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PubMed1990

[Transfixation in treatment of comminuted fractures of the distal end of the radius].

In comminuted fractures of the distal radius we apply our own method of transfixation. A Kirschner-wire is put through the bases of the metacarpal II-V, in addition an above elbow-plaster is applied. 47 persons (38 female, 9 male, age: phi 69 a) treated by this method have been checked-up after 16 months (26-5 months). In spite of the predominantly negative prognosis of the C3 fracture, according to the scheme of AO, we found out in our check-up considering principles of Sarmiento a good or a very good result in 41 cases (87%).

Adult↗
PubMedDate not supplied

[Technic for surgical reconstruction in comminuted fractures of the head of the radius].

Osteosynthesis n comminuted fracture of the head of the radius is extremely difficult because of the small size of the bone fragments. The particularly rich innervation of the elbow explains the violent vasomotor reaction that accompanied injuries of the elbow, reaction responsible in the last instance of the onset of biological alterations the articulation. For this reason, the therapeutical solutions must have in view rapid restoring of the passive and active movements of the elbow. Reactions of the radius head is often followed by ossification around the radius stump, subluxation of the inferior articulation and valgus of the ulna. Osteosynthesis is only possible if there is a single detached bone fragment in posterioexternal position with respect to the radius head circumference. The authors describe an original technique, i.e. reducing the fractured bone fragments which are then fixed with a Kirschner rod, brought out percutaneously. A description is given of the operative procedure and postoperative care in the first eight patients operated. Very good results were obtained in 4 case, good results in 3 and poor results in one case.

Fracture Fixation, Internal↗
PubMed1983

[Operative reduction of comminuted fractures of the heel-bone and its results].

Severe comminuted fractures of the heel-bone involving the joint, which have to be classified according to Böhler into group V-VIII, are treated by a modified form of the so-called raising operation of Palmer. 27 patients (= 14,3%) had bilateral heel-bone fractures. The posterior subtalar supporting plate is raised under image-amplifier control, the defect cavity is filled with spongiosa, and the result of reposition is fixed with Kirschner wires laid under the skin. Functional treatment may begin a few days later; loading is generally possible after ten to twelve weeks, when the metal parts have been removed and the fracture has consolidated. Sixteen patients (= 8,5%) do not need orthopedic instruments, 132 patients (= 69,9%) are provided with arch-supports, and 41 (= 69,9%) with orthopedic footwear.

Adult↗
PubMed2005

Minimally invasive plate osteosynthesis for comminuted fractures of the metaphysis of the radius.

Five comminuted and displaced fractures of the distal metaphysis of the radius were treated by a technique of minimally invasive plate osteosynthesis (MIPO) with the aim of minimizing soft tissue damage and devascularization of the fracture fragments. This technique used the small AO T-shaped locking compression plate (AO LCP T-plate) and left the pronator quadratus intact. Radial inclination, palmar tilt, and ulnar variance were restored without loss of reduction in all five cases and the fractures healed at an average of 10 weeks, with good to excellent clinical outcomes.

Adult↗
PubMed1999

Immediate weight-bearing after treatment of a comminuted fracture of the femoral shaft with a statically locked intramedullary nail.

BACKGROUND: The purpose of this two-part investigation was to test the feasibility, safety, and efficacy of immediate weight-bearing after treatment of fractures of the shaft of the femur with a statically locked intramedullary nail. METHODS: In the first part of the investigation, a biomechanical study was performed to determine the fatigue strength of eleven different statically locked intramedullary nail constructs. Segmentally comminuted midisthmal fractures were simulated with use of sections of polyvinyl chloride pipe; each construct was cyclically loaded in compression with use of physiologically relevant loads in a materials testing machine at eight hertz. The fatigue tests were conducted according to the so-called staircase method, and the construct was considered to have run out (exceeded its anticipated service life) if it had not failed after 500,000 cycles. In the second part of the study, a clinical investigation of immediate weight-bearing after treatment of comminuted fractures of the femoral shaft with a Russell-Taylor (RT-2) construct was performed. Complete follow-up data were available for twenty-eight of the thirty-five patients (thirty-six fractures) entered into the study. RESULTS: In Part I of the study, two constructs, a statically locked twelve-millimeter-diameter Russell-Taylor femoral nail with two distal locking screws (RT-2) and a statically locked twelve-millimeter-diameter Zimmer femoral nail with two distal locking screws (Z-2), had significantly higher mean fatigue strengths (2171 and 2113 newtons, respectively) than all other constructs tested (p<0.001), but the strengths of these two constructs were not significantly different from each other. Constructs with only one distal locking screw demonstrated significantly lower (p<0.05) fatigue strengths than the two-screw constructs. These results suggest that full weight-bearing during the weeks immediately after insertion of the nail may be possible, even for patients who have a comminuted fracture of the femoral shaft. In Part II of the study, twenty-six of the twenty-eight patients were bearing full weight on the fractured limb or limbs at the six-week follow-up visit. All fractures united; only one of these needed an additional procedure (the removal of the screws five months after the insertion of the nail) to stimulate union. No loss of fixation, such as back-out or breakage of a locking screw or breakage or bending of the intramedullary nail, occurred. CONCLUSIONS: We concluded from this two-part investigation that immediate weight-bearing after stabilization of a comminuted fracture of the femoral shaft with a statically locked intramedullary nail is safe when the construct has a relatively high fatigue strength. Immediate weight-bearing after stabilization of a fracture of the femoral shaft permits patients who have multiple fractures of the extremity to walk and to participate in physical therapy earlier, possibly decreasing the duration of the hospital stay or reducing the need for prolonged rehabilitation on an inpatient basis.

Adolescent↗
PubMed1982

Comminuted fractures of the femoral shaft treated by plate osteosynthesis.

22 cases of comminuted fractures of the femoral shaft treated by plate osteosynthesis have been reviewed. This method of treatment gives excellent functional results if successful. However, the risk of failure is high and occurred in 37% of the cases. Unprotected weight-bearing in the post-operative period and comminution of the medial cortex of the femur with bone defect were the main causes of the failure of the implant and subsequent delayed or non-union. 75% of the patients with implant failure required further replating and bone grafting. Perhaps primary bone grafting may be indicated in those who have a medial cortical defect. A full range of knee motion was recorded in 91% of the cases. There was no deep infection in this series.

Adolescent↗
PubMed1985

The management of severely comminuted fractures of the femoral shaft, using the external fixator.

Fractures of the femoral shaft are often treated by an established method of internal fixation, such as a medullary nail or a plate and screws, to obviate the many disadvantages of traction and prolonged rest in bed. Fractures of the femoral shaft which are severely comminuted and open are usually unsuitable for internal fixation. Between July 1981 and March 1983 we treated seven patients with severely comminuted fractures of the femoral shaft (of which three were open), using the ASIF tubular external fixator system or the Wagner apparatus. The technique of application of the external fixator is important and is described. When correctly applied, the knee's movement was not restricted and few complications were experienced. All the fractures united within 8 months in a good position without shortening, and none required an additional operation. The use of the external fixator in these patients reduced their time in the hospital and facilitated their postoperative rehabilitation by allowing uncomplicated healing of a complicated fracture.

Adolescent↗
PubMedDate not supplied

Results after internal fixation of comminuted fractures of the femoral shaft with DC plates.

A series of 131 comminuted fractures of the femoral shaft in 123 patients were externally fixed by the ASIF plating method. Of the 126 fractures in 118 patients, that could be reviewed one to 3 years postoperatively, 115 of 92% presented a good functional result. The most common complication was a fatigue fracture of the plates which, however, only occurred after biomechanically faulty application, without medial buttress of the bone, and in the absence of a cancellous autograft. The application of a bone graft therefore appears mandatory in all fractures of the femoral shaft that are fixed by a plate.

Adolescent↗
PubMed1983

The results of treatment of comminuted fractures and fracture dislocations of the proximal humerus.

Out of 31 patients with a comminuted fracture or fracture dislocation of the proximal humerus, 21 were followed up. Twelve patients were treated operatively by internal fixation or endoprosthesis and nine were treated conservatively. The best results were achieved after internal fixation, especially in the younger patients. In the older patients, implantation of a prosthesis gave a satisfactory result.

Adult↗
PubMed1994

Comminuted fractures of the posterior wall of the acetabulum. A biomechanical evaluation of fixation methods.

Reproducible simple fractures and osteotomies of the posterior wall of the acetabulum were created in twenty paired hemipelves from fresh human cadavera. Comminution was created with an additional fracture line that was either parallel (concentric comminution) or perpendicular (transverse comminution) to the posterior rim of the acetabulum. Under simulated weight-bearing, the stiffness of fixation of the transversely comminuted fractures that had been achieved with use of a reconstruction plate and screws was significantly higher than that achieved with fixation with screws alone (p < 0.05). The load to failure of the fixation of transversely comminuted fractures treated with a reconstruction plate and screws was also significantly higher than that of fixation of such fractures with screws alone (p = 0.05). The load to failure of the fixation of concentrically comminuted fractures was significantly higher when a reconstruction plate and accessory spring plates had been used than when a reconstruction plate alone had been employed (p < 0.05).

Acetabulum↗
PubMed1996

Closed reduction and type-II external fixation of comminuted fractures of the radius and tibia in dogs: 23 cases (1990-1994).

OBJECTIVE: To describe a technique for closed reduction of and application of a type-II external fixator to comminuted fractures of the radius and tibia in dogs and to evaluate outcome of the technique in a series of client-owned dogs. DESIGN: Retrospective case series. ANIMALS: 23 dogs that underwent closed reduction of severely comminuted (> or = 5 fragments); mid-diaphyseal radial (n = 9); and tibial (n = 14) fractures and stabilization with a type-II external fixator. PROCEDURE: Radiographs were made postoperatively and every 4 to 6 weeks until the fixator was removed. The effect of type of fracture (open vs closed), type of pins (threaded vs smooth), and number of fixation pins on surgery time, time between surgery and development of bridging callus, and time between surgery and removal of the fixator was evaluated using one-sided Student's t-tests. RESULTS: 21 fractures healed after a single surgery. Two dogs with radial fractures required a second procedure because of complications. All fractures healed with the original fixation device in place. Mean time between surgery and the development of bridging callus was 11.4 weeks (range, 4 to 22 weeks), and mean time between surgery and fixator removal was 14.7 weeks (range, 4 to 27 weeks). Type of fracture, type of pins, and number of fixation pins did not have a significant effect on surgery time, time to development of bridging callus, or time to fixator removal. CLINICAL IMPLICATIONS: Closed reduction and application of a type-II external fixator was an effective method of treating severely comminuted radial and tibial fractures.

Animals↗
PubMed1975

The long-term effect on the tibiofemoral compartment of the knee joint of comminuted fractures of the patella.

We have studied the long-term effect of comminuted fractures of the patella with particular reference to the development of degenerative changes in the tibiofemoral joint. Degenerative changes which could convincingly be ascribed to the original injury were found in only one case, but we stress that the numbers are small, and that carefull search sould be made at operation for damage to the femoral condyles.

Accidents, Home↗
PubMed1993

[Results of treating comminuted fractures of the distal end of the tibia].

Fifty-seven cases of comminuted fractures of the distal end of the tibia, inclusive of 9 cases of open fractures have been treated between 1987 and 1992. The fractures were rated according to the Ruedi-Allgower classification. Modalities of treatment used by the authors have been discussed. Long-term results have been assessed in 40 cases. Twenty of them were rated good, 13 fair and 7 bad. In 20 cases osteoarthritis of the talocrural joint has been found. Conservative treatment or minimal surgery (fixation of the fibula) rendered good and fair results in grade I and II fractures. Majority of bad results was found in grade III fractures due to the severe destruction of the articular surfaces of the talocrural joint.

Adult↗
PubMed1998

Use of an internal fixator device to treat comminuted fractures of the distal radius: report of a technique.

An internal fixator technique for stabilizing comminuted Colles fractures has been developed in the anatomy laboratory and used in 35 clinical cases. The Colles Fracture Plate (Biomet, Inc, Warsaw, Indiana) can be used to treat any comminuted Colles fracture for which an external fixator is considered proper management. We have determined, based on our surgical experience with both the internal and external fixator techniques, that internal fixation using the Colles Fracture Plate is technically just as simple as external fixation. In addition to requiring a significantly less expensive device, internal fixation using this technique offers the advantages of better patient acceptance and fewer complications. This report will be followed by a more comprehensive analysis of the technical outcome of this procedure to further substantiate the initial results presented here. The process of compiling and analyzing these data is under way.

Bone Plates↗
PubMed1990

Significance of postoperative stability for bony reparation of comminuted fractures. An experimental study.

The significance of postoperative mechanical stability to bone repair of comminuted fractures was investigated in an animal experimental study comparing four commonly employed operative methods of fracture stabilization: 1. Plate osteosynthesis combined with lag screw fixation; 2. Bridging plate osteosynthesis; 3. External fixation; 4. Static interlocking intramedullary nailing. As fracture model, a triple wedge osteotomy of the right sheep tibia was used. In regard to biomechanical strength, the method which gave best postoperative stability, plate osteosynthesis in combination with interfragmentary lag screws, did not result in the best bone repair. In this experimental setup, stabilization by bridging methods, inducing bone healing by secondary intention, gave better bone regeneration in the experimental fractures.

Animals↗
PubMed1984

Plate and screw fixation by autogenous corticocancellous grafts in comminuted fractures of the femur.

The authors present the results of 25 recent cases of comminuted fractures of the femoral shaft treated by internal plate fixation supplemented by autogenous cortico-cancellous grafts. These were cases in which intramedullary nailing was not practicable and simple plate fixation was deemed to carry a high risk of failure. The results were excellent in all cases, with no complications such as failure of the fixation or pseudoarthrosis. This study confirms the validity in such cases of supplementing rigid internal fixation with autogenous cortico-cancellous grafts as a primary procedure in such high risk cases.

Bone Plates↗