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Results for “FRACTURE FIXATION”

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At least 73 records · Page 4Linked to original sources

PubMed1994

Tissue-implant interface at an absorbable fracture fixation plug made of polylactide in cancellous bone of distal rabbit femur.

The tissue-implant interface at a self-reinforced poly-L-lactide (SR-PLLA) expansion plug implanted in distal rabbit femoral cancellous bone was studied histologically, histomorphometrically, and microradiographically in 35 rabbits during consolidation of a transverse transcondylar osteotomy fixed with the SR-PLLA expansion plug. The absorbable plug for internal fixation of fractures and osteotomies measured 4.5 mm in diameter and 30 mm in length and had an expandable distal locking blade system. The femoral specimens were harvested in groups of 5-10 rabbits after a follow-up time of 3, 6, 12, and 24 weeks. The intact contralateral femur served as a control. Vigorous osteogenic response to the implant was already observed at 3 weeks postoperatively, and the osteoid surface fraction at 24 weeks was still significantly higher than in the unoperated contralateral femur. Incomplete union of the osteotomy seemed to result in increased fibrous tissue formation at the tissue-implant boundary. No signs of degradation of the SR-PLLA was observed within the entire follow-up period. The number of inflammatory cells at the tissue-implant interface was low. Consequently, the short-term biocompatibility of the implant was deemed acceptable. Clinical application of the expansion plug is being planned.

Animals↗

PubMed1992

Principles of fracture fixation in growing animals.

Changes in bone structure and conformation can occur very rapidly in growing animals. Injury to the bones or articular surfaces warrant special consideration because of the potential devastating consequences of secondary growth deformities in the animal. Disturbance of normal growth plate activity, imperfect fixation of an articular fracture, and conformational defects in long bones may create lifelong problems for the animal.

Animals↗

PubMed1994

Audit of ankle fracture fixation in the elderly.

To assess the results of operative treatment of ankle fractures in the elderly, we have reviewed the results of ankle fracture fixation in 76 patients aged over 50 years. This was carried out with special reference to the early complications. Our series had a 1.8% incidence of infection and a 5.2% incidence of delayed healing and wound necrosis. Malunion occurred in 7.9% of patients, and was due in all cases to either imperfect peroperative reduction or inadequate fixation. In no case did fixation fail because of poor bone quality. We conclude that internal fixation of ankle fractures in the elderly carries acceptable risks, so long as careful attention is paid to surgical technique, and fixation is in accordance with AO/ASIF principles.

Age Factors↗

PubMed1998

Biodegradable interlocking nails for fracture fixation.

Serious problems such as stress shielding, allergic reactions, and corrosion are associated with the use of metallic fracture fixation devices in fractured long bones. Metal implants often are removed during a second retrieval operation after fracture healing has completed. A biocompatible implant that degrades slowly during implantation would obviate the need for a second operation and save the patient from considerable physical, psychologic, and financial discomfort. The biodegradable implant must provide the fractured limb sufficient support for a certain time, allowing early loading. A gradual transfer of load from the biodegradable implant to the bone would result in a better product of bone healing and avoid stress shielding. In an animal model using adult sheep, two types of biodegradable polymer interlocking nails were tested in comparison with a stainless steel interlocking nail. Fracture healing, mechanical properties of the bones, degradation behavior in vivo and in vitro, and tissue response were monitored during a 2 1/2-year followup study. To detect shifts in acid base relations caused by the release of acid compounds, pH measurements were performed. Fracture healing was unimpaired, and the mechanical test results of all three groups were excellent. Histologic analysis showed a mild inflammatory response, but no pH shifts were observed. The results of this study justify additional research on these promising materials.

Absorbable Implants↗

PubMed1996

Cement augmentation of intertrochanteric fracture fixation: a cadaver comparison of 2 techniques.

We evaluated 2 techniques of cement augmentation to enhance fixation of intertrochanteric hip fractures. 4 fixation groups with 6 cadaver femurs in each group were compared: stainless steel lag screw and side plate with and without cement augmentation and a titanium alloy expandable dome plunger and side plate with and without cement augmentation. Gauges were used to establish the mechanical behavior of intact and then fractured femurs to simple uniaxial loads. Subsequent loading to failure allowed determination of maximum fixation strengths and modes of failure. Cement augmentation of each device increased its load to failure. There was no significant difference between the cemented lag screw and the uncemented dome plunger groups with average loads to failure of 4.0 x 10(3) N. The greatest average load to failure was in the cemented dome plunger group (5.6 x 10(3) N) with the lowest in the uncemented sliding hip screw group (3.6 x 10(3) N). Device cut-out as a cause of failure occurred mostly in the uncemented lag screw group. Sliding was enhanced by those methods that increased the fixation surface area within the femoral head, unless cement encroached in the region of the barrel-screw junction. Strain analysis showed that the dome plunger unloaded the bone at the calcar, regardless of cement augmentation, while the sliding hip screw allowed for compressive stresses in this area. Proper cement augmentation increases load to failure and minimizes nail cut-out for both devices studied. However, the dome plunger, a device with a large fixation area in the femoral head, was equally effective and eliminated potential cement encroachment. Failure of intertrochanteric fracture fixation in osteoporotic bone may be minimized by an appropriate choice of device or cement augmentation.

Bone Cements↗

PubMed1991

Biomechanics of fracture fixation failure.

This article reviews the physiologic forces, stresses, and strains in normal bones. Biomaterials used in implants for fracture fixation devices are described, and the mechanical properties of an implant are discussed. The common mechanisms of implant failure are included.

Animals↗

PubMedDate not supplied

Well-leg compartment pressures during hemilithotomy position for fracture fixation.

OBJECTIVE: To evaluate the relationship between the well-leg compartment pressures and time during hemilithotomy position for fracture fixation. DESIGN: Prospective. SETTING: Level 1 trauma center. PATIENTS/PARTICIPANTS: Ten patients who underwent intramedullary nailing of a fractured femur in the hemilithotomy position (with a well-leg holder). INTERVENTION: Continuous pressure monitoring was achieved with in-dwelling slit catheters inserted into the calf compartments of the well leg. Baseline measurements were obtained in the supine position. After the leg was placed in the hemilithotomy position, compartment pressures were monitored throughout surgery. MAIN OUTCOME MEASUREMENTS: Calf compartment pressures at baseline, during hemilithotomy position, and post-hemilithotomy were compared. The association between body mass index and compartment pressure was analyzed. RESULTS: A consistent pattern was observed between compartment pressures and time. The curve was that of a step function in which the pressure increased as soon as the leg was placed in the well-leg holder and remained elevated until the leg was taken down. The pressure jumped from a baseline of 9.2 to 27.3 millimeters of mercury (mm Hg) (p<0.0001). While in the hemilithotomy position, the leg pressure trended slightly upward. Once the leg was taken down, the pressure immediately returned to a near-baseline level of 8.1 mm Hg (p<0.0001). A significant correlation was also found between the body mass index and leg pressure (R2 = 0.713; F = 0.002). CONCLUSIONS: The use of the well-leg holder to maintain hemilithotomy position increases the calf compartment pressures dramatically and significantly. Therefore, we recommend avoiding this position for fracture fixation in at-risk patients.

Adolescent↗

PubMed1994

Economic considerations on avoiding implant removals after fracture fixation by using absorbable devices.

Pins and screws for internal fracture fixation made of absorbable polymers have been available since the latter half of the 1980s. When using these implants there is no need for a subsequent implant removal operation. During the 7-year period 1985-1991, a total of 1219 patients were treated with such absorbable fixation devices, the most common indications being displaced malleolar fractures of the ankle and fractures of the radial head. Considering the economic viewpoints, the high acquisition costs of the absorbable implants partially outweighed the benefit of avoiding all removal procedures. When all costs also for the implant removal procedure after metallic fixation were included, the average cost saved per patient by using absorbable implants in a trimalleolar fracture was FIM 2023 (4.4% of the total costs). However, the removal of metallic devices is in fact to some degree optional, and in case the metallic implants were not removed, the economic result was in favor of the metallic devices by FIM 3684 per patient. Consequently, the ultimate economic audit of the use of absorbable vs. metallic devices is linearly dependent on the actual implant removal frequency. According to the present cost analysis, the break-even point would be attained at a removal rate of 65% in trimalleolar ankle fractures, at 51% in uni-and bimalleolar fractures and at 30% in fractures of the radial head. Only at a higher removal rate the introduction of absorbable devices would be a financially more favorable alternative.

Bone Nails↗

PubMed1984

[Biomechanical studies on fracture fixation mechanism of the clover leaf medullary nail].

The intramedullary nailing method described by Küntscher is used widely now as an excellent treatment of the fracture of the long bone. However, it is well known from clinical experience that fracture fixation of the clover leaf nail is not so strong and especially rotational fixation is very poor. For the purpose of re-evaluating fracture fixation mechanism with Küntscher's nail, the following studies were performed. Osteotomized human cadaveric femur was fixed with the clover leaf nail in an ordinary manner. This osteosynthesis model was imbedded in plastic resin (RIGOLAC) in situ. Afterwards this model was cut into specimens 1.5 cm in thickness. The contact area between the bone and the nail was investigated macroscopically and roentgenographically on each specimen. Stress distribution in cross section of some commercially available clover leaf nails was investigated by the technique of photoelastography. Total expansive force of the clover leaf nail was obtained by the calculation based on the measured values. From these investigations the author concludes that the clover leaf nail does not fix the fracture by the expansive spring mechanism only, as was originally claimed by Küntscher.

Biomechanical Phenomena↗

PubMed1995

High-impact poly(L/D-lactide) for fracture fixation: in vitro degradation and animal pilot study.

The impact strength of amorphous lactide copolymers can be significantly improved by blending with biodegradable rubbers. Rubber toughening of amorphous poly(85L/15D -lactide) with the copolymer poly (50/50-trimethylenecarbonate-co-epsilon-caprolactone) results in a high-impact polymer (PDLLA/P(TMC-CL)). In vitro, the PDLLA/P(TMC-CL) blend retained its tensile and impact strength for a long period of time. Up to 45 weeks, the amount of water absorbed by the blend remained very low and no significant mass loss was observed. To test the suitability for fracture fixation, in a dog study mandibular fractures were fixated with PDLLA/P(TMC-CL) bone plates and screws. Bone healing was uneventful without premature failure of the implants. Although long-term degradation studies have to be carried out, PDLLA/P(TMC-CL) seems to be promising for application in fracture fixation.

Animals↗

PubMed1993

Symptomatic displacement of the lesser trochanter following trochanteric fracture fixation.

Unstable intertrochanteric hip fractures are characterized by comminution of the posteromedial cortex, resulting in a fragment of variable size containing the lesser trochanter. Controversy exists as to whether it is necessary to perform reduction and fixation of this fragment. This case lends further support to the practice of fixating the lesser trochanteric fragment in unstable intertrochanteric fractures.

Aged↗

PubMed1985

Mandibular fracture fixation and reconstruction using the lower-border threaded rod: an eleven-year follow-up study.

Twenty-five cases in which a lower border threaded rod was used for fracture fixation and mandibular reconstruction were reviewed. These cases were performed during the last 11 years and have been followed for periods of up to five years and ten months. The fixation technique, originally reported in 1978, is well tolerated and provides excellent mechanical stability when enhanced security of fixation is indicated. Three unusual cases are reported in detail.

Adolescent↗

PubMed1981

[Comparative investigations on the stability of fracture fixations with different fixateurs externes (author's transl)].

Short oblique fractures of the tibiae were stabilized with two-dimensional (frame spanner), three-dimensional and various V-shaped fixateurs externes, applied at the ventral-medial side. The stability of all these different types of fracture fixations was tested with and without an additional lag screw. Under a torsional load the stability of the area of osteotomy was measured. The three-dimensional fixateur externe and the V-shaped fixateur externe yielded the best results. The use of an additional lag screw produced a greater and significant (p less than 0,01) improvement.

Biomechanical Phenomena↗

PubMed1998

Comparison of the size of plates for fracture fixation with the size of phalanges and metacarpals in cadavers of Asian origin.

The size and volume of plates and screws for fracture fixation of the hand (1.5-mm screws and titanium miniplates, 2.0-mm screws and stainless-steel AO miniplates, and 2.7-mm screws and stainless-steel AO miniplates) were compared against the phalanges and metacarpal bones and the surrounding soft tissue from male cadavers of Asian decent. In the cadaver study, it was first established that the difference between anatomic measurements and radiologic measurements for the interarticular bone length and midshaft width were not significant (p = .09). Second, the volume occupied by the bone showed a close association to interarticular bone length. This finding would suggest that the volume occupied by the bone may be estimated from the radiographs. When the length of the plates was compared to that of the bones, the analysis showed 4-hole and 6-hole 1.5-mm titanium miniplates, and the 4-hole and 6-hole 2.0-mm AO plates were not suitable for the middle phalanx, although only rarely are fractures in the middle phalanx fixed with plates. For the proximal phalanx, only the 4-hole 1.5-mm and 2.0-mm plates were suitable in length. The 6-hole 2.0-mm AO plate was found to be suitable for only the longer proximal phalanx of the middle digit. For the metacarpals, the 5-hole 2.7-mm AO plate was found not to be suitable for the thumb (in length) and the ring digit (in width). The commonly used plates and screws for fracture fixation of the hand may not be suitable in size for groups of people with smaller hand sizes, in particular some Asians and women.

Adult↗

PubMed1997

Early fracture fixation may be deleterious after head injury.

OBJECTIVE: To determine the neurologic risks associated with early fracture fixation (FF) in multitrauma patients with head injuries. METHODS: We reviewed 33 blunt trauma patients with significant closed head injuries (Abbreviated Injury Scale (AIS) score > or = 2) requiring operative FF. Nineteen patients underwent early FF defined as < or = 24 hours after injury, and 14 patients underwent late FF defined as > 24 hours after injury. The two groups were well matched in regards to age, 40.3 years (range, 8-88 years) versus 36.4 years (range, 8-75 years), admission Glasgow Coma Scale score (12 +/- 4 vs. 11 +/- 5), and Injury Severity Score (25 +/- 10 vs. 27 +/- 12). Additionally, the groups had similar neurologic and orthopedic injury scores (AIS-CNS score = 3.3 +/- 0.9 vs. 3.1 +/- 0.9, AIS-Ortho score = 3.0 +/- 0.9 vs. 2.9 +/- 0.7). Data were collected concerning the volume of fluid resuscitation, neurologic complications, and clinical outcomes. RESULTS: The early FF group received significantly more fluids in the first 48 hours (14.0 +/- 10.2 vs. 8.7 +/- 3.5 liters, p < 0.05). The early group trended towards a higher rate of intraoperative hypotension (systolic blood pressure < 90 mm Hg, 16% vs. 7%) and intraoperative hypoxia (O2-Saturation < or = 90, 11% vs. 7%). The neurologic complication rate was similar in the two groups (early FF = 16% vs. late FF = 21%), but the average discharge Glasgow Coma Scale score was lower in the early group (13.5 +/- 3.7) when compared with the late FF patient group (15.0 +/- 0.0). CONCLUSIONS: Early FF leads to greater fluid administration in patients with head injuries. Hypoxemia and hypotension, risk factors for secondary brain injury, may contribute to a poor neurologic outcome after early fixation. Prospective studies evaluating the impact of the timing of FF on head injury are indicated.

Adolescent↗

PubMed1993

The effect of staple size, orientation, and number on torsional fracture fixation stability.

Staples have been used for fixation of metaphyseal fractures, but there are no guidelines for placing the staples to ensure maximum fixation stability. This study investigated the effect of staple size, orientation, and number on torsional stability in simulated transverse fractures. Six homogeneous foam cylinders were cut transversely, stapled back together using a power driver, and rotated coaxially on a servohydraulic test system. Staples with bridge widths of 7, 10, 13, and 16 mm, and leg lengths of 7, 10, 15, and 20 mm were used. Each test was performed seven times. Torsional holding power was increased when two staples were oriented in opposite directions (45 degrees) and had bridges wide enough to maintain bone purchase with respect to the fracture line. Fixation effectiveness increased with the number of staples: the use of two staples (as opposed to one) yielded the biggest increase; further significant increases were also observed for the use of three, four, and five staples. Bridge width and leg length had minimal effect, as long as bone purchase sufficient to avoid cutout was maintained from the staple to the fracture surface.

Biomechanical Phenomena↗

PubMed1983

Femoral neck fracture fixation: rigidity of five techniques compared.

Artificial cadaveric femoral neck fractures were internally fixed with five different devices and subjected to cyclical loading of 0-1.0 kilonewtons (approximately one body weight) whilst in an anatomical position. Displacement of the proximal fragment was detected by a transducer and charted. Bone strength was assessed by a preliminary control loading phase on the intact bone. Efficiency of each fracture fixator could then be directly compared by the relative movement in each case. Five specimens each were tested with Moore's Pins, Trifin Nail, Garden Screws and a sliding screw-plate (OEC Ltd). By the criteria of the experiment, which put a severe shearing load on the implant, none of these devices reliably bore the representative body weight. An extended barrel-plate, which supported the sliding screw almost up to the fracture line, was then made. This device, employing some of Charnley's concepts, tolerated body weight in four cases out of five.

Aged↗

PubMed1990

[Method of fracture fixation using external fixation devices].

An improvement of the results of treatment can be reached, beside respecting the indication of external fixateurs, with correct tactics of the treatment. Because of the disadvantages of the fixateur externe, we strive to restrict their use, to the time by all means necessary, and if possible to use other methods of fixation. This is motivated especially by the effect on fracture healing and the hindering of the movements and activity of the patient.

Biomechanical Phenomena↗