment at 53 MPa, which corresponded to 77% +/- 5.7% of normal mandibular bone. The data suggest that clinical trials applying this technique to segmental mandibular reconstruction are warranted.

Animals↗
PubMed1975

Primary internal fixation of femoral neck fractures.

The principles in treatment of femoral neck fractures by primary internal fixation have been reviewed. In the rare, undisplaced stress or fatigue fracture, early internal fixation with threaded pins is recommended. Impacted fractures should be treated by primary internal fixation in patients who do not follow orders and patients whose general condition is poor and would require early weight bearing. Displaced fractures may be treated by primary internal fixation at any age and regardless of the patient's general condition. The following principles are emphasized: early operation, anatomical reduction and slight valgus in some cases, compression and impaction of fragments, and firm immobilization of fragments with a device that has a sliding mechanism and provides lateral cortical fixation.

Bone Nails↗
PubMed1975

Subtrochanteric fractures of the femur.

Subtrochanteric fractures of the femur comprise only 5% to 7% of hip fractures, but are important because of the difficulty in management. They combine the problem of instability to varus deformation common to comminuted intertrochanteric fractures and the problem of delayed union common to diaphysial fractures of the femur. While the benefits of open reduction and internal fixation in decreasing morbidity and mortality have been well established, formidable operative complications have occurred when this fracture is treated like an intertrochanteric fracture. Improved results have been obtained by utilizing a fixation device that can control the intertrochanteric instability and that has sufficient strength to withstand deforming forces that may be present for up to a year while the fracture is uniting. Bone grafting has been found very useful in shortening the overall period of healing.

Adult↗
PubMed1982

Reconstruction after the Tikhoff-Linberg procedure.

The Tinhoff-Linberg operation is a limb salvage technique that permits intercapulothoracic resection of malignant neoplasms of the shoulder with preservation of neuromuscular function of the upper extremity. A metallic interpositional device can be used to fix the humerus to the second rib, thus increasing stability and function. This device was used in a patient with a proximal humeral osteosarcoma who was also treated with radiation and chemotherapy and who has reasonably good extremity functional and is free of tumor at one year postoperatively.

Adult↗
PubMed1999

Spinal markers: A new method for increasing accuracy in spinal navigation.

Spinal navigation opens up a completely new dimension in the planning and realization of neurosurgical and orthopedic procedures, and offers the possibility of simulating the operation preoperatively. There is currently only limited experience with spinal navigation, and despite the development of advanced software, intraoperative difficulties include identification of characteristic and reproducible anatomical landmarks, localization of these points in the surgical field, referencing, and intraoperative control. We report the use of a new kind of implantable fiducial marker in a case of a 58-year-old female patient with spondylolisthesis. Percutaneously applied spinal markers were used as prominent anatomical landmarks and permitted much easier intraoperative handling. In our opinion, in the hands of an experienced neurosurgeon or orthopedist, the additional preoperative time required for placement of such spinal markers is negligible.

Bone Nails↗
PubMed1999

Healing of segmental bone defects in rats induced by a beta-TCP-MCPM cement combined with rhBMP-2.

A beta-tricalcium phosphate-monocalcium phosphate monohydrate (beta-TCP-MCPM) cement was evaluated as an effective carrier of recombinant human bone morphogenetic protein-2 (rhBMP-2) in rat femoral critical-size defects. Hard cement cylinders (4 x 5 mm) impregnated with two different doses of rhBMP-2 (1.26 or 6.28 microg) were implanted into each defect, and the results were compared with those in rats that had implantations of cylinders only. Implantation of the 6.28 microg dose of rhBMP-2 caused a large bone shell to form around the defect, resulting in osseous union in all cases within 3 weeks. Except for beta-TCP granules, the cement was resorbed and replaced by bone tissue at 6 weeks. A torsion test at 9 weeks showed that the failure torque and bone stiffness had recovered 99% and 141%, respectively, compared with the intact contralateral femur. The defects that received 1.26 microg of rhBMP-2 resulted in 40% union and 41% of the failure torque at 9 weeks. However, no instances of union were observed in the defects implanted with cylinders only. In conclusion, the beta-TCP-MCPM cement was shown to be effective as a rhBMP-2 carrier. Combined with rhBMP-2, this cement was rapidly resorbed and completely healed the defects.

Animals↗
PubMed2000

Sister chromatid exchanges and ion release in patients wearing fracture fixation devices.

The quantification of sister chromatid exchange (SCE) during mitosis is a useful index for evaluating genotoxic effects in subjects occupationally or incidentally exposed to potentially toxic substances. The authors investigated the hypothesis that ions released by corrosion from prosthetic components of fracture fixation devices are associated with change in SCE incidence. In the present study, ten patients with implants were examined, and fifteen subjects with no implants were used as controls. SCE and high frequency cell (HFC) numbers were evaluated in circulating lymphocytes. In addition, nickel (Ni) and chromium (Cr) ion values in the serum were measured because, after iron, these metals are major components of stainless steel. A significant increase in SCE numbers was observed in patients compared to the control population (4.9 +/- 1.3 vs. 3.5 +/- 1.4). Ni concentration was 1.71 +/- 1.49 ng/mL in patients and 0.72 +/- 0.52 ng/mL in control subjects; Cr concentration was, respectively, 1.01 +/- 0.77 ng/mL and 0.19 +/- 0. 27 ng/mL. The increase of serum Cr and Ni was statistically significant. No correlation was found between the increased Cr concentrations and SCE number while Cr ion levels were found to be significantly correlated to HFC. An inverse correlation between Ni level and SCE numbers was observed. Our findings suggest that Cr release by stainless steel implants could have a genotoxic effect; thus it would be useful to carefully monitor implanted subjects with regard to serum ion dosage, SCE analysis, and HFC evaluation. In any case, it would be appropriate to remove the implant when fracture fixation is reached.

Adolescent↗
PubMed2001

Internal fixation implants for intracapsular proximal femoral fractures in adults.

BACKGROUND: Numerous different implants with screws, pins and side plates have been used for the internal fixation of intracapsular hip fractures. OBJECTIVES: To determine from randomised trials which implant is superior for the internal fixation of intracapsular proximal femoral fractures. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group specialised register. The date of the most recent search was December 2000. SELECTION CRITERIA: Randomised and quasi-randomised trials comparing different implants for the internal fixation of intracapsular hip fractures in adults. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality, by use of a ten item scale, and extracted data. Additional information was sought from trialists. After grouping by implant type, comparable groups of trials were subgrouped and where appropriate, data were pooled using the fixed effects model. MAIN RESULTS: Twenty-seven studies involving 5269 participants (5274 fractures) were included in the study. Considerable variation in the quality of methodology between studies was found and biases due to familiarity with some of the implants were noted. None of the implants tested were found to be significantly superior for any of the outcome measures related to fracture healing complications or mortality. The sliding hip screw was found to take longer to insert and to have an increased operative blood loss compared with multiple screws or pins. REVIEWER'S CONCLUSIONS: No clear conclusions can be made on the choice of implant for internal fixation of intracapsular fractures from the available evidence within randomised trials.

Bone Nails↗
PubMed2004

Pin site care for preventing infections associated with external bone fixators and pins.

BACKGROUND: Metal pins are used to apply skeletal traction or external fixation devices in the management of orthopaedic fractures. These pins protrude through the skin and are therefore described as 'percutaneous' and much has been written on the management of the associated skin wound. The way in which percutaneous pins are treated may affect the incidence of pin site infection. Recommendations for care are not necessarily evidence based. This review set out to summarise the research evidence on the effect of pin site care on infection rates. OBJECTIVES: To assess the effect on infection rates of different methods of cleansing and dressing orthopaedic percutaneous pin sites. SEARCH STRATEGY: The following electronic databases were searched: Medline (from 1966), the Cochrane Central Register of Controlled Trials (2003 issue 1) and the Wounds Group Specialised Trials Register (March 2003). In addition reference lists of review articles and relevant trials were also searched and some handsearching undertaken. SELECTION CRITERIA: All randomised controlled trials (RCTs) in people comparing the effect on infection rates of different methods of cleansing or dressing orthopaedic percutaneous pin sites were evaluated. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed the citations retrieved by the search strategies for reports of relevant RCTs. MAIN RESULTS: Only one trial was eligible for inclusion in the review. Henry (1996) compared cleansing with 0.9% saline, cleansing with 70% alcohol and no cleansing and found significantly fewer infections in pin sites which had not been cleansed. REVIEWER'S CONCLUSIONS: There is very little evidence as to which pin site care regimen best reduces infection rates. Clearly there is a need for large RCTs to determine the best method of pin site management.

Bandages↗
PubMed1976

Animal studies on bone ingrowth kinetics of ceramic material under dynamic stress.

Two of the primary problems of implants in use today result from the materials used in their construction (metal and polyethylene) and from the necessary additional fixation with bone cement. In order to alleviate these well known difficulties, we studied ceramic material (99.7% Al2O3 with 0.25% MgO) which exhibits several advantages in these areas, but has a diminished bending strength. To take advantage of the ceramic material, we tested a cement-free implantation which should allow unhindered growth of bone tissue to or into the material. In particular, the interface relationship under load bearing was investigated. The course of the tissue differentiation and ingrowth on the surface of the ceramic implants under dynamic stress, was studied by a specifically disegned distance-spacer. These were tested on the femur of foxhounds and sheep, as well as by use of temporary immobilization. Histological investigations in intervals of 4 weeks showed the course of the development of the interface tissue. After removal of the binding materials, the behavior of the implant support is studied in 4-week intervals with free load bearing. Radiological and histological development studies are shown. The results we obtained implicate the use of ceremic impants. But the application in humans still seems to be problematic, as there is a need for designs which are loaded by pressure only.

Aluminum↗