SEARCH · PubMed Health
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Although device failure in intramedullary (IM) nailing of subtrochanteric fractures is uncommon, breakage of the nail can occur. Following a review of the literature on this subject, a case is reported that illustrates the surgical and biomechanical factors that can lead to nail failure.
Twenty-seven peritrochanteric fractures in 27 patients were evaluated and treated prospectively. Ten fractures were internally fixed with compression hip screws (CHS) (Omega Howmedica, Rutherford, NJ) and 135 degrees, four-hole side plates. Internal fixation of the posteromedial fragment was not done. Eleven fractures were internally fixed with Gamma nails with distal screws. Six fractures were internally fixed with Gamma nails without distal screws. Each group was evaluated for surgical time, blood loss, hospital days, collapse of the fracture, infections, cut out of the lag screw from the femoral head, fracture healing, perioperative femoral shaft fractures, and implant failure. Surgery time did not differ significantly in either group. Blood loss and hospital days were less in the Gamma nail group. There were no infections, cut out of the lag screw, implant fractures, or pulmonary complications in either group. Fracture healing was the same in both groups. Those fractures treated with Gamma nails, both with and without distal screws, had 50% less collapse than those treated with CHS. There were two femoral shaft fractures in the Gamma nail group (11.76%). There were no femoral shaft fractures in the CHS group. Fractures of the femoral shaft were believed to be caused by two factors: a mismatch of the nail design and the normal geometry of the proximal femur and stress risers in the femoral shaft caused by repeatedly missing the screw hole with the drill bit. Although the Gamma nail is an excellent device for stabilizing and preventing collapse of unstable peritrochanteric fractures, the learning curve is high, and femoral shaft fractures can occur. We believe precautions outlined in this report are helpful in preventing these complications.
Thirty-two consecutive subtrochanteric fractures in 32 patients were stabilized using the Medoff sliding plate and were followed up prospectively for 1 year. Two patients died during the first postoperative year. Twenty-nine of the remaining 30 (97%) fractures united by 1-year followup. Two types of plate dynamization schema were used: uniaxial (17 patients) and biaxial (15 patients). With uniaxial dynamization, plate sliding averaged 12 mm along the femoral shaft without medialization of the femoral shaft. With biaxial dynamization along the femoral shaft and the neck, plate sliding averaged 11 mm and screw in barrel sliding averaged 9 mm; medialization of the femoral shaft ranged from 0% to 35% of the femoral shaft diameter. Three fractures treated with uniaxial dynamization had migration of the lag screw within the femoral head; all three fractures united without additional screw migration after secondary or staged biaxial plate dynamization.
The treatment of segmental multilevel fractures of the femur is problematic. Open methods of fracture fixation which strip the soft tissue attachments from the bone cause devascularisation of the middle segment. Mechanical fixation using 2 separate plates results in a stress riser. The use of closed intramedullary nail addresses some of the problems in this difficult group of fractures, preserving the soft tissue envelope and eliminating stress risers. However, vascularity of the middle segment may still be compromised. Six cases of fractures of the femur that were segmental in nature or associated with a fracture around the hip were treated with a closed intramedullary locked nail. The average operating time was 123 minutes and there were no infections. Average time to union was 7.2 months. Two cases required re-operation, one to correct a residual internal rotation deformity and one required dynamisation to eliminate the gap at the fracture site.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
In two years we treated four women with ununited stress fractures of their proximal tibial diaphyses. They all had arthritis and valgus deformity. The stress fractures had been treated elsewhere by non-operative means in three patients and by open reduction and internal fixation in one, but had failed to unite. After treatment with a modular total knee prosthesis with a long tibial stem extension, all the fractures united. A modular total knee prosthesis is suitable for the rare and difficult problem of ununited tibial stress fractures in patients with deformed arthritic knees since it corrects the deformity and the adverse biomechanics at the fracture site, stabilises the fracture and treats the arthritis.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
One hundred and eleven cases of mandibular fracture in 67 patients who were seen at the San Francisco General Hospital from 1960 to 1962 were reviewed. With the exception of two cases in which displaced fragments interfered with the mandibular range of motion, condylar fractures were successfully treated with closed reduction. Undisplaced fractures of the angle were treated successfully by intermaxillary fixation alone, but the significantly displaced fractures were treated by open reduction and interosseous wire fixation. Fractures of the anterior body and midbody were usually treated with closed reduction if adequate teeth were present for satisfactory intermaxillary fixation. Some fractures of the anterior body, particularly those in the region of the symphysis require open reduction because of the strong pull of the muscles in that area. In this series of patients, clinical infection and non-union were most commonly associated with fractures communicating with teeth. If open reduction is necessary, the results in this series suggest that it should be delayed until the oral tract left by extraction is healed. Prophylactic antibiotics did not appear to be of value in preventing infection or non-union in this small series of patients, although sufficient data were not available for a statistical conclusion.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
A nonunion of a diaphyseal fracture of the humerus can present a major functional problem even in the elderly population. Advances in operative exposures combined with newer techniques of achieving stable internal fixation even in the presence of pathologic bone have enabled the surgeon to successfully treat even the most complex nonunions.
Explore the source record for details and available documents.
This is a retrospective study of 104 open fractures of the tibial shaft seen at a civilian teaching center. Seventy-one per cent of the fractures resulted from vehicular accidents. Twenty-seven per cent of the fractures did not unite and half of these non-unions were infected. Virtually all of the ununited tibial fractures were associated with fractures of the fibula and with extensive avulsions of skin and dirty wounds. Although a variety of techniques for care of the wound and treatment of the fracture was used, none was entirely successful. Some failures were attributable to inadequacies of wound care--either premature primary closure or failure to perform secondary skin closure. Other failures of treatment were associated with use of internal fixation. Early weight-bearing without internal fixation, however, did not uniformly result in union.