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Stable internal fixation of fractures of the partially mineralized thyroid cartilage.

Thyroid cartilage fractures due to external blunt trauma have typically been thought to occur in patients over the age of 40. Lack of mineralization of the cartilage has been considered to be the protective mechanism. Our experience with laryngeal injuries has demonstrated that younger persons are indeed at risk for thyroid cartilage fractures, and that these injuries may be easily overlooked. Although these fractures do not lead to laryngeal stenosis if untreated, they may cause noticeable phonatory changes. Fixation of these fractures is difficult because of the usual soft character of the unmineralized cartilage, prompting us to adopt a wire-tube fixation technique. This technique has been uniformly successful in restoring the anatomic contour of the thyroid cartilage, and our results appear to justify open reduction of these moderately displaced or angulated thyroid cartilage fractures.

Adolescent↗

Delayed internal fixation of fractures of the neck of the femur in young adults. A prospective, randomised study comparing closed and open reduction.

We have compared the results and complications after closed and open reduction with ternal fixation in young adults with displaced intracapsular fractures (Garden grades III and IV) of the neck of the femur. We also studied the risk factors which influenced nonunion and the development of avascular necrosis (AVN). A total of 102 patients aged between 15 and 50 years was randomised to receive either closed or open reduction. Both groups were compared for age, gender, time to surgery and posterior comminution as well as for union and complications. Using univariate and multivariate analysis the factors influencing nonunion and AVN were assessed. Of the 102 patients, 92 were available for review. There was no significant difference between the groups in terms of union (p = 0.93) and AVN at two years (p = 0.85). Posterior comminution, poor reduction and improper placement of the screws were the major factors contributing to nonunion. The overall incidence of AVN was 16.3% (15 of 92 patients) and it was not influenced by these factors. A delay of more than 48 hours before surgery did not influence the rate of union or the development of AVN when compared with operation within 48 hours of injury.

Adolescent↗