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At least 19 recordsLinked to original sources
PubMedDate not supplied

Internal fracture fixation in patients with osteoporosis.

Because of the decreased holding power of plate-and-screw fixation in osteoporotic bone fractures, internal fixation can have a high failure rate, ranging from 10% to 25%. Screws placed into cortical bone have better resistance to pullout than do those placed into adjacent trabecular bone. Plates should not be used to bridge unstable regions of bony comminution in osteoporotic patients. Fixation stability is optimized by securing stable bone contact across the fracture site and by placing screws both as close to and as far from the fracture as possible. Intentional shortening can improve stability and load sharing of the fracture construct. Structural bone graft or other types of fillers can be used to fill voids when comminution prevents stable contact. Load-sharing fixation devices such as the sliding hip screw, intramedullary nail, antiglide plate, and tension band constructs are better alternatives for osteoporotic metaphyseal locations. Proper planning is essential for improved fracture fixation in this high-risk patient group.

Fracture Fixation, Internal↗
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↗
PubMedDate not supplied

Physical and biological aspects of fracture healing with special reference to internal fixation.

Fracture healing is a repair process of a mechanical discontinuity loss of force transmission, and pathological mobility of bone. Through a sequence of changes of tissue development and geometry, the original structural integrity is restored. The recovery of rigidity and strength is related to tissue differentiation. In unified theory of non-operative and operative stabilized fractures, the mechanics of primary bone healing involves a complex interplay of physical and biological factors. The different patterns of bone repair respond to physical influences including strain tolerance.

Animals↗
PubMed1999

The merit of sintered PDLLA/TCP composites in management of bone fracture internal fixation.

Polyesters based on lactic acid have been reported in terms of safety and biodegradation in human beings for 2 decades. The greatest advantage of such material is its degradation conducted only by hydrolysis, whereby the ester backbones are supposed to be unchained in the aqueous condition. The final degradable products are carbon dioxide and water which can be metabolized and digested in the physiological environment. The goal of this study was aimed at developing a composite sintered with poly-DL-lactide (PDLLA) and tricalcium phosphate (TCP) ceramic particles for orthopedic application. The TCP particles in a range of 30-60 wt% with 5 wt% increments were doped into the PDLLA matrix which was prepared by melting and hot pressing techniques for the reinforcement. The basic mechanical strength, biodegradable behavior, and biological response of the composites were investigated in the study. Various techniques such as pH meter, UV, Fourier-transform infrared, and x-ray diffractometer were used to examine and record the degradable process of the composites soaked in saline for 1-16 weeks. The rabbit femur condyle fracture fixation test was used to evaluate tissue compatibility and the effects of bone fracture fixation on the composites. Histological observation and x-ray photography were used for investigating assistance. The mechanical strength of the composites initially increased with TCP additions up to 50wt%, but thereafter they showed no significant difference (p < 0.05). The composite with 50 wt% TCP addition showed greater mechanical strength and had good agreement with cortical bone in terms of its elastic modulus of 30-40 GPa. The weight loss of the pure PDLLA soaked in the saline started at 4 weeks and reached 95% after 16 weeks. The composites compared with pure PDLLA, however, showed no apparent evidence of degradation after soaked for 12 weeks. The possible mechanisms for the delayed degradation of the composites in saline might have been solution penetration retardation by the ceramic particles and chemical bonds formed between the interface of the TCP particles and the PDLLA matrix. In the histological evaluation of the rabbit femur condyle fracture fixation test, the surface of the composite with 50 wt% TCP addition was attached by the newly generated bone without fibrous tissue around 8 weeks after implantation. The fractured bone was gradually healed and the composite firmly and properly fixed on the fracture area during the implanted period, which provided a breeding environment for normal bone remodeling. The developed composite was thought to be an alternative material for orthopedic application in the future, especially for bone screws and bone plates.

Absorption↗
PubMed2006

Internal fracture fixation using the Stoppa approach in pelvic ring and acetabular fractures: technical aspects and operative results.

BACKGROUND: The ilioinguinal approach is well established for the treatment of pelvic fractures. As an alternative, the modified Stoppa approach can be used to expose pelvic and acetabular fractures. We describe our experience with this approach in patients with pelvic and acetabular fractures with respect to fracture reduction, technical aspects, and the incidence of intra- and postoperative complications. METHODS: This retrospective study describes a series of 25 consecutive patients where a modified Stoppa approach was used for pelvic or acetabular fracture fixation. RESULTS: Fifteen patients with acetabular fractures, six patients with a pelvic ring injury not involving the acetabular joint and four patients with a combined fracture were operated through a Stoppa approach. Nine patients had a total of 13 complications, none of which required reoperation. Anatomic or satisfactory reduction was achieved in 95% of the acetabular fractures. Pelvic ring fractures had an anatomic (displacement <1 cm) postoperative result in all 10 cases. CONCLUSION: The modified Stoppa approach allows an adequate exposure and good postoperative results for treatment of pelvic ring fractures and acetabular fractures that are eligible for an anterior approach.

Acetabulum↗
PubMedDate not supplied

[Displaced femoral neck fractures: internal fixation or arthroplasty?].

Femoral neck fractures are a challenge for orthopedic surgeon due to the high rate of complication for such fractures. The aim of this study was to propose a treatment algorithm based on author's current concept in management of femoral neck fractures. Fractures were classified according Garden in four types but, for practical reasons, fractures were considered undisplaced (Garden I and II) and displaced (Garden III and IV). Treatment method was chosen based on next criteria: patient's age, associated pathology, patient's mental status and expectations, quality of the bone (osteoporosis), type and age of fracture, quality of reduction. Based on this criteria, the proposal algorithm may led to close reduction and internal fixation, open reduction and internal fixation or arthroplasty.

Aged↗
PubMed2004

Internal fracture fixation.

Over the past decade, many improvements to small animal internal fracture fixation have been developed, including improved fixation techniques and a more diverse selection of implants. The understanding that appropriate fixation selection is based on a plethora of biologic, mechanical, and clinical factors has also emerged. Classically, the methods of internal fracture fixation have used pins, wires, screws, and plates to rigidly stabilize fractures that have been anatomically reduced with significant disruption to the biologic fracture environment. Newer methods attempt to minimize trauma to the soft tissues surrounding a fracture and promote biologic osteosynthesis using such implants as interlocking nails and plate-rod fixations. This review provides an overview of both the traditional and current principles of small animal internal fracture fixation.

Animals↗
PubMed1988

The displaced femoral neck fracture. Internal fixation versus bipolar endoprosthesis. Results of a prospective, randomized comparison.

The displaced femoral neck fracture poses difficult decision-making issues for the orthopedic surgeon. Young patients frequently require a rapid open reduction and rigid internal fixation in the face of multiple associated injuries. Elderly patients present the typical decision dilemma of internal fixation versus arthroplasty. Consecutive, randomized, prospective series of cases for evaluation of alternatives in the treatment of this difficult fracture are lacking. Between 1982 and 1984, 34 elderly patients with displaced femoral neck fractures were randomized to open reduction or hemiarthroplasty study groups. Although the surgical risks are relatively high, two-year observations showed better functional results in the cemented hemiarthroplasty group.

Aged↗
PubMed1998

Comminuted fractures of the radial head. Arthroplasty versus internal fixation.

Fractures of the radial head continue to challenge orthopaedic surgeons. Fortunately, most simple uncomplicated fractures treated non-operatively with emphasis on early motion achieve good results. Treatment of more complex fractures remains controversial, however. When simple radial head excision is contraindicated, choosing between open reduction and internal fixation and radial head replacement remains difficult. A review of the literature does not provide definite guidelines, but suggest that fracture complexity and technique are critical for success. This paper is not intended to review the treatment of radial head fractures, but rather to focus on choosing between replacement versus internal fixation when preservation of radial head mechanics is indicated.

Arthroplasty↗
PubMed2006

Early internal fracture fixation prevents bacterial translocation.

The aim of our study was to determine whether early internal fixation of major bone fractures helps prevent bacterial translocation in patients with multitrauma. Thirty-seven Sprague-Dawley rats were divided into three groups: (1) anesthesia only (n = 12); (2) the trauma group: tibia and femur fractures and moderate head trauma under anesthesia (n = 14); and (3) the fixation group: fixation of tibia and femur fractures and moderate head trauma under anesthesia (n = 11). After 24 hours, mesenteric lymph nodes, liver, spleen, and systemic blood samples were quantitatively cultured. The terminal ileum was assessed histopathologically. The incidence of bacterial translocation was less in the anesthesia group (two of 12 rats) and the fixation group (two of 11 rats) than in the trauma group (10 of 14 rats). The number of organs containing viable bacteria was significantly lower in the fixation group than in the trauma group. Histopathologically, villous architecture was preserved mostly in the fixation group; however, marked mucosal damage was detected in the trauma group. Our data suggest early internal fixation of long bone fractures in polytraumatized experimental animals with head injury results in preservation of the intestinal mucosal barrier and decreased bacterial translocation from the gut.

Animals↗
PubMed1997

The preliminary study and tentative animal study on the sintered PDLLA/TCP composites as bone fracture internal fixation.

Polyesters based on the lactic acid have been reported safety and biodegradation in the human beings for two decades. The greatest advantage of the material is its degradation only conducted by the hydrolysis, where the ester backbones are supposed to be unchained in the aqueous condition. The final degradable products are carbon dioxide and water which can be metabolized and digested in the physiological environment. The goal of this study was aimed to develop a composite sintered with poly-DL-lactide (PDLLA) and tricalcium phosphate (TCP) ceramic particles as orthopedic application. The TCP particles in a range of 30-60 wt% (with 5 wt% increment) were doped into the PDLLA matrix for the reinforcement, which were prepared by the melting and hot pressing techniques. The basic mechanical strength, biodegradable behavior, and biological response of the composites will be investigated in the study. Various techniques, such as pH meter, UV, FTIR, XRD ect., were used to examine and record the degradable process of the composites soaked in the saline for 1-16 weeks. The rabbit femur condyle fracture fixation test was used to evaluate the tissue compatibility and the effects of bone fracture fixation of the composites. The histological observation and x-ray photography were applied for investigating assistance. In the histological evaluation of rabbit femur condyle fracture fixation test, the surface of the composite with 50 wt% TCP addition was attached by the new generated bone without fibrous tissue around after 8 weeks implantation. The fracture bone was gradually healing and the composite always firmly and properly fixed on the fracture area during the implanted period, which provided a breeding environment for normal bone remodeling. The developed composite was thought to be an alternative material for orthopedic application in the future, especially in bone screw and bone plate.

Animals↗
PubMed1987

Warping of cross sections in the torsion of long bones with internal fracture fixation plates.

Torsion of noncircular beams results in warping of each cross section. When noncircular cross sections are constrained to remain plane, the resulting shear stress distribution is different from what Saint Venant torsion (with warping) would predict. This has practical implications to the stress analysis of plated long bones subjected to torsional loadings. Analyses in which warping is not allowed predict incorrect stress fields in the plate and bone and overpredict the amount of stress shielding associated with fracture plate fixation.

Biomechanical Phenomena↗