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At least 37 records · Page 2Linked to original sources
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↗
PubMed1987

Duration of fracture healing after early versus delayed internal fixation of fractures of the femoral shaft.

The effect of delayed internal fixation in closed uncomplicated fractures of the femoral shaft was studied by comparing 40 patients from a hospital where this fracture was principally treated within 24 hours of the injury, with 46 patients from another hospital where this type of fracture was principally treated after a mean period of 13 days in skeletal traction. The two groups of patients were similar with regard to age, level of fracture, type of fracture and incidence of comminution. All fractures were treated by stable internal fixation. In the group treated by early operation considerably longer AO plates were used. Although delayed fixation resulted in more callus and although secondary bone healing was more frequent than in the group with early internal fixation, no difference in the rate of union of the fractures could be demonstrated.

Adolescent↗
PubMedDate not supplied

Pathophysiology of infections after internal fixation of fractures.

Infection complicating internal fixation of fractures is a serious complication that is difficult to treat. Whenever metallic devices are implanted in vivo, successful biointegration requires that host cells colonize the highly reactive implant surface. Bacteria such as staphylococci can also become adherent to metallic or polymeric implants and will compete with host cells for colonization of the implant surface. Once adherent, these bacteria form a biofilm and undergo phenotypic changes that make them resistant to the normal host immune response as well as to antibiotics. Furthermore, metallic implants themselves cause specific deficits in the function of the local immune system that may render the host response to infection inadequate. Any associated soft-tissue injury causes even greater impairment of local immune function. Despite the potentially detrimental impact of internal fixation, fracture stability is of paramount importance in achieving fracture union and in preventing infection. It has been demonstrated in animal models that contaminated fractures without internal fixation develop clinical infection more commonly than similar fractures treated with internal fixation at the time of colonization. Because of the potential for infection whenever internal fixation is utilized, appropriate prophylactic antibiotic coverage for staphylococci and Gram-negative organisms should be provided. Open wounds and severely damaged soft tissues require aggressive management so that a viable soft-tissue envelope is maintained around the implant. Host factors such as smoking and malnourishment should be corrected. Early diagnosis and aggressive treatment of implant-related infection with antibiotics, debridement, and maintenance of stable internal fixation are essential to successful treatment.

Animals↗
PubMed2001

Trimalleolar fracture with a double fragment of the posterior malleolus: a case report and modified operative approach to internal fixation.

Fractures of the medial and lateral malleoli are frequently associated with fractures of the posterior malleolus, comprising trimalleolar fractures. The posterior fragment may be posteromedial or posterolateral and its size determines the necessity for surgical or non-surgical treatment. The authors describe a case of trimalleolar fracture with double involvement of the posterior malleolus, both a posteromedial and posterolateral fragment. A modified transmalleolar operative approach for internal fixation is recommended when dealing with such complex trimalleolar fractures of the ankle.

Ankle Injuries↗
PubMed1979

[An experimental study on various internal fixations in fracture of a long bone (author's transl)].

In the operative treatment of a long bone fracture, the most important point is to secure the bone healing and to strengthen the bone after removal of internal fixation materials. In this regards, the author has analyzed the mechanical strength of various internal fixation methods (a plate, a medullary nail, screws and encircling wires) on the bone by using acrylics models. Experimental studies of their influences on the bone have also been performed especially investigating the decrease in the bone strength in rabbits. All of internal fixation materials are made of 316L stainless steel. Recently, there has been a tendency to use larger materials for internal fixations such as an AO compression plate or a Küntscher type medullary nail. However, it was found that the rigid plate fixation greatly affects the bone strength. A medullary nail produced less impairment to the bone. But this method is restricted in its application because of the weak fixability of the torsional load. On the other hand, the internal fixations with screws or encircling wires are weaker than the other methods especially against the bending load. Therefore the commencement of postoperative treatment will be delayed. But, these two methods have little influence on the bone during fixation.

Animals↗
PubMed1977

8. Self-compressing implants in the management of fractures.

Internal fixation of fractures has become increasingly important since the introduction of self-compressing implants. Rigidity of fixation thus ensured permits primary bone healing. Two types of self-compressing implants are available--screws and plates. The former produces compression between fracture fragments, the latter, along the long axis of the bone. Two common types of plates are the dynamic compression plate and the Osteo self-compressing plate. Use of self-compressing implants requires familiarity with the technique, a definite plan of operation, and strict asepsis and lack of infection in the patient. Indications for the technique include failure or unsuitability of closed reduction of fractures, care of associated serious soft-tissue injuries, and displaced intra-articular fractures. Use of self-compressing plates hastens rehabilitation, lessens joint stiffness and reduces the duration of hospitalization. The incidence of nonunion with self-compression techniques is lower than with traditional methods of fracture management.

Bone Plates↗
PubMed1991

Experimental evaluation of seven different spinal fracture internal fixation devices using nonfailure stability testing. The load-sharing and unstable-mechanism concepts.

Fracture site immobilization capabilities of seven internal spine fixation systems were experimentally evaluated: Harrington double distraction (plain, supplemented with Edwards sleeves, supplemented with sublaminar wires), Luque rectangle, Kaneda device, transfixed Kaneda device, and Steffee plates. Stability evaluation involved comparing the three-dimensional motion that occurred across an experimentally created L1 slice fracture, and the load resistance of the implants when subjected to axial, flexion, extension, lateral bending, and torsional loads. Each implant was tested on 15 different vertebral segments from 200-250-lb calves. All implants load-shared with the fractured vertebral column to varying degrees. All except the Steffee plate system showed an obvious biomechanical weakness in one or more load modes. The unstable 4R-4bar mechanism configuration of bilevel spinal implants was identified. Mechanism configurations allow free movement with little or no resistance to the applied load until load sharing by the spinal column stops the collapse and resists the applied load.

Animals↗
PubMed1998

Mechanical evaluation of a new minimum-contact plate for internal fracture fixation.

OBJECTIVE: To determine whether the mechanical properties (stiffness and strength) of a new design of internal fixation plate, with reduced bone-to-plate contact area for reducing disturbance to the bone blood supply at the fracture site, are comparable with those of commonly used fracture fixation plates. DESIGN: Four-point bending and torsion tests were conducted to compare the new minimum contact plate (MCP) with two established internal fixation plates: the dynamic compression plate (DCP) and the limited contact dynamic compression plate (LC-DCP). The bending stiffness and strength were determined according to the International Standards Organization bending test for bone plates, and the torsional stiffness and torque to failure were calculated from torsional loading data with the plates attached to synthetic bones. RESULTS: The new MCP plate was significantly stiffer than the other two plates and stronger than the DCP plate in bending (p < 0.01). In torsion, the MCP plate was marginally stiffer (p < 0.11) and significantly stronger (p < 0.01) than the LC-DCP plate and not as stiff and strong as the DCP plate (p < 0.01). CONCLUSIONS: Mechanically, the MCP plate has adequate stiffness and strength for clinical application because it is at least as stiff and strong as one of the commonly used plates under both bending and torsional loading conditions.

Animals↗
PubMed2006

Infection rate in closed fractures after internal fixations in a municipal hospital in Ghana.

This prospective study conducted in the Holy Family Municipal Hospital in Techiman, Ghana aimed to determine the incidence of wound infection following internal fixation of closed fractures in a municipal hospital in a developing country. Between May 2000 and February 2005, 194 patients were treated for closed fractures, implanting a total of 215 internal fixations. Patients were reviewed 10, 30 and 120 days after operation. In 141 (73%) patients, a follow-up of four months was achieved. Of all patients, six developed an infection, two deep and four superficial. The cumulative incidence of wound infection after internal fixation was 3.3%. This study demonstrates that the incidence of wound infection following internal fixation is comparable with hospitals in a temperate climate in industrialized countries. We therefore conclude that specific tropical risk factors play a minimal role in the development of wound infection.

Adolescent↗
PubMed1993

Internal fixation of pathologic fractures. A retrospective study.

The records of 44 patients who underwent internal fixation for metastatic fractures between 1970 and 1989 were studied. Excluded were pathologic fractures involving the spine, pelvis, ribs and clavicles. None of the patients was still alive at the time of the study.

Adolescent↗
PubMed2002

Open reduction and internal fixation of fractures of the radial head.

BACKGROUND: The purpose of this retrospective study was to analyze the functional results following open reduction and internal fixation of fractures of the radial head and to determine which fracture patterns are most amenable to this treatment. METHODS: Fifty-six patients in whom an intra-articular fracture of the radial head had been treated with open reduction and internal fixation were evaluated at an average of forty-eight months after injury. Thirty patients had a Mason Type-2 (partial articular) fracture, and twenty-six had a Mason Type-3 (complete articular) fracture. Twenty-seven of the fifty-six fractures were associated with a fracture-dislocation of the forearm or elbow or an injury of the medial collateral ligament. Fifteen of the thirty Type-2 fractures were comminuted. Fourteen of the twenty-six Type-3 fractures consisted of more than three fragments, and twelve consisted of two or three fragments. The result at the final evaluation was judged to be unsatisfactory when there was early failure of fixation or nonunion requiring a second operation to excise the radial head, <100 degrees of forearm rotation, or a fair or poor rating according to the system of Broberg and Morrey. RESULTS: The result was unsatisfactory for four of the fifteen patients with a comminuted Mason Type-2 fracture of the radial head; all four fractures had been associated with a fracture-dislocation of the forearm or elbow, and all four patients recovered <100 degrees of forearm rotation. Thirteen of the fourteen patients with a Mason Type-3 comminuted fracture with more than three articular fragments had an unsatisfactory result. In contrast, all fifteen patients with an isolated, noncomminuted Type-2 fracture had a satisfactory result. Of the twelve patients with a Type-3 fracture that split the radial head into two or three simple fragments, none had early failure, one had nonunion, and all had an arc of forearm rotation of > or =100 degrees. CONCLUSIONS: Although current implants and techniques for internal fixation of small articular fractures have made it possible to repair most fractures of the radial head, our data suggest that open reduction and internal fixation is best reserved for minimally comminuted fractures with three or fewer articular fragments. Associated fracture-dislocation of the elbow or forearm may also compromise the long-term result of radial head repair, especially with regard to restoration of forearm rotation.

Adolescent↗
PubMed1976

Methylmethacrylate as an adjunct in internal fixation of pathological fractures. Experience with three hundred and seventy-five cases.

In 323 patients with 375 pathological fractures or impending fractures, local tumor resection and internal fixation supplemented by intramedullary methylmethacrylate proved highly successful. One hundred and thirty-nine patients had metastases from breast carcinoma; 142, metastases from other tumors; and forty-two, myeloma or lymphoma. The mean survival for the 210 patients who had undergone operation two years or more before final evaluation was 15.4 months. Ninety-four per cent of the patients who were ambulatory before fracture regained the ability to walk. Eighty-five per cent had excellent or good pain relief and in only five was pain relief rated poor. There were four failures of fixation and six functionally poor results. Twenty patients died within four weeks of operation, but the remaining patients benefited from the procedure in terms of pain relief, improved mobility, and ease of nursing care.

Acetabulum↗