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PubMedDate not supplied

Reduction, stability, and strength provided by internal fixation systems for thoracolumbar spinal injuries.

Anterior, posterior, and combined thoracolumbar spinal injuries were simulated in human cadaver specimens and then stressed in flexion, before and after stabilization, with Weiss Springs, Roy-Camille plates, vertebral body plates, and Harrington compression and distraction rods. The reduction, stability, and strength were determined for each implant-injury combination. For posterior ligamentous injuries, the Harrington compression system on the laminae gave reduction in extension, stability to that of the intact spine, and failure at 87.6 Nm bending load with 14.1 J energy absorption. For anterior vertebral body fracture, Harrington distraction rods from three vertebrae above to three below the injury gave a reduction in extension with stability similar to that of the intact spine. Failure occurred at 81.6 Nm load, one-third greater than with rods two levels above to two below, and 14.0 J energy absorption, twice that for the short rod. The more unstable combined anterior and posterior injury was satisfactorily reduced only by the long distraction system, which failed at 44.1 Nm load, twice that for the short rod, and 5.7 J energy absorption. By accurately determining what structures have been injured, and appropriate fixation device can be selected and the strength of the stabilized spine estimated. A thorough understanding of the biomechanics of the spine is essential for successful clinical utilization of these experimental data.

Aged↗
PubMed1981

Internal fixation of the femur in patients with osteogenesis imperfecta.

The operation of fragmentation and intramedullary rod fixation of the femur with an extensible device has proved valuable for children with osteogenesis imperfecta because it permits these children to remain ambulatory. The use of an extensible rather than a solid rod has greatly decreased the need for reoperation.

Child↗
PubMed1978

[Management of bone metastases. Indication for radiotherapy and surgical internal fixation (author's transl)].

Radiotherapy of bone metastases can achieve in up to 78% of patients complete relief of pain. Recalcification avoids pathological fractures and beginning compression of the spinal cord. Depending on size and site of the osteolytic process a prophylactic surgical stabilisation will be necessary. Bone metastases are a sign of generalized disease. Systemic therapy should be provided in addition to local therapy.

Adult↗
PubMed1994

Open reduction internal fixation of supracondylar fractures above total knee arthroplasties using the intramedullary supracondylar rod.

Seven patients who had low supracondylar fractures above total knee arthroplasties were treated using the intramedullary supracondylar rod. Six of the seven patients were steroid-dependent, long-standing severe polyarticular rheumatoid arthritics with marked osteopenia. The intramedullary supracondylar rod provided stable fixation that allowed early range of motion of the knee. Union occurred in good position in all patients; return to prefracture function was achieved in three months. The surgical procedure was reliable and was associated with minimal morbidity.

Aged↗
PubMed1994

Treatment of non-rheumatoid occipitocervical instability. Internal fixation with the Hartshill-Ransford loop.

We performed posterior fixation with a Hartshill-Ransford contoured loop in 43 patients with instability at the craniocervical junction. No external bracing was used. Fifteen patients had congenital malformations, ten had tumours, seven had 'bone-softening' conditions (such as osteogenesis imperfecta), five had suffered complicated fractures, three had occipito-C1-C2 hypermobility due to lax ligaments and three had severe degenerative spondylosis with pseudotumours of the transverse ligament. Twenty-nine patients had transoral decompression of the cord before fixation. In most cases, cancellous bone grafts taken from the iliac crest were used to induce fusion; in nine very ill patients, no bone graft was used. In the whole series there was no instance of construct failure, broken wire or laminar fracture. The best results were achieved in patients with tumours or bone-softening conditions. No patient with normal neurology deteriorated after surgery but seven had worse neurological deficits after operation than before. Neck stiffness caused half the patients to change their lifestyle.

Adolescent↗
PubMed1993

Biomechanical comparison of 1-screw and 2-divergent pin internal fixations for treatment of slipped capital femoral epiphysis, using specimens obtained from immature dogs.

Biomechanical strength and stiffness of 2 fixation treatments used to repair acute slipped capital femoral epiphysis were evaluated in bone specimens form immature dogs. A servohydraulic testing machine was used to create slipped capital femoral epiphysis in 7 pairs of femurs by shearing the capital femoral epiphysis along the physis in a craniocaudal direction. The slip was reduced and repaired with one 3.5-mm-diameter screw placed in lag fashion or 2 double-pointed, 1.6-mm (0.062 inch)-diameter smooth pins and retested. Strength and stiffness of each intact femur (which served as the control) and repaired femur were compared. Results of the study indicated that the failure strength of 2-pin fixation was significantly (P < 0.05) weaker than its control and the 1-screw fixation. There was no significant difference between failure strength of the 1-screw fixation and its control. The stiffness of 1-screw and 2-pin fixations was not significantly different, compared with each other, but was significantly (P < 0.05) less, compared with their respective controls.

Animals↗
PubMed1993

Suitability of biodegradable polydioxanone materials for the internal fixation of fractures.

A distal femoral osteotomy in 46 rabbits was fixed either with biodegradable polydioxanone (PDS) thread and pins (group A, 31 animals) or with metallic Kirschner wire and pins (group B, 15 animals). Postoperatively, the distal part of each femur was removed and evaluated, and bone sections were evaluated by histology and histomorphometry. Macroscopic studies showed complete PDS absorption in all cases 24 weeks postoperatively. The histologic studies revealed new bone surrounding the area of the implant 3 weeks postoperatively, and at 24 weeks postoperatively, there was thinning or disappearance of the new bone around the implant. On the basis of the present study, PDS thread and pins show promise for the fixation of osteotomies or fractures of cancellous metaphyses of small long bones, such as metacarpals and phalanges.

Animals↗
PubMed1995

Internal fixation (pedicle screw fixation) for fusions of the lumbar spine.

STUDY DESIGN: Literature review. OBJECTIVES: To illustrate the indications and potential complications of pedicle screw application in the lumbar spine. SUMMARY OF BACKGROUND DATA: Except for the treatment of severe spondylolisthesis (grades 3 and 4) at L5-S1, using autogenous bone graft and with device removal often fusion is obtained. Pedicle screw devices labeled for stabilizing the lumbar spine or correcting deformities in fusion procedures are currently considered Class III medical devices by the Food and Drug Administration, that is, investigational or experimental forms of spinal fixation. Recent clinical studies have attested to their usefulness and safety by qualified surgeons for selected surgical indications. METHODS: Literature synthesis. RESULTS: Segmental fixation increases the fusion rate and clinical success of indicated patients undergoing the procedure in lumbar spine operations, as it does in the treatment of fusion of long bone injuries, scoliosis, and other comparable surgeries. CONCLUSION: With this technology, surgeons can effectively reduce the pseudarthrosis rate, improve patient satisfaction and results of functional studies, and ultimately reduce the long-term cost to society as a result of effective initial posterior lumbar spine surgery.

Bone Screws↗
PubMed2005

Stripping torque as a predictor of successful internal fracture fixation.

BACKGROUND: Internal fixation of fractures using plates and screws is a common method of treatment. Occasionally the internal fixation fails prior to fracture healing. This often requires revision surgery. Determining the force that internal fixation needs to withstand postoperatively would enable this force to be applied intraoperatively as a test to predict successful fixation. The purpose of the present paper was to determine the minimum stripping torque needed to predict successful internal fixation strength. METHODS: The pull-out strength and stripping torque relationships of 4.5-mm cortical bone screws in Sawbones polyurethane foam were determined. Screw forces were directly measured using an LCM load cell washer on a model intertrochanteric neck of femur fracture fixed with 135 degrees 4-hole pin and plate loaded to single leg stance conditions. Additionally a 135 degrees 4-hole pin and plate was mounted on foam blocks and loaded until failure of the shaft screws from the foam occurred. Predicted stripping torque/yield load was determined. RESULTS: Pull-out strength and stripping torque of 4.5-mm cortical bone screws in polyurethane foam have a high degree of linear correlation R(2) = 0.95. Direct measurement of shaft screw forces at single leg stance conditions were 585-686 N. This correlated with a stripping torque of 0.9 Nm. Load to yield testing at single leg stance conditions corresponded to a stripping torque of 1.8 Nm. CONCLUSION: Withstanding 0.9-1.8 Nm of torque during insertion of the femoral shaft screws of a 135 degrees 4-hole pin and plate predicts that the construct will successfully withstand single leg stance.

Bone Nails↗
PubMed1991

Treatment of ununited fractures of the carpal scaphoid by iliac bone grafts and Herbert screw fixation.

Internal fixation with a Herbert screw was used to treat 70 ununited fractures of the carpal scaphoid. Bone grafts were utilised in all cases of nonunion (56) and in 10 out of 14 with delayed union. The results were assessed at a mean time of 13 months. Definite radiographic union was achieved in 90% of patients after a mean period of postoperative immobilisation of 5.4 weeks. Although the rate of union was basically the same as in Russe's series, the final functional results were better than those obtained by using his technique. The use of an image intensifier is essential to avoid technical problems.

Adolescent↗
PubMed1988

[Combination of external fixator and internal synthesis in fractures and pseudoarthrosis of the leg. Principle indications and results].

A combination of internal and external fixation has been used on 58 occasions in fractures and pseudarthroses in the leg. In almost two-thirds of the cases, the fractures were compound. Several situations favour this combination of fixation: internal fixation complements an initial external fixation by stabilising the fracture site in the shaft or by allowing reconstruction of joint surfaces, external fixation complements any inadequate internal fixation due to comminution of the fracture or poor skin cover that only allows a minimum of internal fixation, external fixation secondarily comes to the help of internal fixation in cases of skin necrosis or secondary bone infection. The authors believe that a combination of internal and external fixation has real advantages and that, when used with good sense, it should not lead to any specific complications.

Adolescent↗
PubMed2001

Fractures of the distal radius. Current concepts for treatment.

The authors review the treatment of fractures of the distal radius, based on their experience and from data in the literature. The choice of a treatment for any given fracture must take into account first of all the stability of the fracture. The best results are achieved in stable fractures. Only minimally displaced distal radius fractures can be treated functionally. However, a plaster cast for one week is indicated for the comfort of the patient. In displaced but stable fractures both closed reduction and percutaneous fixation are indicated. In case of closed reduction, the plaster cast should be applied for 5 to 6 weeks with an above-elbow cast for 3 weeks. Percutaneous fixation gives the best results in extraarticular fractures in younger patients. Because of its simplicity however, it should not be ignored in the elderly osteoporotic patients. In the authors' experience, both techniques were only used for extraarticular fractures. Good and excellent results were found in the closed reduction and plaster cast group in 74% of the patients; the Kapandji technique gave 75% good and excellent results. These results are in line with other findings which show that, for simple fracture types, the Kapandji technique and closed reduction seem to give similar results. External fixation is widely used for intra-articular comminuted fractures. Dynamic external fixation does not show any advantage over static devices. Additional K-wires or bone grafting may be necessary. External fixation gives superior results to plate and screw fixation. Internal fixation should be reserved for fractures with ventral comminution or severe displacement with unacceptable reduction by closed or minimally invasive techniques.

Adolescent↗