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PubMed2001

Observations concerning different patterns of bone healing using the Point Contact Fixator (PC-Fix) as a new technique for fracture fixation.

The recent trend in all surgical disciplines has been the development of techniques in minimally invasive surgery and the optimal maintenance of the blood supply to the bone fragments during osteosynthesis. Currently, the Point Contact Fixator (PC-Fix) has been introduced as a new implant for the stabilization of forearm bones. This plate-like splint and screw fixation system, which actually acts as an internal fixator, is characterized by minimized isolated contacts to the bone and proven angular stability of the monocortically locked screws. By using the PC-Fix, a further reduction of damage to the blood supply to the bone is achieved. Since 1994, 38 patients have been treated with this new device; we have reviewed the radiographs of 52 consolidated forearm fractures/osteotomies in accordance with the patterns of bone healing associated with the different methods of implant application according to the fracture type. In the groups in which traditionally precise reduction, interfragmentary compression and stable fixation was achieved (N=31), we found in 71% an absence of periosteal callus (direct bone healing). In the groups in which compression and adaptation were combined, or even main fragments adapted without compression, with wedges remaining unreduced in soft tissue connection (N=21), we found a visible external callus in 81% (indirect healing) (P = 0.002). Indirect healing after internal fixation is no longer regarded as a disturbance to healing, but is a goal in itself. The appearance of callus is a welcome sign indicating a prompt and positive reaction in the course of bone union which will lead to progressive fracture immobilization. When using the PC-Fix in a "biological way", callus formation and solid union take place earlier than in conventional plating. The new internal fixator offers substantial technical and mechanical advantages in fracture treatment. Therefore, it is an ideal implant to satisfy the requirements of modern biological osteosynthesis without compromising the restoration of axial alignment, rotation, length and postoperative functional treatment.

Adolescent↗
PubMed1987

The design and analysis of a laminated partially degradable composite bone plate for fracture fixation.

During the early stages of fracture healing, rigid internal fixation maintains alignment and promotes primary osseous union. Unfortunately, as healing progresses rigid fixation from bone plating can cause bone in the region of the plate to undergo stress protection atrophy. This can result in significant loss of bone mass and osteoporosis. Refracture of the bone upon device removal is a widely reported complication. In an effort to minimize or eliminate stress protection atrophy, we have designed a partially absorbable, fiber-reinforced bone plate. Ideally, such a plate gradually loses rigidity as the fracture heals, increasingly transferring stress to the bone. Stress protection may be avoided and removal of the device after healing may be unnecessary. Composite theory was used to determine an optimum fiber layup for a composite bone plate. Composite analysis suggested the mechanical superiority of a 0 degree/ +/ -45 degree laminae layup. Given this laminated design, a thermoplastic absorbable polymer (polylactic acid polymer) was reinforced with high-modulus carbon fiber to produce a semiabsorbable composite. Implant evaluation included optimizing fabrication techniques, thorough mechanical device testing, and implantation on canine femurs to determine biocompatibility and efficacy. The composite design proved to have superior static and fatigue properties to laminated or random fiber designs used previously. Two techniques for hole fabrication were tested. The production of screw holes during the molding process rather than machining postmolding, improved the mechanical integrity of the finished plate. Although the 0 degree/ +/- 45 degree carbon/polylactic acid composite possessed superior mechanical properties, it was unsuccessful in the in vivo environment. Water absorption and subsequent delamination made the plate flexible. Hypertrophic nonunions developed. Further development to prevent water intrusion and premature loss of mechanical properties is necessary.

Absorption↗
PubMed1998

Mechanical evaluation of a new minimum-contact plate for internal fracture fixation.

OBJECTIVE: To determine whether the mechanical properties (stiffness and strength) of a new design of internal fixation plate, with reduced bone-to-plate contact area for reducing disturbance to the bone blood supply at the fracture site, are comparable with those of commonly used fracture fixation plates. DESIGN: Four-point bending and torsion tests were conducted to compare the new minimum contact plate (MCP) with two established internal fixation plates: the dynamic compression plate (DCP) and the limited contact dynamic compression plate (LC-DCP). The bending stiffness and strength were determined according to the International Standards Organization bending test for bone plates, and the torsional stiffness and torque to failure were calculated from torsional loading data with the plates attached to synthetic bones. RESULTS: The new MCP plate was significantly stiffer than the other two plates and stronger than the DCP plate in bending (p < 0.01). In torsion, the MCP plate was marginally stiffer (p < 0.11) and significantly stronger (p < 0.01) than the LC-DCP plate and not as stiff and strong as the DCP plate (p < 0.01). CONCLUSIONS: Mechanically, the MCP plate has adequate stiffness and strength for clinical application because it is at least as stiff and strong as one of the commonly used plates under both bending and torsional loading conditions.

Animals↗
PubMed1997

Comparison of distal humerus fracture fixation: a biomechanical study.

Few biomechanical studies have been done evaluating the rigidity of internal fixation constructs for distal humerus fractures. We assessed the bending and torsional stiffness of five commonly used multiple plate constructs. Plates were applied in three positions: medially, along the medial supracondylar column; laterally, along the lateral supracondylar column; or posterolaterally, extending distally to the capitellum. Each specimen was randomly assigned to one of five construct groups. All plated specimens were stiffer in the frontal plane as compared with the sagittal plane and, when compared with intact specimens, showed a disproportionate decrease in sagittal plane stiffness. Constructs 1 and 5 had significantly greater relative bending stiffness in the sagittal plane than constructs 3 and 4. Construct 4 had the lowest relative bending stiffness in the frontal plane. This reached statistical significance when compared with constructs 2 and 5. There was no significant difference in the torsional stiffness of the five constructs. We conclude that the multiple plate constructs offered significantly less bending stiffness than the intact specimens, with a particular deficiency in the sagittal plane. The triple-plated construct (construct 5) did not confer greater stiffness and was technically difficult to implant. The medial pelvic reconstruction plate combined with the posterolateral DCP (construct 1) provided the greatest sagittal plane stiffness, in addition to comparable frontal plane and torsional stiffness. We recommend its use in the treatment of fractures of the distal humerus.

Adolescent↗
PubMed2003

[Chemical synthesis of biodegradable poly-para-dioxanone and its application for mandibular fracture fixation].

OBJECTIVE: To observe mandibular fracture healing after synthesized bioabsorable poly-para-dioxanone (PDS) ligature fixation. METHODS: Para-dioxanone monomer was prepared by chemical reactions of metallic sodium, ethylene glycol and other raw materials. PDS was synthesized by polymerizing the purified para-dioxanone in the presence of catalyst under the conditions of negative pressure and certain temperature. PDS ligature was obtained by processing the polymer into small granules, drying and melt-extruding through a spinnerette. Eighteen adult male New Zealand rabbits were assigned randomly into two groups. After mandibular fracture models were created, reductions of the artificial fractures were accomplished by means of transosseous PDS ligatures on each of 12 rabbits in experimental group. While the other six rabbits without any internal fixation were set as control. Schedules for killing were arranged to give postoperative samples at two-week interval till 12th week. RESULTS: Radiographical and histological examinations demonstrated that all fractures fixed with PDS ligatures healed without any complication. Periosteal and cartilaginous osteogenesis was observed in newly formed external callus. In contrast, bone fragment migration and the consequent nonunion occurred in the control group. PDS ligature degraded and absorbed without interference with osseous union and healing. The tensile strength reduction of PDS ligature was prior to its absorption in vivo. CONCLUSION: The synthesized PDS is a colorless, flexible, themoplastic and monofilament fiber, which can be sterilized by ethylene oxide embalmment without serious loss of tensile strength. It seems that the application of this macromolecular material in internal fixation is of great worth for further study.

Absorbable Implants↗
PubMed1996

Prevention of heterotopic bone formation after acetabular fracture fixation by single-dose radiation therapy: a preliminary report.

A common complication after acetabular fracture fixation is formation of heterotopic ossification (HO) in the soft tissues about the hip. We are reporting on the use of a single, low-dose radiation therapy regimen to prevent HO in the population of postoperative acetabular fracture patients. Thirty acetabular fracture patients who were at risk for HO after surgery were reviewed with an average follow-up of 12 months. Twenty-one of these patients received radiation therapy in the postoperative period according to a single dose protocol. Nine patients did not receive any prophylactic treatment for the prevention of HO during the same period. One patient from each of these categories was lost to follow-up. Of the 20 treated and followed patients, none developed HO higher than grade 2, and nine had no HO at all. None of the treated patients had any functional deficit due to HO, and none had any complications related to radiation treatment. Of the untreated patients, all had grade 2 HO or above. Three developed grade 4 HO and have undergone reoperation for resection of HO. Study weakness include the fact that the non-treated patients were significantly different from the treated patients in several ways; including the incidence of multiple trauma, head injury, and delay to surgery. No attempt was made to randomize patients prospectively, nor to directly compare the two groups. However, we can conclude, based on comparison with reported rates of HO formation, that single, low-dose radiation therapy is a safe and effective method for prevention of HO in the postoperative acetabular fracture patient. It is as effective as previously reported multidose regimens.

Acetabulum↗
PubMed1998

Mechanical performance of an axially mobile plate for fracture fixation.

BACKGROUND: Emphasis of the advantages of secondary bone healing over primary bone healing has led to a trend of moving from rigid fixation to less-rigid fixation. A reduction in axial stiffness of fixators has been shown to be beneficial to bone healing, and many external fixators have been designed that incorporate axial dynamization. METHODS AND RESULTS: A new axially mobile plate has been designed for long-bone fracture fixation, to give the bone fragments a degree of axial mobility while maintaining bending and torsional stability after fixation. Mechanical bending and torsion tests have been conducted on the axially mobile plate and also on the conventional dynamic compression plate and the limited-contact dynamic compression plate. The results have shown that the new plate is stiffer and stronger in both bending and torsion than at least one of these conventional plates. CONCLUSION: The axially mobile plate has adequate mechanical properties and can be taken forward to clinical trails.

Biomechanical Phenomena↗
PubMedDate not supplied

Biomechanical analysis of olecranon fracture fixation in children.

The authors present an original fixation technique for olecranon fractures in children, achievable without opening the fracture site. The standard method of Kirschner wire fixation with tension band wiring is replaced by a threaded pin stabilization with adjustable lock effect. An olecranon fracture model was used to compare the mechanical properties of this new system with the tension band wiring technique, and with a simple pin fixation. No significant difference was found between the two first techniques, whereas the simple pin fixation had much poorer mechanical properties.

Biomechanical Phenomena↗
PubMed1997

Femoral neck fracture fixation. Clinical decision making.

Femoral neck fractures continue to pose significant decision making problems for the busy practitioner. Indirect factors over which the orthopaedic surgeon has little control include the patient's preinjury medical status, metabolic bone quality, and fracture classification. Direct factors that fall on the decision making ability of the surgeon include surgical timing, capsular hematoma, quality of reduction, and mechanics of fixation. Early, rigid anatomic reduction with 6.5-mm compression screws in patients with few comorbidities will achieve the optimum outcomes using fixation techniques. Anterolateral open approaches afford capsular hematoma decompression and anatomic access for fixation in the young or irreducible fracture pattern.

Bone Density↗
PubMedDate not supplied

The effects of surgical fracture fixation on the systemic inflammatory response to major trauma.

Early stabilization of major long bone fractures is beneficial in reducing the incidence of acute respiratory distress syndrome and multiple organ failure, both of which are caused by activation of the systemic inflammatory response. This activation results in tissue recruitment of and injury by circulating polymorphonuclear leukocytes. The reasons for clinical benefits of early fracture stabilization in major trauma are unknown. Published studies indicate that fracture surgery increases the posttraumatic inflammatory response. Major surgery to stabilize fractures carries a higher complication rate when performed on patients whose hypovolemic shock is not fully corrected. Thus, fracture care should be tailored to the patient, not dictated by the injured bone. Understanding the impact of fracture surgery on the systemic inflammatory response to major trauma is necessary to refine treatment and to apply it optimally to all patients.

Fracture Fixation↗
PubMed2006

Bone density comparison of selected carpal and tarsal bones: validation for their use in compression fracture fixation studies of scaphoid screws.

INTRODUCTION: To determine if trabecular, total and cortical bone densities of the capitate, navicular, cuboid, and first cuneiform were equivalent to those of the scaphoid, such that these bones could be used in place of the scaphoid in evaluating new headless scaphoid compression screws. METHODS: Fifty scaphoids, capitates, naviculars, cuboids, and first cuneiforms were harvested from fresh frozen cadavers. The trabecular, total and cortical bone densities were measured using pQCT technology and statistically compared. RESULTS: A paired t comparison between paired scaphoids and capitates showed no difference between the trabecular bone densities. However, their total bone and cortical densities were found to be different. An independent measures ANOVA comparison of the five bones, showed no significant difference in mean trabecular density between the capitates, naviculars and first cuneiforms when compared to the scaphoids. However, the mean total and cortical densities of the first cuneiforms were less than the scaphoids and the mean trabecular, total and cortical bone densities of the cuboids were all less than the scaphoids. DISCUSSION: Compression fracture fixation studies of headless compression screws could be conducted using the capitate, navicular, and first cuneiform as models of the scaphoid when the supply of scaphoids is limited.

Aged↗
PubMed1991

Fatigue failure of the sliding screw in hip fracture fixation: a report of three cases.

Hardware failure of the sliding screw system used in hip fracture fixation is rare. The fatigue failure of the sliding screw is always related clinically to nonunion or refracture along the path of the screw. In both situations, cyclic loading of the implant exceeds its endurance limit, and failure can ensue. Three cases of failure of the sliding screw are presented: a nonunion of a basicervical fracture, a nonunion secondary to stress fracture at the plate-barrel junction, and a refracture through the femoral neck after healing of an intertrochanteric fracture. A biomechanical analysis of the stresses on the sliding screw focuses on design features such as the internal threaded region used for the compression screw or the barrel length that creates increased stresses in the screw, thus lowering the number of cycles to failure. Based on this analysis, recommendations are made concerning implant design and surgical technique.

Adult↗
PubMed1992

New generation biodegradable plate for fracture fixation: comparison of bending strengths of mandibular osteotomies fixed with absorbable self-reinforced multi-layer poly-l-lactide plates and metallic plates--an experimental study in sheep.

Eighteen osteotomies of sheep's mandibular corpus were fixed: nine with self-reinforced multi-layer poly-l-lactide (SR-PLLA) plates and nine with metallic plates. Both plates were fixed with similar metallic screws. The right corpus of each sheep acted as a control. Radiographic analysis was carried out at 3 weeks and at sacrifice (6, 12 or 24 weeks) when the bending force needed to break the osteotomy site was measured. At 6 and 12 weeks of follow-up the osteotomy fixed with the PLA-plate seemed to tolerate the bending force better but no significant differences were detected at 3 or 24 weeks. The results have been satisfactory and have led the authors to continue with the development of a SR-PLLA plate-and-screw device for fracture fixation.

Absorption↗