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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↗
PubMed2006

Diagnosis and treatment of infections associated with fracture-fixation devices.

The pathogenesis of infections associated with fracture-fixation devices is related to microorganisms growing in biofilms, which render these infections difficult to treat. These infections are classified as early (<2 weeks), delayed (2-10 weeks) or late infections (>10 weeks) according to the implant surgery. Most infections are caused by staphylococci and are acquired during trauma (in penetrating injuries) or subsequent fracture-fixation procedures. A combination of clinical, laboratory, histopathology, microbiology, and imaging studies are usually needed to accurately diagnose infection. Magnetic resonance imaging (MRI) and computed tomography (CT) scans are often used to diagnose infection and plan surgical treatment. Positron emission tomography (PET) and PET-CT are promising new tools for diagnosing implant-associated osteomyelitis. The treatment goal is achieving bone consolidation and avoiding development of chronic osteomyelitis. Successful treatment requires adequate surgical procedures combined with 6-12 weeks of antimicrobial therapy acting on adhering stationary-phase microorganisms. In chronic osteomyelitis, orthopedic and plastic- reconstructive surgery is combined in the same procedure or within a short time span. In this article, pathogenesis, classification, diagnosis, and treatment of infections associated with intramedullary nails, external-fixation pins, plates, and screws are reviewed.

Animals↗
PubMed2006

Polyaxially-locked plate screws increase stability of fracture fixation in an experimental model of calcaneal fracture.

Different calcaneal plates with locked screws were compared in an experimental model of a calcaneal fracture. Four plate models were tested, three with uniaxially-locked screws (Synthes, Newdeal, Darco), and one with polyaxially-locked screws (90 degrees +/- 15 degrees ) (Rimbus). Synthetic calcanei were osteotomised to create a fracture model and then fixed with the plates and screws. Seven specimens for each plate model were subjected to cyclic loading (preload 20 N, 1000 cycles at 800 N, 0.75 mm/s), and load to failure (0.75 mm/s). During cyclic loading, the plate with polyaxially-locked screws (Rimbus) showed significantly lower displacement in the primary loading direction than the plates with uniaxially-locked screws (mean values of maximum displacement during cyclic loading: Rimbus, 3.13 mm (sd 0.68); Synthes, 3.46 mm (sd 1.25); Darco, 4.48 mm (sd 3.17); Newdeal, 5.02 mm (sd 3.79); one-way analysis of variance, p < 0.001). The increased stability of a plate with polyaxially-locked screws demonstrated during cyclic loading compared with plates with uniaxially-locked screws may be beneficial for clinical use.

Biomechanical Phenomena↗
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↗
PubMed2006

Posteromedial approach to the distal humerus for fracture fixation.

The authors report their experience with the posteromedial surgical approach of the humeral shaft for internal fixation of fractures by plating. Sixteen patients were treated for humeral shaft fractures (14 for recent fractures and two for nonunion) below the mid-diaphysis, all without injury of the radial nerve. Patients were operated in the prone position. Plate and screw fixation on the medial side was used in all cases. Fourteen fractures healed without delay, and two after revision with bone grafting. There were no surgical complications. The posteromedial approach allows the surgeon to avoid dissection of the radial nerve, and is an interesting alternative to lateral approaches especially in cases of re-operation or nonunion. Preoperative lesion of the radial nerve is however a relative contraindication to selecting this posteromedial approach, as it does not give access to the radial nerve.

Adolescent↗
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↗
PubMed2004

Internal fracture fixation.

Over the past decade, many improvements to small animal internal fracture fixation have been developed, including improved fixation techniques and a more diverse selection of implants. The understanding that appropriate fixation selection is based on a plethora of biologic, mechanical, and clinical factors has also emerged. Classically, the methods of internal fracture fixation have used pins, wires, screws, and plates to rigidly stabilize fractures that have been anatomically reduced with significant disruption to the biologic fracture environment. Newer methods attempt to minimize trauma to the soft tissues surrounding a fracture and promote biologic osteosynthesis using such implants as interlocking nails and plate-rod fixations. This review provides an overview of both the traditional and current principles of small animal internal fracture fixation.

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↗
PubMed1998

Timing of fracture fixation in blunt trauma patients with severe head injuries.

BACKGROUND: Early fracture fixation in blunt trauma patients is suggested to decrease postoperative morbidity by allowing early mobilization and reducing the release of harmful inflammatory mediators. Some studies have challenged this concept in the presence of severe associated injuries, and especially head trauma. METHODS: The records of 47 consecutive blunt trauma patients with severe head injuries, as defined by a Glasgow Coma Score (GCS) < or =8 and a head Abbreviated Injury Score (AIS) > or =3, and long bone fractures requiring surgical fixation were reviewed. The study population was divided into the early fixation (EF) group, consisting of 22 patients who underwent fracture fixation within 24 hours of admission (mean time 17 +/- 8.5 hours); and the late fixation (LF) group, consisting of 25 patients, who had orthopedic repair at a later time (mean 143 +/- 178 hours). RESULTS: The two groups were similar in terms of overall injury severity, neurologic injuries, hemodynamic and neurologic status on admission, and operations received. Patients in the EF group had a higher injury severity of extremity fractures (extremity AIS: 2.9 +/- 0.2 versus 2.4 +/- 0.5, P = 0.0002) and a higher incidence of open fractures (72% versus 36%, P = 0.02). There was no difference in intraoperative and postoperative hypoxic and hypotensive episodes. Neurologic, orthopedic, and general complications were the same between the two groups. The mean GCS on discharge was 12 +/- 3 for both groups with equal distribution among patients. Although there was a trend toward longer hospital stay (25 +/- 17 versus 17 +/- 10 days, P = 0.057) among LF patients, mechanical ventilation days, length of stay, and mortality were not different. CONCLUSIONS: Timing of fracture fixation in this group of blunt trauma patients with severe head injuries did not influence morbidity, mortality, or neurologic outcome.

Adolescent↗