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Sample records for mandible fracture fixations

  1. A new non-endoscopic intraoral approach for open reduction and internal fixation of subcondylar fractures of the mandible.

    PubMed

    Hakim, Samer George; Trankle, Thomas; Kimmerle, Harald; Sieg, Peter; Jacobsen, Hans-Christian

    2014-10-01

    Open reduction and internal fixation (ORIF) of subcondylar fractures of the mandible is a widely accepted treatment concept aimed at reconstruction of the vertical height of the mandibular ramus and restoration of occlusion. Here, we describe new instruments designed for ORIF via an intraoral approach using a single inverted y-miniplate. The special design allows sufficient visualisation of the fracture site and enables the establishment of a standardised procedure for the treatment of both dislocated and non-dislocated fractures. Several manoeuvres are described and some clinical cases are presented. Challenges frequently met during ORIF of subcondylar fractures via the intraoral approach such as limited exposure and visual control of fracture site can be overcome using the instruments-kit presented, which help to optimise this treatment. PMID:24613104

  2. Management of atrophic mandible fractures.

    PubMed

    Madsen, Matthew J; Haug, Richard H; Christensen, Bryan S; Aldridge, Eron

    2009-05-01

    Traumatic facial fractures that were once rarely encountered now present with increasing frequency in the elderly population. Included in this group of fractures are those of the atrophic edentulous mandible. As patients age and become edentulous, atrophy of the mandibular alveolar ridges and adjacent basal bone reduces bony surface area, bone density, and blood supply, making the mandible more brittle and increasing the likelihood of mandibular fracture during a traumatic event. Surgical treatment of these fractures has become more predictable and less morbid. However, because these fractures present so infrequently, many surgeons lack the relevant experience in handling them, and thus find the reduction and fixation of such injuries difficult. A number of techniques have been employed to treat this injury. This article reviews the more common modalities and presents updates on accepted surgical treatments. PMID:19348982

  3. Biomechanical study in polyurethane mandibles of different metal plates and internal fixation techniques, employed in mandibular angle fractures.

    PubMed

    Semeghini Guastaldi, Fernando Pozzi; Hochuli-Vieira, Eduardo; Guastaldi, Antonio Carlos

    2014-11-01

    The aim of this study was to perform a physicochemical and morphological characterization and compare the mechanical behavior of an experimental Ti-Mo alloy to the analogous metallic Ti-based fixation system, for mandibular angle fractures. Twenty-eight polyurethane mandibles were uniformly sectioned on the left angle. These were divided into 4 groups: group Eng 1P, one 2.0-mm plate and 4 screws 6 mm long; group Eng 2P, two 2.0-mm plates, the first fixed with 4 screws 6 mm long and the second with 4 screws 12 mm long. The same groups were created for the Ti-15Mo alloy. Each group was subjected to linear vertical loading at the first molar on the plated side in a mechanical testing unit. Means and standard deviations were compared with respect to statistical significance using ANOVA. The chemical composition of the Ti-15Mo alloy was close to the nominal value. The mapping of Mo and Ti showed a homogeneous distribution. SEM of the screw revealed machining debris. For the plates, only the cpTi plate undergoes a surface treatment. The metallographic analysis reveals granular microstructure, from the thermomechanical trials. A statistically significant difference was found (P < 0.05) when the comparison between both internal fixation techniques was performed. The 2P technique showed better mechanical behavior than 1P. PMID:25340696

  4. Finite-Element Analysis of a New Designed Miniplate which is Used via Intraoral Approach to the Mandible Angle Fracture: Comparison of the Different Fixation Techniques.

    PubMed

    Coskunses, Fatih Mehmet; Kocyigit, Ismail Doruk; Atil, Fethi; Tekin, Umut; Suer, Berkay Tolga; Tuz, Hakan Hifzi; Ozgul, Ozkan; Yagiz, Ayberk

    2015-07-01

    The mandible is the largest facial bone as well as the most commonly fractured bone in the maxillofacial region. Despite numerous studies conducted to identify optimal treatment modalities and plates configurations for intraoral and transoral approaches, no definitive conclusion has been reached. This study used finite element analysis (FEA) to assess 4 scenarios for treatment of an angle fracture (6-hole noncompression miniplate; 6-hole single plate/Champy's technique, 3D strut plate; 2 parallel 4-hole noncompression miniplates). Analysis included segmental displacement and Von Mises Stress evaluations of a 3D reconstruction of a human mandible. Von Mises Stress values for plates did not vary significantly among treatment groups. Moreover, no significant differences were observed in cumulative displacement of segments subjected to vertical and horizontal loads, with all treatment configurations demonstrating clinical acceptability. PMID:26091053

  5. Management of subcondylar mandible fractures in the adult patient.

    PubMed

    Hackenberg, Berit; Lee, Cameron; Caterson, E J

    2014-01-01

    The treatment of subcondylar mandible fractures is a topic of debate and can be variable even though these fractures are commonly seen. Historically, the treatment algorithm was between open reduction and closed treatment. Now, recent technical advances regarding the use of the endoscope in the field of craniofacial surgery provide additional treatment options. This article aimed to evaluate 3 current management strategies: closed reduction with maxillomandibular fixation, open reduction with internal fixation, and endoscopic-assisted reduction with internal fixation. We present our rationale for surgical decision making and attempt to develop an algorithmic approach to subcondylar fractures. Ankylosis of the temporomandibular joint is a feared complication in these fractures that can lead to the decision to apply maxillomandibular fixation for potentially too short of a period. It is the condylar head fractures within the joint's capsule that contain the hemarthrosis that are often responsible for ankylosis. Subcondylar fractures are, by definition, below the attachment of the joint capsule and in general are devoid of ankylosis. Therefore, maxillomandibular fixation is recommended to be applied for a period of 4 to 6 weeks in most cases. Open reduction with internal fixation can increase the risk for facial nerve damage during the operative approach. However, open reduction is often necessary in fracture patterns with a high degree of displacement. In these cases, facial nerve monitoring can successfully mitigate risks to allow safe exposure for open reduction with internal fixation of subcondylar fractures. Endoscopic-assisted reduction with internal fixation combines the benefits of both techniques while minimizing their associated risks. Nevertheless, reduction can be difficult especially when there is significant medial displacement of the proximal fracture fragment. In our experience, the endoscopic option is optimal for mildly displaced fractures and for

  6. Fracture of mandible during yawning in a patient with osteogenesis imperfecta

    PubMed Central

    Ram, Hari; Shadab, Mohammad; Vardaan, Ajay; Aga, Pallavi

    2014-01-01

    Osteogenesis imperfecta is a genetic disorder characterised by fragility and multiple fractures of bones. Clinical signs and symptoms vary depending on the type of disease. Fractures of facial bones are rare compared with load-bearing long bones. We report a case of fracture of the mandible during yawning which was managed by open reduction and internal fixation. PMID:25103485

  7. Fracture properties of the human mandible.

    PubMed

    Unnewehr, M; Homann, C; Schmidt, P F; Sotony, P; Fischer, G; Brinkmann, B; Bajanowski, T; DuChesne, A

    2003-12-01

    A total of seven human mandibles were struck to breaking point under standardised conditions using a pendulum. The cortical deformation for two impact directions was measured with strain gauge strips located at eight defined sites. Fronto-median impacts led to mostly bilateral and always multiple fractures in the posterior area of the bone, especially in the collum and the condyle. The fracture threshold was between 2.5 and 3.1 kN. Lateral impact caused fractures near the impact area as direct fractures of the ipsilateral corpus. Mainly single and double fractures were observed. For lateral impact the fracture threshold was between 0.6 and 0.8 kN. PMID:13680253

  8. Failed Fixation in Atrophic Mandibular Fractures: The Case against Miniplates.

    PubMed

    Madsen, Matthew J; Kushner, George M; Alpert, Brian

    2011-09-01

    Despite advances in the treatment of the fractured atrophic edentulous mandible, treatment continues to be difficult. Patient management is more complicated due to patients often being elderly with more complex medical problems. Rigid internal fixation has greatly improved outcomes with shorter treatment times, yet a consensus has yet to be reached regarding which method yields the most predictable results. Options include using small miniplates to larger reconstruction plates. Although each method has advantages, we present our experience with retreatment of failed miniplate fixation using load-bearing reconstruction plates of fractured atrophic edentulous mandibles. PMID:22942943

  9. Tongue Blade Bite Test Predicts Mandible Fractures.

    PubMed

    Neiner, John; Free, Rachael; Caldito, Gloria; Moore-Medlin, Tara; Nathan, Cherie-Ann

    2016-06-01

    The aim of the study is to evaluate the utility of a simple tongue blade bite test in predicting mandible fractures and use this test as an alternative screening tool for further workup. This is a retrospective chart review. An institutional review board approved the retrospective review of patients evaluated by the Department of Otolaryngology at a single institution for facial trauma performed from November 1, 2011, to February 27, 2014. Patients who had a bite test documented were included in the study. CT was performed in all cases and was used as the gold standard to diagnose mandible fractures. Variables analyzed included age, sex, fracture type/location on CT, bite test positivity, and operative intervention. A total of 86 patients met the inclusion criteria and of those 12 were pediatric patients. Majority of the patients were male (80.2%) and adult (86.0%; average age: 34.3 years). Fifty-seven patients had a negative bite test and on CT scans had no mandible fracture. Twenty-three patients had a positive bite test and a CT scan confirmed fracture. The bite test revealed a sensitivity of 88.5% (95% CI: 69.8-97.6%), specificity of 95.0% (95% CI:86.1-99%), positive predictive value [PPV] of 88.5% (95% CI: 69.8-97.6%), and negative predictive value [NPV] of 95.0% (95% CI: 86.1-99.0%). Among pediatric patients, the sensitivity was 100% (95% CI: 29.9-100%), specificity was 88.9% (95% CI: 68.4-100%), PPV was 75.0% (95% CI: 19.4-99.4%), and NPV was 100% (95% CI: 63.1-100%). The tongue blade bite test is a quick inexpensive diagnostic tool for the otolaryngologist with high sensitivity and specificity for predicting mandible fractures. In the pediatric population, where avoidance of unnecessary CT scans is of highest priority, a wider range of data collection should be undertaken to better assess its utility. PMID:27162567

  10. Decision-making algorithm in treatment of the atrophic mandible fractures*

    PubMed Central

    DE FEUDIS, F.; DE BENEDITTIS, M.; ANTONICELLI, V.; VITTORE, P.; CORTELAZZI, R.

    2014-01-01

    Aim Closed treatment of atrophic mandible fractures often results in malunion, pseudoarthrosis and pain. Open reduction and rigid internal fixation (ORIF) is still indicated for displaced atrophic mandible fractures. The Authors report a treatment protocol that allows to gain the best results using reconstruction plates, autologous bone grafting and free fibula flap reconstruction when necessary. Methods Retrospective analysis of 15 patients with atrophic mandible fractures who underwent treatment between 2007 and 2011. 7 cases did not receive any treatment because of their general condition, while the others 8 were surgically managed by external approach. In all cases load-bearing osteosynthesis plates with locking screws were used; in 2 of them contextual bone grafts were performed; in 1 case mandible reconstruction needed harvesting a free fibula flap. Results In 6 out of 8 cases complete functional and morphological restoration were obtained without any major complication. In 1 case suppurative infection and necrosis of the bone graft occurred, which made necessary its removing, leaving in situ only the reconstruction plate. In another case, during the first year after surgical treatment, atrophic mandible resorption occurred from one angle to the other, resulting in loss of the anchoring reconstruction plate. Conclusions ORIF is the gold standard procedure for the of atrophic mandible fractures, because it guarantees best morpho-functional outcomes and predictability. Nevertheless the Authors suggest contextual bone grafting in case of substance loss, or a poor quality bone or for dental implant surgery and free fibula flap in selected cases. PMID:24841687

  11. Spontaneous fractures of the mandible concept & treatment strategy

    PubMed Central

    Marcussen, Mette

    2016-01-01

    Background Spontaneous fractures of the mandible dispose a surgical challenge in comparisons to fractures caused by trauma due to several complicating factors. Additionally: controversies exist concerning the terminology of the field. Material and Methods We conducted a retrospective study of all patients with mandibular fractures, with exclusion of fractures of the coronoid process and the alveolar process, treated at the Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, Denmark between February 2003 and February 2013. Data collected from the medical records included sex, age, cause of fracture, site of fracture, and treatment. Results We identified 517 patients with 684 mandible fractures. Twenty-five of these were spontaneous fractures and 659 fractures were of traumatic origin. Condylar fractures rarely occur spontaneously, but constitute the majority of the traumatic fractures. Excluding these fractures from the analysis, we found a non-surgical approach in 14 of 24 (58%) of the spontaneous fractures and 110 of 376 (29%) of the traumatic fractures. This was statistically significant. Conclusions We found a statistical significant difference in favor of non-surgical approach in spontaneous fractures and we discussed the treatment challenges of these fractures. We addressed the terminological controversies regarding pathological fractures, and suggested the term spontaneous fractures denoting a fracture occurring during normal jaw function being either pathological or non-pathological. Key words:Mandibular fractures, spontaneous fractures, pathological fractures, traumatic fractures, treatment. PMID:26636905

  12. Open Reduction and Internal Fixation of Mandibular Fracture without Rigid Maxillomandibular Fixation.

    PubMed

    El-Anwar, Mohammad Waheed; Sayed El-Ahl, Magdy Abdalla; Amer, Hazem Saed

    2015-10-01

    Introduction The ability to treat fracture with open reduction and internal fixation (OR/IF) has dramatically revolutionized the approach to mandible fracture. With OR/IF, the postoperative role of rigid maxillomandibular fixation (MMF) has declined, but it is used to maintain proper occlusion until internal fixation of the fracture is achieved. Objective To assess intraoperative manual MMF during OR/IF of selected cases of mandibular fractures. Methods This prospective study was conducted on 80 patients with isolated mandibular fractures managed by OR/IF using two titanium miniplates. The patients were classified into two groups: a control group (40 patients) treated by OR/IF after intraoperative rigid MMF followed by immediate MMF removal, and a study group (40 patients) treated by rigid MMF, which was replaced by temporary intraoperative manual MMF (3MF) until plate fixation. Results There were no significant differences of the postoperative complication and dental occlusion, although a highly significant reduction of operative time was achieved in the 3MF group. Patient who received the 3MF technique had statistically significantly better average intrinsic vertical mouth opening in the early postoperative period (1 week after surgery), and normal mouth opening could be achieved in all cases in both groups 8 weeks after surgery. Conclusions Intraoperative rigid MMF is not mandatory and can be replaced in selected cases of fracture mandible by manual maintenance of proper dental occlusion until hardware fixation, gaining the advantages of shorter operative time and less risk of blood-transmitted diseases to the surgical team and the patient in addition to the benefits of immediate postoperative mandible mobilization. PMID:26491477

  13. Open Reduction and Internal Fixation of Mandibular Fracture without Rigid Maxillomandibular Fixation

    PubMed Central

    El-Anwar, Mohammad Waheed; Sayed El-Ahl, Magdy Abdalla; Amer, Hazem Saed

    2015-01-01

    Introduction The ability to treat fracture with open reduction and internal fixation (OR/IF) has dramatically revolutionized the approach to mandible fracture. With OR/IF, the postoperative role of rigid maxillomandibular fixation (MMF) has declined, but it is used to maintain proper occlusion until internal fixation of the fracture is achieved. Objective To assess intraoperative manual MMF during OR/IF of selected cases of mandibular fractures. Methods This prospective study was conducted on 80 patients with isolated mandibular fractures managed by OR/IF using two titanium miniplates. The patients were classified into two groups: a control group (40 patients) treated by OR/IF after intraoperative rigid MMF followed by immediate MMF removal, and a study group (40 patients) treated by rigid MMF, which was replaced by temporary intraoperative manual MMF (3MF) until plate fixation. Results There were no significant differences of the postoperative complication and dental occlusion, although a highly significant reduction of operative time was achieved in the 3MF group. Patient who received the 3MF technique had statistically significantly better average intrinsic vertical mouth opening in the early postoperative period (1 week after surgery), and normal mouth opening could be achieved in all cases in both groups 8 weeks after surgery. Conclusions Intraoperative rigid MMF is not mandatory and can be replaced in selected cases of fracture mandible by manual maintenance of proper dental occlusion until hardware fixation, gaining the advantages of shorter operative time and less risk of blood-transmitted diseases to the surgical team and the patient in addition to the benefits of immediate postoperative mandible mobilization. PMID:26491477

  14. A Retrospective 3D Radiologic Analysis of 52 Patients with Mandible Fractures.

    PubMed

    Özkan, Heval Selman; Irkoren, Saime; Durum, Yasemin; Karaca, Can

    2016-02-01

    When fractured, mandible angulates. For better preoperative evaluation, movements of fractured mandibular segments should be documented in x-, y-, and z-axes. This article quantitatively evaluates the pattern and degree of the angulation. Fifty-two patients with mandible fractures were involved in this study. After defining a three-dimensional (3D) coordination system consisting of the x-axis (the axis directed from the medial to lateral side of the skull), y-axis (directed from the inferior to superior side), and z-axis (directed from the posterior to anterior side), the degree with which the fractured mandible angulated around each of these axes was measured using 3D graphic software. The tendency of the angulation was compared between the three axes. Frequency of complications, operation times, maxilla mandibular fixation (MMF) need, and epidemiologic data were compared with the angulation results. Angulation around the x-axis was the most frequent with a 55.8% incidence, followed by a substantial margin of angulation around the y-axis with a 21.2% incidence; angulation around the z-axis was rare, with an incidence of 15.4%. Furthermore, the degree of z-axis angulation was minor compared with x- and y-axes angulations. There were statistically increased rate of complications, operation time, and MMF need in patients with more than 10 degrees of angulation in any case. Operation time and complication rates are also increased in patients with internal rotation of the proximal segment. Preoperative evaluation of mandible fracture angulation degree is useful for determining postoperative complication rates, MMF need, and operative challenge. This finding is helpful for effective performance to reposition the fractured mandible. PMID:26862971

  15. External fixation of distal radius fractures.

    PubMed

    Slutsky, David J

    2007-12-01

    External fixation has been used for the treatment of distal radius fractures for more than 50 years. Although the fixator configurations have undergone considerable modification over time, the type of fixator itself is not as important as the underlying principles that provide the foundation for external fixation. Although volar plate fixation is currently in vogue, the indications for external fixation remain largely unchanged. Newer fixator designs have also expanded the traditional usage to include nonbridging applications that allow early wrist motion. The following discussion focuses on the myriad uses for external fixation as well as the shortcomings and potential pitfalls. PMID:18070654

  16. The Comprehensive AOCMF Classification System: Mandible Fractures- Level 2 Tutorial.

    PubMed

    Cornelius, Carl-Peter; Audigé, Laurent; Kunz, Christoph; Rudderman, Randal; Buitrago-Téllez, Carlos H; Frodel, John; Prein, Joachim

    2014-12-01

    This tutorial outlines the details of the AOCMF image-based classification system for fractures of the mandible at the precision level 2 allowing description of their topographical distribution. A short introduction about the anatomy is made. Mandibular fractures are classified by the anatomic regions involved. For this purpose, the mandible is delineated into an array of nine regions identified by letters: the symphysis/parasymphysis region anteriorly, two body regions on each lateral side, combined angle and ascending ramus regions, and finally the condylar and coronoid processes. A precise definition of the demarcation lines between these regions is given for the unambiguous allocation of fractures. Four transition zones allow an accurate topographic assignment if fractures end up in or run across the borders of anatomic regions. These zones are defined between angle/ramus and body, and between body and symphysis/parasymphysis. A fracture is classified as "confined" as long as it is located within a region, in contrast to a fracture being "nonconfined" when it extents to an adjoining region. Illustrations and case examples of mandible fractures are presented to become familiar with the classification procedure in daily routine. PMID:25489388

  17. The Comprehensive AOCMF Classification System: Mandible Fractures- Level 2 Tutorial

    PubMed Central

    Cornelius, Carl-Peter; Audigé, Laurent; Kunz, Christoph; Rudderman, Randal; Buitrago-Téllez, Carlos H.; Frodel, John; Prein, Joachim

    2014-01-01

    This tutorial outlines the details of the AOCMF image-based classification system for fractures of the mandible at the precision level 2 allowing description of their topographical distribution. A short introduction about the anatomy is made. Mandibular fractures are classified by the anatomic regions involved. For this purpose, the mandible is delineated into an array of nine regions identified by letters: the symphysis/parasymphysis region anteriorly, two body regions on each lateral side, combined angle and ascending ramus regions, and finally the condylar and coronoid processes. A precise definition of the demarcation lines between these regions is given for the unambiguous allocation of fractures. Four transition zones allow an accurate topographic assignment if fractures end up in or run across the borders of anatomic regions. These zones are defined between angle/ramus and body, and between body and symphysis/parasymphysis. A fracture is classified as “confined” as long as it is located within a region, in contrast to a fracture being “nonconfined” when it extents to an adjoining region. Illustrations and case examples of mandible fractures are presented to become familiar with the classification procedure in daily routine. PMID:25489388

  18. Fixation of a severely resorbed mandible for complete arch screw-retained rehabilitation: A clinical report.

    PubMed

    Fabris, Vinicius; Bacchi, Atais

    2016-05-01

    Severely resorbed mandibles with placed endosteal dental implants can fracture. Therefore, techniques to reduce the risk or minimize the consequences of these fractures are needed. This clinical report presents a technique for placing a titanium plate in a severely resorbed mandible subjected to complete-arch implant therapy. The titanium plate is placed in the same surgical procedure as the implants, allowing immediate implant loading. This technique provides safe implant-supported treatment for patients with severe mandibular resorption. PMID:26775245

  19. Tips and Tricks in Mallet Fracture Fixation.

    PubMed

    Chin, Yuin Cheng; Foo, Tun-Lin

    2016-10-01

    We describe three steps to aid fracture assessment and fixation in the extensor block pin technique for mallet fractures. The first step is the use of fluoroscopy in the initial assessment to determine indication for fixation. Next is the use of supplementary extension block pin to control larger dorsal fragments. The third technique described details the steps of open reduction of nascently malunited fractures. PMID:27595969

  20. An unusual case of atrophic mandible fracture in a patient with osteogenesis imperfecta and on oral bisphosphonate therapy: Case report

    PubMed Central

    Al-Osaimi, Abdulrahman; Samman, Mahmood; Al-Shakhs, Mohammad; Al-Suhaim, Faisal; Ramalingam, Sundar

    2014-01-01

    Fractures of severely atrophic (height < 10 mm) edentulous mandibles are infrequent and challenging to manage. Factors such as sclerotic bone and decreased vascularity combined with systemic diseases complicate the management of such fractures. Osteogenesis imperfecta (OI) is a heterogeneous group of inherited disorders of type I collagen metabolism. Patients with OI characteristically present with histories of long bone fractures, deformities, blue sclerae, and opalescent dentin. However, fractures of the facial skeleton are rare. Bisphosphonate therapy has been proven to effectively reduce the fracture risk in patients with OI. The purpose of this clinical report is to present an unusual case of spontaneous fracture of the atrophic mandible in a patient with OI. Despite open reduction and internal fixation (ORIF) with miniplate osteosynthesis, the patient developed a second fracture at a screw placement site distal to the first fracture. The patient was successfully treated with ORIF using locking reconstruction plates fixed in the symphyseal and angle regions. Bone healing following ORIF was normal, and no clinical sign of osteonecrosis as a result of bisphosphonate therapy was observed. Patients with OI can present with spontaneous fractures of already weakened mandibles. Although such fractures can be managed with care using established protocols, further research is required to examine the effects of concomitant medication, such as bisphosphonates. PMID:25408599

  1. An unusual case of atrophic mandible fracture in a patient with osteogenesis imperfecta and on oral bisphosphonate therapy: Case report.

    PubMed

    Al-Osaimi, Abdulrahman; Samman, Mahmood; Al-Shakhs, Mohammad; Al-Suhaim, Faisal; Ramalingam, Sundar

    2014-04-01

    Fractures of severely atrophic (height < 10 mm) edentulous mandibles are infrequent and challenging to manage. Factors such as sclerotic bone and decreased vascularity combined with systemic diseases complicate the management of such fractures. Osteogenesis imperfecta (OI) is a heterogeneous group of inherited disorders of type I collagen metabolism. Patients with OI characteristically present with histories of long bone fractures, deformities, blue sclerae, and opalescent dentin. However, fractures of the facial skeleton are rare. Bisphosphonate therapy has been proven to effectively reduce the fracture risk in patients with OI. The purpose of this clinical report is to present an unusual case of spontaneous fracture of the atrophic mandible in a patient with OI. Despite open reduction and internal fixation (ORIF) with miniplate osteosynthesis, the patient developed a second fracture at a screw placement site distal to the first fracture. The patient was successfully treated with ORIF using locking reconstruction plates fixed in the symphyseal and angle regions. Bone healing following ORIF was normal, and no clinical sign of osteonecrosis as a result of bisphosphonate therapy was observed. Patients with OI can present with spontaneous fractures of already weakened mandibles. Although such fractures can be managed with care using established protocols, further research is required to examine the effects of concomitant medication, such as bisphosphonates. PMID:25408599

  2. Optimizing Stability in Femoral Neck Fracture Fixation.

    PubMed

    Ye, Ye; Hao, Jiandong; Mauffrey, Cyril; Hammerberg, E Mark; Stahel, Philip F; Hak, David J

    2015-10-01

    Optimizing stability of femoral neck fracture fixation is important in obtaining a successful outcome. The mechanical problems and strategies for achieving optimal stability differ depending on patients' age and degree of osteoporosis. Femoral neck fractures in younger adults usually result from high-energy trauma and have a vertical fracture pattern. Strategies for optimizing fixation stability in this group include placing additional screws at right angles to the fracture plane and medial buttress plate augmentation. In elderly patients, screw position relative to the intact cortical femoral neck bone is of critical importance. Additional strategies for optimizing fixation stability in this group include the concept of length stable fixation, use of adjunctive calcium phosphate cement, and use of novel fixed angle fixation implants. PMID:26488776

  3. Bicondylar tibial fractures: Internal or external fixation?

    PubMed

    Kumar, Gunasekaran; Peterson, Nicholas; Narayan, Badri

    2011-03-01

    Bicondylar fractures of the tibia, representing the Schatzker V and VI fractures represent a challenging problem. Any treatment protocol should aim at restoring articular congruity and the metaphyseo-diaphsyeal dissociation (MDD)-both of these are equally important to long-term outcome. Both internal and external fixations have their proponents, and each method of treatment is associated with its unique features and complications. We review the initial and definitive management of these injuries, and the advantages and disadvantages of each method of definitive fixation. We suggest the use of a protocol for definitive management, using either internal or external fixation as deemed appropriate. This protocol is based on the fracture configuration, local soft tissue status and patient condition. In a nutshell, if the fracture pattern and soft tissue status are amenable plate fixation (single or double) is performed, otherwise limited open reduction and articular surface reconstruction with screws and circular frame is performed. PMID:21430865

  4. Distal Humerus Fractures: Open Reduction Internal Fixation.

    PubMed

    Mighell, Mark A; Stephens, Brent; Stone, Geoffrey P; Cottrell, Benjamin J

    2015-11-01

    Distal humerus fractures are challenging injuries for the upper extremity surgeon. However, recent techniques in open reduction internal fixation have been powerful tools in getting positive outcomes. To get such results, the surgeon must be aware of how to properly use these techniques in their respective practices. The method of fixation depends on the fracture, taking the degree of comminution and the restoration of the columns and articular surface into account. This article helps surgeons understand the concepts behind open reduction internal fixation of the distal humerus and makes them aware of pitfalls that may lead to negative results. PMID:26498548

  5. Extra Corporeal Fixation of Fractured Mandibular Condyle

    PubMed Central

    Shenoy K, Vandana; Kengagsubbiah, Srivatsa; V, Sathyabhama; Priya, Vishnu

    2014-01-01

    Condylar fracture is the second most common site in the mandibular fractures. Motor vehicle accident and fall are the major causes of such fractures. Because of the anatomical weakness of the condyle and the shape of the condylar head the antero-medial dislocation of the condyle is common. Open reduction and closed reduction is always debatable. The open reduction will bring back the normal function much earlier than closed reduction. Medially dislocated condylar fracture fragments are always managed with open method. In superior or high condylar fractures,exact reduction with conventional open reduction can be difficult due to the limited surgical and visual fields. In such cases extracorporeal fixation of condyle using vertical ramus osteotomy may be better choice to achieve perfect alignment and absolute maintaince of vertical height of the ramus and facial symmetry. We here present a case of extracorporeal fixation of unilateral left high condylar fracture. PMID:25386546

  6. Periprosthetic fracture fixation in osteoporotic bone.

    PubMed

    Lenz, Mark; Lehmann, Wolfgang; Wähnert, Dirk

    2016-06-01

    Fixation techniques of periprosthetic fractures are far from ideal although the number of this entity is rising. The presence of an intramedullary implant generates its own fracture characteristics since stiffness is altered along the bone shaft and certain implant combinations affect load resistance of the bone. Influencing factors are cement fixation of the implant, intramedullary locking and extramedullary or intramedullary localization of the implant and the cortical thickness of the surrounding bone. Cerclage wires are ideally suited to fix radially displaced fragments around an intramedullary implant but they are susceptible to axial and torsional load. Screws should be added if these forces have to be neutralized. Stability of the screw fixation itself can be enhanced by embracement configuration around the intramedullary implant. Poor bone stock quality, often being present in metaphyseal areas limits screw fixation. Cement augmentation is an attractive option in this field to enhance screw purchase. PMID:27338227

  7. Feasibility of purely endoscopic intramedullary fixation of mandibular condyle fractures.

    PubMed

    Frake, Paul C; Goodman, Joseph F; Joshi, Arjun S

    2015-01-01

    The investigators of this study hypothesized that fractures of the mandibular condyle can be repaired using short-segment intramedullary implants and purely endoscopic surgical technique, using a basic science, human cadaver model in an academic center. Endoscopic instrumentation was used through a transoral mucosal incision to place intramedullary implants of 2 cm in length into osteotomized mandibular condyles. The surgical maneuvers that required to insert these implants, including condyle positioning, reaming, implant insertion, and seating of the mandibular ramus, are described herein. Primary outcome was considered as successful completion of the procedure. Ten cadaveric mandibular condyles were successfully repaired with rigid intramedullary internal fixation without the use of external incisions. Both insertion of a peg-type implant and screwing a threaded implant into the condylar head were possible. The inferior portion of the implant remained exposed, and the ramus of the mandible was manipulated into position on the implant using retraction at the sigmoid notch. The results of this study suggest that purely endoscopic repair of fractures of the mandibular condyle is possible by using short-segment intramedullary titanium implants and a transoral endoscopic approach without the need for facial incisions or punctures. The biomechanical advantages of these intramedullary implants, including improved strength and resistance to mechanical failure compared with miniplates, have been recently established. The combination of improved implant design and purely endoscopic technique may allow for improved fixation and reduced surgical- and implant-related morbidity in the treatment of condylar fractures. PMID:25534058

  8. The Role of a Conservative Minimal Interventional Management Protocol in the Fractures of the Dentate Portion of the Adult Mandible.

    PubMed

    Krishnan, Balasubramanian

    2016-03-01

    Mandibular fractures are commonly encountered by the maxillofacial surgeon. Maxillomandibular fixation (MMF) and open reduction and internal fixation (ORIF), or a combination of both, are the accepted standard treatments. This study aims to assess the role of a conservative minimal intervention protocol in the management of undisplaced/minimally displaced fractures of the dentate portion of the adult mandible and the complications associated with such minimalistic intervention. Thirty-four patients with undisplaced/minimally displaced fractures of the dentate portion of the adult mandible were advised to restrict mouth opening and limit themselves to a soft diet for a minimum of 4 weeks. All patients were advised follow-up at regular intervals for at least 3 months. Five patients were lost to follow-up. Symphysis and parasymphysis fractures were the most common fracture locations. Fourteen patients needed tension band stabilization with a mandibular arch bar/bridle wiring and three patients required extraction of luxated teeth. All patients showed satisfactory healing except three in whom additional intervention (ORIF) was performed. The improvement in mouth opening was statistically significant. Complications were seen more frequently among smokers and alcoholics. For patients with minimally displaced mandibular fractures, it is necessary to consider if the perceived benefits of intervention justify the associated added costs and possible complications. Patients have to be fully informed about the possible complications while using this minimal intervention protocol. This study concludes that a conservative minimal intervention management protocol for such fractures of the dentate portion of the mandible can produce satisfactory results. PMID:26889344

  9. Impact of Infection on Fracture Fixation.

    PubMed

    Willey, Michael; Karam, Matthew

    2016-04-01

    Surgical site infection can be a devastating complication that results in significant morbidity in patients who undergo operative fixation of fractures. Reducing the rate of infection and wound complications in high-risk trauma patients by giving early effective antibiotics, improving soft tissue management, and using antiseptic techniques is a common topic of discussion. Despite heightened awareness, there has not been a significant reduction in surgical site infection over the past 40 years. Patients should be treated aggressively to eliminate or suppress the infection, heal the fracture if there is a nonunion, and maintain the function of the patient. PMID:26772944

  10. Treatment of Edentulous Mandibular Fractures with Rigid Internal Fixation: Case Series and Literature Review

    PubMed Central

    Franciosi, Edgardo; Mazzaro, Eduardo; Larranaga, Juan; Rios, Alfredo; Picco, Pedro; Figari, Marcelo

    2014-01-01

    The aim of the study is to analyze the effectiveness of rigid internal fixation (RIF) for treating edentulous mandibular fractures. Because of the low incidence of fractures in edentulous mandible, there is no consensus of the optimal treatment for it. This study included all edentulous patients with mandibular fracture diagnosis, who were treated with internal fixation at the Hospital Italiano de Buenos Aires from November 1991 to July 2011. Data such as age, gender, etiology and location of fracture, surgical approach, type of osteosynthesis used, and postoperative complications were analyzed. A total of 18 patients, 76.2 years mean age, 12 females (66.6%), presented a total of 35 mandibular fractures. The mandibular body was the most common localization of the fractures. Twenty-five fractures received surgical treatment with RIF, mainly approached extraorally. Reconstruction plates were the most common type of fixation used. Fracture reduction was considered satisfactory in 96.5%, with 22.2% of complications and 11.1% of reoperations needed. Open reduction and RIF demonstrated to be a reliable method for treating edentulous mandibular fractures. Nevertheless, there is lack of high-level recommendation publication to support this. PMID:24624255

  11. Unsuccessful Treatment of Atrophic Mandible Fracture by Use of Improper Materials.

    PubMed

    de Moraes Ferreira, Ana Carulina Rezende; Garcia Junior, Idelmo Rangel; Silva, Adalberto Novaes; de Carvalho Reis, Erik Neiva Ribeiro; Pires, Willian Ricardo; Bonardi, João Paulo; Borba, Alexandre Meireles

    2016-06-01

    Fractures of atrophic mandibles are present on the day by day of buccomaxillofacial surgeons. Mandible atrophy occurs due to tooth loss, which over time induces bone resorption leading to a fragile and susceptible to fracture structure. This paper reports the case of a patient victim of face trauma resulting in atrophic mandible fracture with treatment failure through the use of shared load miniplate. Therefore, a new treatment was performed with miniplate of system 2.4 along with bone graft. After 6 months, the patient was rehabilitated with implant-supported prosthesis installation. It is concluded that for successful treatment of atrophic mandible fractures, the use of rigid plates is necessary, allowing an excellent rehabilitation of the stomatognathic system. PMID:27244201

  12. Biomechanical comparison of four mandibular angle fracture fixation techniques.

    PubMed

    Muñante-Cardenas, Jose Luis; Passeri, Luis Augusto

    2015-06-01

    The aim of this study was to make a comparison of the biomechanical behavior of four different internal fixation systems for mandibular angle fractures. A total of 40 polyurethane mandible replicas were employed with different fixation methods: group 1SP, one 2.0-mm four-hole miniplate; group 2PPL, two 2.0-mm four-hole parallel miniplates; group 3DP, one 3D 2.0-mm four-hole miniplate; and group 3DPP, one 3D 2.0-mm eight-hole miniplate. Each group was subjected to incisal or homolateral molar region loading. The load resistance values were measured at load application causing tip displacement of 1, 3, and 5 mm, and at the time at which the system achieves its maximum strength (MS). Means and standard deviations were compared among groups using analysis of variance and the Tukey test. Group 2PPL showed higher strength for all the displacements. For incisal loading, no statistically significant differences were found between groups 1SP, 3DP, and 3DPP. For molar loading, group 1SP and 3DPP showed statistically significant differences. For MS testing, group 1SP and 2PPL showed statistically significant differences in incisal loading; group 1SP and 3DP showed no statistically significant differences; and group 3DPP showed lower values of strength. Two parallel miniplates provide the most favorable mechanical behavior under the conditions tested. PMID:26000083

  13. Biomechanical Comparison of Four Mandibular Angle Fracture Fixation Techniques

    PubMed Central

    Muñante-Cardenas, Jose Luis; Passeri, Luis Augusto

    2014-01-01

    The aim of this study was to make a comparison of the biomechanical behavior of four different internal fixation systems for mandibular angle fractures. A total of 40 polyurethane mandible replicas were employed with different fixation methods: group 1SP, one 2.0-mm four-hole miniplate; group 2PPL, two 2.0-mm four-hole parallel miniplates; group 3DP, one 3D 2.0-mm four-hole miniplate; and group 3DPP, one 3D 2.0-mm eight-hole miniplate. Each group was subjected to incisal or homolateral molar region loading. The load resistance values were measured at load application causing tip displacement of 1, 3, and 5 mm, and at the time at which the system achieves its maximum strength (MS). Means and standard deviations were compared among groups using analysis of variance and the Tukey test. Group 2PPL showed higher strength for all the displacements. For incisal loading, no statistically significant differences were found between groups 1SP, 3DP, and 3DPP. For molar loading, group 1SP and 3DPP showed statistically significant differences. For MS testing, group 1SP and 2PPL showed statistically significant differences in incisal loading; group 1SP and 3DP showed no statistically significant differences; and group 3DPP showed lower values of strength. Two parallel miniplates provide the most favorable mechanical behavior under the conditions tested. PMID:26000083

  14. Hexapod External Fixation of Tibia Fractures in Children.

    PubMed

    Iobst, Christopher A

    2016-06-01

    Most tibia fractures in children can be treated nonoperatively. For fractures that do require surgery, however, the most common methods of management include plating or flexible nail insertion. Some fracture patterns, such as periphyseal fractures, fractures with bone and/or soft tissue loss, or fractures with delayed presentation, are not easily amenable to these techniques. Hexapod external fixators are especially helpful in these difficult cases. The purpose of this review is to discuss the principles of performing hexapod circular external fixation applied to pediatric tibia fractures. Some of the additional capabilities of the hexapod external fixator will also be highlighted. PMID:27078228

  15. 21 CFR 878.3250 - External facial fracture fixation appliance.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false External facial fracture fixation appliance. 878.3250 Section 878.3250 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... External facial fracture fixation appliance. (a) Identification. An external facial fracture...

  16. 21 CFR 878.3250 - External facial fracture fixation appliance.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false External facial fracture fixation appliance. 878.3250 Section 878.3250 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... External facial fracture fixation appliance. (a) Identification. An external facial fracture...

  17. 21 CFR 878.3250 - External facial fracture fixation appliance.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false External facial fracture fixation appliance. 878.3250 Section 878.3250 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... External facial fracture fixation appliance. (a) Identification. An external facial fracture...

  18. Use of traction screw to aid in fracture reduction in bilateral parasymphysis fracture of mandible.

    PubMed

    Jaisani, Mehul R; Pradhan, Leeza; Dongol, Ashok; Acharaya, Pradeep; Sagtani, Alok

    2016-06-01

    Treatment of bilateral parasymphysis fracture often requires special attention due to airway considerations and difficulty in achieving precise anatomic reduction. The central fracture fragment is often displaced posteriorly and inferiorly due to muscle pull, and this adds to difficulty in reduction and stabilization of the central fracture fragment during plate fixation. With this article, we advocate a technique using stainless steel screw and self-holding screwdriver to manipulate the central fragment and achieve an anatomic reduction. We have used this technique in 12 patients with bilateral parasymphysis fracture without any complications and have found it very effective. PMID:26404945

  19. Successful treatment of osteonecrosis-induced fractured mandible with teriparatide therapy: A case report

    PubMed Central

    Yao, Mayumi; Shimo, Tsuyoshi; Ono, Yuko; Obata, Kyoichi; Yoshioka, Norie; Sasaki, Akira

    2016-01-01

    Introduction The management of medication-related osteonecrosis of the jaw (MRONJ) is controversial. To date, there is no established treatment for cases of advanced stage 3 MRONJ osteoporosis in elderly patients. Presentation An 87-year-old osteoporotic woman with osteonecrosis-induced left mandible fracture related to minodronate therapy was referred to us for treatment. She had a vertebral compression fracture concurrently and had started subcutaneous injection of teriparatide. After 18 months of treatment with teriparatide the pathological mandible fracture was healed and functional recovery of the occlusion was obtained by complete dentures. Discussion Teriparatide may have a powerful anabolic effect on bone, and promote bone regeneration against pathologic mandible fracture induced by MRONJ. Conclusion Based upon these findings, teriparatide might be beneficial for advanced stage 3 MRONJ osteoporosis in elderly patients. PMID:26947555

  20. Fixation of basicervical and related fractures

    PubMed Central

    2009-01-01

    We prospectively studied 42 patients in order to identify a group of proximal femoral fractures having liability for axial and rotational instability, and to present results of their fixation using the dynamic hip screw (DHS) with derotation screw (DRS). At 12 months postoperatively, patients were functionally evaluated and the radiological outcome was analysed. All fractures united within an average period of 11.5 weeks. The mean sliding distance was 5.5 mm and mean shortening of the limbs was 2 mm. According to the criteria of Kyle et al. (J Bone Joint Surg [Am] 61-A:216–221), 39 patients obtained excellent results, two good and one fair. We conclude that the AO types B2.1, A1.1, A2.1, A2.2 and A2.3 have a common instability denominator and therefore should be treated alike. The sliding component of the DHS allows solid fixation of the two major fragments in two planes and the DRS in the third plane. PMID:19475407

  1. Comparative biomechanical study on three miniplates osteosynthesis systems for stabilisation of low condylar fractures of the mandible.

    PubMed

    Hakim, Samer George; Wolf, Melanie; Wendlandt, Robert; Kimmerle, Harald; Sieg, Peter; Jacobsen, Hans-Christian

    2014-04-01

    Open reduction and fixation of low condylar fractures of the mandible can be achieved by many osteosynthesis systems that differ in size, shape, and site of placement according to the surgical approach. We investigated the maximum load and rigidity of 4 osteosynthesis systems: the standard double 4-hole straight miniplates, the inverted y-miniplate (with and without self-drilling screws), and the TriLock Delta condyle trauma plate. The standard double 4-hole straight miniplate osteosynthesis achieved the best fixation and resistance in view of a mean (SD) maximum load of 539.8 (100.2)N, followed by the inverted y-miniplate with the self-drilling screws (246.5 (23.8)N), the inverted y-miniplate with standard screws (242.4 (27.2)N), and finally the TriLock Delta plate (167.4 (39.2)N). Analysis of the slope of the force-displacement diagram from 80N to 100N in each group showed that the TriLock Delta miniplate had the highest values for rigidity (17.3 (5.1)N/μm), followed by the inverted y-miniplate groups with self-drilling screws (14.1 (6.4)N/μm), and with standard screws (12.6 (2.5)N/μm). The double 4-hole straight miniplate osteosynthesis had the lowest rigidity (8.7 1.4)N/μm). Despite the significant difference in the maximum load between the double 4-hole miniplates and other investigated osteosynthesis patterns, all groups had sufficient load for the fixation of low condylar fractures of the mandible when postoperative bite forces and the slowly increasing voluntary clenching during healing were considered. PMID:24629455

  2. Role of soft tissues in metacarpal fracture fixation.

    PubMed

    Ouellette, Elizabeth Anne; Dennis, Jay J; Milne, Edward L; Latta, Loren L; Makowski, Anna-Lena

    2003-07-01

    The contribution of soft tissues in stabilizing fracture fixation in metacarpals is appreciated clinically, but no quantitative biomechanical study of their role has been done. All previous studies of fracture fixation in vitro have been done on metacarpals denuded of soft tissues. To quantify the role of soft tissues in metacarpal fracture fixation, the biomechanical effectiveness of four fixation devices was examined in human cadaver metacarpals with and without soft tissues. Values were compared for three nonrigid methods (expandable intramedullary fixation devices, crossed Kirschner wires, and single half-pin frames) and one rigid method (dorsal plates) in 45 disarticulated metacarpals stripped of soft tissues (denuded) and in 46 metacarpals in whole hands with all soft tissues remaining (intact). Mechanical testing to complete failure in three-point apex dorsal bending was done in all specimens. Ultimate moment (strength) of each of the four fixation methods was significantly greater in intact specimens than in denuded specimens. Crossed Kirschner wires were most stable in intact specimens, and dorsal plates were more stable in denuded specimens. The results show that soft tissues contribute to the strength of fracture fixation. Clinically, surgeons may be able to use a less invasive fixation method than plating without compromising the strength of metacarpal fixation in patients whose soft tissues are not severely disrupted and the fracture configuration allows. Plating may offer optimum stability in patients whose soft tissues are damaged severely and provide less strengthening of the fracture construct. PMID:12838068

  3. Clinical Results of Internal Fixation of Subcapital Femoral Neck Fractures

    PubMed Central

    Moon, Kyoung Ho; Shin, Joong Sup; Shin, Eun Ho; Ahn, Chi Hoon; Choi, Geon Hong

    2016-01-01

    Background Subcapital femoral neck is known to cause many complications, such as avascular necrosis (AVN) of the femoral head or nonunion, compared with other femoral neck fractures. The purpose of this study was to analyze the incidence of AVN and fixation failures in patients treated with internal fixation using cannulated screws for the subcapital femoral neck fractures. Methods This study targeted a total of 84 cases of subcapital femoral neck fractures that underwent internal fixation using cannulated screws. The average follow-up time after surgery was 36.8 months (range, 24 to 148 months). Results Nine hips (10.7%) showing AVN of the femoral head and 6 hips (7.1%) showing fixation failures were observed. The factors affecting the incidence of AVN of the femoral head after sustaining fractures correlated well with fracture types in the Garden classification (p = 0.030). The factors affecting fixation failure were the degree of reduction (p = 0.001) measured by the Garden alignment index and firm fixation (p = 0.009) assessed using the technique of 3-point fixation through the inferomedial cortical bone of the femoral neck. Conclusions The complication rates for subcapital femoral neck fractures were lower than those previously reported; hence, internal fixation could be a primary treatment option for these fractures. PMID:27247738

  4. Intrafocal pin plate fixation of distal ulna fractures associated with distal radius fractures.

    PubMed

    Foster, Brian J; Bindra, Randy R

    2012-02-01

    Subcapital ulnar fractures in association with distal radius fractures in elderly patients increase instability and pose a treatment challenge. Fixation of the ulnar fracture with traditional implants is difficult due to the subcutaneous location, comminution, and osteoporosis. We describe an intrafocal pin plate that provides fixation by a locking plate on the distal ulna and intramedullary fixation within the shaft. The low profile and percutaneous technique make this device a useful alternative for treatment of subcapital ulna fractures in the elderly. PMID:22192166

  5. Arthroscopy Assisted Percutaneous Fixation of Ideberg Type Iii Glenoid Fractures

    PubMed Central

    Acharya, Prashant; Arora, Bakul; Pinto, Nelson

    2015-01-01

    Introduction: Intra-articular glenoid fractures are extremely rare and may be associated with other injuries. Traditionally open reduction and internal fixation has been recommended in displaced intra-articular glenoid fractures. However open reduction is difficult and it may not be possible to address the associated intra-articular soft tissue injuries. A few reports of arthroscopic assisted fixation of these fractures have been recently published. We are reporting a case of Ideberg type 3 glenoid fracture and its treatment. Case Report: We are presenting our case where a 52 year old man presented with Type 3 intra-articular glenoid fracture. The fracture was fixed percutaneously under simultaneous arthroscopic and fluoroscopic guidance. Conclusion: Intra-articular glenoid fractures are uncommon and difficult to treat. Arthroscopy assisted percutaneous fixation technique can be a valuable adjunct for the surgeon in dealing with not only the fracture but also the associated soft-tissue injuries. PMID:27299041

  6. Unusual Unilateral Fracture of the Condylar and Coronoid Processes of the Mandible

    PubMed Central

    Baykul, Timuçin; Aydın, M Asım; Aksoy, Müge Çına; Fındık, Yavuz

    2014-01-01

    The incidence of condylar fracture is very high and most are not caused by direct trauma. On the other hand, fracture of the coronoid process is reported less often than fracture of other parts of the mandible. We report a case of right subcondylar and coronoid fractures without any evidence of direct trauma to the zygomatic area or an indirect trauma to the mandibular corpus or sypmheseal region. The possible cause was identified as acute reflex contraction of the temporalis muscles leading to coronoid and condylar stress fractures. PMID:25379353

  7. Preauricular transmasseteric anteroparotid approach for extracorporeal fixation of mandibular condyle fractures

    PubMed Central

    Gali, Rajasekhar; Devireddy, Sathya Kumar; Venkata, Kishore Kumar Rayadurgam; Kanubaddy, Sridhar Reddy; Nemaly, Chaithanyaa; Dasari, Mallikarjuna

    2016-01-01

    Introduction: Free grafting or extracorporeal fixation of traumatically displaced mandibular condyles is sometimes required in patients with severe anteromedial displacement of condylar head. Majority of the published studies report the use of a submandibular, retromandibular or preauricular incisions for the access which have demerits of limited visibility, access and potential to cause damage to facial nerve and other parotid gland related complications. Purpose: This retrospective clinical case record study was done to evaluate the preauricular transmasseteric anteroparotid (P-TMAP) approach for open reduction and extracorporeal fixation of displaced and dislocated high condylar fractures of the mandible. Patients and Methods: This retrospective study involved search of clinical case records of seven patients with displaced and dislocated high condylar fractures treated by open reduction and extracorporeal fixation over a 3-year period. The parameters assessed were as follows: a) the ease of access for retrieval, reimplantation and fixation of the proximal segment; b) the postoperative approach related complications; c) the adequacy of anatomical reduction and stability of fixation; d) the occlusal changes; and the e) TMJ function and radiological changes. Results: Accessibility and visibility were good. Accurate anatomical reduction and fixation were achieved in all the patients. The recorded complications were minimal and transient. Facial nerve (buccal branch) palsy was noted in one patient with spontaneous resolution within 3 months. No cases of sialocele or Frey's syndrome were seen. Conclusion: The P-TMAP approach provides good access for open reduction and extracorporeal fixation of severely displaced condylar fractures. It facilitates retrieval, transplantation, repositioning, fixing the condyle and also reduces the chances of requirement of a vertical ramus osteotomy. It gives straight-line access to condylar head and ramus thereby permitting

  8. Unilateral Mydriasis After Mandibular Fracture Fixation Surgery

    PubMed Central

    Nesioonpour, Sholeh; Khiabani, Kazem; Hassanijirdehi, Marzieh

    2014-01-01

    Introduction: Unilateral mydriasis is a seriously significant finding in neurologic examinations indicating life-threatening conditions such as cerebral vascular injuries. Case Presentation: A 24 year old woman with mandibular trauma was referred to our center after five days for a reduction of the right mandibular angle fracture. The patient had no history of any loss of consciousness after the accident. Her physical examination showed no abnormalities, except those related to her mandibular fracture. The laboratory results were normal as well. At 8:30 am a general anesthesia was induced. The patient’s eyes were kept shut throughout the surgical procedure. The operation included an intraoral open reduction and fixation using two miniplates without any complications. After the operation, it was noticed that the left eye was completely dilated with no reaction to light, while the right eye was normal. The management and outcomes in this patient were described in the present case report. Conclusions: Evaluating the size of the patient’s pupils before, during and after the operation, careful history, consult, CT scan and MRI would help to diagnosis. Although no probable cause was found to explain the transient mydriasis in our patient. PMID:24829881

  9. Functional and radiological results of open and closed treatment of intracapsular (diacapitular) condylar fractures of the mandible.

    PubMed

    Hlawitschka, M; Loukota, R; Eckelt, U

    2005-09-01

    The study was performed to evaluate and compare the results of open and closed treatments of diacapitular fractures of the mandible. Following open reduction and internal fixation (ORIF) 14 patients with 15 displaced condylar fractures, which had caused a shortening of the mandibular ramus, were examined clinically (Helkimo index), radiologically (Orthopantomogram, Clementschitsch [reversed Towne's] view, Submentovertex view) and axiographically (CARDIAX). These findings were compared to a group of 29 patients with 34 similar condylar fractures which had been treated using closed techniques. Following ORIF patients showed better radiological results with regard to the mandibular ramus height, resorption and pathological changes to the condyle, compared to the patient group after closed functional treatment. In both groups some signs of dysfunction persisted, although there were slightly better results in the ORIF group. In 30% of the closed treatment group, lateral deviation during mouth opening, crepitus and occlusal disturbances were noted. No cases of occlusal disturbance were observed in the ORIF group. The axiographic examinations revealed a significant limitation of movement of the fractured condyle in both groups. However, after open treatment, the temporomandibular joint displayed significantly less irregularities in the condylar paths. In cases of complex reconstruction of the mandibular condyle, ORIF appears to improve the function of fractured condyles, when combined with a postoperative therapeutic exercise regime. PMID:16053886

  10. Fixation of distal radius fractures in adults: a review.

    PubMed

    Obert, L; Rey, P-B; Uhring, J; Gasse, N; Rochet, S; Lepage, D; Serre, A; Garbuio, P

    2013-04-01

    In patients for whom function is a priority, anatomic reduction and stable fixation are prerequisites for good outcomes. Several therapeutic options exist, including orthopedic treatment and internal fixation with pins (intra- and extrafocal), external fixation which may or may not bridge the wrist, and different internal fixation techniques with dorsal or palmar plates using or not, locking screws. Arthroscopy may be necessary in case of articular fracture. In the presence of significant metaphyseal bone defects, filling of the comminution with phosphocalcic cements provides better graft stability. The level of evidence is too low to allow recommending one type of fixation for one type of fracture; and different fixation options to achieve stable reduction exist, each with its own specific complications. With the new generations of palmar plate, secondary displacement is becoming a thing of the past. PMID:23518070

  11. Evaluation of fracture healing and subimplant bone response following fixation with a locking miniplate and screw system for mandibular angle fractures in a sheep model.

    PubMed

    Poon, C C H; Verco, S

    2013-06-01

    This study aims to establish a mandible fracture model, and to review fracture healing following fixation with a locking miniplate system. Eighteen 2-year-old sheep were divided into three groups of six. Each animal had a single fracture that was anatomically reduced and internally fixed by a single 4-hole plate with two monocortical screws each side of the fracture. The fractures were internally fixed with poorly contoured conventional miniplates or poorly contoured mini-locking plate or well contoured conventional miniplates. Two sheep in each of the three groups were killed at 2, 4 and 8 weeks after surgery. The mandibles were radiographed then decalcified specimens were reviewed microscopically. No clinical difference was observed between the groups. All fractures were at an advanced stage of bony union by 4 weeks. Fracture union appeared radiographically more advanced with the locking plate system. This study established a protocol for simulating a fracture model for the study of fracture healing. A more advanced stage of union was seen for fractures internally fixed with locking plates/screws than with a conventional system. The observations suggest the purported biological benefits of locking miniplate system do exist. PMID:23374732

  12. Multipurpose external fixator for intraarticular fracture of distal radius.

    PubMed

    Siripakarn, Yongyuth; Siripakarn, Zongyuti

    2010-12-01

    Fracture of distal radius is one of a complicated injury which can be difficult in reduction and maintaining its alignment and may result in malunion and shortening following a variety of fixation. Since Anderson's and O'neil described the use of sustain traction by extraskeletal device anchored to the radius and the first metacarpal of the hand. Vidal et al [1979] demonstrated that the ligamentotaxis could be used to reduce the fracture around the wrist, ankle, hip and knee. The external fixation frame can maintain radial length and inclination by the pullout force from the radial styloid. External fixation is useful for management of complex intraarticular fracture of distal radius. There are few types of commercially available fixator. It is important to use one that allow versatility and follow biomechanic principles of ligamentotaxis, which can be used to reduce the severe comminution and the most difficult fracture by distraction and stabilization effectively. The ideal characteristic of the external fixation are: Telescoping connecting frame fixed externally compose of two joints which can be easily adjust in any direction, two pins clamp connected to the external connecting rod. Our TU Multipurpose external fixator can be designed as a multiplana, can be used as a bridge or non bridge fixation, and can be adjusted to any direction which require for the treatment of distal radius fracture. It is differed to other commercially available devices. PMID:21294433

  13. Arthroscopic-Assisted Fixation of Ideberg Type III Glenoid Fractures

    PubMed Central

    Tao, Matthew A.; Garrigues, Grant E.

    2015-01-01

    Operative treatment of scapular fractures with extension into the glenoid can be a challenging clinical scenario. Though traditionally addressed in an open fashion, the morbidity of this approach, complemented by advancements in arthroscopic technique and instrumentation, has led to increasing use of arthroscopic-assisted fixation. We describe our technique, including pearls and pitfalls, for minimally invasive fixation of Ideberg type III glenoid fractures. This approach minimizes morbidity, allows optimal visualization and reduction, and provides good functional results. PMID:26052487

  14. Open reduction and internal fixation compared to closed reduction and external fixation in distal radial fractures

    PubMed Central

    Kopylov, Philippe; Geijer, Mats; Tägil, Magnus

    2009-01-01

    Background and purpose In unstable distal radial fractures that are impossible to reduce or to maintain in reduced position, the treatment of choice is operation. The type of operation and the choice of implant, however, is a matter of discussion. Our aim was to investigate whether open reduction and internal fixation would produce a better result than traditional external fixation. Methods 50 patients with an unstable or comminute distal radius fracture were randomized to either closed reduction and bridging external fixation, or open reduction and internal fixation using the TriMed system. The primary outcome parameter was grip strength, but the patients were followed for 1 year with objective clinical assessment, subjective outcome using DASH, and radiographic examination. Results At 1 year postoperatively, grip strength was 90% (SD 16) of the uninjured side in the internal fixation group and 78% (17) in the external fixation group. Pronation/supination was 150° (15) in the internal fixation group and 136° (20) in the external fixation group at 1 year. There were no differences in DASH scores or in radiographic parameters. 5 patients in the external fixation group were reoperated due to malunion, as compared to 1 in the internal fixation group. 7 other cases were classified as radiographic malunion: 5 in the external fixation group and 2 in the internal fixation group. Interpretation Internal fixation gave better grip strength and a better range of motion at 1 year, and tended to have less malunions than external fixation. No difference could be found regarding subjective outcome. PMID:19857180

  15. Amputated Lower Limb Fixation to the Fracture Table.

    PubMed

    Gamulin, Axel; Farshad, Mazda

    2015-11-01

    Fractures of the proximal and diaphyseal femur are frequently internally fixed using a fracture table with fracture reduction obtained by traction and adequate rotation exerted on the slightly abducted extremity. Although rare, these fractures may occur on an amputated limb. If so, standard use of a fracture table is not possible. To address this situation, the authors describe a simple novel technique allowing rigid fixation of the amputated limb to the traction device of the fracture table that provides accurate control of reduction in all planes. PMID:26558660

  16. Technical tips: dualplate fixation technique for comminuted proximal humerus fractures.

    PubMed

    Choi, Sungwook; Kang, Hyunseong; Bang, Hyeongsig

    2014-08-01

    The authors report dualplate fixation technique for providing stable fixation in comminuted proximal humerus fractures. This technique has been used for proximal humerus fractures with metaphyseal comminution and provides excellent anatomical reduction and neck shaft angle (NSA). The recently locking plate is clinically more widely used due to its small size, low rigidity, high elasticity, and biomechanical properties such as fixed initial angle and rotational stability. However, in severely comminuted complex type proximal metaphyseal humerus fractures, the use of locking plate alone does not provide stable fixation, leading to complications such as varus collapse, anterior-posterior angulation, screw cutout, nonunion, malunion, and metal failure. Therefore, a more robust and enhanced fixation method, the dual plating technique using the locking compression plate (Proximal Humeral Internal Locking System and Variable Angle Locking Compression Plate) was developed. PMID:24813097

  17. Percutaneous limited internal fixation combined with external fixation to treat open pelvic fractures concomitant with perineal lacerations.

    PubMed

    Chen, Linwei; Zhang, Guoyou; Wu, Yaoshen; Guo, Xiaoshan; Yuan, Wen

    2011-12-01

    External fixation combined with colostomy is a traditional management of the pelvic fractures associated with perineal lacerations. However, malunion and dysfunction caused by malreduction and loss of reduction are common. One-stage definitive fixation without soft tissue harassment is requisite for the treatment. The purpose of this study was to assess the outcome of 1-stage definitive fixation by combining percutaneous limited internal fixation and external fixation in the treatment of pelvic fractures with perineal lacerations. Eighteen adults with high-energy unstable pelvic ring fractures associated with perineal lacerations were admitted between June 2003 and December 2010. Mean follow-up was 28 months. After wound closure and colostomy, 10 patients received external fixation and percutaneous screw fixation, and 8 patients underwent external fixation. Demographics, wound and fracture classification, and Injury Severity Score were comparable between the groups (P>.05). Initial reduction quality was comparable between the groups (P=.14), but the loss of reduction during follow-up was more significant in the external fixation group (P=.004). Combined fixation achieved better functional results than external fixation (P=.02). There were 2 cases of superficial wound infection in each group (P=1.0). By combining debridement, wound closure, colostomy, percutaneous limited internal fixation, and external fixation, we improved pelvic fracture recovery while reducing the risk of infection. One-stage definitive fixation is a better choice than external fixation in the treatment of open pelvic fracture concomitant with perineal wound. PMID:22146197

  18. Suture Bridge Fixation Technique for Posterior Cruciate Ligament Avulsion Fracture

    PubMed Central

    Lee, Kwang Won; Lee, Gyu Sang; Choy, Won Sik

    2015-01-01

    We presented a surgical technique including a suture bridge technique with relatively small incision for the reduction and fixation of posterior ligament avulsion fractures. A suture anchor was used to hold the avulsed fragment and a knotless anchor was used to continuously compress the bony fragment into the fracture site, thereby maintaining reduction during healing. PMID:26640635

  19. Fixation versus hemiarthroplasty for undisplaced intracapsular hip fractures.

    PubMed

    Parker, Martyn J; White, Andrew; Boyle, Adrian

    2008-07-01

    The conventional treatment for an undisplaced intracapsular hip fracture is internal fixation. A possible alternative treatment is replacement hemiarthroplasty. We have compared the outcomes of an age, sex and co-morbidity matched cohort of 346 patients who have had their undisplaced intracapsular hip fracture treated using cannulated screws with a group of 346 patients who have had a displaced intracapsular fracture treated using a hemiarthroplasty. Patients treated by internal fixation had a shorter operation time (43 versus 67 min), reduced orthopaedic ward stay (11 versus 15 days), lower incidence of peri-operative complications (24 versus 81), and a lower 1-year mortality (19% versus 26%). Additional benefits for the fixation group were less pain at 1 year, less reduction in mobility and lower dependence on walking aids. All these differences were statistically significant. Hemiarthroplasty had a lower re-admission rate (43 versus 14 cases) and re-operation rate (59 versus 22 cases). These results support the use of internal fixation for undisplaced intracapsular fractures and confirm that the final outcome for an undisplaced intracapsular hip fracture is significantly better than for a displaced intracapsular fracture, despite a higher re-operation rate after internal fixation. PMID:18407277

  20. The Role of Fibular Fixation in Distal Tibial Fractures

    PubMed Central

    Antin, S.M.; Akkimaradi, R.C.; Policepatil, Prasad; Naikawadi, Girish.

    2016-01-01

    Introduction Lower tibial extra-articular fractures of lower tibial extra-articular bone, treated with Minimally Invasive Percutaneous plate osteosynthesis (MIPPO) may have certain advantages, though the modiality is technically demanding. Aim To assess the results of distal tibial fractures treated with minimally invasive plate osteosynthesis utilizing precontoured dital medial tibial locking plates without fibular fracture fixation. Material and Methods The study was conducted during the period from june 2009 to june 2011. A series of 30 patients (22 men and 8 women) with concurrent distal tibia and fibula fractures who underwent minimally plate osteosynthesis utilizing precontoured distal tibial medial locking plates without fibular fracture fixation have been reviewed after surgery. 14 fractures were type A1, 6 type A2, and 4 type A3. Open Grade II fracture were 4 and Open Grade IIIA fracture is2. Results The mean follow-up duration was 2 years. The mean time to bone union was 20 weeks. No patient had shortening, hardware breakdown, or deep-seated infection. Out of 30 patients, 24 had excellent results, 6 had good results. Four patients had palpable screws, two patient had blisters which subsidized with conservative treatment. This minimally invasive technique for treatment of distal tibial fractures proved to be a feasible and worthwhile method of stabilization. Conclusion It appears from our study that fibula fixation is not required in non-syndesmotic distal metaphyseal extra articular fractures when fixed by locking plate using minimal invasive techniques. PMID:27190908

  1. Implant materials for fracture fixation: a clinical perspective.

    PubMed

    Disegi, J A; Wyss, H

    1989-01-01

    The optimum management of traumatic skeletal fractures may involve the installation of high quality surgical implants by a skilled orthopedic surgeon. Satisfactory clinical results are very dependent on the ability to maintain stable fracture fixation. Well designed contemporary implants rely on precise control of material composition and properties to achieve a well tolerated level of biological response. Metallic materials, such as 316L stainless steel, pure titanium, and titanium alloys, demonstrate an acceptable combination of strength, ductility, corrosion resistance, and biocompatibility. Polymers, composites, and biodegradable materials may offer selected opportunities for fracture fixation. An understanding of relevant clinical factors is essential to evaluate potential applications for advanced materials. PMID:2915951

  2. Use of 3-d plate in displaced angle fracture of mandible.

    PubMed

    Pal, Uma Shanker; Singh, R K; Dhasmana, Satish; Das, Somdipto; Das, Sanjib K

    2013-03-01

    Introduction Mandibular angle fractures can be treated by various methods, but even the most popular methods may not be able to give satisfactory results, as the pterygomasseteric sling and masticatory forces can result in displaced angle fracture. These displaced fragments cannot be satisfactorily retained by single miniplate fixation. The aim of this study is to assess treatment of displaced angle fracture with 3-D miniplate fixation. This study can also be considered as a therapeutic study with level V evidence. Materials and Methods This study was designed to assess the feasibility of 3-D matrix miniplate fixation in displaced angle fractures. Eighteen patients with displaced angle fractures were included in this study. Matrix miniplate fixation was done transorally under general anesthesia. Results All these cases were treated successfully, and common complications like infection (5.5% of patients), wound dehiscence (11%), paresthesia (16.7%), and malocclusion (11%) were observed in our study. Conclusions Three-dimensional miniplate fixation in displaced angle fractures provides better stability and function. PMID:24436732

  3. Temporary bridging external fixation in distal tibial fracture.

    PubMed

    Lavini, F; Dall'Oca, C; Mezzari, S; Maluta, T; Luminari, E; Perusi, F; Vecchini, E; Magnan, B

    2014-12-01

    Fractures that involve the distal area of the tibia are associated with a high percentage of complications. Soft tissue oedema, swelling, blisters, skin abrasions and open wounds could compromise the outcome of these lesions. The waiting time before surgery with ORIF is mostly due to soft tissue conditions. Early application of a simple joint-spanning external fixator would achieve the initial goal of stability and the respect of soft tissue, thereby decreasing the time necessary for definitive treatment. A total of 40 consecutive patients (22 male and 18 female) with a mean age of 52 years (range 17-82 years) with distal tibial fracture treated between January 2010 and January 2013 were evaluated. Early temporary external fixation was the first treatment step. Twenty patients had pilon fractures, characterised by the intra-articular involvement of the distal tibia with metaphyseal extension, and 20 patients had malleolar fracture-dislocation. Patients were divided into two groups, A and B. Group A comprised 10 patients with ankle fracture-dislocation and bone fragmentation, who were treated with a temporary bridging external fixation that was maintained after ORIF to exploit ligamentotaxis during the first phases of bone healing. In Group B (30 patients), the external fixation was removed after ORIF. The results of the study are in line with the recent literature: temporary external fixation in high-energy trauma and fracture-dislocation of the ankle enables soft tissue to be restored, which facilitates postoperative assessment of bone fragments by CT scan. The complication rate in this study was 5% in patients with malleolar fractures and 20% in patients with pilon fractures. The maintenance of temporary external fixation after ORIF synthesis during the entire first stage of bone healing seems to be a good method of treatment that has a low rate of soft tissue complications. PMID:25457321

  4. Unicortical versus bicortical locked plate fixation in midshaft clavicle fractures.

    PubMed

    Bravman, Jonathan T; Taylor, Michal L; Baldini, Todd; Vidal, Armando F

    2015-05-01

    Higher rates of poor outcomes in displaced midshaft clavicle fractures treated nonoperatively have recently been reported. Along with expanding indications for operative fixation and increasing application of locked plate constructs, it is unknown whether complications related to bicortical penetration of the clavicle can be avoided using unicortical fixation. The purpose of this study is to compare the biomechanical properties of unicortical and bicortical fixation in precontoured vs manually contoured locking clavicle plates. Forty-eight Sawbone composite human clavicle specimens (item #3408; Pacific Research Laboratories, Vashon, Washington) with a midshaft clavicle osteotomy were reduced and plated in 8 specimens each using a bicortical and unicortical fixation for each of 3 locked plate constructs (3.5-mm LCP Reconstruction Plate; 3.5-mm LCP Superior Clavicle Plate; 3.5-mm LCP Superior Anterior Clavicle Plate; Synthes, Inc, West Chester, Pennsylvania). Specimens were tested for stiffness in axial torsion and cantilever bending and then loaded to failure in 3-point bending. Data were analyzed using 2-way analysis of variance and Tukey's test (P<.05). No significant differences were found between unicortical and bicortical fixation in failure load, cantilever bending, and cross body stiffness. Bicortical fixation was significantly stiffer than unicortical fixation in torsion only for the same plates. Significant differences also existed between plates in torsion. Unicortical locked plate fixation may be a reasonable option in the treatment of displaced midshaft clavicle fracture fixation to avoid complications associated with posteroinferior hardware penetration following clavicle fracture fixation based on the biomechanical performance of these constructs. However, it remains unclear whether these differences will be clinically significant. PMID:25970369

  5. The Comprehensive AOCMF Classification System: Mandible Fractures-Level 3 Tutorial

    PubMed Central

    Cornelius, Carl-Peter; Audigé, Laurent; Kunz, Christoph; Rudderman, Randal; Buitrago-Téllez, Carlos H.; Frodel, John; Prein, Joachim

    2014-01-01

    This tutorial outlines the details of the AOCMF image-based classification system for fractures of the mandibular arch (i.e. the non-condylar mandible) at the precision level 3. It is the logical expansion of the fracture allocation to topographic mandibular sites outlined in level 2, and is based on three-dimensional (3D) imaging techniques/computed tomography (CT)/cone beam CT). Level 3 allows an anatomical description of the individual conditions of the mandibular arch such as the preinjury dental state and the degree of alveolar atrophy. Trauma sequelae are then addressed: (1) tooth injuries and periodontal trauma, (2) fracture involvement of the alveolar process, (3) the degree of fracture fragmentation in three categories (none, minor, and major), and (4) the presence of bone loss. The grading of fragmentation needs a 3D evaluation of the fracture area, allowing visualization of the outer and inner mandibular cortices. To document these fracture features beyond topography the alphanumeric codes are supplied with distinctive appendices. This level 3 tutorial is accompanied by a brief survey of the peculiarities of the edentulous atrophic mandible. Illustrations and a few case examples serve as instruction and reference to improve the understanding and application of the presented features. PMID:25489389

  6. Intramedullary Fixation of Clavicle Fractures: Anatomy, Indications, Advantages, and Disadvantages.

    PubMed

    Eichinger, Josef K; Balog, Todd P; Grassbaugh, Jason A

    2016-07-01

    Historically, management of displaced midshaft clavicle fractures has consisted of nonsurgical treatment. However, recent literature has supported surgical repair of displaced and shortened clavicle fractures. Several options exist for surgical fixation, including plate and intramedullary (IM) fixation. IM fixation has the potential advantages of a smaller incision and decreased dissection and soft-tissue exposure. For the last two decades, the use of Rockwood and Hagie pins represented the most popular form of IM fixation, but concerns exist regarding stability and complications. The use of alternative IM implants, such as Kirschner wires, titanium elastic nails, and cannulated screws, also has been described in limited case series. However, concerns persist regarding the complications associated with the use of these implants, including implant failure, migration, skin complications, and construct stability. Second-generation IM implants have been developed to reduce the limitations of earlier IM devices. Although anatomic and clinical studies have supported IM fixation of midshaft clavicle fractures, further research is necessary to determine the optimal fixation method. PMID:27227985

  7. Closed Reduction and Percutaneous Fixation of Calcaneal Fractures in Children.

    PubMed

    Feng, Yongzeng; Yu, Yang; Shui, Xiaolong; Ying, Xiaozhou; Cai, Leyi; Hong, Jianjun

    2016-07-01

    Open reduction and internal fixation has been widely used to treat displaced intra-articular calcaneus fractures in children. However, the complications of surgical trauma and the wound created through the extended lateral approach cannot be ignored. This study analyzed the outcomes of displaced intra-articular calcaneal fractures in children treated with closed reduction and percutaneous fixation. Medical records of pediatric patients who had displaced intra-articular calcaneus fractures and underwent closed reduction and percutaneous fixation at the study institution between January 2008 and January 2013 were reviewed. Preoperative radiographs and computed tomography scans were used to evaluate and classify the fractures. Clinical outcomes and radiographic findings were assessed at postoperative follow-up. The study included 14 displaced intra-articular calcaneal fractures in 11 patients (7 boys and 4 girls). Mean patient age was 11.18 years (range, 6-16 years), and average follow-up time was 42.8 months postoperatively (range, 12-72 months). There were 6 tongue-type fractures and 8 joint depression-type fractures, based on the Essex-Lopresti classification, and there were 11 type II and 3 type III fractures, based on the Sanders classification. Average Böhler angle was 8.00° (range, -5° to 18°) preoperatively and 30.79° (range, 26° to 40°) postoperatively (P<.001). Average subjective American Orthopaedic Foot and Ankle Society hindfoot score was 65.7 (range, 52-68). No patients had wound breakdown or infection. In the treatment of displaced intra-articular calcaneal fractures in pediatric patients, closed reduction and percutaneous fixation achieved good outcomes, with few complications. [Orthopedics. 2016; 39(4):e744-e748.]. PMID:27111072

  8. Biomechanical Analysis of Pedicle Screw Fixation for Thoracolumbar Burst Fractures.

    PubMed

    McDonnell, Matthew; Shah, Kalpit N; Paller, David J; Thakur, Nikhil A; Koruprolu, Sarath; Palumbo, Mark A; Daniels, Alan H

    2016-05-01

    Treatment of unstable thoracolumbar burst fractures remains controversial. Long-segment pedicle screw constructs may be stiffer and impart greater forces on adjacent segments compared with short-segment constructs, which may affect clinical performance and long-term out come. The purpose of this study was to biomechanically evaluate long-segment posterior pedicle screw fixation (LSPF) vs short-segment posterior pedicle screw fixation (SSPF) for unstable burst fractures. Six unembalmed human thoracolumbar spine specimens (T10-L4) were used. Following intact testing, a simulated L1 burst fracture was created and sequentially stabilized using 5.5-mm titanium polyaxial pedicle screws and rods for 4 different constructs: SSPF (1 level above and below), SSPF+L1 (pedicle screw at fractured level), LSPF (2 levels above and below), and LSPF+L1 (pedicle screw at fractured level). Each fixation construct was tested in flexion-extension, lateral bending, and axial rotation; range of motion was also recorded. Two-way repeated-measures analysis of variance was performed to identify differences between treatment groups and functional noninstrumented spine. Short-segment posterior pedicle screw fixation did not achieve stability seen in an intact spine (P<.01), whereas LSPF constructs were significantly stiffer than SSPF constructs and demonstrated more stiffness than an intact spine (P<.01). Pedicle screws at the fracture level did not improve either SSPF or LSPF construct stability (P>.1). Long-segment posterior pedicle screw fixation constructs were not associated with increased adjacent segment motion. Al though the sample size of 6 specimens was small, this study may help guide clinical decisions regarding burst fracture stabilization. [Orthopedics. 2016; 39(3):e514-e518.]. PMID:27135451

  9. 3D Mapping of Safe and Danger Zones in the Maxilla and Mandible for the Placement of Intermaxillary Fixation Screws

    PubMed Central

    Purmal, Kathiravan; Alam, Mohammad Khursheed; Pohchi, Abdullah; Abdul Razak, Noor Hayati

    2013-01-01

    Intermaxillary (IMF) screws feature several advantages over other devices used for intermaxillary fixation, but using cone beam computed tomography (CBCT) scans to determine the safe and danger zones to place these devices for all patients can be expensive. This study aimed to determine the optimal interradicular and buccopalatal/buccolingual spaces for IMF screw placement in the maxilla and mandible. The CBCT volumetric data of 193 patients was used to generate transaxial slices between the second molar on the right to the second molar on the left in both arches. The mean interradicular and buccopalatal/buccolingual distances and standard deviation values were obtained at heights of 2, 5, 8 and 11 mm from the alveolar bone crest. An IMF screw with a diameter of 1.0 mm and length of 7 mm can be placed distal to the canines (2 - 11 mm from the alveolar crest) and less than 8 mm between the molars in the maxilla. In the mandible, the safest position is distal to the first premolar (more than 5 mm) and distal to the second premolar (more than 2 mm). There was a significant difference (p<0.05) between the right and left quadrants. The colour coding 3D template showed the safe and danger zones based on the mesiodistal, buccopalatal and buccolingual distances in the maxilla and mandible.The safest sites for IMF screw insertion in the maxilla were between the canines and first premolars and between the first and second molars. In the mandible, the safest sites were between the first and second premolars and between the second premolar and first molar. However, the IMF screw should not exceed 1.0 mm in diameter and 7 mm in length. PMID:24367643

  10. [Results following percutaneous intramedullary pin fixation in distal radius fractures].

    PubMed

    Kirchner, R; Hüttl, T; Krüger-Franke, M; Rosemeyer, B

    1994-01-01

    42 distal radius fractures have been submitted to further examination after percutaneous intramedullary pin fixation. The outcome were 95.3% of very good to good anatomic results and 90.5% of satisfying functional results. This showed the close link between the radiological-anatomical and functional results. The success of the treatment was very acceptable, although the Morbus Sudeck as the major complication--with 7.2%--was still relatively frequently observed. It could be seen that particularly fractures at the risk of dislocation with smash zone constituted an indication for the percutaneous intramedullary pin fixation, that is to say all fractures for which a retention is primarily difficult. It constitutes a supplement, as well as an extension to the therapy of the distal radius fractures. PMID:7516105

  11. Novel venting technique for intramedullary rod fixation of pathologic fractures.

    PubMed

    Wilkens, Kenneth J; Nicolaou, Daemeon A M; Lee, Mark A

    2011-10-01

    This article introduces a novel technique to vent the femur and potentially decrease the embolic load created by reaming during intramedullary rod fixation of impending pathologic femur fractures. We used readily available operating room equipment to create a distal femoral vent hole without interfering with standard intramedullary instrumentation and with minimal increase in surgical time. This technique can be used for the prophylactic intramedullary stabilization of impending pathologic femur fractures from metabolic bone disease, metastatic cancer, and bisphosphonate use. PMID:21956178

  12. Sclerosing osteomyelitis as a complication of pediatric femur fracture fixation.

    PubMed

    Mooney, James F

    2014-11-01

    Complications of flexible nailing of pediatric femur fractures include angular and rotational malunions, leg-length discrepancy, and, in rare instances, infection. To our knowledge, the development of a sclerosing type of chronic osteomyelitis, which appears most similar to chronic sclerosing osteomyelitis of Garre', has not been reported as a complication of, or associated with, flexible nail fixation of a pediatric femur fracture. PMID:25171570

  13. Strontium-impregnated bioabsorbable composite for osteoporotic fracture fixation.

    PubMed

    Wu, Chang-Chin; Kuo, Chih-Lin; Fan, Fang-Yu; Yang, Kai-Chiang

    2015-10-01

    Osteoporosis impairs the bone-healing process as well as bone fracture fixation. The intervention of osteoporosis is considered to be one part of bone fracture treatment. Thus, orthopedic fixators impregnated with antiosteoporosis regimens will improve fracture fixation in osteoporotic bone. In this study, the strontium (Sr) and calcium phosphate ceramic (CPC) were mixed first and then mixed with poly(ε-caprolactone) (PCL) to fabricate a bioactive and bioabsorbable bone fixators. The prepared Sr-CPC/PCL screws were implanted into the distal femur of ovariectomized rabbits. The results showed that Sr-CPC/PCL composite had the appropriate mechanical properties, good biocompatibility, and radio-opacity. The Sr addition created a porous structure and accelerated the degradation of bone screws, but the degradation products did not acidify the surrounding environment. For osteoporotic animals, favorable osteointegration around the Sr-CPC/PCL screws was found, and the total porosity of trabecular bone was decreased under the inspections of micro-computerized tomography. Compared with PCL or CPC/PCL screw, animals which received Sr-CPC/PCL were found to have better results in terms of trabecular number, thickness, and separation. This study reveals that the Sr-impregnated bone fixator improves osseointegration in osteoporotic animals. Sr-CPC/PCL composite is a good candidate material for osteofixation in osteoporotic patients. PMID:25847487

  14. Anterior subcutaneous internal fixation for treatment of unstable pelvic fractures

    PubMed Central

    2014-01-01

    Background Fractures of the pelvic ring including disruption of the posterior elements in high-energy trauma have both high morbidity and mortality rates. For some injury pattern part of the initial resuscitation includes either external fixation or plate fixation to close the pelvic ring and decrease blood loss. In certain situations – especially when associated with abdominal trauma and the need to perform laparotomies – both techniques may put the patient at risk of either pintract or deep plate infections. We describe an operative approach to percutaneously close and stabilize the pelvic ring using spinal implants as an internal fixator and report the results in a small series of patients treated with this technique during the resuscitation phase. Findings Four patients were treated by subcutaneous placement of an internal fixator. Screw fixation was carried out by minimally invasive placement of two supra-acetabular iliac screws. Afterwards, a subcutaneous transfixation rod was inserted and attached to the screws after reduction of the pelvic ring. All patients were allowed to fully weight-bear. No losses of reduction or deep infections occurred. Fracture healing was uneventful in all cases. Conclusion Minimally invasive fixation is an alternative technique to stabilize the pelvic ring. The clinical results illustrate that this technique is able to achieve good results in terms of maintenance of reduction the pelvic ring. Also, abdominal surgeries no longer put the patient at risk of infected pins or plates. PMID:24606833

  15. The retromandibular transparotid approach for reduction and rigid internal fixation using two locking miniplates in mandibular condylar neck fractures.

    PubMed

    Kanno, T; Sukegawa, S; Tatsumi, H; Nariai, Y; Ishibashi, H; Furuki, Y; Sekine, J

    2014-02-01

    We evaluated the safety, efficacy, and morbidity associated with the treatment of displaced mandibular condylar neck fractures using a retromandibular transparotid approach to reduce and rigidly fix using two 2.0-mm locking miniplates. Our surgical inclusion criteria were: patient selection of open reduction and fixation, displaced unilateral condylar fractures with derangement of occlusion, and bilateral condylar fractures with an anterior open bite. The study group consisted of 19 patients who underwent surgery for 19 mandibular condylar neck fractures; patients were analyzed prospectively, with more than 6 months of follow-up, and were evaluated in terms of functional results, scar formation, postoperative complications, and stability of fixation. The results showed that functional occlusion identical to the preoperative condition and correct anatomical reduction of the condylar segments in centric occlusion, followed by immediate functional recovery, was achieved in all patients. No patient suffered from any major or permanent complication postoperatively, although there were two cases (11%) of temporary facial nerve palsy, which resolved completely within 3 months. Surgical scars were barely visible. The retromandibular transparotid approach with open reduction and rigid internal fixation for displaced condylar neck fractures of the mandible is a feasible and safe, minimally invasive surgical technique that provides reliable clinical results. PMID:24070772

  16. The use of silk-based devices for fracture fixation

    NASA Astrophysics Data System (ADS)

    Perrone, Gabriel S.; Leisk, Gary G.; Lo, Tim J.; Moreau, Jodie E.; Haas, Dylan S.; Papenburg, Bernke J.; Golden, Ethan B.; Partlow, Benjamin P.; Fox, Sharon E.; Ibrahim, Ahmed M. S.; Lin, Samuel J.; Kaplan, David L.

    2014-03-01

    Metallic fixation systems are currently the gold standard for fracture fixation but have problems including stress shielding, palpability and temperature sensitivity. Recently, resorbable systems have gained interest because they avoid removal and may improve bone remodelling due to the lack of stress shielding. However, their use is limited to paediatric craniofacial procedures mainly due to the laborious implantation requirements. Here we prepare and characterize a new family of resorbable screws prepared from silk fibroin for craniofacial fracture repair. In vivo assessment in rat femurs shows the screws to be self-tapping, remain fixed in the bone for 4 and 8 weeks, exhibit biocompatibility and promote bone remodelling. The silk-based devices compare favourably with current poly-lactic-co-glycolic acid fixation systems, however, silk-based devices offer numerous advantages including ease of implantation, conformal fit to the repair site, sterilization by autoclaving and minimal inflammatory response.

  17. 21 CFR 878.3250 - External facial fracture fixation appliance.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false External facial fracture fixation appliance. 878.3250 Section 878.3250 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices §...

  18. 21 CFR 878.3250 - External facial fracture fixation appliance.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false External facial fracture fixation appliance. 878.3250 Section 878.3250 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices §...

  19. Open reduction internal fixation of distal clavicle fracture with supplementary button coracoclavicular fixation.

    PubMed

    Hanflik, Andrew; Hanypsiak, Bryan T; Greenspoon, Joshua; Friedman, Darren J

    2014-10-01

    Distal clavicle fractures are common, and no standard treatment exists. Many different surgical modalities exist. This report describes an open reduction internal fixation technique that achieves both plate and coracoclavicular stabilization using a button device. A precontoured superior-lateral plate is secured to the clavicle. A 3.2-mm spade-tipped drill bit is drilled across the clavicle and coracoid, passing through 4 cortices. The button is loaded onto an insertion device, passed across the 4 cortices, and captured on the undersurface of the coracoid under fluoroscopic guidance. This construct is linked to the distal clavicle plate by heavy sutures using a second button that sits in the plate. The lateral locking holes are then filled to finalize fixation. This technique provides for a simplified way to achieve coracoclavicular stabilization when using a plate for fixation of distal clavicle fractures. PMID:25473604

  20. Open Reduction Internal Fixation of Distal Clavicle Fracture With Supplementary Button Coracoclavicular Fixation

    PubMed Central

    Hanflik, Andrew; Hanypsiak, Bryan T.; Greenspoon, Joshua; Friedman, Darren J.

    2014-01-01

    Distal clavicle fractures are common, and no standard treatment exists. Many different surgical modalities exist. This report describes an open reduction internal fixation technique that achieves both plate and coracoclavicular stabilization using a button device. A precontoured superior-lateral plate is secured to the clavicle. A 3.2-mm spade-tipped drill bit is drilled across the clavicle and coracoid, passing through 4 cortices. The button is loaded onto an insertion device, passed across the 4 cortices, and captured on the undersurface of the coracoid under fluoroscopic guidance. This construct is linked to the distal clavicle plate by heavy sutures using a second button that sits in the plate. The lateral locking holes are then filled to finalize fixation. This technique provides for a simplified way to achieve coracoclavicular stabilization when using a plate for fixation of distal clavicle fractures. PMID:25473604

  1. Scaphoid Fracture Fixation with an Acutrak(®) Screw.

    PubMed

    Loving, Vilert A; Richardson, Michael L

    2006-01-01

    We report a case of fixation of a scaphoid fracture using an Acutrak(®) screw. This screw is cannulated and headless, which allows it to be implanted below the surface of the bone. It uses the same concept of variable thread pitch as the Herbert screw, but unlike the Herbert screw, is fully threaded, with continuously varying pitch along its length. This variable pitch creates constant compression across a fracture as the screw is advanced, and gives the screw its unique appearance. This feature may improve internal holding power, as well as allow a fracture or osteotomy site to lie anywhere along the length of the screw. PMID:27298683

  2. Endoscopy-assisted open treatment of condylar fractures of the mandible: extraoral vs intraoral approach.

    PubMed

    Schön, R; Gutwald, R; Schramm, A; Gellrich, N C; Schmelzeisen, R

    2002-06-01

    By using an endoscopy assisted extraoral and transoral approach for open reduction of condylar mandible fractures with limited incisions, the risk of facial nerve damage and extensive visible scars can be reduced. The endoscopy-assisted treatment of 17 consecutive patients with fractures of the condyle was performed from April 1998 to December 1999. Of the 17 patients, 13 presented with additional mandibular fractures. Nine of the 17 patients were treated by a submandibular approach and eight by a transoral approach. Adequate anatomic reduction was achieved by the submandibular and transoral approach using an endoscopy-assisted technique. The transoral approach proved to be a reliable surgical approach for fractures of the mandibular condyle, even when dislocation with lateral override was present. In four patients, angulated drills and screwdrivers facilitated the transoral treatment of condylar fractures. Transbuccal stab incisions and the use of trochars were not needed in these four patients. The extraoral approach was indicated for severely dislocated fractures such as fractures with medial override or comminution. PMID:12190127

  3. Early Experience with Biodegradable Fixation of Pediatric Mandibular Fractures.

    PubMed

    Mazeed, Ahmed Salah; Shoeib, Mohammed Abdel-Raheem; Saied, Samia Mohammed Ahmed; Elsherbiny, Ahmed

    2015-09-01

    This clinical study aims to evaluate the stability and efficiency of biodegradable self-reinforced poly-l/dl-lactide (SR-PLDLA) plates and screws for fixation of pediatric mandibular fractures. The study included 12 patients (3-12 years old) with 14 mandibular fractures. They were treated by open reduction and internal fixation by SR-PLDLA plates and screws. Maxillomandibular fixation was maintained for 1 week postoperatively. Clinical follow-up was performed at 1 week, 6 weeks, 3 months, and 12 months postoperatively. Radiographs were done at 1 week, 3 months, and 12 months postoperatively to observe any displacement and fracture healing. All fractures healed both clinically and radiologically. No serious complications were reported in the patients. Normal occlusion was achieved in all cases. Biodegradable osteofixation of mandibular fractures offers a valuable clinical solution for pediatric patients getting the benefit of avoiding secondary surgery to remove plates, decreasing the hospital stay, further painful procedures, and psychological impact. PMID:26269728

  4. Open reduction and internal fixation of radial head fractures.

    PubMed

    King, G J; Evans, D C; Kellam, J F

    1991-01-01

    Open reduction and internal fixation of displaced fractures of the radial head were reviewed in 14 elbows. Follow-up averaged 32 months. The average elbow score for Mason type II fractures was 96.8 points, corresponding to 100% good or excellent results. Average flexion was 142.5 degrees, and the mean fixed flexion deformity was 3.9 degrees. There was no loss in grip strength. An almost normal elbow was the expected result. Good or excellent results were achieved in only 33% of Mason type III fractures treated with open reduction and internal fixation. The average elbow score was 72.9 points, and this was statistically significantly different than the Mason type II fractures (p less than 0.05). An associated elbow dislocation did not affect the results significantly, but was associated with a slightly increased fixed flexion deformity. Fractures may be more comminuted than suggested by plain radiographs, and intraoperative decision making is required in deciding between reconstruction or excision of the radial head. Excellent results were obtained provided an anatomical reduction with stable fixation and early range of motion were achieved. If a stable anatomic reduction cannot be obtained, then alternative treatment methods should be considered. PMID:2023039

  5. Ankle motion after external fixation of tibial fractures.

    PubMed Central

    Taylor, G J; Allum, R L

    1988-01-01

    Loss of ankle movement is a complication of severe tibial fractures. This can be exacerbated if the foot is allowed to drop into equinus, particularly when an external fixator is employed. The range of ankle motion following external fixation of tibial fractures as compared to the opposite normal ankle was studied in 40 of 55 patients treated over a ten-year period. Nine were excluded due to other causes of ankle stiffness, leaving 31 cases for analysis. The mean follow up was 2 years 7 months (range 1 year to 8 years 3 months), and union had occurred by a mean of 35 weeks (range 9-100 weeks). The mean loss of ankle movement was 8 degrees of plantar-flexion and 12 degrees of dorsiflexion (overall loss 20 degrees), the difference between the two being highly significant (P greater than 0.001, t test). Loss of ankle motion closely paralleled the degree of soft tissue trauma, being 6 degrees for closed fractures and 22 degrees for open fractures (0.05 greater than P greater than 0.02). Ankle function is therefore at risk when a severe tibial fracture is treated by external fixation, and appropriate measures should be taken to preserve movement and prevent an equinus contracture. Images Figure 1. Figure 2. Figure 3. PMID:3343667

  6. Effectiveness of external fixator combined with T-plate internal fixation for the treatment of comminuted distal radius fractures.

    PubMed

    Han, L R; Jin, C X; Yan, J; Han, S Z; He, X B; Yang, X F

    2015-01-01

    This study compared the efficacy between external fixator combined with palmar T-plate internal fixation and simple plate internal fixation for the treatment of comminuted distal radius fractures. A total of 61 patients classified as type C according to the AO/ASIF classification underwent surgery for comminuted distal radius fractures. There were 54 and 7 cases of closed and open fractures, respectively. Moreover, 19 patients received an external fixator combined with T-plate internal fixation, and 42 received simple plate internal fixation. All patients were treated successfully during 12-month postoperative follow-up. The follow-up results show that the palmar flexion and dorsiflexion of the wrist, radial height, and palmar angle were significantly better in those treated with the external fixator combined with T-plate compared to those treated with the simple plate only (P < 0.05); however, there were no significant differences in radial-ulnar deviation, wrist range of motion, or wrist function score between groups (P > 0.05). Hence, the effectiveness of external fixator combined with T-plate internal fixation for the treatment of comminuted distal radius fractures was satisfactory. Patients sufficiently recovered wrist, forearm, and hand function. In conclusion, compared to the simple T-plate, the external fixator combined with T-plate internal fixation can reduce the possibility of the postoperative re-shifting of broken bones and keep the distraction of fractures to maintain radial height and prevent radial shortening. PMID:25867441

  7. Biomechanical failure of metacarpal fracture resorbable plate fixation.

    PubMed

    Lionelli, Gerald T; Korentager, Richard A

    2002-08-01

    Metacarpal fractures are a relatively common hand injury that may require operative intervention to ensure adequate reduction and stabilization. The use of permanent hardware, although acceptable, may lead to complications and an increased number of surgical procedures. The use of resorbable hardware such as poly-L-lactic acid and polyglycolic acid copolymer plates and screws may circumvent some of these complications. In vitro studies have demonstrated that the biomechanical characteristics of these resorbable plates may provide the rigid fixation necessary to allow for union of metacarpal fractures in vivo. However, limited clinical data are available regarding the success of their use in this application. The authors present what they believe is the first reported case of the failure of a poly-L-lactic acid and polyglycolic acid copolymer miniplate after use in the fixation of a metacarpal shaft fracture. PMID:12187350

  8. Lumbopelvic fixation for multiplanar sacral fractures with spinopelvic instability.

    PubMed

    Tan, Guo-qing; He, Ji-liang; Fu, Bai-sheng; Li, Lian-xin; Wang, Bo-min; Zhou, Dong-sheng

    2012-08-01

    Sacral fractures with both transverse and bilateral vertical fracture components are by definition multiplanar fractures, and often present with spinopelvic instability and cauda equina deficits. The treatment is challenging. Between 2006 and 2009, we treated nine such patients at our trauma centre. There were six men and three women, with a mean age of 32.2 years. Preoperative neurologic deficits were noted in seven patients; four patients had complete cauda equina paralysis, and three patients had incomplete cauda equina syndrome. All patients were treated using lumbopelvic instrumented fixation without other devices for their multiplanar sacral fractures. Six patients who had neurological deficits and sacral canal compression underwent decompression laminectomy. The mean postoperative follow-up time was 21.7 months (range, 14-32 months). All fractures went on to union without loss of reduction or hardware failure. The mean Gibbons score improved from 3.5 preoperatively to 2.3 postoperatively among the patients who underwent decompression laminectomy. Eight out of nine patients had fair or better results based on radiographic criteria and the Majeed pelvic fracture outcome score. Our experience suggests lumbopelvic fixation can be used for the treatment of multiplanar sacral fractures with spinopelvic instability with a low rate of complications. Neurologic improvement can be expected, but whether surgical decompression results in substantially better neurologic recovery than conservative treatment remains uncertain. PMID:22632803

  9. Hot topics in biomechanically directed fracture fixation.

    PubMed

    Bonyun, Marissa; Nauth, Aaron; Egol, Kenneth A; Gardner, Michael J; Kregor, Philip J; McKee, Michael D; Wolinsky, Philip R; Schemitsch, Emil H

    2014-01-01

    The evolution of locking plates and modern nail constructs provides the orthopaedic trauma surgeon with a myriad of options with regard to implant selection for common fractures. There is a significant amount of biomechanical literature comparing modern constructs with those conventionally used. A basic understanding of this literature is required to make informed decisions with regard to implant selection in the management of these injuries. This article reviews the most recent biomechanical literature regarding implant selection and application for a variety of commonly treated injuries, including fractures of the clavicle, proximal humerus, distal humerus, intertrochanteric hip region, distal femur, and bicondylar tibial plateau. PMID:24464098

  10. A Pathological Fracture of the Mandible due to Osteomyelitis following a Full Dental Clearance.

    PubMed

    Jauhar, Preeti; Handley, Thomas; Hammersley, Nicholas

    2016-03-01

    Orofacial infections following dental extractions are a common referral to an oral and maxillofacial department as an emergency, especially when combined with swelling and limited mouth opening. The case presented demonstrates a rare complication of chronic suppurative osteomyelitis with bilateral pathological fractures of the mandible, which occurred following a staged dental clearance. CPD/Clinical Relevance: Dental extractions are one of the most common treatments carried out by oral surgeons and general dental practitioners. This case highlights a rare but encountered complication of routine oral surgery and demonstrates when it is necessary to make an immediate referral to the local oral and maxillofacial surgery unit. PMID:27188132

  11. The use of augmentation techniques in osteoporotic fracture fixation.

    PubMed

    Kammerlander, Christian; Neuerburg, Carl; Verlaan, Jorrit-Jan; Schmoelz, Werner; Miclau, Theodore; Larsson, Sune

    2016-06-01

    There are an increasing number of fragility fractures, which present a surgical challenge given the reduced bone quality of underlying osteoporosis. Particularly in aged patients, there is a need for early weight bearing and mobilization to avoid further complications such as loss of function or autonomy. As an attempt to improve fracture stability and ultimate healing, the use of biomaterials for augmentation of osseous voids and fracture fixation is a promising treatment option. Augmentation techniques can be applied in various locations, and fractures of the metaphyseal regions such as proximal humerus, femur, tibia and the distal radius remain the most common areas for its use. The current review, based on the available mechanical and biological data, provides an overview of the relevant treatment options and different composites used for augmentation of osteoporotic fractures. PMID:27338226

  12. Contemporary Issues in the Open Management of Subcondylar Fractures of the Mandible.

    PubMed

    Cranford, Jeffrey; Kadakia, Sameep; Sawhney, Raja; Ducic, Yadranko

    2016-08-01

    Subcondylar fractures encompass a large portion of mandible fractures. Owing to their proximity to the temporomandibular joint and difficulty achieving surgical exposure, treatment of these fractures has been challenging and highly debated throughout the literature. While no one modality is the accepted gold standard, there are multiple options for addressing these fractures that can yield satisfying results for both patient and surgeon alike. A thorough literature review was conducted using PubMed, analyzing articles in the past 15 years for relevance to the subject matter. Various search terms were used to glean information regarding closed treatment, open treatment, and the risks and benefits of the different surgical approaches involved. The articles were reviewed by all of the authors for applicability and quality of data provided. A total of 50 articles were selected for inclusion in the current study. The open management of subcondylar fractures encompasses a vast array of techniques. While some surgeons advocate closed treatment in some circumstances, open treatment affords numerous advantages with the advent of multiple access modalities. There is no single superior method, and as such, the craniofacial surgeon should have a comprehensive understanding of options so as to select the appropriate option that is individualized to the patient. A clear understanding of fracture biomechanics balanced with patient expectations and operative safety allows for the surgeon to make a sound decision for treatment. PMID:27494587

  13. [Implant materials for the internal fixation of midfacial fractures].

    PubMed

    Stuck, B A; Heller, T

    2011-11-01

    The material used for osteosynthesis plays a crucial role in the management of facial fractures. Plates need to be flexible enough to be bent and should not be palpable through the skin, while ensuring stable fixation und adequate biocompatibility. Although stainless steel was initially the material of choice, titanium has become the standard material due to its superior biocompatibility. While the explantation of titanium plates and screws appears unnecessary in general, it should be considered in cases of dislocation, cosmetic concerns, pain and infection. Due to their limited initial stability and a potential increase in local complications, resorbable materials based on polymeric lactose are used with caution in midfacial fractures in adults. Our own retrospective study comparing the postoperative complications after fixation of lateral midfacial fractures with titanium and resorbable systems demonstrated a low complication rate for both systems (7-8%) and no statistically significant difference between the two. The appropriate material for fixation should be selected based on the localization and severity of the fracture, the experience of the surgeon as well as on the age and overall condition of the patient. PMID:22012485

  14. Dorsal Buttress Plate Fixation of Ulnar Carpometacarpal Joint Fracture Dislocations.

    PubMed

    Tan, En Si; Chao, Tay Shian

    2016-06-01

    We propose a method for open reduction and internal fixation of early and unstable ulnar (fourth and/or fifth) carpometacarpal joint (CMCJ) fracture subluxations or dislocations using a dorsal buttress plate. In ulnar CMCJ fracture dislocations, the metacarpal has a tendency to displace dorsally and proximally when there is an axial load. Using the dorsal buttress plate method of fixation, a plate is fixed proximally to the hamate, aligned parallel and dorsal to the metacarpal to act as a buttress, to resist this movement. To preserve the fourth and the fifth CMCJ mobility, the distal end of the plate is not fixed to the metacarpal base. We illustrate the use of this technique on 4 patients who had different patterns of injury at the ulnar CMCJ. All patients regained excellent range of motion and function. None of the patients had redisplacement or nonunion of fracture. The dorsal buttress plate is a viable option for fixation of early and unstable ulnar CMCJ fracture subluxations or dislocations. PMID:27077465

  15. An in vivo evaluation of PLLA/PLLA-gHA nano-composite for internal fixation of mandibular bone fractures.

    PubMed

    Peng, Weihai; Zheng, Wei; Shi, Kai; Wang, Wangshu; Shao, Ying; Zhang, Duo

    2015-12-01

    Internal fixation of bone fractures using biodegradable poly(L-lactic-acid) (PLLA)-based materials has attracted the attention of many researchers. In the present study, 36 male beagle dogs were randomly assigned to two groups: PLLA/PLLA-gHA (PLLA-grafted hydroxyapatite) group and PLLA group. PLLA/PLLA-gHA and PLLA plates were embedded in the muscular bags of the erector spinae and also implanted to fix mandibular bone fractures in respective groups. At 1, 2, 3, 6, 9, and 12 months postoperatively, the PLLA/PLLA-gHA and PLLA plates were evaluated by adsorption and degradation tests, and the mandibles were examined through radiographic analysis, biomechanical testing, and histological analysis. The PLLA/PLLA-gHA plates were non-transparent and showed a creamy white color, and the PLLA plates were transparent and faint yellow in color. At all time points following surgery, adsorption and degradation of the PLLA/PLLA-gHA plates were significantly less than those of the PLLA plates, and the lateral and longitudinal bending strengths of the surgically treated mandibles of the beagle dogs in the PLLA/PLLA-gHA group were significantly greater than those of the PLLA group and reached almost the value of intact mandibles at 12 months postoperatively. Additionally, relatively rapid bone healing was observed in the PLLA/PLLA-gHA group with the formation of new lamellar bone tissues at 12 months after the surgery. The PLLA/PLLA-gHA nano-composite can be employed as a biodegradable material for internal fixation of mandibular bone fractures. PMID:26551378

  16. Combined Type II Odontoid Fracture with Jefferson's Fracture Treated with Temporary Internal Fixation.

    PubMed

    Pawar, Abhijit Yuvaraj; O'Leary, Patrick F

    2015-12-01

    An 18-year-old male presented after a motor vehicle rollover accident. Computed tomography (CT) scan confirmed the diagnosis of Type II odontoid fracture. Considering the patient's young age and the limitations of C1-C2 fusion including significant loss of cervical rotation, temporary internal fixation with a lateral mass fixation of C1 and pedicle fixation of C2 without fusion was done. CT scan done at 6-month follow-up visit showed healed odontoid fracture and excellent C1-C2 alignment. At ninth postoperative month, internal fixation was removed. Patient had normal movements of cervical spine at 1-year follow-up. Temporary internal fixation can be an important tool in the armamentarium of the surgeon in treating type II odontoid fractures in young adults and children. This strategy avoids the complications halo fixation and immobilizes the unstable C1-C2 segment without fusion. Removal of the internal fixation after healing allows restoration of the rotational motion. PMID:26713132

  17. Retrospective Comparison of Percutaneous Fixation and Volar Internal Fixation of Distal Radius Fractures

    PubMed Central

    Lozano-Calderón, Santiago A.; Doornberg, Job N.

    2007-01-01

    A change in the practice of a single surgeon provided an opportunity for retrospective comparison of comparable cohorts treated with percutaneous fixation (17 patients) or a volar plate and screws (23 patients) an average of 30 months after surgery. The final evaluation was performed according to the Gartland and Werley and Mayo rating systems and the DASH questionnaire. There were no significant differences on the average scores for the percutaneous and volar plating groups, respectively: Gartland and Werley, 4 vs 5; Mayo, 82 vs 83; and DASH score 13 for both cohorts. Motion, grip, and radiographical parameters were likewise comparable. Volar internal plate and screw fixation can achieve results comparable to percutaneous fixation techniques in the treatment of fractures of the distal radius. PMID:18780085

  18. A novel fixation system for acetabular quadrilateral plate fracture: a comparative biomechanical study.

    PubMed

    Zha, Guo-Chun; Sun, Jun-Ying; Dong, Sheng-Jie; Zhang, Wen; Luo, Zong-Ping

    2015-01-01

    This study aims to assess the biomechanical properties of a novel fixation system (named AFRIF) and to compare it with other five different fixation techniques for quadrilateral plate fractures. This in vitro biomechanical experiment has shown that the multidirectional titanium fixation (MTF) and pelvic brim long screws fixation (PBSF) provided the strongest fixation for quadrilateral plate fracture; the better biomechanical performance of the AFRIF compared with the T-shaped plate fixation (TPF), L-shaped plate fixation (LPF), and H-shaped plate fixation (HPF); AFRIF gives reasonable stability of treatment for quadrilateral plate fracture and may offer a better solution for comminuted quadrilateral plate fractures or free floating medial wall fracture and be reliable in preventing protrusion of femoral head. PMID:25802849

  19. Perspectives of patients about bioabsorbable internal fixation for maxillofacial fractures

    PubMed Central

    Landes, Constantin; Hoefer, Sebastian H.; Richards, Tereza; Walcher, Felix; Sader, Robert

    2015-01-01

    Purpose: Resorbable/bioabsorbable internal fixation provides effective treatment for maxillofacial fractures and avoids the need for metal hardware removal. We evaluated the initial knowledge, attitudes, subjective demand, and treatment satisfaction of patients concerning bioabsorbable osteofixation for maxillofacial trauma. Materials and Methods: From May 2007 to October 2009, there were 71 patients (63 males and 8 females; mean age: 35 ± 15 years) included in this prospective study. The patients completed preoperative and postoperative (4–6 weeks and 1 year) questionnaires. Results: After receiving information, 70 patients (99%) preferred resorbable/bioabsorbable bone fixation, usually because they preferred to avoid a second operation to remove metal hardware (67 patients [94%]). The higher cost of resorbable/bioabsorbable bone fixation was believed and justified by 41 patients (58%) and not justified by 30 patients (42%). No adverse events were reported by 27 of 34 patients (79%) at 4–6 weeks and by 14 of 21 patients (67%) at 1 year after surgery. Most patients were very satisfied with the outcome of surgery. Conclusion: Patients who have maxillofacial trauma have a high frequency of preference and high satisfaction with resorbable/bioabsorbable than metal osteofixation. Literature review showed increased activity in research and publication worldwide about resorbable bone fixation, suggesting that there may be increased patient demand for resorbable bone fixation in the future. PMID:26981468

  20. Volar, Intramedullary, and Percutaneous Fixation of Distal Radius Fractures.

    PubMed

    Alluri, Ram; Longacre, Matthew; Pannell, William; Stevanovic, Milan; Ghiassi, Alidad

    2015-11-01

    Background The management of extra-articular distal radius fractures is highly variable, with no clear consensus regarding their optimal management. Purpose To assess comparatively the biomechanical stability of Kirschner wire (K-wire) fixation, volar plating, and intramedullary nailing for unstable, extra-articular distal radius fractures with both (1) constant and (2) cyclical axial compression, simulating forces experienced during early postoperative rehabilitation. Methods Twenty-six volar locking plate, intramedullary nail, and K-wire bone-implant constructs were biomechanically assessed using an unstable extra-articular distal radius bone model. Bone implant models were created for each type of construct. Three samples from each construct underwent compressive axial loading until fixation failure. The remaining samples from each construct underwent fatigue testing with a 50-N force for 2,000 cycles followed by repeat compressive axial loading until fixation failure. Results Axial loading revealed the volar plate was significantly stiffer than the intramedullary nail and K-wire constructs. Both the volar plate and intramedullary nail required greater than 300 N of force for fixation failure, while the K-wire construct failed at less than 150 N. Both the volar plate and intramedullary nail demonstrated less than 1 mm of displacement during cyclic loading, while the K-wire construct displaced greater than 3 mm. Postfatigue testing demonstrated the volar plate was stiffer than the intramedullary nail and K-wire constructs, and both the volar plate and intramedullary nail required greater than 300 N of force for fixation failure while the K-wire construct failed at less than 150 N. Conclusions Volar plating of unstable extra-articular distal radius fractures is biomechanically stiffer than K-wire and intramedullary fixation. Both the volar plate and intramedullary nail demonstrated the necessary stability and stiffness to maintain anatomic

  1. Modified arthroscopic suture fixation of a displaced tibial eminence fracture.

    PubMed

    Lehman, Ronald A; Murphy, Kevin P; Machen, M Shaun; Kuklo, Timothy R

    2003-02-01

    This study describes a new arthroscopic method using a whip-stitch technique for treating a displaced type III tibial eminence fracture. A 12-year-old girl who sustained a displaced type III tibial eminence fracture was treated with arthroscopic fixation using the Arthrosew disposable suture device (Surgical Dynamics, Norwalk, CT) to place a whip stitch into the anterior cruciate ligament (ACL). The Arthrex ACL guide (Arthrex, Naples, FL) was used to reduce the avulsed tibial spine fragment. Sutures were then passed through the tibial tunnel and secured over a bony bridge with the knee in 20 degrees of flexion. At 9 months, the patient has a full range of motion with normal Lachman and anterior drawer testing, and she has returned to competitive basketball. Radiographs show complete fracture healing. KT-1000 and isokinetic testing at 9-month follow-up show only minimal side-to-side differences. The Arthrosew device provides a significant advantage in the treatment of type III and IV fractures of the tibial eminence by obtaining arthroscopic fixation within the substance of the ACL, thus obviating arthrotomy and hardware placement. This technique also restores the proper length and tension to the ACL, and provides a simplified, reproducible method of treatment for this injury. PMID:12579135

  2. Skeletal Stability after Bilateral Sagittal Split Advancement and Setback Osteotomy of the Mandible with Miniplate Fixation

    PubMed Central

    Rao, Srinivasan Hanumantha; Selvaraj, Loganathan; Lankupalli, Arathy S.

    2013-01-01

    The purpose of this study was to evaluate intraorally placed mini plates and monocortical screws in terms of postoperative skeletal stability after bilateral sagittal split advancement and setback osteotomy of the mandible. Ten patients were included in this study with five requiring advancement (group I) and five requiring setback of the mandible (group II). Bell and Epker modified surgical technique was followed for all the patients. All the patients underwent pre- and postsurgical orthodontics. Cephalometric radiographs were taken preoperatively, immediate, 3, 6, and 12 months postoperatively. Cephalometric tracings were performed by one individual examiner using a modified burstone analysis. Statistical analysis was performed using the student paired t-test. In advancement patients, SNB (sella, Nasion, B point) angle showed relapse at 12th month postoperative period which was statistically significant (2.4 degrees). No changes were observed in anterior facial height, posterior facial height, Frankfort-mandibular incisor angle (FmiA), and overjet during the follow-up period. In setback patients, posterior facial height (p < 0.05), angles between the lower incisors and mandibular plane and pogonion had a statistically significant change position of 1.4 mm (paired t-test, p = 0.03). The SNB angle, anterior facial height, interincisal angle, and FmiA remained constant (0.8–1.2 degrees) during the follow-up period. In advancement cases, the relapse was seen from the third month postoperative period but in setback cases, the relapse was noted from the sixth month onward and the skeletal relapse in these cases were noticed cephalometrically. PMID:24624252

  3. Distal Humeral Fixation of an Intramedullary Nail Periprosthetic Fracture

    PubMed Central

    Divecha, Hiren M.; Marynissen, Hans A. J.

    2013-01-01

    Distal humeral periprosthetic fractures below intramedullary nail devices are complex and challenging to treat, in particular due to the osteopenic/porotic nature of bone found in these patients. Fixation is often difficult to satisfactorily achieve around the intramedullary device, whilst minimising soft tissue disruption. Descriptions of such cases in the current literature are very rare. We present the case of a midshaft humeral fracture treated with a locking compression plate that developed a nonunion, in a 60-year old female. This went on to successful union after exchange for an intramedullary humeral nail. Unfortunately, the patient developed a distal 1/5th humeral periprosthetic fracture, which was then successfully addressed with a single-contoured, extra-articular, distal humeral locking compression plate (Synthes) with unicortical locking screws and cerclage cables proximally around the distal nail tip region. An excellent postoperative range of motion was achieved. PMID:23662231

  4. Femoral neck fracture fixation: rigidity of five techniques compared.

    PubMed Central

    Mackechnie-Jarvis, A C

    1983-01-01

    Artificial cadaveric femoral neck fractures were internally fixed with five different devices and subjected to cyclical loading of 0-1.0 kilonewtons (approximately one body weight) whilst in an anatomical position. Displacement of the proximal fragment was detected by a transducer and charted. Bone strength was assessed by a preliminary control loading phase on the intact bone. Efficiency of each fracture fixator could then be directly compared by the relative movement in each case. Five specimens each were tested with Moore's Pins, Trifin Nail, Garden Screws and a sliding screw-plate (OEC Ltd). By the criteria of the experiment, which put a severe shearing load on the implant, none of these devices reliably bore the representative body weight. An extended barrel-plate, which supported the sliding screw almost up to the fracture line, was then made. This device, employing some of Charnley's concepts, tolerated body weight in four cases out of five. PMID:6887186

  5. Intraoperative Periprosthetic Femur Fracture: A Biomechanical Analysis of Cerclage Fixation.

    PubMed

    Frisch, Nicholas B; Charters, Michael A; Sikora-Klak, Jakub; Banglmaier, Richard F; Oravec, Daniel J; Silverton, Craig D

    2015-08-01

    Intraoperative periprosthetic femur fracture is a known complication of total hip arthroplasty (THA) and a variety of cerclage systems are available to manage these fractures. The purpose of this study was to examine the in situ biomechanical response of cerclage systems for fixation of periprosthetic femur fractures that occur during cementless THA. We compared cobalt chrome (CoCr) cables, synthetic cables, monofilament wires and hose clamps under axial compressive and torsional loading. Metallic constructs with a positive locking system performed the best, supporting the highest loads with minimal implant subsidence (both axial and angular) after loading. Overall, the CoCr cable and hose clamp had the highest construct stiffness and least reduction in stiffness with increased loading. They were not demonstrably different from each other. PMID:25765131

  6. Percutaneous screw fixation of acetabular fractures: applicability of hip arthroscopy.

    PubMed

    Yang, Jae-Hyuk; Chouhan, Devendra Kumar; Oh, Kwang-Jun

    2010-11-01

    Percutaneous screw fixation of the anterior column of the acetabulum has been a challenging task because of its unique anatomy and a risk of intra-articular penetration. Evidence is lacking for any tools to provide visual scrutiny of fracture reduction and intra-articular screw penetration. We report 2 cases of fracture of the acetabulum that developed in young female athletes, in which the anterior column was fixed with a percutaneous screw by use of hip arthroscopy as an assisting tool for intra-articular observation. In our experience this method was found to be promising in terms of anatomic reduction of the fracture site, avoiding articular penetration during screw insertion, with additional advantages of joint debridement, lavage, and reduction in radiation exposure. PMID:20888169

  7. Adult tibial eminence fracture fixation: arthroscopic procedure using K-wire folded fixation.

    PubMed

    Bonin, Nicolas; Jeunet, Laurent; Obert, Laurent; Dejour, David

    2007-07-01

    The purpose of this article is to describe a new and simple technique for arthroscopic fixation of tibial intercondylar eminence avulsion fractures using folded surgical pin. This technique allows reduction and fixation of the bone fragment without using special equipment. After standard arthroscopic procedure to explore the knee and to remove fracture debris and blood clot, the bone block is reduced and advanced with the spike of the anterior cruciate ligament tibial drill guide. A 1.8-mm K-wire is drilled through the guide from the proximal tibia into the reduced fragment. It is bent on its end into the joint with a strong needle case. The K-wire is then pulled back until good fragment compression to the tibia appears with the wire starting unbending. Next, the other side is bent on the anterior tibial cortex and cut. This arthroscopic fixation allows elastic compression fragment stabilization that authorizes early weight bearing and rehabilitation programs. The material is extracted by traction after 6 months. PMID:17235617

  8. Biomechanical in vitro evaluation of three stable internal fixation techniques used in sagittal osteotomy of the mandibular ramus: a study in sheep mandibles

    PubMed Central

    de OLIVERA, Leandro Benetti; SANT'ANA, Eduardo; MANZATO, Antonio José; GUERRA, Fábio Luis Bunemer; ARNETT, G. William

    2012-01-01

    Among the osteotomies performed in orthognathic surgery, the sagittal osteotomy of the mandibular ramus (SOMR) is the most common, allowing a great range of movements and stable internal fixation (SIF), therefore eliminating the need of maxillomandibular block in the postoperative period. Objectives: The purpose of this study was to evaluate the biomechanical resistance of three national systems used for SIF in SOMR in sheep mandibles. Material and methods: The study was performed in 30 sheep hemi-mandibles randomly divided into 3 experimental groups, each containing 10 hemi-mandibles. The samples were measured to avoid discrepancies and then subjected to SOMR with 5-mm advancement. In group I, 2.0x12 mm screws were used for fixation, inserted in an inverted "L" pattern (inverted "L" group). In group II, fixation was performed with two 2.0x12 mm screws, positioned in a linear pattern and a 4-hole straight miniplate and four 2.0x6.0 mm monocortical screws (hybrid group). In group III, fixation was performed with two 4-hole straight miniplates and eight 2.0x6.0 mm monocortical screws (mini plate group). All materials used for SIF were supplied by Osteosin - SIN. The hemimandibles were subjected to vertical linear load test by Kratos K2000MP mechanical testing unit for loading registration and displacement. Results: All groups showed similar resistance during mechanical test for loading and displacement, with no statistically significant differences between groups according to analysis of variance. Conclusion: These results indicate that the three techniques of fixation are equally effective for clinical fixation of SOMR. PMID:23032203

  9. Minimally invasive dynamic hip screw for fixation of hip fractures

    PubMed Central

    Ho, Michael; Garau, Giorgio; Walley, Gayle; Oliva, Francesco; Panni, Alfredo Schiavone; Longo, Umile Giuseppe

    2008-01-01

    We compared a minimally invasive surgical technique to the conventional (open approach) surgical technique used in fixation of hip fractures with the dynamic hip screw (DHS) device. Using a case-control design (44 cases and 44 controls), we tested the null hypothesis that there is no difference between the two techniques in the following outcome measures: duration of surgery, time to mobilisation and weight bearing postoperatively, length of hospital stay, mean difference of pre- and postoperative haemoglobin levels, position of the lag screw of the DHS device in the femoral head, and the tip–apex distance. The minimally invasive DHS technique had significantly shorter duration of surgery and length of hospital stay. There was also less blood loss in the minimally invasive DHS technique. The minimally invasive DHS technique produces better outcome measures in the operating time, length of hospital stay, and blood loss compared to the conventional approach while maintaining equal fixation stability. PMID:18478227

  10. Intramedullary screw fixation of proximal fifth metatarsal fractures in athletes

    PubMed Central

    Massada, Marta Maria Teixeira de Oliveira; Pereira, Manuel Alexandre Negrais Pinho Gonçalves; de Sousa, Ricardo Jorge Gomes; Costa, Paulo Guimarães; Massada, José Leandro da Rocha

    2012-01-01

    Objective The purpose of this study was to review the short- and long-term clinical and radiological results of intramedullary compression screw fixation of proximal fifth metatarsal fractures in athletes. Methods Eleven male and six female active patients with fifth metatarsal zone II and zone III fractures fixed with a 4.5-mm cannulated compression screw were evaluated by chart review, review of radiographs, and clinical evaluation. Fifteen of the patients were high-level athletes (soccer: n=11; basketball: n=1; track and field: n=3) and two were recreational-level athletes. Mean follow-up from surgery to evaluation was 54 (38-70) months. Results Mean time to healing as shown on radiographs and mean time to return to full activity after surgery were 7.3 and 7.5 weeks, respectively. All patients were able to return to their previous levels of activity. There were no reports of union delay, nonunion or refracture to date. Conclusion In our patients, cannulated screw fixation of proximal fifth metatarsal fractures was a reliable procedure with low morbidity associated that provided athletes a quick return to activity. Level of Evidence I, Case Series. PMID:24453614

  11. Tosic external fixator in the management of proximal tibial fractures in adults.

    PubMed

    Tosic, A; Ebraheim, N A; Abou Chakra, I; Emara, K

    2001-06-01

    This retrospective clinical study assessed proximal tibial fractures managed with the Tosic external fixator. Nineteen patients with 21 proximal tibial fractures treated with the Tosic external fixator between July 1997 and October 1998 comprised the study population. Eleven fractures were graded as 41A2, 3 fractures as 41 A3, 4 fractures as 41C1, and 3 fractures as 41 C2. Fourteen fractures were closed, and 7 fractures were open. Average time to healing was 1 7 weeks. No revision of fixation was needed. There were five cases of pin tract infection. Average range of knee motion was 2 degrees-135 degrees. These results indicate the Tosic external fixator is an efficient and simple way to treat proximal tibial metaphyseal fractures. PMID:11430739

  12. Multiple cannulated screw fixation of young femoral neck fractures

    PubMed Central

    Kim, Joo Yong; Kong, Gyu Min; Park, Dae Hyun; Kim, Dae Yoo

    2015-01-01

    Objective: We wanted to analyze the factors affecting the results of multiple cannulated screws fixation in patients less than 60 years old with femoral neck fracture (FNF). Methods: We reviewed 52 patients (30 males, 22 females) who were treated with multiple cannulated screws fixation for FNFs. They were followed up for more than one year during January 2002 to December 2012. They were classified by Garden’s classification. The anatomic reduction was evaluated by Garden’s alignment index on hip both anteroposterior and lateral images. Postoperative complications were analyzed during follow up periods. Results: By Garden’s classification, 6 cases were in stage I, 13 cases in stage II, 30 cases in stage III and 3 cases in stage IV. During follow up periods, avascular necrosis of the femoral head was observed in 12 cases (23%) and nonunion was observed in 5 cases (9%). The 16 patients who had complications underwent total hip arthroplasty (31%). In non-displaced fracture groups (Garde I, II) did not have AVN nor nonunion. The incidence of complications in displaced fracture group was 51.5%. The complicated cases showed tendency for increased apex anterior angulation of femoral neck on hip lateral images and the result was statistically significant. (p=0.0260). Conclusion: The patients less than 60 years old who were treated with multiple cannulated screws fixation for displaced FNFs showed the incidence of complications was more than 50%. It needs a cautious approach for anatomical reduction, especially related to anterior angulation on hip lateral image. PMID:26870127

  13. Biomechanical Analysis of the Fixation System for T-Shaped Acetabular Fracture

    PubMed Central

    Fan, Yanping; Lei, Jianyin; Zhu, Feng; Li, Zhiqiang; Chen, Weiyi; Liu, Ximing

    2015-01-01

    This study aims to evaluate the biomechanical mechanism of fixation systems in the most frequent T-shaped acetabular fracture using finite element method. The treatment of acetabular fractures was based on extensive clinical experience. Three commonly accepted rigid fixation methods (double column reconstruction plates (P × 2), anterior column plate combined with posterior column screws (P + PS), and anterior column plate combined with quadrilateral area screws (P + QS)) were chosen for evaluation. On the basis of the finite element model, the biomechanics of these fixation systems were assessed through effective stiffness levels, stress distributions, force transfers, and displacements along the fracture lines. All three fixation systems can be used to obtain effective functional outcomes. The third fixation system (P + QS) was the optimal method for T-shaped acetabular fracture. This fixation system may reduce many of the risks and limitations associated with other fixation systems. PMID:26495030

  14. Ipsilateral Intracapsular Hip Fracture 2 Years after Fixation of Extracapsular Fracture by Dynamic Hip Screw

    PubMed Central

    Syed, Farhan; Nunag, Perrico; Mustafa, Abubakar; Pillai, Anand

    2015-01-01

    Introduction: Sustaining an intracapsular fracture in a hip which was previously fixed with dynamic hip screw for extracapsular fracture, is a very rarely reported occurrence. We present one such case in order to discuss the presentation and management of this fracture. We have also reviewed the literature and pooled the previously reported cases to look at potential cause & risk factors. Case Report: A 92 year old female, presented with new onset hip pain following a trivial injury. Couple of years back, she had sustained an extracapsular fracture on same side which was treated by DHS fixation. Further investigations confirmed a de-novo fracture which was treated by removal of DHS and cemented bipolar hemiarthroplasty. Conclusion: This complication might not be as rare as earlier thought to be. All patients, especially elderly females who present with new onset hip pain following DHS fixation of their hip fracture previously must be evaluated for a de-novo intracapsular fracture. On confirmation of diagnosis, they can be treated by removal of dynamic hip screw and hemiarthroplasty as most of these are low demand elderly patients. PMID:27299034

  15. Fat Embolism Syndrome After Femur Fracture Fixation: a Case Report

    PubMed Central

    Akoh, Craig C; Schick, Cameron; Otero, Jesse; Karam, Matthew

    2014-01-01

    Fat embolism syndrome (FES) is a multi-organ disorder with potentially serious sequelae that is commonly seen in the orthopaedic patient population after femur fractures. The major clinical features of FES include hypoxia, pulmonary dysfunction, mental status changes, petechiae, tachycardia, fever, thrombocytopenia, and anemia. Due to technological advances in supportive care and intramedullary reaming techniques, the incidence of FES has been reported as low as 0.5 percent. Here, we present a rare case of FES with cerebral manifestations. A previously healthy 24-year old nonsmoking male was admitted to our hospital after an unrestrained head-on motor vehicle collision. The patient's injuries included a left olecranon fracture and closed bilateral comminuted midshaft femur fractures. The patient went on to develop cerebral fat embolism syndrome (CFES) twelve hours after immediate bilateral intramedullary nail fixation. His symptoms included unresponsiveness, disconjugate gaze, seizures, respiratory distress, fever, anemia, thrombocytopenia, and visual changes. Head computed tomography and brain magnetic resonance imaging showed pathognomonic white-matter punctate lesions and watershed involvement. With early recognition and supportive therapy and seizure therapy, the patient went on to have complete resolution of symptoms without cognitive sequelae. PMID:25328460

  16. [Internal fixation of radial shaft fractures: Anatomical and biomechanical principles].

    PubMed

    Bartoníček, J; Naňka, O; Tuček, M

    2015-10-01

    Radius is a critical bone for functioning of the forearm and therefore its reconstruction following fracture of its shaft must be anatomical in all planes and along all axes. The method of choice is plate fixation. However, it is still associated with a number of unnecessary complications that were not resolved even by introduction of locking plates, but rather the opposite. All the more it is surprising that discussions about anatomical and biomechanical principles of plate fixation have been reduced to minimum or even neglected in the current literature. This applies primarily to the choice of the surgical approach, type of plate, site of its placement and contouring, its working length, number of screws and their distribution in the plate. At the same time it has to be taken into account that a plate used to fix radius is exposed to both bending and torsion stress. Based on our 30-year experience and analysis of literature we present our opinions on plate fixation of radial shaft fractures:We always prefer the volar Henry approach as it allows expose almost the whole of radius, with a minimal risk of injury to the deep branch of the radial nerve.The available studies have not so far found any substantial advantage of LCP plates as compared to 3.5mm DCP or 3.5mm LC DCP plates, quite the contrary. The reason is high rigidity of the locking plates, a determined trajectory of locking screws which is often unsuitable, mainly in plates placed on the anterior surface of the shaft, and failure to respect the physiological curvature of the radius. Therefore based on our experience we prefer "classical" 3.5mm DCP plates.Volar placement of the plate, LCP in particular, is associated with a number of problems. The volar surface covered almost entirely by muscles, must be fully exposed which negatively affects blood supply to the bone. A straight plate, if longer, either lies with its central part partially off the bone and overlaps the interosseous border, or its ends

  17. Percutaneous Screw Fixation of Crescent Fracture-Dislocation of the Sacroiliac Joint.

    PubMed

    Shui, Xiaolong; Ying, Xiaozhou; Mao, Chuanwan; Feng, Yongzeng; Chen, Linwei; Kong, Jianzhong; Guo, Xiaoshan; Wang, Gang

    2015-11-01

    Crescent fracture-dislocation of the sacroiliac joint (CFDSIJ) is a type of lateral compression pelvic injury associated with instability. Open reduction and internal fixation is a traditional treatment of CFDSIJ. However, a minimally invasive method has never been reported. The purpose of this study was to assess the outcome of closed reduction and percutaneous fixation for different types of CFDSIJ and present their clinical outcome. The authors reviewed 117 patients diagnosed with CFDSIJ between July 2003 and July 2013. Closed reduction and percutaneous fixation was performed in 73 patients. Treatment selection was based on Day's fracture classification. For type I fractures, fixation perpendicular to the fracture line were performed. For type II fractures, crossed fixation was performed. For type III fractures, fixation was performed with iliosacral screws. Forty-four patients were treated by open reduction and plate fixation. Demographics, fracture pattern distribution, blood loss, incision lengths, revision surgeries, radiological results, and functional scores were compared. All 117 patients were followed for more than 6 months (mean, 14 months [range, 6-24 months]). Blood loss, extensive exposure, duration of posterior ring surgery, duration of hospital stay, and infection rates were lower in the closed group (P<.01). Patients in the closed group achieved better functional performance (P<.01). There were no significant differences in reduction quality (P=.32), revision surgery rates (P=.27), and iatrogenic neurologic injuries (P=.2) between the 2 groups. The authors' results indicate that closed reduction and percutaneous fixation is a safe and effective surgical method for CFDSIJ. PMID:26558677

  18. Surgical outcome of posterior fixation, including fractured vertebra, for thoracolumbar fractures

    PubMed Central

    Zhao, Quan M.; Gu, Xiao F.; Yang, Hui L.; Liu, Zhong T.

    2015-01-01

    Objective: To evaluate the role of posterior fixation including the fractured vertebra (PFFV) for the treatment of thoracolumbar vertebral fractures. Methods: Sixty-seven patients that sustained a single-level thoracolumbar fracture were included in this retrospective study carried out in the Wuxi People’s Hospital, Wuxi, China between August 2010 and June 2013. Thirty-two cases were treated with PFFV, and 35 cases were treated with traditional short-segment fixation (TSSF). All patients were periodically followed-up with clinical and radiologic evaluation. Cobb’s angle and vertebral body height were analyzed and compared, and the operational time, intra-operational blood loss, and the Denis pain scale scores were also compared. Results: Compared with preoperative angles, the Cobb’s angles were reduced and the vertebral body height of the fractured vertebra was increased after operation at a statistically significant level. Twelve months post-operative, the loss of Cobb’s angle and vertebral body height in the PFFV group was significantly less than that in the TSSF group. There was no statistical significance in the Denis pain scale score 12 months post-operatively between the 2 groups. Conclusion: Selective adoption of PFFV is helpful not only for stabilization of fractures and restoration of anatomy, but also maintaining the effectiveness of the restoration with good functional outcome. PMID:26492116

  19. Treatment of Unstable Thoracolumbar Fractures through Short Segment Pedicle Screw Fixation Techniques Using Pedicle Fixation at the Level of the Fracture: A Finite Element Analysis

    PubMed Central

    Li, Changqing; Zhou, Yue; Wang, Hongwei; Liu, Jun; Xiang, Liangbi

    2014-01-01

    Objective To compare the von Mises stresses of the internal fixation devices among different short segment pedicle screw fixation techniques to treat thoracic 12 vertebral fractures, especially the mono-segment pedicle screw fixation and intermediate unilateral pedicle screw fixation techniques. Methods Finite element methods were utilised to investigate the biomechanical comparison of the four posterior short segment pedicle screw fixation techniques (S4+2: traditional short-segment 4 pedicle screw fixation [SPSF]; M4+2: mono-segment pedicle screw fixation; I6+2: intermediate bilateral pedicle screw fixation; and I5+2: intermediate unilateral pedicle screw fixation). Results The range of motion (ROM) in flexion, axial rotation, and lateral bending was the smallest in the I6+2 fixation model, followed by the I5+2 and S4+2 fixation models, but lateral bending was the largest in the M4+2 fixation model. The maximal stress of the upper pedicle screw is larger than the lower pedicle screw in S4+2 and M4+2. The largest maximal von Mises stress was observed in the upper pedicle screw in the S4+2 and M4+2 fixation models and in the lower pedicle screw in the I6+2 and I5+2 fixation models. The values of the largest maximal von Mises stress of the pedicle screws and rods during all states of motion were 263.1 MPa and 304.5 MPa in the S4+2 fixation model, 291.6 MPa and 340.5 MPa in the M4+2 fixation model, 182.9 MPa and 263.2 MPa in the I6+2 fixation model, and 269.3 MPa and 383.7 MPa in the I5+2 fixation model, respectively. Comparing the stress between different spinal loadings, the maximal von Mises stress of the implants were observed in flexion in all implanted models. Conclusion Additional bilateral pedicle screws at the level of the fracture to SPSF may result in a stiffer construct and less von Mises stress for pedicle screws and rods. The largest maximal von Mises stress of the pedicle screws during all states of motion were observed in the mono-segment pedicle

  20. Use of a single 2.0-mm locking AO reconstruction titanium plate in linear, non-comminuted, mandible fractures

    PubMed Central

    Parmar, Babu S.; Makwana, Kalpesh G.; Patel, Aditi M.; Tandel, Ramanuj C.; Shah, Jay

    2014-01-01

    Purpose: The aim of the following study is to prospectively evaluate the use of a single Arbeitsgemeinschaft für Osteosynthesefragen (AO) 2.0-mm locking reconstruction plate for linear non-comminuted mandibular fractures without the use of a second plate. Materials and Methods: This study consisted of a sample of 10 patients who reported to the department with fractures of the mandible and were treated over a period of 24 months from November 2010 to November 2012. Out of these, there were 8 male patients and 2 female patients. There were four cases of isolated parasymphysis fractures, 1 of the case had a parasymphysis fracture associated with subcondylar fracture, 4 had a body fracture and 2 had a symphysis fracture. Results: All patients had satisfactory fracture reduction and a successful treatment outcome without major complications. Only one patient (10%) developed minor complications. Conclusion: The study has demonstrated that treating linear non-comminuted mandibular fractures with a single AO 2.0-mm locking reconstruction plate provides excellent stability at the fracture site which in turn leads to sound bone healing and early functional rehabilitation. PMID:24987599

  1. Percutaneous Lumbopelvic Fixation for Reduction and Stabilization of Sacral Fractures With Spinopelvic Dissociation Patterns

    PubMed Central

    Quinnan, Stephen M.

    2016-01-01

    Summary: Sacral fractures that result in spinopelvic dissociation are unstable injuries that are often treated surgically, with iliosacral screw fixation and/or lumbopelvic fixation from L4 to the pelvis. Open lumbopelvic fixation allows for direct fracture reduction and immediate postoperative weight bearing, but is associated with a relatively high wound complication rate. Open surgery often takes several hours and can be associated with significant blood loss, and therefore may not be well tolerated physiologically in these patients who often have multiple injuries. We developed a percutaneous lumbopelvic reduction and fixation technique to address these issues. PMID:26894767

  2. Does Extraction or Retention of the Wisdom Tooth at the Time of Surgery for Open Reduction and Internal Fixation of the Mandible Alter the Patient Outcome?

    PubMed

    Hammond, Douglas; Parmar, Sat; Whitty, Justin; Pigadas, Nick

    2015-12-01

    Whether to extract or retain wisdom teeth present in a fracture line is a controversial topic. This study reviewed the records of all patients who had mandibular wisdom teeth at the time of the injury, and had an open reduction and internal fixation procedure between January 2009 and January 2012. The cohort of patients who concomitantly had their wisdom tooth extracted at the time of fixation had a greater complication rate (24.3%) compared with patients who did not (14.9%). This suggests that if third molars in the line of a fracture have caries, are fractured, show signs of pericoronitis, are periodontally involved, or are interfering with the occlusion are extracted at the time of fixation, this will increase the incidence of complications. PMID:26576231

  3. Arthroscopic Reduction and Transportal Screw Fixation of Acetabular Posterior Wall Fracture: Technical Note.

    PubMed

    Park, Jin Young; Chung, Woo Chull; Kim, Che Keun; Huh, Soon Ho; Kim, Se Jin; Jung, Bo Hyun

    2016-06-01

    Acetabular fractures can be treated with variable method. In this study, acetabular posterior wall fracture was treated with arthroscopic reduction and fixation using cannulated screw. The patient recovered immediately and had a satisfactory outcome. In some case of acetabular fracture could be good indication with additional advantages of joint debridement and loose body removal. So, we report our case with technical note. PMID:27536654

  4. Arthroscopic Reduction and Transportal Screw Fixation of Acetabular Posterior Wall Fracture: Technical Note

    PubMed Central

    Park, Jin young; Kim, Che Keun; Huh, Soon Ho; Kim, Se Jin; Jung, Bo Hyun

    2016-01-01

    Acetabular fractures can be treated with variable method. In this study, acetabular posterior wall fracture was treated with arthroscopic reduction and fixation using cannulated screw. The patient recovered immediately and had a satisfactory outcome. In some case of acetabular fracture could be good indication with additional advantages of joint debridement and loose body removal. So, we report our case with technical note. PMID:27536654

  5. Strength analysis of clavicle fracture fixation devices and fixation techniques using finite element analysis with musculoskeletal force input.

    PubMed

    Marie, Cronskär

    2015-08-01

    In the cases, when clavicle fractures are treated with a fixation plate, opinions are divided about the best position of the plate, type of plate and type of screw units. Results from biomechanical studies of clavicle fixation devices are contradictory, probably partly because of simplified and varying load cases used in different studies. The anatomy of the shoulder region is complex, which makes it difficult and expensive to perform realistic experimental tests; hence, reliable simulation is an important complement to experimental tests. In this study, a method for finite element simulations of stresses in the clavicle plate and bone is used, in which muscle and ligament force data are imported from a multibody musculoskeletal model. The stress distribution in two different commercial plates, superior and anterior plating position and fixation including using a lag screw in the fracture gap or not, was compared. Looking at the clavicle fixation from a mechanical point of view, the results indicate that it is a major benefit to use a lag screw to fixate the fracture. The anterior plating position resulted in lower stresses in the plate, and the anatomically shaped plate is more stress resistant and stable than a regular reconstruction plate. PMID:25850983

  6. The use of external fixators in the immobilization of pediatric fractures.

    PubMed

    Norman, D; Peskin, B; Ehrenraich, A; Rosenberg, N; Bar-Joseph, G; Bialik, V

    2002-09-01

    The use of external fixation in the immobilization of diaphyseal and metaphyseal fractures in children is still controversial, as these fractures are generally managed by immediate plaster casting, by traction followed by casting, by various methods of internal fixation, including the recently developed flexible rods, and by plating. Between 1982 and 1998, we treated 64 children with fractures of the long bones of the lower limb using external fixation, 44 of whom were available for follow-up (46 fractures). Their average age on the day of injury was 8.l years. Average follow-up extended for 4 years. The external fixation used was left in place for an average of 67 days. Full range of movement was achieved in 42 children (44 limbs). The longitudinal axis was anatomically correct (<5 degrees angulation) in 40 children (42 limbs). Due to malalignment of the fracture (15 degrees varus) in one child, tibial osteotomy was performed 4 years after fracture healing. There was no leg length discrepancy in 38 children, and shortening of >2 cm was measured in the fractured limbs of 2 children. We found the use of external fixators to be easy, quick, with a short learning curve, and appropriate for comminuted and closed fractures of the long bones, and especially for children with polytrauma. PMID:12228797

  7. Semi-automatic customization of internal fracture fixation plates.

    PubMed

    Musuvathy, Suraj; Azernikov, Sergei; Fang, Tong

    2011-01-01

    A new method for customization of fixation plates for repairing bone fractures is proposed. Digital models of plates are typically available as CAD models that contain smooth analytic geometry representations including NURBS. With the existing pre-operative planning solutions, these models are converted to polygonal meshes and adapted manually to the patient's bone geometry by the user. Based on the deformed model, physical bending is then performed by the surgeon in operating room. With the proposed approach, CAD models are semi-automatically adapted using NURBS to generate customized plates that conform to the desired region of the bone surface of patients. This enables an efficient and accurate approach that is also computationally suitable for interactive planning applications. Moreover, the patient-specific customized plates can then be produced directly from the adapted CAD models with a standard CNC machine before surgery. This may dramatically reduce time spent in OR, improve precision of the procedure and as a result improve the patient's outcome. PMID:22254380

  8. The biomechanical effect of bone quality and fracture topography on locking plate fixation in periprosthetic femoral fractures.

    PubMed

    Leonidou, Andreas; Moazen, Mehran; Lepetsos, Panagiotis; Graham, Simon M; Macheras, George A; Tsiridis, Eleftherios

    2015-02-01

    Optimal management of periprosthetic femoral fractures (PFF) around a well fixed prosthesis (Vancouver B1) remains controversial as adequate fixation needs to be achieved without compromising the stability of the prosthesis. The aim of this study was to highlight the effect of bone quality i.e. canal thickness ratio (CTR), and fracture topography i.e. fracture angle and its position in relation to the stem, on the biomechanics of a locking plate for a Vancouver B1 fracture. A previously corroborated simplified finite element model of a femur with a cemented total hip replacement stem was used in this study. Canal thickness ratio (CTR) and fracture topography were altered in several models and the effect of these variations on the von Mises stress on the locking plate as well as the fracture displacement was studied. Increasing the CTR led to reduction of the von Mises stress on the locking plate as well as the fracture movement. In respect to the fracture angle with the medial cortex, it was shown that acute angles resulted in lower von Mises stress on the plate as opposed to obtuse angles. Furthermore, acute fracture angles resulted in lower fracture displacement compared to the other fractures considered here. Fractures around the tip of the stem had the same biomechanical effect on the locking plate. However, fractures more distal to the stem led to subsequent increase of stress, strain, and fracture displacement. Results highlight that in good bone quality and acute fracture angles, single locking plate fixation is perhaps an appropriate management method. On the contrary, for poor bone quality and obtuse fracture angles alternative management methods might be required as the fixation might be under higher risk of failure. Clinical studies for the management of PFF are required to further support our findings. PMID:25467710

  9. Suture anchor versus screw fixation for greater tuberosity fractures of the humerus--a biomechanical study.

    PubMed

    Lin, Cheng-Li; Hong, Chih-Kai; Jou, I-Ming; Lin, Chii-Jeng; Su, Fong-Chin; Su, Wei-Ren

    2012-03-01

    Suture anchors and screws are commonly used for fixation of humeral greater tuberosity (GT) fractures in either arthroscopic or open surgeries, but no biomechanical studies have been performed to compare the strength of fixation constructs using these two implants. This cadaveric study aimed to compare the biomechanical strength of three different fixation constructs in the management of GT fractures: Double-Row Suture Anchor Fixation (DR); Suture-Bridge Technique using suture anchors and knotless suture anchors (SB); and Two-Screw Fixation (TS). The experimental procedure was designed to assess fracture displacement after cyclic loading, failure load, and failure mode of the fixation construct. Significant differences were found among the SB (321 N), DR (263 N), and TS (187 N) groups (SB > DR > TS, p < 0.05) in the mean force of cyclic loading to create 3 mm displacement. Regarding the mean force of cyclic loading to create 5 mm displacement and ultimate failure load, no significant difference was found between the DR (370 N, 480 N) and SB (399 N, 493 N) groups, but both groups achieved superior results compared with the TS group (249 N, 340 N) (p < 0.05). The results suggested that the suture anchor constructs would be stronger than the fixation construct using screws for the humeral GT fracture. PMID:21858857

  10. Serum albumin and fixation failure with cannulated hip screws in undisplaced intracapsular femoral neck fracture.

    PubMed

    Riaz, O; Arshad, R; Nisar, S; Vanker, R

    2016-07-01

    Introduction Internal fixation of undisplaced intracapsular femoral neck fractures with cannulated hip screws is a widely accepted surgical technique, despite reported failure rates of 12%-19%. This study determined whether preoperative serum albumin levels are linked to fixation failure. Methods We retrospectively reviewed 251 consecutive undisplaced intracapsular femoral neck fracture patients treated with cannulated hip screws in a district general hospital. Preoperative albumin levels were measured, and the fixation technique, classification and posterior tilt on radiography assessed. Fixation failure was defined as a screw cut, avascular necrosis (AVN) or non-union. Results Of the patients, 185 were female and 66 male. The mean age was 77 years (range 60-101 years). Thirty seven (15%) patients had fixation failure: 10 (4%) due to AVN; 12 (5%) due to non-union; and 15 (6%) due to fixation collapse. Low serum albumin levels were significantly associated with failure (p=0.01), whereas gender (p=0.56), operated side (p=0.62), age (p=0.34) and screw configuration (p=0.42) were not. A posterior tilt angle greater than 20° on lateral radiography significantly predicted failure (p=0.002). Conclusions Preoperative serum albumin is an independent predictor of cannulated hip screw fixation failure in undisplaced femoral neck fractures. Nutritional status should therefore be considered when deciding between surgical fixation and arthroplasty to avoid the possibility of revision surgery, along with an increased risk of morbidity and mortality. PMID:27055409

  11. Biomechanical Comparison of Different Volar Fracture Fixation Plates for Distal Radius Fractures

    PubMed Central

    Sobky, Kareem; Baldini, Todd; Thomas, Kenneth; Bach, Joel; Williams, Allison

    2007-01-01

    The purpose of this study was to compare the biomechanical properties of four volar fixed-angle fracture fixation plate designs in a novel sawbones model as well as in cadavers. Four volar fixed angle plating systems (Hand Innovations DVR-A, Avanta SCS/V, Wright Medical Lo-Con VLS, and Synthes stainless volar locking) were tested on sawbones models using an osteotomy gap model to simulate a distal radius fracture. Based on a power analysis, six plates from each system were tested to failure in axial compression. To simulate loads with physiologic wrist motion, six plates of each type were then tested to failure following 10,000 cycles applying 100N of compression. To compare plate failure behavior, two plates of each type were implanted in cadaver wrists and similar testing applied. All plate constructs were loaded to failure. All failed with in apex volar angulation.The Hand Innovations DVR-A plate demonstrated significantly more strength in peak load to failure and failure after fatigue cycling (p value < 0.001 for single load and fatigue failure). However, there was no significant difference in stiffness among the four plates in synthetic bone. The cadaveric model demonstrated the same mode of failure as the sawbones. None of the volar plates demonstrated screw breakage or pullout, except the tine plate (Avanta SCS/V) with 1 mm of pullout in 2 of 12 plates. This study demonstrates the utility of sawbones in biomechanical testing and indicates that volar fixation of unstable distal radius fractures with a fixed angle device is a reliable means of stabilization. PMID:18780084

  12. Extreme femoral valgus and patella dislocation following lateral plate fixation of a pediatric femur fracture.

    PubMed

    Ezzat, Ahmed; Iobst, Christopher

    2016-07-01

    A 15-year-old boy presented with a 35° femoral valgus deformity, leg-length discrepancy, painful retained hardware, and a lateral dislocation of the patella 4 years after undergoing lateral plate fixation of a distal femur fracture. Femoral valgus is a possible complication of lateral plate fixation in up to 30% of pediatric distal femur fractures. With this patient's unusual combination of deformities as an example, we suggest early hardware removal after fracture union to prevent the development of deformity. If plate removal is not chosen, then continued close monitoring of the patient is necessary until skeletal maturity. PMID:27243610

  13. Evaluation of Tibial Condyle Fractures Treated with Ilizarov Fixation, A Prospective Study

    PubMed Central

    Reddy R, Sandeep; Shah, Harshad M; Golla, Dinesh Kumar; Ganesh D J, Niranthara; Kumar P, Ashok

    2014-01-01

    Background: Tibial plateau fractures are associated with significant soft tissue injuries which increases the risks of complications and must be considered when managing tibial plateau fractures. Various modalities of treatment are available for treatment of these fractures but Ilizarov fixation has a special advantage over others. Review of literature shows many studies of Ilizarov fixation in the treatment of tibial plateau fractures with variable results. Aim of our study was to evaluate tibial condyle fractures treated by Ilizarov fixation. Materials and Methods: Study included 43 patients with Schatzker type II and above tibial plateau fractures treated by ilizarov fixation. Standard trauma evaluation, a meticulous musculoskeletal and neurologic examination was carried out. All patients underwent Ilizarov fixation by same team of surgeons. Clinicoradilogical assessment of the patients carried out at regular intervals. Results: Our study included 43 cases of tibial plateau of various types except type I. Mean time for radiological union was 24.51 wk (range 15 to 32 wk). Mean fixator period was 26.6 wk( 16-34 wk). The functional results were measured by Lyshom’s and Hohl and Luck score. The mean Lyshom’s score was at the end of one year was 82.16. At end of one year by Hohl and Luck grading 11 patients had fair, 23 had good and 9 had excellent results. Conclusion: High energy tibial plateau fractures can be definitively treated with Ilizarov external fixation. Treatment with this method gives good union rates and less risk of infection. Closed reduction, minimal soft tissue damage and early mobilization are the key to low complications. PMID:25584250

  14. Transoral Miniplate Fixation of Mandibular Angle Fracture with and without 2 Weeks of Maxillomandibular Fixation: A Clinical Trial Study.

    PubMed

    Khiabani, Kazem S; Mehmandoost, Meghdad Khanian

    2013-06-01

    Background and Objectives The ideal line of osteosynthesis in mandibular angle fractures indicates that a plate might be placed either along or just below the external oblique ridge. Some authors believe that using one miniplate at this line at the mandibular angle region provides sufficient strength to stabilize the fracture but others imply a second plate is required. Such controversies exist in the use of maxillomandibular fixation (MMF). The intention of the present study was to compare efficiency and complications of using one miniplate with and without MMF in mandibular angle fractures. Methods and Materials Forty patients with facial trauma with mandibular angle fractures including displaced and unfavorable fractures were categorized into two groups of 20 persons. In all patients, one miniplate was placed on the external oblique ridge. In the first group, patients had light maxillomandibular elastic bands just after surgery but no rigid MMF. In the second group, patients had rigid MMF for 2 weeks after surgery. Patients were followed to evaluate complications and treatment efficiency. Conclusions Our study showed that use of a single miniplate in the external oblique ridge is a functionally stable treatment for all types of angle fractures (including displaced and unfavorable fractures) except comminuted and long oblique fractures, which were not included in our study. Use of postoperative MMF did not improve the results. PMID:24436745

  15. Transoral Miniplate Fixation of Mandibular Angle Fracture with and without 2 Weeks of Maxillomandibular Fixation: A Clinical Trial Study

    PubMed Central

    Khiabani, Kazem S.; Mehmandoost, Meghdad Khanian

    2013-01-01

    Background and Objectives The ideal line of osteosynthesis in mandibular angle fractures indicates that a plate might be placed either along or just below the external oblique ridge. Some authors believe that using one miniplate at this line at the mandibular angle region provides sufficient strength to stabilize the fracture but others imply a second plate is required. Such controversies exist in the use of maxillomandibular fixation (MMF). The intention of the present study was to compare efficiency and complications of using one miniplate with and without MMF in mandibular angle fractures. Methods and Materials Forty patients with facial trauma with mandibular angle fractures including displaced and unfavorable fractures were categorized into two groups of 20 persons. In all patients, one miniplate was placed on the external oblique ridge. In the first group, patients had light maxillomandibular elastic bands just after surgery but no rigid MMF. In the second group, patients had rigid MMF for 2 weeks after surgery. Patients were followed to evaluate complications and treatment efficiency. Conclusions Our study showed that use of a single miniplate in the external oblique ridge is a functionally stable treatment for all types of angle fractures (including displaced and unfavorable fractures) except comminuted and long oblique fractures, which were not included in our study. Use of postoperative MMF did not improve the results. PMID:24436745

  16. Hinged external fixation for Regan-Morrey type I and II fractures and fracture-dislocations.

    PubMed

    Castelli, Alberto; D'amico, Salvatore; Combi, Alberto; Benazzo, Francesco

    2016-06-01

    Elbow fracture-dislocation is always demanding to manage due to the considerable soft-tissue swelling or damage involved, which can make an early open approach and ligamentous reconstruction impossible. The purpose of this study was to evaluate the role of elbow hinged external fixation (HEF) as a definitive treatment in patients with elbow dislocations associated with Regan-Morrey (R-M) type I and II coronoid fractures and soft-tissue damage. We treated 11 patients between 2010 and 2012 with HEF. Instability tests and standard X-ray examinations were performed before surgery and 1-3 to 3-6 months after surgery, respectively. All patients underwent a preoperative CT scan. Outcomes were assessed with a functional assessment scale (Mayo Elbow Performance Score, MEPS) that included 4 parameters: pain, ROM, stability, and function. The results were good or excellent in all 11 patients, and no patient complained of residual instability. Radiographic examination showed bone metaplasia involving the anterior and medial sides of the joint in 5 patients. HEF presented several advantages: it improves elbow stability and it avoids long and demanding surgery in particular in cases with large soft tissue damage. We therefore consider elbow HEF to be a viable option for treating R-M type I and II fracture-dislocations. PMID:26875088

  17. The relationship between interfragmentary movement and cell differentiation in early fracture healing under locking plate fixation.

    PubMed

    Miramini, Saeed; Zhang, Lihai; Richardson, Martin; Mendis, Priyan; Oloyede, Adekunle; Ebeling, Peter

    2016-03-01

    Interfragmentary movement (IFM) at the fracture site plays an important role in fracture healing, particularly during its early stage, via influencing the mechanical microenvironment of mesenchymal stem cells within the fracture callus. However, the effect of changes in IFM resulting from the changes in the configuration of locking plate fixation on cell differentiation has not yet been fully understood. In this study, mechanical experiments on surrogate tibia specimens, manufactured from specially formulated polyurethane, were conducted to investigate changes in IFM of fractures under various locking plate fixation configurations and loading magnitudes. The effect of the observed IFM on callus cell differentiation was then further studied using computational simulation. We found that during the early stage, cell differentiation in the fracture callus is highly influenced by fracture gap size and IFM, which in turn, is highly sensitive to locking plate fixation configuration. The computational model predicted that a small gap size (e.g. 1 mm) under a relatively flexible configuration of locking plate fixation (larger bone-plate distances and working lengths) could experience excessive strain and fluid flow within the fracture site, resulting in excessive fibrous tissue differentiation and delayed healing. By contrast, a relatively flexible configuration of locking plate fixation was predicted to improve cartilaginous callus formation and bone healing for a relatively larger gap size (e.g. 3 mm). If further confirmed by animal and human studies, the research outcome of this paper may have implications for orthopaedic surgeons in optimising the application of locking plate fixations for fractures in clinical practice. PMID:26634603

  18. Lesser Trochanter Migration following Intramedullary Fixation of an Intertrochanteric Femur Fracture

    PubMed Central

    Montoli, Carlo; Pasquali, Cecilia; Paiusco, Elia; Pellecchia, Vincenzo

    2016-01-01

    Intertrochanteric femur fractures are commonly observed in the elderly and may be associated with a complete fracture of the lesser trochanter in over 50% of cases. The migration of the lesser trochanter secondary to the psoas muscle contracture is a rare event. This case report presents a rare case of sudden groin pain three-week status after intramedullary fixation of a intertrochanteric femur fracture. PMID:27006846

  19. Comparison of Internal Fixations for Distal Clavicular Fractures Based on Loading Tests and Finite Element Analyses

    PubMed Central

    Sakai, Rina; Matsuura, Terumasa; Tanaka, Kensei; Nakao, Masaki

    2014-01-01

    It is difficult to apply strong and stable internal fixation to a fracture of the distal end of the clavicle because it is unstable, the distal clavicle fragment is small, and the fractured region is near the acromioclavicular joint. In this study, to identify a superior internal fixation method for unstable distal clavicular fracture, we compared three types of internal fixation (tension band wiring, scorpion, and LCP clavicle hook plate). Firstly, loading tests were performed, in which fixations were evaluated using bending stiffness and torsional stiffness as indices, followed by finite element analysis to evaluate fixability using the stress and strain as indices. The bending and torsional stiffness were significantly higher in the artificial clavicles fixed with the two types of plate than in that fixed by tension band wiring (P < 0.05). No marked stress concentration on the clavicle was noted in the scorpion because the arm plate did not interfere with the acromioclavicular joint, suggesting that favorable shoulder joint function can be achieved. The stability of fixation with the LCP clavicle hook plate and the scorpion was similar, and plate fixations were stronger than fixation by tension band wiring. PMID:25136691

  20. [Histologic finding of fracture healing using external fixation and its clinical significance].

    PubMed

    Stürmer, K M

    1984-06-01

    The histology of bone healing under external fixation of fractures is studied in 2 human bone specimen and in the sheep's tibia. Primary bone healing occurs under absolute stable fixation. The regular course shows secundary bone healing by endosteal and periosteal callus formation, caused by motion in the fracture gap. Nonunion results, if motion is not big enough to induce callus formation and if motion is too big to allow primary bone healing. So one of the main problems in external fixation of fractures is to find out the adequate dose of stability and motion in the fracture gap. External fixation does not disturb the vascular supply of bone. Intramedullary vessels, that are cut during the osteotomy of the sheep's tibia, are perfectly regenerated 4-5 weeks later. In the surroundings of the Schanz' screws, cortical remodelling is the biomechanical response of bone to strees, which is generated by external fixation. This cortical remodelling can reduce compression, originally applied to the bone. The indication and the timing for a change to internal fixation is discussed. PMID:6474602

  1. The stability of fixation of proximal femoral fractures: a radiostereometric analysis.

    PubMed

    van Embden, D; Stollenwerck, G A N L; Koster, L A; Kaptein, B L; Nelissen, R G H H; Schipper, I B

    2015-03-01

    The aim of this study was to quantify the stability of fracture-implant complex in fractures after fixation. A total of 15 patients with an undisplaced fracture of the femoral neck, treated with either a dynamic hip screw or three cannulated hip screws, and 16 patients with an AO31-A2 trochanteric fracture treated with a dynamic hip screw or a Gamma Nail, were included. Radiostereometric analysis was used at six weeks, four months and 12 months post-operatively to evaluate shortening and rotation. Migration could be assessed in ten patients with a fracture of the femoral neck and seven with a trochanteric fracture. By four months post-operatively, a mean shortening of 5.4 mm (-0.04 to 16.1) had occurred in the fracture of the femoral neck group and 5.0 mm (-0.13 to 12.9) in the trochanteric fracture group. A wide range of rotation occurred in both types of fracture. Right-sided trochanteric fractures seem more rotationally stable than left-sided fractures. This prospective study shows that migration at the fracture site occurs continuously during the first four post-operative months, after which stabilisation occurs. This information may allow the early recognition of patients at risk of failure of fixation. PMID:25737524

  2. External Fixation vs. Skeletal Traction for Treatment of Intertrochanteric Fractures in the Elderly

    PubMed Central

    Kazemian, Gholam Hossein; Emami, Mohammad; Manafi, Alireza; Najafi, Farideh; Najafi, Mohammad Amin

    2016-01-01

    Background Hip fractures are one of the causes of disability amongst elderly patients. External fixator and skeletal traction are two modes of treatment. Objectives The aim of this study is to compare two different treatment modes for intertrochanteric fractures in elderly patients. Patients and Methods Sixty elderly patients with intertrochanteric fractures were randomized for treatment with either skeletal traction (Group A) or an external fixation (Group B). In this study patients at least 60 years of age, with AO/OTA A1 or A2 type fracture and intertrochanteric fracture as a result of minor trauma, were enrolled. Results Acceptable reduction was achieved in eight and 26 patients of group A and B, respectively. The mean duration of hospitalization in Group A and Group B was 14.3 ± 1.1 and 2.2 ± 0.6 days, respectively. Significant differences between the two groups were observed, regarding acceptable reduction and duration of hospitalization. Less pain was observed in group B, at five days and twelve months after surgery; the average HHS was 57 and 66, in group A and B, respectively (P > 0.05). Conclusions Treatment with an external fixator is an effective treatment modality for intertrochanteric fractures in elderly high-risk patients. The advantages include rapid and simple application, insignificant blood loss, less radiation exposure, adequate fixation, pain reduction, early discharge from the hospital, low cost and more favorable functional outcome. PMID:27218039

  3. Revision surgery for nonunion after early failure of fixation of fractures of the distal humerus.

    PubMed

    Ali, A; Douglas, H; Stanley, D

    2005-08-01

    Sixteen patients who underwent a revision operation for nonunion of fractures of the distal humerus following previous internal fixation were reviewed at a mean follow-up of 39 months (8 to 69). The Mayo elbow performance score was excellent in 11, good in two, fair in two and poor in one. In 15 patients union was achieved and in one with an infected nonunion a subsequent bone graft was necessary in order to obtain union.Age, gender, a history of smoking, mechanism of the injury and the AO classification of the initial fracture did not correlate with the development of nonunion. In 12 patients (75%), the initial fixation was assessed as being suboptimal. The primary surgery was regarded as adequate in only three patients. Our findings suggest that the most important determinant of nonunion of a distal humeral fracture after surgery is the adequacy of fixation. PMID:16049248

  4. Anterior and posterior fixation for delayed treatment of posterior atlantoaxial dislocation without fracture.

    PubMed

    Yu, Hai Ming; Malhotra, Karan; Butler, Joseph S; Wu, Shi Qiang

    2015-01-01

    Posterior atlantoaxial dislocation (PAAD) without fracture of the odontoid process is a rare injury. Authors have variously reported closed or open reduction, followed by either anterior or posterior fixation, but there is no consensus on best treatment. We present a particularly unstable case of PAAD. Open reduction through a retropharyngeal approach with odontoidectomy was required for reduction. Anterior fixation with transarticular lag screws was required prior to posterior fixation with pedicle screws. Despite non-compliance with postoperative immobilisation, imaging at 20-month follow-up confirmed solid fusion. The patient is pain-free with a good range of movement of the neck and has returned to a manual job. Our case had a greater degree of instability than was previously reported, which necessitated 360° fixation. This is the first reported case of this treatment strategy, which provided a very stable fixation allowing fusion despite early movement and without causing undue stiffness. PMID:26516249

  5. External fixator configurations in tibia fractures: 1D optimization and 3D analysis comparison.

    PubMed

    Roseiro, Luis M; Neto, M Augusta; Amaro, Ana; Leal, Rogerio P; Samarra, Miguel C

    2014-01-01

    The use of external fixation devices in orthopedic surgery is very common in open tibial fractures. A properly applied fixator may improve the healing process while one improperly applied might delay the healing process. The several external fixator systems used in clinical today, can be categorized into uniplanar-unilateral, uniplanar-bilateral, biplanar and multiplanar. The stability on the fracture focus and, therefore, the fracture healing process, is related with the type of external fixator configuration that is selected. The aim of this study is to discuss the principles for the successful application of unilateral-uniplanar external fixation, the assembly of its components, for the case of a transverse fractures using computational models. In this context, the fixation stiffness characteristics are evaluated using a simplified 1D finite element model for the tibia and external fixator. The beams are modeled with realistic cross-sectional geometry and material properties instead of a simplified model. The VABS (the Variational Asymptotic Beam Section analysis) methodology is used to compute the cross-sectional model for the generalized Timoshenko model, which was embedded in the finite element solver FEAP. The use of Timoshenko beam theory allows accounting for several kinds of loads, including torsion moments. Optimal design is performed with respect to the assembly of fixator components using a genetic algorithm. The optimization procedure is based on the evaluation of an objective function, which is dependent on the displacement at the fracture focus. The initial and optimal results are compared by performing a 3D analysis, for which different three-dimensional finite element models are created. The geometrical model of a tibia is created on the basis of data acquired by CAT scan, made for a healthy tibia of a 22 year old male. The 3D comparison of the 1D optimal results show a clear improvement on the objective function for the several load cases and

  6. Long-term results after non-plate head-preserving fixation of proximal humeral fractures

    PubMed Central

    Bahrs, Christian; Rolauffs, Bernd; Weise, Kuno; Zipplies, Sebastian; Dietz, Klaus; Eingartner, Christoph

    2009-01-01

    A retrospective study was conducted to evaluate displaced proximal humeral fractures treated with a non-plate head-preserving fixation and to detect factors predicting functional outcome. After a median follow-up period of 79.7 months, 105 patients with nine A-fractures, 36 B-fractures and 60 C-fractures (nine two-part-fractures, 41 three-part fractures and 55 four-part fractures) were assessed. Functional outcome was measured based on the Constant and UCLA scores. Of all patients, 70–75% had excellent or good Constant and UCLA scores. In 74% a good or satisfactory quality of initial reduction fracture was achieved. About one-fifth (21%) of the fractures showed a secondary displacement. Twenty-seven percent of the patients had signs of humeral head necrosis and 22% had implant related problems. There were significant correlations between a high final score and young age, low AO fracture severity, good quality of fracture reduction and residual osseous deformity, absence of secondary fracture displacement, implant-related complications, shoulder arthrosis and humeral head necrosis at the time of follow-up. In conclusion, the non-plate head-preserving fixation of proximal humeral fractures is an alternative treatment for displaced proximal humeral fractures. Especially in severely displaced C-fractures in older patients, non-anatomical reduction leads to a high rate of secondary displacement, residual osseous deformity and only a fair shoulder function. For these cases alternative methods such as prosthetic replacement should be chosen. PMID:19705115

  7. Long-term results after non-plate head-preserving fixation of proximal humeral fractures.

    PubMed

    Bahrs, Christian; Badke, Andreas; Rolauffs, Bernd; Weise, Kuno; Zipplies, Sebastian; Dietz, Klaus; Eingartner, Christoph

    2010-08-01

    A retrospective study was conducted to evaluate displaced proximal humeral fractures treated with a non-plate head-preserving fixation and to detect factors predicting functional outcome. After a median follow-up period of 79.7 months, 105 patients with nine A-fractures, 36 B-fractures and 60 C-fractures (nine two-part-fractures, 41 three-part fractures and 55 four-part fractures) were assessed. Functional outcome was measured based on the Constant and UCLA scores. Of all patients, 70-75% had excellent or good Constant and UCLA scores. In 74% a good or satisfactory quality of initial reduction fracture was achieved. About one-fifth (21%) of the fractures showed a secondary displacement. Twenty-seven percent of the patients had signs of humeral head necrosis and 22% had implant related problems. There were significant correlations between a high final score and young age, low AO fracture severity, good quality of fracture reduction and residual osseous deformity, absence of secondary fracture displacement, implant-related complications, shoulder arthrosis and humeral head necrosis at the time of follow-up. In conclusion, the non-plate head-preserving fixation of proximal humeral fractures is an alternative treatment for displaced proximal humeral fractures. Especially in severely displaced C-fractures in older patients, non-anatomical reduction leads to a high rate of secondary displacement, residual osseous deformity and only a fair shoulder function. For these cases alternative methods such as prosthetic replacement should be chosen. PMID:19705115

  8. Traumatic atlantoaxial rotatory fixation associated with C2 articular facet fracture in adult patient: Case report

    PubMed Central

    Bellil, Mehdi; Hadhri, Khaled; Sridi, Maamoun; Kooli, Mondher

    2014-01-01

    Traumatic atlantoaxial rotatory fixation is a very rare injury in adults which is often misdiagnosed initially. Its combination with C2 fractures is predominated by dens lesions. Therapeutic management is challenging because of the difficulty to achieve optimal reduction and permanent stability. We report a rare case of traumatic atlantoaxial rotatory fixation in a 56-year-old women associated with C2 articular facet fracture successfully treated by conservative means after patient-awake manual reduction with optimal functional and radiographic outcome. PMID:25558147

  9. Two-Tension-Band Technique in Revision Surgery for Fixation Failure of Patellar Fractures.

    PubMed

    Xue, Zichao; Qin, Hui; Ding, Haoliang; Xu, Haitao; An, Zhiquan

    2016-01-01

    BACKGROUND Failed patellar fracture fixation is rare, and is usually attributed to technical errors. There are no specific details available on how to address this problem. We present our two-tension-band technique for fixing patellar fractures. MATERIAL AND METHODS Between March 2010 and March 2013, 4 men and 2 women with failed fixation patellar fractures were treated in our department. Their average age was 34 years (range 23-49 years). The initial fracture type was C1 in 3, C2 in 1, and C3 in 2, according to the AO classification. The initial fracture patterns included 3 transverse and 3 comminuted fractures. There were no open fractures. All patients underwent internal fixation with a modified anterior tension band (MATB) supplemented with cerclage wiring. All failures were caused by tension bands sliding past the tip of the Kirschner wires. The mean time between the primary and revision operations was 16.2 months (range 2-63 months). We revised the fractures by two-separate-tension-band technique. RESULTS The mean follow-up was 52 months (range 31-67 months). All patients healed radiographically without complications at an average of 14.7 weeks (range 8-20 weeks). The Bostman knee score was excellent in 3 and good in 3. All patients regained full extension and the mean range of flexion was 147.5° (135-155°). CONCLUSIONS Use of this two-tension-band technique can avoid technical errors and provide more secure fixation. We recommend it for both primary and revision surgery of patellar fractures. PMID:27485104

  10. Two-Tension-Band Technique in Revision Surgery for Fixation Failure of Patellar Fractures

    PubMed Central

    Xue, Zichao; Qin, Hui; Ding, Haoliang; Xu, Haitao; An, Zhiquan

    2016-01-01

    Background Failed patellar fracture fixation is rare, and is usually attributed to technical errors. There are no specific details available on how to address this problem. We present our two-tension-band technique for fixing patellar fractures. Material/Methods Between March 2010 and March 2013, 4 men and 2 women with failed fixation patellar fractures were treated in our department. Their average age was 34 years (range 23–49 years). The initial fracture type was C1 in 3, C2 in 1, and C3 in 2, according to the AO classification. The initial fracture patterns included 3 transverse and 3 comminuted fractures. There were no open fractures. All patients underwent internal fixation with a modified anterior tension band (MATB) supplemented with cerclage wiring. All failures were caused by tension bands sliding past the tip of the Kirschner wires. The mean time between the primary and revision operations was 16.2 months (range 2–63 months). We revised the fractures by two-separate-tension-band technique. Results The mean follow-up was 52 months (range 31–67 months). All patients healed radiographically without complications at an average of 14.7 weeks (range 8–20 weeks). The Bostman knee score was excellent in 3 and good in 3. All patients regained full extension and the mean range of flexion was 147.5° (135–155°). Conclusions Use of this two-tension-band technique can avoid technical errors and provide more secure fixation. We recommend it for both primary and revision surgery of patellar fractures. PMID:27485104

  11. Bicondylar tibial plateau fractures managed with the Sheffield Hybrid Fixator. Biomechanical study and operative technique.

    PubMed

    Ali, A M; Yang, L; Hashmi, M; Saleh, M

    2001-12-01

    The two main challenges in the management of bicondylar tibial plateau fractures are: Firstly, the compromised skin and soft tissue envelope which invite a high rate of complications following attempted open reduction and dual plating. Secondly, poor bone quality and comminuted fracture patterns, which create difficulty in achieving stable fixation. Although dual plating is considered to be the best mechanical method of stabilizing these complex fractures, there remains concern regarding the high rate of complications associated with extensive soft tissue dissection, required for the insertion of these plates in an already compromised knee. The Sheffield Hybrid fixator (SHF) technique offers a solution to the two main problems of these difficult fractures by minimizing soft tissue dissection, since bone fragments are reduced and fixed percutaneously, and providing superior cancellous bone purchase with beam loading stabilization for comminuted fractures. Our biomechanical testing showed the SHF with four tensioned wires to be as strong as dual plating and able to provide adequate mechanical stability in the fixation of bicondylar tibial plateau fractures. This was confirmed clinically by a prospective review of the use of the SHF at our centre, for managing complex and high-energy tibial plateau fractures with a good final outcome and no cases of deep infection or septic arthritis. PMID:11812481

  12. A Pediatric Comminuted Talar Fracture Treated by Minimal K-Wire Fixation Without Using a Tourniquet

    PubMed Central

    Inal, Sermet; Inal, Canan

    2014-01-01

    Background Pediatric comminuted talar fractures are reported to be rare, and treatment options such as minimal internal K-wire fixation without using a tourniquet to prevent avascular necrosis have not previously been investigated. Case Description We report a case of a comminuted talar body and a non-displaced neck fracture with dislocation of the tibiotalar, talonavicular and subtalar joints with bimalleolar epiphyseal fractures in an 11-year-old boy due to a fall from height. We present radiological findings, the surgical procedure and clinical outcomes of minimal internal K-wire fixation without using a tourniquet. Literature Review Avascular necrosis rates are reported to be between 0 % and 66 % after fractures of the neck of the talus and the talar body in children. The likelihood of developing avascular necrosis increases with the severity of the fracture. Clinical Relevance To avoid avascular necrosis in a comminuted talar fracture accompanied by tibiotalar, talonavicular, subtalar dislocations and bimalleolar epiphyseal fractures, a minimal internal K-wire fixation without the use of a tourniquet was performed. The outcome was evaluated by the American Orthopedic Foot and Ankle Society score (AOFAS). A score of 90 (excellent) was found at the end of the second year of follow up. Radiology revealed preservation of the joint with no evidence of avascular necrosis, and clinical findings revealed a favorable functional outcome after two years. Level of Evidence 4 PMID:25328479

  13. Fractures of the radial head treated by internal fixation: late results in 26 cases.

    PubMed

    Esser, R D; Davis, S; Taavao, T

    1995-01-01

    Twenty-six patients, ranging in age from 14 to 57 years (average 29 years), were evaluated an average of 7 years and 4 months (range 1-14 years) after open reduction and internal fixation of a displaced radial head fracture. Using Mason's classification, there were 11 type II fractures, 9 type III fractures, and 6 type IV fractures with associated dislocation of the elbow. Seven patients had ipsilateral extremity injuries that included fractures of the coronoid process, capitellum, humerus, and distal radius. Using the Broberg and Morrey elbow score, good or excellent results were achieved in all Mason type II and type III fractures. Four of the six Mason type IV fractures were rated good or excellent. Fair results were obtained in two patients who had an associated dislocation of the elbow and multiple ipsilateral extremity injuries. In these two patients, secondary excision of the radial head relieved pain and yielded some improvement in flexion and forearm rotation. PMID:7562154

  14. Periprosthetic femoral fracture--a biomechanical comparison between Vancouver type B1 and B2 fixation methods.

    PubMed

    Moazen, Mehran; Mak, Jonathan H; Etchels, Lee W; Jin, Zhongmin; Wilcox, Ruth K; Jones, Alison C; Tsiridis, Eleftherios

    2014-03-01

    Current clinical data suggest a higher failure rate for internal fixation in Vancouver type B1 periprosthetic femoral fracture (PFF) fixations compared to long stem revision in B2 fractures. The aim of this study was to compare the biomechanical performance of several fixations in the aforementioned fractures. Finite element models of B1 and B2 fixations, previously corroborated against in vitro experimental models, were compared. The results indicated that in treatment of B1 fractures, a single locking plate can be without complications provided partial weight bearing is followed. In case of B2 fractures, long stem revision and bypassing the fracture gap by two femoral diameters are recommended. Considering the risk of single plate failure, long stem revision could be considered in all comminuted B1 and B2 fractures. PMID:24035619

  15. Fast pinless external fixation for open tibial fractures: preliminary report of a prospective study

    PubMed Central

    Huang, Zheyuan; Wang, Bowen; Chen, Fengrong; Huang, Jianming; Jian, Guojian; Gong, Hao; Xu, Tianrui; Chen, Ruisong; Chen, Xiaolin; Ye, Zhiyang; Wang, Jun; Xie, Desheng; Liu, Haoyuan

    2015-01-01

    A major drawback of conventional fixator system is the penetration of fixator pins into the medullary canal. The pins create a direct link between the medullary cavity and outer environment, leading to higher infection rates on conversion to intramedullary nailing. This study was designed to prospectively evaluate the role of new rapid pinless external fixators in primary stabilization of open tibial shaft fractures. In our study, a prospective study of 96 consecutive patients of open tibial shaft fractures treated with new rapid pinless external fixator and reamed intramedullary nail was carried out. The bone healing status, ability to maintain alignment were examined for radiologic outcome, whereas initial management, length of hospital stay, associated morbidity, range of knee and ankle motion, time to partial and full weight-bearing, employment status and perioperative and postoperative complications were used for clinical evaluation. We followed up for over two years for the patients underwent clinical and radiologic after the surgery. The mean hospital stay was 15 days (ranges, 8-68). Bone healing was achieved for all cases except 3 patients who were lost to follow-up study. No patient suffered compartment syndromes. There was no statistically significance in range of motion among the knees of injury and uninjured limbs at final follow-up (P > 0.05). To the last follow-up, there were no cases of deep infection or implant-related fractures. Seventy-one patients who were employed before the injury returned to work after the operation, 16 had changed to less strenuous work. We concluded that better results can be achieved on clinical and radiologic evaluation of primary stabilization with rapid pinless external fixator and early exchange reamed intramedullary nail for suitable patients with open tibial shaft fractures. The incident rate of relative complications is low. The rapid pinless external fixator can be combined favorably with the reamed intramedullary

  16. Anaesthesia of the inferior alveolar and lingual nerves following subcondylar fractures of the mandible.

    PubMed

    Politis, Constantinus; Sun, Yi; De Peuter, Bruno; Vandersteen, Marjan

    2013-10-01

    A retrospective chart review of 387 patients with condylar and subcondylar fractures revealed 2 cases of inferior alveolar nerve (IAN) and lingual nerve (LN) anaesthesia following the subcondylar fracture. Only 5 cases have been reported previously. The mechanism of action remains unknown but a review of the literature and an analysis of 120 dry human skulls supported the hypothesis that compression of the mandibular nerve at a high level, close to the foramen ovale, could cause anaesthesia. This complication is rare, because it requires compression at a particular angle. The antero-median angulation of the condyle must be close to the foramen ovale, and the fracture must be a unilaterally displaced fracture. The presence of an enlarged lateral pterygoid plate appeared to enhance the risk of compression. The IAN and LN anaesthesia could be resolved after open reduction of the fracture and IAN and LN anaesthesia constitute a strict indication for an early open fracture reduction. PMID:23453271

  17. Provisional pin fixation can maintain reduction in A3 intertrochanteric fractures.

    PubMed

    Cho, Jae-Woo; Kim, Hyung-Jin; Kim, Jinil; Cho, Won-Tae; Jeong, Chan-Dong; Oh, Jong-Keon

    2016-07-01

    A3 intertrochanteric fracture has a higher incidence of intraoperative re-displacement than A1 and 2. The authors have also experienced difficulty with maintenance of reduction in A3 intertrochanteric fractures, as the technique depends on manual effort and can fail easily during the procedure. It induced us to develop this surgical technique to ease the surgical procedure and improve clinical outcomes. This paper introduces a modified provisional guide pin fixation technique applicable to even AO/OTA A3 intertrochanteric fractures, and presents preliminary results of 11 patients who were treated by provisional pin fixation-assisted nailing in A3 intertrochanteric fractures. Using this technique, we have reduced the chances of intraoperative reduction loss and achieved favorable clinical outcomes. PMID:27245452

  18. CIRCULAR EXTERNAL FIXATOR PLACEMENT FOR REPAIR OF AN OPEN DISTAL TARSOMETATARSAL FRACTURE IN AN AFRICAN SACRED IBIS (THRESKIORNIS AETHIOPICUS).

    PubMed

    Kinney, Matthew E; Gorse, Mary Jean; Anderson, Mark A

    2015-12-01

    An adult male African sacred ibis (Threskiornis aethiopicus) was diagnosed with an open right distal tarsometatarsal fracture on physical examination and radiographs. External coaptation in the form of an L splint failed to stabilize the fracture appropriately and additional fixation options were explored. The location of the fracture near the articulation between the tarsometatarsus and the hallux, the short distal fracture segment, and decreased viability of the foot precluded the use of previously described fixation methods for tarsometatarsal fracture repair. A three-ring external fixator system with modification to the distal-most ring allowed for postoperative weight-bearing with minimal nursing care. The fixator was removed after 41 days, and the bird remained fully weight-bearing. The use of a circular external fixator for distal tarsometatarsal repair in long-legged birds may be a viable option when full return to function with minimal postoperative care is desired. PMID:26667561

  19. Result of Internal Fixation for Stable Femoral Neck Fractures in Elderly Patients

    PubMed Central

    Min, Byung-Woo; Bae, Ki-Cheor; Lee, Si-Wuk; Lee, Seok-Jung; Choi, Jung-Hoon

    2016-01-01

    Purpose This study was conducted to evaluate the results of internal fixation for stable femoral neck fractures occurring in patients over 65 years old. Materials and Methods Between 2008 and 2014, we evaluated 25 patients over 65 years old with Garden type 1 and 2 femoral neck fractures that were treated with internal fixation after a minimum follow up of 1 year. There were 5 males and 20 females and the average age was 72.3 years (range, 65-84 years) at the time of surgery. Fracture site union, horizontal shortening and complications were evaluated as radiographic parameters and change of walking ability (as measured using Koval walking ability score) was investigated as a clinical parameter. Results Union of fracture site was achieved in 24 out of the 25 cases (96.0%). The average length of horizontal shortening was 6.5 mm (range, 0.2-19.7 mm). At final follow up, 3 cases experienced complications: nonunion (n=1), avascular necrosis (n=1), and subtrochanteric fracture after minor trauma (n=1). Walking ability decreased an average of 1 step at the final follow up. Conclusion Internal fixation for stable femoral neck fractures occurring in patients over 65 years showed satisfactory union rates. However, care should be taken with this technique given the possibility of decreased walking ability resulting from horizontal shortening.

  20. Open Reduction and Internal Fixation of Intraarticular Fractures of the Humerus: Evaluation of 33 Cases

    PubMed Central

    Mardanpour, Keykhosro; Rahbar, Mahtab

    2013-01-01

    Background Standard treatment of type C elbow fractures is open reduction and internal fixation using reconstruction plates and pins. Objectives The aim of this study was to evaluate the functional outcome following internal fixation of intraarticular fractures of the distal humerus (AO Type C) with a minimum follow-up of three years. A retrospective evaluation was undertaken. Patients and Methods Thirty-three patients (28 males, 5 females; mean age 34.3years) type C elbow fractures were treated and observed over a period of three years. Six fractures were open and 27 closed; causes were falls (7 cases), traffic accidents (22 cases) and altercation (4 cases). All operations were performed using a posterior approach with an olecranon osteotomy. Mean duration of follow-up was 18 months (range 6–36). Mean duration of fracture healing was 2.3 months (range 2–4). Functional outcomes were assessed by Jupiter criteria. Results Excellent results were found in 69.7% (23 cases), very good reaults and good results were found in the remaining 30.3% (10 cases). Three of 33 patients 9% (3 cases) presented postoperative complications. No patient exhibited symptoms of ulnar nerve injury following surgery. One patient had cubitusvarus deformities and one case had heterotopic ossification. One patient had malunion and one case had deep infection. Conclusions Complications were minimal and outcomes were satisfactory in patients with type C distal humerus fractures who underwent bilateral plate fixation via a posterior approach. PMID:24350136

  1. Vertical open patella fracture, treatment, rehabilitation and the moment to fixation.

    PubMed

    Larangeira, Joao Alberto; Bellenzier, Liliane; Rigo, Vanessa da Silva; Ramos Neto, Elias Josue; Krum, Francisco Fritsch Machry; Ribeiro, Tiango Aguiar

    2015-02-01

    Patella fracture is relatively uncommon and the vertical trace fracture represents almost 12-17%. The open patella fracture expresses 6-30%. The association of these two uncommon conditions was the aim of this case report even as the treatment and the moment of fixation (definitive surgical treatment). A 27-year-old man after a motorcycle accident showed an open patella fracture classified as a Gustilo and Anderson type IIIA lesion. The patient was immediately treated with precocious surgery fixation with a modified tension band which consists of two parallel K-wires positioned orthogonal to the fracture line and a cerclage wire shaped anteriorly at patella as an eight. The premature fixation benefited the infection prevention and provided earlier joint motion, which increased the nutrition of articular cartilage. Six months postoperatively, the patient had a satisfactory joint motion with full extension and 116° of joint flexion and returned to his daily life activities without restriction. Twelve months postoperatively, the patient had full extension and 120° of knee flexion without pain, joint effusion and instability. Muscle strength force was considered normal at grade V. In conclusion, early chirurgic treatment and precocious articular mobilization improve prognosis, suggesting that the employment of these practices should be adopted whenever possible in most of the open fractures. PMID:25436033

  2. The biocompatibility of materials for internal fixation of fractures.

    PubMed

    Brown, S A; Mayor, M B

    1978-01-01

    Surgically produced fractures of rabbit tibiae were internally stabilized with intramedullary rods of stainless steel (316LVM), titanium (6A1,4V), polyacetal (Delrin), and polyamide (Nylon 101). Periodic radiographs were taken until sacrifice at 16 weeks after fracture. Structural properties of the tibiae were determined in torsion with the rods in situ, and then the tissue was prepared for histology or microradiography. The results demonstrated that fracture remodeling was adversely affected by the metal rods. New bone was seen to have formed over the ends of the metal rods, and cortical bone resorption was observed in the fracture region, suggestive of transfer of mechanical stress to the rods, resulting in stress shielding of the diaphysis. Negligible osseous response to the polymeric rods was observed; fracture callus remodeling was extensive. The torsional test results demonstrated that fractures with polymeric rods were significantly stronger and tougher than those with metallic rods. With the exception of titanium, the strength of healed fractures was inversely related to the elastic moduli of the implant materials. PMID:632318

  3. Augmentation of femoral neck fracture fixation with an injectable calcium-phosphate bone mineral cement.

    PubMed

    Stankewich, C J; Swiontkowski, M F; Tencer, A F; Yetkinler, D N; Poser, R D

    1996-09-01

    The first goal of this study was to determine if augmentation with an injectable, in situ setting, calcium-phosphate cement that is capable of being remodeled and was designed to mimic bone mineral significantly improved the strength and stiffness of fixation in a cadaveric femoral neck fracture model. The second goal was to determine if greater increases in fixation strength were achieved as the bone density of the specimen decreased. Sixteen pairs of fresh cadaveric human femora with a mean age of 70.9 years (SD = 17.2 years) were utilized. The bone density of the femoral neck was measured with dual-energy x-ray absorptiometry. The femoral head was impacted vertically with the femoral shaft fixed in 12 degrees of adduction using a materials testing machine to create a fully displaced fracture. Following fracture, 30% inferior comminution was created in each specimen. One randomly chosen femur from each pair underwent anatomic reduction and fixation with three cannulated cancellous bone screws, 7 mm in diameter, in an inverted triangle configuration. The contralateral femur underwent the same fixation augmented with calcium-phosphate cement. Specimens were preconditioned followed by 1.000 cycles to one body weight (611.6 N) at 0.5 Hz to simulate single-limb stance loading. The stiffness in the first cycle was observed to be significantly greater in cement-augmented specimens compared with unaugmented controls (p < 0.05). After cycling, each specimen was loaded at 10 mm/min until complete displacement of the fracture surface and failure of fixation occurred. Specimens augmented with bone mineral cement failed at a mean of 4,573 N (SD = 1,243 N); this was significantly greater (p < 0.01) than the mean for controls (3,092 N, SD = 1,258 N). The relative improvement in fixation strength (augmented/control x 100%) was not inversely correlated to femoral neck bone density (p = 0.25, R2 = 0.09), was weakly correlated to the volume of cement injected (p = 0.07, R2 = 0

  4. Failure of intertrochanteric fracture fixation with a dynamic hip screw in relation to pre-operative fracture stability and osteoporosis.

    PubMed

    Kim, W Y; Han, C H; Park, J I; Kim, J Y

    2001-01-01

    We have reviewed 178 intertrochanteric fractures treated by dynamic hip screw (DHS) fixation between March 1995 and December 1999 and followed for a minimum of 1 year. We used Singh's classification of the trabecular bone structure in the proximal femur as a measure of osteoporosis and also classified the fractures according to three different systems (Boyd-Griffin, Evans, AO). The postoperative radiographs were examined for loss of reduction, i.e. varus angulation >100, perforation of the femoral head, more than 20-mm extrusion of a lag screw or metal failure. We found 49 cases which showed radiographic failures. Two were stable fractures and 47 unstable fractures (Evans' classification). Unstable fractures with osteoporosis had a failure rate of more than 50%. In such cases DHS should not be the first choice for treatment. PMID:11820441

  5. Alloplastic template fixation of blow-out fracture.

    PubMed

    Hwang, Kun; Kita, Yoko

    2002-07-01

    Alloplasts are widely used to reconstruct the orbital defects. The alloplastic material, however, is not uncommonly infected, displaced, and extruded, and forms an epithelial pseudocyst around it. To prevent the depressed fractured bone of the orbital floor from dropping down into the maxillary sinus, an en block fragment of the depressed fracture of the orbital floor was restored after being attached to an alloplastic sheet template which was fixed to the intact orbital floor. This procedure is simple and secure, and intramaxillary packing is not needed to buttress the depressed fractured bone into the sinus. PMID:12140413

  6. Arthroscopic Suture Fixation in Femoral-Sided Avulsion Fracture of Anterior Cruciate Ligament

    PubMed Central

    Prasathaporn, Niti; Umprai, Vantawat; Laohathaimongkol, Thongchai; Kuptniratsaikul, Somsak; Kongrukgreatiyos, Kitiphong

    2015-01-01

    A femoral-sided avulsion fracture of the anterior cruciate ligament (ACL) is a rare and challenging condition. Most reported cases have occurred in childhood or adolescence. Many techniques of ACL repair have been reported, and in recent years, techniques in arthroscopic surgery have been developed and have become ever more popular with orthopaedic surgeons. We created a technique of arthroscopic ACL repair with suture anchor fixation for a femoral-sided ACL avulsion fracture. This technique saves the natural ACL stump. It is available for cases in which creation of a tibial tunnel is not allowed. Moreover, it does not require a skin incision for fixation on the far femoral cortex and, therefore, does not require a second operation to remove the fixation device. The arthroscopic technique also has a good cosmetic outcome. PMID:26258035

  7. A Novel Technique for Closed Reduction and Fixation of Paediatric Calcaneal Fracture Dislocation Injuries

    PubMed Central

    Faroug, Radwane; Stirling, Paul; Ali, Farhan

    2013-01-01

    Paediatric calcaneal fractures are rare injuries usually managed conservatively or with open reduction and internal fixation (ORIF). Closed reduction was previously thought to be impossible, and very few cases are reported in the literature. We report a new technique for closed reduction using Ilizarov half-rings. We report successful closed reduction and screwless fixation of an extra-articular calcaneal fracture dislocation in a 7-year-old boy. Reduction was achieved using two Ilizarov half-ring frames arranged perpendicular to each other, enabling simultaneous application of longitudinal and rotational traction. Anatomical reduction was achieved with restored angles of Bohler and Gissane. Two K-wires were the definitive fixation. Bony union with good functional outcome and minimal pain was achieved at eight-weeks follow up. ORIF of calcaneal fractures provides good functional outcome but is associated with high rates of malunion and postoperative pain. Preservation of the unique soft tissue envelope surrounding the calcaneus reduces the risk of infection. Closed reduction prevents distortion of these tissues and may lead to faster healing and mobilisation. Closed reduction and screwless fixation of paediatric calcaneal fractures is an achievable management option. Our technique has preserved the soft tissue envelope surrounding the calcaneus, has avoided retained metalwork related complications, and has resulted in a good functional outcome. PMID:23819090

  8. Internal fixation treatments for intertrochanteric fracture: a systematic review and meta-analysis of randomized evidence

    PubMed Central

    Yu, Jiajie; Zhang, Chao; Li, Ling; Kwong, Joey S. W.; Xue, Li; Zeng, Xiantao; Tang, Li; Li, Youping; Sun, Xin

    2015-01-01

    The relative effects of internal fixation strategies for intertrochanteric fracture after operation remain uncertain. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to address this important issue. We searched PubMed, EMBASE and CENTRAL for RCTs that compared different internal fixation implants in patients with intertrochanteric fracture at 6-month follow-up or longer. We ultimately included 43 trials enrolling 6911 patients; most trials were small in sample sizes and events. Their risk of bias was generally unclear due to insufficient reporting. Because of these, no statistically significant differences were present from most of the comparisons across all the outcomes, and no definitive conclusions can be made. However, a number of trials compared two commonly used internal fixation strategies, gamma nail (GN) and sliding hip screw (SHS). There is good evidence suggesting that, compared to SHS, GN may increase the risk of cut out (OR = 1.87, 95% CI, 1.08 to 3.21), re-operation (OR = 1.61, 95% CI, 1.02 to 2.53), intra-operative (OR = 3.14, 95% CI, 1.34 to 7.35) and later fractures (OR = 3.67, 95% CI, 1.37 to 9.83). Future randomized trials or observational studies that are carefully designed and conducted are warranted to establish the effects of alternative internal fixation strategies for intertrochanteric fracture. PMID:26657600

  9. Correlations between posturographic findings and symptoms in subjects with fractures of the condylar head of the mandible.

    PubMed

    Faralli, Mario M; Calenti, Claudio C; Ibba, Maria Cristina M; Ricci, Gianpietro G; Frenguelli, Antonio A

    2009-04-01

    Our study examined the posture of 15 patients who had sustained a simple unilateral or bilateral fracture of the condylar head of the mandible as a result of sports or traffic accidents. Following preliminary testing of vestibular function, the patients underwent balance testing: Romberg test with eyes closed (EC), Romberg EC and bite test (ECBT), EC and head retroflexed (ECR). The study parameters were: surface (S) of the statokinesigram, stomatognathic influence index related to S (SSI), and postural oscillations on the frontal plane (X). In keeping with the literature, we felt that the following pattern in static balance suggested a posture destabilised by the stomatognathic system: SSI values of less than 60, reduction of S in the transition from EC to ECR, pathological increase of postural oscillations on the X plane. The study was completed by obtaining a list of new symptoms reported by the patients (altered bite, fullness, tinnitus, pain, loss of balance). The most significant patterns were observed in patients with vestibular dysfunctions and neck pain. It seems that a fracture of the condylar head can affect postural behaviour, although proprioceptive changes alone are not enough to cause true loss of balance and there must be concomitant vestibular dysfunction. The stabilometric pattern is not conditioned by the extent of the trauma or the related treatment. In terms of proprioceptive elements, the presence of muscle pain seems to point to cervical muscle tension as the main culprit in the onset of posttraumatic instability. PMID:18810477

  10. Biomechanical Evaluation of Plate Versus Lag Screw Only Fixation of Distal Fibula Fractures.

    PubMed

    Misaghi, Amirhossein; Doan, Josh; Bastrom, Tracey; Pennock, Andrew T

    2015-01-01

    Traditional fixation of unstable Orthopaedic Trauma Association type B/C ankle fractures consists of a lag screw and a lateral or posterolateral neutralization plate. Several studies have demonstrated the clinical success of lag screw only fixation; however, to date no biomechanical comparison of the different constructs has been performed. The purpose of the present study was to evaluate the biomechanical strength of these different constructs. Osteotomies were created in 40 Sawbones(®) distal fibulas and reduced using 1 bicortical 3.5-mm stainless steel lag screw, 2 bicortical 3.5-mm lag screws, 3 bicortical 3.5-mm lag screws, or a single 3.5-mm lag screw coupled with a stainless steel neutralization plate with 3 proximal cortical and 3 distal cancellous screws. The constructs were tested to determine the stiffness in lateral bending and rotation and failure torque. No significant differences in lateral bending or rotational stiffness were detected between the osteotomies fixed with 3 lag screws and a plate. Constructs fixed with 1 lag screw were weaker for both lateral bending and rotational stiffness. Osteotomies fixed with 2 lag screws were weaker in lateral bending only. No significant differences were found in the failure torque. Compared with lag screw only fixation, plate fixation requires larger incisions and increased costs and is more likely to require follow-up surgery. Despite the published clinical success of treating simple Orthopaedic Trauma Association B/C fractures with lag screw only fixation, many surgeons still have concerns about stability. For noncomminuted, long oblique distal fibula fractures, lag screw only fixation techniques offer construct stiffness similar to that of traditional plate and lag screw fixation. PMID:25990534

  11. An external fixation method and device to study fracture healing in rats.

    PubMed

    Mark, Hans; Bergholm, Jan; Nilsson, Anders; Rydevik, Björn; Strömberg, Lennart

    2003-08-01

    We wished to establish a reproducible model for fracture fixation to be used in fracture healing research and therefore developed an external fixation construct and surgical procedure adapted to Sprague-Dawley rats. We evaluated the mechanical properties of the construct in brass rods and rat bone, in an Instron test machine with axial and transverse loading, and the in vivo performance. We found that the mechanical properties of the construct in brass rods were predictable and could be repeated in rat femora. In all tests, the axial load was about 10 times the transverse for the same degree of deformation. The stiffness among fixators was uniform. 1 mm pins caused about 50% less stiffness than 1.2 mm pins in axial loading of rat bone (p < 0.001) and brass rods (p < 0.001) as well as in transverse loading of brass rods (p < 0.001). Loosening of 1 or 2 screws that lock the pins to the fixator reduced stiffness by about 50% in axial loading of rat bone (p = 0.009) and brass rods (p = 0.05). A change in the distance between the bone surface and the fixator was linearly related to the stiffness in axial loading of rat bone (p < 0.001) and brass rods (p < 0.001) and in transverse loading of brass rods (p < 0.001). If the bone ends touched each other, the axial stiffness of the construct increased almost 10 times (265 N/mm), as compared to a fracture gap size of 2 mm (31 N/mm). In vivo experiments had a complication rate of less than 10% when we used 1.2 mm pins, 6 mm offset and rats weighing 350-450 g. Our method and device for experimental external fixation of rat femora are reliable and the findings are reproducible. These can be used in bone repair and fracture healing research. PMID:14521302

  12. Functional outcome after successful internal fixation versus salvage arthroplasty of patients with a femoral neck fracture

    PubMed Central

    Zielinski, Stephanie M.; Keijsers, Noël L.; Praet, Stephan F.E.; Heetveld, Martin J.; Bhandari, Mohit; Wilssens, Jean Pierre; Patka, Peter; Van Lieshout, Esther M.M.

    2014-01-01

    Objectives To determine patient independency, health-related and disease-specific quality of life (QOL), gait pattern, and muscle strength in patients after salvage arthroplasty for failed internal fixation of a femoral neck fracture. Design Secondary cohort study to a randomized controlled trial. Setting Multicenter trial in the Netherlands, including 14 academic and non-academic hospitals Patients Patients after salvage arthroplasty for failed internal fixation of a femoral neck fracture were studied. A comparison was made with patients who healed uneventfully after internal fixation. Intervention None (observatory study) Main outcome measurements Patient characteristics, SF-12, and WOMAC scores were collected. Gait parameters were measured using plantar pressure measurement. Maximum isometric forces of the hip muscles were measured using a handheld dynamometer. Differences between the fractured and contralateral leg were calculated. Groups were compared using univariate analysis. Results Of 248 internal fixation patients (median age 72 years), salvage arthroplasty was performed in 68 patients (27%). Salvage arthroplasty patients had a significantly lower WOMAC score (median 73 versus 90, P=0.016) than patients who healed uneventfully after internal fixation. Health-related QOL (SF-12) and patient independency did not differ significantly between the groups. Gait analysis showed a significantly impaired progression of the center of pressure in the salvage surgery patients (median ratio −8.9 versus 0.4, P=0.013) and a significant greater loss of abduction strength (median −25.4 versus −20.4 N, P=0.025). Conclusion Despite a similar level of dependency and QOL, salvage arthroplasty patients have inferior functional outcome than patients who heal after internal fixation of a femoral neck fracture. PMID:24835623

  13. A new biomechanical model for evaluation of fixation systems of maxillofacial fractures.

    PubMed

    Ji, Baohui; Wang, Chun; Song, Fumin; Chen, Mengshi; Wang, Hang

    2012-07-01

    The aim of this study was to develop a new type of biomechanical model for biomechanical researches of maxillofacial fractures and then evaluate it. Twenty synthetic polyurethane maxillary and mandibular models were used to simulate the mandible and maxilla. Springs were used to represent the forces of masseter, medial pterygoid, temporalis, and lateral pterygoid muscles acting on the models. Four masticatory conditions, namely clenching in the intercuspal position (ICP), incisal clenching (INC), left unilateral molar clenching (L-MOL, contralateral side of fracture) and right unilateral molar clenching (R-MOL, fracture side) were simulated. The strain on a miniplates placed across a simulated fracture was measured using strain gauges attached to the plate surface. During INC and L-MOL, the strain on the miniplates confirmed the findings of Champy. The upper miniplate was subjected to tension force and the lower miniplate to compression. When the bite point moved to the fracture, the tension-compression zone reversed, with the upper miniplate relatively compressed and the lower miniplate tension. During ICP, the tension-compression zone changed again, with both miniplates tension. In conclusion, we have successfully developed a model which is much closer to physiological conditions than models used previously. It is reliable and useful for biomechanical tests of mandibular fractures. Models including soft tissue need developing to further understand fracture healing biomechanics. PMID:21865052

  14. Comminuted long bone fractures in children. Could combined fixation improve the results?

    PubMed

    El-Alfy, Barakat; Ali, Ayman M; Fawzy, Sallam I

    2016-09-01

    Comminuted diaphyseal fractures in the pediatric age group represent a major orthopedic problem. It is associated with a high incidence of complications and poor outcomes because of the instability and difficulty in treatment. The aim of this study was to evaluate the efficacy of combined external skeletal fixation and flexible intramedullary nails in reconstruction of comminuted diaphyseal fracture in skeletally immature patients. Combined external fixator and elastic stable intramedullary nails were used in the management of 27 pediatric patients (15 males and 12 females) with unstable comminuted diaphyseal fractures of the tibia and femur. There were 19 fractures of the femur and eight fractures of the tibia. The average age of the patients was 8.7 years (range 7-14 years) for the femur and 10.8 years (range 6-15 years) for the tibia. Fractures were classified according to the system of Winquist and Hansen as grade II (five cases), grade III (nine cases), and grade IV (13 cases). All cases were operated within 6 days (range 0-6 days) after injury. The mean follow-up period was 2.8 years (range 2-3.5 years). The average duration of the external fixation was 1.6 months for fractures of the tibia, whereas it was 1.4 months for fractures of the femur. The average time for tibia fracture union was 2.8 months for fractures of the tibia, whereas it was 1.9 months for fractures of the femur. Malalignment in varus less than 5° was noted in one patient. One patient had a limb-length discrepancy of 1.5 cms. There were five cases (18.5%) with pin-tract infection. According to the Association for the Study and Application of the Methods of Ilizarov evaluation system, bone results were excellent in 23 cases (85.2%), good in three cases (11.1%), and poor in one case (3.7%). Functional results were excellent in 22 (81.5%) cases and good in five (18.5%) cases. Combined use of external fixators and elastic intramedullary nails is a good method for the treatment of comminuted

  15. Management of Femoral Shaft Fracture in Klippel-Trenaunay Syndrome with External Fixator

    PubMed Central

    Gupta, Yogendra; Jha, Ranjib Kumar; Karn, Navin Kumar; Sah, Sanjaya Kumar; Mishra, Bibhuti Nath; Bhattarai, Manoj Kumar

    2016-01-01

    Klippel-Trenaunay syndrome (KTS) is a rare complex malformation characterized by the clinical triad of capillary malformations, soft tissue and bone hypertrophy, and venous/lymphatic malformation. Fractures of long bones in such cases are challenging to treat. A 12-year-old female with this syndrome presented with femoral shaft fracture of right thigh. She was initially kept on skeletal traction for two weeks and then she underwent closed reduction and immobilization with external fixator with uneventful intraoperative and postoperative period. Fracture united at four and half months. PMID:26885423

  16. Intramedullary fixation of forearm fractures with new locked nail

    PubMed Central

    Bansal, Himanshu

    2011-01-01

    Background: Lack of availability of interlocked nails made plate osteosynthesis the first choice of treatment of forearm fractures inspite of more surgical exposure, periosteal stripping and big skin incision subsequent scar along with higher risk of refracture on implant removal. We hereby report the first 12 cases with 19 forearm bone fractures internally fixed by indegenous interlocked nail. Materials and Methods: Existing square nails were modified to have a broad proximal end of 5.5 mm with a hole for locking screw of 2.5 mm. The nail has a distal hole of 1/1.2/1.5 mm in 2.5/3/3.5 mm diameter nail, respectively. A new method of distal locking with a clip made of k wire is designed. The clip after insertion into the bone and hole in nail and opposite cortex snuggly fits the bone providing a secure locking system. Twelve skeletally mature patients, mean age 32 years (range 24-45 years) with 19 diaphyseal fractures of the forearm were treated with this indigenously made new nail. The patient were evaluated for fracture union, functional recovery and complications. The functional outcome was assessed by disabilities of arm, shoulder and hand questionnaire (DASH score). Results: Time to radiographic union ranged between 12 and 28 weeks, with a 100% union rate. Complications were minimal, with mild infection in open fracture (n=1) and delayed union (n=1) in patient with comminuted fracture of the ulna only. The clinical results were excellent. The DASH score ranged between 0 and 36 points. Conclusion: This new interlocking nail may be considered as an alternative to plate osteosynthesis for fractures of the forearm in adults. The advantages are benefit of closed reduction, smaller residual scar, reduced cost and early union with allowance of immediate movements. PMID:21886921

  17. Assessment of carbon fibre composite fracture fixation plate using finite element analysis.

    PubMed

    Saidpour, Seyed H

    2006-07-01

    In the internal fixation of fractured bone by means of bone-plates fastened to the bone on its tensile surface, an on-going concern has been the excessive stress shielding of the bone by the excessively-stiff stainless-steel plate. The compressive stress shielding at the fracture-interface immediately after fracture-fixation delays callus formation and bone healing. Likewise, the tensile stress shielding in the layer of bone underneath the plate can cause osteoporosis and decrease in tensile strength of this layer. In this study a novel forearm internal fracture fixation plate made from short carbon fibre reinforced plastic (CFRP) was used in an attempt to address the problem. Accordingly, it has been possible to analyse the stress distribution in the composite plates using finite-element modelling. A three-dimensional, quarter-symmetric finite element model was generated for the plate system. The stress state in the underlying bone was examined for several loading conditions. Based on the analytical results the composite plate system is likely to reduce stress-shielding effects at the fracture site when subjected to bending and torsional loads. The design of the plate was further optimised by reducing the width around the innermost holes. PMID:16732432

  18. The sustentaculum tali screw fixation for the treatment of Sanders type II calcaneal fracture: A finite element analysis

    PubMed Central

    Pang, Qing-Jiang; Yu, Xiao; Guo, Zong-Hui

    2014-01-01

    Objective: In the surgery of calcaneal fracture, whether the sustentaculum tali screw should always be placed is widely controversial. The aim of this study was to explore the necessity and function of the sustentaculum tali screw placement for the treatment of Sanders type II calcaneal fracture. Methods: The finite element analysis was used in this study. After the establishment of the finite element model of Sanders type II calcaneal fracture, the two internal fixation simulations were designed. In one model, the AO calcaneal plate was simulated on the lateral side of the calcanues with 7 screws being fixated at different position of the plate. In the other model, the calcaneus was fixated with the same AO calcaneal plate together with an additional screw being infiltrated into the sustentaculum tali. The two models were simulated under the same loading and the displacement of the fracture line and the stress distribution in the two models were calculated respectively. Results: The maximum principal stress focused on the cortical bone of sustentaculum tali in both the models under the same loading. The displacement of the fracture line, the maximum principal stress of calcaneus and internal fixation system in the model with sustentaculum screw fixation were smaller than that in the model without sustentaculum screw fixation. The stress in the model with sustentaculum screw fixation was more dispersed. Conclusions: The placement of sustentaculum tali screw is essential for fixation of type II calcaneal fracture to achieve the biomechanical stability. PMID:25225534

  19. Locking plate fixation of distal femoral fractures is a challenging technique: a retrospective review

    PubMed Central

    Toro, Giuseppe; Calabrò, Giampiero; Toro, Antonio; de Sire, Alessandro; Iolascon, Giovanni

    2015-01-01

    Summary Distal femoral fractures have typically a bimodal occurrence: in young people due to a high-energy trauma and in older people related to a low-energy trauma. These fractures are associated to a very high morbidity and mortality in elderly. Distal femoral fractures might be treated with plates, intramedullary nails, external fixations, and prosthesis. However, difficulties in fracture healing and the rate of complications are important clinical issues. The purpose of this retrospective review was to present our experience in treatment of distal femoral fracture in a sample of older people in order to evaluate the technical pitfalls and strategies used to face up the fractures unsuccessfully treated with locking plates. We included people aged more than 65 years, with a diagnosis of distal femoral fracture, treated with locking plates. We considered ‘unsuccessfully treated’ the cases with healing problems or hardware failures. Of the 12 patients (9 females and 3 males; mean aged 68.75 ± 3.31 years) included, we observed 3 ‘unsuccessfully cases’, 2 due to nonunions and 1 due to an early hardware failure, all treated using a condylar blade plate with a bone graft. One patient obtained a complete fracture healing after 1 year and in the other cases there was a nonunion. We observed as most common technical pitfalls: inadequate plate lengthening, fracture bridging, and number of locking screws. The use of locking plates is an emerging technique to treat these fractures but it seems more challenging than expected. In literature there is a lack of evidences about the surgical management of distal femoral fractures that is still an important challenge for the orthopaedic surgeon that has to be able to use all the fixation devices available. PMID:27134634

  20. C1-c2 pedicle screw fixation for treatment of old odontoid fractures.

    PubMed

    Qi, Lei; Li, Mu; Zhang, Shuai; Si, Haipeng; Xue, Jingsong

    2015-02-01

    Nonunion and C1-C2 instability of odontoid fractures usually result from delayed diagnosis and inappropriate treatment. However, the available treatment options for odontoid fractures remain controversial. The authors evaluated the effectiveness of internal screw fixation via the C1 and C2 pedicle in cases of old odontoid fractures. This retrospective study included 21 patients with old odontoid fractures (13 men and 8 women; mean age, 46.5 years; range, 24-69 years). Internal screw fixation via the C1 and C2 pedicle was performed in all patients. Fracture reduction and C1-C2 fusion were assessed with imaging. The neck pain visual analog scale score and cervical spinal cord functional Japanese Orthopaedic Association score (for those who had cervical spinal cord injury) were used to evaluate the effectiveness of treatment. Postoperative complications were recorded. Postoperative imaging showed that the C1-C2 dislocation was satisfactorily repositioned in all patients. Bone fusion was observed 1 year after surgery in all patients. No loosening or breaking of internal fixation occurred. The preoperative neck pain visual analog scale score was 5.9±1.5 and improved significantly to 1.8±0.8 after surgery (P<.001). The Japanese Orthopaedic Association score in patients with cervical spinal injury (n=14) was 9.2±1.9 and also significantly improved to 13.8±1.9 at the last follow-up examination (P<.001), with an average improvement rate of 61.0%. No iatrogenic vertebral artery injury or severe spinal cord injury occurred. Screw fixation via the C1 and C2 pedicle was found to be an effective and safe surgical approach for the treatment of old odontoid fractures with C1-C2 dislocation or instability. PMID:25665108

  1. Mid-term functional outcome after the internal fixation of distal radius fractures

    PubMed Central

    2012-01-01

    Background Distal radius fracture is a common injury with a variety of operative and non-operative management options. There remains debate as to the optimal treatment for a given patient and fracture. Despite the popularity of volar locking plate fixation, there are few large cohort or long term follow up studies to justify this modality. Our aim was to report the functional outcome of a large number of patients at a significant follow up time after fixation of their distal radius with a volar locking plate. Methods 180 patients with 183 fractures and a mean age of 62.4 years were followed up retrospectively at a mean of 30 months (Standard deviation = 10.4). Functional assessment was performed using the Disabilities of the Arm, Shoulder and Hand (DASH) and modified MAYO wrist scores. Statistical analysis was performed to identify possible variables affecting outcome and radiographs were assessed to determine time to fracture union. Results The median DASH score was 2.3 and median MAYO score was 90 for the whole group. Overall, 133 patients (74%) had a good or excellent DASH and MAYO score. Statistical analysis showed that no specific variable including gender, age, fracture type, post-operative immobilisation or surgeon grade significantly affected outcome. Complications occurred in 27 patients (15%) and in 11 patients were major (6%). Conclusion This single centre large population series demonstrates good to excellent results in the majority of patients after volar locking plate fixation of the distal radius, with complication rates comparable to other non-operative and operative treatment modalities. On this basis we recommend this mode of fixation for distal radius fractures requiting operative intervention. PMID:22280557

  2. Novel Intramedullary-Fixation Technique for Long Bone Fragility Fractures Using Bioresorbable Materials

    PubMed Central

    Nishizuka, Takanobu; Kurahashi, Toshikazu; Hara, Tatsuya; Hirata, Hitoshi; Kasuga, Toshihiro

    2014-01-01

    Almost all of the currently available fracture fixation devices for metaphyseal fragility fractures are made of hard metals, which carry a high risk of implant-related complications such as implant cutout in severely osteoporotic patients. We developed a novel fracture fixation technique (intramedullary-fixation with biodegradable materials; IM-BM) for severely weakened long bones using three different non-metallic biomaterials, a poly(l-lactide) (PLLA) woven tube, a nonwoven polyhydroxyalkanoates (PHA) fiber mat, and an injectable calcium phosphate cement (CPC). The purpose of this work was to evaluate the feasibility of IM-BM with mechanical testing as well as with an animal experiment. To perform mechanical testing, we fixed two longitudinal acrylic pipes with four different methods, and used them for a three-point bending test (N = 5). The three-point bending test revealed that the average fracture energy for the IM-BM group (PLLA + CPC + PHA) was 3 times greater than that of PLLA + CPC group, and 60 to 200 times greater than that of CPC + PHA group and CPC group. Using an osteoporotic rabbit distal femur incomplete fracture model, sixteen rabbits were randomly allocated into four experimental groups (IM-BM group, PLLA + CPC group, CPC group, Kirschner wire (K-wire) group). No rabbit in the IM-BM group suffered fracture displacement even under full weight bearing. In contrast, two rabbits in the PLLA + CPC group, three rabbits in the CPC group, and three rabbits in the K-wire group suffered fracture displacement within the first postoperative week. The present work demonstrated that IM-BM was strong enough to reinforce and stabilize incomplete fractures with both mechanical testing and an animal experiment even in the distal thigh, where bone is exposed to the highest bending and torsional stresses in the body. IM-BM can be one treatment option for those with severe osteoporosis. PMID:25111138

  3. One point fixation of zygomatic tripod fractures in the zygomatic buttress through Keen's intraoral approach: A review of 30 cases.

    PubMed

    Dakir, Abu; Muthumani, T; Prabu, N P; Mohan, Rakesh; Maity, Abhishek

    2015-04-01

    For decades, facial beauty and esthetics have been one of the most important quests of the human race. The lateral prominence and convexity of the zygomatic bone makes it the most important bone for providing the aesthetic facial look and sets up the facial width but at the same time this prominence and convexity makes this bone more vulnerable to injury. Zygomatic complex fractures or tripod fractures are the second most common fractures after nasal fractures among facial injuries. Several studies have been undertaken regarding the reduction and fixation of zygomatic fractures with mini plates and screws. In 2002 Fujioka et al in vivo studies successfully proved that one point fixation at the zygomaticomaxillary complex gives three point alignment and sufficient rigidity when the fractures are not comminuted. In this article, 30 cases have been reviewed with one point fixation of zygomatic complex tripod fractures at the zygomatic buttress through Keen's intraoral approach along with advantages and disadvantages. PMID:26015722

  4. Fixation of supraglenoid tubercle fractures using distal femoral locking plates in three Warmblood horses.

    PubMed

    Frei, Sina; Fürst, Anton E; Sacks, Murielle; Bischofberger, Andrea S

    2016-05-18

    Three horses that were presented with supraglenoid tubercle fractures were treated with open reduction and internal fixation using distal femoral locking plates (DFLP). Placing the DFLP caudal to the scapular spine in order to preserve the suprascapular nerve led to a stable fixation, however, it resulted in infraspinatus muscle atrophy and mild scapulohumeral joint instability (case 1). Placing the DFLP cranial to the scapular spine and under the suprascapular nerve resulted in a stable fixation, however, it resulted in severe atrophy of the supraspinatus and infraspinatus muscles and scapulohumeral joint instability (case 2). Placing the DFLP cranial to the scapular spine and slightly overbending it at the suprascapular nerve passage site resulted in the best outcome (case 3). Only a mild degree of supraspinatus and infraspinatus muscle atrophy was apparent, which resolved quickly and with no effect on scapulohumeral joint stability. In all cases, fixation of supraglenoid tubercle fractures using DFLP in slightly different techniques led to stable fixations with good long-term outcome. One case suffered from a mild incisional infection and plates were removed in two horses. Placement of the DFLP cranial to the scapular spine and slightly overbending it at the suprascapular nerve passage prevented major nerve damage. Further cases investigating the degree of muscle atrophy following the use of the DFLP placed in the above-described technique are justified to improve patient outcome. PMID:27070124

  5. [Arthroscopic fracture fixation of intercondylar eminence in children using instrumentarium for the reconstruction of anterior cruciate ligament].

    PubMed

    Sleczka, Paweł; Krzywoń, Jerzy; Ambrozy, Wojciech

    2010-01-01

    In our article we introduce a proposal of intercondylar tibial eminence fracture in children management. When dealing with II and III type fracture according to Mes and McKeever classification, we would like to suggest artroscopic fracture fixation with the help of a tension band wiring technique using single bundle reconstruction set of anterior cruciate ligament.The method mentioned above was presented on two cases managed in our ward. Stable fixation of this type fracture allows for quick mobilization and physiotherapy of a patient. It appears to be the key element to full recovery in articular surface fracture. PMID:21648155

  6. A biomechanical comparison of four different fixation methods for midshaft clavicle fractures.

    PubMed

    Chen, Yang; Yang, Yang; Ma, Xinlong; Xu, Weiguo; Ma, Jianxiong; Zhu, Shaowen; Ma, Baoyi; Xing, Dan

    2016-01-01

    Clavicle fractures may occur in all age groups, and 70%-80% of clavicle fractures occur in the midshaft. Many methods for treating midshaft clavicular fractures have been reported and remain controversial. To provide some guidance for clinical treatment, 30 artificial polymethyl methacrylate models of the clavicle were sewn obliquely at the midshaft to simulate the most common type of clavicular fractures, and the fracture models were divided into five groups randomly and were fixed as follows: the reconstruction plates were placed at the superior position of the fracture model (R-S group), the reconstruction plates were placed at the anteroinferior position of the fracture model (R-AI group), the locking plates were placed at the superior position (L-S group), the locking plates were placed at the anteroinferior position (L-AI group); and the control models were unfixed (control group). The strain gauges were attached to the bone surface near the fracture fragments, and then, the biomechanical properties of the specimens were measured using the compression test, torsion test and three-point bending test. The results showed that plate fixation can provide a stable construct to help with fracture healing and is the preferred method in the treatment of clavicle fractures. The locking plate provides the best biomechanical stability when placed at the anteroinferior position, and this surgical method can reduce the operation time and postoperative complications; thus, it would be a better choice in clinical practice. PMID:26586526

  7. Biomechanical analysis and clinical effects of bridge combined fixation system for femoral fractures.

    PubMed

    Wang, Da-xing; Xiong, Ying; Deng, Hong; Jia, Fu; Gu, Shao; Liu, Bai-lian; Li, Qun-hui; Pu, Qi; Zhang, Zhong-Zi

    2014-09-01

    This work aimed to compare the stress distribution and mechanical properties of our bridge combined fixation system and commonly used metal locking plate screw system by finite element analysis and by using the Zwick/Z100 testing machine. In addition, we also investigated the clinical outcome of our bridge combined fixation system for femoral fractures in 59 patients from June 2005 to January 2013. As a result, the stress distribution in the bone plate and screws of metal locking plate screw system during walking and climbing stairs was significantly lower than that of metal locking plate screw system. No significant difference in the displacement was observed between two systems. The equivalent bending stiffness of bridge combined fixation system was significantly lower than that of metal locking plate screw system. There were no significant differences in the bending strength, yield load, and maximum force between two systems. All the cases were followed up for 12-24 months (average 18 months). The X-ray showed bone callus was formed in most patients after 3 months, and the fracture line was faint and disappeared at 6-9 months postoperatively. No serious complications, such as implant breakage and wound infection, occurred postoperatively. According to self-developed standard for bone healing, clinical outcomes were rated as excellent or good in 55 out of 59 patients (success rate: 93.2%). Therefore, our findings suggest that our bridge combined fixation system may be a promising approach for treatment of long-bone fractures. PMID:25201264

  8. Pulmonary and cardiovascular consequences of immediate fixation or conservative management of long-bone fractures.

    PubMed

    Lozman, J; Deno, D C; Feustel, P J; Newell, J C; Stratton, H H; Sedransk, N; Dutton, R; Fortune, J B; Shah, D M

    1986-09-01

    We randomly assigned patients with multiple trauma who had tibial or femoral fractures to one of two groups--one group received immediate fixation of all fractures, and the second group received conservative orthopedic management, consisting of traction or plaster casts. Studies were conducted twice each day for four days following injury. Mean cardiac index was 1.3 L/min/m2 higher and mean shunt was 5.2% lower in the immediate fixation group compared with the group receiving conservative treatment. Other pulmonary and systemic hemodynamic variables did not differ between the groups. The incidence of fat macroglobules in blood aspirated from the pulmonary capillaries was higher when compared with that in pulmonary arterial blood but was not significantly different between the two treatment groups. Platelet count was significantly lower and fibrinogen concentration was significantly higher in the group receiving immediate fixation. We found no diagnostic significance of the incidence of fat macroglobules in samples of blood aspirated from the pulmonary circulation. We conclude that patients receiving immediate fixation had less pulmonary dysfunction following multiple trauma and long-bone fractures. PMID:3741107

  9. Retrograde intramedullary fixation of long bone fractures through ipsilateral traumatic amputation sites.

    PubMed

    Wagner, Scott C; Chi, Benjamin B; Gordon, Wade T; Potter, Benjamin K

    2015-06-01

    The technique of retrograde intramedullary fixation of fractures through open traumatic amputations has not been previously described. We performed a retrospective case series at a tertiary-care military hospital setting. Ten patients met inclusion criteria. All were male, and all were injured through improvised explosive device. Outcome measures included the incidence of fracture nonunion, osteomyelitis or acute infection, heterotopic ossification (HO), as well as successful prosthesis fitting and ambulation. Average time to fixation after injury and amputation closure was 11.7 and 12.2 days, respectively. Follow-up averaged 20.2 months. The radiographic union rate was 100%, and time to osseous union averaged 7.5 months. One patient had an amputation site infection requiring revision, but none of the nails was removed for infectious reasons. HO occurred in 7 patients, and 2 patients required revision for symptomatic HO. All patients were successfully fitted with prostheses and able to ambulate. To our knowledge, this is the only series in the literature to specifically describe retrograde intramedullary fixation of long bone fractures through the zone of traumatic amputation sites. The infectious risk is relatively low, whereas the union rate (100%) and successful prosthesis fitting are high. For patients with similar injuries, retrograde intramedullary fixation through the zone of amputation is a viable treatment option. PMID:25272202

  10. The Correlation between the Fracture Types and the Complications after Internal Fixation of the Femoral Neck Fractures

    PubMed Central

    Jo, Suenghwan; Lee, Hyeon Jun

    2016-01-01

    Purpose This study aims to determine the correlation between the fracture patterns and the complications in patients with femoral neck fracture treated with internal fixation. Materials and Methods The study comprises 45 patients with femoral neck fracture treated with multiple screws or compression hip screw between May 2008 and April 2012. The mean age was 48 years at the time of the surgery and the mean duration from initial injury to surgery was 20 hours. The fracture patterns were identified according to the anatomical location, the Garden classification and the Pauwels classification. The occurrence of nonunion and avascular necrosis were reviewed with clinical results including Harris hip score and Lunceford hip function test. The correlation between the fracture pattern and occurrence of complications were analyzed. Results Fracture site union was achieved in 40 hips with the average union time of 17 weeks. Five nonunions occurred which showed high likelihood to occur in subcapital type, displaced (Garden stage III or IV) and Pauwels type III fractures (P<0.05). Avascular necrosis was developed in 10 hips which was mostly in subcapital type and Pauwels type III fracture but no statistical significance was found (P>0.05). The mean Harris hip score was 91 points, and Lunceford functional results were excellent in 15 hips, good in 24, fair in 4 and poor in 2. Conclusion There was high risk of nonunion in subcapital type fracture, displaced fracture (Garden stage III and IV) and vertically oriented fracture (Pauwels type III). Careful attention is needed in these fracture types.

  11. COMPARISON OF VOLUMES OCCUPIED BY DIFFERENT INTERNAL FIXATION DEVICES FOR FEMORAL NECK FRACTURES

    PubMed Central

    Lauxen, Daniel; Schwartsmann, Carlos Roberto; Silva, Marcelo Faria; Spinelli, Leandro de Freitas; Strohaecker, Telmo Roberto; Souza, Ralf Wellis de; Zimmer, Cinthia Gabriely; Boschin, Leonardo Carbonera; Gonçalves, Ramiro Zilles; Yépez, Anthony Kerbes

    2015-01-01

    Objective: The objective of this paper is to measure the volume occupied by the most widely used internal fixation devices for treating femoral neck fractures, using the first 30, 40 and 50 mm of insertion of each screw as an approximation. The study aimed to observe which of these implants caused least bone aggression. Methods: Five types of cannulated screws and four types of dynamic hip screws (DHS) available on the Brazilian market were evaluated in terms of volume differences through water displacement. Results: Fixation with two cannulated screws presented significantly less volume than shown by DHS, for insertions of 30, 40 and 50 mm (p=0.01, 0.012 and 0.013, respectively), fixation with three screws did not show any statistically significant difference (p= 0.123, 0.08 and 0.381, respectively) and fixation with four cannulated screws presented larger volumes than shown by DHS (p=0.072, 0.161 and 0.033). Conclusions: Fixation of the femoral neck with two cannulated screws occupied less volume than DHS, with a statistically significant difference. The majority of screw combinations did not reach statistical significance, although fixation with four cannulated screws presented larger volumes on average than those occupied by DHS. PMID:27047886

  12. Short segment screw fixation without fusion in treatment for unstable thoracolumbar burst fracture

    PubMed Central

    Tang, Jiaguang; Liu, Yishan; Cao, Zheng; Hu, Yuan; Lu, Xiang; Lin, Bin

    2014-01-01

    This study aims to evaluate clinical efficacy of short segment pedicle screw fixation without bone fusion for unstable thoracolumbar burst fracture. Nineteen patients younger than 40 years old with unstable thoracolumbar burst fractures were included. The surgical procedure included postural reduction for 3 days and screw fixations at one level above, one level below and at the fractured level itself. The implants were removed 12 months after initial operation. Imaging and clinical findings were analyzed at preoperative, 12 months after surgery, just before implant removal, and at six months after implant removal. Results indicated that difference was statistically significant between preoperative period or postoperative 1 year follow-up, just before implant removal and 6 months after implant removal (P < 0.05). Results at postoperative 1 year follow-up, just before implant removal and 6 months after implant removal were better than preoperative period. There were no significant complications or neurological deterioration after screws insert and removal in any patient. The rate of clinical outcome with excellent and good was 94.7%. In conclusion, short segment pedicle screw fixation without bone fusion can be an effective and safe operative srategytechnique in the management of young patients suffering from unstable burst fracture. PMID:25664090

  13. Open reduction and internal fixation of posterior pilon fractures with buttress plate

    PubMed Central

    Chen, Da-wei; Li, Bing; Aubeeluck, Ashwin; Yang, Yun-feng; Zhou, Jia-qian; Yu, Guang-rong

    2014-01-01

    Objective: Posterior pilon fractures are rare injuries and have not yet gained well recognition. The purpose of this study was to present the treatment outcome for patients with posterior pilon fractures treated with buttress plate. Method: In this retrospective study we identified patients with posterior pilon fractures of the distal tibia who had undergone open reduction and internal fixation at our institute. Between January 2007 and December 2009, 10 patients (mean age, 46.5 years) who had undergone buttress plating via either a posterolateral approach or a dual posterolateral-posteromedial approach, were selected. All 10 patients were available for follow-up. The clinical outcome was evaluated with the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the visual analogue scale (VAS). The radiological evaluation was performed using the osteoarthritis-score (OA-score). Results: Satisfactory reduction and stable fixation were accomplished in all patients. At a mean follow-up of 36.2 months, all patients had good radiological results and showed satisfactory clinical recovery. The mean AOFAS sore was 87.8, the mean OA-score was 0.6, and the mean VAS scores during rest, active motion, and weight-bearing walking were 0.6, 0.8, and 1.4, respectively. Conclusion: Buttress plating for posterior pilon fractures gave satisfactory clinical outcomes. It also ensured rigid fixation which in turn enabled earlier postoperative mobilization. Level of Evidence IV, Retrospective Study. PMID:24644421

  14. Image-guided percutaneous internal fixation of sacral fracture.

    PubMed

    Kinon, Merritt D; Desai, Rupen; Loriaux, Daniel; Houten, John K

    2016-01-01

    Percutaneous iliosacral screw placement is a technically challenging procedure with a significant complication profile for misplaced screws. The use of stereotactic image guidance has been shown to provide superior accuracy in the placement of spinal instrumentation. Here, the authors describe a novel application of O-arm technology (Medtronic Sofamor Danek, Memphis, TN, USA) to help safely place iliosacral screws for the treatment of a traumatic sacral fracture. PMID:26433323

  15. Primary internal fixation and soft-tissue reconstruction in the treatment for an open Lisfranc fracture-dislocation.

    PubMed

    Sanli, Ilknur; Hermus, Joris; Poeze, Martijn

    2012-06-01

    The importance of anatomical reduction for improved outcome has been recognised in the management of Lisfranc injuries. Operative fixation is indicated in case of dislocation or unstable ligamentous injury, because discongruity of the Lisfranc joint can lead to deleterious functional outcome. Screws are the recommended method of fixation of the medial en middle column, and K-wires are used for stabilisation of the unstable lateral column. Primary arthrodesis can provide advantages in pure ligamentous injury. In the management of complex open Lisfranc fractures, external fixation with K-wires can be used, but often results in a high percentage of arc deformities and functional limitations. In recent years, there is a progressive change from external to internal fixation in primary stabilisation of open fractures. This case report describes the treatment for a grade III open Lisfranc fracture-dislocation by use of primary internal fixation and soft-tissue reconstruction. PMID:21706153

  16. Retromandibular approach in the management of condylar fractures by open reduction and internal fixation a prospective study

    PubMed Central

    Kshirsagar, Rajesh; Singh, Vikram; Pawar, Sudhir; Shah, Rahul

    2015-01-01

    Aim: To evaluate the efficacy and safety of the retromandibular approach in the management of condylar fractures by open reduction and internal fixation (ORIF). Materials and Methods: A total of 20 patients with unilateral mandibular condylar fractures underwent ORIF using retromandibular approach. Pertinent data were collected and subjected to evaluation. Results: The retromandibular approach was found to be expeditious in adequately exposing the fracture site and enabling ORIF. The anatomic reduction of the fractured segments and the fixation was satisfactory in all the cases. Average duration of surgery was 39 min (range: 17-56 min) for satisfactory exposure, reduction, and fixation of each condylar fracture. Conclusion: The retromandibular approach provides adequate exposure of the subcondylar region and should be considered as commendable alternative in the management of condylar fractures. PMID:27390493

  17. Locked META intramedullary nailing fixation for tibial fractures via a suprapatellar approach

    PubMed Central

    Fu, Beigang

    2016-01-01

    Background: Intramedullary nailing is an effective approach for treatment of diaphyseal tibial fractures. However, infrapatellar intramedullary nailing can easily cause angulation and rotation displacement at the fracture ends and increase risk of postoperative infection. Intramedullary nailing via the suprapatellar approach was proved with good reduction and fixation. We used locked intramedullary nailing for the treatment of tibial fractures via a suprapatellar approach in this study. Materials and Methods: 23 patients undergoing tibial fractures fixation by locked META intramedullary nailing via a suprapatellar approach were enrolled between June 2012 and October 2013. There were 18 males and 5 females. The average age was 35.5 years (range 18-60 years). The intraoperative data including operative time and blood loss and postoperative data consisting of hospital stays, fluoroscopy time, fracture healing time and complications were all recorded. Results: The average operative time, blood loss, fluoroscopy time and hospital stay were 78.2 ± 9.1 min, 90.4 ± 23.4 mL, 38.5 ± 6.5 s and 11 ± 3.4 days respectively. The mean followup period in all the patients was 15.5 months. Callus appeared in the patients at average 8 weeks after surgery. The mean knee and ankle range of motion were significantly improved at the last followup (P < 0.05). The average Hospital for Special Surgery and Olerud–Molander scores was 92 ± 4.3 points and 93.6 ± 3.9 points, respectively. No complications were observed. Conclusion: Locked META intramedullary nail fixation via a suprapatellar approach is safe and effective for patients suffering from tibial fractures and earlier functional recovery. PMID:27293289

  18. Surgical outcome of posterior short segment trans-pedicle screw fixation for thoracolumbar fractures

    PubMed Central

    Khare, Shailendra; Sharma, Vijay

    2013-01-01

    Background Vast majority of spine fractures in thoracolumbar region are unstable and often associated with neurological deficit. With the advancement of technology, these fractures are now more often managed operatively. The present study aimed at evaluating the role of open reduction & internal fixation using pedicle screws and short segment fixation in patients with Thoracic and Lumbar spine fractures. Design In this prospective study, 25 patients in age group of 15–65 years (mean age 28.25 years) with thoracolumbar fractures with associated neurological deficit or compression fractures with loss of more than 50% vertebral height or angulations more than 20° with or without neurological deficit were included. The results were evaluated based on restoration and maintenance of vertebral body height, spinal lordosis/kyphosis and evaluation of the neurological recovery which was done at regular intervals using Frankel's grading. Results The mean follow-up period was 20.3 months. The average preoperative kyphotic angle as measured by Cobbs method was 20° which improved to 7.8° following instrumentation. The average preoperative vertebral height was 58.65% which improved to 78.55% postoperatively. Preoperatively, only 20% of patients had useful paraplegia (Frankel grade D and E) while 80% had useless paraplegia (Frankel's grade C and below). Following surgery, 60% patients had useful paraplegia while 40% had useless paraplegia. Conclusion Short segment trans-pedicle posterior fixation is helpful for not only stabilization of the fractures and restoration of anatomy, but also maintaining the same over a period with good functional outcome. PMID:24396235

  19. Comparison of outcome of tibial plafond fractures managed by hybrid external fixation versus two-stage management with final plate fixation

    PubMed Central

    Cisneros, Luis Natera; Gómez, Mireia; Alvarez, Carlos; Millán, Angélica; De Caso, Julio; Soria, Laura

    2016-01-01

    Background: Tibial platfond fractures are usually associated with massive swelling of the foot and ankle, as well as with open wounds. This swelling may cause significant decrease of the blood flow, so the state of the soft tissue is determinant for the surgical indication and the type of implant. This retrospective study compares the union times in cases of tibial plafond fractures managed with a hybrid external fixation as a definitive procedure versus those managed with a two stage strategy with final plate fixation. Materials and Methods: A retrospective study in a polytrauma referral hospital was performed between 2005 and 2011. Patients with a tibial plafond fracture, managed with a hybrid external fixation as a definitive procedure or managed with a two stage strategy with the final plate fixation were included in the study. Postoperative radiographs were evaluated by two senior surgeons. Fracture healing was defined as callus bridging of one cortex, seen on both lateral and anteroposterior X-ray. The clinical outcome was evaluated by means of 11 points Numerical Rating Scale for pain and The American Orthopedic Foot and Ankle Society ankle score, assessed at the last followup visit. Thirteen patients had been managed with a hybrid external fixation and 18 with a two-stage strategy with the final plate fixation. There were 14 males and 17 females with a mean age of 48 years (range 19–82 years). The mean followup was 24 months (range 24–70 months). Results: The mean time from surgery to weight bearing was 7 ± 6.36 days for the hybrid fixation group and 57.43 ± 15.46 days for the plate fixation group (P < 0.0001); and the mean time from fracture to radiological union was 133.82 ± 37.83) and 152.8 ± 72.33 days respectively (P = 0.560). Conclusion: Besides the differences between groups regarding the baseline characteristics of patients, the results of this study suggest that in cases of tibial plafond fractures, the management with a hybrid external

  20. Implant failure in a proximal femoral fracture treated with dynamic hip screw fixation

    PubMed Central

    Dabis, John; Abdul-Jabar, Hani B.; Dabis, Hosam

    2015-01-01

    Dynamic hip screw fixation is a common orthopaedic procedure and to date, still can cause difficulties to the senior trauma surgeon. We present a case where an extra-capsular fracture of the proximal femur was managed with a dynamic hip screw (DHS) fixation. She proceeded to the operating theatre, where the fracture was stabilized with a 75-mm DHS and short-barrelled plate. The implant position was checked with intraoperative screening and the position accepted. Following attempted mobilization at 11 days post-operatively, the patient developed a recurrence of her preoperative pain. X-ray showed that the implant screw had separated from the barrel. Later scrutiny of the intraoperative screening films revealed that the barrel and screw were not engaged at the time of surgery. Intraoperative screening films should be carefully checked to ensure congruity of implant components. PMID:26136561

  1. Implant failure in a proximal femoral fracture treated with dynamic hip screw fixation.

    PubMed

    Dabis, John; Abdul-Jabar, Hani B; Dabis, Hosam

    2015-01-01

    Dynamic hip screw fixation is a common orthopaedic procedure and to date, still can cause difficulties to the senior trauma surgeon. We present a case where an extra-capsular fracture of the proximal femur was managed with a dynamic hip screw (DHS) fixation. She proceeded to the operating theatre, where the fracture was stabilized with a 75-mm DHS and short-barrelled plate. The implant position was checked with intraoperative screening and the position accepted. Following attempted mobilization at 11 days post-operatively, the patient developed a recurrence of her preoperative pain. X-ray showed that the implant screw had separated from the barrel. Later scrutiny of the intraoperative screening films revealed that the barrel and screw were not engaged at the time of surgery. Intraoperative screening films should be carefully checked to ensure congruity of implant components. PMID:26136561

  2. Open reduction and plate fixation of femoral shaft fractures in children aged 4 to 10.

    PubMed

    Eren, Osman Tugrul; Kucukkaya, Metin; Kockesen, Caglar; Kabukcuoglu, Yavuz; Kuzgun, Unal

    2003-01-01

    A retrospective review of 40 children aged 4 to 10 years with 46 femur fractures treated with open reduction and plate fixation is presented. Follow-up time was 6.3 years (range 2.5-17.5). There were no nonunions. One case of osteomyelitis and one refracture occurred. Leg-length discrepancy averaging 1.2 cm (range 0.4-1.8), with lengthening on the operated side, was observed in 15 patients. Although there is some risk for complications, and although good early results have been reported with elastic intramedullary nails, plate fixation continues to be a viable alternative in the surgical treatment of femoral shaft fractures in children aged 4 to 10. PMID:12604949

  3. Arthroscopically assisted fixation of the lesser trochanter fracture: a case series

    PubMed Central

    Khemka, Aditya; Raz, Guy; Bosley, Belinda; Ludger, Gerdesmeyer; Al Muderis, Munjed

    2014-01-01

    Avulsion fractures of the lesser trochanter in adolescents are uncommon. This injury is a result of a sudden forceful contraction of the iliopsoas tendon. It usually occurs during vigorous sport activity. Historically, these injuries were treated non-operatively, with guarded results, including weak hip flexor strength and non-union, hindering return to competitive sport. We report a series of three arthroscopically assisted fracture fixations performed by the senior author, using cannulated screw fixation in two cases and an anchor in one case. Mobilization was commenced immediately following surgery, allowing weight bearing as tolerated using crutches for 4 weeks, thereafter unaided walking was allowed. Patients were assessed at 2 weeks, 6 weeks, 3 months and 1-year post-operatively. Radiographs were utilized to confirm full union. All three patients were able to mobilize unaided by 4 weeks post-operatively and two of the three patients returned to competitive sport at 3 months. Near—anatomical union was achieved in all cases. No complications were noted during surgery and the peri-operative period in our series. The utilization of arthroscopic reduction and fixation of avulsion of the lesser trochanter results in good fixation and allows a faster recovery with a return to sports activity, and therefore, we suggest it as a viable treatment option for such injuries. PMID:27011799

  4. Arthroscopically assisted fixation of the lesser trochanter fracture: a case series.

    PubMed

    Khemka, Aditya; Raz, Guy; Bosley, Belinda; Ludger, Gerdesmeyer; Al Muderis, Munjed

    2014-07-01

    Avulsion fractures of the lesser trochanter in adolescents are uncommon. This injury is a result of a sudden forceful contraction of the iliopsoas tendon. It usually occurs during vigorous sport activity. Historically, these injuries were treated non-operatively, with guarded results, including weak hip flexor strength and non-union, hindering return to competitive sport. We report a series of three arthroscopically assisted fracture fixations performed by the senior author, using cannulated screw fixation in two cases and an anchor in one case. Mobilization was commenced immediately following surgery, allowing weight bearing as tolerated using crutches for 4 weeks, thereafter unaided walking was allowed. Patients were assessed at 2 weeks, 6 weeks, 3 months and 1-year post-operatively. Radiographs were utilized to confirm full union. All three patients were able to mobilize unaided by 4 weeks post-operatively and two of the three patients returned to competitive sport at 3 months. Near-anatomical union was achieved in all cases. No complications were noted during surgery and the peri-operative period in our series. The utilization of arthroscopic reduction and fixation of avulsion of the lesser trochanter results in good fixation and allows a faster recovery with a return to sports activity, and therefore, we suggest it as a viable treatment option for such injuries. PMID:27011799

  5. Technical tips for (dry) arthroscopic reduction and internal fixation of distal radius fractures.

    PubMed

    Del Piñal, Francisco

    2011-10-01

    Contrary to general belief, arthroscopic assisted reduction in distal radius fractures can be done in an expeditious manner and with minimal consumption of operating room resources. This article presents the steps for a pleasant arthroscopic experience in detail. The technique proposed combines the benefits of rigid fixation with volar locking plates (for the extra-articular component) and arthroscopic control of the reduction (for the articular component). It is important that the operation be carried out using the dry arthroscopic technique. However, arthroscopy is just an addition to conventional methods. Thorough knowledge of and facility with classic techniques of distal radius fracture treatment is essential for a good result. PMID:21971058

  6. [PDS cord fixation of sternoclavicular dislocation and para-articular clavicular fractures].

    PubMed

    Friedl, W; Fritz, T

    1994-05-01

    Sternoclavicular joint dislocation and para-articular fractures of the clavicle are rare injuries. Because severe complications of dorsal dislocations have often been seen and because functional impairment has often followed ventral dislocations, we treat most patients with such injuries operatively. Internal fixation with K-wires frequently leads to severe complications. We present our operation techniques with a resorbable 2 mm polydioxanon cord. This pack up technique can be used in both dislocations and para-articular fractures with no risk of implant dislocation. PMID:8052863

  7. Hybrid Anterolateral Approach for Open Reduction and Internal Fixation of Femoral Neck Fractures.

    PubMed

    Vopat, Bryan G; Daniels, Alan H; Lareau, Craig R; Christino, Melissa A; Kane, Patrick M; Hayda, Roman A; Born, Christopher T

    2015-07-01

    Displaced femoral neck fractures in physiologically young patients are best treated with anatomic reduction and stable fixation. Several surgical approaches to the femoral neck have previously been described, although they are fraught with disadvantages such as poor visualization, the need for 2 incisions, and risk of injury to the lateral femoral cutaneous nerve and branches of the medial femoral circumflex artery. The authors' hybrid anterolateral approach to the hip allows for excellent visualization of femoral neck fractures and for placement of plate and/or screw constructs through a single incision. This surgical technique additionally minimizes risk to neurovascular structures. PMID:26186310

  8. SUPRACONDYLAR FRACTURE OF THE HUMERUS IN CHILDREN: FIXATION WITH TWO CROSSED KIRSCHNER WIRES

    PubMed Central

    Carvalho, Roni Azevedo; Filho, Nelson Franco; Neto, Antonio Batalha Castello; Reis, Giulyano Dias; Dias, Marcos Pereira

    2015-01-01

    Objective: To analyze and present the surgical results from unstable supracondylar fractures of the humerus in children, treated by means of reduction and percutaneous fixation using two crossed Kirschner wires. Methods: A cross-sectional study was conducted on 20 children, taking into consideration sex, age at the time of the fracture, age at the time of the assessment, side affected, type and mechanism of trauma, postoperative complications and radiographic and clinic variables. Results: Ten fractures were observed in the left arm and ten in the right arm. The age at the time of the fracture ranged from 2 to 13 years (mean: 5.9 ± 2.48 years). Three fractures were classified as type II and 17 as type III. The length of follow-up ranged from four months to three years. Baumann's angle ranged from 69 to 100 (mean: 78.3) and cubitus varus was observed in four patients (values ranging from 84 to 100). According to the modified Flynn's criteria, 20 cases presented satisfactory outcomes: 17 excellent (85%), two good (10%) and one regular (5%). Two patients presented limited range of motion, two had paresthesia in the cubital region and one had transient neuropraxia of the ulnar nerve for six weeks. Conclusion: Percutaneous fixation with two crossed Kirschner wires leads to good results when carried out under direct viewing and with isolation of the ulnar nerve. PMID:27047887

  9. Long-term results following polydioxanone sling fixation technique in unstable lateral clavicle fracture.

    PubMed

    Teoh, Kar H; Jones, Sian A; Robinson, Juan D; Pritchard, Mark G

    2016-04-01

    Neer type II (Edinburgh type 3B) fractures of the lateral clavicle are unstable fractures. The optimal management of these fractures remains controversial with many surgical techniques described in the literature. Our study reports the long-term results of a modified suture (1.5-mm polydioxanone cord) and sling technique for these fractures to avoid complications associated with current techniques in the literature. Over a 5-year period, 23 patients who were (12 males, 11 females; 14 left, 9 right) with a mean age of 42 years were treated with this technique. At last follow-up, the mean Oxford score was 45.1 (range 36-48); the mean SPADI score was 7.4 (range 0-32.3); and the mean Constant score was 91.5 (range 71-100). There were one non-union and no malunion. All patients in our series, except one, returned to their pre-injury activity level. This modified suture fixation technique is safe, technically simple to perform and cheap. It achieves excellent rates of fracture union without the complications associated with other fixation methods in the literature. PMID:26794324

  10. Use of a hybrid external skeletal fixator for repair of a periarticular tibial fracture in a Patagonian cavy.

    PubMed

    Joyner, Priscilla H; Rochat, Mark C; Hoover, John P

    2004-04-15

    An 8-week-old female Patagonian cavy was examined because of acute right hind limb lameness; radiography revealed a moderately displaced, comminuted fracture of the proximal third of the tibia. The fracture was stabilized with a hybrid external skeletal fixator. Two Kirschner wires were placed in the main proximal fragment, parallel to the tibial plateau and at right angles to each other. These wires were connected to a partial circular external fixator ring. Three half pins were placed in the distal fragment, and a straight connecting rod positioned on the medial side of the limb was connected to these pins and the fixator ring. A second connecting rod was positioned on the craniomedial side of the limb and was connected to the fixator ring and a fourth half pin in the distal fragment. The fracture healed without complications, and the fixator was removed 3 weeks after surgery. Hybrid external skeletal fixators combine the benefits of circular and linear external skeletal fixation methods, enabling rigid fixation of periarticular long bone fractures without adversely affecting mobility of the adjacent joint. PMID:15112778

  11. Intraoperative Computed Tomography Navigation for Transpedicular Screw Fixation to Treat Unstable Thoracic and Lumbar Spine Fractures

    PubMed Central

    Lee, Ching-Yu; Wu, Meng-Huang; Li, Yen-Yao; Cheng, Chin-Chang; Hsu, Chu-Hsiang; Huang, Tsung-Jen; Hsu, Robert Wen-Wei

    2015-01-01

    Abstract Transpedicular screw (TPS) fixation in unstable thoracic and lumbar (TL) spine fractures remains technically difficult because of destroyed anatomical landmarks, unstable gross segments, and discrepancies in anatomic orientation using conventional anatomic landmarks, fluoroscopic guidance, or computed tomography (CT)-based navigation. In this study, we evaluated the safety and accuracy of TPS placement under intraoperative computed tomography (iCT) navigation in managing unstable TL spine fractures. From 2010 to 2013, we retrospectively reviewed the Spine Operation Registry records of patients who underwent posterior instrumented fusion to treat unstable TL spine fractures via the iCT navigation system. An unstable spine fracture was identified as AO/Magerl classification type B or type C. In all, 316 screws in 37 patients with unstable TL spine fractures were evaluated and involved 7 thoracic, 23 thoracolumbar junctional, and 7 lumbar fractures. The accuracy of TPS positioning in the pedicle without breach was 98% (310/316). The average number of iCT scans per patient was 2.1 (range 2–3). The average total radiation dose to patients was 15.8 mSv; the dose per single level exposure was 2.7 mSv. The TPS intraoperative revision rate was 0.6% (2/316) and no neurovascular sequela was observed. TPS fixation using the iCT navigation system obtained a 98% accuracy in stabilizing unstable TL spine fractures. A malplaced TPS could be revised during real-time confirmation of the TPS position, and no secondary operation was required to revise malplaced screws. The iCT navigation system provides accurate and safe management of unstable TL spine fractures. In addition, operating room personnel, including surgeons and nurses, did not need to wear heavy lead aprons as they were not exposed to radiation. PMID:25997042

  12. Wire internal fixation: an obsolete, yet valuable method for surgical management of facial fractures

    PubMed Central

    Bouletreau, Pierre; Konsem, Tarcissus; Traoré, Ibraïma; Coulibaly, Antoine Toua; Ouédraogo, Dieudonné

    2014-01-01

    In some developing countries wire is still widely used in facial fractures internal fixation. This study presents the effectiveness and complications of wire osteosynthesis in a university teaching hospital in Burkina Faso and discusses some of its other benefits and disadvantages. Notes of 227 patients with facial fractures treated by wire internal fixation at department of stomatology and maxillofacial surgery of CHU Souro Sanou, Burkina Faso between 2006 and 2010 are reviewed retrospectively. A satisfactory treatment outcome was recorded in 91.2% of the 227 patients. Complications occurred in 8.8% of the patients who had operative site infection (3.1%), malocclusion (1.8%), sensory disturbance (1.8), facial asymmetry (1.3%), delayed bone union (0.9%) or enophtalmos (0.4%). The overall complications rate was 7.4% after mandibular osteosynthesis, 6.9% after Le Fort osteosynthesis and 6.5% after zygoma osteosynthesis. Post operative infections occurred irrespective to the surgical site. The other complications were more specific to the surgical site. Wire internal fixation may be a reasonable alternative for the surgical treatment of non-comminuted facial fractures and those without bone substance loss, in the setting of limited resources. PMID:25237416

  13. A preliminary study of bending stiffness alteration in shape changing nitinol plates for fracture fixation.

    PubMed

    Olender, Gavin; Pfeifer, Ronny; Müller, Christian W; Gösling, Thomas; Barcikowski, Stephan; Hurschler, Christof

    2011-05-01

    Nitinol is a promising biomaterial based on its remarkable shape changing capacity, biocompatibility, and resilient mechanical properties. Until now, very limited applications have been tested for the use of Nitinol plates for fracture fixation in orthopaedics. Newly designed fracture-fixation plates are tested by four-point bending to examine a change in equivalent bending stiffness before and after shape transformation. The goal of stiffness alterable bone plates is to optimize the healing process during osteosynthesis in situ that is customized in time of onset, percent change as well as being performed non-invasively for the patient. The equivalent bending stiffness in plates of varying thicknesses changed before and after shape transformation in the range of 24-73% (p values <0.05 for all tests). Tests on a Nitinol plate of 3.0 mm increased in stiffness from 0.81 to 0.98 Nm² (corresponding standard deviation 0.08 and 0.05) and shared a good correlation to results from numerical calculation. The stiffness of the tested fracture-fixation plates can be altered in a consistent matter that would be predicted by determining the change of the cross-sectional area moment of inertia. PMID:21286815

  14. Delayed Union of a Sacral Fracture: Percutaneous Navigated Autologous Cancellous Bone Grafting and Screw Fixation

    SciTech Connect

    Huegli, R. W. Messmer, P.; Jacob, A. L.; Regazzoni, P.; Styger, S.; Gross, T.

    2003-09-15

    Delayed or non-union of a sacral fracture is a serious clinical condition that may include chronic pain, sitting discomfort, gait disturbances, neurological problems, and inability to work. It is also a difficult reconstruction problem. Late correction of the deformity is technically more demanding than the primary treatment of acute pelvic injuries. Open reduction, internal fixation (ORIF), excision of scar tissue, and bone grafting often in a multi-step approach are considered to be the treatment of choice in delayed unions of the pelvic ring. This procedure implies the risk of neurological and vascular injuries, infection, repeated failure of union, incomplete correction of the deformity, and incomplete pain relief as the most important complications. We report a new approach for minimally invasive treatment of a delayed union of the sacrum without vertical displacement. A patient who suffered a Malgaigne fracture (Tile C1.3) was initially treated with closed reduction and percutaneous screw fixation (CRPF) of the posterior pelvic ring under CT navigation and plating of the anterior pelvic ring. Three months after surgery he presented with increasing hip pain caused by a delayed union of the sacral fracture. The lesion was successfully treated percutaneously in a single step procedure using CT navigation for drilling of the delayed union, autologous bone grafting, and screw fixation.

  15. Triangular Fixation Technique for Bicolumn Restoration in Treatment of Distal Humerus Intercondylar Fracture

    PubMed Central

    Kang, Seung-Hoon; Jeong, Min; Lim, Hae-Seong

    2016-01-01

    Background Distal humerus intercondylar fractures are intra-articular and comminuted fractures involving soft tissue injury. As distal humerus is triangle-shaped, parallel plating coupled with articular fixation would be suitable for bicolumn restoration in treatment of distal humerus intercondylar fracture. Methods This study included 38 patients (15 males and 23 females) who underwent olecranon osteotomy, open reduction and internal fixation with the triangle-shaped cannulated screw and parallel locking plates (triangular fixation technique). Functional results were assessed with the visual analog scale (VAS) scores, Mayo elbow performance (MEP) scores and Disabilities of the Arm, Shoulder and Hand (DASH) questionnaires. Anteroposterior and lateral elbow radiographs were assessed for reduction, alignment, fracture union, posttraumatic arthrosis, and heterotopic ossification, and computed tomography (CT) scans were used to obtain more accurate measurements of articular discrepancy. Results All fractures healed primarily with no loss of reduction. The mean VAS, MEP, and DASH scores of the affected elbow were not significantly different from those of the unaffected elbow (p = 0.140, p = 0.090, and p = 0.262, respectively). The mean degree of flexion was significantly lower in the affected elbow than in the unaffected elbow, but was still considered as functional (p = 0.001, > 100° in 33 of 38 patients). Two cases of articular step-offs (> 2 mm) were seen on follow-up CT scans, but not significantly higher in the affected elbow than in the unaffected elbow (p = 0.657). Binary logistic regression analysis revealed that only Association for Osteosynthesis (AO) type C3 fractures correlated with good/excellent functional outcome (p = 0.012). Complications occurred in 12 of the 38 patients, and the overall reoperation rate for complications was 10.5% (4 of 38 patients). Conclusions Triangular fixation technique for bicolumn restoration was an effective and reliable

  16. Minifragment screw fixation of oblique metacarpal fractures: a biomechanical analysis of screw types and techniques.

    PubMed

    Liporace, Frank A; Kinchelow, Tosca; Gupta, Salil; Kubiak, Erik N; McDonnell, Matthew

    2008-12-01

    The lag screw technique has historically been a successful and accepted way to treat oblique metacarpal fractures. However, it does take additional time and involve multiple steps that can increase the risk of fracture propagation or comminution in the small hand bones of the hand. An alternate fixation technique uses bicortical interfragmentary screws. Other studies support the clinical effectiveness and ease of this technique. The purpose of this study is to biomechanically assess the strength of the bicortical interfragmentary screw versus that of the traditional lag screw. Using 48 cadaver metacarpals, oblique osteotomies were created and stabilized using one of four methods: 1.5 mm bicortical interfragmentary (IF) screw, 1.5 mm lag technique screw, 2.0 mm bicortical IF screw, or 2.0 mm lag technique screw. Biomechanical testing was performed to measure post cyclic displacement and load to failure. Data was analyzed using one-way analysis of variance (ANOVA). There was no significant difference among the fixation techniques with regard to both displacement and ultimate failure strength. There was a slight trend for a higher load to failure with the 2.0 mm IF screw and 2.0 mm lag screw compared to the 1.5 mm IF and 1.5 mm lag screws, but this was not significant. Our results support previously established clinical data that bicortical interfragmentary screw fixation is an effective treatment option for oblique metacarpal fractures. This technique has clinical importance because it is an option to appropriately stabilize the often small and difficult to control fracture fragments encountered in metacarpal fractures. PMID:18780019

  17. Endoscope-Assisted Transoral Fixation of Mandibular Condyle Fractures: Submandibular Versus Transoral Endoscopic Approach.

    PubMed

    Hwang, Na-Hyun; Lee, Yoon-Hwan; You, Hi-Jin; Yoon, Eul-Sik; Kim, Deok-Woo

    2016-07-01

    In recent years, endoscope-assisted transoral approach for condylar fracture treatment has attracted much attention. However, the surgical approach is technically challenging: the procedure requires specialized instruments and the surgeons experience a steep learning curve. During the transoral endoscopic (TE) approach several instruments are positioned through a narrow oral incision making endoscope maneuvering very difficult. For this reason, the authors changed the entry port of the endoscope from transoral to submandibular area through a small stab incision. The aim of this study is to assess the advantage of using the submandibular endoscopic intraoral approach (SEI).The SEI approach requires intraoral incision for fracture reduction and fixation, and 4 mm size submandibular stab incision for endoscope and traction wires. Fifteen patients with condyle neck and subcondyle fractures were operated under the submandibular approach and 15 patients with the same diagnosis were operated under the standard TE approach.The SEI approach allowed clear visualization of the posterior margin of the ramus and condyle, and the visual axis was parallel to the condyle ramus unit. The TE approach clearly shows the anterior margin of the condyle and the sigmoid notch. The surgical time of the SEI group was 128 minutes and the TE group was 120 minutes (P >0.05). All patients in the TE endoscope group were fixated with the trocar system, but only 2 lower neck fracture patients in the SEI group required a trocar. The other 13 subcondyle fractures were fixated with an angulated screw driver (P <0.05). There were no differences in complication and surgical outcomes.The submandibular endoscopic approach has an advantage of having more space with good visualization, and facilitated the use of an angulated screw driver. PMID:27380571

  18. Biomechanical evaluation of four different posterior screw and rod fixation techniques for the treatment of the odontoid fractures.

    PubMed

    Li, Lei; Liu, Wen-Fei; Jiang, Hong-Kun; Li, Yun-Peng

    2015-01-01

    Problems that screw cannot be inserted may occur in screw-rod fixation techniques such as Harms technique. We compared the biomechanical stability imparted to the C-2 vertebrae by four designed posterior screw and rod fixation techniques for the management of odontoid fractures. A three-dimensional finite element model of the odontoid fracture was established by subtracting several unit structures from the normal model from a healthy male volunteer. 4 different fixation techniques, shown as follows: ① C-1 lateral mass and C-2 pedicle screw fixation (Harms technique); ② C-1 lateral mass and unilateral C-2 pedicle screw fixation combined with ipsilateral laminar screw fixation; ③ Unilateral C-1lateral mass combined with ipsilateral C-1 posterior arch, and C-2 pedicle screw fixation; and ④ Unilateral C1 lateral mass screw connected with bilateral C2 pedicle screw fixation was performed on the odontoid fracture model. The model was validated for axial rotation, flexion, extension, lateral bending, and tension for 1.5 Nm. Changes in motion in flexion-extension, lateral bending, and axial rotation were calculated. The finite element model of the odontoid fracture was established in this paper. All of the four screw-rod techniques significantly decreased motion in flexion-extension, lateral bending, and axial rotation, as compared with the destabilized odontoid fracture complex (P<0.05). There was no statistically significant difference in stability among the four screw techniques. We concluded that the first three fixation techniques are recommended to be used as surgical intervention for odontoid fracture, while the last can be used as supplementary for the former three methods. PMID:26309508

  19. Biomechanical evaluation of four different posterior screw and rod fixation techniques for the treatment of the odontoid fractures

    PubMed Central

    Li, Lei; Liu, Wen-Fei; Jiang, Hong-Kun; Li, Yun-Peng

    2015-01-01

    Problems that screw cannot be inserted may occur in screw-rod fixation techniques such as Harms technique. We compared the biomechanical stability imparted to the C-2 vertebrae by four designed posterior screw and rod fixation techniques for the management of odontoid fractures. A three-dimensional finite element model of the odontoid fracture was established by subtracting several unit structures from the normal model from a healthy male volunteer. 4 different fixation techniques, shown as follows: ① C-1 lateral mass and C-2 pedicle screw fixation (Harms technique); ② C-1 lateral mass and unilateral C-2 pedicle screw fixation combined with ipsilateral laminar screw fixation; ③ Unilateral C-1lateral mass combined with ipsilateral C-1 posterior arch, and C-2 pedicle screw fixation; and ④ Unilateral C1 lateral mass screw connected with bilateral C2 pedicle screw fixation was performed on the odontoid fracture model. The model was validated for axial rotation, flexion, extension, lateral bending, and tension for 1.5 Nm. Changes in motion in flexion-extension, lateral bending, and axial rotation were calculated. The finite element model of the odontoid fracture was established in this paper. All of the four screw-rod techniques significantly decreased motion in flexion-extension, lateral bending, and axial rotation, as compared with the destabilized odontoid fracture complex (P<0.05). There was no statistically significant difference in stability among the four screw techniques. We concluded that the first three fixation techniques are recommended to be used as surgical intervention for odontoid fracture, while the last can be used as supplementary for the former three methods. PMID:26309508

  20. Comparison of stability of 2.0 mm standard and 2.0 mm locking miniplate/screws for the fixation of sagittal split ramus osteotomy on sheep mandibles.

    PubMed

    Oguz, Yener; Saglam, Haci; Dolanmaz, Dogan; Uckan, Sina

    2011-03-01

    Ten unembalmed adult sheep mandibles were used. The mandibles were sectioned in the midline, followed by sagittal split ramus osteotomies to obtain 20 hemimandibles. Each distal segment was advanced 5mm on each hemimandible. Ten of the specimens were fixed with 4-hole extended 2.0 mm titanium miniplates and screws and the other 10 were fixed with 4-hole extended 2.0 mm locking miniplates/screws. Each fixed specimen was mounted on a servo-hydraulic testing unit with the fixation device, and was tested to a range of forces of 0-140 N. The displacement values (mm) under 20, 60, 120, and 140 N were compared with the help of the Mann-Whitney U-test, and there were no significant differences between them at any force tested. Locking miniplate/screws and standard miniplate/screws showed similar displacement values at the range of forces tested. PMID:20226575

  1. Effects of different mandibular fracture patterns on the stability of miniplate screw fixation in angle mandibular fractures.

    PubMed

    Pektas, Z O; Bayram, B; Balcik, C; Develi, T; Uckan, S

    2012-03-01

    The aim of the present study was to evaluate the effects of horizontally favourable and unfavourable mandibular fracture patterns on the fixation stability of titanium plates and screws by simulating chewing forces. Favourable and unfavourable mandibular fractures on 22 sheep hemimandibles were fixed with 4-hole straight titanium plates and 2.0mm×7mm titanium screws according to the Champy technique. Hemimandibles were mounted with a fixation device in a servohydraulic testing unit for compressive testing. Displacement values under 20, 60, 100, 120, 150, 200N, maximum displacements, and maximum forces the model could resist before breakage were recorded and compared. The authors found no statistically significant differences between the groups for the displacement values in the force range 60-200N (60, 100, 120, 150 and 200N). Statistically significant differences for maximum displacement values (displacement values at the breaking forces) between the groups were found (P<0.05). There was no evidence for the need to apply different treatment modalities to mandibular fractures regardless of whether the factures are favourable or not. PMID:22178275

  2. Rotational osteoplasty and bioabsorbable polylactate pin fixation in Pipkin type 2 fracture with acute osteochondral defect: a case report.

    PubMed

    Maluta, Tommaso; Micheloni, Gian Mario; Sandri, Andrea; Regis, Dario; Costanzo, Alessandro; Magnan, Bruno

    2016-01-01

    Pipkin fractures are relative rare high-energy lesions characterized by an intra-articular fracture of the femoral head after posterior hip dislocation. Early anatomic reduction and stable fixation are the main goals of treatment. This case evaluates the outcome of managing Pipkin type 2 fracture with acute osteochondral defect of the femoral head using "rotational osteoplasty" and bioabsorbable polylactate pin fixation. 24-year-old male patient was involved in a motorcycle accident, suffering from a left hip fracture-dislocation, and pelvic Computed Tomography revealed a Pipkin type 2 lesion. An open urgent treatment was performed. After  anatomic reduction of the femoral head fragment a large osteochondral defect in the anterior-superior weight bearing surface was evident. The pattern of the fracture allowed us to perform a "rotational osteoplasty" including rotation of the femoral head fragment, to obtain an osteochondral cartilage congruence of the anterior-superior surface. Stable fixation was obtained by three bioabsorbable polylactate pins. At four-year follow up the patient had an excellent outcome and Magnetic Resonance Imaging (MRI) showed fracture healing, minimal signs of arthritis, excluding osteonecrosis of the femoral head. The reported case confirms that Pipkin fractures are very insidious surgical urgencies. In selected cases, "rotational osteoplasty" may be an alternative to osteochondral transplant for acute osteochondral defect of the femoral head. Bioabsorbable polylactate pin fixation allowed us to have a stable fixation evaluating the bone healing process and vitality of femoral head by MRI. PMID:27104330

  3. TREATMENT OF POST-TRAUMATIC HUMERAL FRACTURES AND COMPLICATIONS USING THE OSTEOLINE® EXTERNAL FIXATOR: A TREATMENT OPTION

    PubMed Central

    de Azevedo, Marcos Coelho; de Azevedo, Gualter Maldonado; Hayashi, Alexandre Yoshio; Dourado Nascimento, Paulo Emilio

    2015-01-01

    To evaluate the results obtained from treatment of humeral shaft fractures and their complications using the Osteoline® uniplanar external fixator. Methods: The radiographic and functional results from 78 patients with humeral shaft fractures treated using the uniplanar external fixation technique were retrospectively assessed. The patients' ages ranged from 23 to 71 years, with a mean of 47 years. Male patients predominated (79%). Out of the 78 patients, 45 presented open fractures, 14 presented pseudarthrosis and six presented synthesis failure. There were no losses during the follow-up and all the patients were discharged after fracture consolidation and functional recovery. The results were evaluated based on the studies by Catagni, as good, fair or poor. Results: Fracture consolidation was observed in 98% of the cases treated with uniplanar external fixation. Only one pseudarthrosis case required conversion to rigid internal fixation and autologous bone grafting. At the end of the treatment, all the patients were discharged with consolidated fractures, without pain, and good limb function. Conclusion: The external fixation described in this paper was shown to be an efficient and safe method for treating humeral shaft fractures and their complications. It preserved the local biological status and enabled passive and active movement immediately after surgery. PMID:27027026

  4. Biomechanical comparison of straight and helical compression plates for fixation of transverse and oblique bone fractures: Modeling and experiments.

    PubMed

    Sezek, Sinan; Aksakal, Bunyamin; Gürger, Murat; Malkoc, Melih; Say, Y

    2016-08-12

    Total deformation and stability of straight and helical compression plates were studied by means of the finite element method (FEM) and in vitro biomechanical experiments. Fixations of transverse (TF) and oblique (45°) bone (OF) fractures have been analyzed on sheep tibias by designing the straight compression (SP) and Helical Compression Plate (HP) models. The effects of axial compression, bending and torsion loads on both plating systems were analyzed in terms of total displacements. Numerical models and experimental models suggested that under compression loadings, bone fracture gap closures for both fracture types were found to be in the favor of helical plate designs. The helical plate (HP) fixations provided maximum torsional resistance compared to the (SP) fixations. The fracture gap closure and stability of helical plate fixation for transverse fractures was determined to be higher than that found for the oblique fractures. The comparison of average compression stress, bending and torsion moments showed that the FEM and experimental results are in good agreement and such designs are likely to have a positive impact in future bone fracture fixation designs. PMID:27567775

  5. Treatment of Humeral Shaft Fractures: Minimally Invasive Plate Osteosynthesis Versus Open Reduction and Internal Fixation

    PubMed Central

    Esmailiejah, Ali Akbar; Abbasian, Mohammad Reza; Safdari, Farshad; Ashoori, Keyqobad

    2015-01-01

    Background: The optimal technique for operative fixation of humeral shaft fractures remains controversial and warrants research. Objectives: The purpose of the current study was to compare the functional and clinical outcomes of conventional open reduction and internal fixation (ORIF) with minimally invasive plate osteosynthesis (MIPO) in patients with fractures in two-third distal humeral shaft. Patients and Methods: In the current prospective case-control study, 65 patients with humeral shaft fractures were treated using ORIF (33 patients) or MIPO (32 patients). Time of surgery, time of union, incidence of varus deformity and complications were compared between the two groups. Also, the university of California-Los Angeles (UCLA) shoulder rating scale and Mayo Elbow performance score (MEPS) were used to compare the functional outcomes between the two groups. Results: The median of union time was shorter in the MIPO group (4 months versus 5 months). The time of surgery and functional outcomes based on the UCLA and MEPS scores were the same. The incidence of varus deformity was more than 5° and was higher and the incidence of nonunion, infection and iatrogenic radial nerve injury were lower in the MIPO group; however, the differences were not significant. Conclusions: Due to the shorter union time, to some extent less complication rate and comparable functional and clinical results, the authors recommend to use the MIPO technique in treating the mid-distal humeral shaft fracture. PMID:26543844

  6. PERPENDICULAR DOUBLE-PLATE FIXATION WITH LOCKING SYSTEM FOR ACROMION PEDICLE FRACTURE

    PubMed Central

    Zhu, Junkun; Pan, Zhijun; Zheng, Rongzong; Lan, Shuhua

    2016-01-01

    Objective : To describe the surgical technique and preliminary clinical outcomes in a series of open reduction internal fixation of basal acromion process fractures applying a double-plating technique. Methods : Nine consecutive patients, mean age 33.4 years old (range, 23-61 years old) with unilateral acromion fracture (Type 3 AO/OTA) with more than 1cm displacement who underwent fixation utilizing a locked double-plating technique, were evaluated on average at 7.8 months (range, 3-15 months) for outcomes related to pain, shoulder function, and surgical complications. Results : Eight patients recovered with complete radiographic union and favorable shoulder function. One case failed to be fully evaluated for more than 3 months follow-up. The overall scores of Constant, Shoulder Pain and Disability Index (SPADI) and DASH for the eight patients reviewed were 91.9± 6.31, 3.11± 3.79 and 5.2± 6.35, respectively. No post-operative infection or surgical hardware irritation was identified at final follow-up of these eight patients. Conclusion : While more evidence is needed to justify its advantages over traditional implants, perpendicular double-plate with a locking system may be indicated for acromion pedicle fracture treatment, since it performed well for fracture healing and joint function rehabilitation. Level of Evidence IV, Therapeutic Study. PMID:26981047

  7. Volar Plate Fixation of Intra-Articular Distal Radius Fractures: A Retrospective Study

    PubMed Central

    Fok, Margaret W. M.; Klausmeyer, Melissa A.; Fernandez, Diego L.; Orbay, Jorge L.; Bergada, Alex Lluch

    2013-01-01

    Background Intra-articular fractures of the distal radius represent a therapeutic challenge as compared with the unstable extra-articular fractures. With the recent development of specifically designed internal fixation materials for the distal radius, treatment of these fractures by fragment-specific implants using two or more incisions has been advocated. Purpose The purpose of this study was to investigate the efficacy of a fixed-angle locking plate applied through a single volar approach in maintaining the radiographic alignment of unstable intra-articular fractures as well as to report the clinical outcomes. We only excluded those with massive comminution, as is discussed in greater detail in the text. Patients and Methods This is a multicentered, retrospective study involving three hospitals situated in Spain, Switzerland, and the United States. In the period between January 2000 and March 2006, 97 patients with 101 intra-articular distal radius fractures, including 13 volarly displaced and 88 dorsally angulated fractures were analyzed. Over 80% were C2/C3 fractures, based on the AO classification. 16 open fractures were noted. Results With an average follow-up of 28 months (range 24-70 months), the range of movement of the wrist was very satisfactory, and the mean grip strength was 81% of the opposite wrist. The Disabilities of the Arm, Shoulder, and Hand (DASH) score was 8. The complications rate was < 5%, including loss of reduction in two patients. All fractures healed by 3 months postinjury. Conclusions Irrespective of the direction and amount of initial displacement, a great majority of intra-articular fractures of the distal radius can be managed with a fixed-angle volar plate through a single volar approach. Level IV retrospective case series PMID:24436824

  8. Use of the trochanteric flip osteotomy to facilitate internal fixation of a femoral head fracture.

    PubMed

    Gillespie, James A; Marsh, Andrew G; Patil, Sanjeev R

    2016-01-01

    We report the case of a 42-year-old male who suffered a fracture-dislocation of the femoral head. After a closed reduction of the hip, this proceeded to an open reduction with internal fixation of the fractured femoral head, in addition to labral repair and micro-fracture of an articular cartilage defect. After considering the risks to the femoral head blood supply, the trochanteric flip osteotomy was used. This provided ample and safe exposure. At 14 months follow-up, the patient-reported outcome measures are favourable: modified Harris Hip Score (81/100), the non-arthritic hip score (92.5/100) and SF-12 (41/48). PMID:27470013

  9. Plating versus intramedullary fixation for mid-shaft clavicle fractures: a systemic review and meta-analysis.

    PubMed

    Gao, Yan; Chen, Wei; Liu, Yue-Jv; Li, Xu; Wang, Hai-Li; Chen, Zhao-Yu

    2016-01-01

    Background. Plate fixation and intramedullary fixation are the most commonly used surgical treatment options for mid-shaft clavicle fractures; the latter method has demonstrated better performance in some studies. Objectives. Our aim was to critically review and summarize the literature comparing the outcomes of mid-shaft clavicle fracture treatment with plate fixation or intramedullary fixation to identify the better approach. Search Methods. Potential academic articles were identified from the Cochrane Library, MEDLINE (1966-2015.5), PubMed (1966-2015.5), EMBASE (1980-2015.5) and ScienceDirect (1966-2015.5). Gray studies were identified from the references of the included literature. Selection Criteria. Randomized controlled trials (RCTs) and non-RCTs comparing plate fixation and intramedullary fixation for mid-shaft clavicle fracture were included. Data Collection and Analysis. Two reviewers performed independent data abstraction. The I (2) statistic was used to assess heterogeneity. A fixed- or random-effects model was used for the meta-analysis. Results. Six RCTs and nine non-RCTs were retrieved, including 513 patients in the intramedullary fixation group and 521 patients in the plating group. No significant differences in terms of the union rate and shoulder function were found between the groups. Patients in the intramedullary fixation group had a shorter operative time, less blood loss, smaller wound size, and shorter union time than those in the plating group. With respect to complications, significant differences were identified for all complications and major complications (wound infection, nonunion, implant failures, transient brachial plexopathy, and pain after 6 months). Similar secondary complications (symptomatic hardware, hardware irritation, prominence, numbness, hypertrophic callus) were observed in both groups. Conclusions. Intramedullary fixation may be superior to plate fixation in the treatment of mid-shaft clavicle fractures, with similar

  10. Plating versus intramedullary fixation for mid-shaft clavicle fractures: a systemic review and meta-analysis

    PubMed Central

    Gao, Yan; Chen, Wei; Liu, Yue-Jv; Li, Xu; Wang, Hai-Li

    2016-01-01

    Background. Plate fixation and intramedullary fixation are the most commonly used surgical treatment options for mid-shaft clavicle fractures; the latter method has demonstrated better performance in some studies. Objectives. Our aim was to critically review and summarize the literature comparing the outcomes of mid-shaft clavicle fracture treatment with plate fixation or intramedullary fixation to identify the better approach. Search Methods. Potential academic articles were identified from the Cochrane Library, MEDLINE (1966-2015.5), PubMed (1966-2015.5), EMBASE (1980-2015.5) and ScienceDirect (1966-2015.5). Gray studies were identified from the references of the included literature. Selection Criteria. Randomized controlled trials (RCTs) and non-RCTs comparing plate fixation and intramedullary fixation for mid-shaft clavicle fracture were included. Data Collection and Analysis. Two reviewers performed independent data abstraction. The I2 statistic was used to assess heterogeneity. A fixed- or random-effects model was used for the meta-analysis. Results. Six RCTs and nine non-RCTs were retrieved, including 513 patients in the intramedullary fixation group and 521 patients in the plating group. No significant differences in terms of the union rate and shoulder function were found between the groups. Patients in the intramedullary fixation group had a shorter operative time, less blood loss, smaller wound size, and shorter union time than those in the plating group. With respect to complications, significant differences were identified for all complications and major complications (wound infection, nonunion, implant failures, transient brachial plexopathy, and pain after 6 months). Similar secondary complications (symptomatic hardware, hardware irritation, prominence, numbness, hypertrophic callus) were observed in both groups. Conclusions. Intramedullary fixation may be superior to plate fixation in the treatment of mid-shaft clavicle fractures, with similar

  11. Long contoured locking plate fixation of traumatic proximal humeral fractures with distal extension

    PubMed Central

    George Malal, Joby J; Arouri, Faten; Noorani, Ali M; Kent, Matthew; Smith, Matt; Guisasola, Inigo; Brownson, Peter

    2014-01-01

    Background There is a paucity of data available with respect to outcome on long contoured locking plate fixation for proximal humerus fractures with distal fracture extension. Methods Thirty-four patients with traumatic proximal humerus fractures with distal extension underwent fixation with long contoured locking plates. Twenty-five patients (74%) were included in the study: one patient died, two patients had unrelated illnesses resulting in them being unable to complete follow-up assessment and six were lost to follow-up. Patients’ case notes and radiographs were retrospectively reviewed, and patients were contacted to assess functional outcome using the Visual Analogue Scale (VAS) for pain, Disabilities of the Arm, Shoulder and Hand (DASH) score, Oxford Shoulder Score (OSS) and Stanmore Percentage of Normal Shoulder Assessment (SPONSA). Results Mean follow-up was 27 months (range 11 months to 60 months). Mean pain at final follow-up was 3.6 [95% confidence interval (CI) = 2.5 to 4.8] with only four patients having residual pain greater than 5 on the VAS scale. Mean DASH score was 41.2 (95% CI = 32.0 to 50.4), mean OSS was 29.1 (95% CI = 24.3 to 33.9) and mean SPONSA was 63.9% (95% CI = 50.8 to 77.2). There was one wound infection. Three patients had non-unions that required bone grafting and revision internal fixation. Conclusions We feel long contoured locking plates represent a useful treatment option for complex proximal humerus fractures

  12. Open reduction and internal fixation of displaced clavicle fractures in adolescents.

    PubMed

    Hosalkar, Harish S; Parikh, Gaurav; Bomar, James D; Bittersohl, Bernd

    2012-01-01

    The literature available on patient oriented outcomes of operative management for clavicle fractures in adolescents is fairly limited. The purpose of this study was to analyze the potential of open reduction and internal fixation for displaced mid-shaft clavicle fractures in adolescent patients. We reviewed our series of surgical cases performed in 19 adolescents (mean age: 14.6 years) with displaced unilateral clavicle fractures. Baseline data acquisition included demographic and radiographic variables. A Synthes(®) LCP clavicular plate was utilized for fixation in all cases. Follow-up data included functional outcome assessment using the Quick Disability of Arm, Shoulder, and Hand Questionnaire (DASH), the simple shoulder test (SST) and additional binary questions. At a mean follow-up of 16 months, quick DASH scores were 4.0 (range: 0-35.5) and mean number of positive yes responses on the SST for all operative patients was 11 (range: 9-12). All cases proved complete radiological union at the 3-month follow-up. All patients returned to full athletics at a mean time of 14 weeks (range: 12-17 weeks). Two patients had minimal hypertrophic scars while no patient was noted with keloid formation or neurovascular deficit. One patient complained of implant prominence and occasional symptoms of discomfort at the 15 month follow-up and opted for implant removal. This was successfully performed with uneventful full recovery. All patients were fully satisfied with their choice for surgical intervention. Anatomical reduction with internal fixation and early mobilization of adolescent displaced clavicle fractures remains a viable treatment option with predictable results and no major complications in reliable hands. PMID:22577497

  13. Open reduction and internal fixation of displaced clavicle fractures in adolescents

    PubMed Central

    Hosalkar, Harish S.; Parikh, Gaurav; Bomar, James D.; Bittersohl, Bernd

    2011-01-01

    The literature available on patient oriented outcomes of operative management for clavicle fractures in adolescents is fairly limited. The purpose of this study was to analyze the potential of open reduction and internal fixation for displaced mid-shaft clavicle fractures in adolescent patients. We reviewed our series of surgical cases performed in 19 adolescents (mean age: 14.6 years) with displaced unilateral clavicle fractures. Baseline data acquisition included demographic and radiographic variables. A Synthes® LCP clavicular plate was utilized for fixation in all cases. Follow-up data included functional outcome assessment using the Quick Disability of Arm, Shoulder, and Hand Questionnaire (DASH), the simple shoulder test (SST) and additional binary questions. At a mean follow-up of 16 months, quick DASH scores were 4.0 (range: 0–35.5) and mean number of positive yes responses on the SST for all operative patients was 11 (range: 9–12). All cases proved complete radiological union at the 3-month follow-up. All patients returned to full athletics at a mean time of 14 weeks (range: 12–17 weeks). Two patients had minimal hypertrophic scars while no patient was noted with keloid formation or neurovascular deficit. One patient complained of implant prominence and occasional symptoms of discomfort at the 15 month follow-up and opted for implant removal. This was successfully performed with uneventful full recovery. All patients were fully satisfied with their choice for surgical intervention. Anatomical reduction with internal fixation and early mobilization of adolescent displaced clavicle fractures remains a viable treatment option with predictable results and no major complications in reliable hands. PMID:22577497

  14. Ankle fracture configuration following treatment with and without arthroscopic-assisted reduction and fixation

    PubMed Central

    Angthong, Chayanin

    2016-01-01

    AIM: To report ankle fracture configurations and bone quality following arthroscopic-assisted reduction and internal-fixation (ARIF) or open reduction and internal-fixation (ORIF). METHODS: The patients of ARIF (n = 16) or ORIF (n = 29) to treat unstable ankle fracture between 2006 and 2014 were reviewed retrospectively. Baseline data, including age, sex, type of injury, immediate postoperative fracture configuration (assessed on X-rays and graded by widest gap and largest step-off of any intra-articular site), bone quality [assessed with bone mineral density (BMD) testing] and arthritic changes on X-rays following surgical treatments were recorded for each group. RESULTS: Immediate-postoperative fracture configurations did not differ significantly between the ARIF and ORIF groups. There were anatomic alignments as 8 (50%) and 8 (27.6%) patients in ARIF and ORIF groups (P = 0.539) respectively. There were acceptable alignments as 12 (75%) and 17 (58.6%) patients in ARIF and ORIF groups (P = 0.341) respectively. The arthritic changes in follow-up period as at least 16 wk following the surgeries were shown as 6 (75%) and 10 (83.3%) patients in ARIF and ORIF groups (P = 0.300) respectively. Significantly more BMD tests were performed in patients aged > 60 years (P < 0.001), ARIF patients (P = 0.021), and female patients (P = 0.029). There was no significant difference in BMD test t scores between the two groups. CONCLUSION: Ankle fracture configurations following surgeries are similar between ARIF and ORIF groups, suggesting that ARIF is not superior to ORIF in treatment of unstable ankle fractures. PMID:27114933

  15. Management of Unstable Thoracolumbar Spinal Fractures by Pedicle Screws and Rods Fixation

    PubMed Central

    B.M., Muralidhar; Hegde, Durgaprasad; Hussain, P.S.B.

    2014-01-01

    Background: The thoracolumbar junction is the most common area of injury to the axial skeleton. Forces along the long stiff kyphotic thoracic spine switch abruptly into the mobile lordotic lumbar spine at the thoracolumbar junction. Goals of treatment are to obtain a painless, balanced, stable spine with optimum neurological function and maximum spine mobility. The present prospective study has evaluated the effectiveness of pedicle screw instrumentation in various fractures around the TL spine to overcome the complications encountered in the conservative line of management of these fractures. Materials & Methods: Thirty cases of fractures around the TL spine were operated with posterior pedicle screw fixation one or two level above and below the fracture. The cases were followed up for a mean of 9.5 months with radiological and neurological evaluation. Results: The average age groups of the patients studied were 21 to 53 years majority were males, fall from height being the predominant mode of injury involving the T12 and L1 vertebral body. The unstable burst fractures the most common type of fracture, radiological parameters sagittal angle and index were recorded pre and post-operatively. The neurological grading was done using the ASIA score. Follow-up was done for a minimum of 5 months where sagittal angle reduction achieved was 10.75 at final follow-up from 23.5 pre-operative. The sagittal index achieved at final follow-up was 72% compared to the pre-operative mean of 53%. The neurological improvement was regarded to be fair enough for the type of injury sustained and fixation achieved. Conclusion: We found that the application of posterior instrumentation using pedicle screw and rod resulted in a reasonable correction of the deformity with a significant reduction in recumbency-associated complications; the limiting factor being the small study group and short follow-up period. PMID:24701500

  16. Monitoring immune responses in a mouse model of fracture fixation with and without Staphylococcus aureus osteomyelitis.

    PubMed

    Rochford, Edward T J; Sabaté Brescó, Marina; Zeiter, Stephan; Kluge, Katharina; Poulsson, Alexandra; Ziegler, Mario; Richards, R Geoff; O'Mahony, Liam; Moriarty, T Fintan

    2016-02-01

    Post-traumatic bone fractures are commonly fixed with implanted devices to restore the anatomical position of bone fragments and aid in the healing process. Bacterial infection in this situation is a challenge for clinicians due to the need for aggressive antibiotic therapy, debridement of infected tissues, and the need to maintain fracture stability. The aim of this study was to monitor immune responses that occur during healing and during Staphylococcus aureus infection, in a clinically relevant murine model of fracture fixation. Skeletally mature C57bl/6 mice received a transverse osteotomy of the femur, which was treated with commercially available titanium fracture fixation plates and screws. In the absence of infection, healing of the fracture was complete within 35days and was characterized by elevated Interleukin (IL)-4 and Interferon-gamma secretion from bone-derived cells and expression of these same genes. In contrast, mice inoculated with S. aureus could not heal the fracture within the observation period and were found to develop typical signs of implant-associated bone infection, including biofilm formation on the implant and osteolysis of surrounding bone. The immune response to infection was characterized by a TH17-led bone response, and a pro-inflammatory cytokine-led Tumor necrosis factor (TNF)-α, Interleukin (IL)-1β) soft tissue response, both of which were ineffectual in clearing implant related bone and soft tissue infections respectively. In this murine model, we characterize the kinetics of pro-inflammatory responses to infection, secondary to bone trauma and surgery. A divergent local immune polarization is evident in the infected versus non-infected animals, with the immune response ultimately unable to clear the S. aureus infection. PMID:26525592

  17. [Original vacuum dressing for the treatment of open femur fracture with gangrene immobilized by external fixation].

    PubMed

    Debarge, R; Pinaroli, A; Caillot, J-L; Voiglio, E-J

    2008-02-01

    We report a case of gangrene, which developed following an open fracture of the femur immobilized with an external fixator in a 45-year-old patient. A conventional vacuum dressing (VAC Therapy) could not be applied with the external fixator in place. An original vacuum dressing was thus fashioned after surgical debridement. Scabs were covered with calcium alginate. The lower limb was enveloped in sterile dressings and vacuum was achieved by suction with gastric tubes under adhesive films. The dressing was redone every 48 h in a surgical setting. Antibiotic prophylaxis enabled cure of the infection. Budding appeared within two weeks enabling skin grafting. Centro-medullary nailing was undertaken on day 30 to accelerate bone healing. At three months from the trauma, the initial loss of sensitivity in the leg and foot noted at the first weight bearing required programmed disarticulation of the knee after femur and wound healing. At six months, the patient had resumed his occupational activities and was pain free. This type of dressing could be useful for tissue loss over a fracture immobilized with an external fixator. This type of assembly can easily be installed in the operating room. PMID:18342034

  18. Posterior internal fixation plus vertebral bone implantation under navigational aid for thoracolumbar fracture treatment

    PubMed Central

    ZHOU, WEI; KONG, WEIQING; ZHAO, BIZHEN; FU, YISHAN; ZHANG, TAO; XU, JIANGUANG

    2013-01-01

    The aim of this study was to investigate the method of posterior thoracolumbar vertebral pedicle screw reduction and fixation combined with vertebral bone implantation via the affected vertebral body under navigational aid for the treatment of thoracolumbar fractures. The efficacy of the procedure was also measured. Between June 2005 and March 2011, posterior thoracolumbar vertebral pedicle screw reduction and fixation plus artificial bone implantation via the affected vertebral pedicle under navigational aid was used to treat 30 patients with thoracolumbar fractures, including 18 males and 12 females, ranging in age from 21 to 57 years. Compared with the values prior to surgery, intraspinal occupation, vertebral height ratio and Cobb angle at the follow-up were significantly improved. At the long-term follow-up, the postoperative Cobb angle loss was <1° and the anterior vertebral body height loss was <2 mm. Posterior thoracolumbar vertebral pedicle screw reduction and fixation combined with vertebral bone implantation via the affected vertebral body under navigational aid may increase the accuracy and safety of surgery, and it is an ideal method of internal implantation. Bone implantation via the affected vertebral body may increase vertebral stability. PMID:23935737

  19. A new volar plate DiPhos-RM for fixation of distal radius fracture: preliminary report.

    PubMed

    Tarallo, Luigi; Mugnai, Raffaele; Adani, Roberto; Catani, Fabio

    2013-03-01

    We analyzed the efficiency of a new plate DiPhos-RM in CFR-PEEK [carbon-fiber-reinforced poly (etheretherketone)] for the volar fixation of distal radius fractures. The new plate's composition has the advantage of x-ray absolute transparency, therefore allowing to monitor the healing of the fracture. The desired combination of high strength and low rigidity is obtained through the use of the polymer composites CFR-PEEK. In this preliminary study (from March 2012 to June 2012), 10 cases of intra-articular distal radius fractures were treated with DiPhos-RM produced by Lima Corporate (Italy). The fractures were classified according to the AO classification, 4 fractures were type C1, 3 type C2, and 3 were A2. A preoperative computed tomography scan was carried out in all patients. One patient also underwent a postoperative computed tomography scan. Grip strength, range of motion, and DASH score were evaluated at follow-up. There were no cases of hardware failure. Specifically, no loss of position or alignment of fixed-angle locking screws or breakage of the plate were observed. Radiographic union was present at an average of 6 weeks (range, 5 to 8 wk). The overall preliminary experience with this new plate is favorable. The new plate is easy to apply and provides the surgeon dual options of fixed-angle or variable-angle screws. It was rigid enough to maintain the reduction also in AO type C articular fractures. PMID:23423235

  20. Arthroscopic evaluation for omalgia patients undergoing the clavicular hook plate fixation of distal clavicle fractures

    PubMed Central

    2014-01-01

    Background The aim of this study is to investigate the anatomic changes in the shoulder joints responsible for omalgia after the clavicular hook plate fixation under arthroscope. Methods Arthroscopic examination was carried out for 12 omalgia patients who underwent clavicular hook plate fixation due to distal clavicle fractures. Functional outcome of shoulder was measured by the Japanese Orthopaedic Association (JOA) score before and after the withdrawal of the fixation plate. Results The rotator cuff compression by the clavicular hook was arthroscopically observed in 11 of the 12 cases. The JOA scores of the shoulder were significantly improved at 1 month after the withdrawal of the fixation plate (pain, 28 ± 2.4 vs. 15 ± 5.2; function, 19.2 ± 1.0 vs. 11.7 ± 1.9; range of movements, 26.8 ± 2.6 vs. 14.8 ± 3.4) compared with before. Conclusions The impingement of the hook to the rotator cuff may be the main cause for the omalgia. The appropriate hook and plate that fit to the curve of the clavicle as well as the acromion are necessary to decrease the severity of omalgia. PMID:24917508

  1. Comminuted olecranon fracture fixation with pre-contoured plate: Comparison of composite and cadaver bones

    PubMed Central

    Hamilton Jr, David A; Reilly, Danielle; Wipf, Felix; Kamineni, Srinath

    2015-01-01

    AIM: To determine whether use of a precontoured olecranon plate provides adequate fixation to withstand supraphysiologic force in a comminuted olecranon fracture model. METHODS: Five samples of fourth generation composite bones and five samples of fresh frozen human cadaveric left ulnae were utilized for this study. The cadaveric specimens underwent dual-energy X-ray absorptiometry (DEXA) scanning to quantify the bone quality. The composite and cadaveric bones were prepared by creating a comminuted olecranon fracture and fixed with a pre-contoured olecranon plate with locking screws. Construct stiffness and failure load were measured by subjecting specimens to cantilever bending moments until failure. Fracture site motion was measured with differential variable resistance transducer spanning the fracture. Statistical analysis was performed with two-tailed Mann-Whitney-U test with Monte Carlo Exact test. RESULTS: There was a significant difference in fixation stiffness and strength between the composite bones and human cadaver bones. Failure modes differed in cadaveric and composite specimens. The load to failure for the composite bones (n = 5) and human cadaver bones (n = 5) specimens were 10.67 nm (range 9.40-11.91 nm) and 13.05 nm (range 12.59-15.38 nm) respectively. This difference was statistically significant (P ˂ 0.007, 97% power). Median stiffness for composite bones and human cadaver bones specimens were 5.69 nm/mm (range 4.69-6.80 nm/mm) and 7.55 nm/mm (range 6.31-7.72 nm/mm). There was a significant difference for stiffness (P ˂ 0.033, 79% power) between composite bones and cadaveric bones. No correlation was found between the DEXA results and stiffness. All cadaveric specimens withstood the physiologic load anticipated postoperatively. Catastrophic failure occurred in all composite specimens. All failures resulted from composite bone failure at the distal screw site and not hardware failure. There were no catastrophic fracture failures in the cadaveric

  2. Treatment of an open book pelvic fracture and bilateral femoral fractures with an external fixator in a 14-month-old: a case report.

    PubMed

    Atherton, Thomas G; Chase, Helen E; Stohr, Kuldeep; Melton, Joel T K

    2016-05-01

    A 14-month-old girl was involved in a road traffic accident that resulted in an open book pelvic fracture and bilateral femoral fractures. Acute treatment involved a novel collar and the cuff pelvic closure technique to tamponade the pelvis and reduce bleeding. The patient was treated surgically with an external fixator, which provided good reduction of the pelvic and femoral fractures. A literature search found no previous information on open book pelvic fractures in infants younger than 2 years. The success of this surgery led us to suggest that the use of an external fixator is a potential treatment method for open book pelvic fractures and bilateral femoral fractures in extremely young infants. PMID:26717190

  3. One Month Old Neglected Lisfrancs Fracture Dislocation Treated with Wagner’s External Fixator and Percutaneous Screw Fixation : A Case Report

    PubMed Central

    Kale, Dinesh R; Khadabadi, Nikhil A; Putti, Babu B; Jatti, Ravi S

    2014-01-01

    Introduction: Lisfrancs Fracture dislocation is not commonly seen and it often goes missed leading to numerous complications. We present a case of neglected Lisfrancs fracture dislocation who presented after 1 month and its management. Case Report: A 27-year-old man came with the complaints of pain and swelling of the right foot following a fall from a motorcycle 1 month back. On Radiographic evaluation it showed presence Lisfrancs fracture Dislocation with comminuted fracture of the proximal phalanx of the great toe and distal fibula fracture. Closed reduction was attempted initially which was unsuccessful and was followed by open reduction which also failed. Reduction was then achieved using Wagner’s external fixation distractor device and supplemented with percutaneously passed screws. The external fixator was continued for 3 weeks followed by below knee cast for 6 weeks. The patient regained normal gait and returned to work and his previous physical activity level without recurrent dislocation. Conclusion: This report highlights the necessity of prompt open reduction and the need of external fixation to achieve and maintain reduction in case of neglected cases. We advocate this approach to achieve reduction in neglected cases where open reduction is unsuccessful. PMID:27298958

  4. Management of mandibular angle fracture.

    PubMed

    Braasch, Daniel Cameron; Abubaker, A Omar

    2013-11-01

    Fractures through the angle of the mandible are one of the most common facial fractures. The management of such fractures has been controversial, however. This controversy is related to the anatomic relations and complex biomechanical aspects of the mandibular angle. The debate has become even more heated since the evolution of rigid fixation and the ability to provide adequate stability of the fractured segments. This article provides an overview of the special anatomic and biomechanical features of the mandibular angle and their impact on the management of these fractures. PMID:24183373

  5. Finite element analysis of three patterns of internal fixation of fractures of the mandibular condyle.

    PubMed

    Aquilina, Peter; Chamoli, Uphar; Parr, William C H; Clausen, Philip D; Wroe, Stephen

    2013-06-01

    The most stable pattern of internal fixation for fractures of the mandibular condyle is a matter for ongoing discussion. In this study we investigated the stability of three commonly used patterns of plate fixation, and constructed finite element models of a simulated mandibular condylar fracture. The completed models were heterogeneous in the distribution of bony material properties, contained about 1.2 million elements, and incorporated simulated jaw-adducting musculature. Models were run assuming linear elasticity and isotropic material properties for bone. This model was considerably larger and more complex than previous finite element models that have been used to analyse the biomechanical behaviour of differing plating techniques. The use of two parallel 2.0 titanium miniplates gave a more stable configuration with lower mean element stresses and displacements over the use of a single miniplate. In addition, a parallel orientation of two miniplates resulted in lower stresses and displacements than did the use of two miniplates in an offset pattern. The use of two parallel titanium plates resulted in a superior biomechanical result as defined by mean element stresses and relative movement between the fractured fragments in these finite element models. PMID:22981343

  6. Transmasseteric antero-parotid facelift approach for open reduction and internal fixation of condylar fractures

    PubMed Central

    2015-01-01

    Surgical approaches to the condylar fracture include intraoral, preauricular, submandibular, and retromandibular approaches. Each approach has its own advantages and disadvantages. When a patient needs esthetic results and an intraoral approach is not feasible, the transmasseteric antero-parotid facelift approach is considered. This approach permits direct exposure and allow the surgeon to fixate the fractured unit tangentially. Tangential fixation is critical to osteosynthesis. Disadvantages of the transmasseteric antero-parotid facelift approach include damage to the facial nerve and a longer operation time. However, after the initial learning curve, facial nerve damage can be avoided and operation time may decrease. We report three cases of subcondylar fractures that were treated with a transmasseteric antero-parotid facelift approach. Among these, two cases had trivial complications that were easily overcome. Instead of dissecting through the parotid gland parenchyma, the transmasseteric antero-parotid facelift approach uses transmasseteric dissection and reduces facial nerve damage more than the retromandibular transparotid approach. The esthetic result is superior to that of other approaches. PMID:26131433

  7. Femoral neck shortening after internal fixation of a femoral neck fracture.

    PubMed

    Zielinski, Stephanie M; Keijsers, Noël L; Praet, Stephan F E; Heetveld, Martin J; Bhandari, Mohit; Wilssens, Jean Pierre; Patka, Peter; Van Lieshout, Esther M M

    2013-07-01

    This study assesses femoral neck shortening and its effect on gait pattern and muscle strength in patients with femoral neck fractures treated with internal fixation. Seventy-six patients from a multicenter randomized controlled trial participated. Patient characteristics and Short Form 12 and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were collected. Femoral neck shortening, gait parameters, and maximum isometric forces of the hip muscles were measured and differences between the fractured and contralateral leg were calculated. Variables of patients with little or no shortening, moderate shortening, and severe shortening were compared using univariate and multivariate analyses. Median femoral neck shortening was 1.1 cm. Subtle changes in gait pattern, reduced gait velocity, and reduced abductor muscle strength were observed. Age, weight, and Pauwels classification were risk factors for femoral neck shortening. Femoral neck shortening decreased gait velocity and seemed to impair gait symmetry and physical functioning. In conclusion, internal fixation of femoral neck fractures results in permanent physical limitations. The relatively young and healthy patients in our study seem capable of compensating. Attention should be paid to femoral neck shortening and proper correction with a heel lift, as inadequate correction may cause physical complaints and influence outcome. PMID:23823040

  8. External fixation of intra-articular fracture of the distal radius in young and old adults.

    PubMed

    Huch, K; Hünerbein, M; Meeder, P J

    1996-01-01

    Forty patients (18-89 years old, mean 58 years) with comminuted intra-articular fractures of the distal radial end (AO-type C 2 or C 3) treated with external fixation could be followed for an average of 2.3 years. After 3 weeks, the distraction was released, and after another 3 weeks, the device was removed. Complications seen were one malunion, one radial shaft fracture caused by excentric drilling of a Schanz screw, one Sudeck atrophy, and one subcutaneous pin-track infection. Radial and ulnar deviations were reduced to 52% and 71% of the untreated wrist, whereas the range of motion in the other planes reached about 80% or more of the healthy side. In all, 82.5% of the patients showed good or excellent radiological and functional results. This study demonstrates that external fixation of distal radial C 2 and 3 fractures for 6 weeks results in good recovery for young patients and elderly patients with osteoporosis. PMID:8775708

  9. Enhancement of Apoptosis by Titanium Alloy Internal Fixations during Microwave Treatments for Fractures: An Animal Study

    PubMed Central

    Zhang, Lina; Ye, Dongmei; Feng, Xianxuan; Fu, Tengfei; Bai, Yuehong

    2015-01-01

    Objective Microwaves are used in one method of physical therapy and can increase muscle tissue temperature which is useful for improving muscle, tendon and bone injuries. In the study, we sought to determine whether titanium alloy internal fixations influence apoptosis in tissues subjected to microwave treatments at 2,450 MHz and 40 W during the healing of fractures because this issue is not yet fully understood. Methods In this study, titanium alloy internal fixations were used to treat 3.0-mm transverse osteotomies in the middle of New Zealand rabbits’ femurs. After the operation, 30-day microwave treatments were applied to the 3.0 mm transverse osteotomies 3 days after the operation. The changes in the temperatures of the muscle tissues in front of the implants or the 3.0 mm transverse osteotomies were measured during the microwave treatments. To characterize the effects of titanium alloy internal fixations on apoptosis in the muscles after microwave treatment, we performed TUNEL assays, fluorescent real-time (quantitative) PCR, western blotting analyses, reactive oxygen species (ROS) detection and transmission electron microscopy examinations. Results The temperatures were markedly increased in the animals with the titanium alloy implants. Apoptosis in the muscle cells of the implanted group was significantly more extensive than that in the non-implanted control group at different time points. Transmission electron microscopy examinations of the skeletal muscles of the implanted groups revealed muscular mitochondrial swelling, vacuolization. ROS, Bax and Hsp70 were up-regulated, and Bcl-2 was down-regulated in the implanted group. Conclusion Our results suggest that titanium alloy internal fixations caused greater muscular tissue cell apoptosis following 2,450 MHz, 40 W microwave treatments in this rabbit femur fracture models. PMID:26132082

  10. Comparison of external fixation, locking and non-locking palmar plating for unstable distal radius fractures in the elderly

    PubMed Central

    Schmelzer-Schmied, N.; Wieloch, P.; Martini, A. K.

    2008-01-01

    This study compares the effectiveness of locking and non-locking palmar plating and external fixation for unstable distal radius fractures in the elderly. In a retrospective match-paired study, 45 patients aged 50 to 70 years who underwent surgery for C1/C2 distal radius fractures were evaluated. The surgical procedures were external fixation or plating with locking or non-locking palmar plates. Radiological and functional outcomes were assessed. Outcomes according to Gartland and Werley, Martini and the Disability of the Arm, Shoulder and Hand (DASH) questionnaire were compared. The locking palmar plate fixation method demonstrated significantly better radiological and functional results in comparison to external fixation and the non-locking palmar plating methods. The subjective assessment of plate fixation proved to be better than that of external fixation. Complications and reoperations were fewer for both plate fixation groups. Our data indicates that most displaced intra-articular distal radius fractures can be treated successfully with the locking palmar plate. PMID:18193224