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PubMed1990

Mechanical analysis of the factors affecting dynamization of the Orthofix Dynamic Axial Fixator.

Loading trials were conducted to identify mechanical factors affecting dynamization of a commercially available external fixator (Orthofix) that is designed to undergo free telescopic motion when axially loaded. Angular variations between the proximal and distal screw clamps and the telescoping fixator body failed to produce fixator binding (failure to dynamize) in any of the loading trials. However, binding was produced by applying external torques in magnitudes that occasionally occur during routine ambulation. The specific torque necessary to induce binding (typically 3-4 Nm) was only a weak function of axial load magnitude, axial loading frequency, or simulated fracture stiffness. Among several geometrical variables of fixator application, only the pre-extension of the telescoping body and circumferential misalignment between proximal and distal pin clusters had an appreciable influence on the threshold binding torque. Axial fixator motions were also monitored in a small adjunct clinical series of 22 dynamized tibial fractures. The fixator dynamized appropriately in 15 cases (68%). Three patients (14%) showed evidence of fixator binding, and another four (18%) had less than predicted slider excursions. The role of several design factors implicated in torque-induced fixator binding is discussed in light of the benchtop and clinical observations.

Biomechanical Phenomena↗

PubMed1987

The influence of fixation on the morphology of mouse epidermis. A light and electron microscopical study with special reference to "dark cells" and epidermal carcinogenesis.

Different opinions exist on the normal ultrastructure of the epidermis including the significance of so-called basal dark cells. Thus, the dark cells are still assumed to be key elements in experimental skin carcinogenesis. We therefore explored the effects of tissue fixation on the ultrastructure of the epidermis. Untreated normal hairless mouse skin was processed for transmission electron microscopy with two different sets of fixatives, applied either by perfusion-immersion or immersion fixation only. The morphology of both the basal and the lower suprabasal layers of the epidermis, including the extracellular space, the shape and volume of the cells, their electron density, and the organisation of some of the organelles, were profoundly affected by the choice of fixatives. The non-keratinocytes showed comparable changes, including the appearance of a dark phenotype. The incidence of small electron-dense keratinocytes (dark cells) and the nature of their ultrastructure changed markedly with the fixation procedure. We were not able to identify undifferentiated dark cells. The pattern of changes and the quality of the morphological picture were almost unaffected by the mode of fixation. The upper suprabasal and the cornified layers appeared to be more or less unaltered by the change in fixatives and the method of application. The vehicle osmolality of the primary fixative was found to be mainly responsible for the ultrastructural appearances. A low vehicle osmolality may be responsible for the occurrence of the dark cell phenomenon, by inducing swelling artefacts of many cells with compression of some neighbouring cells.

Animals↗

PubMed1988

Combined Kirschner-Ehmer apparatus and dorsal spinal plate fixation of caudal lumbar fractures in dogs: biomechanical properties.

The strength and rigidity of a new surgical technique for the stabilization of caudal lumbar fractures in dogs, using a Kirschner-Ehmer apparatus and a dorsal spinal plate (KE/DSP), were compared with 2 other methods of internal spinal fixation and with intact (control) spines, using a spinal test system that subjected the spines to 4-point bending. The fixation devices were applied to isolated canine lumbosacral spines (L1 to S3) from cadavers. A complete spinal separation was made in the spine implant specimens at L5-L6 by sharp dissection of all ligamentous structures connecting the two vertebrae. Bending moment vs L5-L6 angular deformation curves, and rigidity and load sustained at 10 degrees angular deformation (failure) were recorded for each fixation method and for the control spines. Values were compared by statistical analysis. The combined KE/DSP fixation and a combined vertebral body plate/dorsal spinal plate (VBP/DSP) fixation were stronger and more rigid than were the control spines and those fixed with a modified segmental-fixation method (P less than 0.05). There were no statistical differences in strength and rigidity between the 2 combined-fixation techniques. Although the VBP/DSP technique is not applicable to clinical caudal lumbar (L5-L6) fractures, it was compared in this study to the KE/DSP technique because a similar VBP/DSP technique was reported strongest in a similar study of L3-L4 simulated fractures, compared with 3 other spinal-fixation techniques that have been used in repair of caudal lumbar fractures. The technique has been used successfully in 6 dogs with caudal lumbar fractures.

Animals↗

PubMed1987

[Scapulohumeral arthrodesis by combined external and internal fixation. A biomechanical, technical and clinical study].

The indications for arthrodesis of the shoulder are controversial and limited and fusion is difficult to achieve, as is shown by the number of methods described in the literature. Since 1970, the authors have used combined internal and external fixation for arthrodesis of the shoulder. From a biomechanical study of arthrodesed shoulders, an attempt has been made to define the best combination of fixation. Three progressively more complex methods combining intra-articular fixation with a Hoffmann external fixator in compression have been tested. The ideal method combines transverse double scapulo-humeral screws with a vertical acromio-humeral screw. The addition of a bony subacromial strut controls the shearing effects arising from the application of the fixator in compression and also provides an upper site of fusion. In 14 arthrodeses using combined internal and external fixation analysed with a two to sixteen year follow-up, acromio-humeral fixation has been used in 11 cases with 10 primary successes and in 3 cases triple screw fixation has given very rapid fusion without the need for spica immobilisation.

Arthrodesis↗

PubMed1986

Reading with a macular scotoma. I. Retinal location of scotoma and fixation area.

To investigate how patients with macular scotomas use residual functional retinal areas to inspect visual detail, a scanning laser ophthalmoscope (SLO) was used to map the retinal locations of scotomas and areas used to fixate. Three patients with dense macular scotomas of at least 20 months duration and with no explicit low vision training were tested. SLO stimuli were produced by computer modulation of the scanned laser beam, and could be placed on known retinal loci by direct observation of the retina on a television monitor. Videotaped SLO images were analyzed to produce retinal maps that are corrected for shifts of stimulus position due to fixational eye movement, thus showing the true retinal locations of scotomas and fixation loci. Major findings were as follows: 1) each patient used a single, idiosyncratic retinal area, immediately adjacent to the scotoma to fixate, and did not attempt to use the nonfunctional foveola, 2) fixation stability with the eccentric fixation locus was as good as, or better than, that of ocularly normal subjects trying to fixate at comparable eccentricities, 3) fixation stability was not systematically related to clinical visual acuity, and 4) there is good agreement as to the shape and overall size of SLO and standard clinical tangent screen scotoma maps for these three patients.

Adult↗

PubMed1983

Experimental fixation of femoral osteotomies by cerclage with nylon straps.

Following the successful experience of Partridge in the fixation of human femoral fractures by nylon-strap cerclage, this research in 23 mature dogs was performed to compare nylon-strap with wire-loop cerclage for healing periods of up to 12 weeks. Supplemented by intramedullary fixation with Steinmann pins, long oblique femoral osteotomies were fixed in one femur of each dog by nylon straps and in the other femur by wire loops, at separate operations. The nylon straps were all secured at the same tension by a special "gun." The wire loops were all secured at the same tension by the Rhinelander tightener-twister. Half of the nylon straps had "bumps" along the inner surface, which were added by Partridge in an effort to circumvent the microvascular disturbance reported with Parham bands. On examination by microangiography and correlated histology, all of the osteotomies, regardless of the type of fixation, showed good progress toward osseous union. After fixation by wire cerclage no loss of position or disturbance of blood supply was noted. After fixation by nylon straps slight (clinically insignificant) longitudinal displacement, attributed to slight lengthening of the straps, with consequent loosening was noted in all cases. This loosening was considered advantageous because it appeared to be responsible for the unexpected lack of impairment of the vascularization of the underlying cortical bone by any of the straps. The bumps on the undersurface of some of the straps were, thus, of no vascular advantage, and their presence made accurate fixation of the ostectomy fragments more difficult on the small bones. These studies support the value of fixation by plain nylon straps and show their advantage over straps with bumps for fixation of long oblique single osteotomies of bones the size of the canine femur.

Animals↗

PubMed1978

Eccentric fixation in amblyopia: is reduced foveal acuity the cause?

The Worth-Chavasse theory of amblyopia is briefly reviewed with particular attention to Worth's explanation that eccentric fixation develops in an attempt by the amblyopic eye to fixate with an eccentric retinal locus having higher acuity than the fovea. Three experiments are reviewed; these show that of 8 eccentrically fixating amblyopic eyes tested, 7 had foveal acuity that was higher than or equal to the acuity at the eccentric fixation locus. A fourth study is reviewed, however, which reports that 24 of 25 eccentrically fixating amblyopic eyes had highest acuity at the eccentric retinal locus. With only slight reservations, the conclusion from the first 3 experiments that eccentric fixation does not occur to improve acuity appears justified, but the contrary results of the fourth study, in which fixation was not controlled, cannot easily be dismissed. The importance of performing an experiment that accurately measures acuity across the retinas of amblyopic eyes with careful control of fixation and target location is stressed.

Amblyopia↗

PubMed1995

Stability of fixation: results of fundus-controlled examination using the scanning laser ophthalmoscope.

We evaluated the stability of fixation in 38 healthy eyes (N), 30 eyes with macular degeneration (AMD) and 20 eyes with juvenile macular dystrophy (JMD) during our newly developed automated full-threshold static perimetry using the scanning laser ophthalmoscope (SLO). The point of fixation was recorded for each stimulus presentation. After the examination, the mean fixation point (MFP) as well as the standard deviation from the MFP, the examination time, and the reaction time were evaluated. Healthy eyes did not show a mean SD of more than 0.7 degree from the center of gravity of fixation with one exception. There was only poor correlation between age and deviation from the MFP (r = 0.09 for N; r = 0.18 for AMD; and r = 0.18 for JMD), whereas the correlation between visual acuity (VA) and deviation from the MFP was slightly better (r = 0.22 for N; r = 0.34 for AMD; and r = 0.52; P < 0.02 for JMD). Eyes with functional impairment mostly showed instable fixation (deviation, > 3 degrees), which was observed even in two patients with only slightly diminished VA of 20/25. However, stable fixation was observed in isolated cases even when VA was reduced to 20/100. The deviation of fixation was more pronounced horizontally than vertically in normals (0.40 degree:0.31 degree) and in patients suffering from AMD (0.88 degree:0.68 degree), whereas eyes with macular dystrophy did not show this phenomenon (0.82 degree:0.82 degree). The results demonstrate that there is the possibility of stable fixation even in eyes with a decrease in VA due to morphological changes in the macula.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1995

[The echographic follow-up of patients treated with an external fixator in childhood and adolescence].

In the last few years external fixation has started to be extensively used in pediatric orthopedics and traumatology and ultrasound (US) monitoring has been adopted. The role of US was investigated in a study on 64 patients aged 2 to 30 years treated from November, 1989, to December, 1993. Some patients underwent several interventions with different methods and therefore belong to more than one of the three considered groups. In case of surgical lengthening (group A), the role of US was investigated in a study on 54 patients aged 2 to 26 years. The following variables were studied with US: diastasis entity, stump axis and the evolution of regenerated tissue within 10 days of the beginning of lengthening (first follow-up), at 20 days (second follow-up) and at 30 days (third follow-up). Ilizarov and Wagner fixators and one external fixation reduction fixator were used on 54 patients in 83 segments (43 femurs, 39 tibias and 1 humerus). In all, 104 corticotomies were performed. In fractures treated with external fixators (group B), US allowed the study of the hematoma surrounding the lesion and of its progressive evolution from fibrous tissue to bone callus, within 30 days of external fixation (first follow-up), at 60 days (second follow-up) and at 90 days (third follow-up). Eight patients were treated. The segments treated were 9 femurs and 2 tibias, 11 fixators in all. Patients age ranged 9 to 19 years. Five patients underwent corrective osteotomies with external fixators (group C), in which group US follow-up exams were not standardized. For all 252 US examinations, performed in real time, an Acuson 128 unit with a 5-MHz linear probe was used and anterior, median and lateral longitudinal scans were acquired.

Adolescent↗

PubMed1993

A comparison of femoral neck fixation with the reconstruction nail versus cancellous screws in anatomic specimens.

Femoral neck fixation techniques were applied to five matched pairs of autopsy specimens to evaluate the fixation of the Russell-Taylor femoral nail in ipsilateral neck and shaft fractures of the femur. Reconstruction nail fixation of the femoral neck was compared with that of three parallel screws. The intact and postfixation femora were subjected to an applied bending moment in 0 degrees, 30 degrees, and 90 degrees of simulated hip flexion. The bending stiffness was determined from the load deformation data for each intact femur and then after the appropriate fixation. The fatigue response of the fixation, presence of osteopenia, degree of fracture reduction, and device alignment showed that the stiffness ratio (fixed to normal) of the nail was greater in most specimens. There was no statistical difference in retained stiffness after cyclic loading between the nail and cancellous screw fixations. The ultimate strength of the nail was 2.5 times the strength of the screw fixation of the femoral neck. Thus, the nail provided biomechanically sound fixation of the femoral neck.

Aged↗

PubMed1999

Early outcome of hybrid external fixation for fracture of the distal tibia.

OBJECTIVE: To evaluate the early results of treatment when using hybrid external fixation for fractures of the tibial plafond. DESIGN: Retrospective review of patients treated according to protocol. Patients treated with the hybrid fixator were compared with patients treated with open reduction and internal fixation. SETTING: Orthopaedic trauma service of a Level I trauma center, with a single surgeon directing care. PATIENTS/PARTICIPANTS: All patients with fractures of the distal tibia during a five-year period (n = 63) were treated according to protocol, with specific criteria determining method of treatment. Eleven patients were lost to follow-up, and three additional patients were not reviewed for other reasons. Follow-up period averaged twenty months. INTERVENTION: Fracture stabilization was accomplished with the use of a hybrid external fixator (n = 34) or with internal fixation (n = 27), as determined by patient or fracture criteria. Two patients did not receive planned treatment. MAIN OUTCOME MEASUREMENTS: Range of motion, clinical ankle score, and incidence of complications. RESULTS: Patients treated with hybrid fixation had lower clinical scores, slower return to function, a higher rate of complications, more nonunions and malunions, and more infections. CONCLUSIONS: Due to differences in patient populations, the superiority of either treatment method is uncertain; however, hybrid fixation did not seem to solve the problems inherent in severe pilon fractures. The sanguine results reported in the literature did not hold true in this group.

Adolescent↗

PubMed2004

Treatment of unstable pelvic fractures: use of a transiliac sacral rod for posterior lesions and an external fixator for anterior lesions.

BACKGROUND: This study sought to define the role of transiliac sacral rods used in combination with an external fixator for the management of unstable pelvic fractures. METHODS: This retrospective study evaluated cases in which the surgical strategy was open reduction and internal fixation of posterior lesions with two transiliac sacral rods and closed reduction and external fixation of anterior lesions with an AO external fixator. The data for 65 cases were analyzed. Comprehensive Classification (AO) identified 42 C1 cases, 21 C2, cases and 2 C3 cases. Fractures with iliac bone involvement that impeded the application of an external fixator or transiliac sacral rods were excluded. The follow-up period was 85 months (range, 24-140 months). RESULTS: All the fractures/dislocations healed well. The complications involved 17 cases (26.2%) of persistent posterior pain, 16 cases (24.6%) of irreversible neurologic deficit, 2 cases (3.1%) of posterior wound infection, 3 cases (4.6%) of pin tract infection, and 4 cases (6.2%) of irreversible urologic deficit. The functional results showed that the surgical results were satisfactory in 42 cases (64.6%) and unsatisfactory in 23 cases (35.4%). CONCLUSIONS: For type C pelvic fractures without significant iliac bone involvement, surgical management with posterior transiliac fixation using sacral rods and anterior external fixation yields good radiologic results. The functional results correlated primarily with avoidance of complications and not necessarily with the radiologic results.

Adolescent↗

PubMed2007

Evaluation of two dynamic axial fixators for large ruminants.

OBJECTIVES: To evaluate healing of a radial osteotomy repaired by application of dynamic axial fixation devices (DAF) in large ruminants. STUDY DESIGN: In vivo study of bone healing after application of 2 DAF types. Model I had 2 sidebars, each with a central cylindrical cuff (internally threaded) with 2 detachable connecting rods telescoping within the cuff. Model II had 2 side bars with 2 moveable clamps with multiple holes. SAMPLE POPULATION: Bull calves (n=8; aged, 1.5-2.0 years; weighing, 175-250 kg). METHODS: A mid-diaphyseal radial osteotomy was repaired by use of a model I (n=4) or model II (n=4) DAF. Calves were monitored for weight bearing, stability of fixation, and radiographically for fracture reduction, alignment and healing at intervals for 6 months. Fixators were removed when there was radiographic evidence of healing. RESULTS: Both the fixators were well tolerated with free movement of adjacent joints. Fragment fixation was maintained until healing in all but 1 model I calf where failure occurred within 7 days. Model II DAF provided more rigid fixation as indicated by early full weight bearing and fracture healing with less callus formation. Functional recovery of repaired limbs occurred within 60 days in surviving calves. CONCLUSIONS: Both bilateral DAFs were easy to apply; however, the model II DAF provided better fixation. CLINICAL RELEVANCE: The model II DAF made of low carbon steel was economical and may be useful for treating long bone fractures in large ruminants.

Animals↗

PubMed1990

Effect of sulcus vs capsular fixation on YAG-induced pressure rises following posterior capsulotomy.

Neodymium-YAG capsulotomy for secondary cataracts can induce acute intraocular pressure rises, possibly by a blocking of the trabecular meshwork by debris. To test a hypothesis that bag-fixated intraocular lenses may act as a barrier to debris, thus reducing pressure rises after YAG capsulotomy, we conducted a study comparing pressures (at 1, 2, 3, 6, and 24 hours after YAG capsulotomy) between bag-fixated and sulcus-fixated cases. There were substantial and statistically significant intraocular pressure rises in the sulcus-fixated group starting at 1 and 2 hours after YAG capsulotomy, and peaking at 3 hours (mean rise, 7.83 mm Hg). There were no such peaks of intraocular pressure rise among bag-fixated cases (mean change, -0.32 mm Hg at 3 hours). There was a weak but significant (r = -.18) correlation between the change 1 hour after YAG capsulotomy in intraocular pressure and percent of enclosure of the intraocular lens optic among bag-fixated cases. Higher proportions (fourfold to fivefold) of cases with sulcus-fixated lenses had significant flare and particulate matter in the anterior chamber, compared with bag-fixated cases.

Adolescent↗

PubMed1999

NADPH diaphorase histochemistry in the thoracic ganglia of locusts, crickets, and cockroaches: species differences and the impact of fixation.

The NADPH diaphorase (NADPHd) reaction is widely used as a histochemical marker for nitric oxide synthase (NOS). In this study on locusts, crickets, and cockroaches, we demonstrate 1) that related species can differ considerably in the fixation sensitivity of putatively NOS-related NADPHd; and 2) that prolonged fixation can induce NADPHd activity in cells that are diaphorase negative under mild fixation regimes. These two phenomena reconcile previous, contradictory reports on the distribution of NADPHd in locusts and crickets. In locusts, neuronal NADPHd is found exclusively in interneurones. The projection neuropiles of the exteroceptors contain a dense NADPHd-positive fibre meshwork, but sensory afferents do not stain. In crickets, staining has been reported in sensory afferents, in motor neurones and dorsal unpaired median (DUM) neurones, and in a non-fibrous distribution throughout the sensory neuropiles. We demonstrate that this widespread, non-selective staining is induced by strong formaldehyde fixation. Weak fixation resulted in a highly selective labelling of a few individual interneurones and of a fibre meshwork in the projection neuropiles of the exteroceptive afferents. Staining was absent in the afferents themselves, in motor neurones, and in efferent DUM neurones. Thus, after weak fixation, the staining pattern closely matched that in the locust. The similar distribution of putatively NOS-related NADPHd in the thoracic nervous systems of orthopteroid insects suggests a species-independent role for nitric oxide in the processing of mechanosensory information. Histopharmacological techniques such as permanganate oxidation, or incubation in the NOS inhibitors methylene blue or dichlorophenolindophenol, did not allow discrimination between the selective and the fixation-induced staining. The species-specific impact of different fixation regimes may necessitate reconsideration of results obtained in other cross-species comparisons.

Animals↗

PubMed1975

The effects of various fixative-buffer combinations on lung fine structure.

A variety of fixatives, buffers and fixation procedures were compared in rat and squirrel monkey lung in an attempt to preserve optimally both the cytologic details of pulmonary parenchyma as well as the acellular avelolar lining layer. In initial experiments utilizing the fixative of Ito and Karnovsky ('68), an electron-dense deposit was observed on the alveolar surface. Experiments were carried out in an attempt to determine what component of this fixative was responsible for the reaction product observed. In addition,immersion fixation of tissue blocks was compared to the whole lung fixation method of Kikkawa ('70). Kikkawa ('70) achieved excellent preservation of the acellular alveolar lining layer by such a fixation technique. In all lungs examined, whenever a phosphate buffer was utilized with primary aldehyde fixation, an electron-dense precipitate was observed on the luminal surfaces of the type I and II pulmonary epithelial cells. Additional sites of reaction product were pinocytotic vesicles of the type I cells and membranous arrays within the alveolar lumen. Such deposits were never observed when a sodium cacodylate buffer was used. No such granules were observed in areas of lung where the acellular alveolar lining layer had been preserved. The implications of these findings with regard to lung histochemical procedures and the possible relationship of these phosphate buffer-dependent granules to the surfactant system are discussed.

Animals↗

PubMed2005

Saline irrigation does not affect bone formation or fixation strength of hydroxyapatite/tricalcium phosphate-coated implants in a rat model.

Intramembranous bone regeneration is critical to implant fixation. In cementless joint replacement (as opposed to cemented joint replacement), saline irrigation is not typically performed during surgery so that the osteogenic stimulus provided by the marrow is preserved. Several groups are now using the rat marrow ablation model to study intramembranous bone regeneration and implant fixation. In this model, the marrow contents are mechanically disrupted, and debris is often cleared by saline irrigation, a step that appears inconsistent with the clinical situation. Furthermore, in contrast to conventional wisdom, it has been reported that saline irrigation enhanced bone-implant contact and peri-implant bone formation in the rat model (Ishizaka et al. Bone 1996;19:589-594), although mechanical fixation of the implant was not investigated. Accordingly, the present study was performed to determine if saline irrigation leads to enhanced mechanical fixation of implants in the rat model. Forty-eight 400 to 450 g male rats were divided equally into two groups. The treatment group, in contrast to the control group, received saline irrigation in the ablated medullary canal prior to placement of hydroxyapatite/tricalcium phosphate-coated implants. Eight animals in each group were killed at 2, 4, or 8 weeks after implantation, at which time the specimens were analyzed by micro computed tomography to measure bone formation around the implant, followed by a mechanical pull-out test to measure the strength of fixation of the implant. As expected, there was increased fixation strength over time, but there were no significant differences in peri-implant bone volume, bone-implant contact, or implant fixation strength between the two groups. Thus, we found no effect of saline irrigation on bone formation or implant fixation strength in this study in which the implant had an osteoconductive coating.

Animals↗

PubMed2000

Loosening of sacral screw fixation under in vitro fatigue loading.

Sacral screw fixation is frequently used for fusion of the lower lumbar spine, but sacral screws appear to offer less secure fixation than lumbar pedicle screws, and failure due to loosening under fatigue loading is common. The aim of this study was to examine in vitro the stability of medial and lateral bicortical and unicortical sacral screw fixation under a physiologically relevant fatigue-loading pattern. Bone mineral density, screw insertion torque, and screw-fixation stiffness were measured prior to cyclic loading between 40 and 400 N compression at 2 Hz for 20,000 cycles. The screw-fixation stiffness was measured every 500 cycles, and the axial pullout strength of the screws was recorded following loading. All of the lateral insertions loosened under the applied loading, but some of the medial insertions remained stable. Medial insertions proved stiffer and stronger than lateral insertions, and bicortical fixations were stronger than unicortical fixations. Bone mineral density and insertion torque were correlated with screw stiffness and pullout strength, although better correlation was found for insertion torque than bone mineral density. Bone mineral density is a good preoperative indicator of sacral screw-fixation strength, and insertion torque is a good intraoperative indicator. An insertion torque greater than 1.5 Nm is suggested as an indicative value for a stable medial unicortical insertion, whereas an insertion torque greater than 2 Nm suggests a stable medial bicortical insertion. It appears that, apart from the choice of technique (screw orientation and depth), minimizing the load on the screws during the initial part of the fusion process is also critical to maintain stability of the fused section and to obtain a solid fusion mass.

Adult↗