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PubMed1998

Open reduction and internal fixation of acetabular fractures.

Between 1982 and 1995, 84 patients with displaced acetabular fractures underwent open reduction and internal fixation in our institution. The mean follow-up was 5.5 years with a minimum of 2 years. There were 33 simple and 51 complex fractures according to the classification of Judet and Letournels. Reduction after operation was anatomical in 49% of the patients, satisfactory in 24%, and unsatisfactory in 27%. Using Merle d'Aubigné's scale, the clinical results were excellent in 39% of the patients, good in 29%, fair in 8%, and poor in 24%. Factors of statistical significance associated with a poor clinical outcome were T-shaped fractures, unsatisfactory reduction (> 3 mm residual displacement), age > 40 years and development of avascular necrosis. Acetabular surgery is demanding, and a high rate of complications can be expected. Trauma centres should designate a group of surgeons who will consistently treat these fractures in order to obtain more experience and better results.

Acetabulum↗
PubMed2002

[Minimal invasive treatment of massively dislocated radial neck fractures in children by percutaneous joystick reposition and Prevot nailing].

Undisplaced fractures of the proximal radius can generally be treated conservatively with good results. In children, spontaneous correction of some angular deformities can be expected during growth. Nevertheless, more severely displaced fracture types may require reduction in children, too. Open reduction and internal fracture fixation have shown to lead to a loss in range of motion frequently. A technique of percutaneous fracture reduction is demonstrated that can provide good results in cases when closed techniques have failed. A Kirschner wire is used to manipulate the fracture fragments percutaneously, which can often prevent open techniques. An additionally performed elastic-stable intramedullary nailing can add to an effective stabilisation and encourage to early physiotherapy.

Bone Wires↗
PubMed1990

Internal fixation of children's fractures of the lower extremity.

Lower grade fractures are by definition stable and almost always treated with casting or functional splinting. The best kind of fixation for the higher grade fractures, however, differs between adults and children. Appropriate treatments are discussed, and case-study illustrations are provided. Background on the anatomy of the tibia and femur is included.

Adolescent↗
PubMed1993

[Injuries with severe soft tissue damage. Osseous defects--septic complications; plastic surgery management to osseous reconstruction].

Most of the severe soft tissue problems following open or closed fractures can be treated successfully by means of local or microvascular muscle flaps. Thus open fractures can be changed to closed fractures, or cases of high grade osteomyelitis can be transformed into non-infected or low-grade infected ones as a prerequisite for successful internal fracture fixation or bony reconstruction. Follow-up of 319 muscle flaps shows a low flap loosening rate (4%) and low overall complication rate (8%). The results demonstrate the high value and benefit of soft tissue reconstruction in trauma and reconstructive surgery.

Adolescent↗
PubMed1991

Total hip arthroplasty following failed internal fixation of hip fractures.

A retrospective review was performed on 27 consecutive patients with total hip arthroplasty (THA) following failure of internal fixation of fractures of the proximal femur. The results were comparable to primary THA in femoral neck fractures. Considerably less satisfactory results were obtained in THA in intertrochanteric fractures. Bone loss and medial displacement of the femoral shaft led to high incidence of intraoperative complications and postoperative dislocations. Extreme care must be taken to avoid fracture and penetration of the femoral shaft. Autograft, allograft, or head and neck replacement components should be available for reconstruction of the difficult cases.

Adult↗
PubMed2003

Open reduction and internal fixation of calcaneal fractures with a low profile titanium calcaneal perimeter plate.

Forty-two intra-articular calcaneus fractures underwent open reduction and internal fixation with a low profile, titanium plate with a shape similar to the lateral aspect of the calcaneus. All 42 fractures healed without complication. There were no cases of hardware breakage. None of the patients were noted to have a loss of reduction. The plates were applied without bending and molded to the side of the calcaneus with tightening of the screws. No patient complained of symptomatic hardware during the follow-up period. With postoperative plain radiographs, the reduction was judged as anatomic in 35 patients, less than a 2 mm step off in six patients, and one patient with greater than 2 mm step off. Use of this new plate allows for easy application as it does not require contouring, is well tolerated without complaints of hardware prominence, and none of the hardware broke prior to fracture union.

Adolescent↗
PubMed2005

Internal fixation for displaced fractures of the femoral neck. Does bone density affect clinical outcome?

The results of meta-analysis show a revision rate of 33% for internal fixation of displaced fractures of the femoral neck, mostly because of nonunion. Osteopenia and osteoporosis are highly prevalent in elderly patients. Bone density has been shown to correlate with the intrinsic stability of the fixation of the fracture in cadaver and retrospective studies. We aimed to confirm or refute this finding in a clinical setting. We performed a prospective, multicentre study of 111 active patients over 60 years of age with a displaced fracture of the femoral neck which was eligible for internal fixation. The bone density of the femoral neck was measured pre-operatively by dual-energy x-ray absorptiometry (DEXA). The patients were divided into two groups namely, those with osteopenia (66%, mean T-score -1.6) and those with osteoporosis (34%, mean T-score -3.0). Age (p = 0.47), gender (p = 0.67), delay to surgery (p = 0.07), the angle of the fracture (p = 0.33) and the type of implant (p = 0.48) were similar in both groups. Revision to arthroplasty was performed in 41% of osteopenic and 42% of osteoporotic patients (p = 0.87). Morbidity (p = 0.60) and mortality were similar in both groups (p = 0.65). Our findings show that the clinical outcome of internal fixation for displaced fractures of the femoral neck does not depend on bone density and that pre-operative DEXA is not useful.

Absorptiometry, Photon↗
PubMed2006

The usefulness of computed tomography following open reduction and internal fixation of acetabular fractures.

PURPOSE: To investigate the role of a supplemental imaging modality in postoperative assessment of acetabular fractures following open reduction and internal fixation. METHODS: Postoperative axial computed tomographic (CT) scans were compared with plain radiographs of 20 patients with regard to their sensitivity for detecting articular fracture reduction in terms of gap displacement and step deformity or offset. Three observers independently reviewed the plain radiographs and CT scans at 2 separate time points and categorised the outcome as either anatomical or non-anatomical. The inter-observer reliability and intra-observer reproducibility of these measurements was expressed as a kappa statistic. The radiological result was correlated with the clinical outcome measures using the Merle D'Aubigne scale, the Harris Hip Score, and the SF-36 score. RESULTS: Plain radiography was less effective in the detection of postoperative articular displacement (mean, 75.1% sensitive). The inter-observer and intra-observer agreement between reviewers was good to excellent in detecting reduction quality between the 2 modalities. Patient management was not altered by the findings of the CT scans. CONCLUSIONS: Although postoperative CT scanning of acetabular fractures in selective cases may be useful, issues such as higher cost, less effective allocation of resources, and excessive radiation doses do not support its routine use.

Acetabulum↗
PubMed1994

[Distal diaphyseal fracture of the humerus].

Fractures of the distal humeral diaphysis are rare and have not been reported very often in the literature, although therapeutic management is more difficult than that of midshaft humeral fractures. As they are so near to the elbow, these fractures are not suitable for bracing, because pro/supination movements cannot be eliminated. Muscular forces, especially of the pronator teres muscle, force the fracture into a varus position with every supination movement. From 1974 to 1990 we treated 174 fractures of the humeral diaphysis by operative means; 31 of these were located in the distal third. According to the AO classification, 8 were graded as less difficult type A fractures, 15 as type B and 7 as type C fractures. In 22.6% of the patients primary radial palsy was present. In all, 15 fractures were treated by plating, 9 with Hackethal's bundle nails and 6 with monolateral fixators. These last patients had sustained either multiple trauma or severe soft tissue injury or both. The plated cases included 1 with non-union and with superficial infection, both in type C comminuted fractures. In 1 case the fracture was not suitable for plating, and in the other case technical errors led to failure. In the 9 cases treated with Hackethal nails there were no complications. The advantage of the method is that the nails are inserted far distant from the fracture site. Anatomical reduction is not necessary, which means there is no danger of devitalizing fragments; the technique is also quick. In the "fixator" group, we saw 1 case of non-union and 1 of refracture, both following compound fractures.(ABSTRACT TRUNCATED AT 250 WORDS)

Bone Plates↗
PubMed2004

Functional outcome following internal fixation of intraarticular fractures of the distal humerus (AO type C).

The aim of this study was to evaluate the functional outcome following internal fixation of intraarticular fractures of the distal humerus (AO Type C) with a minimum follow-up of two years. A retrospective evaluation with prospective clinical review was carried out. Twenty-six consecutive patients with fractures of the distal humerus were treated over a 31-month period. Their mean age was 56 years (range, 18-82). Six patients were not available for final clinical review. Analysis of the results were based on the medical records, pre-operative and postoperative radiographs of all 26 patients and clinical review of 20 patients at a mean follow-up of 35 months (range, 24-48 months). Twenty-six fractures were fixed using the AO double column plating techniques. Radiographic evaluation of the quality of reduction was carried out using a grading system. Clinical outcome was assessed using the Broberg and Morrey functional rating index. Fourteen patients (70%) had an excellent or good outcome, five patients (25%) a fair outcome and one patient (5%) had a poor result. Three patients (15%) underwent a second procedure for hardware removal. The mean arc of flexion was 112 degrees (range, 85 to 122). Mean pronation was 75 degrees (range, 60-82) and supination was 76 degrees (range, 60-80). No patients had achieved normal grip strength; the mean grip strength was 82% (range, 46-90%) compared to the uninjured side. Fifteen patients (75%) were able to return to their pre-injury level of occupation and activity. Seventeen patients (85%) were satisfied with the final outcome. We conclude that internal fixation of intraarticular fractures of the distal humerus is an effective procedure with an excellent or good functional outcome in most patient age groups. Patients have a high level of satisfaction and the majority return to their previous level of activity.

Adolescent↗
PubMed2005

"Smile" incision: an approach for open reduction and internal fixation of calcaneal fractures.

MATERIALS: A consecutive group of 73 patients (77 calcaneal fractures) treated with open reduction and internal fixation through a smile-shaped lateral approach to the hindfoot were reviewed retrospectively. Inclusion criteria were a closed displaced intra-articular fracture of the calcaneus, no compartment syndrome, and adequate followup. Followup ranged from 4 months to 4 years. RESULTS: One patient had a deep wound infection that required removal of hardware and intravenous antibiotics. No deep dehiscence or flap necrosis occurred. Superficial dehiscence occurred in three patients (4%) and superficial necrosis was seen in nine patients (12%); all resolved with continued casting to protect the wound. Six patients (8%) complained of numbness or pain in the sural nerve distribution. No symptomatic neuromas were seen. Reflex sympathetic dystrophy occurred in three patients (4%); all resolved with sympathetic blocks. Only one patient required an additional procedure for treatment of a wound-related problem or infection. CONCLUSION: The "smile" incision provides good fracture exposure for reduction without added morbidity.

Calcaneus↗
PubMed2001

Total knee arthroplasty after open reduction and internal fixation of fractures of the tibial plateau: a minimum five-year follow-up study.

BACKGROUND: There is little information in the literature regarding the outcome of total knee arthroplasty following open reduction and internal fixation of fractures of the tibial plateau. The goal of this study was to evaluate the results of such procedures after a minimum of five years of follow-up. METHODS: We retrospectively analyzed the outcomes of fifteen total knee arthroplasties performed at an average of 38.6 months (range, eight months to eleven years) after open reduction and internal fixation of a fracture of the tibial plateau in fifteen consecutive patients. The average duration of follow-up after the total knee arthroplasty procedures was 6.2 years (range, 5.4 to 11.1 years). The average age of the patients was fifty-six years (range, thirty-seven to sixty-eight years) at the time of the arthroplasty. We evaluated the outcomes on the basis of the Hospital for Special Surgery knee score, the Short Form-36 score, and radiographs of the knees. RESULTS: The average Hospital for Special Surgery knee score was 51 points (range, 20 to 74 points) before the arthroplasty, and it increased to 80 points (range, 44 to 91 points) postoperatively. Four knees were scored as excellent, eight had a good result, one was rated as fair, and two had a poor result. The average Short Form-36 scores were 58.0 points for general health, 72.4 points for bodily pain, 72.1 points for mental health, 58.3 points for physical functioning, 84.6 points for physical role functioning, 81.0 points for social functioning, and 57.7 points for vitality. The average active postoperative arc of motion was 105 degrees (range, 70 degrees to 135 degrees ) compared with 87 degrees (range, 20 degrees to 125 degrees ) preoperatively. Incomplete radiolucencies were noted on all of the postoperative radiographs made after the total knee arthroplasties. There was a high rate of infection (three patients), patellar tendon disruption (two patients), and postoperative secondary procedures (three patients required closed manipulation). The patients with infection were considered to have a failure of treatment: two required arthrodesis, and one required a two-stage exchange. CONCLUSION: On the basis of our results, we concluded that total knee arthroplasty after open reduction and internal fixation of a fracture of the tibial plateau decreases pain and improves knee function, but the procedure is technically demanding and is associated with a high failure rate (five of fifteen).

Adult↗
PubMed1991

Internal fixation of forearm fractures in the 1980s: lessons to be learnt.

A series of 156 diaphyseal forearm fractures in 108 patients were treated by internal fixation between 1980 and 1985. These cases have been critically reviewed in the light of the present knowledge and expertise of internal fixation. A total of 122 fractures were fixed with ASIF compression plates. An analysis of results shows that 17 patients (15.7 per cent) had a poor clinical symptom result, 29 patients (26.9 per cent) had a poor functional score, 14 (13 per cent) had a poor subjective and employment score, and 40 fractures (32 per cent) united after 18 weeks. Non-union rate was 10.3 per cent, the infection rate was 5.5 per cent and there were three cases (2.7 per cent) of synostosis. Only six patients had primary cancellous bone grafting. A statistical analysis of the variables which may affect the result shows that the most important factors are accurate reduction of the fracture, correct use of interfragmentary screw fixation and rigid fixation. Failure to observe these rules will produce a poor result. Fracture complexity and comminution, especially if combined with a butterfly fragment, predispose to a poor result.

Adolescent↗
PubMed1992

Newest factors in fracture healing.

Natural selection has evolved a process of fracture healing that is characterized by callus formation and is enhanced by physical loading and motion at the fracture site. Internal fixation of fractures alters the biology of fracture healing, especially when rigid fixation using plates is performed. Intramedullary nails that allow some motion and loading usually are associated with callus formation. Plates that practically eliminate interfragmentary motion, however, prevent external periosteal callus formation. Primary osteonal healing can occur with plate fixation, but if interfragmental gaping of greater than 1 mm exists, delayed healing occurs. Closed treatment of fractures occasionally results in nonunion. In addition, physicians' high expectations for skeletal restoration have prompted vigorous research in areas of bone grafting, graft substitutes, and analysis of local and systemic factors that regulate fracture healing. A better understanding of the activity of bone morphogenetic protein and growth factors, such as transforming growth factor beta, will allow manipulation of the biology of healing to enhance the surgical treatment of skeletal trauma.

Bone Morphogenetic Proteins↗
PubMed1982

The fibular reciprocal fracture in tibial shaft fractures caused by indirect violence.

A series of 200 consecutive junctional middle-distal third tibial shaft fractures caused by indirect violence was analysed with emphasis on the significance of the location of the fibular reciprocal fracture. The fibular fracture was eccentric, i.e. subcapital or malleolar, in 96 patients. This fracture pattern was encountered only in adults and showed significantly more severe initial displacement and with conservative treatment longer union time than fractures with intact fibula or the fibular fracture on the same level with the tibial fracture. Especially for fractures with an initial lateral displacement of more than one half of the diaphyseal diameter and with an eccentric fibular reciprocal fracture internal fixation with uncomplicated postoperative course shortened the union time and prevented residual deformity. A malleolar fibular fracture and the rare separate displaced posterior triangle fracture should in addition as such be regarded as indications for osteosynthesis.

Adolescent↗