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PubMed1976

Prophylactic internal fixation of the femur for neoplastic lesions.

Prophylactic intramedullary nailing was performed in eighteen femora of fourteen patients who had neoplastic lesions in the femur and survived for from thirty-eight to 1309 days after nailing. The procedure enabled all but three patients to be ambulatory with a walker by four days after operation and to continue to walk until they became moribund shortly before death. The complications were: one postoperative infection, penetration of the nail through the femoral cortex in three femora before prebending of the nail became part of the procedure, and ectopic bone about the proximal end of the rod. The procedure is recommended for the prevention of pathological fracture and relief of pain.

Aged↗
PubMed2000

Internal fixation of cervical trauma following corpectomy and reconstruction. The effects of posterior element injury.

Although biomechanical data indicates that anterior fixation alone in unstable cervical injuries may not provide adequate stability, reports of clinical series indicate general success with this method of treatment. The specific contribution of posterior column injury to overall stability following reconstruction has not been evaluated. This study examined the biomechanical stability of anterior and/or posterior plate fixation following anterior corpectomy and reconstruction for unstable cervical injuries with varying degrees of posterior element injury. The C4-C6 motion segments of ten fresh frozen bovine cervical spines were used. After mounting, nondestructive mechanical testing in axial compression, torsion, flexion, extension, and lateral bending was done as an intact control. A C5 corpectomy with reconstruction using a synthetic bone graft was performed and the posterior ligaments sectioned at the C5-C6 level. Each specimen was sequentially instrumented with anterior and posterior plating alone and in combination and each construct was mechanically retested. The specimens were then further destabilized by bilateral facetectomies at C5-C6 and again tested with the same instrumentation combinations. In comparison to the controls, the spines with a C5 corpectomy/bone graft and posterior ligament rupture with anterior plating demonstrated significantly increased stiffness in flexion, extension, and lateral bending; posterior plating increased stiffness in only flexion and lateral bending. In axial compression and torsion, anterior or posterior plating demonstrated stiffness similar to the controls. Further destabilization by facetectomy significantly decreased stiffness of the instrumented construct (less than control) in torsion with anterior or posterior plate fixation alone. Combined plating showed increased stability compared to controls in all loading conditions for both patterns of instability. Anterior plating alone was able to restore the stability of the cervical spines with posterior ligamentous injury after corpectomy, but it failed to do so with the addition of bilateral facetectomies. For the unstable cervical spine with significant bilateral loss of posterior bony contact, anterior or posterior plating alone may not provide sufficient stabilization in the absence of any additional external immobilization. Combined plating should be considered, which may obviate the need for external immobilization.

Analysis of Variance↗
PubMed2000

[Anterior interbody autografting and internal fixation for primary surgical management of thoracolumbar spinal tuberculosis].

OBJECTIVES: To verify the importance of early reconstruction of spinal stability and to evaluate the safety of anterior instrumentation in surgical management of spinal tuberculosis. METHODS: Eleven cases of thoracolumbar spinal tuberculosis were treated with primary anterior debridement, interbody autografting and Z-plate fixation from October 1997 to January 1999. RESULTS: All the 11 cases healed without any recurrence after follow-up for an average of 16 months. Spinal fusion occurred in 3.8 months on average after surgery. 18 degrees of kyphosis correction was achieved with no associated complication. CONCLUSIONS: Early reconstruction of spinal stability plays an important role in surgical management of spinal tuberculosis, and it is safe to implant anterior titanium spinal instrument in tuberculosis foci.

Adolescent↗
PubMed1992

Biomechanical comparison of three internal fixations for treatment of slipped capital femoral epiphysis in immature dogs.

The biomechanical strength and stiffness of 3 fixation techniques used to repair acute slipped capital femoral epiphysis were evaluated in bone specimens from immature dogs. A servohydraulic testing machine was used to create slipped capital femoral epiphysis in 9 pairs of femurs by shearing the capital femoral epiphysis along the physis in a craniocaudal direction. The slip was reduced and repaired with 1, 2, or 3 double-pointed, 1.6-mm (0.062-inch) smooth pin(s) and retested. The strength and stiffness of each intact femur (which served as the control) and repaired femur were compared. Results of the study indicated that differences among the failure strengths of 1- and 2-pin fixations and their respective controls were not significant; however, the 3-pin fixation was 29% stronger than its control and was 60 and 45% stronger than the 1- and 2-pin fixations, respectively. One- and 2-pin fixations were 34 and 24% less stiff than their respective controls, whereas the stiffness of the 3-pin fixation was similar to its control. The 2- and 3-pin fixations were 48 and 76% stiffer, respectively, than the 1-pin fixation, but were not significantly different, compared with each other.

Animals↗