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At least 1,639 records · Page 91Linked to original sources
PubMed2000

The management of laryngeal fractures using internal fixation.

BACKGROUND: Laryngeal fracture is a rare injury with the potential to affect all functions of the larynx. Restoration of the laryngeal framework is critical for the rehabilitation of laryngeal function. OBJECTIVE: To ascertain the efficacy of adaptation plate fixation (APF) to repair the laryngeal skeleton. STUDY DESIGN: Retrospective review of the clinical data of all patients who underwent APF of laryngeal fractures from January 1989 to September 1999. RESULTS: Our series consisted of 16 men and 4 women presenting with laryngeal fractures caused by blunt (n = 16) or penetrating (n = 4) trauma. Most of these patients presented with severe fractures classified as category III (n = 6), IV (n = 10), or V (n = 1), according to the Schaefer-Fuhrman classification. All patients who required a tracheotomy (n = 13) were de-cannulated. Nineteen of the 20 patients recovered a social voice. The exception was a patient with aphasia secondary to head trauma No patient had aspiration problems. We encountered no complication associated with the use of APF. CONCLUSION: APF is an effective and well-tolerated method to repair laryngeal fractures.

Adolescent↗
PubMed1999

Transoral fusion with internal fixation in a displaced hangman's fracture.

STUDY DESIGN: A case is reported in which late displacement of a "hangman's fracture" was managed by transoral C2-C3 fusion by using bicortical iliac crest graft and a titanium cervical locking plate. OBJECTIVES: To review the management of unstable fractures of the axis and to study other reports of transoral instrumentation of the cervical spine. SUMMARY OF BACKGROUND DATA: Undisplaced fractures of the axis are considered to be stable injuries. Although late displacement is unusual, it can lead to fracture nonunion with persisting instability and spinal cord dysfunction. In this situation, an anterior fusion of the second and third cervical vertebrae is preferred to a posterior fusion from the atlas to the third cervical vertebra, which would abolish lateral rotation between C1 and C2. METHODS: The literature on hangman's fractures was reviewed. Clinical and radiographic details of a case of C2 instability were recorded, and the particular problems posed by late displacement were considered. RESULTS: There are no other reports of transoral instrumentation of the cervical spine. A sound fusion of C2-C3 was obtained without infection or other complications. Good neck movement returned by 6 months after surgery. CONCLUSION: Undisplaced fractures of the axis are not always stable. The transoral route allows good access for stabilization of displaced hangman's fractures. In special circumstances, a locking plate may prove useful in securing the bone graft. The cervical spine locking plate can be inserted transorally with no complications and by using standard instrumentation.

Aged↗
PubMed2004

Coverage of distal radius internal fixation and wrist fusion devices with AlloDerm.

Dorsal plating for wrist arthrodesis, although a well-accepted form of treatment of the unstable or arthritic wrist, is accompanied by a high incidence of problems related to soft tissues. Dorsal plating of distal radius fractures has also been associated with soft-tissue complications, particularly extensor tendon ruptures. In an effort to reduce adhesions, extensor synovitis, or tendon rupture, we describe a technique for plate coverage using AlloDerm, an immunologically inert acellular dermal matrix with an intact basement membrane.

Journal Article↗
PubMed2005

Internal fixation of diaphyseal fractures of the forearm by interlocking intramedullary nail: short-term results in eighteen patients.

OBJECTIVE: This study was designed to evaluate the efficacy of the treatment of diaphyseal fractures of the forearm using the ForeSight forearm interlocking intramedullary nail. DESIGN: Retrospective study. SETTING: University-affiliated teaching hospital. PATIENTS: Eighteen patients with 32 displaced diaphyseal forearm fractures were identified. INTERVENTION: All fractures were treated with the ForeSight forearm interlocking intramedullary nail. Eighteen fractures were stabilized with static interlocking technique. MAIN OUTCOME MEASURES: The assessment of patients was based on the time to union, the functional recovery, and the incidence of complications. Physical capability was evaluated by using the rating system of Grace and Eversmann. Patient-rated outcome was assessed by completion of the Disability of Arm Shoulder Hand questionnaire (DASH). RESULTS: All fractures healed with the index procedure. The average time to union for fractures utilizing a closed technique was 10 weeks; for fractures using an open reduction technique, 15 weeks. The mean pronation was 62 (range, 0-96) degrees, and the mean supination was 80 (range, 0-105) degrees. Compared with the normal arm, the mean loss of rotation of the forearm was 32 (range, 5-162) degrees. Using the rating system of Grace and Eversmann, 13 patients had an excellent or good result, 3 had an acceptable result, and 2 had an unacceptable result. Using the patient-rated functional questionnaire, the mean DASH of 19 (range, 4-72) points at the time of the most recent follow-up indicated a mild-to-moderate impairment. There were 7 postoperative complications. The incidence of complications was 22% (7/32). One cross-union between forearm bones occurred in a patient with a closed head injury and high-energy trauma. Two nondriving end screws of the ulna nail backed out causing wrist pain and had to be removed. There were 4 superficial infections occurring all in the fractures that necessitated an open reduction technique. The overall rate of infection was 12.5% (4/32). Three patients who presented with an open fracture needed a skin graft to cover the open wound. CONCLUSIONS: Forearm interlocking intramedullary nailing is an acceptable method to stabilize displaced diaphyseal forearm fractures in adult.

Adult↗
PubMed2006

Wear and corrosion in retrieved thoracolumbar posterior internal fixation.

STUDY DESIGN: Posterior thoracolumbar spine implants retrieved as part of routine clinical practice over a 2-year period were analyzed to identify wear and corrosion. OBJECTIVE: Engineering analyses of retrieved posterior instrumentation for indications of performance and failure and correlation of this information with clinical factors. SUMMARY OF BACKGROUND DATA: Recent studies have reported spinal instrumentation particulate wear debris and have noted the importance of design considerations at implant connector interfaces. METHODS: A total of 57 implants were analyzed from patients (39 female, 18 male) whose average age at implantation was 43.9 years (range, 13.7-77.4 years). Time of implantation ranged from 2 months to 13.5 years. The top 3 implantation diagnoses were radiculopathy (33%), scoliosis (30%), and back pain (25%). Metallurgical analyses were performed to characterize the wear and/or corrosion, and fractures of the implants. RESULTS: Wear was present in 75%, corrosion in 39%, and fractures in 7% of the retrieved implants. Wear and/or corrosion was more prevalent, with respect to the total number of implants retrieved, in implants that had been in service at least 1 year. There was no evidence of corrosion in any of the Ti implants, whereas corrosion was present (with wear) in 58% of the stainless steel (SS) implants. Wear and corrosion were more frequently observed in long rods than in short rods. Implantation times were longer for SS implants than for Ti implants. CONCLUSIONS: Retrieved rods exhibited corrosion, wear, and fracture, with wear and corrosion mainly located at the interfaces with hooks, screws, or cross-connectors. The mechanisms causing this material loss in situ, as well as what local or systemic responses it may stimulate are of clinical significance and should be studied further.

Adolescent↗
PubMed1997

Modern trends in internal fixation of femoral shaft fractures in children. A critical review.

Elastic intramedullary (IM) devices, which avoid the physeal region like Nancy and Ender nails do, can be used in children younger than even 4 years without compromising the trochanter physis or risking an avascular necrosis. Intramedullary fixation of femoral shaft fractures leads to satisfactory results of alignment and union. Prerequisites for intramedullary closed nailing are a traction table, especially for older children and adolescents, and an image intensifer. Interlocking IM, Ender, and Nancy nails all have the equal advantage of early weight bearing and reduced hospitalization time compared with traction and cast management. Küntscher or interlocking nails should only be used in adolescents close to the end of growth to avoid growth arrest of the trochanterocervical physis. Küntscher nails and interlocking IM nails are both associated with the small but troublesome risk of avascular necrosis. Ender and Nancy nails, with retrograde or antegrade pinning, have a low complication rate and a short learning curve for surgeons. Overgrowth in late controls after IM rodding of shaft fractures is about the same as the other types of treatment with an average overgrowth of 7 mm. Short hospital stay for children with IM nails reduces cost of treatment to about one half compared with in-hospital traction and cast management.

Adolescent↗
PubMed1993

Ophthalmic contact lens with internal fixation light for examination of the optic nerve head.

Stereoscopic slitlamp examination of the optic nerve head in one-eyed patients is difficult because there is currently no way to provide the patient with a fixation target. This situation is often aggravated in glaucoma patients by a miotic and fixed pupil. We have developed a funduscopic contact lens which incorporates a fixation target, allowing the patient to view the target with the eye being examined. The device has been successfully tested on normal volunteers.

Contact Lenses↗
PubMed1995

The stability of facial osteotomies. 4. Maxillary and mandibular (with or without chin) advancement with rigid internal fixation.

The short-term (6 weeks postoperative) and long-term (12 months postoperative) horizontal skeletal stability of combined maxillary and mandibular advancement was evaluated by cephalometric analysis of 15 patients. The mean horizontal advancement of the maxilla was 5.84 mm. Six weeks later a mean horizontal relapse of 0.03 mm (0.05%) was identified. The mean horizontal relapse at long-term follow-up was 0.59 mm (10.1%). The mean horizontal advancement of the mandible was 12.35 mm at menton and 12.65 mm at pogonion. At 6 weeks, mean horizontal relapse, respectively at the above landmarks, was 0.11 mm and 0.21 mm (1.3%). The mean horizontal relapse at long-term follow-up was 2.19 mm and 1.98 mm (16.6%) respectively for the same landmarks. Subjectively and objectively, improvements were seen in facial aesthetics and dental occlusion. The results indicate that rigid fixation of osteotomies undertaken to correct 'horizontal facial deficiency' is a surgically predictable and relatively stable procedure when reviewed up to 12 months after surgery.

Adolescent↗