Current concepts of internal fixation of fractures.
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Bone Plates↗
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Results for “Fracture Fixation, Internal”
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Compression plate fixation and the effect of different types of internal fixation on fracture healing.
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Animals↗
Functional outcome of internal fixation for pelvic ring fractures.
OBJECTIVE: Evaluation of the functional outcome after unstable pelvic ring fractures stabilized with internal fixation. METHODS: Between January 1, 1990, and September 1, 1997, 37 patients were treated with internal fixation for unstable pelvic fracture. Demographic data, type of accident, Hospital Trauma Index-Injury Severity Score, and fracture type according to Tile classification were scored. One patient died the day after the accident from neurologic injury. A Short Form-36 health questionnaire and a form regarding functional result after pelvic trauma, adapted from Majeed et al., were returned by 31 of 36 patients (86%). Twenty-eight patients (78%) were seen for physical and radiologic examination. RESULTS: Twenty-six men and 11 women, with an average age of 34.7 years (range, 15-66 years) were included. The mean Injury Severity Score reached 30.4 (range, 16-66). According to the Tile classification, there were 16 type B fractures and 21 type C fractures. Seven patients were treated with open reduction and internal fixation of the pubic arch, 10 patients were treated with a combination of anterior open reduction and internal fixation with additional external fixation to increase the stability of the posterior ring. Nineteen patients underwent internal fixation of both anterior and posterior arch. In the remaining case, percutaneous posterior screw fixation was combined with anterior external fixation, because of estimated infectious risk. The average follow-up time was 35.6 months. Patients scored 78.6 of 100 on the Majeed score. Remarkable was the reported change in sexual intercourse in 12 patients (40%). Only 12 patients (40%) did not have complaints when sitting. On the SF-36 scales physical and social functioning, role limitations due to physical problems and vitality were limited compared with the averages for the Dutch population. Patients treated with combined anterior and posterior internal fixation scored significantly better on both the Majeed score and on the categories physical functioning, pain, general health and social functioning compared with patients with similar fractures treated with a combination of anterior internal fixation with external fixation. At the physical examination, 11 of 28 patients (39%) did not have any abnormality. Nineteen patients (68%) were back at their original job, which was physically demanding in 9 cases. There was a suspicion of nonunion of the posterior arch in two patients, which could be confirmed with a computed tomographic scan. CONCLUSION: In general, limitations in functioning are reported, even after long-term follow-up. In partially unstable fractures, solitary anterior fixation gives good results. In completely unstable fractures, patients treated with combined internal fixation anterior as well as posterior scored a better outcome compared with combined internal and external fixation. Therefore, this technique is recommended as treatment of first choice in completely unstable fractures.
Activities of Daily Living↗
[Internal fixation of fractured ribs with Kirschner wires for serious traumatic chest instability].
Internal fixation of fractured ribs with kirschner wires was done in 14 patients with serious traumatic chest wall instability. Four of these patients had fracture of prothorax ribs, and 10 fracture of lateral thorax ribs. This method can not only stabilize the chest wall but also reduce the fractured ribs. It is an ideal treatment for serious traumatic chest wall instability. In this paper, operative opportunity, indication and the main technical points of surgery are discussed.
Adult↗
Absorbable polyglycolide pins in internal fixation of fractures in children.
Absorbable implants made of synthetic biodegradable polymers were recently introduced clinically in internal fixation of fractures. In this prospective study of 71 pediatric patients with a variety of displaced physeal or nonphyseal fractures, self-reinforced polyglycolide pins 1.5 or 2.0 mm in diameter were used instead of Kirschner wires to fix the fragments. The majority of patients (45 children) had a fracture affecting the distal humerus. Mean age of the patients was 9.8 years (range 2-15 years). Follow-up averaged 15.8 months. In 62 patients (87%), an exact reduction of the fracture could be maintained until union. Among the remaining patients, six had minor inaccuracies or redisplacements of the fracture position, but in three patients with supracondylar fractures of the humerus breakage of the pins resulted in a severe redisplacement that necessitated a change in treatment method. With the exception of supracondylar fractures of the humerus, these preliminary results of polyglycolide pin fixation were deemed satisfactory. The fundamental advantage of this method is that no hardware removal procedures are required.
Adolescent↗
On secondary fractures after removal of internal fixation material.
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Adolescent↗
The management of secondary neoplastic deposits in long bones by prophylactic internal fixation.
Pathological fracture through a secondary neoplastic deposit is a distressing event. Prevention of such a fracture is clearly of considerable benefit. To determine which secondary deposits are liable to fracture the notes and X-rays of 57 patients with 91 secondary deposits were examined. Fractures are unlikely (2.4%) to develop where the deposit involves less than 50% of the cortex as seen on radiological examination, but 2 out of 3 deposits with over 50% involvement will fracture. As the benefits of internal fixation in those that would otherwise fracture are so great, it is recommended that all deposits involving over 50% of the cortex of a long bone should be treated by prophylactic internal fixation. The results of 26 patients treated by prophylactic internal fixation are summarized. Apart from fracture-prevention, the benefits of such internal fixation were found to be: pain relief, simple operation, rapid postoperative recovery, facilitation of administration of radiotherapy and maintenance of the independance of the patient. The possible effects on local and general tumour spread are not considered to be a contraindication to operation.
Adult↗
Pathological fractures: cement and internal fixation.
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Bone Cements↗
A comparison of the effect of open intramedullary nailing and compression-plate fixation on fracture-site blood flow and fracture union.
UNLABELLED: We compared the effects of compression-plating and open intramedullary nailing after reaming on the vascular supply to a standard fracture site, on the rate of fracture union, and on the biomechanical quality of bone after union, and on the biomechanical quality of bone after union in dogs. The proper location of a compression plate in relation to the periosteum also was investigated. Bone blood flow reached higher levels and remained elevated longer in fractures that were fixed with a rod than in those fixed with a plate. Rod-fixed fractures healed by periosteal callus, whereas plate-fixed fractures healed by endosteal callus. The fracture gained mechanical strength more slowly in the rod-fixed group than in the plate-fixed group. Subperiosteal or extraperiosteal placement of a plate revealed similar effects on bone-healing. CLINICAL RELEVANCE: Decisions to use intramedullary rods or compression plates for internal fixation of fractures should be based on knowledge of the biological effects of these procedures on blood flow at the fracture site and on the mechanical strength of the healing fracture. This study defines in quantitative terms the advantages and disadvantages of intramedullary rods compared with compression plates in the internal fixation of fractures.
Animals↗
Evaluation of biodegradable cefazolin sodium microspheres for the prevention of infection in rabbits with experimental open tibial fractures stabilized with internal fixation.
Immediate internal fixation of severe open tibial fractures usually is contraindicated due to the high risk of infection. The objective of this study was to evaluate the efficacy of local antibiotic therapy with biodegradable poly-(DL-lactide-co-glycolide) cefazolin-loaded microspheres for the prevention of infection in experimental open fractures stabilized with internal fixation. Rabbits with experimental tibial fractures that were contaminated with Staphylococcus aureus were treated with local application of cefazolin microspheres, an equivalent local dose of free Ancef powder, or systemic Ancef therapy. The bones then were fixed with a four-hole plate, and the animals were observed for 8 weeks. Clinically, deep infection was present in 86% of control animals that received no antibiotics and in 60% of animals that received a 7 day course of systemic Ancef therapy. In contrast, no infections were noted among any of the surviving rabbits that received local therapy with either cefazolin microspheres or free Ancef powder. Significantly higher levels of serum cefazolin were measured at 1 h for animals treated with free Ancef powder (18.7 +/- 6.1 micrograms/ml) than for those treated with cefazolin microspheres (0.57 +/- 0.27 micrograms/ml). Follow-up studies are in progress to evaluate further the potential clinical benefits of local antibiotic therapy for the management of contaminated open fractures in humans.
Animals↗
Biomechanics of fracture healing.
Internal fixation of fractures alters the physical environment of living bone. The authors have studied the reaction of living bone to force and motion, mainly in sheep. Cortical bone does not undergo pressure necrosis when compression is applied in internal fixation. Compressing the fragments increases the stability of the reduction and leads to uneventful healing without resorption. Small areas of plastic bone deformation owing to mechanical overload are nor removed by surface resorption but by internal remodelling. Interfragmentary motion produces callus and resorption of the contact surfaces. The static compression applied to cortical bone does not induce a change in the rate of internal remodelling. The static forces must exceed the dynamic load to maintain close coaptation at the contact surface.
Animals↗
Subperiosteal elevation of the ulnar nerve during internal fixation for fractures of the distal humerus assessed by intra-operative neurophysiological monitoring.
Ulnar nerve function, during and after open reduction and internal fixation of fractures of the distal humerus with subperiosteal elevation of the nerve, was assessed by intra-operative neurophysiological monitoring. Intermittent recording of the compound muscle action potentials was taken from the hypothenar muscles in 18 neurologically asymptomatic patients. The mean amplitude of the compound muscle action potential after surgery was 98.1% (sd 17.6; -37% to +25%). The amplitude improved in six patients following surgery. Despite unremarkable recordings one patient had progressive paresis. Motor impairment is unlikely if the compound muscle action potential is continuously preserved and not reduced by more than 40% at the end of surgery. Temporary decreases in amplitude by up to 70% were tolerated without clinical consequences. However, repeated clinical examination is obligatory to recognise and treat early post-operative palsy.
Action Potentials↗
Outcome of infection following internal fixation of closed fractures.
A retrospective study was done in 30 patients with infected closed fractures treated initially by open reduction and internal fixation. Nineteen fractures involved the femur, 8 the tibia, 2 the radius and 1 the ulna. Twenty-five were diaphyseal and 5 metaphyseal. Twenty-two fractures had initially been treated with plating and 8 with intramedullary nailing. Thirteen patients presented in the acute phase and 17 in the subacute phase of infection. Twenty-two patients presented with low grade infection and 8 with florid infection. The commonest organism isolated was Staphylococcus aureus (80%), of which fifty four percent was resistant to Methicillin (MRSA). This study showed that 77% of infected fractures with a stable implant united even in the presence of infection.
Adolescent↗
The value of osteosynthesis in the treatment of bimalleolar fractures.
A total of 69 patients with displaced bimalleolar fractures were treated by open reduction and internal fixation, 35 using AO/ASIF implants and 34 using biodegradable self-reinforced polyglycolide or polylactide devices. A third group consisted on 35 patients who were treated non-operatively. The result of treatment was evaluated after a minimum follow-up time of twelve months. A would infection complicated the course in four patients treated with AO/ASIF implants. A transient local fluid accumulation was seen in two patients with biodegradable implants. Four patients under non-operative treatment suffered redisplacement of the fracture. In conclusion, biodegradable internal fracture fixation devices proved to be a valuable new method for the treatment of displaced ankle fractures.
Activities of Daily Living↗
The role of early internal fixation in the management of open fractures.
A series of 101 victims of multiple trauma and open fractures were treated by early open reduction and internal fixation. Some of the fractures included associated vascular injury. Some of the patients had extensive intraarticular fractures. Femur fractures in the elderly were included. All wounds were left open. In 94 patients, the early infection rate was 1.9% in small clean open (type I) wounds, 8% in large open (type II) wounds, and 41% in extensively contused large open (type III) wounds. In 94 cases the overall infection rate was 10.6%. In only one infection (1%) a long-term chronic osteomyelitis ensued; there were no non-unions in long bone fractures. Open fractures with type I wounds have the same infection rate as reported for closed fractures. In fractures with types II and III wounds salvage of limb, life, or joint function must justify the high risk of infection. Immediate plate fixation of severe open fractures of the tibia could save a limb from amputation. Closed intramedullary nailing of open fractures of the femur carries a high rate of success.
Adolescent↗
A comparison of the treatment of trochanteric fractures of the femur by internal fixation with a nail plate and the Ender technique.
In our experience, trochanteric fractures fixed with Ender nails achieved a degree of success similar to those treated by nail plating, but the risk of wound infection was much less with the former method. The results of 78 trochanteric fractures of the femur internally fixed with Ender nails have been analysed and compared with the results in 100 similar patients treated by nail plate fixation. The Ender method has advantages over existing operative methods, in that in our series the infection rate was zero and we found that the operation produced less shock. We consider that this method, although technically more difficult, can be used for most intertrochanteric fractures and merits further trial.
Adult↗
[Osteosynthesis in the presence of soft-tissue lesions: delayed internal fixation and indications for conservative treatment (author's transl)].
When there are concomitant soft-tissue lesions with closed fractures, delayed osteosynthesis is indicated to prevent infection. Nonetheless, primary osteosynthesis is rarely necessary. In the case of open fractures, internal fixation should only be performed when bone and the materials used for fixation can be covered with tissues that are well supplied with blood. In case of doubt the surgeon can rely on the fact that most fractures can be effectively treated by conservative methods, and it is wise in such cases to forego the advantages of osteosynthesis and avoid the risks involved.
Adolescent↗
Open reduction and internal fixation of acetabular fractures.
Between 1982 and 1995, 84 patients with displaced acetabular fractures underwent open reduction and internal fixation in our institution. The mean follow-up was 5.5 years with a minimum of 2 years. There were 33 simple and 51 complex fractures according to the classification of Judet and Letournels. Reduction after operation was anatomical in 49% of the patients, satisfactory in 24%, and unsatisfactory in 27%. Using Merle d'Aubigné's scale, the clinical results were excellent in 39% of the patients, good in 29%, fair in 8%, and poor in 24%. Factors of statistical significance associated with a poor clinical outcome were T-shaped fractures, unsatisfactory reduction (> 3 mm residual displacement), age > 40 years and development of avascular necrosis. Acetabular surgery is demanding, and a high rate of complications can be expected. Trauma centres should designate a group of surgeons who will consistently treat these fractures in order to obtain more experience and better results.
Acetabulum↗