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PubMed2002

A biomechanical study of femoral neck fracture fixation with the VHS Vari-Angle Hip Fixation System.

Femoral neck fracture fixation with a new device, the VHS Vari-Angle Hip Fixation System (Biomet Orthopaedics Inc, Warsaw, IN), was studied in 14 fresh-frozen cadaver femurs. A Pauwels class III fracture was simulated in these femurs. Seven femurs were fixed by placing the screw at a high (150 degrees) angle to the femoral axis; the other 7 femurs were fixed by placing the screw at a low (135 degrees) angle to the femoral axis. Mean compressive failure load was found to be significantly higher for the high-angle group than for the low-angle group. We concluded that compared with a low-angle screw placement (135 degrees), high-angle screw placement (150 degrees) results in a biomechanically stronger fixation.

Aged↗
PubMed1985

Parametric analyses of pin-bone stresses in external fracture fixation devices.

Problems occurring in the use of external fixators for bone fractures include pin-bone interface necrosis, infection, and loosening. These may be initiated and enhanced by pin-bone interface stress levels. Based on stress data from finite element method (FEM) models, an analytical "closed-form" model of the local pin-bone configuration in long-bone fracture fixation is developed. This model is relatively simple and useful for routine applications in combination with clinical studies and animal experiments. Although approximate, the most significant stress predictions in the pin-bone structure compare well with more sophisticated FEM analysis results. The analytical model is used for extensive parametric analyses, investigating the effects on the pin-bone interface stress distribution of frame configuration parameters, pin diameter and modulus, bone dimensions, and elastic characteristics. The results indicate that these stresses may reach very high levels under unfavorable circumstances but can be drastically reduced by increasing the bending rigidity of the pin, reducing the side-bar separation and applying full-pin configuration in favor of half-pins.

Bone and Bones↗
PubMed1993

Intraosseous cellular response to biodegradable fracture fixation screws made of polyglycolide or polylactide.

As biodegradable pins and screws have increasingly been used in the internal fixation of fractures, sterile inflammatory reactions have occasionally occurred. The aim of the present experimental study was to assess the cellular response within cancellous bone to biodegradable polyester screws. In 45 rabbis a transverse distal femoral osteotomy was fixed with a 4.5 x 30 mm screw made either of polyglycolide (PGA, in 20 rabbits) or polylactide (PLA, in 25 rabbits). The follow-up times were 3, 6, 12, 36 or 48 weeks. The time-related and spatial characteristics of the cellular response were examined histomorphometrically using standardised sample fields under polarised-light microscopy. Polymorphonuclear granulocytes and mononuclear round cells were scarce in all follow-up groups. The occurrence of phagocytic cells (mononuclear macrophages and foreign-body giant cells) was highest in the PGA-fixed 12-week specimens. The giant cells seemed to adhere to the implant surface at an early stage, whereas the ultimate digestion and clearing of the decomposing polymeric material later on were performed by macrophages invading the implant body. No PGA was left in the 36-week specimens, while the gross geometry of the PLA screws was still intact at 48 weeks. In conclusion, the inflammatory response to these polymers was quite mild. Thus it seems probable that some other additional factors must influence the occurrence of the clinical inflammatory reactions.

Animals↗
PubMed2000

Metacarpal and proximal phalangeal fractures--fixation with multiple intramedullary Kirschner wires.

The use of intramedullary wires for fixation of fractures of the metacarpal and proximal phalanx in our hospital was reviewed. Twenty-six patients with 26 metacarpal fractures and four proximal phalangeal fractures were treated using this technique from 1993 to 1998. After a minimal follow-up of nine months, all the patients were assessed clinically and radiologically. All fractures proceeded to bony union at an average of 5.7 weeks (range four to eight weeks). With this simple and minimally invasive technique, most of these patients required very short hospital stay and were able to start mobilisation relatively early. The general outcome was good hand function with few complications.

Adolescent↗
PubMed1984

The role of rigidity in fracture fixation. An overview.

UNLABELLED: The optimal degree of rigidity of internal fixation of fractures is still a matter of controversy. Since any attempt to clarify this situation must rest on a clear terminology, we propose terms relating to different degrees of rigidity. They are based on the material and the design of implants as well as the morphologic features of repair. From our morphologic findings it is obvious that the healing response and the subsequent structural remodelling depend on bone deformation and gap motion. CLINICAL SIGNIFICANCE: For sound patient care, the most ideal mode of internal fixation by plates, yielding rapid and efficient fracture healing, has to be established scientifically in a comparative study.

Animals↗
PubMed1977

A preliminary analysis of the forces in screws in tibial fracture fixation.

If a fracture of the tibia is incorrectly reduced and a plate fixed across the fracture site, then all of the load during subsequent weight bearing can be considered to be taken by the screws fixing the plate to the bone. An analysis of this extreme situation and determination of the magnitude of the consequent forces on the screws indicate that the screws are in danger of failing due to the shear forces but are in little danger from the tensile forces.

Bone Plates↗
PubMed1994

Dual-energy X-ray absorptiometry of canine femurs with and without fracture fixation devices.

The effect of 5 fracture fixation methods on bone mineral density (BMD) measurement of femurs, using dual-energy X-ray absorptiometry (DXA) was determined in a canine model. Six regions of interest were measured, including the entire femur, the diaphysis of the femur, and small regions centered over the middiaphysis of the bone (lateral middiaphyseal cortex, medial middiaphyseal cortex, middiaphyseal medullary canal, and total middiaphysis). Eight unpaired femurs were collected and scanned by use of DXA before (5 separate scans/femur) and after (5 separate scans/femur) fixation by use of 1 of 5 fixation methods. These fixation methods included: intramedullary (IM) nail; IM nail and cerclage wires; IM nail and external skeletal fixation; locked IM nail; and a dynamic compression plate (DCP). All implants were made of stainless steel. The IM nail fixation devices caused significant decreases in the DXA measurement of BMD in the small regions of interest, compared with femurs without fixation devices (mean decrease, 37.3%; P < 0.05). The locked nail caused similar, but larger, decreases in the DXA measurement of BMD, compared with the IM nail fixation methods (P < 0.05). Plate fixation caused a small, but significant (P < 0.05), decrease (2.8%) in the DXA measurement of BMD in the large regions of interest, but when all regions were averaged, it did not cause significant change in this measurement, compared with femurs without fixation devices.(ABSTRACT TRUNCATED AT 250 WORDS)

Absorptiometry, Photon↗
PubMed2002

Timing of femur fracture fixation: effect on outcome in patients with thoracic and head injuries.

BACKGROUND: Optimal timing of femur fracture fixation remains controversial. This study examines the association between the timing of femur fracture fixation and outcome in patients with concomitant chest and head injuries. METHODS: A retrospective review of registry data from a Level I trauma center identified 1362 patients with a femoral shaft fracture over a 12-year period. Patients were categorized into five groups by timing of femur fracture fixation: Group 1, within 24 hours; Group 2, 24 to 48 hours; Group 3, 48 to 120 hours; Group 4, > 120 hours; and Group 5, patients with no operative fixation. Primary outcome measures included morbidity (specifically, pulmonary complications) and mortality. Secondary outcome measures were hospital length of stay, intensive care unit length of stay, and discharge Glasgow Coma Scale score. Subsets of patients were examined including all patients with multiple injuries (Injury Severity Score > 15), chest trauma (Chest Abbreviated Injury Scale score > or = 2), and head trauma (Head Abbreviated Injury Scale score > or = 2). RESULTS: Acute respiratory distress syndrome, pneumonia, hospital length of stay, and intensive care unit length of stay were lowest in the group fixed within 24 hours, even in patients with concomitant head or chest trauma. Fixation between 2 and 5 days was associated with a significantly increased incidence of acute respiratory distress syndrome, pneumonia, and fat embolization syndrome in patients with concurrent chest trauma (p < 0.0001). In head-injured patients, discharge Glasgow Coma Scale score was highest in the group fixed within 24 hours. Timing of operative fixation did not affect mortality. CONCLUSION: Our data show that early femur fracture fixation (< 24 hours) is associated with an improved outcome, even in patients with coexistent head and/or chest trauma. Fixation of femur fractures at 2 to 5 days was associated with a significant increase in pulmonary complications, particularly with concomitant head or chest trauma, and length of stay. Chest and head trauma are not contraindications to early fixation with reamed intramedullary nailing.

Adult↗
PubMed2003

Fracture fixation in the mutilated hand.

Early anatomic (or near anatomic; lingers do not impinge or overlap during flexion or extension) stable fracture fixation provides the foundation for successful wound management and for the repair, reconstruction, and healing of all damaged tissues in a mutilating hand injury. It also plays an instrumental role in pain control and affords an optimal opportunity for timely and favorable rehabilitation of and recovery from mutilating injuries of the hand. Kirschner or other wiring systems or mini external fixators may be used for simple fractures, in children, when rapid fracture fixation is necessary, and for provisional fracture fixation. Mini plates should be considered for fractures with comminution or loss and in instances of multiple fractures. Fingers with segmental injury of three or more tissues should be considered for early amputation to avoid prolonged and impaired recovery of the hand. Every effort should be made to preserve the thumb and its function by repair or reconstruction.

Adult↗
PubMed2003

[Early fracture fixation alleviates gut barrier function damage after multiple firearm injuries in pigs].

OBJECTIVE: To explore if early fracture fixation can alleviate gut barrier function damage caused by multiple firearm injuries in pigs. METHODS: Twelve healthy pigs were subjected to tangential fracture of parietal bone and comminuted fractures of bilateral femora (ISS >or= 16) due to 5.8 mm bullets shooting and these pigs were divided randomly into 2 groups. Control group (n = 6) were not treated at all. Fracture fixation Group (n = 6) were managed by immediate fracture fixation of bilateral femora with intramedullary nails. Plasma concentration of D-lactate, DAO and endotoxin (in portal vein) were detected at different intervals before and after trauma. The portal vein blood was cultured and the percentage of positive isolation was calculated. The concentration of DAO in small bowel was also detected 72 hours later after trauma. RESULTS: In control group, the plasma concentrations of D-lactate, DAO and endotoxin increased at early stage and kept high till 72 hours after trauma; the percentage of positive blood culture was 63.3%. In Group F, the levels of plasma D-lactate, DAO and endotoxin were also elevated at early stage (6 - 12 h), but declined significantly from 24 h or 48 h after trauma compared with control group (P < 0.05), and the percentage of positive blood culture was lower (30.0%, P < 0.05). The concentrations of DAO in small bowel decreased in both groups, but to a less extent in Group F. CONCLUSION: Bacterial and endotoxin translocation emerged with increasing gut permeability after multiple firearm injuries. The damage of gut barrier function could be alleviated and the chance of enterogenous infection could be by early fracture fixation after trauma.

Animals↗
PubMed1990

Timing of fracture fixation: a review.

The timing of fracture stabilization has received little attention in the current orthopaedic literature. The existing data on fracture fixation will be reviewed specifically with regard to early versus delayed stabilization. Timing relative to the multiple trauma patient, open fractures, periarticular fractures, and hip fractures requires special consideration.

Aged↗
PubMed1992

[New information about the biomechanics of fracture fixation].

The better knowledge of the biomechanics of bone tissue and fracture healing resulted in the development of the AO principles and its methods of treatment. I have demonstrated on the femora of rabbits that the consequence of progressive dynamization versus the current unchanging stability of fracture fixation was a more rapid healing. According to our knowledge the more elastic, dynamizating or dynamizable fixation of the fracture are the methods of future. The new biodegradive implantates make not only their removal superfluous but help the fracture healing, too.

Biomechanical Phenomena↗
PubMed1999

Fracture fixation with screws and bone plates.

The treatment goal of fracture fixation is to restore the patient to normal function as quickly as possible. Fracture fixation can be accomplished by various means; fixation with screws and bone plates is not only a popular but a successful technique. In this article, the authors provide concepts that a surgeon must understand for successful screw and bone plate use. In addition, case examples demonstrating the application of many of the concepts are included.

Animals↗
PubMed1999

Technical note: biomechanical analysis of two absorbable fracture fixation pins after long-term canine implantation.

The design requirements for bioabsorbable fracture fixation devices for specific applications are as yet unknown. Therefore, a range of initial mechanical properties and degradation kinetics may provide developers with additional choices for the design of absorbable fracture fixation devices. This study evaluated the changes in push-out strength, polymer mechanical properties, and bone mechanical properties of self-reinforced poly(glycolide) (SR-PGA) and poly(ortho ester) (POE) fracture fixation pins implanted into the canine femoral canal for 18 months. Mechanical testing indicated that SR-PGA pins had degraded to a pasty consistency by 3 months, showing complete loss of all mechanical properties. Meanwhile, POE pins showed a simultaneous linear decrease in both compressive strength and stiffness to almost zero by the end of the study period, suggesting that these devices were undergoing surface erosion. However, changes in specimen diameter, which would support this mechanism, were not apparent. The decrease in polymer density after 12 months suggests that there was an increase in bulk erosion for POE devices. This was further supported by the observation of internal polymer resorption noticed in specimen cross-sections after 18 months. This observation appears to be related to the method of polymer processing; hot-compression molding of fine powdered polymer. The appearance of grain boundaries would provide a path for water to penetrate into the bulk polymer and cause autocatalysis in the interior of the implant.

Absorption↗
PubMed1982

Rigidity and stress analyses of external fracture fixation devices--a theoretical approach.

The rigidity and stresses in external fracture fixation devices were studied by means of the finite element method. Different geometries and material parameters were simulated using a beam element model. Axial, bending and torsional loads were applied through the bone ends and the displacement obtained at the fracture sites was used to calculate the fracture fixation stiffness. The key parameters which increased fixation rigidity were identified. High pin stresses were predicted under certain application conditions. Possible clinical implications for the use of such apparatus are discussed in the light of bone fracture healing. The present results are expected to have a significant impact on future design modifications and clinical applications of this popular instrument in orthopedic surgery and traumatology.

Biomechanical Phenomena↗
PubMed1994

A biomechanical analysis of four humeral fracture fixation systems.

A biomechanical study was initiated to compare four fracture fixation devices: the AO dynamic compression plate, a distal fin locking nail, a solid locked intramedullary nail, and paired flexible nails for humeral fracture fixation. Eighteen pairs of fresh-frozen, intact humeri were harvested, standardized midshaft transverse osteotomies were created in each specimen, and left and right specimens were fixed with plates and nails, respectively. The bending properties of the plate-fixed humeri were significantly greater than the nailed humeri in both the anteroposterior and mediolateral planes on a paired basis. The distal fin nail and solid locked nail had comparable bending properties, and both had bending properties superior to those measured for the paired flexible nails. The torsional properties of humeri fixed with plates and solid locked nails were equivalent, except for rigidity and stiffness, which were superior for the nail. Both fixation methods resulted in torsional properties significantly greater to those measured for humeri fixed with paired flexible nails or a distal fin nail.

Biomechanical Phenomena↗