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At least 19 recordsLinked to original sources
PubMed1977

[Use of palacos in osteosynthesis for the connection of fragments (combined internal fixation)].

Internal fixations have become a frequent approach in surgery due to the profound studies dealing with biomechanical details of fractures and quality of metal devices. In the beginning, it seemed practically possible to manage easily, almost all the fractures by using various internal fixation devices excluding, naturally, those which have retained or shall retain probably some indications of further cure by closed methods. Moreover, certain doubts remain still open, particularly for the reason whether all internal fixations have been sufficiently rigid and if so, shall it be indispensable to count on the introduction of additional materials in order to strenghten these fractures. The outcome of the daily practice 1rd traumatho to approach the use of the bone cement, initially to help the fixation of new joints. Later the use of the bone cement was applied for the shaft and pathological fractures in combination with autogenous cancellous bone. Thus, the new notion was borne in traumathology which in the form of combined internal fixation has become a familiar term throughout the professional literature. Cases of the experience gained and this particular approache in surgery will be a subject of the report.

Adult↗
PubMed1987

Experimental studies on the use of a cushioned plate for internal fixation.

Internal fixation is widely used in the operative treatment of fractures, but various problems, such as local osteoporosis, may occur when living bone is fixed with a rigid metal plate. We propose a new method of immobilisation, which we have termed "cushioned plate fixation", in an attempt to solve some of these problems. Cushioned plate fixation involves a silicone rubber cushion placed between the steel plate and the bone. On the basis of data obtained from animal experiments in vivo and mechanical tests in vitro, we conclude that the cushion is effective in preventing osteoporosis without decreasing the strength of fracture fixation. We believe that this method might improve the mechanical biocompatibility of plate fixation.

Animals↗
PubMed1997

Modified lateral approach to the distal humerus for internal fixation.

Internal fixation of fractures of the most distal portion of the humeral shaft is problematic. A modified lateral approach was assessed to determine its role in the surgical management of these injuries. Posterior plating of the lateral column was performed in each case. Eight patients with eight fractures (seven acute, one nonunion) were treated. All fractures united. There were no complications. On the basis of these results, displaced fractures of the most distal portion of the humeral shaft can be managed successfully via a modified lateral approach to the distal humerus.

Adolescent↗
PubMed2004

External fixation versus internal fixation for closed unstable intra-articular fracture of the distal radius. Early results from a prospective study.

This is a prospective study of a series of 26 patients with closed unstable comminuted intra-articular fracture distal end of the radius treated with two different methods of treatment to compare their anatomical and functional results. The external fixation group consisted of 12 patients and internal fixation group consisted of 14 patients. The anatomical and functional assessments were performed at six months and one year. The anatomical results at six months and one year showed that the internal fixation group was effective in maintaining the reduction compared to the external fixation group. The radial height, volar tilt and radial inclination were well maintained. However, the functional results at six months and one year showedno differences between these two types of fixation. The complication rate was higher in external fixation group.

Adolescent↗
PubMed1991

Comminuted fractures of the basilar joint of the thumb: combined treatment by external fixation, limited internal fixation, and bone grafting.

Displaced, comminuted fractures of the thumb carpometacarpal joint were treated by intermetacarpal external fixation, anatomic reduction of the joint surfaces, bone grafting and adjunctive internal fixation in thirteen patients. Retrospectively, at an average follow-up time of 35 months, nine patients showed a good result and one patient had a fair result. All fractures had united without secondary displacement, but focal irregularities of the joint surface were commonly seen. As compared with the uninvolved side, axial rotation averaged 79%, radial abduction 89%, key pinch 88%, and grip strength 81%.

Adolescent↗
PubMed2003

[Our experiences with change of osteosynthesis from external fixator to internal fixation in fractures of the lower limb].

INTRODUCTION: In polytrauma patients and fractures with severe soft tissue damage of the lower limb the use of external fixator is indicated. To show the possibilities and limits of change of external fixation to internal osteosynthesis we performed a retrospective analysis. PATIENTS AND METHODS: Between 1.1.1993 to 30.6.1997 671 cases were primarily treated with external fixator. After a mean of 16.5 days a change of osteosynthesis was performed in 75 cases. RESULTS: 5 infections of the pin tracks, 3 infections of the wound, two thromboses, one case of thromboembolism and one osteomyelitis were seen in these 75 cases. One patient died due to severe brain damage after head injury. No further operations were necessary, all fractures showed primary healing. Taking the severe soft tissue damages and severe multiple trauma into account only few complications were observed. CONCLUSION: The main problems and risks of internal fixation occur in the early phase of treatment, whereas complications after external fixation are more likely to occur in later stages. By a change from external fixation to internal osteosynthesis the advantages of both methods can be combined.

Accidents, Traffic↗
PubMed1993

Comparative postoperative infection rates in midfacial trauma using intermaxillary fixation, wire fixation, and rigid internal fixation implants.

The use of rigid internal fixation implants in the repair of midfacial fractures requires more extensive bone exposure, soft-tissue manipulation, and operative time. We wished to determine the relative contribution of this method of repair to postoperative infection rates. Midfacial trauma cases occurring between the years 1984 and 1991 at the University of Iowa Hospitals and Clinics, Iowa City, were reviewed. Patients were grouped according to method of repair (intermaxillary fixation, open reduction with wire fixation, or open reduction with rigid internal fixation plates). Postoperative infection data (wound infections, sinusitis, etc) were obtained by chart review and telephone interview. Minimum follow-up for inclusion in the study was 3 months, with an average follow-up for all groups of 28.8 months. We found no significant difference in the rate, or the type, of postoperative infections in all three groups. We conclude that rigid internal fixation implants do not contribute increased postoperative infection rates in midfacial trauma.

Adult↗
PubMed2003

Tibial lengthening: technique for speedy lengthening by external fixation and secondary internal fixation.

BACKGROUND: The conventional Ilizarov technique for tibial lengthening is frequently time-consuming, causes suffering, and is associated with many complications. This study takes a retrospective approach to investigate the outcome of applying a slightly speedier procedure using an Ilizarov apparatus and secondary internal fixation. METHODS: Twelve adult patients displaying tibial shortening (median, 4.0 cm; mean, 4.6 cm; range, 3.0-12.0 cm) with various causes were treated with or without tibial osteotomy and stabilized using an Ilizarov lengthening apparatus. Postoperatively, lengthening of 1 to 1.5 mm/day was performed until the desired length was achieved. External fixation was then converted to internal fixation and either pure autogenous bone graft, or a mixture of autogenous and allogenous bone graft was supplemented. Postoperatively, protected weight bearing was advised until bony union was achieved. RESULTS: Eleven patients were followed up for a median of 3.4 years (mean, 4.0 years; range, 2.1-6.7 years) and solid union was achieved in all cases. Median external fixation occurred after 1.8 months (mean, 1.9 months; range, 1.2-4.5 months) and the median time until union after internal fixation was 4.5 months (mean, 4.8 months; range, 4-6 months). Two patients with rigid equinus feet required concomitant Achillis tendon lengthening. No other significant complications were noted. Classification of the results revealed that improvement from an unsatisfactory to a satisfactory outcome was achieved in all patients (p < 0.001). CONCLUSION: The described technique shortens the external fixation period and reduces patient suffering. Moreover, a high union rate and a low complication rate are achieved. Subjectively and objectively, patients can achieve satisfactory outcomes. Consequently, the described technique may be considered as an alternative to conventional techniques when indicated.

Adult↗
PubMed1995

External fixation and limited internal fixation for complex fractures of the tibial plateau.

Twenty-one complex fractures of the tibial plateau in twenty patients were treated with closed reduction, interfragmental screw fixation of the articular fragments, and application of a unilateral half-pin external fixator. The average duration of external fixation was twelve weeks (range, three to twenty weeks). The fixator was left in situ until the fracture had united in all but two patients. All of the fractures healed. The complications with this technique were attributable primarily to the proximal half-pins of the external fixator. Seven patients needed antibiotics for an infection at a pin site, and two had septic arthritis that necessitated arthrotomy and débridement. The average duration of follow-up was thirty-eight months. The range of motion of nineteen of the twenty-one knees was at least a 115-degree arc. Laxity was evident in seven knees, but no patient complained of instability of the knee. Radiographs showed malalignment of more than 6 degrees in three knees compared with the normal, contralateral knee and evidence of post-traumatic osteoarthrosis in five knees. The Iowa knee score, determined for nineteen patients, averaged 87 points (range, 55 to 100 points). The SF-36 general health survey demonstrated that most patients had function close to that of age-matched controls. We concluded that external fixation with limited internal fixation is a satisfactory technique for the treatment of selected complex fractures of the tibial plateau.

Adult↗
PubMed2002

Evolution of the internal fixation of long bone fractures. The scientific basis of biological internal fixation: choosing a new balance between stability and biology.

The advent of 'biological internal fixation' is an important development in the surgical management of fractures. Locked nailing has demonstrated that flexible fixation without precise reduction results in reliable healing. While external fixators are mainly used today to provide temporary fixation in fractures after severe injury, the internal fixator offers flexible fixation, maintaining the advantages of the external fixator but allowing long-term treatment. The internal fixator resembles a plate but functions differently. It is based on pure splinting rather than compression. The resulting flexible stabilisation induces the formation of callus. With the use of locked threaded bolts, the application of the internal fixator foregoes the need of adaptation of the shape of the splint to that of the bone during surgery. Thus, it is possible to apply the internal fixator as a minimally invasive percutaneous osteosynthesis (MIPO). Minimal surgical trauma and flexible fixation allow prompt healing when the blood supply to bone is maintained or can be restored early. The scientific basis of the fixation and function of these new implants has been reviewed. The biomechanical aspects principally address the degree of instability which may be tolerated by fracture healing under different biological conditions. Fractures may heal spontaneously in spite of gross instability while minimal, even non-visible, instability may be deleterious for rigidly fixed small fracture gaps. The theory of strain offers an explanation for the maximum instability which will be tolerated and the minimal degree required for induction of callus formation. The biological aspects of damage to the blood supply, necrosis and temporary porosity explain the importance of avoiding extensive contact of the implant with bone. The phenomenon of bone loss and stress protection has a biological rather than a mechanical explanation. The same mechanism of necrosis-induced internal remodelling may explain the basic process of direct healing.

Animals↗
PubMed2004

Effect of cortical thickness and cancellous bone density on the holding strength of internal fixator screws.

Internal fixators are a new class of implants designed to preserve the periosteal blood supply of the bone. In contrast to conventional plate fixation in which the screws have spherical heads and are loaded mainly by axial pullout forces, screws in internal fixators are "locked" within the plate and therefore subjected to axial as well as bending loads. In this study the ultimate loads of screws of a commercially available internal fixator system were tested in a pullout (n = 72) and cantilever bending mode (n = 72) in metaphyseal and diaphyseal regions of four pairs of human tibiae with different bone qualities. Cortical thickness and cancellous bone density were determined at the screw insertion sites. Stepwise multiple linear regression revealed that cortical thickness and cancellous density can explain 93% and 98% of the variance of the ultimate load of the screws in an axial pullout and cantilever bending mode. Screws in internal fixators are better suited to transmit shear forces and thereby make better use of the strength potential of bone than screws used in conventional plate fixation: this is especially advantageous when bone strength is reduced, e.g. due to osteoporosis.

Aged↗
PubMed2000

Critical concepts of absorbable internal fixation.

Absorbable internal fixation implants, by virtue of their temporary in situ residence and variable load sharing with the healing tissues, have the potential to yield a clinical outcome that approaches the native state. Despite the growing availability and acceptance of absorbable fixation, however, many surgeons continue to rely on metal fixation for their patients, because, in part, of unfamiliarity with the technology. Although many of the principles of metallic internal fixation also apply to absorbable internal fixation, significant differences exist as well. This article presents basic background in absorbable technology and proposes a set of principles that may help govern the development and use of absorbable fixation devices in clinical practice.

Absorbable Implants↗
PubMed2000

Principles of development and use of absorbable internal fixation.

Absorbable internal fixation implants, by virtue of their temporary in situ residence and variable load sharing with the healing tissues, have the potential to yield a clinical outcome that approaches the native state. Despite the growing availability and acceptance of absorbable fixation, however, many surgeons continue to rely upon metal fixation for their patients, due, in part, to unfamiliarity with the technology. Although many of the principles of metallic internal fixation also apply to absorbable internal fixation, significant differences exist as well. This paper presents basic background in absorbable technology and proposes a set of principles that may help govern the development and use of absorbable fixation devices in clinical practice.

Animals↗
PubMedDate not supplied

[Internal fixation of thoracolumbar, lumbar and lumbosacral spine with internal fixators].

The report is a review of the literature on fully implantable transpedicular fixation device known under the general name internal fixator, and designed for short (one to three segments) internal fixation of the spine in various pathologies. The implants are found in a routine clinical use throughout many European countries and have become more familiar to spine surgeons in the U.S. The authors present a general description of the fixators, indications and contraindications to their implantation, the implantation technique and possibilities of intraoperative reposition of the spine. The advantages of usage of the fixators and the history of their development are presented.

Equipment Design↗
PubMed2000

Osteotomy, compression and reaming techniques for internal fixation of extracapsular hip fractures.

BACKGROUND: Many different surgical techniques, such as osteotomy, have been used in internal fixation of extracapsular hip fractures. OBJECTIVES: To compare different aspects of surgical technique in internal fixation of extracapsular hip fractures that have been subjected to randomised trials in adults. SEARCH STRATEGY: The Cochrane Musculoskeletal Injuries Group trials register, Medline, CENTRAL and reference lists of relevant articles were searched. Date of the most recent search: March 1999. SELECTION CRITERIA: All randomised and quasi-randomised trials investigating operative technique for the treatment of extracapsular hip fractures. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality, by use of an eleven item check list, and extracted data. Wherever possible and appropriate, results of outcome measures were pooled. MAIN RESULTS: All eight included trials were of only modest methodological quality. One trial of 65 patients undergoing fixation with a fixed nail-plate compared osteotomy versus anatomical reduction. There was a tendency to a reduced fixation failure rate after osteotomy. Four trials involving 465 patients undergoing fixation with a sliding hip screw (SHS) compared osteotomy versus anatomical reduction. Osteotomy was associated with an increased operative blood loss and length of surgery. There was also a tendency to an increased length of hospital stay and limb shortening for osteotomy. One trial of 200 patients undergoing fixation with a SHS compared results with or without compression across the fracture site. The only significant difference in outcomes was increased varus deformity in those fractures treated with compression. One trial of 19 patients reported reduced temperatures generated by a modified method of reaming the femoral head. Another study used oesophageal ultrasound to demonstrate reduced bone marrow intravascular embolism when a Gamma nail was inserted in 50 patients with, rather than without, a distal pressure venting hole in the femur. REVIEWER'S CONCLUSIONS: There is inadequate evidence to determine if any benefits exist for the routine use of osteotomy in conjunction with a SHS for the internal fixation of an unstable trochanteric femoral fracture. Osteotomy may be relevant if used in conjunction with a fixed nail plate. Based on the evidence of one trial only, there is inadequate evidence to support the application of compression across the fracture site of a trochanteric fracture during SHS fixation. Inadequate information exists for different reaming techniques during SHS or Gamma nail fixation to make definite conclusions.

Fracture Fixation, Internal↗
PubMed1993

Evaluation of biodegradable cefazolin sodium microspheres for the prevention of infection in rabbits with experimental open tibial fractures stabilized with internal fixation.

Immediate internal fixation of severe open tibial fractures usually is contraindicated due to the high risk of infection. The objective of this study was to evaluate the efficacy of local antibiotic therapy with biodegradable poly-(DL-lactide-co-glycolide) cefazolin-loaded microspheres for the prevention of infection in experimental open fractures stabilized with internal fixation. Rabbits with experimental tibial fractures that were contaminated with Staphylococcus aureus were treated with local application of cefazolin microspheres, an equivalent local dose of free Ancef powder, or systemic Ancef therapy. The bones then were fixed with a four-hole plate, and the animals were observed for 8 weeks. Clinically, deep infection was present in 86% of control animals that received no antibiotics and in 60% of animals that received a 7 day course of systemic Ancef therapy. In contrast, no infections were noted among any of the surviving rabbits that received local therapy with either cefazolin microspheres or free Ancef powder. Significantly higher levels of serum cefazolin were measured at 1 h for animals treated with free Ancef powder (18.7 +/- 6.1 micrograms/ml) than for those treated with cefazolin microspheres (0.57 +/- 0.27 micrograms/ml). Follow-up studies are in progress to evaluate further the potential clinical benefits of local antibiotic therapy for the management of contaminated open fractures in humans.

Animals↗
PubMed2003

Three-dimensional stabilization provided by the external spinal fixator compared to two internal fixation devices: a biomechanical in vitro flexibility study.

We performed an in vitro study to investigate the stabilization (i.e. motion reduction) provided by the external spinal fixator (ESF), and to compare the three configurations of the ESF with two internal fixation techniques. Six human cadaveric lumbar spine specimens (L3-S1) were subjected to multidirectional flexibility testing in six configurations: (1) intact, (2) ESF in neutral, (3) ESF in distraction, (4) ESF in compression, (5) translaminar facet screw fixation, and (6) internal transpedicular fixation. Both the ESF and the internal fixation systems stabilized the specimens from L4 to S1. In each testing configuration, pure bending moments of flexion-extension, bilateral axial rotation, and bilateral lateral bending were applied to the uppermost vertebra stepwise to a maximum of 10 Nm. The rigid body motion between the vertebrae was measured using an optoelectronic camera system, and custom software was used to calculate the intervertebral rotations. For each applied motion in all testing configurations, the total range of motion (ROM) of L4-S1 is reported. All three ESF configurations stabilized the spine significantly when compared to the intact specimen. The ESF in compression provided significantly more stabilization in flexion-extension than the two other ESF configurations, but no other significant differences were found between the three ESF modes. In flexion-extension the ESF stabilized the spine significantly when compared with the two internal fixation devices. Only in bilateral lateral bending was the ESF inferior to internal transpedicular fixation in providing stabilization. The results of the present study suggest that the ESF provides a high degree of stabilization for preoperative assessment of selected low back pain patients. Whether other non-mechanical factors affect the pain relief experienced by the patients remains unknown.

Adult↗
PubMed2000

A financial analysis of maxillomandibular fixation versus rigid internal fixation for treatment of mandibular fractures.

PURPOSE: The aim of this study was to compare the cost-effectiveness of mandibular fracture treatment by closed reduction with maxillomandibular fixation (CRF) with open reduction and rigid internal fixation (ORIF). PATIENTS AND METHODS: This was a retrospective study of 85 patients admitted to the Oral and Maxillofacial Surgery Service at San Francisco General Hospital and treated for mandibular fractures from January 1 to December 31, 1993. The patients were divided into 2 groups: 1) those treated with CRF and 2) those treated with ORIF. The outcome variables were length of hospital stay, duration of anesthesia, and time in operating room. The charge for primary fracture treatment included the fees for the operation and hospitalization without any complications. Within the group of 85 patients treated for mandibular fractures in 1993, 10 patients treated with CRF and 10 patients treated with ORIF were randomly selected, and hospital billing statements were used to estimate the average charge of primary treatment. The average charge to manage a major postoperative infection also was estimated based on the billing statements of 10 randomly selected patients treated in 1992 (5 treated with CRF, 5 with ORIF) who required hospital admission for the management of a complication. The average total charge was computed by using the average charge for primary treatment plus the incidence of postoperative infection multiplied by the average charge for management of that complication. RESULTS: Eighty-five patients were included in the study. The average charge for primary treatment was $10,100 for the CRF group and $28,362 for the ORIF group. The average charge for the inpatient management of a major postoperative infection was $26,671 for the CRF group and $39,213 for the ORIF group. The average total charge for management of a mandible fracture with CRF was $10,927; the total charge for the ORIF group was $34,636. CONCLUSION: The results of this retrospective study suggest that the use of CRF in the management of mandibular fractures at our institution provides considerable savings over treatment by using ORIF. The use of ORIF should be reserved for patients and fracture types with specific indications.

Adult↗