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PubMed1996

Internal fixation of femoral shaft fractures in children and adolescents: a ten- to twenty-one-year follow-up of 52 fractures.

In a long-term follow-up (mean 16 years) of 52 femoral shaft fractures treated by internal fixation in 50 children and adolescents, we noted a mean overgrowth of 1 mm after plating and a mean undergrowth or relative shortening of 2 and 9 mm after nailing with broad (IMN) and slender (flexible rods: IMR) intramedullary nails, respectively. The mean overgrowth was 8 mm in children, but adolescents had a mean undergrowth of 5 mm (p < 0.01). Excessive overgrowth tended to occur less frequently after intramedullary nailing than after plating (p = 0.1). Undergrowth tended to occur with increasing frequency with increasing age and attained troublesome levels in three patients with severe trauma. Three cases of moderate valgus deformity of the hip and one case of late arthrosis of the hip occurred after intramedullary nailing with IMN introduced through the greater trochanter. We conclude that this method should not be used in patients with open physes.

Adolescent↗
PubMed2004

[Palmar fixed angle plating systems for instable distal radius fractures].

Internal fixation of distal radius fractures often shows the problem of secondary dislocation due to dorsal comminution and osteoporosis. Although dorsal plating systems provide good stabilization, the intraoperative control of reduction is difficult in the comminuted area with high incidence for the need of cancellous bone graft. Occurrence of extensor tendon complications including tendonitis and rupture is not uncommon. The use of fixed angle devices by a palmar approach has demonstrated the advantage of better visualization and control at the fracture side. The subchondrale support of the articular surface by fixed angle pegs or screws prevents secondary dislocation allowing early mobilization. Better soft tissue coverage is associated with a low complication rate. 62 patients (average age 55 years) were treated with different fixed angel devices according to the fracture type and underwent retrospective evaluation with mean follow-up of 11 months (6-23 months). According to the AO Classification there were 3 A2, 24 A3, 7 B3, 14 C1, 9 C2 und 5 C3 fractures. The majority beside the B3 types and one C3 fracture were dorsally displaced. All of them showed healing without relevant secondary loss of reduction. Mean DASH score reached 19 points.

Adult↗
PubMed1987

Resorbable materials of poly(L-lactide). VI. Plates and screws for internal fracture fixation.

Poly(L-lactide) (PLLA) with an extremely high molecular weight (Mv up to 1 X 10(6)) was synthesized at a low catalyst concentration (0.015 wt%) and temperatures between 100-110 degrees C. Besides good mechanical properties the as-polymerized PLLA exhibited a microporous structure. Plates and screws of this material were used for the treatment of mandibular fractures, both in dogs and in sheep. Bone healing was uneventful and proceeded without callus formation or signs of inflammation. Fracture healing was accompanied by a progressive degradation of the microporous implants of PLLA.

Animals↗
PubMed2001

Open volar repair of acute scaphoid fractures.

Internal fixation of acute scaphoid fractures has significant advantages over conservative treatment, using cast immobilization. Healing rates are improved, functional recovery is accelerated, and morbidity is reduced. Percutaneous fixation has become the treatment of choice for the majority of acute fractures, since it is an out-patient procedure, which produces virtually no scarring and enables an extremely-rapid recovery; however, in those cases where a stable and anatomical reduction cannot be achieved by closed means, open volar repair remains the best method of treatment. With careful attention to technique, and the avoidance of postoperative immobilization, excellent results can be achieved, even in the case of transscaphoid fracture-dislocation of the carpus.

Fracture Fixation, Internal↗
PubMed1994

Prediction of fracture union after internal fixation of intracapsular femoral neck fractures.

This study was based on a series of 470 patients with an intracapsular proximal femoral fracture treated by internal fixation; the characteristics of those patients with non-union were contrasted with those of patients in which union occurred, to determine which variables would predict bony union of the fracture. Radiological factors studied included measurements of fracture displacement, anatomical site and degree of osteoporosis. Patient characteristics studied were age, sex, prefracture mobility and mental state. Patient age and pre-operative fracture displacement were found to be of the greatest value in predicting non-union.

Age Factors↗
PubMed1984

Internal fixation of fractures in children and adolescents. A comparative analysis.

A retrospective analysis of 4,411 consecutive pediatric fracture patients managed between 1979 and 1983 demonstrated that only 3.6% (170 patients) required internal fixation. Two patient groups with sufficient follow-up study were compared: Group 1-90 skeletally immature children and young adolescents, and Group 2-66 skeletally mature adolescents. Upper-extremity fractures, especially of the distal humerus, and displaced epiphyseal fractures were the major indication for internal fixation in Group 1, while lower-extremity diaphyseal and intra-articular fractures predominated in Group 2. Complication rates were higher than expected but fortunately most were minor-18% in Group 1 and 12% in Group 2. The results of this study demonstrate that internal fixation can be beneficial in selected fractures in children and adolescents in preventing major complications, such as premature epiphyseal closure and malunion, and in restoring and maintaining normal extremity growth and function.

Adolescent↗
PubMed2004

Infrapectineal plating for acetabular fractures: a technical adjunct to internal fixation.

Acetabular fractures with medial displacement patterns, particularly medial displacement of the quadrilateral surface, may be technically challenging to treat. Minimal bone stock, limited anatomic access, and difficulty in obtaining stable internal fixation in the true pelvis contribute to the surgical challenge of open reduction and internal fixation. Applying a medial buttress plate across the quadrilateral plate below the iliopectineal line in the true pelvis can be a helpful adjunct to internal fixation in these fractures. The quadrilateral plate is approached from the opposite side of the injury through a standard ilioinguinal approach or a modified Stoppa approach. An undercontoured plate is secured posteriorly along the sciatic buttress posterior to the joint and the quadrilateral plate and anteriorly on the posterior surface of the pubic ramus. By resisting medial secondary redisplacement, this technique adds to stable fixation for acetabular fractures involving medial displacement, particularly of the quadrilateral plate.

Acetabulum↗
PubMed2001

[Analysis and experimental study of reasons for breakage in the bone fracture plate during internal fixation].

Bone fracture plate has been in clinical use for internal fixation of fracture, however, during healing, the steel plate breaks occasionally. This paper applied the static strength theory to imitate the pressed down combination out of shape that was borne by single limb of human body standing. Fracture was made on low limbs of the fresh dead body, fixed with a bone fracture plate. Strain measure was made on a bone fracture plate. Additionally, fatigue experiment and four-point bending experiment were carried out on a bone fracture plate. The reason for a breakage in the bone fracture plate was analyzed with static strength theory and low period fatigue theory.

Bone Plates↗
PubMed2002

[Orthopaedic applications for biodegradable and absorbable internal fixation of fractures].

OBJECTIVE: To illustrate the effect and complication of orthopedic applications for biodegradable and absorbable internal fixation of fractures, and to indicate the existent problem and research aspect currently. METHODS: The recent literatures on orthopedic applications and study of biodegradable and absorbable internal fixation for fractures were reviewed. The effect of biodegradable materials on bone healing was summarized. RESULTS: It is good for the stability of fracture fixation and result of treatment. The biodegradable and absorbable internal fixation fractures had no adverse effect on bone healing. CONCLUSION: There will be more widespread application for biodegradable and absorbable materials in orthopedics, but the intensive research should be carried out to prevent its complication.

Absorbable Implants↗
PubMed2002

Open reduction and internal fixation of fractured mandibular condyles by a retromandibular approach: surgical morbidity and informed consent.

Treatment of fractured mandibular condyles remains controversial. In this paper we present data collected prospectively on 42 fractured condyles treated by open reduction and internal fixation. The central issue, which is sometimes forgotten, is the informed consent of our patients. To this end we have looked at the surgical morbidity related to the retromandibular approach.

Adult↗
PubMed1994

Open reduction and internal fixation of fractures of the acetabulum. Results in 163 fractures.

Management of displaced fractures of the acetabulum represents one of the greatest challenges in fracture surgery. This study reports intermediate term results for a single surgeon of 163 fractures in 161 patients treated by open reduction and internal fixation. The mean length of followup was 3.7 years. The most common fracture patterns treated were both column (67), transverse/posterior wall (32), posterior wall (14), and T shaped (12). The surgical approaches chosen were ilioinguinal (86), Kocher-Langenbeck (58), and extended iliofemoral (26) with 7 patients having sequential or simultaneous dual approaches. Reductions were rated by plain radiography and considered anatomic in 93 (56%) and near anatomic (< 2 mm displacement) in 40 (25%). There were 7 (4%) infections, 2 (1%) vascular injuries, 3 (2%) sciatic injuries, and 1 (1%) obturator nerve injury. Overall outcome was rated as excellent in 23 (14%), good in 101 (61%), fair in 25 (16%), and poor in 14 (9%). Nine patients have undergone hip salvage procedures. These results add to the growing body of clinical data which validates open reduction as the treatment of choice in most displaced fractures of the acetabulum.

Acetabulum↗
PubMed1993

Use of a tourniquet in the internal fixation of fractures of the distal part of the fibula. A prospective, randomized trial.

A prospective, randomized trial was undertaken to determine the rate of complications after the use of a tourniquet during open reduction and internal fixation of simple, closed fractures of the distal part of the fibula. Forty patients were operated on with use of a tourniquet (Group 1) and forty patients, without use of a tourniquet (Group 2). The average duration of the operation was significantly different between the two groups (41 +/- 9 minutes for Group 1 compared with 53 +/- 12 minutes for Group 2 [p = 0.026]). There were more complications in the patients in Group 1, two of whom had an isolated deep-vein thrombosis of the calf. The wound was possibly infected in eleven patients (seven in Group 1 and four in Group 2 [p < 0.05]) and frankly infected in three patients, all in Group 1 (p < 0.05). The plaster-of-Paris cast needed to be changed in three patients from Group 1. The patients in Group 1 returned to work an average of one week later than those in Group 2. The mean duration of follow-up was eighteen months (range, nine to thirty-two months). Given the lower prevalence of postoperative complications and the shorter time to recovery for the patients in Group 2, we believe that it is justified not to use a tourniquet in the operative treatment of simple, isolated fibular fractures.

Adult↗
PubMed2005

[Internal fixation of proximal humerus fractures].

BACKGROUND: Intramedullary nails and angle-fixed plates have recently been used in proximal humerus fractures. Rigid implants might be associated with an increased risk of failure in osteoporotic conditions. METHODS: Unstable fractures of the surgical neck were created in 24 pairs of human humeri. The biomechanical properties of four implants were analysed. These were a nail with conventional interlocking (PHN-K), a nail with spiral blade interlocking (PHN-S), the T-plate, and an internal fixator with elastic screw properties (reference). The specimens were subjected to axial loading and torque. Stiffness, plastic deformity, and load to failure were assessed. RESULTS: The PHN-S was stiffer than the internal fixator. The PHN-K and T-plate were stiffer only during torque. Less subsidence was observed for the PHN-S. This implant failed at higher loads than the other implants. CONCLUSIONS: The PHN-S offers biomechanical advantages in unstable fractures of the surgical neck of the humerus. Elastic implant properties, however, are disadvantageous.

Aged↗
PubMed1997

Treatment of humeral pathological fractures by internal fixation and methylmetacrylate injection.

Between 1986 and 1993, 18 patients with complete or impending fractures of the humerus were treated using Hacketall rods in association with semi-liquid methylmetacrylate after excision of the metastatic lesion. Methylmetacrylate was always injected proximally and distally to the curetted bone through drill holes. Fourteen patients had a pathological fracture and four presented with an impending lesion. The mean age at time of surgery was 62 years (range: 42-83). The primary tumour was a breast carcinoma in 10 cases, bronchogenic squamous cell carcinoma in three cases and hypernephroma, multiple myeloma, malignant melanoma, rectal adenocarcinoma and unknown primary tumour in one case each. The left arm was involved in seven cases and the right in 11. All patients experienced immediate relief from the pre-operative pain, although three patients complained of a residual discomfort during motion. In these three cases the residual pain can easily be managed with use of oral non-morphinic drugs. The functional aspect was not evaluated in two patients who died in the early post-operative period as a result of their general condition. In 15 patients, the post-operative range of motion was at least 80% of a normal humerus mobility. One patient encountered motion limitation because of an important lymph oedema. There was no infection, one patient had a temporary radial palsy with a complete restoration after a period of 5 days. No migration of the material was observed during an average follow-up of 9 months (range: 1-24).

Adult↗
PubMed1977

[Minimal internal fixation of fractures in elder children (author's transl)].

The fractures in elder children (9--17 years) need a special treatment. Regarding the exact reposition they have to be handled like the fractures of adults. Regarding localisation, morphology of the bone and the way of internal fixation they have to be treated like those of smaller children. The "Minimal-Osteosynthesis" primarily means adaptation, refixation and continuous retention. The procedure is less traumatizing, however the indication should be as strictly as in other cases. The minimal osteosynthesis is giving more respect to the growing bone. The material of internal fixation may be removed much earlier than in adults. Stability for early physical exercises is rarely necessary in children. Even different types of minimal internal fixation are possible. A number of cases are demonstrated.

Accidents, Home↗