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Sample records for mandible fracture fixations

  1. Management of pediatric mandible fractures.

    PubMed

    Goth, Stephen; Sawatari, Yoh; Peleg, Michael

    2012-01-01

    The pediatric mandible fracture is a rare occurrence when compared with the number of mandible fractures that occur within the adult population. Although the clinician who manages facial fractures may never encounter a pediatric mandible fracture, it is a unique injury that warrants a comprehensive discussion. Because of the unique anatomy, dentition, and growth of the pediatric patient, the management of a pediatric mandible fracture requires true diligence with a variance in treatment ranging from soft diet to open reduction and internal fixation. In addition to the variability in treatment, any trauma to the face of a child requires additional management factors including child abuse issues and long-term sequelae involving skeletal growth, which may affect facial symmetry and occlusion. The following is a review of the incidence, relevant anatomy, clinical and radiographic examination, and treatment modalities for specific fracture types of the pediatric mandible based on the clinical experience at the University of Miami/Jackson Memorial Hospital Oral and Maxillofacial Surgery program. In addition, a review of the literature regarding the management of the pediatric mandible fracture was performed to offer a more comprehensive overview of this unique subset of facial fractures. PMID:22337373

  2. Fractures of the growing mandible.

    PubMed

    Kushner, George M; Tiwana, Paul S

    2009-03-01

    Oral and maxillofacial surgeons must constantly weigh the risks of surgical intervention for pediatric mandible fractures against the wonderful healing capacity of children. The majority of pediatric mandibular fractures can be managed with closed techniques using short periods of maxillomandibular fixation or training elastics alone. Generally, the use of plate- and screw-type internal fixation is reserved for difficult fractures. This article details general and special considerations for this surgery including: craniofacial growth & development, surgical anatomy, epidemiology evaluation, various fractures, the role rigid internal fixation and the Risdon cable in pediatric maxillofacial trauma. It concludes with suggestions concerning long-term follow-up care in light of the mobility, insurance obstacles, and family dynamics facing the patient population.

  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. Analysis of Fractured Mandible Over Two Decades.

    PubMed

    Oruç, Melike; Işik, Veysel Murat; Kankaya, Yüksel; Gürsoy, Koray; Sungur, Nezih; Aslan, Gürcan; Koçer, Uğur

    2016-09-01

    Mandible fractures have a special place within the injuries of the other bones of the maxillofacial system. In their management, cosmetic issues and functional aspects such as chewing, speaking, and swallowing become very important.In this study, a retrospective analysis of 419 mandible fractures in 283 patients was performed in relation to epidemiologic factors, treatment strategies, and complications. The average age was 32.14 years (4-69 years). The male/female ratio was 4/1. The most frequent etiologic factor was interpersonal violence (104 patients, 36.7%). The parasymphysis region was the mostly affected site (28.4%). A total of 157 patients (55.5%) were presented with single fracture and the rest with 2, 3, or 4 fracture lines on the mandible. The most common fracture combination was angulus-parasymphysis fracture combination (24.6%). Open reduction and fixation with mini plates and screws was the most preferred treatment strategy (48.2%). Transient short arch bars were not used intraoperatively for any of the patients. There was not any difference in terms of complications between the patients treated with plating systems and plating systems plus intermaxillary fixation.In conclusion, proper treatment of mandible fractures is critical. Except certain fracture types, the usage of intermaxillary fixation as an adjunct to fixation with plating systems is not necessary. PMID:27536913

  5. Analysis of Fractured Mandible Over Two Decades

    PubMed Central

    Oruç, Melike; Işik, Veysel Murat; Kankaya, Yüksel; Gürsoy, Koray; Sungur, Nezih; Aslan, Gürcan; Koçer, Uğur

    2016-01-01

    Abstract Mandible fractures have a special place within the injuries of the other bones of the maxillofacial system. In their management, cosmetic issues and functional aspects such as chewing, speaking, and swallowing become very important. In this study, a retrospective analysis of 419 mandible fractures in 283 patients was performed in relation to epidemiologic factors, treatment strategies, and complications. The average age was 32.14 years (4–69 years). The male/female ratio was 4/1. The most frequent etiologic factor was interpersonal violence (104 patients, 36.7%). The parasymphysis region was the mostly affected site (28.4%). A total of 157 patients (55.5%) were presented with single fracture and the rest with 2, 3, or 4 fracture lines on the mandible. The most common fracture combination was angulus–parasymphysis fracture combination (24.6%). Open reduction and fixation with mini plates and screws was the most preferred treatment strategy (48.2%). Transient short arch bars were not used intraoperatively for any of the patients. There was not any difference in terms of complications between the patients treated with plating systems and plating systems plus intermaxillary fixation. In conclusion, proper treatment of mandible fractures is critical. Except certain fracture types, the usage of intermaxillary fixation as an adjunct to fixation with plating systems is not necessary. PMID:27536913

  6. Miniplate osteosynthesis of fractures of the edentulous mandible.

    PubMed

    Mugino, Hiroshi; Takagi, Shinji; Oya, Ryoichi; Nakamura, Syoichi; Ikemura, Kunio

    2005-12-01

    This study was performed to analyze treatment of fractures of the edentulous mandible and to discuss this method in relation to the mandibular height at the fracture site. Fifteen fracture sites in 11 patients with an edentulous mandible were retrospectively examined. These fractures were located: nine fractures in the mandibular body, three in the paramedian region, and three in the mandibular angle. Fractures in a mandible measuring more than 10 mm in the vertical height were treated with one miniplate. Fractures in an extremely atrophic mandible with 10 mm or less were treated using one or two miniplates, also using a modified Champy plate with 1.3 mm in thickness. A mandibular fracture with a height of 5 mm was treated with a combination of a microplate on the buccal side and a miniplate on the inferior border of the mandible with additional direct circumferential wiring. Oblique or splitting fractures were treated with direct circumferential wiring or a Herbert screw, at one fracture site each, respectively. Complications, including infection, fibrous union, nonunion and trismus, were not seen. In one patient, hypesthesia of the lower lip was, however, persistent 1 month after surgery. Miniplate osteosynthesis is the less invasive treatment, and it is suitable for fractures of the atrophic edentulous mandible, except for comminuted or defect fractures. To obtain stable fixation in severely atrophic mandibles, we need to consider the use of two miniplates or a combination with microplates. PMID:16311742

  7. Fractures of angle of mandible – A retrospective study

    PubMed Central

    Singh, Sourav; Fry, Ramesh R.; Joshi, Ajit; Sharma, Geeta; Singh, Smita

    2012-01-01

    Aims This retrospective study was done to evaluate the efficacy of single miniplate osteosynthesis at superior border of angle of mandible. Material and methods In this study 50 patients were treated by single miniplate osteosynthesis according to Champy's principle. Bite force generated was used as a parameter for judging the efficacy of internal fixation. In this article we present our experience over the years in the management of the fractures of angle of mandible based on this model. Results Most patients were of 21–30 yrs of age with unilateral angle fracture of mandible except one patient who had isolated bilateral angle fracture. The patients were treated successfully according to Champy's principle of osteosynthesis. There was a progressive improvement in the bite force generated after osteosynthesis. Conclusions The angle of the mandible is an anatomically weak and an area susceptible to fracture. The presence of an impacted or partially erupted third molar tooth further weakens it. Angle of mandible is the most common site for fracture however, bilateral angle fracture is very rare and uncommon. Osteosynthesis according to Champy's model led to an early functional improvement as demonstrated by the bite force generated. PMID:25737858

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

    PubMed

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

    2014-08-07

    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.

  9. 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

  10. Biomechanical Concepts for Fracture Fixation.

    PubMed

    Bottlang, Michael; Schemitsch, Christine E; Nauth, Aaron; Routt, Milton; Egol, Kenneth A; Cook, Gillian E; Schemitsch, Emil H

    2015-12-01

    Application of the correct fixation construct is critical for fracture healing and long-term stability; however, it is a complex issue with numerous significant factors. This review describes a number of common fracture types and evaluates their currently available fracture fixation constructs. In the setting of complex elbow instability, stable fixation or radial head replacement with an appropriately sized implant in conjunction with ligamentous repair is required to restore stability. For unstable sacral fractures with vertical or multiplanar instabilities, "standard" iliosacral screw fixation is not sufficient. Periprosthetic femur fractures, in particular Vancouver B1 fractures, have increased stability when using 90/90 fixation versus a single locking plate. Far cortical locking combines the concept of dynamization with locked plating to achieve superior healing of a distal femur fracture. Finally, there is no ideal construct for syndesmotic fracture stabilization; however, these fractures should be fixed using a device that allows for sufficient motion in the syndesmosis. In general, orthopaedic surgeons should select a fracture fixation construct that restores stability and promotes healing at the fracture site, while reducing the potential for fixation failure.

  11. 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

  12. 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

  13. Nonbridging external fixation of distal radius fractures.

    PubMed

    Eichenbaum, Matthew D; Shin, Eon K

    2010-08-01

    Surgical management of distal radius fractures continues to evolve because of their high incidence in an increasingly active elderly population. Traditional radiocarpal external fixation relies on ligamentotaxis for fracture reduction but has several drawbacks. Nonbridging external fixation has evolved to provide early wrist mobility in the setting of anatomic fracture reduction. Several studies of the nonbridging technique have demonstrated satisfactory results in isolated nonbridging external fixation series and in comparison with traditional spanning external fixation. Nonbridging external fixation for surgical treatment of distal radius fractures can be technically demanding and requires at least 1 cm of intact volar cortex in the distal fracture fragment for successful implementation.

  14. Aspiration pneumonia associated with a double fracture of the mandible.

    PubMed

    Ohba, Seigo; Yoshimura, Hitoshi; Matsuda, Shinpei; Sano, Kazuo

    2014-11-01

    Aspiration pneumonia is one of the most life-threatening diseases in the elderly. A 73-year-old woman was diagnosed with aspiration pneumonia after a mandibular fracture. Because her persistent aspiration pneumonia was accompanied by a diminished swallowing function that was believed to be due to a double fracture of the mandible, the patient underwent an open reduction while having pneumonia. Her symptoms of aspiration pneumonia improved immediately after the surgery. The hyoid bone was repositioned to its original position, and the movements of the hyoid bone and mandible were recovered after the surgery. In cases in which the medial bone segment of the mandible moves inside because of a double fracture and the movement of the hyoid bone declines, we strongly suggest that an open reduction should be performed as soon as possible to prevent aspiration pneumonia caused by a swallowing dysfunction.

  15. Management and treatment of a mandible fracture in an athlete.

    PubMed

    Koloskie, J; Orr, D L

    1992-01-01

    The purpose of this paper is to demonstrate a treatment program that may permit a student-athlete who has a mandible fracture to continue participation in a sport without further jeopardizing his or her health. This article is based on an actual case in which a student-athlete sustained a mandible fracture during an intercollegiate basketball game. Within 24 hours, the injured athlete resumed basketball practice. Three days following the injury, he was permitted to compete in a game. In addition to recommendations regarding acute care, we discuss protective equipment, follow-up guidelines, and nutritional considerations. These guidelines may assist the sports medicine team in determining when an athlete with a mandible fracture can return to competitive and contact sports.

  16. 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.

  17. 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

  18. 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

  19. 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

  20. 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

  1. [Blood circulation features by treatment of multiply mandible fractures by means of transosseus osteosynthesis].

    PubMed

    Krasnov, V V; Kononovich, N A

    2013-01-01

    The multiple injury of the mandible was modeled experimentally in 27 adult mongrel dogs with subsequent fixation using a device for transosseous osteosynthesis. The special features of soft tissue hemodynamics in the injury zone and contralateral symmetrical part were studied. It has been determined that the unidirectional changes in functional properties of the arterial bed vessels occur under the conditions created, and these changes are more marked on the injury side and characterized by vasodilatation. Circulation in the injury zone doesn't recover by the end of fixation. Performing the measures directed for the improvement of vascular elastotonic properties during mandibular fracture treatment will allow to decrease the degree of hemodynamics disorders in paraosseous tissues, as well as will have a positive effect on a final clinical outcome.

  2. Fracture biology, biomechanics, and internal fixation.

    PubMed

    Trostle, S S; Markel, M D

    1996-03-01

    The success of orthopedic surgery in ruminants is directly related to the surgeon's knowledge and understanding of bone physiology and mechanics. The relationship of the macro and micro structure and function of bone as it relates to fracture physiology and repair is discussed. A basic review of the biomechanical principles of bone, bone fracture, and fracture repair are presented. The clinical and biomechanical principles of internal fixation are described for fracture repair in ruminants.

  3. 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.

  4. A Complication of Posterior Malleolar Fracture Fixation.

    PubMed

    Patel, Ankit; Charles, Loren; Ritchie, James

    2016-01-01

    We present a case of tibial nerve impingement by an anteroposterior screw inserted for stabilization of a posterior malleolar fracture. This specific complication has not previously been described in published studies, although numerous reports have described various forms of peripheral nerve entrapment. We discuss the merits of fixation of these fractures using a posterolateral approach.

  5. Complications in operative fixation of calcaneal fractures

    PubMed Central

    Li, Ying; Bao, Rong-Hua; Jiang, Zhi-Qiang; Wu, Huo-Yan

    2016-01-01

    Objective: The purpose of this study focused on a number of factors that have been implicated in calcaneal complications and find the incidence of wound complications. Methods: This was a retrospective study. A total of 162 patients (176 feet) who underwent calcaneal fractures between 2007 and 2012 were included. The patient’s personal details, age, time from injury to surgery, cause of injury, type of fracture, operative details, operating and tourniquet times were collected from hospital computers and paper records. Evidence of complications including wound infection, wound necrosis, pain, malunion, nonunion, impingement, loss of fixation, ect were studied. Results: Forty-seven of one hundred and seventy-six fractures (26.704%) had complications, wound infection was noted in seven fractures (3.977%), twelve fractures developed necrosis (6.818%), 14 fractures (7.955%) developed pain. Malunion was found in five fractures (2.841%), nonunion in two fractures (1.136%) and loss of fixation in four fractures (2.272%). Three neurologic injury was also seen in our study (1.705%). Operating time, time from injury to surgery and type of fracture had some association with complications in operative fixation of calcaneal fractures, which showed a statistically significant improvement (P=0.000, 0.031, 0.020, respectively), but there were no evidence that age and tourniquet time affect the incidence of complication after calcaneal fracture surgery (P=0.119, 0.682, respectively). Conclusions: Despite developments in the surgical treatment of calcaneal fracture, wound complications still remain inevitable. Advanced imaging techniques, less invasive surgical procedures, wealth of anatomical knowledge, surgical experience and better postoperative care should be ensured.

  6. Complications in operative fixation of calcaneal fractures

    PubMed Central

    Li, Ying; Bao, Rong-Hua; Jiang, Zhi-Qiang; Wu, Huo-Yan

    2016-01-01

    Objective: The purpose of this study focused on a number of factors that have been implicated in calcaneal complications and find the incidence of wound complications. Methods: This was a retrospective study. A total of 162 patients (176 feet) who underwent calcaneal fractures between 2007 and 2012 were included. The patient’s personal details, age, time from injury to surgery, cause of injury, type of fracture, operative details, operating and tourniquet times were collected from hospital computers and paper records. Evidence of complications including wound infection, wound necrosis, pain, malunion, nonunion, impingement, loss of fixation, ect were studied. Results: Forty-seven of one hundred and seventy-six fractures (26.704%) had complications, wound infection was noted in seven fractures (3.977%), twelve fractures developed necrosis (6.818%), 14 fractures (7.955%) developed pain. Malunion was found in five fractures (2.841%), nonunion in two fractures (1.136%) and loss of fixation in four fractures (2.272%). Three neurologic injury was also seen in our study (1.705%). Operating time, time from injury to surgery and type of fracture had some association with complications in operative fixation of calcaneal fractures, which showed a statistically significant improvement (P=0.000, 0.031, 0.020, respectively), but there were no evidence that age and tourniquet time affect the incidence of complication after calcaneal fracture surgery (P=0.119, 0.682, respectively). Conclusions: Despite developments in the surgical treatment of calcaneal fracture, wound complications still remain inevitable. Advanced imaging techniques, less invasive surgical procedures, wealth of anatomical knowledge, surgical experience and better postoperative care should be ensured. PMID:27648028

  7. 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

  8. 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

  9. Mechanical Comparison of Headless Screw Fixation and Locking Plate Fixation for Talar Neck Fractures.

    PubMed

    Karakasli, Ahmet; Hapa, Onur; Erduran, Mehmet; Dincer, Cemal; Cecen, Berivan; Havitcioglu, Hasan

    2015-01-01

    For talar neck fractures, open reduction and internal fixation have been thought to facilitate revascularization and prevent osteonecrosis. Newer screw systems allow for placement of cannulated headless screws, which provide compression by virtue of a variable pitch thread. The present study compared the biomechanical fixation strength of cannulated headless variable-pitch screw fixation and locking plate fixation. A reproducible talar neck fracture was created in 14 fresh cadaver talar necks. Talar head fixation was then performed using 2 cannulated headless variable-pitch 4-mm/5-mm diameter (4/5) screws (Acutrak; Acumed, Hillsboro, OR) and locking plate fixation. Headless variable-pitch screw fixation had lower failure displacement than did locking plate fixation. No statistically significant differences were found in failure stiffness, yield stiffness (p = .655), yield load (p = .142), or ultimate load between the 2 fixation techniques. Cannulated headless variable-pitch screw fixation resulted in better failure displacement than locking plate fixation in a cadaveric talus model and could be considered a viable option for talus fracture fixation. Headless, fully threaded, variable-pitch screw fixation has inherent advantages compared with locking plate fixation, because it might cause less damage to the articular surface and can compress the fracture for improved reduction. Additionally, plate fixation can increase the risk of avascular necrosis owing to the wider incision and dissection of soft tissues.

  10. The effect of a blast on the mandible and teeth: transverse fractures and their management.

    PubMed

    Shuker, Sabri T

    2008-10-01

    Transverse mandibular fractures caused by blast waves have given us a better understanding of the physical and pathophysiological effects on this anatomical region. The external contour of the mandible, being rounded in parts (en face) and flat in others (lateral) will experience different effects of the blast. Impact of a spherical blast wave will inflict transverse lines of fractures on the mandibular body, and may be associated with transverse shearing of teeth at the cementoenamel junction. Fractures of the mandible caused by blast are different from those in the same region caused by any type of civilian trauma; these are the vertical to the longitudinal axis unlike comminuted fractures caused by shrapnel or bullet injuries. Fractures of the mandibular body by blasts are single or multiple parallel fractures in the lower border, between the apices of the roots and the mandibular lower border. Fractures are broken off by acceleration or deceleration of the blast wave. PMID:18440677

  11. Use of Orthodontic Mini-Implants for Maxillomandibular Fixation in Mandibular Fracture

    PubMed Central

    Pires, Mario Sergio Medeiros; Reinhardt, Leandro Calcagno; Antonello, Guilherme de Marco; Torres do Couto, Ricardo

    2011-01-01

    Orthodontic appliances for skeletal anchorage are becoming increasingly more common in clinical practice. Similarly, different terms such as mini-implants, microimplants, and miniscrews have been used. There is a wide array of appliances currently on the market, in different designs and sizes, diameters, degree of titanium purity, and surface treatment. These appliances have been used for a variety of indications, including tooth retraction, intrusion, and traction. This study aimed to report the clinical case of a 19-year-old patient with a fractured mandible and to propose a novel use of mini-implants: the perioperative placement of mini-implants as anchors for maxillomandibular fixation steel wire ligatures. We concluded that this appliance provides an effective maxillomandibular fixation in patients with mandibular fracture, with little increase in the cost of surgery. PMID:23205173

  12. 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

  13. 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

  14. Open reduction and internal fixation of proximal humerus fractures.

    PubMed

    Drosdowech, Darren S; Faber, Kenneth J; Athwal, George S

    2008-10-01

    Open reduction of proximal humeral fractures has the advantage of providing direct control over each fracture fragment and permitting anatomic reduction and fixation with advanced devices. Modern fixed-angle locking plates designed specifically for proximal humerus fractures have allowed the expansion of surgical indications permitting surgeons to address more complicated fractures. Advanced preoperative imaging and fluoroscopy allow a better understanding of fracture patterns and permit the surgeon to use this knowledge intraoperatively. Research is required to further validate fracture classification systems, to develop surgical guidelines for decision making, and to compare the outcomes of the various treatments options for proximal humerus fractures.

  15. Biodegradable implant materials in fracture fixation.

    PubMed

    Illi, O E; Weigum, H; Misteli, F

    1992-01-01

    Based on our experiences in paediatric traumatology treated conservatively or with metallic implants, we looked for alternative fixation possibilities in the field of biodegradables. We designed a new driving system for screws consisting of an indwelling screw driver which transduces the torque force over the whole length of the thread. With this technical approach, the head and the neck of the screw as the most friable point for the fracture of the implant could be avoided. In 48 calves aged 6 weeks we performed a comparative study with either conservative treatment (repositioning and casting) or osteosynthesis with biodegradable screws made from polylactate acid or metallic screws (AO type) after an oblique osteotomy at a 45 degrees angle to the axis of the right metacarpal bone. Results from 1 to 6 weeks postoperatively were compared and good to excellent results obtained in equal amounts for PLA and steel screw osteosynthesis, whereas conservative treatment was only successful in one third of the cases. Clinical, radiological and histological follow-up proved the feasibility of biodegradable osteosynthesis in the growing skeleton. For clinical evaluation in children, the resorption time of biodegradable materials has to be lowered to 3 to 6 months. PMID:10149979

  16. [Dynamic magnetotherapy use in comprehensive treatment phlegmons of maxillofacial region and mandible fractures].

    PubMed

    Lepilin, A V; Raĭgorodckiĭ, Iu M; Nozdrachev, V G; Erokina, N L

    2007-01-01

    145 patients (60 with phlegmons of submandibular and submental regions, 85--with fractures of mandible) were observed and treated with the use of moving pulse magnetic field (MPMF) produced by special apparatus (AMO-ATOS-E, , Saratov-city), 60 patients with the same pathology were treated by traditional physical methods and served as control. Use of MPMF led to quicker patient recovery: quicker reduction (if compared with traditional physical methods of treatment) of oedema and soft tissue inflammatory infiltration, quicker relief from inflammatory reaction (according to data of cytokinin profile), improvement of tissue blood supply in the region of fractures in patients with mandible fractures. As the result--we had shortening treatment terms of such patients and complication number reduction. PMID:18163065

  17. Proximal Periprosthetic Femur Fractures: Strategies for Internal Fixation.

    PubMed

    Moloney, Gele B; Toro, Jose B; Helfet, David L; Wellman, David S

    2016-01-01

    As the number of patients living with total hip arthroplasty continues to rise, there will be an increase in periprosthetic fractures requiring surgical treatment. Treatment of periprosthetic femur fractures below a well-fixed hip arthroplasty stem presents a unique set of challenges. A review of the existing literature on surgical technique, including plate selection and configuration, proximal fixation options, and use of allograft, can serve to guide treatment of these challenging injuries. While not conclusive, the literature supports using soft tissue preserving techniques, bicortical proximal fixation, and fixation spanning the length of the femur. PMID:27327912

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

    PubMed

    Lee, Kwang Won; Yang, Dae Suk; Lee, Gyu Sang; Choy, Won Sik

    2015-12-01

    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.

  19. Arthroscopic Fixation of Tibial Spine Avulsion Fracture in Open Physis

    PubMed Central

    Chouhan, Varun

    2016-01-01

    Introduction: Arthroscopic fixation of tibial spine fracture in patients with open physis without damaging the growth plate is very important. We have described a very simple and effective technique for the first time in this article. Case report: A 16-year-old boy sustained avulsion fractures of tibial spine while playing. He was treated arthroscopically with excellent results. Conclusion: Arthroscopic fixation of tibial spine fracture in patients with open physis with two cannulated screws perpendicular to each other is a very simple technique providing strong construct, and allowing early mobilization without risk of damage to the growth plate. PMID:27703945

  20. 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.

  1. 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

  2. Outcome Analysis of Locking Plate Fixation in Proximal Humerus Fracture

    PubMed Central

    Pathak, Abhishek; Gaur, Sanjiv

    2016-01-01

    Introduction Proximal humerus fractures account for approximately 5% of all fractures. Stable minimally displaced fractures can be treated nonoperatively but the management of displaced fractures remain controversial with various modalities of treatment available. Locking plates provide stable fixation and enable early postoperative mobilization specially in osteoporotic proximal humerus fracture. Aim To evaluate the functional outcome of locking plate fixation and to compare the results of two approaches used for fixation. Materials and Methods This prospective study was conducted at a tertiary level hospital between September 2011 to December 2013. PHILOS plates were used for internal fixation of displaced proximal humerus fractures Neer’s type 2 part, 3 part and 4 part fractures on 26 patients (M/F ratio 1.36:1; mean age 46 years). According to Neer classification, 5,12 and 9 patients had displaced 2, 3 and 4 part fractures respectively. Deltopectoral and deltoid splitting approaches were used for fixation on 13 patients each. Functional outcome was assessed using Constant-Murley shoulder score. Graphpad software version 6.0 was used with Chi-square test and Fisher-exact test are used to compare data. The p-value< 0.05 is considered significant. Results Of the 26 patients, all fractures united radiologically and clinically and average constant score at final follow-up was 72.5. At the final follow-up 8 patients had good score, 10 patients had moderate score, 6 patients had excellent outcome and 2 patients had poor outcome according to Constant score. Mean time to union was 12.3 weeks (9 –15 weeks). Four complications (15.4%) were encountered, 2 cases of varus malunion, 1 case of wound infection which required wound debridement and 1 case of screw cut-out in which screw removal was done. Mean constant score in delto splitting approach was 70.9 and 74 in deltopectoral group (p-value= 0.54). No significant difference existed in constant score in 2 approaches

  3. 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

  4. Fractured facial bone reduction and resorbable plate fixation using tapper.

    PubMed

    Kim, Chang Yeon; Kim, Kee Woong

    2011-07-01

    A resorbable fixation system has many advantages, but there are complicated procedures to be accomplished to fix a resorbable plate. The complicated procedures in the fixation of a resorbable plate make the operation for facial fractures more difficult and can result in extended operation time and incomplete reduction or fixation. For these reasons, we suggest a new way of using a tapper that can make the surgery more simple and accurate than before. After the resorbable plate is properly located above the fractured site, a hole on the fracture fragment is made by drill, and the tapper is inserted into the hole. When the tapper is inserted at the proper depth, the fracture fragment can be reduced to right place by handling the inserted tapper. Then, the tapper is inserted to the end, and the handle is split. While the inserted tapper acting as a temporary metal screw is placed, another hole is made at nearby site and the screw is inserted. Next, the inserted tapper acting as a temporary metal screw is removed, and another screw is inserted into the hole from which the tapper was removed. From October 2006 to April 2008, we applied this procedure to 106 facial bone fractures in 68 patients, and no major complications were noted. In conclusion, we tried to make the operation more simple and accurate by using the tapper as an instrument for reduction and fixation of fracture fragment.

  5. Far-forward fracture stabilization: external fixation versus splinting.

    PubMed

    Camuso, Matthew R

    2006-01-01

    With improvements in body armor, soldiers often survive previously fatal injuries but incur devastating extremity trauma. Orthopaedic and general surgeons in forward-deployed areas must be well-versed in the selection and application of both external fixation and splinting devices in order to best preserve life and limb of the wounded. The surgeon must consider tactical environment, injury severity, injury location, available resources, and his or her own level of experience. Advantages to using external fixation in the field include preventing future injury to the traumatized soft-tissue envelope, reducing the risk of infection, minimizing fracture hemorrhage, providing pain control, and facilitating medical evacuation. Splinting is reserved for closed, low-energy, stable fractures of either the upper or lower extremity and for unstable fractures that are not amenable to battlefield external fixation; because of the risks of compartment syndrome, casts are avoided. PMID:17003182

  6. Subchondral insufficiency fracture of the femoral head after internal fixation for femoral neck fracture: histopathological investigation.

    PubMed

    Sonoda, Kazuhiko; Yamamoto, Takuaki; Motomura, Goro; Kido, Hidehiko; Iwamoto, Yukihide

    2014-08-01

    Late segmental collapse after internal fixation for femoral neck fracture is the phenomenon observed in post-traumatic osteonecrosis of the femoral head (ON), which has generally been reported to occur over a year or more after internal fixation. Subchondral insufficiency fracture of the femoral head (SIF) has also been recognized to cause femoral head collapse, however, only two cases of SIF after internal fixation for femoral neck fracture have been reported. We report a case with femoral head collapse observed 5 months after internal fixation for femoral neck fracture, which was histopathologically diagnosed as SIF. Clinically, differentiating SIF from ON is important because some cases of SIF have been reported to heal without surgical treatments. The timing of femoral head collapse after femoral neck fracture may be different between SIF and post-traumatic ON.

  7. Rigid fixation with teeth in the line of mandibular fractures.

    PubMed

    Gerbino, G; Tarello, F; Fasolis, M; De Gioanni, P P

    1997-06-01

    The treatment results and the incidence of complications were evaluated retrospectively in a group of 68 patients. They all had mandibular fractures with a tooth in the line of fracture and were treated using miniplates for fixation. The follow up ranged from 1 to 6 years (mean 2.6 years) and 90 fracture sites were involved. Results showed that the incidence of complications when the tooth was extracted was higher (3/12) than when it was left in place (8/78). With regard to both healing of the fracture and fate of the tooth in the line of fracture, it is recommended to retain teeth in the line of fracture, unless there is an absolute indication for extraction. It is advisable to monitor the vitality of teeth adjacent to the fracture line for at least one year.

  8. [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

  9. Pathophysiology of infections after internal fixation of fractures.

    PubMed

    Schmidt, A H; Swiontkowski, M F

    2000-01-01

    Infection complicating internal fixation of fractures is a serious complication that is difficult to treat. Whenever metallic devices are implanted in vivo, successful biointegration requires that host cells colonize the highly reactive implant surface. Bacteria such as staphylococci can also become adherent to metallic or polymeric implants and will compete with host cells for colonization of the implant surface. Once adherent, these bacteria form a biofilm and undergo phenotypic changes that make them resistant to the normal host immune response as well as to antibiotics. Furthermore, metallic implants themselves cause specific deficits in the function of the local immune system that may render the host response to infection inadequate. Any associated soft-tissue injury causes even greater impairment of local immune function. Despite the potentially detrimental impact of internal fixation, fracture stability is of paramount importance in achieving fracture union and in preventing infection. It has been demonstrated in animal models that contaminated fractures without internal fixation develop clinical infection more commonly than similar fractures treated with internal fixation at the time of colonization. Because of the potential for infection whenever internal fixation is utilized, appropriate prophylactic antibiotic coverage for staphylococci and Gram-negative organisms should be provided. Open wounds and severely damaged soft tissues require aggressive management so that a viable soft-tissue envelope is maintained around the implant. Host factors such as smoking and malnourishment should be corrected. Early diagnosis and aggressive treatment of implant-related infection with antibiotics, debridement, and maintenance of stable internal fixation are essential to successful treatment.

  10. Fixation of zygomatic and mandibular fractures with biodegradable plates

    PubMed Central

    Degala, Saikrishna; Shetty, Sujeeth; Ramya, S

    2013-01-01

    Context: In this prospective study, 13 randomly selected patients underwent treatment for zygomatic–complex fractures (2 site fractures) and mandibular fractures using 1.5 / 2 / 2.5-mm INION CPS biodegradable plates and screws. Aims: To assess the fixation of zygomatic-complex and mandibular fractures with biodegradable copolymer osteosynthesis system. Materials and Methods: In randomly selected 13 patients, zygomatic-complex and mandibular fractures were plated using resorbable plates and screws using Champy's principle. All the cases were evaluated clinically and radiologically for the type of fracture, need for the intermaxillary fixation (IMF) and its duration, duration of surgery, fixation at operation, state of reduction at operation, state of bone union after operation, anatomic reduction, paresthesia, occlusal discrepancies, soft tissue infection, immediate and late inflammatory reactions related to biodegradation process, and any need for the removal of the plates. Statistical Analysis Used: Descriptives, Frequencies, and Chi-square test were used. Results: In our study, the age group range was 5 to 55 years. Road traffic accidents accounted for the majority of patients six, (46.2%). Postoperative occlusal discrepancies were found in seven patients as mild to moderate, which resolved with IMF for 1-8 weeks. There were minimal complications seen and only as soft tissue infection. Conclusions: Use of biodegradable osteosynthesis system is a reliable alternative method for the fixation of zygomatic-complex and mandibular fractures. The biodegradable system still needs to be refined in material quality and handling to match the stability achieved with metal system. Biodegradable plates and screws is an ideal system for pediatric fractures with favorable outcome. PMID:23662255

  11. Internal fixators: a safe option for managing distal femur fractures?

    PubMed Central

    Batista, Bruno Bellaguarda; Salim, Rodrigo; Paccola, Cleber Antonio Jansen; Kfuri, Mauricio

    2014-01-01

    OBJECTIVE: Evaluate safety and reliability of internal fixator for the treatment of intra-articular and periarticular distal femur fractures. METHODS: Retrospective data evaluation of 28 patients with 29 fractures fixed with internal fixator was performed. There was a predominance of male patients (53.5%), with 52% of open wound fractures, 76% of AO33C type fractures, and a mean follow up of 21.3 months. Time of fracture healing, mechanical axis deviation, rate of infection and postoperative complications were registered. RESULTS: Healing rate was 93% in this sample, with an average time of 5.5 months. Twenty-seven percent of patients ended up with mechanical axis deviation, mostly resulting from poor primary intra-operative reduction. There were two cases of implant loosening; two implant breakage, and three patients presented stiff knee. No case of infection was observed. Healing rate in this study was comparable with current literature; there was a high degree of angular deviation, especially in the coronal plane. CONCLUSION: Internal fixators are a breakthrough in the treatment of knee fractures, but its use does not preclude application of principles of anatomical articular reduction and mechanical axis restoration. Level of Evidence II, Retrospective Study. PMID:25061424

  12. Stability of the mandible after advancement and use of dental plus skeletal maxillomandibular fixation: an experimental investigation in Macaca mulatta.

    PubMed

    Mayo, K H; Ellis, E

    1987-03-01

    This study examined short-term stability of the mandible following advancement surgery and the use of skeletal suspension wires plus dental maxillomandibular fixation. Twenty-four adult female Macaca mulatta underwent bilateral sagittal ramus osteotomy and advancement of approximately 6 mm. All animals had dental maxillomandibular fixation secured by bonding the upper and lower teeth together with an orthodontic composite resin. In half of the animals, the use of circummandibular wires connected to pyriform aperture wires were additionally applied. Tantalum bone markers were placed and cephalograms analyzed during the first six postoperative weeks to evaluate skeletal stability. A statistically significant mean horizontal relapse at the mandibular symphysis occurred in the group without the skeletal wires, whereas no relapse occurred in the group with the skeletal wires. A significant difference in the vertical displacement of the anterior mandible occurred, with an inferior movement of the symphysis in the group without skeletal wires, and a superior movement of the symphysis in the group with skeletal wires. The results of this study indicate that the use of skeletal suspension wires is advantageous in the prevention of horizontal and vertical skeletal relapse.

  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.

  14. 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

  15. 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

  16. 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 SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices §...

  17. 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 §...

  18. 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 SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices §...

  19. 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 SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices §...

  20. 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 §...

  1. 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.

  2. Extra-platysma fixation of bisphosphonate-related mandibular fractures: a suggested technical solution.

    PubMed

    Biglioli, F; Pedrazzoli, M

    2013-05-01

    Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is an evolving epidemic. Often the patients are in poor general condition and therefore the aim of surgical treatment is generally limited to pain control and restoration of feeding ability. We present a useful surgical technique for the stabilization of BRONJ-related mandibular fractures, including application of a reconstructive plate. With an extraoral approach, a 2.5-mm reconstructive locking plate is contoured and placed in the plane of dissection, superficial to the platysma. The fracture site is accessed through an intraoral approach, which limits surgery to curettage and rinsing of the surgical site. Since there is no removal of the periosteal support to the residual stumps, the blood supply to the affected mandible is maintained. Avoidance of direct contact of the infected fractured site with the reconstructive plate is another advantage of working in a surgical plane over the platysma muscle. Although fracture healing is not achieved, plate fixation with this technique is stable and painless and patients can easily eat; therefore, patients enjoy a great improvement in their quality of life. We consider this easy and effective procedure to be a reliable palliative solution in these patients. PMID:23490473

  3. Open reduction and fixation of proximal humeral fractures and fracture-dislocations.

    PubMed

    Moda, S K; Chadha, N S; Sangwan, S S; Khurana, D K; Dahiya, A S; Siwach, R C

    1990-11-01

    Open reduction and internal fixation was employed in the treatment of 25 severely displaced fractures and fracture-dislocations of the proximal humerus. Our aims were accurate reduction and stable fixation to allow early mobilisation and to achieve full functional recovery. In 15 fractures an AO T-plate was used and in 10 a bent semitubular plate was employed as a blade plate. Excellent or satisfactory results were obtained in all six patients with two-part fractures involving the surgical neck; in four of the five patients with three-part fractures involving the surgical neck and tuberosities; in nine of the 11 patients with fracture-dislocation; and in two of the three patients with split fractures of the humeral head. Overall results were good or satisfactory in 21 of the 25 cases. Unsatisfactory results were associated with rotator cuff damage.

  4. 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

  5. Osteoporotic hip fractures: the burden of fixation failure.

    PubMed

    Broderick, J M; Bruce-Brand, R; Stanley, E; Mulhall, K J

    2013-01-01

    Osteoporotic hip fractures are a major cause of morbidity and mortality in the elderly. Furthermore, reduced implant anchorage in osteoporotic bone predisposes towards fixation failure and with an ageing population, even low failure rates represent a significant challenge to healthcare systems. Fixation failure in fragility fractures of the hip ranges from 5% in peritrochanteric fractures through to 15% and 41% in undisplaced and displaced fractures of the femoral neck, respectively. Our findings, in general, support the view that failed internal fixation of these fragility fractures carries a poor prognosis: it leads to a twofold increase in the length of hospital stay and a doubling of healthcare costs. Patients are more likely to suffer a downgrade in their residential status upon discharge with a consequent increase in social dependency. Furthermore, the marked disability and reduction in quality of life evident before salvage procedures may persist at long-term followup. The risk, of course, for the elderly patient with a prolonged period of decreased functioning is that the disability becomes permanent. Despite this, however, no clear link between revision surgery and an increase in mortality has been demonstrated in the literature.

  6. 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

  7. Biomechanical evaluation of maxillary Lefort Ι fracture with bioabsorbable osteosynthesis internal fixation.

    PubMed

    Wu, Wei; Zhou, Jiang; Xu, Chong-Tao; Zhang, Jie; Jin, Yan-Jiao; Sun, Geng-Lin

    2014-12-01

    The aim of this study was to apply biomechanical analysis model to evaluate the effects of bioabsorbable internal fixation devices on maxillary Lefort Ι fracture. CT scan technology and the finite element software (ansys) were used to establish three-dimensional finite element models of five resorbable internal fixation devices in maxillary Lefort Ι fractures. We used the model to calculate the stress of the upper jaw and internal fixation. We further analyzed the stability of fixation under four occlusions. The fixation using two bioabsorbable plates was not stable. The zygomaticomaxillary pillars fixation is more stable than other fixations. The stability of fracture fixation was influenced with the molar occlusion. The current study developed a functional three-dimensional finite element model of bioabsorbable internal fixation and compared the stability of five fixation methods for maxillary Lefort Ι fractures. The results would facilitate the application of bioabsorbable materials in dental clinic.

  8. [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.

  9. 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

  10. 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.

  11. 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

    2015-11-09

    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.

  12. 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

  13. Temporary intra-operative reduction techniques for tibial fracture fixation: A review of the literature.

    PubMed

    Beazley, J C; Hull, P

    2010-12-01

    Accurate intra-operative reduction and maintenance of reduction is essential for successful fixation of tibial fractures. Although many tibial fractures can be reduced with minimal manipulation, numerous techniques have been described to facilitate fixation of more difficult fractures. These include use of a traction table, manual traction techniques, temporary distracters, reduction clamps and temporary unicortical plating. This article reviews the literature and assesses the options available for the temporary reduction and maintenance of reduction of tibial fractures prior to definitive fixation.

  14. A Novel Fixation System for Acetabular Quadrilateral Plate Fracture: A Comparative Biomechanical Study

    PubMed Central

    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

  15. Retrospective comparison of percutaneous fixation and volar internal fixation of distal radius fractures.

    PubMed

    Lozano-Calderón, Santiago A; Doornberg, Job N; Ring, David

    2008-06-01

    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.

  16. Outpatient percutaneous screw fixation of the acute Jones fracture.

    PubMed

    Mindrebo, N; Shelbourne, K D; Van Meter, C D; Rettig, A C

    1993-01-01

    Nine patients (8 men and 1 woman, ranging in age from 17 to 22 years) who sustained a Jones fracture were treated with percutaneous intramedullary screw fixation as outpatients. All of the patients were varsity athletes. Seven were Division I scholarship athletes. Beginning at 7 to 10 days after surgery, all patients were allowed weightbearing as tolerated with a CAM walker. Stationary bicycling, swimming, and Stairmaster were allowed at 2 to 3 weeks. The average return to running was 5.5 weeks (range, 3 to 10). The average return to full competition was 8.5 weeks (range, 7 to 12). No perioperative or postoperative complications occurred. Average followup was 2.5 years. All fractures attained clinical and radiographic union. We believe that outpatient percutaneous intramedullary screw fixation of the acute Jones fracture is a reasonable alternative for those active patients who would have difficulty with a non-weightbearing cast and crutches or who desire an expeditious return to activities. Time restraints are particularly critical for in-season or preseason athletes. With the outpatient screw fixation method, our patient population had predictable healing, and they returned to full sports participation within 12 weeks.

  17. Comparison of open reduction internal fixation and conservative treatment plus open reduction internal fixation for calcaneal fractures

    PubMed Central

    Pan, Yongmiao; Yuan, Linyi; Ye, Chengfeng

    2014-01-01

    To compare the effect of open reduction internal fixation and conservative treatment combined with open reduction internal fixation for subjects with calcaneal fractures, 130 patients with calcaneal fractures were divided into observation group and control group. Observation group were treated with open reduction internal fixation and conservative treatment, control group treated as open reduction internal fixation. The healing related indicators, daily life activities ability score of observation group after treatment 6 months were significantly higher than that of the control group, there was no significant difference for the healing rate of excellent and good rate, the daily life activities ability score after one and three year between two groups. Open reduction internal fixation combined with conservative treatment in treatment of calcaneal fractures can clear anatomic structure and have fast function recovery. Thus, it should be as the preferred method for the treatment of calcaneal fractures. PMID:25550973

  18. Fixation orientation in ankle fractures with syndesmosis injury.

    PubMed

    Nimick, Craig J; Collman, David R; Lagaay, Pieter

    2013-01-01

    Accurate reduction of the syndesmosis has been shown to be an important prognostic factor for functional outcome in ankle injuries that disrupt the syndesmosis. The purpose of the present case series was to assess the fixation orientation and the position of the fibula within the tibial incisura after open reduction and internal fixation of ankle fractures with syndesmosis injury. Computed tomography was used to assess the accuracy of the reduction. Twelve patients were included in the present case series. A ratio representing the relationship between the tibia and fibula and the orientation of the syndesmotic fixation was measured preoperatively and postoperatively and compared with the uninjured contralateral ankle, representing the patient's normal anatomy. The measurements were accomplished electronically to one tenth of 1 mm using Stentor Intelligent Informatics, I-site, version 3.3.1 (Phillips Electronics; Andover, MA). Posteriorly oriented syndesmotic fixation caused posterior translation of the fibula with respect to the tibia and anteriorly oriented syndesmotic fixation caused anterior translation. PMID:23540759

  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. 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.

  1. 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.

  2. [Morphological peculiarities of consolidation of experimental mandible fractures by osteosynthesis using Kollapan and retabolil].

    PubMed

    Beriashvili, G K; Menabde, G T; Chikhladze, R T

    2006-07-01

    The Purpose of the research was to study in the experiment morphological particularities of mandible fracture consolidation by osteosynthesis using Kollapan and Retabolil. The experiments were carried out on sexually matured rabbits. In the first series of the experiments (the control group), mandibula bones fracture was prototyped lower, whereas bone fragments were fixed by miniplate. In the second series of the experiments (the study group) bone fragments were bolted by the above mentioned way but diastase between bone fragments was filled by Kollapan granules, containing klaforan, and animals were intramuscularly anabolic material (the retabolil 0.4 mg/kg). On the 3-d and 15-th days, as well as, after 1 and 2 months after operation observing all corresponding rules, animals were killed and patologico-anatomic study of jaw bone was carried out. The analysis of the results showed that in experimental animals both in the control and the study groups reparative regeneration of bone tissues runs with the formation of periosteum and intermedium regenerator, at the same time consolidation of the bone defect in the main group occurs earlier than in the control group. The Results of the studies point out that Retabolil under osteosynthesis is an osteoinductive material and Kollapan, having osteoinductive, osteoconductive, and osteoprotective characteristics, promotes speeding of the process of jaw bones fracture consolidation. PMID:16905861

  3. Multifocal Langerhans cell histiocytosis in an adult with a pathological fracture of the mandible and spontaneous malunion: A case report

    PubMed Central

    SHI, SAILANG; LIU, YANMING; FU, TAO; LI, XIUZHEN; ZHAO, SHIFANG

    2014-01-01

    Langerhans cell histiocytosis (LCH) is rare in the adult population and even rarer with jaw involvement. The current study presents the case of a 39-year-old male who complained of recurrent pain, swelling of the gingiva and an occasional pus-like discharge in the right mandible for one year. The patient was previously prescribed antibiotics, but this did not resolve the problem. An initial panoramic radiograph showed an osteolytic lesion and bone fracture in the right mandible. Eight months later, a new radiograph showed the spontaneous malunion of the fractured mandible. The patient was eventually diagnosed with Langerhans cell histiocytosis by histopathology and immunohistochemistry. Further lesions were found in the ribs and ilium by nuclear bone scanning. The patient was subsequently treated with systemic chemotherapy, and the lesions are currently effectively being controlled. This study is the first to show that spontaneous intralesional bone regeneration may lead to reunification of the mandible fracture caused by LCH in an adult. PMID:25120660

  4. 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

  5. Arthroscopic Fixation of Glenoid Rim Fractures After Reduction by Labral Repair.

    PubMed

    Voleti, Pramod B; Camp, Christopher L; Sinatro, Alec L; Dines, Joshua S

    2016-04-01

    Surgical fixation of displaced, intra-articular glenoid fractures represents a clinical challenge. These fractures have traditionally been treated through open approaches to the glenohumeral joint; however, the morbidity associated with open surgery may be reduced with arthroscopic techniques. Previously described arthroscopic methods commonly use clamps and/or Kirschner wires to obtain and maintain provisional fixation. We describe our technique for minimally invasive, arthroscopic fixation of glenoid rim fractures using labral repair as an indirect reduction maneuver, followed by final fixation with an extra-articular screw. This method is safe, efficient, and reliable, and it can be used to approach a variety of intra-articular glenoid fractures. PMID:27462537

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

    PubMed

    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.

  7. 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

  8. 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

  9. Segmental fractures of the tibia treated by circular external fixation.

    PubMed

    Giotakis, N; Panchani, S K; Narayan, B; Larkin, J J; Al Maskari, S; Nayagam, S

    2010-05-01

    We have carried out a retrospective review of 20 patients with segmental fractures of the tibia who had been treated by circular external fixation. We describe the heterogeneity of these fractures, their association with multiple injuries and the need for multilevel stability with the least compromise of the biology of the fracture segments. The assessment of outcome included union, complications, the measurement of the functional IOWA knee and ankle scores and the general health status (Short-form 36). The mean time to union was 21.7 weeks (12.8 to 31), with no difference being observed between proximal and distal levels of fracture. Complications were encountered in four patients. Two had nonunion at the distal level, one a wire-related infection which required further surgery and another shortening of 15 mm with 8 degrees of valgus which was clinically insignificant. The functional scores for the knee and ankle were good to excellent, but the physical component score of the short-form 36 was lower than the population norm. This may be explained by the presence of multiple injuries affecting the overall score. PMID:20436007

  10. Treatment of Palatal Fractures by Osteosynthesis with 2.0-mm Locking Plates as External Fixator

    PubMed Central

    Cienfuegos, Ricardo; Sierra, Eduardo; Ortiz, Benjamin; Fernández, Gerardo

    2010-01-01

    Treatment options for palatal fractures range from orthodontic braces, acrylic bars, and arch bars for maxillomandibular fixation to internal fixation, with plates and screws placed under the palate mucosa and periosteum, together with pyriform aperture or alveolar plating plus buttress reconstruction. Forty-five patients, ages 4 to 56, were treated using medium- or high-profile locking plates placed over the palatal mucosa as an external fixator for palatal fractures, together with treatment for other associated facial fractures. In open fractures, plates were placed after approximating the edges of the mucosal wounds. Plates and screws for palate fixation were removed at 12 weeks, when computed tomography scans provided evidence of fracture healing. All palatal fractures healed by 12 weeks, with no cases of mucosal necrosis, bone exposure, fistulae, or infections. This approach achieves adequate stability, reduces the risk of bone and mucosal necrosis, and promotes healing of mucosal wounds in case of open fractures. PMID:22132261

  11. Treatment of Midshaft Clavicle Fractures: Application of Local Autograft With Concurrent Plate Fixation.

    PubMed

    Slette, Erik L; Mikula, Jacob D; Turnbull, Travis Lee; Hackett, Thomas R

    2016-06-01

    Currently, open reduction-internal fixation using contoured plates or intramedullary nails is considered the standard operative treatment for midshaft clavicle fractures because of the immediate rigid stability provided by the fixation device. In addition, autologous iliac crest bone graft has proved to augment osteosynthesis during internal fixation of nonunion fractures through the release of osteogenic factors. The purpose of this article is to describe a surgical technique developed to reduce donor-site morbidity and improve functional and objective outcomes after open reduction-internal fixation with autologous bone graft placement through local autograft harvesting and concurrent plate fixation. PMID:27656378

  12. What is new in distal femur periprosthetic fracture fixation?

    PubMed

    Tosounidis, Theodoros H; Giannoudis, Peter V

    2015-12-01

    Distal femoral periprosthetic fractures are on the rise. Increased mortality of these injuries is also evident from recent data. Their incidence and risk factors have been extensively reported in the past but new data are being available that merit attention. The increased incidence and the even higher projected incidence should direct the focus of future strategies to the education of surgeons, relevant capacity of hospital and reconfiguration of health care resources. New and potentially modifiable risk factors should be taken into consideration to the informed consent process and new studies should be developed to clarify the causative relationship of the new risk factors such as the peptic ulcer disease and the COPD. The main internal fixation techniques remain the lateral locking plating and the retrograde intramedullary nailing. New techniques in plating are the supplementary medial plate in selected cases and the far cortical locking. Nailing is considered a valid option especially in fractures located well above the anterior flange of the femoral component of the arthroplasty. Results and outcomes from good quality studies are still sparse regarding the comparison between plating and nailing. Interprosthetic fractures constitute an entity that is lately gaining considerable attention. The best method of management of these injuries is still evolving with considerable amount of work being done in the clinical and biomechanical level.

  13. 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

  14. [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

  15. A Meta-Analysis for Postoperative Complications in Tibial Plafond Fracture: Open Reduction and Internal Fixation Versus Limited Internal Fixation Combined With External Fixator.

    PubMed

    Wang, Dong; Xiang, Jian-Ping; Chen, Xiao-Hu; Zhu, Qing-Tang

    2015-01-01

    The treatment of tibial plafond fractures is challenging to foot and ankle surgeons. Open reduction and internal fixation and limited internal fixation combined with an external fixator are 2 of the most commonly used methods of tibial plafond fracture repair. However, conclusions regarding the superior choice remain controversial. The present meta-analysis aimed to quantitatively compare the postoperative complications between open reduction and internal fixation and limited internal fixation combined with an external fixator for tibial plafond fractures. Nine studies with 498 fractures in 494 patients were included in the present study. The meta-analysis found no significant differences in bone healing complications (risk ratio [RR] 1.17, 95% confidence interval [CI] 0.68 to 2.01, p = .58], nonunion (RR 1.09, 95% CI 0.51 to 2.36, p = .82), malunion or delayed union (RR 1.24, 95% CI 0.57 to 2.69, p = .59), superficial (RR 1.56, 95% CI 0.43 to 5.61, p = .50) and deep (RR 1.89, 95% CI 0.62 to 5.80) infections, arthritis symptoms (RR 1.20, 95% CI 0.92 to 1.58, p = .18), or chronic osteomyelitis (RR 0.31, 95% CI 0.05 to 1.84, p = .20) between the 2 groups.

  16. Immediate Weight-Bearing after Ankle Fracture Fixation

    PubMed Central

    Harnden, Emily

    2015-01-01

    We believe that a certain subset of surgical ankle fracture patients can be made weight-bearing as tolerated immediately following surgery. Immediate weight-bearing as tolerated (IWBAT) allows patients to return to ambulation and activities of daily living faster and may facilitate rehabilitation. A prospectively gathered orthopaedic trauma database at a Level 1 trauma center was reviewed retrospectively to identify patients who had ORIF after unstable ankle injuries treated by the senior author. Patients were excluded if they were not IWBAT based on specific criteria or if they did meet followup requirement. Only 1/26 patients was noted to have loss of fixation. This was found at the 6-week followup and was attributed to a missed syndesmotic injury. At 2-week followup, 2 patients had peri-incisional erythema that resolved with a short course of oral antibiotics. At 6-week followup, 20 patients were wearing normal shoes and 6 patients continued to wear the CAM Boot for comfort. To conclude, IWBAT in a certain subset of patients with stable osteosynthesis following an ankle fracture could potentially be a safe alternative to a period of protected weight-bearing. PMID:25785201

  17. Fibrin glue fixation of a digital osteochondral fracture: case report and review of the literature.

    PubMed

    Shah, Munir A; Ebert, Andrew M; Sanders, William E

    2002-05-01

    Surgical treatment options for digital osteochondral fractures are limited by the small amount of bone available for fixation and the propensity for digital stiffness with the introduction of hardware. Fibrin sealant is used in a variety of clinical settings as a biologic bonding agent and may circumvent the drawbacks of traditional fixation or simple excision for certain digital osteochondral injuries. Successful use of fibrin sealant fixation for a patient with an osteochondral fracture involving the proximal interphalangeal joint is documented, and the literature on fibrin sealant for osseous fixation is reviewed.

  18. 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

  19. Extraperiosteal Dual Plate Fixation of Acute Mid-Shaft Clavicle Fractures: A Technical Trick.

    PubMed

    Shannon, Steven F; Chen, Xiaobin; Torchia, Michael; Schoch, Bradley

    2016-10-01

    Historically, surgical treatment of acute mid-shaft clavicle fractures has excellent outcomes with low rates of nonunion. More complex fracture patterns with significant comminution may limit the fixation that can be obtained with a single plate. The authors describe the surgical technique and case series of patients treated with extraperiosteal dual plating for acute mid-shaft clavicle fractures.

  20. 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

  1. 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

  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.

  3. Intramedullary versus extramedullary fixation in the management of subtrochanteric femur fractures: a meta-analysis

    PubMed Central

    Liu, Pengcheng; Wu, Xing; Shi, Hui; Liu, Run; Shu, Hexi; Gong, JinPeng; Yang, Yong; Sun, Qi; Wu, Jiezhou; Nie, Xiaoyang; Cai, Ming

    2015-01-01

    Background Intramedullary and extramedullary fixation methods are used in the management of subtrochanteric femur fractures. However, whether intramedullary or extramedullary fixation is the primary treatment for subtrochanteric femur fractures in adults remains debatable. Level of evidence Meta-analyses of prospective studies, level I. Materials and methods The Cochrane library, Embase, Google Scholar, and PubMed databases were searched separately for all relevant studies published before January 1, 2015. No language restriction was applied. Prospective randomized controlled trials that compared intramedullary or extramedullary internal fixation to repair subtrochanteric femur fractures in adults were included. We determined intraoperative data, postoperative complications, fracture fixation complications, wound infection, hospital stay days, and final outcome measures to assess the relative effects of different internal fixation methods for the treatment of subtrochanteric femur fractures in adults. Results Six studies were included in our meta-analysis. The relative risks (RRs) of revision rate was 83% lower (RR, 0.17, 95% confidence interval [CI], 0.05 to 0.60; P=0.006), fixation failure rate was 64% lower (RR, 0.36, 95% CI, 0.12 to 1.08; P=0.07), non-union rate was 77% lower (RR, 0.23, 95% CI, 0.07 to 0.81; P=0.02) in the intramedullary group compared with the extramedullary group. No significant differences were found between the intramedullary group and extramedullary group for intraoperative data, postoperative complications, wound infection, hospital stay days or final outcome measures. Conclusion In conclusion, our meta-analysis suggests that there was no significant difference in intraoperative data, postoperative complications, wound infection, hospital stay days or final outcome measures between intramedullary and extramedullary internal fixation. However, a significant decrease occurred in the rate of fracture fixation complications for patients

  4. Callus Formation and Mineralization after Fracture with Different Fixation Techniques: Minimally Invasive Plate Osteosynthesis versus Open Reduction Internal Fixation.

    PubMed

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

    2015-01-01

    Minimally invasive plate osteosynthesis(MIPO) has been considered as an alternative for fracture treatment. Previous study has demonstrated that MIPO technique has the advantage of less soft tissue injury compared with open reduction internal fixation (ORIF). However, the comparison of callus formation and mineralization between two plate osteosynthesis methods remains unknown. In this experiment, ulna fracture model was established in 42 beagle dogs. The fractures underwent reduction and internal fixation with MIPO or ORIF. Sequential fluorescent labeling and radiographs were applied to determine new callus formation and mineralization in two groups after operation. At 4, 8 and 12 weeks postoperatively, the animals were selected to be sacrificed and the ulna specimens were analyzed by Micro-CT. The sections were also treated with Masson staining for histological evaluation. More callus formation was observed in MIPO group in early stage of fracture healing. The fracture union rate has no significant difference between two groups. The results indicate that excessive soft tissue stripping may impact early callus formation. As MIPO technique can effectively reduce soft tissue injury with little incision, it is considered to be a promising alternative for fracture fixation.

  5. Callus Formation and Mineralization after Fracture with Different Fixation Techniques: Minimally Invasive Plate Osteosynthesis versus Open Reduction Internal Fixation

    PubMed Central

    Ding, Haoliang; Qin, Hui; An, Zhiquan

    2015-01-01

    Minimally invasive plate osteosynthesis(MIPO) has been considered as an alternative for fracture treatment. Previous study has demonstrated that MIPO technique has the advantage of less soft tissue injury compared with open reduction internal fixation (ORIF). However, the comparison of callus formation and mineralization between two plate osteosynthesis methods remains unknown. In this experiment, ulna fracture model was established in 42 beagle dogs. The fractures underwent reduction and internal fixation with MIPO or ORIF. Sequential fluorescent labeling and radiographs were applied to determine new callus formation and mineralization in two groups after operation. At 4, 8 and 12 weeks postoperatively, the animals were selected to be sacrificed and the ulna specimens were analyzed by Micro-CT. The sections were also treated with Masson staining for histological evaluation. More callus formation was observed in MIPO group in early stage of fracture healing. The fracture union rate has no significant difference between two groups. The results indicate that excessive soft tissue stripping may impact early callus formation. As MIPO technique can effectively reduce soft tissue injury with little incision, it is considered to be a promising alternative for fracture fixation. PMID:26444295

  6. 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.

  7. 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.

  8. Arthroscopic 4-Point Suture Fixation of Anterior Cruciate Ligament Tibial Avulsion Fractures

    PubMed Central

    Boutsiadis, Achilleas; Karataglis, Dimitrios; Agathangelidis, Filon; Ditsios, Konstantinos; Papadopoulos, Pericles

    2014-01-01

    Tibial eminence avulsion fractures are rare injuries occurring mainly in adolescents and young adults. When necessary, regardless of patient age, anatomic reduction and stable internal fixation are mandatory for fracture healing and accurate restoration of normal knee biomechanics. Various arthroscopically assisted fixation methods with sutures, anchors, wires, or screws have been described but can be technically demanding, thus elongating operative times. The purpose of this article is to present a technical variation of arthroscopic suture fixation of anterior cruciate ligament avulsion fractures. Using thoracic drain needles over 2.4-mm anterior cruciate ligament tibial guidewires, we recommend the safe and easy creation of four 2.9-mm tibial tunnels at different angles and at specific points. This technique uses thoracic drain needles as suture passage cannulas and offers 4-point fixation stability, avoiding potential complications of bony bridge fracture and tunnel connection. PMID:25685674

  9. Development of a robotic navigation and fracture fixation system.

    PubMed

    Fuechtmeier, Bernd; Egersdoerfer, Stefan; Tuma, Georg; Monkman, Gerit J; Nerlich, Michael

    2003-01-01

    The use of robotics in surgery is nothing new. However, there are areas of surgery, such as in fracture fixation, where robots have yet to be implemented. This paper considers the choice of robot, gripper and ancillary equipment together with navigation systems necessary for their application. Hitherto robots have seen operation in surgery only in cases where relatively low manipulation forces are required. Nothing yet exists with the capability of handling forces in excess of 200 Newton as would be required in the above scenario. Another encumbrance to robots which are already in medical use is the difficulty in programming. Unfortunately most of these robots are programmed by specialists for a particular application. However, there exists a number of robot programming languages, like Unimation VA-LII (recently superceded by Stäubli V+), which do not require specialist knowledge. The application of industrial robots to the "heavier" side of modern surgery is without doubt technically realisable. The remainder of this research project aims to determine exactly which robots and what ancilliary equipment are needed and then to implement them, first on plastic models and later on cadavers. A second phase is expected to deal with type approval and a final third phase with operations on live patients.

  10. A survey of current practices and preferences for internal fixation of displaced olecranon fractures

    PubMed Central

    Wood, Thomas; Thomas, Katie; Farrokhyar, Forough; Ristevski, Bill; Bhandari, Mohit; Petrisor, Bradley

    2015-01-01

    Background Olecranon fractures represent 10% of upper extremity fractures. There is a growing body of literature to support the use of plate fixation for displaced olecranon fractures. The purpose of this survey was to gauge Canadian surgeons’ practices and preferences for internal fixation methods for displaced olecranon fractures. Methods Using an online survey tool, we administered a cross-sectional survey to examine current practice for fixation of displaced olecranon fractures. Results We received 256 completed surveys for a response rate of 31% (95% confidence interval [CI] 30.5–37.5%). The preferred treatment was tension band wiring (78.5%, 95% CI 73–83%) for simple displaced olecranon fractures (Mayo IIA) and plating (81%, 95% CI 75.5–85%) for displaced comminuted olecranon fractures (Mayo IIB). Fracture morphology with a mean impact of 3.31 (95% CI 3.17–3.45) and comminution with a mean impact of 3.34 (95% CI 3.21–3.46) were the 2 factors influencing surgeons’ choice of fixation method the most. The major deterrent to using tension band wiring for displaced comminuted fractures (Mayo IIB) was increased stability obtained with other methods described by 75% (95% CI 69–80%) of respondents. The major deterrent for using plating constructs for simple displaced fractures (Mayo IIA) was better outcomes with other methods. Hardware prominence was the most commonly perceived complication using either method of fixation: 77% (95% CI 71.4–81.7%) and 76.2% (95% CI 70.6–81.0%) for tension band wiring and plating, respectively. Conclusion Divergence exists with current literature and surgeon preference for fixation of displaced olecranon fractures. PMID:26204363

  11. Three-wire fixation technique for displaced fifth metatarsal base fractures.

    PubMed

    Thomas, James L; Davis, Barry C

    2011-01-01

    Fractures of the tuberosity of the fifth metatarsal are the most common type of fifth metatarsal fractures. This particular fracture usually produces low morbidity and low rates of nonunion when treated nonoperatively. However, on occasion, significant displacement, comminution, or significant intra-articular involvement may warrant operative intervention. Multiple techniques have been described for the operative care of this fracture. We present a somewhat simplified fixation method for displaced fifth metatarsal fractures in a small set of patients who were all followed up to final healing of the fracture.

  12. Degloving Injuries of the Oral Cavity Change the Operative Approach to Fractures of the Anterior Segment of the Mandible

    PubMed Central

    Pollock, Richard A.; Huber, Katherine M.; Sickels, Joseph E. Van

    2011-01-01

    No report to date describes the added risk traumatic, degloving injuries of the oral cavity may pose when treating fractures of the mandible. The authors describe the oral degloving injury, characterized by separation of periosteum and soft tissue of the anterior floor of the mouth from the inner cortex of the anterior segment. Vascular anatomy of the floor of the mouth is reviewed as a prelude to a description of pathomechanics of the injury and a case report. The higher incidence of oral degloving in youth and in young adulthood and parallels in elective, orthognathic surgery are identified. When this unusual clinical presentation occurs, and when open reduction of fractures of the anterior segment is chosen, a vestibular incision is best avoided. Instead, a submental or upper neck incision is chosen for sufficient exposure to allow reduction and the application of appliances. Meticulous closure of the intraoral void is achieved using one of two techniques, depending on the level of degloving. PMID:22942942

  13. A comparative study of fixation techniques for type II fractures of the odontoid process.

    PubMed

    Graziano, G; Jaggers, C; Lee, M; Lynch, W

    1993-12-01

    Primary screw fixation of a Type II odontoid fracture or non-union is an attractive alternative to posterior atlanto-axial arthrodesis in that normal cervical motion can be maintained. Eight cervical cadaver spines, ranging in age from 17-90 years, were used for study. Type II fractures of the dens were created using an osteotome. Simulated fractures were fixed using one or two 3.5-mm bone screws. After testing each screw fixation technique, the screws were removed and a posterior C1-C2 brooks sublaminar wiring was performed using four 18-gauge wires with wooden blocks to simulate bone graft. No significant differences were found between bending and torsional stiffnesses for the one-screw and two-screw specimens. No significant differences were found between one- and two-screw fixation when compared with primary C1-C2 wiring in torsion. One- or two-screw fixation was as stiff as primary C1-C2 wiring in bending. One or two screws offers similar stability for fixation for a dens fracture. One- and two-screw fixation is at least as stiff as primary C1-C2 wiring in torsion and one- or two-screw fixation is stiffer than primary C1-C2 wiring in bending. PMID:8303437

  14. Management of extra-articular fractures of the distal tibia: intramedullary nailing versus plate fixation.

    PubMed

    Casstevens, Chris; Le, Toan; Archdeacon, Michael T; Wyrick, John D

    2012-11-01

    Intramedullary nailing and plate fixation represent two viable approaches to internal fixation of extra-articular fractures of the distal tibia. Although both techniques have demonstrated success in maintaining reduction and promoting stable union, they possess distinct advantages and disadvantages that require careful consideration during surgical planning. Differences in soft-tissue health and construct stability must be considered when choosing between intramedullary nailing and plating of the distal tibia. Recent advances in intramedullary nail design and plate-and-screw fixation systems have further increased the options for management of these fractures. Current evidence supports careful consideration of the risk of soft-tissue complications, residual knee pain, and fracture malalignment in the context of patient and injury characteristics in the selection of the optimal method of fixation.

  15. Late extensor pollicis longus rupture following plate fixation in Galeazzi fracture dislocation.

    PubMed

    Sabat, Dhananjaya; Dabas, Vineet; Dhal, Anil

    2014-07-01

    Late rupture of extensor pollicis longus (EPL) tendon after Galeazzi fracture dislocation fixation is an unknown entity though it is a well-established complication following distal radius fractures. We report the case of a 55-year old male who presented with late EPL tendon rupture 4 months following internal fixation of Galeazzi fracture dislocation with a Locking Compression Plate (LCP). He was managed with extensor indicis proprius (EIP) transfer to restore thumb extension. At 4 years followup, functional result of the transfer was good. We identify possible pitfalls with this particular patient and discuss how to avoid them in future.

  16. 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

  17. 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

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

    PubMed

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

    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. Comparison of Intraoperative C-Arm Fluoroscopy to Postoperative Radiographs in Operative Fracture Fixation.

    PubMed

    Horst, Taylor A; Mooney, James F; Hooker, Jennifer A; Barfield, William R; Glaser, John A

    2015-01-01

    The purpose of this study is to evaluate the differences between intraoperative C-arm images and postoperative plain film radiographs and the utility of each in assessing fracture fixation and determining postoperative management. Intraoperative and postoperative images with varying fracture types and locations were analyzed. C-arm images were compared to postoperative plain film radiographs for each treated fracture and reviewed by two orthopaedic surgeons. Image adequacy and quality for each radiograph were analyzed. The quality of reduction and fixation was also analyzed. Information was apparent on the postoperative radiographs, such that a reviewer felt that the postoperative treatment plan should change in 8.2% of cases. In the cases where treatment change was recommended, fracture gap, rotation, and angulation were found to be the strongest predictors. The ability of intraoperative and postoperative images to reflect fracture gap, rotation, and angulation may vary between images.

  1. Hybrid External Fixation for Arbeitsgemeinschaft für Osteosynthesefragen (AO) 43-C Tibial Plafond Fractures.

    PubMed

    Abd-Almageed, Emad; Marwan, Yousef; Esmaeel, Ali; Mallur, Amarnath; El-Alfy, Barakat

    2015-01-01

    Arbeitsgemeinschaft für Osteosynthesefragen (AO) type 43-C tibial plafond/pilon fractures represent a challenge for the treating orthopedic surgeon. We assessed the outcomes of using hybrid external fixation for this fracture type. The present prospective cohort study was started in August 2009 and ended by July 2012. Thirty consecutive patients (mean age 37.4 ± 10.7 years) with a type C tibial plafond fracture who had presented to our tertiary care orthopedic hospital were included. Motor vehicle accidents and fall from height were the cause of the fracture in 14 (46.7%) and 13 (43.3%) patients, respectively. A type C3 fracture was present in 25 patients (83.3%), and type C1 and C2 fractures were present in 2 (6.7%) and 3 (10.0%) patients, respectively. Nine fractures (30.0%) were open. Hybrid external fixation was used for all fractures. All fractures were united; clinical healing was achieved by a mean of 18.1 ± 2.2 weeks postoperatively and radiologic healing at a mean of 18.9 ± 1.9 weeks. The fixator was removed at a mean of 20.4 ± 2.0 weeks postoperatively. At a mean follow-up point of 13.4 ± 2.6 months, the mean modified Mazur ankle score was 84.6 ± 10.4. It was not associated with wound classification (p = .256). The most commonly seen complication was ankle osteoarthritis (17 patients; 56.7%); however, it was mild in >50.0% of the affected patients. In conclusion, using hybrid external fixation for type C tibial plafond fractures resulted in good outcomes. However, this should be investigated further in studies with a higher level of evidence.

  2. Delayed fixation of displaced bilateral, atraumatic, femoral neck fractures in a patient with pregnancy related osteomalacia.

    PubMed

    Docker, Charles; Starks, Ian; Wade, Roger; Wynn-Jones, Charles

    2011-06-01

    We present the case of a woman diagnosed with simultaneous displaced intracapsular femoral neck fractures following the birth of her second child. No traumatic event was identified. Diagnosis was delayed as the cause of her pain was thought to be non-skeletal in origin. Radiological and serological investigations were diagnostic of osteomalacia. Surgical fixation of her fractures was further delayed due to profound hypocalcaemia. Despite the delays, fixation with bilateral dynamic hip screws resulted in union with no evidence of avascular necrosis at 2 years follow-up. We believe this to be the first report of atraumatic bilateral femoral neck fractures and it shows that a good result can be achieved even in the presence of delayed fixation.

  3. Technique for reduction and percutaneous fixation of U- and H-shaped sacral fractures.

    PubMed

    Ruatti, S; Kerschbaumer, G; Gay, E; Milaire, M; Merloz, P; Tonetti, J

    2013-09-01

    We describe an early reduction and percutaneous fixation technique for isolated sacral fractures. Strong manual traction combined with manual counter-traction on the torso is used to disimpact the fracture. Transcondylar traction is then applied bilaterally and two ilio-sacral screws are inserted percutaneously on each side. Open reduction and fixation, with sacral laminectomy in patients with neurological abnormalities, remains the reference standard. Early reduction and percutaneous fixation ensures restoration of the pelvic parameters while minimising soft-tissue damage and the risk of infection. Decompression procedures can be performed either during the same surgical procedure after changing the installation or after a few days. These complex fractures warrant patient referral to specialised reference centres.

  4. Finite element analysis of three commonly used external fixation devices for treating Type III pilon fractures.

    PubMed

    Ramlee, Muhammad Hanif; Kadir, Mohammed Rafiq Abdul; Murali, Malliga Raman; Kamarul, Tunku

    2014-10-01

    Pilon fractures are commonly caused by high energy trauma and can result in long-term immobilization of patients. The use of an external fixator i.e. the (1) Delta, (2) Mitkovic or (3) Unilateral frame for treating type III pilon fractures is generally recommended by many experts owing to the stability provided by these constructs. This allows this type of fracture to heal quickly whilst permitting early mobilization. However, the stability of one fixator over the other has not been previously demonstrated. This study was conducted to determine the biomechanical stability of these external fixators in type III pilon fractures using finite element modelling. Three-dimensional models of the tibia, fibula, talus, calcaneus, navicular, cuboid, three cuneiforms and five metatarsal bones were reconstructed from previously obtained CT datasets. Bones were assigned with isotropic material properties, while the cartilage was assigned as hyperelastic springs with Mooney-Rivlin properties. Axial loads of 350 N and 70 N were applied at the tibia to simulate the stance and the swing phase of a gait cycle. To prevent rigid body motion, the calcaneus and metatarsals were fixed distally in all degrees of freedom. The results indicate that the model with the Delta frame produced the lowest relative micromovement (0.03 mm) compared to the Mitkovic (0.05 mm) and Unilateral (0.42 mm) fixators during the stance phase. The highest stress concentrations were found at the pin of the Unilateral external fixator (509.2 MPa) compared to the Mitkovic (286.0 MPa) and the Delta (266.7 MPa) frames. In conclusion, the Delta external fixator was found to be the most stable external fixator for treating type III pilon fractures.

  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. Displaced avulsion fractures of the posterior cruciate ligament: Treated by stellate steel plate fixation

    PubMed Central

    Li, Lijun; Tian, Wei

    2015-01-01

    Background: The open reduction with internal fixation is an effective approach for treatment of avulsion fracture of posterior cruciate ligament. The previously used internal fixation materials including hollow screws, absorbable screw, tension bands and sutures have great defects such as insufficient fixation strength, susceptibility to re-fracture, etc. Stellate steel plate is novel material for internal fixation which has unique gear-like structure design. We used stellate steel plate for treatment of displaced avulsion fractures of posterior cruciate ligament in this study. Materials and Methods: 14 patients (9 men, 5 women; aged, 19–35 years; mean age, 28 years) with displaced avulsion fractures of the tibial insertion of the posterior cruciate ligament were retrospectively analyzed between June 2009 and June 2011. The mean duration from injury to the operation was 8.3 days (range 6–15 days). All the patients were treated with open reduction and internal fixation of a stellate steel plate (DePuy, Raynham, MA 02767, USA). The Lysholm-Tegner knee function score criteria were used to analyze results. Results: The mean followup was 24.6 months (range 18–32 months). After 6 months, all the fractures healed and knee joint activity was normal, with no knee stiffness or instability. The Lysholm-Tegner scores were 97.1 ± 1.7 points at the final followup. Conclusion: Owing to its unique gear structure, the stellate steel plate design can effectively fix an avulsion fracture block and it is a simple operation with short postoperative rehabilitation time and firm fixation. PMID:26015605

  7. Comparison of two-transsacral-screw fixation versus triangular osteosynthesis for transforaminal sacral fractures.

    PubMed

    Min, Kyong S; Zamorano, David P; Wahba, George M; Garcia, Ivan; Bhatia, Nitin; Lee, Thay Q

    2014-09-01

    Transforaminal pelvic fractures are high-energy injuries that are translationally and rotationally unstable. This study compared the biomechanical stability of triangular osteosynthesis vs 2-transsacral-screw fixation in the repair of a transforaminal pelvic fracture model. A transforaminal fracture model was created in 10 cadaveric lumbopelvic specimens. Five of the specimens were stabilized with triangular osteosynthesis, which consisted of unilateral L5-to-ilium lumbopelvic fixation and ipsilateral iliosacral screw fixation. The remaining 5 were stabilized with a 2-transsacral-screw fixation technique that consisted of 2 transsacral screws inserted across S1. All specimens were loaded cyclically and then loaded to failure. Translation and rotation were measured using the MicroScribe 3D digitizing system (Revware Inc, Raleigh, North Carolina). The 2-transsacral-screw group showed significantly greater stiffness than the triangular osteosynthesis group (2-transsacral-screw group, 248.7 N/mm [standard deviation, 73.9]; triangular osteosynthesis group, 125.0 N/mm [standard deviation, 66.9]; P=.02); however, ultimate load and rotational stiffness were not statistically significant. Compared with triangular osteosynthesis fixation, the use of 2 transsacral screws provides a comparable biomechanical stability profile in both translation and rotation. This newly revised 2-transsacral-screw construct offers the traumatologist an alternative method of repair for vertical shear fractures that provides biplanar stability. It also offers the advantage of percutaneous placement in either the prone or supine position.

  8. Bilateral traumatic proximal humerus fractures managed by open reduction and internal fixation with locked plates.

    PubMed

    Jaiswal, Atin; Kachchhap, Naiman Deepak; Chaterjee, Rupak; Tanwar, Yashwant Singh; Habib, Masood; Singh, Satya Prakash

    2013-01-01

    Fractures of the proximal humerus are uncommon in young patients. Although bilateral fracture of proximal humerus itself is rare, association with epilepsy and electrocution is frequent. Only one case of traumatic bilateral proximal humerus fracture has been reported in the literature. We report a rare case of bilateral traumatic displaced proximal humerus fractures in a 40 years old male patient, which was treated by means of open reduction and internal fixation with proximal humerus locked pates on both sides and obtained a good functional outcome.

  9. A mini external fixator for hand and finger fractures constructed from readily available materials.

    PubMed

    Walter, Frank L; Papandrea, Rick F

    2011-12-01

    Phalangeal and metacarpal fractures with severe comminution and/or soft tissue compromise can present a challenge for the orthopedic surgeon. Maintaining viability of the soft tissues while providing rigid fixation of bony injuries is the goal when treating these injuries. Commercially available mini external fixators can help to achieve these goals. However, these devices are costly and are not always available when the surgeon needs them. In this technique study, we discuss the implementation of a mini external fixator using readily available implements in the operating room that is efficient, cost effective, and easy to apply.

  10. 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

  11. 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.

  12. 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

  13. Analysis of Sternal Fixation Results According to Plate Type in Sternal Fracture

    PubMed Central

    Byun, Chun Sung; Park, Il Hwan; Hwang, Wan Jin; Lee, Yeiwon; Cho, Hyun Min

    2016-01-01

    Background Sternal fractures are relatively rare, and caused mainly by blunt anterior chest wall trauma. In most cases, sternal fractures are treated conservatively. However, if the patient exhibits problematic symptoms such as intractable chest wall pain or bony crepitus due to sternal instability, surgical correction is indicated. But no consensus exists regarding the most appropriate surgical method. We analyzed the results of surgical fixation in cases of sternal fracture in order to identify which surgical method led to the best outcomes. Methods We retrospectively reviewed the medical records of patients with sternal fractures from December 2008 to December 2011, and found 19 patients who underwent open reduction and internal fixation of the sternum with a longitudinal plate (L-group) or a T-shaped plate (T-group). We investigated patients’ characteristics, clinical details regarding each case of chest trauma, the presence of other associated injuries, the type of open reduction and fixation, whether a combined operation was performed, and postoperative complications. Results Of the 19 patients, 10 patients (52.6%) were male, and their average age was 56.8 years (range, 32 to 82 years). Seven patients (36.8%) had isolated sternal fractures, while 12 (63.2%) had other associated injuries. Seven patients (36.8%) were in the L-group and 12 patients (63.2%) were in the T-group. Three patients in the L-group (42.9%) showed a loosening of the fixation. In all patients in the T-group, the fracture exhibited stable alignment. Conclusion Open reduction and internal fixation with a T-shaped plate in sternal fractures is a safer and more efficient treatment method than treatment with a longitudinal plate, especially in patients with a severely displaced sternum or anterior flail chest, than a longitudinal plate. PMID:27733996

  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. 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

  16. Vertical Open Patella Fracture, Treatment, Rehabilitation and the Moment to Fixation

    PubMed Central

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

    2015-01-01

    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

  17. 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

  18. External Fixation of Unstable, “Flail” Nasal Fractures

    PubMed Central

    Anastassov, George E.; Payami, Ali; Manji, Zain

    2012-01-01

    Nasal bone fractures are the most common among facial fractures. Usually these are adequately treated with closed reduction and internal and/or external stabilization with splints. However, there are clinical situations where the nasal bones are severely displaced, the nasal septum fractured and displaced, or there are external drape lacerations which preclude the use of nasal splints. If the nasal bones are reducible but unstable we consider them “flail” and in this case transmucosal, endonasal Kirschner wires are used for dorsal support until sufficient healing occurs. The technique is simple, quick, and predictable and causes minimal discomfort to the patients. PMID:23730426

  19. 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

  20. When Should Open Reduction and Internal Fixation Ankle Fractures Begin Weight Bearing? A Systematic Review.

    PubMed

    Smith, Toby O; Davies, Leigh

    2008-02-01

    The objective of this paper was to review the literature to assess when open reduction and internal fixation ankle fractures should commence weight bearing for the best outcome. An electronic search was undertaken of the databases AMED, Cinahl, Embase, Medline (via Ovid), Pedro and Pubmed, from their inception to November 2005. References lists were scrutinised and a hand search was also performed. We included all English language, human subject, controlled clinical trials, comparing the effects of early against later weight bearing following open reduction and internal fixation of ankle fractures. Two reviewers independently assessed the methodological quality of the literature using the PEDro (Physiotherapy Evidence Database) scoring system. Five papers comprising of 366 ankle fractures were reviewed. Overall, there was no significant difference between commencing early, compared to later weight bearing in subjects following open reduction and internal fixation, when evaluated against function, pain, range of movement, radiological assessment, complications, and return to work. The evidence reviewed was generally poor, with numerous methodological design limitations. The literature suggested that were was little difference between encouraging early or delayed weight bearing after open reduction and internal fixation of ankle fractures. Neither early nor later weight bearing significantly improves or jeopardises outcomes. However, due to the plethora of methodological limitations and limited evidence, it is not possible to reference this conclusion with conviction. Further large, well-designed randomized controlled trials are required to evaluate this area. PMID:26815494

  1. 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

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

    PubMed

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

    2015-12-11

    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.

  3. Cheek drooping in 2 patients with maxillary fractures after rigid fixation with bioabsorbable mesh.

    PubMed

    Oh, Seung Hyun; Kim, Chung Hun; Choi, Hyun Gon; Hwang, Euna

    2014-03-01

    Bioabsorbable plate-screw systems are commonly used for the internal fixation of facial bone fractures. The anterior maxilla has a unique curved shape, and fractured bony fragments tend to be small and fragile; therefore, more effective rigid fixation can be achieved using a molded bioabsorbable mesh rather than a bioabsorbable plate. Herein, we describe 2 patients with cheek drooping after a rigid fixation of comminuted maxillary fracture using bioabsorbable meshes and screws.The postoperative courses were uneventful, but both showed soft tissue bulging in the cheek area of the operation site for 12 to 13 months after the operation. No other symptom or sign related to inflammation or foreign body reaction was noted.In comminuted maxillary fractures, bone fragments are more conveniently fixed with a 1-piece molded bioabsorbable mesh. However, it is believed that a single large mesh may interfere with adhesion between the maxillary surface and the overlying soft tissue. Therefore, we recommend using the least amount of mesh to fixate maxillary bone fragments.

  4. Infection in fracture fixation: can we influence infection rates through implant design?

    PubMed

    Moriarty, T Fintan; Schlegel, U; Perren, S; Richards, R Geoff

    2010-03-01

    Musculoskeletal infection is one of the most common complications associated with surgical fixation of bones fractured during trauma. These infections usually involve bacterial colonisation and biofilm formation on the fracture fixation device itself, as well as infection of the surrounding tissues. Antibiotic prophylaxis, wound debridement and postsurgical care can reduce the incidence of, but do not prevent, these infections. Much research and development has been focussed on ways to further reduce the incidence of infection and in the following short review we describe our experiences investigating the contribution of the basic design of fracture fixation devices on the susceptibility to infection. It has been shown in animal studies that device size, shape, mode of action and material and topography play an interrelated role in the susceptibility to infection. Although direct extrapolation from animal studies to the clinical setting is difficult, close consideration of the design factors that can reduce the incidence of infection in animal models is expected to help minimise the incidence of infection associated with any clinically implemented fracture fixation device.

  5. New maneuver for fixation of pediatric nasal bone fracture.

    PubMed

    Aldelaimi, Tahrir N

    2011-07-01

    Surgical treatment of nasal bone fractures in children is a complex and challenging task not only to maxillofacial surgeons but exceeding to ears, nose, and throat and plastic surgeons. Twelve child patients including 9 boys (75%) and 3 girls (25%) with nasal bone fractures were seen at the Maxillofacial Surgery Department at Ramadi Teaching Hospital during the period of December 2009 to December 2010. Fractured nasal bone is reduced to its anatomic position with Walsham forceps, and the dislocated or disrupted nasal septum with Asch forceps. The most common cause of the injury was road traffic accident and motorcycle accident 5 (42%); nasal deviation was found in 9 cases (75%), and depression in 2 (17%). In 9 patients (75%), injuries were isolated, and 3 (25%) were associated with other facial bone fractures. Significant advances have been made in the management of these injuries, decreasing the incidence of secondary deformities.

  6. 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.

  7. 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

  8. 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

  9. 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

  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.

  11. 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

  12. 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

  13. The use of short carbon fibre reinforced thermoplastic plates for fracture fixation.

    PubMed

    Gillett, N; Brown, S A; Dumbleton, J H; Pool, R P

    1985-03-01

    Thermoplastic plates of Nylon 6-10 and Polybutylene terephthalate reinforced with 30% short randomly oriented carbon fibres were tested for internal fixation of canine femoral transverse midshaft fractures. The elastic modulus of the plates was one-half that of bone: however, ultimate strength and strain in bending were comparable to bone. The fractures healed with moderate callus formation which was completely remodelled by 8 to 12 wk post surgery. Although a moderate inflammatory reaction to occasional particulate debris was noted, the materials appeared to possess the proper elastic moduli to allow sufficient support for the healing fracture without protecting the remodelling process.

  14. 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.

  15. 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

  16. Early motion protocol for select Galeazzi fractures after radial shaft fixation.

    PubMed

    Gwinn, David E; O'Toole, Robert V; Eglseder, W Andrew

    2010-01-01

    Galeazzi fractures traditionally are treated in long arm casts with the wrist fully supinated for 6 weeks after open reduction and internal fixation. Recent literature suggests that early motion can be permitted for a subset of Galeazzi fractures. Defining a safe postoperative protocol that allows immediate elbow motion, immediate platform weight bearing, and early wrist motion might decrease elbow morbidity, increase range of motion, and improve outcomes. A retrospective review of a prospectively collected database of 26 patients at a level I trauma center was conducted. Early motion protocol was assigned to patients who were radiographically and clinically stable after plate and screw fixation. Elbow flexion and platform weight bearing were allowed immediately; increased wrist rotation was allowed at 2-week intervals. Early motion of elbow and wrist seems to be safe during postoperative rehabilitation of repaired Galeazzi fractures. The postoperative protocol might maximize elbow and wrist range of motion.

  17. 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. PMID:27536642

  18. Trimalleolar fracture with a double fragment of the posterior malleolus: a case report and modified operative approach to internal fixation.

    PubMed

    Karachalios, T; Roidis, N; Karoutis, D; Bargiotas, K; Karachalios, G G

    2001-02-01

    Fractures of the medial and lateral malleoli are frequently associated with fractures of the posterior malleolus, comprising trimalleolar fractures. The posterior fragment may be posteromedial or posterolateral and its size determines the necessity for surgical or non-surgical treatment. The authors describe a case of trimalleolar fracture with double involvement of the posterior malleolus, both a posteromedial and posterolateral fragment. A modified transmalleolar operative approach for internal fixation is recommended when dealing with such complex trimalleolar fractures of the ankle.

  19. Novel intramedullary-fixation technique for long bone fragility fractures using bioresorbable materials.

    PubMed

    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

  20. 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

  1. 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

  2. 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.

  3. Biomechanical comparison of locking plate and crossing metallic and absorbable screws fixations for intra-articular calcaneal fractures.

    PubMed

    Ni, Ming; Wong, Duo Wai-Chi; Mei, Jiong; Niu, Wenxin; Zhang, Ming

    2016-09-01

    The locking plate and percutaneous crossing metallic screws and crossing absorbable screws have been used clinically to treat intra-articular calcaneal fractures, but little is known about the biomechanical differences between them. This study compared the biomechanical stability of calcaneal fractures fixed using a locking plate and crossing screws. Three-dimensional finite-element models of intact and fractured calcanei were developed based on the CT images of a cadaveric sample. Surgeries were simulated on models of Sanders type III calcaneal fractures to produce accurate postoperative models fixed by the three implants. A vertical force was applied to the superior surface of the subtalar joint to simulate the stance phase of a walking gait. This model was validated by an in vitro experiment using the same calcaneal sample. The intact calcaneus showed greater stiffness than the fixation models. Of the three fixations, the locking plate produced the greatest stiffness and the highest von Mises stress peak. The micromotion of the fracture fixated with the locking plate was similar to that of the fracture fixated with the metallic screws but smaller than that fixated with the absorbable screws. Fixation with both plate and crossing screws can be used to treat intra-articular calcaneal fractures. In general, fixation with crossing metallic screws is preferable because it provides sufficient stability with less stress shielding.

  4. [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

  5. Arthroscopic-assisted reduction and percutaneous fixation of tibial plateau fractures.

    PubMed

    Hartigan, David E; McCarthy, Mark A; Krych, Aaron J; Levy, Bruce A

    2015-02-01

    Tibial plateau fractures present a difficult range of fractures to treat. Arthroscopy allows for a less invasive option when compared with arthrotomy. Furthermore, visualization of the articular surface arthroscopically can allow for a precise reduction and assessment of any concomitant injuries to the articular cartilage and meniscus. By use of arthroscopy, unicondylar lateral plateaus were traditionally approached through a laterally based metaphyseal window. However, in carefully selected patients and fracture patterns, a medially based, arthroscopic-assisted approach can create long bony tunnels for subchondral support and allow for greater ease in fracture reduction. We present our technique using a medial approach for arthroscopic-assisted fixation of lateral tibial plateau fractures. PMID:25973374

  6. Refracture of proximal fifth metatarsal (Jones) fracture after intramedullary screw fixation in athletes.

    PubMed

    Wright, R W; Fischer, D A; Shively, R A; Heidt, R S; Nuber, G W

    2000-01-01

    This study details six instances of refracture of clinically and radiographically healed fractures of the base of the fifth metatarsal after intramedullary screw fixation. Four professional football players, one college basketball player, and one recreational athlete underwent intramedullary screw fixation of fifth metatarsal fractures. The athletes were released to full activities an average of 8.5 weeks (range, 5.5 to 12) after fixation, when healing was clinically and radiographically documented. Three football players developed refracture within 1 day of return to full activity. The other three athletes refractured at 2.5, 4, and 4.5 months after return to activity. Two football players underwent repeat fixation with larger screws and returned to play in the same season. The college basketball player underwent bone grafting and returned to play in subsequent seasons. The other three athletes underwent nonoperative management and healed uneventfully over 6 to 8 weeks. On the basis of this series, we recommend that 1) screw fixation using a large-diameter screw should be given careful consideration for patients with large body mass for whom early return to activity is important; 2) functional bracing, shoe modification, or an orthosis should be considered for return to play; 3) if refracture occurs, exchange to a larger screw may allow return to play in the same season; and 4) alternative imaging should be considered to help document complete healing.

  7. 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.

  8. 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.

  9. Hinged external fixation for complex fracture-dislocation of the elbow in elderly people.

    PubMed

    Maniscalco, P; Pizzoli, A L; Renzi Brivio, L; Caforio, M

    2014-12-01

    The authors report their experience of treating complex elbow fracture-dislocations in elderly people, using a minimally-invasive approach with a new articulated external fixator that is associated with minimal internal fixation. The clinical results for 19 patients are presented according to outcome factors, such as range of motion, pain and function, rate and type of complications, and reoperation rate. The results indicate that this treatment strategy should be considered as a good alternative to other treatment options reported in the literature, including conservative treatment, ORIF with angular stable plates and total elbow arthroplasty. PMID:25457320

  10. The Utility of the Fluoroscopic Skyline View During Volar Locking Plate Fixation of Distal Radius Fractures

    PubMed Central

    Vaiss, Lucile; Ichihara, Satoshi; Hendriks, Sarah; Taleb, Chihab; Liverneaux, Philippe; Facca, Sybille

    2014-01-01

    Background Open reduction and internal fixation (ORIF) using a volar locking plate is a common method for treating displaced distal radius fractures. There is, however, the risk of extensor tendon rupture due to protrusion of the screw tips past the dorsal cortex, which cannot always be adequately seen on a lateral fluoroscopic view. We therefore wished to compare the sensitivity of an intraoperative fluoroscopic skyline view to a lateral fluorosocopic view in detecting past pointing of these screws. Material and Methods Our series included 75 patients with an average age of 59 years who underwent volar locked plate fixation of a displaced distal radius fracture. Intraoperative anteroposterior (AP), lateral, and skyline fluoroscopic views were performed in each case. The number of screws that were seen to protrude past the dorsal cortex of the distal fracture fragment were recorded for both the lateral and skyline views. The number of screws that required exchange was also documented. Results No screws were seen to protrude past the dorsal cortical bone on the lateral fluroscopic views. 15 of 300 screws (5%) were seen to protrude past the dorsal cortex by an average of 0.8 mm (range, 0.5 to 2 mm) and were exchanged for shorter screws in 11/75 patients. Conclusion Our results demonstrate that the skyline is more sensitive than a lateral fluoroscopic view at demonstrating protrusion of the screws in the distal fracture fragment following volar locked plate fixation. Level of Evidence IV PMID:25364637

  11. 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

  12. 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.

  13. 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

  14. 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

  15. Complications encountered while using thin-wire-hybrid-external fixation modular frames for fracture fixation. A retrospective clinical analysis and possible support for "Damage Control Orthopaedic Surgery".

    PubMed

    Lerner, A; Chezar, A; Haddad, M; Kaufman, H; Rozen, N; Stein, H

    2005-05-01

    One hundred ninety eight adult patients who had sustained long bone fractures were treated by external fixation from admission to bone healing and consolidation. Of these, 135 had sustained high-energy injuries, 39 of them had suffered multi-system injuries. Superficial pin track infection was the most common complication, occurring predominantly in pins located in the femur, upper tibia and upper humerus. There were no cases of deep infection or osteomyelitis. One patient with a femoral shaft fracture developed a DVT although he was on preventive low molecular weight heparin, i.e. sc Clexane 40 mg daily. There were no cases of PE or ARDS. External fixation systems are a minimal invasive surgical modality, which allow three-dimensional fracture fixation after closed or minimal open reduction. They require a good command of surgical anatomy, but provide an optimal preservation of the fracture's soft tissue envelope, the critical biological factor for new bone formation and fracture healing. Recent publications have suggested that in the critically ill patient, minimally invasive fracture fixation surgery may prevent the perpetuation of a reactive, life threatening inflammatory reaction (the "second hit") which may induce the development of multiple organ dysfunction (MODS).

  16. 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

  17. Variability in Fluoroscopic Image Acquisition During Operative Fixation of Ankle Fractures.

    PubMed

    Harris, Dorothy Y; Lindsey, Ronald W

    2015-10-01

    The goal of this study was to determine whether injury, level of surgeon training, and patient factors are associated with increased use of fluoroscopy during open reduction and internal fixation of ankle fractures. These relationships are not well defined. The study was a retrospective chart review of patients treated at an academic institution with primary open reduction and internal fixation of an ankle. Patient demographics, including sex, age, and body mass index, were collected, as was surgeon year of training (residency and fellowship). Image acquisition data included total number of images, total imaging time, and cumulative dose. Ankle fractures were classified according to the Weber and Lauge-Hansen classifications and the number of fixation points. Bivariate analysis and multiple regression models were used to predict increasing fluoroscopic image acquisition. Alpha was set at 0.05. Of 158 patients identified, 58 were excluded. After bivariate analysis, fracture complexity and year of training showed a significant correlation with increasing image acquisition. After multiple regression analysis, fracture complexity and year of training remained clinically significant and were independent predictors of increased image acquisition. Increasing fracture complexity resulted in 20 additional images, 16 additional seconds, and an increase in radiation of 0.7 mGy. Increasing year of training resulted in an additional 6 images and an increase of 0.35 mGy in cumulative dose. The findings suggest that protocols to educate trainee surgeons in minimizing the use of fluoroscopy would be beneficial at all levels of training and should target multiple fracture patterns.

  18. Evidence based postoperative treatment of distal radius fractures following internal locking plate fixation.

    PubMed

    Klein, S M; Prantl, L; Koller, M; Vykoukal, J; Dolderer, J H; Graf, S; Nerlich, M; Loibl, M; Geis, S

    2015-01-01

    Originally, the treatment method of choice for distal radial fractures (DRF) has been a non-operative approach with six to eight weeks of plaster casting. The introduction of volar locking plate systems at the beginning of the 21 st century has pushed trends towards open reduction and internal fixation (ORIF). While the introduction of fixed angle locking plates together with the increasing knowledge on wrist function and related variable outcomes has led to consensus that operative fixation in instable DRF is the treatment method of choice, there is no agreement on a postoperative care of these injuries. The authors will discuss the available evidence for current concepts of postoperative treatment of DRFs following fixed angle fixation under socioeconomical, biomechanical and burden of disease aspects. Further, relevant randomized controlled trials are evaluated with regard to applied postoperative treatment regimes and related risks for complications.

  19. Tips of the trade #38. The Herbert screw in closed reduction and internal fixation of the Jones fracture.

    PubMed

    Traina, S M; McElhinney, J P

    1991-08-01

    A technique of using a cannulated Herbert screw is presented for addressing the troublesome Jones fracture. This closed intramedullary fixation technique allows early healing without many of the screw head problems encountered in the more traditional AO screw techniques.

  20. Displaced Intra-Articular Fractures of the Distal Radius: Open Reduction With Internal Fixation Versus Bridging External Fixation

    PubMed Central

    Fakoor, Mohammad; Fakoor, Morteza; Mohammadhoseini, Payam

    2015-01-01

    Background: Distal radius fracture is common in all ages. Mobility and wrist function is important. The choice of treatment should aim for optimal function with minimal complications. Objectives: In this study we compared two surgical approaches, open reduction and internal fixation (ORIF) and closed reduction with external fixation (CR + EF), for treatment of intra-articular distal radius fractures. Patients and Methods: Ninety-four patients with distal radius fracture (type 3, 4 and 5 Fernandez classification) were treated with two surgical methods (ORIF and CR + EF); 55 were treated with CR + EF and 39 were treated with ORIF by different surgeons. All patients were assessed at the end of the first, third and sixth week; and then after the third, sixth and 12th month. At the end of the follow-up, all patients completed the Michigan hand outcome questionnaire (MHOQ). We compared radiological parameters of distal radius, range of motion (ROM) of the wrist, duration of rehabilitation, complication and patient satisfaction of the methods. Results: In our study, radiological findings for the ORIF group were radial inclination (RI): 19.35, radial length (RL): 10.35, radial tilt (RT): 8.92, and ulnar variance (UV): 1.64, while for the CR + EF group these were RI: 15.13, RL: 8, RT: 4.78, and UV: 0.27. The ROM for ORIF were flexion/extension (F/E): 137, Radial/Ulnar deviation (R/U): 52, and Supination/Pronation (S/P): 141, while for the CR + EF group these were F/E: 117, R/U: 40 and S/P: 116. Michigan hand outcome score for ORIF was 75% and for Ext. fix was 60%. The rate of complication with the ORIF method was 58% and in Ext. fix this was 69%. The patients in CR + EF had more than the ORIF course of physiotherapy and rehabilitation. Conclusions: In comparison of ORIF and CR + EF, all results including functional score, clinical and radiologic criteria were in favor of the ORIF method while there were less complications with this method. We believe that ORIF is a better

  1. 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

  2. Late vertebral body fracture after lumbar transpedicular fixation. Report of three cases.

    PubMed

    Missori, Paolo; Ramieri, Alessandro; Costanzo, Giuseppe; Peschillo, Simone; Paolini, Sergio; Miscusi, Massimo; D'Andrea, Giancarlo; Delfini, Roberto

    2005-07-01

    Late-onset vertebral body (VB) fracture after lumbar transpedicular fixation has not been previously described in the literature. The authors present three cases in which VB fracture occurred several months after posterolateral fixation in patients with degenerative disease or traumatic injury. The authors suggest that postoperative osteopenia, modified load-sharing function, and intravertebral clefts were responsible for the fractures. Two women and one man were evaluated at a mean follow-up interval of 3 months. Two patients suffered recurrent lumbar pain. Radiography and magnetic resonance imaging revealed fracture of some of the instrumentation-treated VBs. These two patients underwent surgical superior or inferior extension of instrumentation. The third, an asymptomatic patient, received conservative management. The two patients who underwent reoperation made complete recoveries, and there was no evidence of further bone collapse in any case. The authors speculate that alterations in the VBs may occur following application of spinal instrumentation. In rare cases, the device can fracture and consequently lead to recurrent lumbar back pain. Recovery can be achieved by extending the instrumentation in the appropriate direction.

  3. Early outcomes of proximal humerus fracture fixation with locking plate and intramedullary fibular strut graft.

    PubMed

    Tan, Edwin; Lie, Denny; Wong, M K

    2014-09-01

    Proximal humerus fractures are commonly encountered in elderly patients. Surgical treatment demonstrates high complication rates, including varus construct collapse and screw cutout. In this study, the authors evaluate the clinical outcome of locking plate fixation with intramedullary fibular strut graft augmentation as a primary surgical treatment in the prevention of early collapse and screw cutout. A total of 9 patients were evaluated. Surgery was performed for displaced proximal humerus fractures between April and December 2011. Patients were either class 2, 3, or 4, according to Neer classification. Mean patient age was 75.4 years. Preoperative and immediate, 6-week, and 3-month postoperative radiographs were evaluated. Head-shaft angles were measured to assess for varus collapse and displacement. Range of motion, complication rates, and functional recovery were also evaluated. Patients underwent open reduction and internal fixation with placement of an intramedullary fibular strut graft. Fixation was achieved with a Philos plate (Synthes, Oberdorf, Switzerland). Reduction and fixation were evaluated with radiographs. Passive exercises and range of motion were allowed immediately postoperatively, and all patients achieved active abduction and forward flexion 6 weeks postoperatively. Shoulder radiographs taken 12 weeks postoperatively revealed no loss of reduction or screw cutout. The introduction of the locking plate has improved outcomes. The addition of an intramedullary strut graft has shown improved preliminary results. Maintained reduction was observed in all 9 patients in the early postoperative period, and good functional motion was achieved. No incidence of screw cutout was recorded.

  4. 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

  5. Combining of small fragment screws and large fragment plates for open reduction and internal fixation of periprosthetic humeral fractures.

    PubMed

    Seybold, Dominik; Citak, Mustafa; Königshausen, Matthias; Gessmann, Jan; Schildhauer, Thomas A

    2011-10-01

    Operative treatment of periprosthetic humeral fractures in elderly patients with osteoporotic bone requires a stable fixations technique. The combination of 3.5 cortical screws with washers in a 4.5 Arbeitsgemeinschaft für Osteosynthesefragen, Limited-contact dynamic compression plate or Locking plate, allows a stable periprosthetic fixation with the small 3.5 screws and 4.5 screws above and below the prosthesis, respectively. This combination is a cost-effective technique to treat periprosthetic humeral fractures.

  6. 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

  7. A Pitfall in Fixation of Distal Humeral Fractures with Pre-Contoured Locking Compression Plate

    PubMed Central

    Jayakumar, Prakash; Ring, David

    2015-01-01

    Anatomically precontoured locking plates are intended to facilitate the fixation of articular fractures and particularly those associated with osteoporosis. Fractures of the distal humerus are relatively uncommon injuries where operative intervention can be exceptionally challenging. The distal humeral trochlea provides a very narrow anatomical window through which to pass a fixed-angle locking screw, which must also avoid the olecranon, coronoid, and radial fossae. We describe 3 patients (ages 27, 49, and 73 years) with a bicolumnar fracture of the distal humerus where very short distal locking screws were used. Intra-articular screw placement was avoided but loss of fixation occurred in two patients and a third was treated with a prolonged period of immobilization. We postulate that fixed-angle screw trajectories may make it difficult for the surgeon to place screws of adequate length in this anatomically confined region, and may lead to insufficient distal fixation. Surgical tactics should include placement of as many screws as possible into the distal fragment, as long as possible and that each screw passes through a plate without necessarily locking in. PMID:26110181

  8. Internal fixation after fracture or osteotomy of the femur in young children with polyostotic fibrous dysplasia.

    PubMed

    Benedetti Valentini, Matteo; Ippolito, Ernesto; Catellani, Francesco; Farsetti, Pasquale

    2015-07-01

    Children from 4 to 7 years of age with polyostotic fibrous dysplasia (PFD) may need internal fixation of the femur for either fracture or osteotomy. At that age, the small size of the femur allows only the use of small intramedullary nails. However, titanium elastic nails and rigid intramedullary pediatric interlocking femoral nails - good for fracture or osteotomy fixation in the normal femur - are not indicated in PFD. From 2009 to 2011, we treated eight cases of PFD femoral fracture and deformity by internal fixation with a custom-modified adult humeral nail to which a spiral blade was connected. The 7-mm thick nail fit properly into the small femoral shaft and the spiral blade conferred ideal mechanical support to the femoral neck. Three cases had replacement of the humeral nail with a more appropriate adult femoral nail 3 years after the index procedure when the femur had reached an adequate size. In the maximum follow-up period of 4 years, few complications were observed.

  9. Coronal Acetabular Fractures: The Anterior Approach in Computed Tomography-Navigated Minimally Invasive Percutaneous Fixation

    SciTech Connect

    Jacob, Augustinus Ludwig; Suhm, Norbert; Kaim, Achim; Regazzoni, Pietro; Steinbrich, Wolfgang; Messmer, Peter

    2000-09-15

    Purpose: To demonstrate the technical feasibility of the anterior approach to the coronal roof component of carefully selected acetabular fractures in computed tomography (CT)-navigated closed reduction and percutaneous fixation (CRPF).Methods: Four patients with nondisplaced or slightly displaced coronal fractures of the acetabular roof were treated with percutaneous screw fixation. Screws were implanted over guidepins placed under CT navigation. Mean clinical and radiological follow-up was 16 months.Results: All screws could be placed as intended. There were no peri- or postoperative complications. Radiological follow-up showed primary osseous union. Clinical results were excellent according to a median Merle-d'Aubigne score of 18.Conclusion: Nondisplaced or slightly displaced coronally oriented fractures of the acetabular roof can be treated by minimally invasive percutaneous CT-navigated fixation through an anterior approach that does not endanger the sciatic nerve. Early clinical results are encouraging. Close cooperation between trauma surgeons and radiologists and careful selection of cases is mandatory.

  10. 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.

  11. 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

  12. Analysis of risk factors for femoral head necrosis after internal fixation in femoral neck fractures.

    PubMed

    Wang, Tao; Sun, Jun-Ying; Zha, Guo-Chun; Jiang, Tao; You, Zhen-Jun; Yuan, De-Jing

    2014-12-01

    Femoral head necrosis is a rare but devastating complication following femoral neck fracture. The reported incidence of avascular necrosis after femoral neck fracture fixation varies widely, and there is no consensus regarding its risk factors. The aim of this study was to analyze the risk factors for femoral head necrosis after internal fixation in femoral neck fracture. This retrospective study included 166 patients with femoral neck fractures treated with surgical reduction and internal fixation at the authors' institution from January 2004 to December 2008. Eight patients died for reasons unrelated to the surgery, and 12 patients were lost to follow-up. The remaining 146 patients (146 fractures) were followed until union or until conversion to total hip arthroplasty. The patients included 61 males and 85 females with an average age of 47.5 years (range, 18-68 years). The authors analyzed the following factors: age, sex, Garden classification, reduction quality, surgical methods, injury-to-surgery interval, preoperative traction, weight-bearing time, and implant removal. All patients were followed for a mean of 52 months (range, 6-90 months). The incidence of femoral head necrosis was 14.4% (21/146). Garden classification (P=.012), reduction quality (P=.008), implant removal (P=.020), and preoperative traction (P=.003) were significantly associated with femoral head necrosis. Patient age (P=.990), sex (P=.287), injury-to-surgery interval (P=.360), weight-bearing time (P=.868), and surgical methods (P=.987) were not significantly associated with femoral head necrosis. In multivariate logistic regression analysis, implant removal was not a significant risk factor for femoral head necrosis development (P=.498). Garden classification, reduction quality, and preoperative traction had a significant effect on femoral head necrosis development. PMID:25437087

  13. 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

  14. Management of Proximal Tibia Fractures Using Wire Based Circular External Fixator

    PubMed Central

    Misra, Rakesh Kumar; Kaur, Manjinder

    2015-01-01

    Introduction Management of high grade proximal tibia or tibial plateau fractures is often associated with complications. The use of wire fixators for the definitive treatment of such fractures entails a minimally invasive technique of insertion that gives good fracture reduction and stability combined with minimal postoperative complications. Aim To assess the outcome of treatment of such fractures by the use of Joshi’s external stabilization system (JESS), which is a wire based, circular external fixator system. Materials and Methods A prospective, uncontrolled study was done using JESS on 20 consecutive patients of high energy fractures of the tibial plateau, classified according to the Schatzker’s classification as type VI. Results In this series, road traffic accidents accounted for most of the injuries (n=12), while pedestrian accidents (n=4), injury due to fall from height (n=3) and injury due to fall while playing (n=1) were the other modes of injury. The mean patient age was 39.4 years. The mean follow up period was 24 weeks. In this study, using Knee society score evaluation, excellent results were seen in 12 patients (60%), good results were seen in 5 patients (25%), fair in 2 patients (10%) and bad in 1 patient (5%). Complications seen were, pin tract infections in two cases (10%) which resolved with dressings and oral antibiotics and one case of non-union (5%), in which the tibial plateau fracture extended into proximal 1/3 of the tibial shaft with severe comminution. No other complication was encountered. Conclusion JESS is a simple, inexpensive and useful technique in the management of high grade tibial plateau fractures. PMID:26500969

  15. Locking compression plate distal ulna hook plate as alternative fixation for fifth metatarsal base fracture.

    PubMed

    Lee, Sang Ki; Park, Ju Sang; Choy, Won Sik

    2014-01-01

    Intramedullary screw fixation has been the most common treatment for fifth metatarsal base fractures. However, screw application will not achieve accurate reduction in fractures with small fragments, osteoporotic bone, or Lawrence zone 1 fractures. Because of the similar anatomic architecture between the distal ulna and the fifth metatarsal base, the purpose of the present study was to assess the results of a locking compression plate distal ulna hook plate in stabilizing displaced zone 1 or 2 fifth metatarsal base fractures. A total of 19 patients with Lawrence zone 1 (n = 12) or 2 (n = 7) fractures of the fifth metatarsal base were treated surgically with a locking compression plate distal ulna hook plate. The patients were evaluated clinically and radiographically, and the functional outcomes were graded using the American Orthopaedic Foot and Ankle Society midfoot scoring system. Radiographic bony union was obtained in all patients, at an average of 7.4 weeks. The mean American Orthopaedic Foot and Ankle Society midfoot score improved from 26 (range 0 to 45) points preoperatively to 94 (range 72 to 100) points at the final follow-up visit. Three patients developed post-traumatic cubometatarsal arthrosis, and 1 patient developed sural nerve neurapraxia. In our experience, the distal ulna hook plate achieved a high rate of bony consolidation and anatomically suitable fixation in zone 1 or 2 fifth metatarsal base fractures. We suggest that the locking compression plate distal ulna hook plate should be considered as an alternative treatment of multifragmentary, osteoporotic, and tuberosity avulsion (zone 1) fifth metatarsal base fractures.

  16. LCP distal ulna hook plate as alternative fixation for fifth metatarsal base fracture.

    PubMed

    Lee, Sang Ki; Park, Ju Sang; Choy, Won Sik

    2013-08-01

    Intramedullary screw fixation is the most common treatment for fifth metatarsal base fractures. Screw application does not achieve accurate reduction in fracture with small fragments, osteoporotic bone, or Lawrence zone 1 fractures, however. On the basis of similar anatomical architectures between the distal ulna and the fifth metatarsal base, the purpose of this study was to assess the results of a locking compression plate (LCP) distal ulna hook plate in stabilizing displaced zone 1 or 2 fifth metatarsal base fractures. Nineteen patients with Lawrence zone 1 (n = 12) or 2 (n = 7) fractures of the fifth metatarsal base were treated surgically with an LCP distal ulna hook plate. The patients were evaluated clinically and radiographically, and functional outcomes were graded by using the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot scoring system. Radiographic bony union was obtained in all patients, at an average of 7.4 weeks. The mean AOFAS midfoot score improved from 26 (range, 0-45) preoperatively to 94 (range, 72-100) points at the final follow-up. There were three patients with post-traumatic cubometatarsal arthrosis and one patient with sural nerve neuropraxia. In our experience, the distal ulna hook plate achieves a high rate of bony consolidation and anatomically suitable fixation in zone 1 or 2 fifth metatarsal base fractures. We also suggest that the LCP distal ulna hook plate should be considered as an alternative treatment in multifragmentary, osteoporotic, and tuberosity avulsion (zone 1) fifth metatarsal base fractures.

  17. 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

  18. 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.

  19. 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

  20. 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

  1. 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

  2. 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

  3. 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

  4. Delayed distal radio-ulnar joint instability after Galeazzi type fracture fixation in a child.

    PubMed

    Jettoo, P; de Kiewiet, Gp

    2010-10-15

    We report a rare case of delayed distal radio-ulnar joint instability with malunion of a Galeazzi-type radius fracture in a 10- year-old boy. He underwent operative intervention with flexible intramedullary nailing of the radius. He had careful clinical and intra-operative evaluation under image intensifier, and regular clinical and radiological assessments subsequently in clinic, and his distal radio-ulnar joint (DRUJ) was stable. He nonetheless developed DRUJ instability with malunion of radial midshaft fracture at 4 months. Corrective osteotomy for forearm fracture malunion is an uncommon procedure in children. He underwent a corrective radial osteotomy at the site of malunion, held with a Pennig external fixator, with reconstruction of the DRUJ subluxation. He made a good recovery with full restoration of wrist and forearm function, which was maintained at 17 months.

  5. Characterization of short-fibre reinforced thermoplastics for fracture fixation devices.

    PubMed

    Brown, S A; Hastings, R S; Mason, J J; Moet, A

    1990-10-01

    This study focuses on determining the effects of clinically relevant procedures on the flexural and fracture toughness properties of three short-fibre thermoplastic composites for potential application as fracture fixation devices. The procedures included sterilization, heat contouring and saline soaking. The three materials tested were polysulphone, polybutylene terephthalate and polyetheretherketone, all reinforced with 30% short carbon fibres. The polysulphone composite showed significant degradation in mechanical properties due to saline soaking. The polybutylene terephthalate exhibited significant degradation of mechanical properties following both contouring and saline soaking. The polyetheretherketone composite, however, exhibited no degradation in mechanical properties. The results demonstrated that flexion and fracture toughness testing were effective for determining the response of the composites to different applied conditions and demonstrated the stability of polyetheretherketone subjected to these treatments. Scanning electron microscopy demonstrated the most effective fibre-matrix bonding to be in the polyetheretherketone.

  6. 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

  7. [Angle-fixed plate fixation or double-plate osteosynthesis in fractures of the proximal humerus: a biomechanical study].

    PubMed

    Hessmann, Martin H; Korner, Jan; Hofmann, Alexander; Sternstein, Werner; Rommens, Pol M

    2008-06-01

    Internal fixation of fractures of the proximal humerus needs a high stability of fixation to avoid secondary loss of fixation. This is especially important in osteoporotic bone. In an experimental study, the biomechanical properties of the angle-fixed Philos plate (internal fixator) and a double-plate osteosynthesis using two one-third tubular plates were assessed. The fracture model was an unstable three-part fracture (AO type B2). Eight pairs of human cadaveric humeri were submitted to axial load and torque. In the first part of the study, it was assessed to which degree the original stiffness of the humeri could be restored after the osteotomy by the osteosynthesis procedure. Subsequently, subsidence during 200 cycles of axial loading and torque was analysed. During axial loading, the Philos plate was significantly stiffer and showed less irreversible deformation. Two double-plate fixations, but none of the Philos plate osteosynthesis, failed. During torsion, there were no significant differences between the two implants. From the biomechanical point of view, the angle-fixed Philos plate represents the implant of choice for the surgical fixation of highly unstable three-part fractures of the proximal humerus, as the internal fixator system is characterised by superior biomechanical properties.

  8. 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

  9. 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.

  10. Odontoid balloon kyphoplasty associated with screw fixation for Type II fracture in 2 elderly patients.

    PubMed

    Terreaux, Luc; Loubersac, Thomas; Hamel, Olivier; Bord, Eric; Robert, Roger; Buffenoir, Kevin

    2015-03-01

    Anterior screw fixation is a well-recognized technique that is used to stabilize Type IIB fractures of the odontoid process in the elderly. However, advanced age and osteoporosis are 2 risk factors for pseudarthrosis. Kyphoplasty has been described in the treatment of lytic lesions in C-2. The authors decided to combine these 2 techniques in the treatment of unstable fractures of the odontoid. Two approximately 90-year-old patients were treated for this type of fracture. Instability was demonstrated on dynamic radiography in one patient, and the fracture was seen on static radiography in the other. Clinical parameters, pain, range of motion, 36-Item Short Form Health Survey (SF-36) score (for the first patient), and radiological examinations (CT scans and dynamic radiographs) were studied both before and after surgery. After inflating the balloon both above and below the fracture line, the authors applied a high-viscosity polymethylmethacrylate cement. Some minor leakage of cement was noted in both cases but proved to be harmless. The screws were correctly positioned. The clinical result was excellent, both in terms of pain relief and in the fact that there was no reduction in the SF-36 score. The range of motion remained the same. A follow-up CT scan obtained 1 year later in one of the patients showed no evidence of change in the materials used, and the dynamic radiographs showed no instability. This combination of kyphoplasty and anterior screw fixation of the odontoid seems to be an interesting technique in osteoporotic Type IIB fractures of the odontoid process in the elderly, with good results both clinically and radiologically.

  11. 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

  12. 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

  13. [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

  14. Managing Vancouver B1 fractures by cerclage system compared to locking plate fixation - a biomechanical study.

    PubMed

    Gordon, Katharina; Winkler, Martin; Hofstädter, Thomas; Dorn, Ulrich; Augat, Peter

    2016-06-01

    With increasing life expectancy and number of total hip arthroplasties (THA), the need for revision surgery is increasing too. The aim of this study was to evaluate the optimal fracture treatment for a clinically characteristic Vancouver B1 fracture. We hypothesized that locking plate fixation has biomechanical advantages over fixation with a simple cerclage system. Additionally, we hypothesized that removal of the primary short stem and revision with a long stem would show biomechanical benefit. The biomechanical testing was performed with a static and a dynamic loading protocol on twenty 4th Generation sawbones. These were divided into four different groups (n = 5 each). In group 1, the primary uncemented short stem remained and the fracture was stabilized with a locking plate. In group 2, the primary stem remained and the fracture was stabilized with a cerclage stabilization system containing two stabilizers and four cerclages. In group 3, the primary stem was replaced by an uncemented long revision stem and the fracture was fixed with a locking plate. In group 4, the short stem was replaced by a long revision stem and the fracture was fixed with the cerclage system. Static testing revealed that the revision of the short stem with the long stem caused a 2-fold (p < 0.001, ANOVA) increase of axial stiffness. In dynamic testing, the number of cycles to failure was 4 times (p < 0.001, ANOVA) higher with the long revision stem. Compared to locked plating cerclage wiring demonstrated a 26% more cycles to failure (p = 0.031, ANOVA). The load to failure was 91% larger (p < 0.001, ANOVA) with the long revision stem and 11% smaller with locked plating (p < 0.001, ANOVA). In conclusion, the present biomechanical study indicates that periprosthetic Vancouver B1 fractures can be sufficiently fixed by simple cerclage systems. Revision with a long replacement stem provides a superior mechanical stability regardless of type of osteosynthesis fixation and is therefore a viable

  15. 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

  16. Corrective osteotomy through fracture site and internal fixation with headless screws for type I (Hahn-Steinthal) capitellar malunion

    PubMed Central

    Jeevannavar, Santosh Somayya; Shenoy, Keshav Someshwar; Daddimani, Ravi M

    2013-01-01

    A 20-year-old woman presented 6 months after an initial injury to her left elbow with pain and restricted movements. She was diagnosed with a type I malunited (Hahn-Steinthal) type of capitellum fracture through radiographic studies. Classically, the treatment has been excision of the fragment, which carries a risk of valgus instability of the elbow and late osteoarthrosis. We report a case of malunited type I capitellum fracture, for which corrective osteotomy through fracture site, open reduction and internal fixation was done 6 months following missed trauma. At 24 months follow-up the capitellum fracture had united and the patient has a stable elbow and excellent range of motion. Our case demonstrates that for type I malunited capitellum fractures corrective osteotomy through fracture site and internal fixation rather than excision of the fragment in young can result in successful union and stable elbow. PMID:23709538

  17. Comparison of palmar fixed-angle plate fixation with K-wire fixation of distal radius fractures (AO A2, A3, C1) in elderly patients.

    PubMed

    Goehre, F; Otto, W; Schwan, S; Mendel, T; Vergroesen, P P; Lindemann-Sperfeld, L

    2014-03-01

    The objective of this prospective, randomized, controlled trial was to compare the results of two operative techniques used for the treatment of unstable distal radius fractures in elderly patients classified as AO types A2, A3, and C1. Patients were treated with either fixed-angle volar plates or K-wires using a combined Kapandji and Willenegger technique. The functional results were determined after 3, 6, and 12 months. We included 40 patients aged over 65 years. Twenty-one patients were treated with plate fixation and 19 with K-wire fixation. The functional results, after 1 year, were nearly the same in both treatment groups, suggesting that either method is suitable for the treatment of unstable distal radius fractures of AO types A2, A3, and C1 in elderly patients. Sixteen of 21 patients with plate fixation and 17 of 19 patients with K-wire fixation present good results as assessed by the Castaing score. The median DASH score was three in both groups after 1 year. The patients with plate fixation were able to resume activities of daily living 4 weeks earlier. The most common complication was an intermediate post-traumatic median nerve irritation. Both methods are suitable for the treatment of elderly patients with unstable distal radius fractures of AO types A2, A3, and C1. If early functional post-operative care is important, palmar fixed-angle plate fixation is an ideal treatment approach. Otherwise, K-wire fixation is an effective, minimally invasive method with comparable clinical results.

  18. Rigid internal fixation with titanium versus bioresorbable miniplates in the repair of mandibular fractures in rabbits.

    PubMed

    Hochuli-Vieira, E; Cabrini Gabrielli, M A; Pereira-Filho, V A; Gabrielli, M F R; Padilha, J G

    2005-03-01

    The purpose of this study was to compare by qualitative histology the efficacy of rigid internal fixation with titanium system and the Lacto Sorb system in mandibular fractures in rabbits. Thirty male adult rabbits Oryctolagus cuniculus were used. Unilateral mandibular osteotomies were performed between the canine and first premolar. The animals were divided into two groups: for Group I-rigid internal fixation was performed with titanium system 1.5 mm (Synthes, Oberdorf, Switzerland), with two screws of 6 mm (bicortical) on each side of the osteotomy. For Group II-rigid internal fixation was performed with PLLA/PGA system 1.5 mm (Lacto Sorb, WLorenz, Jacksonville, FL, USA). The histological analysis evaluated the presence of inflammatory reaction, degree of bone healing and degree of resorption of the Lacto Sorb screws. The results of both fixation systems were similar, only with a small difference after 15 and 30 days. In Group I a faster bony healing was noted. But after 60 days, bony healing was similar in both groups. It is concluded that both PLLA/PGA and titanium plates and screws provide sufficient strength to permit mandibular bone healing. The resorption process of PLLA/PGA osteosynthesis material did not cause acute or chronic inflammatory reaction or foreign body reaction during the studied period.

  19. Investigation of metallic and carbon fibre PEEK fracture fixation devices for three-part proximal humeral fractures.

    PubMed

    Feerick, Emer M; Kennedy, Jim; Mullett, Hannan; FitzPatrick, David; McGarry, Patrick

    2013-06-01

    A computational investigation of proximal humeral fracture fixation has been conducted. Four devices were selected for the study; a locking plate, intramedullary nail (IM Nail), K-wires and a Bilboquet device. A 3D model of a humerus was created using a process of thresholding based on the grayscale values of a CT scan of an intact humerus. An idealised three part fracture was created in addition to removing a standard volume from the humeral head as a representation of bone voids that occur as a result of the injury. All finite element simulations conducted represent 90° arm abduction. Simulations were conducted to investigate the effect of filling this bone void with calcium phosphate cement for each device. The effect of constructing devices from carbon fibre polyetheretherketone (CFPEEK) was investigated. Simulations of cement reinforced devices predict greater stability for each device. The average unreinforced fracture line opening (FLO) is reduced by 48.5% for metallic devices with a lesser effect on composite devices with FLO reduced by 23.6%. Relative sliding (shear displacement) is also reduced between fracture fragments by an average of 58.34%. CFPEEK device simulations predict reduced stresses at the device-bone interface.

  20. Single Oblique Posterolateral Approach for Open Reduction and Internal Fixation of Posterior Malleolar Fractures With an Associated Lateral Malleolar Fracture.

    PubMed

    Choi, Jun Young; Kim, Ji Hoon; Ko, Hyeong Tak; Suh, Jin Soo

    2015-01-01

    The purpose of the present retrospective study was to describe the single oblique posterolateral approach for open reduction and internal fixation of large, displaced, posterior malleolar fractures with an associated lateral malleolar fracture. A single oblique posterolateral approach was used for osteosynthesis of the posterior and lateral malleolus in 50 consecutive patients (23 females [46%], 27 males [54%]; mean age, 47.44 ± 16.13 years; mean follow-up duration, 26.32 ± 5.15 months). The mean interval to surgery was 4.3 ± 1.9 days after the inciting trauma. During the follow-up period, the surgery was complicated by skin necrosis around the incision in 2 (4%) patients and sural nerve damage in 2 (4%) patients. We found that the single oblique posterolateral approach to large, displaced, posterior malleolar fractures with an associated lateral malleolar fracture provided easy exposure of the posterior and lateral malleoli and had the potential to decrease the incidence of sural nerve injury because of the smaller incision size.

  1. Stress fractures of the femur after ACL reconstruction with transfemoral fixation.

    PubMed

    Arriaza, Rafael; Señaris, Jose; Couceiro, Gonzalo; Aizpurua, Jesus

    2006-11-01

    The ACL reconstruction with hamstring tendons has become increasingly popular, in part because it is assumed that the complication rate associated with the technique and their severity are lower than with patellar tendon. Two cases of stress reaction of the medial supracondylar area of the femur after ACL reconstruction with hamstring tendons using BioTransfix (Arthrex, Naples, FL, USA) devices for fixation within femur are presented. Both patients were professional athletes (one soccer and one basketball player), and it is hypothesized that the accelerated rehabilitation program used might have represented a risk factor for stress fractures when associated with the guide pin exit hole in the medial femoral cortex. To our knowledge, no such cases have been published to date, but it is important to consider this possibility if an unexplained pain arises in the rehabilitation process of an ACL reconstruction using transfemoral fixation.

  2. 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

  3. 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

  4. Acute compartment syndrome of the foot following fixation of a pilon variant ankle fracture.

    PubMed

    Henning, Amy; Gaines, Robert J; Carr, Donald; Lambert, Edward

    2010-12-01

    Acute traumatic compartment syndrome of the foot is a serious potential complication after fractures, crush injuries, or reperfusion injury after vascular repair. Foot compartment syndrome in association with injuries to the ankle is rare. This article presents a case of acute compartment syndrome of the foot following open reduction and internal fixation of an ankle fracture. A 16-year-old girl presented after sustaining a left ankle injury. Radiographs demonstrated a length-stable posterior and lateral malleolar ankle fracture. Initial treatment consisted of a bulky splint and crutches pending the improvement of her swelling. Over the course of a week, the soft tissue environment of the distal lower extremity improved, and the patient underwent open reduction and internal fixation of both her fibula and distal tibia through 2 approaches. Approximately 2 hours from the completion of surgery, the patient reported worsening pain over the medial aspect of her foot and into her calcaneus. Physical examination of the foot demonstrated a swollen and tense abductor hallicus and heel pad. Posterior tibial and dorsalis pedis pulses were palpable and her sensation was intact throughout her foot. Emergently, fasciotomy of both compartments was performed through a medial incision. Postoperatively, the patient reported immediate pain relief. At 18-month follow-up, she reported no pain and had returned to all of her preinjury athletic activities.

  5. Arthroscopic Fixation of Comminuted Glenoid Fractures Using Cannulated Screws and Suture Anchors

    PubMed Central

    Qu, Feng; Yuan, Bangtuo; Qi, Wei; Li, Chunbao; Shen, Xuezhen; Guo, Qi; Zhao, Gang; Wang, Jiangtao; Li, Hongliang; Lu, Xi; Liu, Yujie

    2015-01-01

    Abstract We investigate the feasibility of arthroscopic fixation of comminuted glenoid fractures using cannulated screws and suture anchors. We retrospectively review 11 cases of closed comminuted glenoid fractures treated at our institution from August 2010 to May 2013. The 11 patients, 8 males and 3 females, had a mean age of 41 years (range: 27–55 years). The mechanisms of injury were traffic accidents in 9 cases and falls from height in 2 cases. The mean time from injury to surgery was 12 days (range: 3–28 days). All glenoid fractures were confirmed on x-ray and computed tomography. The major fracture fragments were fixed with cannulated screws and the small fragments were fixed with suture anchors. All surgical wounds healed with primary closure and no complications including infection and neurovascular damage were observed. All 11 patients were followed up for a mean of 21 months (range: 14–29 months). Bone union was achieved in all patients with a mean time of 10 months. At the last follow-up, range of motion of the shoulder joint was significantly improved (P < 0.05). Both ASES scores (41.4 ± 24.9, 87.3 ± 13.8) and Rowe scores (28.2 ± 18.6, 93.2 ± 11.2) were significantly increased after the surgery (P < 0.01), indicating significantly improved function and stability of the shoulder joint. Arthroscopic fixation using cannulated screws and suture anchors is feasible for the treatment of comminuted glenoid fractures. This method is minimally invasive and provides good functional recovery with a lower risk of complications. PMID:26656324

  6. 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

  7. Use of a locking compression plate as an external fixator for repair of a tarsometatarsal fracture in a bald eagle (Haliaeetus leucocephalus).

    PubMed

    Montgomery, Ronald D; Crandall, Elizabeth; Bellah, Jamie R

    2011-06-01

    We describe the successful treatment of a tarsometatarsal fracture in a mature bald eagle (Haliaeetus leucocephalus) using a locking compression plate as an external fixator. The anatomy of the area (inelastic dermis and minimal subcutaneous space) and the high forces placed on a fracture at that site necessitated a unique approach to fixation. The unconventional use of a locking compression plate as an external fixator was minimally invasive, well tolerated by the eagle, and provided adequate stability in opposing fracture forces. This technique may serve as a method of fixation for tarsometatarsal fractures in other large avian species.

  8. Use of a locking compression plate as an external fixator for repair of a tarsometatarsal fracture in a bald eagle (Haliaeetus leucocephalus).

    PubMed

    Montgomery, Ronald D; Crandall, Elizabeth; Bellah, Jamie R

    2011-06-01

    We describe the successful treatment of a tarsometatarsal fracture in a mature bald eagle (Haliaeetus leucocephalus) using a locking compression plate as an external fixator. The anatomy of the area (inelastic dermis and minimal subcutaneous space) and the high forces placed on a fracture at that site necessitated a unique approach to fixation. The unconventional use of a locking compression plate as an external fixator was minimally invasive, well tolerated by the eagle, and provided adequate stability in opposing fracture forces. This technique may serve as a method of fixation for tarsometatarsal fractures in other large avian species. PMID:21877449

  9. The calcar screw in angular stable plate fixation of proximal humeral fractures - a case study

    PubMed Central

    2011-01-01

    Background With new minimally-invasive approaches for angular stable plate fixation of proximal humeral fractures, the need for the placement of oblique inferomedial screws ('calcar screw') has increasingly been discussed. The purpose of this study was to investigate the influence of calcar screws on secondary loss of reduction and on the occurrence of complications. Methods Patients with a proximal humeral fracture who underwent angular stable plate fixation between 01/2007 and 07/2009 were included. On AP views of the shoulder, the difference in height between humeral head and the proximal end of the plate were determined postoperatively and at follow-up. Additionally, the occurrence of complications was documented. Patients with calcar screws were assigned to group C+, patients without to group C-. Results Follow-up was possible in 60 patients (C+ 6.7 ± 5.6 M/C- 5.0 ± 2.8 M). Humeral head necrosis occurred in 6 (C+, 15.4%) and 3 (C-, 14.3%) cases. Cut-out of the proximal screws was observed in 3 (C+, 7.7%) and 1 (C-, 4.8%) cases. In each group, 1 patient showed delayed union. Implant failure or lesions of the axillary nerve were not observed. In 44 patients, true AP and Neer views were available to measure the head-plate distance. There was a significant loss of reduction in group C- (2.56 ± 2.65 mm) compared to C+ (0.77 ± 1.44 mm; p = 0.01). Conclusions The placement of calcar screws in the angular stable plate fixation of proximal humeral fractures is associated with less secondary loss of reduction by providing inferomedial support. An increased risk for complications could not be shown. PMID:21943090

  10. A Comparison of Internal Fixation and Bipolar Hemiarthroplasty for the Treatment of Reverse Oblique Intertrochanteric Femoral Fractures in Elderly Patients

    PubMed Central

    Park, Bong-Ju; Min, Woong-Bae

    2015-01-01

    Purpose To compare the clinical and radiological results between internal fixation using the proximal femoral nail system and bipolar hemiarthroplasty (BHA) in reverse oblique intertrochanteric hip fractures in elderly patients. Materials and Methods From January 2005 to July 2012, we reviewed the medical records of 53 patients who had been treated surgically for reverse oblique intertrochanteric fracture and had been followed-up on for a minimum of two years. All patients were ≥70 years of age, and divided into two groups for retrospective evaluation. One group was treated with internal fixation using the proximal femoral nail system (31 cases), and the other group was treated with BHA (22 cases). Results Early ambulation postoperatively and less pain at postoperative three month were significantly superior in the BHA group. However, by 24 months postoperatively, the internal fixation group exhibited higher Harris scores and correspondingly less pain than the BHA group. There were no significant differences in union rate, duration of hospitalization or lateral wall fracture healing between the two groups. Four patients in the internal fixation group underwent reoperation. Conclusion In the treatment of intertrochanteric fracture of the reverse oblique type, open reduction and internal fixation should be considered to be the better choice for patients with good health and bone quality. However, in cases of severe comminition of fracture and poor bone quality, BHA is an alternative offering advantages including early ambulation, less pain at early stages, and a lower risk of reoperation. PMID:27536619

  11. New tool for applying traction during open reduction and internal fixation of acetabular fractures.

    PubMed

    Lien, Fang-Chieh

    2012-04-01

    Open reduction and internal fixation is used to treat complex acetabular fractures. Traction on the femur is necessary to reduce the acetabulum and is accomplished by surgical assistants or with mechanical devices. To overcome the disadvantages of various traction methods, the author designed a simple, novel traction device that can be used on an ordinary orthopedic or radiolucent operating table and has advantages over manual traction and commercial traction tables. The device consists of a horizontal cross-bar supported over the patient by 2 free-standing legs and is constructed from commercially available parts.

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

    PubMed Central

    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

  13. Modified arthroscopic suture fixation of displaced tibial eminence fractures using a suture loop transporter.

    PubMed

    Yip, D K; Wong, J W; Chien, E P; Chan, C F

    2001-01-01

    Current arthroscopic suture fixation techniques of tibial eminence fractures are time consuming and the number of anchor sutures that can be placed is limited by the cumbersome and repetitive numerous needle threading steps. This occurs at 2 stages: first, when placing anchoring sutures through the avulsed anterior cruciate ligament stump with a suture punch, and second, when there is a need to traverse the tibial bone canal with the suture ends. We describe a modification that reduces the reliance on conventional rigid instruments and instead uses a loop transporter made from readily available suture material. The suture loop transporter being malleable reduces the necessary width of the tibial bone canal to be made and has a further advantage of minimizing the bone loss during the reaming of the bone tunnel. The subsequent potential for a stress fracture at these tunnel sites is also substantially reduced. Our technique is more user friendly, more accurate, and quicker to perform.

  14. Screw fixation diameter for fifth metatarsal jones fracture: a cadaveric study.

    PubMed

    Scott, Ryan T; Hyer, Christopher F; DeMill, Shyler L

    2015-01-01

    The fifth metatarsal Jones fracture is a well-documented injury occurring at the proximal diaphyseal-metaphyseal junction. Conservative versus surgical intervention has been discussed in published studies for the management of Jones fractures. Solid intramedullary fixation relies on accurate matching of the screw diameter to the intraosseous diameter. The purpose of the present cadaveric study was to determine the average intraosseous diameter of the proximal fifth metatarsal as it relates to screw size selection for Jones fracture stabilization. Twenty fresh-frozen cadaver legs were used for examination. The fifth metatarsal was completely dissected. A transverse osteotomy was performed from laterally to medially along the midline of the metatarsal. A digital caliper was used to measure the diameter of the medullary canal of the fifth metatarsal. The measurement was taken at the narrowest portion of the medullary canal just distal to the proximal metaphysis. The mean dorsal to plantar diameter of the fifth metatarsal was 6.475 ± 1.54 (range 4 to 12) mm and the mean medial to lateral diameter was 4.6 ± 0.85 (range 3 to 6) mm. Intramedullary screw fixation has shown beneficial results in the treatment protocol of fifth metatarsal Jones fractures. Our study has demonstrated that a 4.5-mm cannulated screw is the narrowest diameter screw that can be used in the average fifth metatarsal and still obtain adequate intraosseous purchase. When selecting the appropriate screw, the surgeon must be comfortable selecting the largest screw that will achieve the maximal interface with the dense cortical bone in both the medial to lateral and dorsal to plantar plane.

  15. Review of techniques for monitoring the healing fracture of bones for implementation in an internally fixated pelvis.

    PubMed

    Wong, Lydia Chwang Yuh; Chiu, Wing Kong; Russ, Matthias; Liew, Susan

    2012-03-01

    Sacral fractures from high-impact trauma often cause instability in the pelvic ring structure. Treatment is by internal fixation which clamps the fractured edges together to promote healing. Healing could take up to 12 weeks whereby patients are bedridden to avoid hindrances to the fracture from movement or weight bearing activities. Immobility can lead to muscle degradation and longer periods of rehabilitation. The ability to determine the time at which the fracture is stable enough to allow partial weight-bearing is important to reduce hospitalisation time. This review looks into different techniques used for monitoring the fracture healing of bones which could lead to possible methods for in situ and non-invasive assessment of healing fracture in a fixated pelvis. Traditional techniques being used include radiology and CT scans but were found to be unreliable at times and very subjective in addition to being non in situ. Strain gauges have proven to be very effective for accurate assessment of fracture healing as well as stability for long bones with external fixators but may not be suitable for an internally fixated pelvis. Ultrasound provides in situ monitoring of stiffness recovery but only assesses local fracture sites close to the skin surface and has only been tested on long bones. Vibration analysis can detect non-uniform healing due to its assessment of the overall structure but may suffer from low signal-to-noise ratio due to damping. Impedance techniques have been used to assess properties of non-long bones but recent studies have only been conducted on non-biological materials and more research needs to be done before it can be applicable for monitoring healing in the fixated pelvis.

  16. Preoperative Planning of Virtual Osteotomies Followed by Fabrication of Patient Specific Reconstruction Plate for Secondary Correction and Fixation of Displaced Bilateral Mandibular Body Fracture.

    PubMed

    Thor, Andreas

    2016-06-01

    This paper describes the course of treatment of a severely diplaced bilateral mandibular body fracture, where the first osteosynthesis failed. The subject developed an open bite due to a posterior rotation of the distal part of the mandible and anterior rotation of the proximal parts of the mandible. This situation was evaluated with CBCT and the facial skeleton was segmented using computer software. Correct occlusion was virtually established by bilateral virtual osteotomies in the fracture areas of the mandible. After segmentation, the mandible was virtually rotated back into position and the open bite was closed. A patient specific mandibular reconstruction plate was outlined and fabricated from the new virtual situation and the plate was thereafter installed utilizing the preoperative plan. Osteotomy- and drill-guides was used and thus simplified the surgery resulting in uneventful healing. Virtual planning and patient specific implants and guides were valuable in this case of secondary reconstructive trauma surgery. PMID:27162581

  17. High-impact poly(L/D-lactide) for fracture fixation: in vitro degradation and animal pilot study.

    PubMed

    Tams, J; Joziasse, C A; Bos, R R; Rozema, F R; Grijpma, D W; Pennings, A J

    1995-12-01

    The impact strength of amorphous lactide copolymers can be significantly improved by blending with biodegradable rubbers. Rubber toughening of amorphous poly(85L/15D -lactide) with the copolymer poly (50/50-trimethylenecarbonate-co-epsilon-caprolactone) results in a high-impact polymer (PDLLA/P(TMC-CL)). In vitro, the PDLLA/P(TMC-CL) blend retained its tensile and impact strength for a long period of time. Up to 45 weeks, the amount of water absorbed by the blend remained very low and no significant mass loss was observed. To test the suitability for fracture fixation, in a dog study mandibular fractures were fixated with PDLLA/P(TMC-CL) bone plates and screws. Bone healing was uneventful without premature failure of the implants. Although long-term degradation studies have to be carried out, PDLLA/P(TMC-CL) seems to be promising for application in fracture fixation.

  18. Retrospective study of mandibular angle fractures treated with three different fixation systems

    PubMed Central

    Bhatt, Krushna; Arya, Satyavrat; Bhutia, Ongkila; Pandey, Sandeep; Roychoudhury, Ajoy

    2015-01-01

    Aim: To evaluate the outcomes of mandibular angle fractures treated with metal 2.0 mm locking, metal 2.0 mm nonlocking, and 2.5 mm resorbable systems. Study Design: Retrospective cohort study. Materials and Methods: Trauma records were screened for linear angle fractures treated with open-reduction and internal semi-rigid fixation with single metal/bioresorbable plates, and baseline variables were tabulated. The outcome variable was the presence or absence of any complication. Statistical Analysis Used: The Fisher's exact test and analysis of covariance (ANCOVA) using STATA 11. Results: A total of 60 case records of over four years were included. The mean age of the patients was 27.4 (SD 9.7) years. Fifty-five were male and five female. There were 20 nonlocking and 16 locking metal miniplates and 24 bioresorbable plates. In 55 (91.6%) cases there was a third molar in the fracture line. In 51/55 (92.7%) cases the third molar was retained. In seven patients postoperative complications were seen. There was no difference between the complication rates of the three treatment groups. Infection was the most common complication followed by delayed union and hardware failure. Conclusions: This retrospective study found no difference in the complication rate when fractures of the mandibular angle were treated with locking or nonlocking miniplates or bioresorbable plates. PMID:26668450

  19. Fixation stability dictates the differentiation pathway of periosteal progenitor cells in fracture repair.

    PubMed

    Hagiwara, Yusuke; Dyment, Nathaniel A; Jiang, Xi; Jiang Ping, Huang; Ackert-Bicknell, Cheryl; Adams, Douglas J; Rowe, David W

    2015-07-01

    This study compared fracture repair stabilized by intramedullary pin (IMP) or external fixation (EF) in GFP reporter mice. A modified IMP was used as control while EF utilized six needles inserted transversely through the tibia and into a segment of a syringe barrel. X-rays taken at days 0, 14, and 35 showed that IMP resulted in significant three-dimensional deformity with a large callus while EF showed minimal deformity and callus formation. Cryohistological analysis of IMP at day 14 confirmed a large ColX-RFPchry+ callus surrounded by woven bone (Col3.6-GFPcyan) and TRAP+ osteoclasts with mature bone (hOC-GFPtpz) at the base. By day 35, cartilaginous components had been resorbed and an outer cortical shell (OCS) showed evidence of inward modeling. In contrast, the EF at day 14 showed no evidence of cartilage formation. Instead, periosteal-derived osteoblasts (Col3.6-GFPcyan) entered the fracture cleft and formed woven bone that spanned the marrow space. By day 35, mature bone had formed that was contiguous with the opposing cortical bone. Fracture site stability greatly affects the cellular response during repair and must be considered in the preclinical models that test therapies for improving fracture healing. PMID:25639792

  20. Early postoperative failure of a new intramedullary fixation device for midshaft clavicle fractures.

    PubMed

    Wilson, David J; Weaver, DeWayne L; Balog, Todd P; Arrington, Edward D

    2013-11-01

    The Sonoma CRx device (Sonoma Orthopedic Products, Santa Rosa, California) is a recently introduced intramedullary device with a flexible shaft that becomes rigid once actuated to allow deployment within the sigmoidal contour of the clavicular shaft. Medial intramedullary cortical purchase is obtained by grippers and lateral purchase through a locking bicortical buttressing screw. This article describes 2 cases of early hardware failure using this device. In both cases, early postoperative radiographs demonstrate adequate initial fracture reduction and implant position. Both patients sustained repeat injuries, one under low physiologic load and the other after returning to mixed martial arts 4 months postoperatively. Implant failure was noted after reinjury in both cases. Complete healing and full return to function was documented for both patients at 2 years. Proper patient selection and counseling regarding the limitations of this intramedullary fixation device are important. Biomechanical comparison of this implant to plate fixation under physiologic loads of combined axial compression and torsion may shed light on differences in fixation stability. PMID:24200452

  1. Intermaxillary fixation screws versus Erich arch bars in mandibular fractures: A comparative study and review of literature

    PubMed Central

    Qureshi, Ahtesham Ahmad; Reddy, Umesh K.; Warad, N. M.; Badal, Sheeraz; Jamadar, Amjad Ali; Qurishi, Nilofar

    2016-01-01

    Objective: Various techniques have been employed from time to time to achieve maxillomamdibular fixation. Although arch bars provide an effective and versatile means of maxillomandibular fixation, their use is not without shortcomings. However the introduction of intermaxillary fixation screws (IMF) has eliminated many of these issues of arch bars. The aim of the present study was to compare the advantages and disadvantages of intermaxillary fixation screws over the Erich arch bars in mandibular fractures. Materials and Methods: Sixty dentulous patients who reported to Department of Oral and Maxillofacial Surgery, Al-Ameen Dental College and Hospital, Bijapur with mandibular fractures and required intermaxillary fixation as a part of treatment plan followd by open reduction and internal fixation under GA were selected and randomly divided into 2 groups of 30 patients each that is Group A and Group B. Group A included patients who received intermaxillary fixation with Erich arch bars. Group B includes patients who received intermaxillary fixation with IMF Screws. The parameters compared in both the groups included, surgical time taken, gloves perforation, post-operative occlusion, IMF stability, oral hygiene, patient acceptance and comfort and non-vitality characteristics. Results: The average surgical time taken and gloves perforations were more in Group A,the patient acceptance and oral hygiene was better in Group B, there was not much statistically significant difference in postoperative occlusion and IMF stability in both groups. Accidental root perforation was the only limitation of IMF screws. Conclusion: Intermaxillary fixation with IMF screws is more efficacious compared to Erich arch bars in the treatment of mandibular fractures. PMID:27563602

  2. Design-Optimization and Material Selection for a Proximal Radius Fracture-Fixation Implant

    NASA Astrophysics Data System (ADS)

    Grujicic, M.; Xie, X.; Arakere, G.; Grujicic, A.; Wagner, D. W.; Vallejo, A.

    2010-11-01

    The problem of optimal size, shape, and placement of a proximal radius-fracture fixation-plate is addressed computationally using a combined finite-element/design-optimization procedure. To expand the set of physiological loading conditions experienced by the implant during normal everyday activities of the patient, beyond those typically covered by the pre-clinical implant-evaluation testing procedures, the case of a wheel-chair push exertion is considered. Toward that end, a musculoskeletal multi-body inverse-dynamics analysis is carried out of a human propelling a wheelchair. The results obtained are used as input to a finite-element structural analysis for evaluation of the maximum stress and fatigue life of the parametrically defined implant design. While optimizing the design of the radius-fracture fixation-plate, realistic functional requirements pertaining to the attainment of the required level of the devise safety factor and longevity/lifecycle were considered. It is argued that the type of analyses employed in the present work should be: (a) used to complement the standard experimental pre-clinical implant-evaluation tests (the tests which normally include a limited number of daily-living physiological loading conditions and which rely on single pass/fail outcomes/decisions with respect to a set of lower-bound implant-performance criteria) and (b) integrated early in the implant design and material/manufacturing-route selection process.

  3. The role of biofilm formation in percutaneous Kirschner-wire fixation of radial fractures.

    PubMed

    Hargreaves, D G; Pajkos, A; Deva, A K; Vickery, K; Filan, S L; Tonkin, M A

    2002-08-01

    This study examines the formation of bacterial biofilms on percutaneous wires used for fracture fixation. Twelve control (clinically uninfected) wires and ten infected wires were collected and examined using broth culture and scanning electron microscopy. Three of the 12 control wires grew Staphylococcus spp. with very low bacterial counts in their percutaneous portions. In the clinically infected wires, six wires in four subjects had positive cultures in their percutaneous portions and four of these also had positive cultures in their deep portions with much higher bacterial counts than the controls. In two patients (four wires) treated with antibiotics, cultures were negative except for the percutaneous portion of one wire. Scanning electron microscopy did not reveal bacterial biofilm formation, but biological deposit without bacteria was noted on most wires. During the 6 weeks of fracture fixation, some bacterial colonization of wires occurred, but bacteria did not form biofilms which may increase bacterial resistance to systemic antibiotics, cause implant loosening and act as a source of late infection.

  4. [Acetabular fractures in the elderly. Outcome of open reduction and internal fixation].

    PubMed

    Tosounidis, G; Culemann, U; Bauer, M; Holstein, J H; Garcia, P; Kurowski, R; Pizanis, A; Aghayev, E; Pohlemann, T

    2011-08-01

    The aim of this study was to analyze the clinical outcome and incidence of hip arthritis in elderly patients with acetabular fractures. Because of poor bone quality in the elderly, even a low-energy trauma may lead to an acetabular fracture. An anatomical reconstruction of the acetabulum is necessary to achieve sufficient stability also for a potential hip arthroplasty. So far, there is very limited information on the outcome of acetabular fractures in the elderly. During a period of 6 years (2001-2006), 48 patients older than 60 years were admitted to our department with an acetabular fracture. Thirty-nine patients were treated operatively and nine patients non-operatively. Twenty-nine operatively treated patients were followed up. Nineteen of them were assessed using EQ-5D, SF-12 and Merle d'Aubigné questionnaires in addition to their clinical examination. Ten other surgical patients were only examined using the questionnaires. Of the 29 patients that were followed up, 5 underwent total hip arthroplasty due to secondary post-traumatic hip arthritis after open reduction and internal fixation (ORIF). The range of motion of the operated hip was comparable to that of the non-operated contralateral side. However, the internal rotation was found to be slightly decreased at the operated side when compared to the non-operated contralateral side. Merle d'Aubigné score and physical and mental SF-12 score components as well as quality of life were better in patients treated with ORIF compared to those patients that were treated by secondary hip arthroplasty. Regarding the different treatment strategies (ORIF vs primary hip arthroplasty vs non-operative treatment) of acetabular fractures in the elderly, data from the literature are conflicting. Our results indicate that ORIF represents a good treatment option for acetabular fractures in the elderly. In patients that did not develop secondary hip arthritis, a good clinical outcome and quality of life was documented. PMID

  5. Fibular Strut Graft Augmentation for Open Reduction and Internal Fixation of Proximal Humerus Fractures

    PubMed Central

    Saltzman, Bryan M.; Erickson, Brandon J.; Harris, Joshua D.; Gupta, Anil K.; Mighell, Mark; Romeo, Anthony A.

    2016-01-01

    Background: Proximal humerus fractures are common problems plaguing the elderly population. Purpose: The purposes of this study were to determine the outcomes of fibular strut allografts in treatment of proximal humerus fractures with open reduction internal fixation (ORIF) and to present the authors’ preferred surgical technique. The hypothesis was that the use of fibular strut allografts in treating proximal humerus fractures with ORIF will provide low reoperation rates with acceptable outcomes. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was registered with PROSPERO and performed with PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines using 3 publicly available free databases. Therapeutic clinical outcome investigations reporting arthroscopic elbow outcomes with levels of evidence 1 through 4 were eligible for inclusion. All study, subject, and surgical technique demographics were analyzed and compared between continents and countries. Statistics were calculated using Student t tests, 1-way analysis of variance, chi-square tests, and 2-proportion Z tests. Results: Four studies met the inclusion criteria. While there is great heterogeneity existing in the literature surrounding use of a fibular strut allograft as an adjunct to ORIF of proximal humerus fractures, current evidence shows a humeral head screw penetration rate of 3.7% with acceptable functional outcome scores, with a reoperation rate of 4.4% at a weighted mean 80.78 weeks (1.55 years) of postoperative follow-up. Conclusion: There is great heterogeneity that exists in the literature surrounding the use of a fibular strut allograft as an adjunct to ORIF of proximal humerus fractures. Current evidence shows a screw penetration rate of 3.7% with acceptable functional outcome scores, demonstrating fibular strut allograft is a viable option for treating proximal humerus fractures. PMID:27504463

  6. The biomechanical advantages of bilateral lumbo-iliac fixation in unilateral comminuted sacral fractures without sacroiliac screw safe channel

    PubMed Central

    Song, Wenhao; Zhou, Dongsheng; He, Yu

    2016-01-01

    Abstract Background: The aim of this study was to compare the biomechanical characteristics between bilateral and unilateral lumbo-iliac fixation in unilateral comminuted sacral fractures (USF) by finite element analysis. Methods: A 3-dimensional finite element model of unilateral sacral fractures was simulated. Three kinds of implants were instrumented into the model, including the unilateral lumbopelvic fixation (ULF), bilateral lumbopelvic fixation (BLF), and unilateral iliac fixation with bilateral lumbar pedicle screws (UBF). Loads of compression and rotation were distributed to the superior endplate of L3. To evaluate the biomechanical properties, the construct stiffness, the micromotion of the fractures, the stress distribution of implants, and the balance of hemilumbar vertebra are recorded and analyzed. Results: The highest construct stiffness was provided by BLF. In BLF model, the displacement between iliums was only 0.009 mm (compressional) and 0.001 mm (rotational), which was less than that under normal condition (0.02 mm). The maximum von Misses stress of implants appeared on the UBF. By using unilateral fixation, the L4 endured obvious imbalance on bilateral hemivertebra. A marked difference was exposed in BLF and UBF models, and the equilibrium of stress and activity was shown. Conclusion: From the finite element view, the stability of ULF is insufficient to reconstruct the posterior pelvic ring. Furthermore, the unilateral fixation may lead to imbalance of lumbar vertebra and pelvis. On the contrary, the BLF can provide satisfied stability and lumbar balance. PMID:27749563

  7. Osteosynthesis in Distal Radius Fractures with Conventional Bridging External Fixator; Tips and Tricks for Getting Them Right

    PubMed Central

    Chilakamary, Vamshi Krishna; Koppolu, Kiran Kumar; Rapur, Shivaprasad

    2016-01-01

    Background Distal radius fractures are the commonest fractures occurring in the upper extremity, accounting for 15-20% of patients treated in emergency department. Although distal radial fractures were described 200 years ago, they still remain as unsolved fractures with no clear guidelines. It is often reported that anatomical reduction has a bearing on the functional outcome. Aim To study the management of distal end radius fracture by utilizing the principle of ligamentotaxis where in the reduction obtained by closed means is maintained by external fixator till solid bony union occurs. Materials and Methods A total of 26 cases were selected for study by scrutiny of the inclusion and exclusion criteria. Most of our cases were treated with external fixator within 8 hrs of injury. Small A.O external fixator (bridging ex-fix) with 2 pins each in radius and 2nd metacarpal percutaneously was used for all the cases. Selective k wire fixation was done in cases of instability. Fixator was removed after 6 weeks. Guided physiotherapy was ensured in all the cases. Patients were followed up for an average of 9 months. Results Modified Gartland and Werley scoring system was used to evaluate the overall functional results. Excellent to good results were achieved in 88.45% of our cases while fair result was in 11.54 %. One case had pin loosening and two other cases had malunion. Conclusion External fixator used for ligamentotaxis is an effective method of treating unstable extraarticular and complex intraarticular fractures of distal radius. Improved anatomical restoration with early rehabilitation has produced favourable functional outcome in our series. The complications like pin tract infection is rare due to the availability of superior antibiotics and sterile surgical technique. complications like wrist and finger stiffness has improved with physiotherapy. PMID:26894133

  8. Arthroscopically Assisted Open Reduction-Internal Fixation of Ankle Fractures: Significance of the Arthroscopic Ankle Drive-through Sign.

    PubMed

    Schairer, William W; Nwachukwu, Benedict U; Dare, David M; Drakos, Mark C

    2016-04-01

    Standalone open reduction-internal fixation (ORIF) of unstable ankle fractures is the current standard of care. Intraoperative stress radiographs are useful for assessing the extent of ligamentous disruption, but arthroscopic visualization has been shown to be more accurate. Concomitant arthroscopy at the time of ankle fracture ORIF is useful for accurately diagnosing and managing syndesmotic and deltoid ligament injuries. The arthroscopic ankle drive-through sign is characterized by the ability to pass a 2.9-mm shaver (Smith & Nephew, Andover, MA) easily through the medial ankle gutter during arthroscopy, which is not usually possible with both an intact deltoid ligament and syndesmosis. This arthroscopic maneuver indicates instability after ankle reduction and fixation and is predictive of the need for further stabilization. Furthermore, when this sign remains positive after fracture fixation, it may guide the surgeon to further evaluate the adequacy of fixation for the possible need for further fixation of the syndesmosis or deltoid. We present the case of an ankle fracture managed with arthroscopy-assisted ORIF and describe the clinical utility of the arthroscopic ankle drive-through sign. PMID:27462542

  9. Combining of small fragment screws and large fragment plates for open reduction and internal fixation of periprosthetic humeral fractures

    PubMed Central

    Seybold, Dominik; Citak, Mustafa; Königshausen, Matthias; Gessmann, Jan; Schildhauer, Thomas A.

    2011-01-01

    Operative treatment of periprosthetic humeral fractures in elderly patients with osteoporotic bone requires a stable fixations technique. The combination of 3.5 cortical screws with washers in a 4.5 Arbeitsgemeinschaft für Osteosynthesefragen, Limited-contact dynamic compression plate or Locking plate, allows a stable periprosthetic fixation with the small 3.5 screws and 4.5 screws above and below the prosthesis, respectively. This combination is a cost-effective technique to treat periprosthetic humeral fractures. PMID:22223961

  10. Use of a Locked Fibular Plate for Fixation of a Vertical Shear Medial Malleolus Fracture: A Case Report.

    PubMed

    Blake, Sean; Yakubek, George; Shaer, James

    2015-01-01

    Vertical shear fractures of the medial malleolus are less common than transverse fractures. These fractures are often treated with lag screws, posteromedial buttress plating, antiglide plates, and neutralization plates with screws. We report on a 37-year-old male who had fractured his ankle after tripping and falling into a ditch. Initially, the patient was treated with closed reduction and a splint for a trimalleolar fracture with a laterally subluxed talus. However, on review of his preoperative radiographs and computed tomography studies, we confirmed a medial malleolus fracture with a vertical shear pattern and communition. Recently, a contoured fibular locking plate has been developed. We considered this plate to be effective for containing the bone in part because of its broader plate design. We present a case in which a fibular locking plate was used successfully as a neutralization plate as an alternative fixation method for a vertical shear medial malleolar fracture. PMID:26253474

  11. Total Hip Arthroplasty Using Non-Modular Cementless Long-Stem Distal Fixation for Salvage of Failed Internal Fixation of Intertrochanteric Fracture.

    PubMed

    Shi, Xiaojun; Zhou, Zongke; Yang, Jing; Shen, Bin; Kang, Pengde; Pei, Fuxing

    2015-11-01

    Thirty one patients were treated with salvage total hip arthroplasty (THA) for failed internal fixation of intertrochanteric fracture. After a mean follow-up of 47.5 months, all patients reported remarkable pain relief and return to ambulation. Twenty five patients had no pain, and 6 patients complained of residual trochanteric low-grade pain without compromise of activities. The Harris Hip score increased from a preoperative average of 28.4 points to a postoperative average of 85.6 points. All patients demonstrated successful bony union and five had Brooker I or II heterotopic ossification. Seven patients had intraoperative or early complications and were treated successfully. There was no infection, re-fracture, loosening, or revision for any reason. Salvage THA using non-modular cementless long-stem prosthesis represents an effective procedure after failed intertrochanteric fixation.

  12. Arthroscopic-Assisted Fixation of Tibial Plateau Fractures: Patient-Reported Postoperative Activity Levels.

    PubMed

    Kampa, John; Dunlay, Ryan; Sikka, Robby; Swiontkowski, Marc

    2016-05-01

    Tibial plateau fractures may result in significant limitations postoperatively. Studies have described outcomes of arthroscopic-assisted percutaneous fixation (AAPF) of these injuries but have rarely reported postoperative activity levels. Between 2009 and 2013, patients who sustained a lateral split, split depression, or pure depression type tibial plateau fracture (Schatzker types I-III fractures) and underwent outpatient AAPF were eligible for the study. Outcomes were assessed using Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Lysholm score, and Marx activity score. Twenty-five consecutive patients were eligible for the study, and 22 (88%) were included in the final analysis, with average follow-up of 2.5 years (range, 1-5.2 years). Thirteen women and 9 men with an average age of 48.3 years (range, 23-65 years) comprised the study population. Average number of screws used for fixation was 2 (range, 1-4). The average depression was 8 mm preoperatively and 0.9 mm (range, 0-3 mm) postoperatively. Four patients (18%) had complications: 2 with hardware removal and 2 with postoperative deep venous thrombosis. Average postoperative Marx activity score was 5.7. Average postoperative KOOS Symptoms, Sports, and Quality of Life scores were 88 (range, 68-100), 85 (range, 45-100), and 77 (range, 50-100), respectively. Average IKDC and Lysholm scores were 81 (range, 55-97) and 87 (range, 54-100), respectively. The AAPF surgical technique, which was performed in an outpatient setting, facilitated excellent postoperative range of motion, outcomes, and activity scores with minimal complications. [Orthopedics. 2016; 39(3):e486-e491.].

  13. Treatment of stress fracture of the olecranon in throwing athletes with internal fixation through a small incision.

    PubMed

    Fujioka, Hiroyuki; Tsunemi, Kenjiro; Takagi, Yohei; Tanaka, Juichi

    2012-01-01

    The present study is a report of retrospective case series of stress fracture of the olecranon. Six patients presented posterior elbow pain in throwing in baseball and softball, but fracture was not diagnosed in radiographs. We detected stress fracture of the olecranon using computed tomographic (CT) scan and treated the patient with internal fixation with a headless cannulated double threaded screw through a small skin incision. All patients returned to competitive level without elbow complaints after the operation.When throwing athletes present with unusual posterior elbow pain and no significant findings on radiographs, a CT scan examination should be performed. We recommend surgical treatment of internal fixation with a screw through a small skin incision, as a good option for stress fracture of the olecranon in order to allow early return to sports activity in competitive athletes.

  14. An analysis of postoperative complications and efficacy of 3-D miniplates in fixation of mandibular fractures

    PubMed Central

    Gokkulakrishnan, Sadhasivam; Singh, Sanjay; Sharma, Ashish; Shahi, Ashish Kumar

    2012-01-01

    Background: Recently, various modifications in transorally placed miniplates for direct fixation of the mandibular fracture are gaining popularity. The modifications have various advantages like more rigidity, less foreign material, less time in application, etc. Among the various modifications of miniplates, three-dimensional (3-D) plating system is also gaining popularity. Thus, in the present study, we tried to evaluate the efficacy and postoperative complications of 3-D titanium miniplates in the treatment of mandibular fractures. Materials and Methods: A prospective study was conducted on 40 patients with non-comminuted mandibular fractures. They were treated using a 2-mm 3-D titanium miniplate through intraoral approach. All patients were systematically monitored 6 months postoperatively. Outcome parameters like infection, hardware failure, wound dehiscence, sensory disturbance of the inferior alveolar nerve, occlusion, and 3-D plate stability were recorded. The statistical tests used in study were mean, standard deviation, and Chi-square test. P values less than 0.05 were considered significant and values less than 0.001 were considered very highly significant. Results: Two patients had a postoperative infection with no consequences. All patients had normal sensory function 3 months after surgery. Plate fracture had not occurred in any patient. Occlusal was normal and wound dehiscence was not reported. 3-D plate was stable in all the patients. Conclusions: It was seen that 3-D titanium miniplates were effective in the treatment of mandibular fractures and overall complication rates were lesser. In symphysis and parasymphysis regions, 3-D plating system uses lesser foreign material than the conventional miniplates using Champy's principle. PMID:23162581

  15. Combined Percutaneous Iliosacral Screw Fixation With Sacroplasty Using Resorbable Calcium Phosphate Cement for Osteoporotic Pelvic Fractures Requiring Surgery.

    PubMed

    Collinge, Cory A; Crist, Brett D

    2016-06-01

    Osteoporotic sacral fractures, including acute and chronic insufficiency fractures, are increasing in frequency and present a number of management problem. Many of these patients are treated nonoperatively with relative immobility (eg, bedrest, wheelchair, or weight-bearing restrictions) and analgesics, which likely make the osteoporotic component worse. Surgery in this patient population may be desirable in some cases with the goals of improving mobility, relieving pain, and healing in an aligned position while minimizing deformity progression. However, internal fixation of the osteoporotic pelvis can be difficult. Large unicortical lag screws are the workhorse of posterior pelvic fixation, and yet fixation in cancellous bone corridors of an osteoporotic sacrum seems unlikely to achieve optimal fixation. As a result, the operative management and clinical results of these difficult injuries may not be uniformly successful. The authors present a technique for treating osteoporotic patients with a sacral fracture when operative treatment is indicated using percutaneous screw fixation combined with screw augmentation using a resorbable calcium phosphate bone substitute or "cement." The guide wire for a 7.3-mm or other large cannulated lag screw is fully inserted along the desired bony sacral corridor as is standard. The lag screw is then inserted over the wire to the depth where cement is desired. The guide wire is removed, and the aqueous calcium phosphate is injected through the screw's cannulation. For acute fractures, cement was applied to the areas distant to the fracture; whereas in insufficiency fractures, the cement was inserted along most of the screw path. The guide wire then can be reinserted and the lag screw fully inserted. The rationale for using these 2 modalities is their synergistic effect: the cannulated screw provides typical screw fixation and also a conduit for cement application. The cement augments the lag screw's purchase in osteoporotic bone

  16. UK Fixation of Distal Tibia Fractures (UK FixDT): protocol for a randomised controlled trial of ‘locking’ plate fixation versus intramedullary nail fixation in the treatment of adult patients with a displaced fracture of the distal tibia

    PubMed Central

    Achten, Juul; Parsons, Nicholas R; McGuinness, Katie R; Petrou, Stavros; Lamb, Sarah E; Costa, Matthew L

    2015-01-01

    Introduction The treatment of displaced, extra-articular fractures of the distal tibia remains controversial. These injuries are difficult to manage due to limited soft tissue cover, poor vascularity of the area and proximity to the ankle joint. Surgical treatment options are expanding and include locked intramedullary nails, plate and screw fixation and external fixator systems. The nail and plate options are most commonly used in the UK, but controversy exists over which treatment is most clinically and cost-effective. In this multicentre randomised controlled trial we aim to assess ratings of disability 6 months postinjury in patients who have sustained a distal tibia fracture treated with either an intramedullary nail or plate and locking screw fixation. Methods and analysis Adult patients presenting at trial centres with an acute fracture of the distal tibia will be considered for inclusion. A total of 320 patients will provide 90% power to detect a difference of 8 points in Disability Rating Index (DRI) score at 6 months at the 5% level. The randomisation sequence is stratified by trial centre and age, and administered via web-based service with 1:1 treatment allocation. Baseline demographic and pre-injury functional data and radiographs will be collected using the DRI, Olerud and Molander, and EuroQol EQ-5D questionnaire. Clinical assessment, early complications and radiographs will be recorded at 6–8 weeks. Functional outcome, health-related quality of life and resource use will be collected at 3, 6 and 12 months postoperatively. The main analysis will investigate differences in DRI 6 months postsurgery, between the two treatment groups, on an intention-to-treat basis. Tests will be two-sided and considered to provide evidence for a significant difference if p values are <0.05. Ethics and dissemination NRES Committee West-Midlands, 6/11/2012 (ref:12/WM/0340). The results of the trial will be disseminated via peer-reviewed publications and

  17. Open reduction and internal fixation of two- and three-part displaced surgical neck fractures of the proximal humerus.

    PubMed

    Cuomo, F; Flatow, E L; Maday, M G; Miller, S R; McIlveen, S J; Bigliani, L U

    1992-11-01

    Twenty-two patients aged 20 to 82 years (average 56 years) were followed for 1.1 to 8.9 years (average 3.3 years) after open reduction and internal fixation of two- and three-part displaced surgical neck fractures of the proximal humerus. There were 14 two-part displaced surgical neck fractures, seven three-part displaced greater tuberosity and surgical neck fractures, and one three-part displaced lesser tuberosity and surgical neck fracture. Fixation was achieved with heavy nonabsorbable sutures or wire that incorporated the rotator cuff tendons, tuberosities, and shaft. In cases with significant surgical neck comminution, humeral Enders nails were incorporated in a tension-band construct to provide longitudinal stability. Eighteen (82%) of the 22 patients had good or excellent results. Three (14%) of the 22 had satisfactory results, and one (5%) had an unsatisfactory result. The use of a technique of limited internal fixation for these displaced fractures without the use of plates and screws achieved fracture stability and a high percentage of acceptable results.

  18. A Biomechanical Comparison of Locking Versus Conventional Plate Fixation for Distal Fibula Fractures in Trimalleolar Ankle Injuries.

    PubMed

    Nguyentat, Annie; Camisa, William; Patel, Sandeep; Lagaay, Pieter

    2016-01-01

    Previous biomechanical studies have advocated the use of locking plates for isolated distal fibula fractures in osteoporotic bone. Complex rotational ankle injuries involve an increased number of fractures, which can result in instability, potentially requiring the same fixed angle properties afforded by locking plates. However, the mechanical indication for locking plate technology has not been tested in this fracture model. The purpose of the present study was to compare the biomechanical properties of locking and conventional plate fixation for distal fibula fractures in trimalleolar ankle injuries. Fourteen (7 matched pairs) fresh-frozen cadaver leg specimens were used. The bone mineral density of each was obtained using dual x-ray absorptiometry scans. The fracture model simulated an OTA 44-B3.3 fracture. The syndesmosis was not disrupted. Each fracture was fixated in the same fashion, except for the distal fibula plate construct: locking (n = 7) and one-third tubular (n = 7). The specimens underwent axial and torsional cyclic loading, followed by torsional loading to failure. No statistically significant differences were found between the locking and conventional plate constructs during both fatigue and torque to failure testing (p > .05). Our specimen bone mineral density averages did not represent poor bone quality. The clinical implication of the present study is that distal fibular locking plates do not provide a mechanical advantage for trimalleolar ankle injuries in individuals with normal bone density and in the absence of fracture comminution.

  19. Proximal tibial fractures with impending compartment syndrome managed by fasciotomy and internal fixation: A retrospective analysis of 15 cases

    PubMed Central

    Sharma, Naveen; Singh, Varun; Agrawal, Ashish; Bhargava, Rakesh

    2015-01-01

    Background: Proximal tibia fractures with compartment syndrome present a challenge for orthopedic surgeons. More often than not these patients are subjected to multiple surgeries and are complicated by infection osteomyelitis and poor rehabilitation. There is no consensus in the management of these fractures. Most common mode is to do early fasciotomy with external fixation, followed by second stage definitive fixation. We performed a retrospective study of proximal tibia fractures with impending compartment syndrome treated by single stage fasciotomy and internal fixation. Results in terms of early fracture union, minimum complications and early patient mobilization were very good. Materials and Methods: Fifteen patients who were operated between July 2011 and June 2012 were selected for the study. All documents from their admission until the last followup in December 2013 were reviewed, data regarding complications collected and results were evaluated using Oxford Knee scoring system. Results: At the final outcome, there was anatomical or near anatomical alignment with no postoperative problems with range of motion of near complete flexion (>120) in all patients within 3 months. 13 patients started full weight bearing walking at 3 months. Delayed union in two patients and skin necrosis in one patient was observed. Conclusions: Since the results are encouraging and the rehabilitation time is much less when compared to conventional approaches, it is recommended using this protocol to perform early fasciotomy with the definitive internal fixation as single stage surgery to obtain excellent followup results and to reduce rehabilitation time, secondary trauma, expense of treatment and infection rate. PMID:26538755

  20. Temporary Stabilization with External Fixator in ‘Tripolar’ Configuration in Two Steps Treatment of Tibial Pilon Fractures

    PubMed Central

    Daghino, Walter; Messina, Marco; Filipponi, Marco; Alessandro, Massè

    2016-01-01

    Background: The tibial pilon fractures represent a complex therapeutic problem for the orthopedic surgeon, given the frequent complications and outcomes disabling. The recent medical literature indicates that the best strategy to reduce amount of complications in tibial pilon fractures is two-stages procedure. We describe our experience in the primary stabilization of these fractures. Methods: We treated 36 cases with temporary external fixation in a simple configuration, called "tripolar": this is an essential structure (only three screws and three rods), that is possible to perform even without the availability of X-rays and with simple anesthesia or sedation. Results: We found a sufficient mechanical stability for the nursing post-operative, in absence of intraoperative and postoperative problems. The time between trauma and temporary stabilization ranged between 3 and 144 hours; surgical average time was 8.4 minutes. Definitive treatment was carried out with a delay of a minimum of 4 and a maximum of 15 days from the temporary stabilization, always without problems, both in case of ORIF (open reduction, internal fixation) or circular external fixation Conclusion: Temporary stabilization with external fixator in ‘tripolar’ configuration seems to be the most effective strategy in two steps treatment of tibial pilon fractures. These preliminary encouraging results must be confirmed by further studies with more cases. PMID:27123151

  1. Comparison between cast immobilization versus volar locking plate fixation of distal radius fractures in active elderly patients, the Asian perspective.

    PubMed

    Chan, Ying-Ho; Foo, Tun-Lin; Yeo, Chong-Jin; Chew, Winston Yoon-Chong

    2014-01-01

    Displaced distal radius fractures in active elderly patients with high functional demand present a clinical dilemma because current evidence is equivocal in the recommendation of treatment. Internal fixation is an increasingly popular option with proposed superior results. Our study aims to evaluate the results among a population of active elderly patients with displaced fractures managed with either cast immobilization or internal fixation with volar locking plate. Seventy-five patients (35 cast immobilization and 40 internal fixation) with mean age of 74 ± 7.5 years with minimum of 12 months follow-up were studied. The radiological and clinical parameters were assessed at three, six, and 12 months. Functional outcomes (DASH, Green-O'Brien) were assessed at 12 months. Patients who underwent surgery regain wrist motion and grip strength earlier, but this was not statistically significant after six months.

  2. An Effective and Feasible Method, “Hammering Technique,” for Percutaneous Fixation of Anterior Column Acetabular Fracture

    PubMed Central

    Zhang, Lihai; Zhang, Wei; Li, Tongtong; Li, Jiantao; Chen, Hua

    2016-01-01

    Objective. The objective of this study was to evaluate the effectiveness and advantages of percutaneous fixation of anterior column acetabular fracture with “hammering technique.” Materials and Methods. We retrospectively reviewed 16 patients with percutaneous fixation of anterior column acetabular fracture with “hammering technique.” There were 11 males and 5 females with an average age of 38.88 years (range: 24–54 years) in our study. Our study included 7 nondisplaced fractures, 6 mild displaced fractures (<2 mm), and 5 displaced fractures (>2 mm). The mean time from injury to surgery was 4.5 days (range: 2–7 days). Results. The average of operation time was 27.56 minutes (range: 15–45 minutes), and the mean blood loss was 55.28 mL (range: 15–100 mL). The mean fluoroscopic time was 54.78 seconds (range: 40–77 seconds). The first pass of the guide wire was acceptable without cortical perforation or intra-articular perforation in 88.89% (16/18) of the procedures, and the second attempt was in 11.11% (2/18). Conclusion. Our study suggested that percutaneous fixation of anterior column acetabular fracture with “hammering technique” acquired satisfying surgical and clinical outcomes. It may be an alternative satisfying treatment for percutaneous fixation of anterior column acetabular fracture by 2D fluoroscopy using a C-arm with less fluoroscopic time. PMID:27493962

  3. [Meaning of living with external fixation for grade III open fracture of lower limbs: patient view].

    PubMed

    Lopez, Catia Cristina Gomes; Gamba, Mônica Antar; Matheus, Maria Clara Cassuli

    2013-06-01

    The present study is aimed to understand the meaning of living with an external fixation device for grade III open fractures of the lower limbs from the perspective of the patient. The data were collected with six young adults who were undergoing outpatient orthopedic treatment in a public hospital in the city of São Paulo, through semi-structured interviews with open questions, between June and August 2010. Seeking to understand the meaning of this experience, we have maintained a phenomenological attitude during the analysis, which made it possible to reveal the phenomenon "try to live in spite of feeling trapped in a cage." Patients said that their personal desire and support from others helped them reorganize their lives, despite the several challenges they had to overcome to adapt to the fastener attached to their body and the fear of the future and doubts about the success of treatment.

  4. Medial Calcar Support and Radiographic Outcomes of Plate Fixation for Proximal Humeral Fractures

    PubMed Central

    Lin, Shih-Jie; Tsai, Yao-Hung; Yang, Tien-Yu; Shen, Shih-Hsun; Huang, Kuo-Chin; Lee, Mel S.

    2015-01-01

    Plate fixation remains one of the most popular surgical procedures for treating proximal humeral fractures (PHFx); however, substantial rates of complications have been reported in the literature. The objectives of the study were to examine how medial calcar support (MCS) affects the radiographic outcomes and to determine the prognostic factors predicting treatment failure. We performed a retrospective cohort study of 89 adult patients who had PHFx and were treated with plate fixation at our institution in 2007–2011. The enrolled patients were separated into two groups according to disruption of medial calcar. Our results revealed an increased rate of poor radiographic outcomes in patients with disrupted medial calcar. Osteonecrosis of the humeral head and redisplacement were the two radiographic outcomes which had a positive causality with disruption of medial calcar (P = 0.008 and 0.050, resp.). Deficient medial calcar, inadequate reduction, diabetes mellitus, chronic kidney disease, and chronic liver disease were all significant predictors for the development of osteonecrosis in patients after PHFx surgery. Inadequate reduction was also a predictor for redisplacement. We confirmed that the restoration of medial calcar as well as comorbid conditions plays key roles in treatment of patients having PHFx with disrupted medial calcar. PMID:25692132

  5. Triplane fractures of the distal tibia requiring open reduction and internal fixation. Pre-operative planning using computed tomography.

    PubMed

    Jones, S; Phillips, N; Ali, F; Fernandes, J A; Flowers, M J; Smith, T W D

    2003-05-01

    Computed tomography (CT) of triplane fractures provides useful information not available on conventional radiographs. Knowledge of the size and position of displaced fragments, the location of the intra-articular fracture and any associated articular incongruency is useful when undertaking pre-operative planning.A postal survey of surgeons revealed only 38% always requested CT scans before undertaking open reduction and internal fixation of displaced triplane fractures. Examples of the usefulness of CT scans in pre-operative planning is presented in two cases.

  6. Finite element analysis of a bone healing model: 1-year follow-up after internal fixation surgery for femoral fracture

    PubMed Central

    Jiang-jun, Zhou; Min, Zhao; Ya-bo, Yan; Wei, Lei; Ren-fa, Lv; Zhi-yu, Zhu; Rong-jian, Chen; Wei-tao, Yu; Cheng-fei, Du

    2014-01-01

    Objective: Finite element analysis was used to compare preoperative and postoperative stress distribution of a bone healing model of femur fracture, to identify whether broken ends of fractured bone would break or not after fixation dislodgement one year after intramedullary nailing. Method s: Using fast, personalized imaging, bone healing models of femur fracture were constructed based on data from multi-slice spiral computed tomography using Mimics, Geomagic Studio, and Abaqus software packages. The intramedullary pin was removed by Boolean operations before fixation was dislodged. Loads were applied on each model to simulate a person standing on one leg. The von Mises stress distribution, maximum stress, and its location was observed. Results : According to 10 kinds of display groups based on material assignment, the nodes of maximum and minimum von Mises stress were the same before and after dislodgement, and all nodes of maximum von Mises stress were outside the fracture line. The maximum von Mises stress node was situated at the bottom quarter of the femur. The von Mises stress distribution was identical before and after surgery. Conclusion : Fast, personalized model establishment can simulate fixation dislodgement before operation, and personalized finite element analysis was performed to successfully predict whether nail dislodgement would disrupt femur fracture or not. PMID:24772140

  7. Outcome of proximal humerus fractures treated by PHILOS plate internal fixation. Experience of a district general hospital.

    PubMed

    Shahid, Rizwan; Mushtaq, Abid; Northover, Julian; Maqsood, Mohammad

    2008-10-01

    Proximal humerus fractures have been a challenge to achieve stable fixation. PHILOS (Proximal Humerus internal locking system) is part of the latest generation of locking compression plates for proximal humeral fracture fixation. We aim to assess the clinical and functional outcome of proximal humeral fractures (2-part, 3-part and 4-part) treated with the PHILOS plate. We prospectively reviewed 50 patients who had a proximal humeral fracture treated with the PHILOS plate from September 2002 to September 2006 in our institution. Clinical outcome was measured using the patient-based Oxford shoulder and DASH scoring systems. Five patients died and four were lost to follow-up. Eleven patients had 2-part, eleven 3-part and eighteen 4-part fractures. Mean follow-up time was 21.7 months (range: 6-44 months). Radiological union was achieved within 8 weeks in 40/41 fractures; complications were noted in four cases. Better results were achieved in younger than in older patients, and in male than in female patients. The number of fracture fragments did not appear to affect the results, but associated dislocation of the humeral head was a pejorative factor. Our study has shown that the PHILOS plate is a reliable implant. A direct correlation was observed between Oxford shoulder and DASH scores.

  8. Surgical stabilization for open tibial fractures in children: External fixation or elastic stable intramedullary nail - which method is optimal?

    PubMed Central

    Ramasubbu, Rohan A; Ramasubbu, Benjamin M

    2016-01-01

    Background: Management of open tibial fractures is well documented in adults, with existing protocols outlining detailed treatment strategies. No clear guidelines exist for children. Surgical stabilization of tibial fractures in the pediatric population requires implants that do not disrupt the open epiphyses (growth plate). Both elastic stable intramedullary nails and external fixation can be used. The objective of this study was to identify the optimal method of surgical stabilization in the treatment of open tibial fractures in children. Materials and Methods: MEDLINE and Embase were searched from their inception to March 2014 using the following advanced search terms (Key words): “open tibia fracture,” “fracture fixation,” “external fixation,” “intramedullary,” and “bone nail.” Only studies in English and pertaining to children with open fractures treated with elastic stable intramedullary nails or external fixation between 1994 and 2014 were included. Twelve clinical studies were critically appraised. Results: Due to a paucity in the literature coupled with a nonsystematic presentation of results, it proved to be very difficult in extracting relevant results from the studies. This was further added by a variation in outcome measures. Consequently, the results we obtained were difficult to draw conclusions from. Conclusion: There is no conclusive evidence or best practice guidelines for their management. Thus, as is highlighted in this study, more research is needed to determine the optimum treatment strategy for this common pediatric injury. The existing literature is of poor quality; consisting mainly of retrospective reviews of patients’ medical records, charts, and radiographs. Carefully designed, high-quality prospective cohort studies utilizing a nationalized multi-hospital approach are needed to improve understanding before protocols and guidelines can be developed and implemented. PMID:27746486

  9. Scaphoid fracture fixation: localization of bones through statistical model to ultrasound registration

    NASA Astrophysics Data System (ADS)

    Anas, Emran Mohammad Abu; Rasoulian, Abtin; St. John, Paul; Pichora, David; Mousavi, Parvin; Lessoway, Victoria A.; Seitel, Alexander; Hacihaliloglu, Ilker; Rohling, Robert; Abolmaesumi, Purang

    2015-03-01

    Percutaneous treatment of scaphoid fractures has found increasing interest in recent years as it promises to minimize soft-tissue damage, and minimizes the risk of infections and the loss of the joint stability. However, as this procedure is mostly performed on 2D fluoroscopic images, the accurate localization of the scaphoid bone for fracture fixation renders extremely challenging. In this work, we thus propose the integration of a statistical wrist model with 3D intraoperative ultrasound for accurate localization of the scaphoid bone. We utilize a previously developed statistical wrist model and register it to bone surfaces in ultrasound images using a probabilistic approach that involves expectation-maximization. We utilize local phase symmetry to detect features in noisy ultrasound images; in addition, we use shadow information in ultrasound images to enhance and set apart bone from other features. Feasibility experiments are performed by registering the wrist model to 3D ultrasound volumes of two different wrists at two different wrist positions. And the result indicates a potential of the proposed technique for localization of the scaphoid bone in ultrasound images.

  10. Google Glass as an Alternative to Standard Fluoroscopic Visualization for Percutaneous Fixation of Hand Fractures: A Pilot Study.

    PubMed

    Chimenti, Peter C; Mitten, David J

    2015-08-01

    This pilot study investigated the feasibility of Google Glass to assist visualization of fluoroscopic images during percutaneous pinning of hand fractures. Cadavers were used to compare total time to pin each fracture and total number of radiographs per fracture from a mini C-arm. A FluoroScan monitor was used for radiographic visualization compared to projecting the images in the Google Glass display. All outcome measures significantly improved for proximal phalanx fractures (127 versus 86 seconds, p = 0.017; 5.3 versus 2.2 images, p = 0.003), and fewer images were obtained during fixation of metacarpal fractures using Google Glass compared with traditional techniques (6.4 versus 3.6, p < 0.001). Typical FluoroScan monitor placement may require the surgeon to alter focus away from the operative field, whereas Google Glass allows constant attention directed toward the operative field.

  11. Percutaneous Reduction and Fixation with Kirschner Wires versus Open Reduction Internal Fixation for the Management of Calcaneal Fractures: A Meta-Analysis.

    PubMed

    Wu, Jianbin; Zhou, Feiya; Yang, Lei; Tan, Jun

    2016-01-01

    The aim of our meta-analysis was to compare outcomes for two surgical treatments of calcaneal fractures, percutaneous reduction and fixation with Kirschner wires (PRFK) and open reduction internal fixation (ORIF), with the intent of evaluating the quality of evidence to inform practice. Search of MEDLINE, Cochrane and CNKI databases to identify randomized controlled trials (RCTs) comparing PRKF and ORIF on the following outcomes: post-operative function, complications and quality of the reduction. Odd ratios (OR) and weighted mean differences were pooled using either a fixed-effects or random-effects model, depending on the heterogeneity of the trials included in the analysis. Eighteen RCTs provided the data from 1407 patients. PRFK was associated with a lower risk of surgical wound complications, and ORIF with better post-operative function, angle of Gissane, calcaneal height, and calcaneal width. There were no statistically significant differences between the techniques with regards to post-operative Böhler's angle. PRFK does not provide a substantive advantage over ORIF for the treatment of calcaneal fractures in adults. PRFK may, however, yield comparable functional outcomes to ORIF for closed Sanders type II calcaneal fractures but with less complication related to surgical wound healing. PMID:27457262

  12. Percutaneous Reduction and Fixation with Kirschner Wires versus Open Reduction Internal Fixation for the Management of Calcaneal Fractures: A Meta-Analysis

    PubMed Central

    Wu, Jianbin; Zhou, Feiya; Yang, Lei; Tan, Jun

    2016-01-01

    The aim of our meta-analysis was to compare outcomes for two surgical treatments of calcaneal fractures, percutaneous reduction and fixation with Kirschner wires (PRFK) and open reduction internal fixation (ORIF), with the intent of evaluating the quality of evidence to inform practice. Search of MEDLINE, Cochrane and CNKI databases to identify randomized controlled trials (RCTs) comparing PRKF and ORIF on the following outcomes: post-operative function, complications and quality of the reduction. Odd ratios (OR) and weighted mean differences were pooled using either a fixed-effects or random-effects model, depending on the heterogeneity of the trials included in the analysis. Eighteen RCTs provided the data from 1407 patients. PRFK was associated with a lower risk of surgical wound complications, and ORIF with better post-operative function, angle of Gissane, calcaneal height, and calcaneal width. There were no statistically significant differences between the techniques with regards to post-operative Böhler’s angle. PRFK does not provide a substantive advantage over ORIF for the treatment of calcaneal fractures in adults. PRFK may, however, yield comparable functional outcomes to ORIF for closed Sanders type II calcaneal fractures but with less complication related to surgical wound healing. PMID:27457262

  13. Open Reduction and Internal Fixation Versus Hemiarthroplasty in the Management of Proximal Humerus Fractures

    PubMed Central

    Thorsness, Robert; Iannuzzi, James; Noyes, Katia; Voloshin, Ilya

    2014-01-01

    Objectives: The purpose of this study was to use a nationally representative database to determine the differences in 30-day outcomes based on procedure type for management of proximal humerus fractures including complications, readmission, operative time, and length of stay. Further, we sought to determine patient characteristics and perioperative factors associated with poor outcomes. Design/Setting: This was a retrospective study of the National Surgical Quality Improvement Program (NSQIP) database. The NSQIP comprises a clinical database with systematic patient tracking at multiple hospitals across the United States. Patients: A total of 413 patients with proximal humerus fractures managed surgically were included. Intervention: Of 413 patients, 330 underwent open reduction and internal fixation (ORIF) and 83 underwent hemiarthroplasty. Main Outcomes/Measurements: The primary end points included major and minor complications, operative time, rate of return to the operating room, and length of stay. Results: Compared to the hemiarthroplasty cohort, patients in the ORIF cohort were significantly younger (64.2; 17-90 and 69.3; 20-90, respectively, P = .007) and were significantly less likely to be of functionally dependent status (17.5% and 27.7%, P = .036). Compared to the hemiarthroplasty cohort, the ORIF cohort demonstrated fewer postoperative bleeding complications (2.4% and 8.4%, respectively, P = .016) and shorter operative times (115 vs 131 minutes, P = .017). There were no significant differences between the groups with respect to complications, reoperation rates, or length of hospital stay. On multivariable analysis, hemiarthroplasty demonstrated increased risk of postoperative bleeding compared to ORIF (odds ratio = 7.06, confidence interval: 2.06-24.24; P = .002) as well as increased operative time (P = .01). Conclusions: Patients who undergo hemiarthroplasty for management of proximal humerus fractures are significantly older and often functionally

  14. Biomechanical Study of the Fixation Strength of Anteromedial Plating for Humeral Shaft Fractures

    PubMed Central

    Zheng, Yin-Feng; Zhou, Jun-Lin; Wang, Xiao-Hong; Shan, Lei; Liu, Yang

    2016-01-01

    Background: Open reduction and internal fixation with plate and screws are the gold standard for the surgical treatment of humeral shaft fractures, this study was to compare the mechanical properties of anteromedial, anterolateral, and posterior plating for humeral shaft fractures. Methods: A distal third humeral shaft fracture model was constructed using fourth-generation sawbones (#3404, composite bone). A total of 24 sawbones with a distal third humeral shaft fracture was randomly divided into three Groups: A, B, and C (n = 8 in each group) for anteromedial, anterolateral, and posterior plating, respectively. All sawbones were subjected to horizontal torsional fatigue tests, horizontal torsional and axial compressive fatigue tests, four-point bending fatigue tests in anteroposterior (AP) and mediolateral (ML) directions and horizontal torsional destructive tests. Results: In the horizontal torsional fatigue tests, the mean torsional angle amplitude in Groups A, B, and C were 6.12°, 6.53°, and 6.81°. In horizontal torsional and axial compressive fatigue tests, the mean torsional angle amplitude in Groups A, B, and C were 5.66°, 5.67°, and 6.36°. The mean plate displacement amplitude was 0.05 mm, 0.08 mm, and 0.10 mm. Group A was smaller than Group C (P < 0.05). In AP four-point bending fatigue tests, the mean plate displacement amplitude was 0.16 mm, 0.13 mm, and 0.20 mm. Group B was smaller than Group C (P < 0.05). In ML four-point bending fatigue tests, the mean plate displacement amplitude were 0.16 mm, 0.19 mm, and 0.17 mm. In horizontal torsional destructive tests, the mean torsional rigidity in Groups A, B, and C was 0.82, 0.75, and 0.76 N·m/deg. The yielding torsional angle was 24.50°, 25.70°, and 23.86°. The mean yielding torque was 18.46, 18.05, and 16.83 N·m, respectively. Conclusions: Anteromedial plating was superior to anterolateral or posterior plating in all mechanical tests except in AP four-point bending fatigue tests compared to the

  15. Mandibular fracture after endosseous implant placement in conjunction with inferior alveolar nerve transposition: a patient treatment report.

    PubMed

    Kan, J Y; Lozada, J L; Boyne, P J; Goodacre, C J; Rungcharassaeng, K

    1997-01-01

    A patient with a severely atrophic right posterior mandible had three endosseous implants placed in conjunction with transposition of the inferior alveolar nerve. Three weeks following implant placement surgery, the patient experienced a spontaneous fracture of the mandible involving the two anterior implants. The two implants were removed, and the fracture was treated with open reduction and fixation with titanium mesh. The fracture healed, and the posterior implant integrated. This report suggests that the buccolingual and superior-inferior position of the mandibular canal can increase the possibility of mandibular fracture by increasing the size of the buccal cortical plate that is removed to expose the nerve during surgery. PMID:9337027

  16. Comparison of functional outcomes of total elbow arthroplasty vs plate fixation for distal humerus fractures in osteoporotic elbows.

    PubMed

    Egol, Kenneth A; Tsai, Peter; Vazques, Oscar; Tejwani, Nirmal C

    2011-02-01

    Treating intra-articular fractures about the osteoporotic distal humerus poses a significant challenge. The purpose of this retrospective study was to evaluate functional outcomes for distal humeral fractures treated with total elbow arthroplasty (TEA) or open reduction and internal fixation (ORIF) in a nonarthritic elderly population with osteoporosis. We reviewed the records of all women older than age 60 who had undergone surgical treatment for intraarticular distal humerus fractures (Orthopaedic Trauma Association types 13B and 13C) by 1 of 2 surgeons. Demographic and operative data were obtained, charts were reviewed, and patients were asked to have their outcomes evaluated with the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and the Mayo Elbow Performance Index (MEPI). Twenty-two patients (23 elbows) were identified, and 2 of these (3 elbows) were excluded. Of the remaining 20 patients, 9 had undergone cemented, semiconstrained TEA as initial treatment, and 11 had undergone ORIF. These 2 groups were compared. Mean follow-up was 14.8 months (range, 6-38 months). There were no significant differences between the TEA and ORIF groups with respect to demographic factors. Final elbow range of motion was 92° flexion-extension arc (arthroplasty group) and 98° (fixation group). Two patients in the arthroplasty group and 2 in the fixation group died. For the remaining patients, mean DASH scores were 30.2 (arthroplasty) and 32.1 (fixation), and mean MEPI scores were 79 (arthroplasty) and 85 (fixation). These differences were not statistically significant. Four TEAs developed radiographic loosening by a mean of 15 months, and 1 of these underwent revision with good outcome. Ten of the 11 fractures in the fixation group healed radiographically; the 1 nonunion with collapse continued to be asymptomatic. Two patients in the fixation group underwent contracture release after union for limited elbow range of motion. Many factors come into play in the

  17. Comparison of functional outcomes of total elbow arthroplasty vs plate fixation for distal humerus fractures in osteoporotic elbows.

    PubMed

    Egol, Kenneth A; Tsai, Peter; Vazques, Oscar; Tejwani, Nirmal C

    2011-02-01

    Treating intra-articular fractures about the osteoporotic distal humerus poses a significant challenge. The purpose of this retrospective study was to evaluate functional outcomes for distal humeral fractures treated with total elbow arthroplasty (TEA) or open reduction and internal fixation (ORIF) in a nonarthritic elderly population with osteoporosis. We reviewed the records of all women older than age 60 who had undergone surgical treatment for intraarticular distal humerus fractures (Orthopaedic Trauma Association types 13B and 13C) by 1 of 2 surgeons. Demographic and operative data were obtained, charts were reviewed, and patients were asked to have their outcomes evaluated with the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and the Mayo Elbow Performance Index (MEPI). Twenty-two patients (23 elbows) were identified, and 2 of these (3 elbows) were excluded. Of the remaining 20 patients, 9 had undergone cemented, semiconstrained TEA as initial treatment, and 11 had undergone ORIF. These 2 groups were compared. Mean follow-up was 14.8 months (range, 6-38 months). There were no significant differences between the TEA and ORIF groups with respect to demographic factors. Final elbow range of motion was 92° flexion-extension arc (arthroplasty group) and 98° (fixation group). Two patients in the arthroplasty group and 2 in the fixation group died. For the remaining patients, mean DASH scores were 30.2 (arthroplasty) and 32.1 (fixation), and mean MEPI scores were 79 (arthroplasty) and 85 (fixation). These differences were not statistically significant. Four TEAs developed radiographic loosening by a mean of 15 months, and 1 of these underwent revision with good outcome. Ten of the 11 fractures in the fixation group healed radiographically; the 1 nonunion with collapse continued to be asymptomatic. Two patients in the fixation group underwent contracture release after union for limited elbow range of motion. Many factors come into play in the

  18. Delayed Open Reduction and K-Wire Fixation of Widely Displaced Supracondylar Fractures of Humerus in Children using Medial Approach

    PubMed Central

    Waikhom, Sanjib; Ibomcha, Irom; Digendra, Akoijam; Sohkhlet, Handboy R

    2016-01-01

    Introduction Supracondylar fractures of humerus in children are usually treated with percutaneous pinning on emergency basis. When the operating time is delayed, percutaneous pinning is difficult due to massive swelling. Late presentation is common in developing countries. Aim To assess the outcome of open reduction and internal fixation with K-wire of widely displaced supracondylar fracture when operated later than 2 days after the injury. Materials and Methods A total of 52 children (aged 3-12 years) with widely displaced supracondylar fracture of humerus (Gartland type-III) who presented later than 2 days after injury were treated with open reduction through medial approach and fixation with cross K-wires. Results were assessed with Flynn’s criteria. Result: A total of 40 patients completed follow-up. Mean age of all (n=52) patients was 4.8 years (range 3-12 years). Mean delay of presentation was 7.5 days (range 2-14 days). Hundred percent patients had satisfactory results according to Flynn’s criteria. Two patients had pin infections. Conclusion Open reduction through medial approach and fixation with two cross K-wires is a reliable method of treatment for supracondylar fractures of humerus in children when the operation is delayed. PMID:27656516

  19. Technique of Open Reduction and Internal Fixation of Comminuted Proximal Humerus Fractures With Allograft Femoral Head Metaphyseal Reconstruction.

    PubMed

    Parada, Stephen A; Makani, Amun; Stadecker, Monica J; Warner, Jon J P

    2015-10-01

    Proximal humerus fractures are common injuries that can require operative treatment. Different operative techniques are available, but the hallmark of fixation for 3- and 4-part fractures is a locking-plate-and-screw construct. Despite advances in this technology, obtaining anatomical reduction and fracture union can be difficult, and complications (eg, need for revision) are not uncommon. These issues can be addressed by augmenting the fixation with an endosteally placed fibular allograft. Although biomechanical and clinical results have been good, the technique can lead to difficulties in future revision to arthroplasty, a common consequence of failed open reduction and internal fixation. The technique described, an alternative to placing a long endosteal bone graft, uses a trapezoidal, individually sized pedestal of allograft femoral head to facilitate the reduction and healing of the humeral head and tuberosity fragments in a displaced 3- or 4-part fracture of the proximal humerus. It can be easily incorporated with any plate-and-screw construct and does not necessitate placing more than 1 cm of bone into the humeral intramedullary canal, limiting the negative effects on any future revision to arthroplasty.

  20. Surgical treatment and a unique management of rostral mandibular fracture with cerclage wire in a horse.

    PubMed

    Naddaf, Hadi; Sabiza, Soroush; Kavosi, Narges

    2015-01-01

    A 3-year-old Arabian colt was presented for a major gingiva wound at the right rostral part of mandible. After clinical assessments, rostral mandibular fracture was determined. Stabilization of fractured region was achieved via cerclage wire application under general anesthesia. Fixation wires were left in place for 6 weeks. A 3 -month follow up revealed complete fracture healing. The purpose of this case report was to give clinical information about rostral mandibular fractures and treatment of these fractures and nutrition protocol in a horse, as this fracture is of the most common type of jaw fracture sustained by young horses.

  1. Surgical treatment and a unique management of rostral mandibular fracture with cerclage wire in a horse.

    PubMed

    Naddaf, Hadi; Sabiza, Soroush; Kavosi, Narges

    2015-01-01

    A 3-year-old Arabian colt was presented for a major gingiva wound at the right rostral part of mandible. After clinical assessments, rostral mandibular fracture was determined. Stabilization of fractured region was achieved via cerclage wire application under general anesthesia. Fixation wires were left in place for 6 weeks. A 3 -month follow up revealed complete fracture healing. The purpose of this case report was to give clinical information about rostral mandibular fractures and treatment of these fractures and nutrition protocol in a horse, as this fracture is of the most common type of jaw fracture sustained by young horses. PMID:26261717

  2. Surgical treatment and a unique management of rostral mandibular fracture with cerclage wire in a horse

    PubMed Central

    Naddaf, Hadi; Sabiza, Soroush; Kavosi, Narges

    2015-01-01

    A 3-year-old Arabian colt was presented for a major gingiva wound at the right rostral part of mandible. After clinical assessments, rostral mandibular fracture was determined. Stabilization of fractured region was achieved via cerclage wire application under general anesthesia. Fixation wires were left in place for 6 weeks. A 3 -month follow up revealed complete fracture healing. The purpose of this case report was to give clinical information about rostral mandibular fractures and treatment of these fractures and nutrition protocol in a horse, as this fracture is of the most common type of jaw fracture sustained by young horses. PMID:26261717

  3. Total Hip Arthroplasty for Failed Internal Fixation After Femoral Neck Fracture Versus That for Acute Displaced Femoral Neck Fracture: A Comparative Study.

    PubMed

    Yang, Zhouyuan; Liu, Huifang; Xie, Xiaowei; Tan, Zhen; Qin, Tianqiang; Kang, Pengde

    2015-08-01

    The outcome of total hip arthroplasty (THA) for failed internal fixation after femoral neck fracture (FNF) versus that for acute displaced femoral neck fracture is still controversial. This study retrospectively analyzed a consecutive series of 130 THAs for acute displaced FNF (64, group I) and for failed internal fixation (66, group II). Results showed THAs in group II were more technically demanding procedures with longer operative time and larger amounts of drainage compared to that in group I. Furthermore, multivariate analysis revealed that the associations between THAs (group II) and hip complications were notable (OR=4.15, P=0.017). These increased risks should be paid much attention to, not only for choosing the appropriate treatment option, but also for providing effective perioperative care.

  4. In vivo biomechanical evaluation of nail-plate fixation of femoral neck fractures of rehabilitated patients.

    PubMed

    Mizrahi, J; Kantarovski, A; Najenson, T; Susak, Z

    1985-01-01

    A major advantage of internal fixation of intertrochanteric fractures is that it can normally be followed by early and fast rehabilitation of the patient, finding expression in weight bearing and locomotion abilities of the patients. Complications which nevertheless occur, are mostly of mechanical origin. The purpose of our study was to evaluate the biomechanical performance of rehabilitated patients treated with four different types of nail-plates. Forty nine patients (12 men and 37 women) with walking ability, and with an average age of 70.5 years, were tested on a 10 m walkway, instrumented for the monitoring of the time distance parameters of the stride. This method of evaluation is especially suitable for pathological gait, free or supported, as it does not impose any constraints on the natural and individual walking trend of the patient. The average time elapsed between the actual fracture and the locomotor test was 764 days, implying that the investigated patients formed a homogeneous, well-rehabilitated group. The main average stride results were as follows: contact time 1.25 sec, double contact time 0.41 sec, stride length 68.2 cm, velocity 51.39 cm/sec and symmetry 0.51. No significant differences were found in these parameters between the subgroups of patients using different nail-plates. These results show that while the biomechanical performance of the patients with their implants was satisfactory (good walking symmetry) this group can be characterized by its smaller stride and slower gait, compared to those of a healthy population of the same age.

  5. Postoperative bedrest improves the alignment of thoracolumbar burst fractures treated with the AO spinal fixator

    PubMed Central

    Dang, Yen; Yen, David; Hopman, Wilma M.

    2009-01-01

    Background A loss of reduction due to inadequate support of the anterior column when using short-segment instrumentation to treat burst fracture and novel methods for support of the anterior column through a posterior approach to augment posterior instrumentation have been reported in the literature. We hypothesized that if anterior column support is an important adjunct to posterior short-segment instrumentation, then avoidance of axial load until sufficient anterior column healing occurs, allowing load-sharing with the implant, would improve spinal alignment at follow-up. Methods We conducted a retrospective cohort study in which consecutive patients who had instrumentation and fusion with the AO spinal fixator were immediately ambulated after surgery or had 4 weeks of bedrest. We measured kyphosis and wedge angles preoperatively, immediately postoperatively and at the time of final follow-up. We used radiologic measures to assess instrumentation and bone failure. Results We found significant differences in the mean loss of wedge and kyphosis angle correction between patients immediately ambulated and those who had 4 weeks of bedrest (0.71º v. − 4.73º for wedge and 1.81º v. − 6.55º for kyphosis, respectively). There was significant correlation between instrumentation and bone failure in both the immediate ambulation and bedrest groups. Conclusion Bedrest improves the maintenance of intraoperative sagittal alignment correction, which is in agreement with the theory that inadequate support of the anterior spinal column is the mechanism for loss of reduction when using short-segment instrumentation to treat burst fractures. Therefore, addressing the anterior column directly through anterior surgery or by employing novel techniques in posterior surgery is recommended if one of the goals of treatment is to maintain the sagittal correction achieved at the time of surgery. Trying to achieve this goal by addressing posterior implant design or bone quality alone

  6. Effect of Pentoxifylline Administration on an Experimental Rat Model of Femur Fracture Healing With Intramedullary Fixation

    PubMed Central

    Vashghani Farahani, Mohammad Mahdi; Masteri Farahani, Reza; Mostafavinia, Ataroalsadat; Abbasian, Mohammad Reza; Pouriran, Ramin; Noruzian, Mohammad; Ghoreishi, Seyed Kamran; Aryan, Arefe; Bayat, Mohammad

    2015-01-01

    Background: Globally, musculoskeletal injuries comprise a major public health problem that contributes to a large burden of disability and suffering. Pentoxifylline (PTX) has been originally used as a hemorheologic drug to treat intermittent claudication. Previous test tube and in vivo studies reported the beneficial effects of PTX on bony tissue. Objectives: This study aims to evaluate the effects of different dosages of PTX on biomechanical properties that occur during the late phase of the fracture healing process following a complete femoral osteotomy in a rat model. We applied intramedullary pin fixation as the treatment of choice. Materials and Methods: This experimental study was conducted at the Shahid Beheshti University of Medical Sciences, Tehran, Iran. We used the simple random technique to divide 35 female rats into five groups. Group 1 received intraperitoneal (i.p.) PTX (50 mg/kg, once daily) injections, starting 15 days before surgery, and group 2, group 3, and group 4 received 50 mg/kg, 100 mg/kg, and 200 mg/kg i.p. PTX injections, respectively, once daily after surgery. All animals across groups received treatment for six weeks (until sacrificed). Complete surgical transverse osteotomy was performed in the right femur of all rats. At six weeks after surgery, the femurs were subjected to a three-point bending test. Results: Daily administration of 50 mg/kg PTX (groups 1 and 2) decreased the high stress load in repairing osteotomized femurs when compared with the control group. The highest dose of PTX (200 mg/kg) significantly increased the high stress load when compared with the control group (P = 0.030), group 1 (P = 0.023), group 2 (P = 0.008), and group 3 (P = 0.010), per the LSD findings. Conclusions: Treatment with 200 mg/kg PTX accelerated fracture healing when compared with the control group. PMID:26756019

  7. Fracture fixation with two locking screws versus three non-locking screws

    PubMed Central

    Grawe, B.; Le, T.; Williamson, S.; Archdeacon, A.; Zardiackas, L.

    2012-01-01

    Objectives We aimed to further evaluate the biomechanical characteristics of two locking screws versus three standard bicortical screws in synthetic models of normal and osteoporotic bone. Methods Synthetic tubular bone models representing normal bone density and osteoporotic bone density were used. Artificial fracture gaps of 1 cm were created in each specimen before fixation with one of two constructs: 1) two locking screws using a five-hole locking compression plate (LCP) plate; or 2) three non-locking screws with a seven-hole LCP plate across each side of the fracture gap. The stiffness, maximum displacement, mode of failure and number of cycles to failure were recorded under progressive cyclic torsional and eccentric axial loading. Results Locking plates in normal bone survived 10% fewer cycles to failure during cyclic axial loading, but there was no significant difference in maximum displacement or failure load. Locking plates in osteoporotic bone showed less displacement (p = 0.02), but no significant difference in number of cycles to failure or failure load during cyclic axial loading (p = 0.46 and p = 0.25, respectively). Locking plates in normal bone had lower stiffness and torque during torsion testing (both p = 0.03), but there was no significant difference in rotation (angular displacement) (p = 0.84). Locking plates in osteoporotic bone showed lower torque and rotation (p = 0.008), but there was no significant difference in stiffness during torsion testing (p = 0.69). Conclusions The mechanical performance of locking plate constructs, using only two screws, is comparable to three non-locking screw constructs in osteoporotic bone. Normal bone loaded with either an axial or torsional moment showed slightly better performance with the non-locking construct. PMID:23610681

  8. Epoxy putty external skeletal fixation for fractures of the four main metacarpal and metatarsal bones in cats and dogs.

    PubMed

    De La Puerta, B; Emmerson, T; Moores, A P; Pead, M J

    2008-01-01

    The objective of this retrospective study was to report the clinical use, advantages, disadvantages, complications and outcome of an epoxy putty external skeletal fixator (EPESF) used for the repair of fractures of all four main metatarsal or metacarpal bones in a single limb in 11 dogs and 11 cats. The aim of this technique was to achieve satisfactory alignment of the proximal and distal joints and the digits, rather than anatomical reconstruction of the metacarpal/metatarsal bones themselves. All of the cases achieved fracture union and they all recovered fully without any residual lameness.

  9. Treatment of Unstable Posterior Pelvic Ring Fracture with Pedicle Screw-Rod Fixator Versus Locking Compression Plate: A Comparative Study

    PubMed Central

    Bi, Chun; Wang, Qiugen; Nagelli, Christopher; Wu, Jianhong; Wang, Qian; Wang, Jiandong

    2016-01-01

    Background The aim of this study was to assess the clinical results of treatment for unstable posterior pelvic fractures using a pedicle screw-rod fixator compared to use of a locking compression plate. Material/Methods A retrospective study was performed between June 2010 and May 2014 and the data were collected from 46 patients with unstable posterior pelvic ring fractures. All patients were treated using either a pedicle screw-rod fixator (study group, 24 patients) or locking compression plate (control group, 22 patients). In these patients, causes of injury included traffic accidents (n=27), fall from height (n=12), and crushing accidents (n=7). The quality of reduction and radiological grading were assessed. Clinical assessments included the operation time, times of X-ray exposures, bleeding volume during operation, incision length, and Majeed postoperative functional evaluation. Results No iatrogenic neurovascular injuries occurred during the operations in these 2 groups. The average follow-up time was 24.5 months. All fractures were healed. The significant differences (P<0.05) between the 2 groups were operation duration, size of incision, and intraoperative bleeding volume. Statistically significant differences in the Majeed postoperative functional evaluation and times of X-ray exposures were not found between the 2 groups. Conclusions Similar clinical effects were achieved in treating the posterior pelvic ring fractures using the pedicle screw-rod fixator and the locking compression plate. However, the pedicle screw-rod fixator has the advantages of smaller incision, shorter duration of the operation, and less bleeding volume compared to using the locking compression plate. PMID:27748355

  10. Kirschner wire migration causing spinal cord injury one year after internal fixation of a clavicle fracture.

    PubMed

    Fransen, Patrick; Bourgeois, Sylvie; Rommens, Jacques

    2007-06-01

    K-wire migration after internal fixation of the clavicle has rarely been reported to cause spinal cord injuries. A 30-year-old man presented with progressive paraparesis, hypaesthesia under a Th4 level and electric pain in the neck and arms. CT of the spine revealed a migrated K-wire from a one-year-old clavicle osteosynthesis, penetrating the spinal canal through the Th2 nerve root foramen, and perforating the spinal cord with a transversal trajectory. Surgical removal of the K-wire was performed after exposing both ends. Laminectomy allowed visual control of the entry point and correction of cerebrospinal fluid leakage. The pain disappeared and the patient recovered a normal gait after 6 weeks. The use of two incisions is advocated in such cases: one lateral to allow wire removal, and one medial for dural repair and early intradural bleeding control. Regular follow ups, K-wire removal after fracture healing as well as bending the wire end in a walking stick shape should minimise the risk of migration. PMID:17715732

  11. Investigation of the influence of mallet and chisel techniques on the lingual fracture line and comparison with the use of splitter and separators during sagittal split osteotomy in cadaveric pig mandibles.

    PubMed

    Verweij, Jop P; Mensink, Gertjan; Houppermans, Pascal N W J; Frank, Michael D; van Merkesteyn, J P Richard

    2015-04-01

    In bilateral sagittal split osteotomy the proximal and distal segments of the mandible are traditionally separated using chisels. Modern modifications include prying and spreading the segments with splitters. This study investigates the lingual fracture patterns and status of the nerve after sagittal split osteotomy (SSO) using the traditional chisel technique and compares these results with earlier studies using the splitter technique. Lingual fractures after SSO in cadaveric pig mandibles were analysed using a lingual split scale and split scoring system. Iatrogenic damage to the inferior alveolar nerve was assessed. Fractures started through the caudal cortex more frequently in the chisel group. This group showed more posterior lingual fractures, although this difference was not statistically significant. Nerve damage was present in three cases in the chisel group, but was not observed in the splitter group. A trend was apparent, that SSO using the chisel technique instead of the splitter technique resulted in more posterior lingual fracture lines, although this difference was not statistically significant. Both techniques resulted in reliable lingual fracture patterns. Splitting without chisels could prevent nerve damage, therefore we propose a spreading and prying technique with splitter and separators. However, caution should be exercised when extrapolating these results to the clinic. PMID:25697050

  12. Parallel analysis of finite element model controlled trial and retrospective case control study on percutaneous internal fixation for vertical sacral fractures

    PubMed Central

    2013-01-01

    Background Although percutaneous posterior-ring tension-band metallic plate and percutaneous iliosacral screws are used to fix unstable posterior pelvic ring fractures, the biomechanical stability and compatibility of both internal fixation techniques for the treatment of Denis I, II and III type vertical sacral fractures remain unclear. Methods Using CT and MR images of the second generation of Chinese Digitized Human “male No. 23”, two groups of finite element models were developed for Denis I, II and III type vertical sacral fractures with ipsilateral superior and inferior pubic ramus fractures treated with either a percutaneous metallic plate or a percutaneous screw. Accordingly, two groups of clinical cases that were fixed using the above-mentioned two internal fixation techniques were retrospectively evaluated to compare postoperative effect and function. Parallel analysis was performed with a finite element model controlled trial and a case control study. Results The difference of the postoperative Majeed standards and outcome rates between two case groups was no statistically significant (P > 0.05). Accordingly, the high values of the maximum displacements/stresses of the plate-fixation model group approximated those of the screw-fixation model group. However, further simulation of Denis I, II and III type fractures in each group of models found that the biomechanics of the plate-fixation models became increasingly stable and compatible, whereas the biomechanics of the screw-fixation models maintained tiny fluctuations. When treating Denis III fractures, the biomechanical effects of the pelvic ring of the plate-fixation model were better than the screw-fixation model. Conclusions Percutaneous plate and screw fixations are both appropriate for the treatment of Denis I and II type vertical sacral fractures; whereas percutaneous plate fixation appears be superior to percutaneous screw fixation for Denis III type vertical sacral fracture. Biomechanical

  13. Least Possible Fixation Techniques of 4-Part Valgus Impacted Fractures of the Proximal Humerus: A Systematic Review

    PubMed Central

    Panagopoulos, Andreas; Tatani, Irini; Ntourantonis, Dimitrios; Seferlis, Ioannis; Kouzelis, Antonis; Tyllianakis, Minos

    2016-01-01

    The valgus-impacted (VI) 4-part fractures are a subset of fractures of the proximal humerus with a unique anatomic configuration characterized by a relatively lower incidence of avascular necrosis after operative intervention. We systematically reviewed clinical studies assessing the benefits and harms of least possible fixation techniques (LPFT) for this unique fracture type. Such information would be potentially helpful in developing an evidence-based approach in the management of these complex injuries. We performed analytic searches of PubMed, Embase, Web of Science, Google Scholar and the Cochrane Library, restricting it to the years 1991-2014. Included studies had to describe outcomes and complications after primary osteosynthesis with any type of LPFT apart from plate-screws and intramedullary nailing. Eligibility criteria were also included English language, more than 5 cases, minimum follow up of one year and report of clinical outcome using at least one relevant score (Constant, Neer or ASES). Based on 292 database hits we identified 12 eligible studies including 190 four-part valgus impacted fractures in 188 patients. All eligible studies were case series composed of min 8 to max 45 patients per study. The gender distribution was 60% (112) female and 40% (76) male. The average age of the patients at the time of injury was 54.5 years. In 8/12 studies an open reduction was used for fracture fixation using different surgical techniques including KW, cerclage wires, cannulated screws and osteosutures. Closed reduction and percutaneous fixation was used in 4 studies. Mean follow-up time ranged from 24 to 69 months. A good functional outcome (constant score >80) was reported in 9/12 studies. The most common complication was avascular necrosis of the humeral head with an overall incidence of 11% (range, 0-26.3%). Total avascular necrosis (AVN) was found in 15/188 patients (7.9%) and was more common in percutaneous techniques and partial AVN in 6/188 (3

  14. Plate selection for fixation of extra-articular distal humerus fractures: a biomechanical comparison of three different implants.

    PubMed

    Scolaro, John A; Hsu, Jason E; Svach, David J; Mehta, Samir

    2014-12-01

    Operative fixation of extra-articular distal humerus using a single posterolateral column plate has been described but the biomechanical properties or limits of this technique is undefined. The purpose of this study was to evaluate the mechanical properties of distal humerus fracture fixation using three standard fixation constructs. Two equal groups were created from forty sawbones humeri. Osteotomies were created at 80mm or 50mm from the tip of the trochlea. In the proximal osteotomy group, sawbones were fixed with an 8-hole 3.5mm LCP or with a 6-hole posterolateral plate. In the distal group, sawbones were fixed with 9-hole medial and lateral 3.5mm distal humerus plates and ten sawbones were fixed with a 6-hole posterolateral plate. Biomechanical testing was performed using a servohydraulic testing machine. Testing in extension as well as internal and external rotation was performed. Destructive testing was also performed with failure being defined as hardware pullout, sawbone failure or cortical contact at the osteotomy. In the proximal osteotomy group, the average bending stiffness and torsional stiffness was significantly greater with the posterolateral plate than with the 3.5mm LCP. In the distal osteotomy group, the average bending stiffness and torsional stiffness was significantly greater with the posterolateral plate than the 3.5mm LCP. In extension testing, the yield strength was significantly greater with the posterolateral plate in the proximal osteotomy specimens, and the dual plating construct in the distal osteotomy specimens. The yield strength of specimens in axial torsion was significantly greater with the posterolateral plate in the proximal osteotomy specimens, and the dual plating construct in the distal osteotomy specimens. Limited biomechanical data to support the use of a pre-contoured posterolateral distal humerus LCP for fixation of extra-articular distal humerus exists. We have found that this implant provided significantly greater

  15. Lateral fixation of AO type-B2 ankle fractures in the elderly: the Knowles pin versus the plate

    PubMed Central

    Huang, Hui-Ling; Lo, Ting-Ying; Huang, Chien-Rae

    2006-01-01

    The study was a retrospective evaluation and comparison. Seventy-five elderly patients (>50 years) with AO type-B2 ankle fractures were treated by open reduction and internal fixation. All patients were followed up retrospectively for at least 12 months. The 75 patients were divided into two groups, based on the method of treatment. The Knowles pin (KP) group included 45 patients with an average age of 62.7 years. The tubular plate (TP) group included 30 patients with an average age of 60.0 years. The clinical results were compared between the two groups. Both of the groups were similar in respect to the injury mechanisms, fracture pattern, open fracture grade, compounding medical conditions, and ankle score (all P values <0.28). However, the KP group had significantly smaller wound incisions, shorter surgery time, shorter hospital stay, less meperidine use, less symptomatic hardware, and lower complication rates than the TP group (all P values <0.03). In conclusion, lateral fixation of AO type-B2 ankle fractures in the elderly by the Knowles pin is recommended due to its simplicity, efficacy and low complication rate. PMID:17043861

  16. Patellar Shape-Memory Fixator for the Treatment of Comminuted Fractures of the Inferior Pole of the Patella

    NASA Astrophysics Data System (ADS)

    Liu, Xin-Wei; Shang, Hui-Juan; Xu, Shuo-Gui; Wang, Zhi-Wei; Zhang, Chun-Cai; Fu, Qing-Ge

    2011-07-01

    Comminuted and displaced fractures of the inferior pole of the patella are not easy to reduce and it is difficult to fix the fragments soundly enough to allow early movement of the knee. The purpose of this study is to evaluate the clinical effectiveness of the internal fixation technique with Patellar Shape-Memory Fixator (PSMF) in acute comminuted fractures of the inferior pole of the patella. We retrospectively studied 25 patients with comminuted fractures of the inferior pole of the patella who were treated with PSMF and followed up for a mean period of 26 months (14 to 60). All the fractures healed at a mean of 6 weeks (5 to 7). The mean grading at the final follow-up was 29.5 points (27 to 30) using the Bostman score, with no observable restriction of movement. No breakage of the PSMF or infection occurred. No delayed union, nonunion, and infection were seen. This technique preserved the length of the patella, reduced the comminuted fragments of the inferior pole and avoided long-term immobilization of the knee.

  17. Complex fractures of the proximal humerus in the elderly--outcome and complications after locking plate fixation.

    PubMed

    Schliemann, B; Siemoneit, J; Theisen, Ch; Kösters, C; Weimann, A; Raschke, M J

    2012-05-01

    Open reduction and internal fixation (ORIF) with locking plates or primary arthroplasty remains a controversial issue in the management of complex proximal humerus fractures. Aim of this study was to evaluate the surgeon- and patient-based outcome of patients older than 65 years who underwent ORIF using locking plate fixation of a 3- or 4-part fracture of the proximal humerus. Twenty-seven patients older than 65 years were treated with locking plate fixation (PHILOS, Fa. Synthes, Umkirch, Germany). At an average follow-up of 44 months, the clinical and the subjective outcome were evaluated, and complications were analyzed. The mean age- and gender-related Constant score was 70% (30–100%) compared with 92% (47–108%) of the contralateral non-injured shoulder. The mean DASH score was 29 points (0–71). Five patients (18.5%) showed clinical signs of an impingement, which was related to malpositioning of the plate in 3 cases. Screw cutout was seen in 22.2% (6 patients). Avascular necrosis of the head or the tubercula was found in 8 patients (29.6%). The revision rate was 29.6%. However, the patients considered the functional status of their shoulder as “good” or “satisfactory.” The functional and patient-orientated results of the locking plate fixation of complex displaced proximal humerus fractures in the elderly are comparable to those of primary arthroplasty and minimally invasive treatment. Proper surgical technique (screw length, plate position) is mandatory for reducing the revision rate.

  18. Use of external fixation and primary wound closure in an open comminuted first metatarsal fracture: a case report.

    PubMed

    Miller, Jason C; Shever, Sepideh

    2008-01-01

    Management of open, comminuted fractures presents a challenge for the foot and ankle surgeon. Reconstructive surgery for such injuries has a high potential for the development of serious complications, and factors such as the extent of soft tissue injury, neurovascular status to the foot, and fracture stability must be taken into consideration before determining a surgical plan. This article describes the case of a patient who presented with an open, comminuted first metatarsal fracture as a result of a chainsaw injury. The patient was treated with a uniplanar mini-external fixator, demineralized bone matrix, primary wound closure, and external bone growth stimulation. At 1-year follow-up, the interview and examination revealed the patient to be pain free with a functional first ray. ACFAS Level of Clinical Evidence: 4.

  19. Comparative Study Using Intramedullary K-wire Fixation Over Titanium Elastic Nail in Paediatric Shaft Femur Fractures

    PubMed Central

    Anand, Tushar; Singh, Sudhir

    2014-01-01

    Background: Fracture shaft femur is common paediatric trauma leading to significant morbidity. Conservative treatments available are associated with prolonged periods of immobilization. Use of flexible intramedullary implant allows early rehabilitation in diaphyseal fractures of femur in children. Aim: The aim of the present study is to compare fixation of diaphyseal femur fracture by titanium elastic nail and intramedullary K-wires in children. Setting and Design: Prospective randomized study in a tertiary care hospital. Material and Methods: Fifty-two children between 6 years and 14 years of age with femoral shaft fracture were assigned either in Group I or Group II based on computer generated random numbers. In Group I closed percutaneous intramedullary K- wire fixation and in Group II closed percutaneous intramedullary titanium elastic nail was used to fix the fractures. Partial weight bearing was allowed after 6 weeks of surgery and full weight bearing at clinico-radiological union. Results: Average time of radiological union was 6 to 10 weeks in both groups. In both the groups two cases had entry site irritation which resolved with early implant removal. One case in both the groups had unacceptable mal-alignment. Both the groups had few cases of limb-length discrepancy, which was in acceptable limit, except two cases of TENS. There was no statistically significant difference between the results of both the groups. But, using K-wires significantly reduced the cost of treatment. Conclusion: Most of such fractures in our society are neglected because of high cost of treatment. Providing a cheaper alternative in form of K-wires may be beneficial for the patients from low socio-economic status. PMID:25584251

  20. Internal fixation of fractures of the shaft of the humerus by dynamic compression plate or intramedullary nail: A prospective study

    PubMed Central

    Raghavendra, S; Bhalodiya, Haresh P

    2007-01-01

    Background: The indications for surgical management of fractures of the shaft of the humerus are clear, but selecting the right implant for internal fixation of humeral fractures has been a dilemma. Materials and Methods: Thirty-six patients (mean age 40.53 years) with fractures of the shaft of the humerus were followed for 12 to 24 months in a prospective study. Eighteen patients each underwent open reduction and internal fixation with compression plating and ante grade interlock nailing. Clinical and radiographic outcome measures included fracture healing, shoulder and elbow functions, need for additional procedures and any complication such as infection and recovery of radial nerve palsy. The results were analyzed statistically using the SPSS 11.5 software, with parametric and nonparametric tests. Results: Nine of the fractures treated with compression plating and seven of those treated with interlock nailing achieved union within six months. Though there was no significant difference in union time between the treatment groups, patients operated with interlock nailing underwent more number of secondary bone grafting procedures to obtain union (six against two). There were 12 patients (66.6%) with excellent and good results in the plating group compared to four patients (25%) in the nailing group. Interlock nailing was associated with significant reduction in shoulder function (P=0.03) and in overall results (P=0.02). Conclusion: Though there was no significant difference between plating or nailing in terms of time to union, compression plating is the preferred method in the majority of fractures of the shaft of the humerus with better preservation of joint function and lesser need for secondary bone grafting for union. PMID:21139747

  1. Early Definitive Fixation of an Open Periprosthetic Femur Fracture in the Polytraumatized Patient: A Case Report and Review of the Literature

    PubMed Central

    Aleem, Ilyas S; Bhandari, Mohit; Elizalde, Sebastian Rodriguez

    2016-01-01

    Introduction: Periprosthetic fractures of the femur after total hip arthroplasty are increasing in frequency. In the polytraumatized patient with long-bone fracture, an ongoing debate exists regarding early definitive stabilization versus initial damage control orthopaedics, followed by delayed fixation. It remains to be seen whether this rationale applies to the polytraumatized patient with periprosthetic fracture. Case presentation: We present the case of a 73-years old Caucasian woman who sustained bilateral Gustillo-Anderson grade III open femur fractures; the fracture on the right was a Vancouver C open periprosthetic fracture after cemented total hip arthroplasty. After massive fluid resuscitation in the trauma bay she was taken to the intensive care unit in a hemodynamically unstable condition. She was subsequently operated and underwent early definitive fixation of both femurs with the rationale of potentially reducing pulmonary complications and promoting early mobilization. Conclusion: Early definitive stabilization versus delayed fixation in the polytraumatized patient with an open periprosthetic femur fracture is reviewed. Although several treatment algorithms based on fracture classification and implant stability exist, further study is required to delineate the preferred method and timeline of fixation for this growing cohort of patients. PMID:27299122

  2. [Treatment of the femoral, tibia and humeral shaft fractures in children with the use of intramedullary nailing or external fixation, a long term study].

    PubMed

    Kołecka, Ewa; Niedzielski, Kryspin Ryszard; Lipczyk, Zbigniew; Flont, Paweł

    2009-01-01

    The treatment of long bones shaft fractures with intramedullary nailing and external fixation is gaining popularity nowadays. The aim of this study was to analyze operative methods of treatment of the long bones shafts fractures in children. We compared outcomes of surgical treatment with the use of external fixation and flexible nails. The study group consisted of 127 patients (4 to 18 years old) who were operated on in our hospital during the period 1990-2005: 90 patients with femoral shaft fractures, 31 with tibia fractures and 6 with humeral fractures. In 81 children we performed fixation with Wagner's tool and in 46 cases we used Prevot or Ender nails. The follow up (performed at least one year after treatment cessation) included clinical examination and X-ray imaging. Union in an almost anatomical position was obtained in 126 patients. There was one fracture-healing complication ( nonunion- due to to early hardware removal). The study showed many advantages of the surgical treatment: minimal invasiveness, short hospitalization period, early rehabilitation. In our group both methods of management were comparable. We recommend intramedullary nailing in closed, transverse fractures and external fixator in open, multifragmentary and possibly unstable fractures. PMID:19777945

  3. [Retrospective analysis of consecutively treated distal radius fractures with the external fixator].

    PubMed

    Melik, N; Togninalli, D; Biegger, P

    1994-12-01

    The purpose of this study was to determine retrospectively some subjective and objective parameters following the operative treatment of 32 patients with "complex" (intraarticular and/or comminuted) fractures of the distal radius using the small AO external fixation device. The mean follow-up period was 20 months (minimum 4, maximum 48) and the mean age of the subjects was 62 years (minimum 27, maximum 91). Subjective results such as "general feeling", mobility, strength and pain, expressed with a scoring system (% of maximum obtainable points), showed an overall good result and ranged between 71% (pain), 81% (strength) and 91% (mobility and "general feeling"). Regarding the objective results, no major skin or soft tissue distress (Sudeck dystrophy) was noted. However, there was a general tendency towards a mobility deficit of the wrist operated on, which was statistically significant (P < 0.01) for flexion, extension, supination and abduction (respectively, -17.7%, -12.4%, -7.1% and -12.5%). The late standard radiological and lateral controls showed a mean radial angle of +2.13 degrees (B or lateral radial angle) and +23.13 degrees (A or AP angle), respectively. The analysis of data, as expressed by time after operation (< or > than 10 months), showed no relevant difference between the two groups (age of both similar), as expressed by age (< or > than 60 years); the data only showed differences in strength and pain (scores by 92% vs 82% for force and 92% vs 76% for pain) and in flexion and extension (-22.8% and -14%, P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7855610

  4. External fixation is more suitable for intra-articular fractures of the distal radius in elderly patients.

    PubMed

    Ma, Chuang; Deng, Qiang; Pu, Hongwei; Cheng, Xinchun; Kan, Yuhua; Yang, Jing; Yusufu, Aihemaitijiang; Cao, Li

    2016-01-01

    The purpose of this study was to compare the functional outcomes, psychological impact, and complication rates associated with external fixation and volar or dorsal plating in relation to the functional parameters following treatment of intra-articular fractures of the distal radius (IFDR) in patients older than 65 years. We hypothesized that using volar or dorsal plating would improve functional outcomes, but that it would be associated with more complications and equivalent functional outcomes when compared with the external fixation group. A total of 123 consecutive patients suffering from IFDR were recruited into the study. The patients were measured for clinical, radiological, and psychosocial functioning outcomes and were followed up after 1 week and 3, 6 and 12 months. After 3 months, the plating group had better pronation (P=0.001), supination, (P=0.047) and extension (P=0.043) scores. These differences were somewhat attenuated by 6 months and disappeared at 1 year. The plating group had a greater occurrence of wound infection (P=0.043), tendonitis, (P=0.024) and additional surgery compared with the external fixation group. The only TNO-AZL Adult Quality of Life scores in the plating group that were lower than those in the external fixation group were in the "gross motor" category (walking upstairs, bending over, walking 500 yards; P=0.023). Internal fixation was more advantageous than external fixation in the early rehabilitation period; after 1 year the outcomes were similar. The plating group showed significantly higher levels of wound infection and tendonitis and had a greater need for additional surgeries. PMID:27408765

  5. External fixation is more suitable for intra-articular fractures of the distal radius in elderly patients

    PubMed Central

    Ma, Chuang; Deng, Qiang; Pu, Hongwei; Cheng, Xinchun; Kan, Yuhua; Yang, Jing; Yusufu, Aihemaitijiang; Cao, Li

    2016-01-01

    The purpose of this study was to compare the functional outcomes, psychological impact, and complication rates associated with external fixation and volar or dorsal plating in relation to the functional parameters following treatment of intra-articular fractures of the distal radius (IFDR) in patients older than 65 years. We hypothesized that using volar or dorsal plating would improve functional outcomes, but that it would be associated with more complications and equivalent functional outcomes when compared with the external fixation group. A total of 123 consecutive patients suffering from IFDR were recruited into the study. The patients were measured for clinical, radiological, and psychosocial functioning outcomes and were followed up after 1 week and 3, 6 and 12 months. After 3 months, the plating group had better pronation (P=0.001), supination, (P=0.047) and extension (P=0.043) scores. These differences were somewhat attenuated by 6 months and disappeared at 1 year. The plating group had a greater occurrence of wound infection (P=0.043), tendonitis, (P=0.024) and additional surgery compared with the external fixation group. The only TNO-AZL Adult Quality of Life scores in the plating group that were lower than those in the external fixation group were in the “gross motor” category (walking upstairs, bending over, walking 500 yards; P=0.023). Internal fixation was more advantageous than external fixation in the early rehabilitation period; after 1 year the outcomes were similar. The plating group showed significantly higher levels of wound infection and tendonitis and had a greater need for additional surgeries. PMID:27408765

  6. Less invasive surgery using external fixator for the treatment of subtrochanteric femur fracture in a high-risk geriatric patient.

    PubMed

    Atik, O Şahap; Can, Fatih I; Şenol, M Selçuk; Eren, Toygun K

    2016-08-01

    A 90-year-old female patient was admitted to our clinic complaining of pain in her left hip which occurred due to fall from a chair. Her medical history included memory loss and mental changes associated with Alzheimer's disease and depression. Patient's cooperation and orientation were weak. Range of motion of the left hip was restricted and painful. Radiographs of the left hip demonstrated subtrochanteric comminuted fracture of femur. Laboratory tests revealed anemia and liver insufficiency. Departments of internal medicine and anesthesiology reported high risk for surgery. Surgery was performed under spinal anesthesia on radiolucent table and in supine position. Using fluoroscopy, subtrochanteric comminuted fracture of femur was reduced. Proximally, two Schanz screws were placed through femoral neck and head in axial plane, and distally, three Schanz screws were placed through femoral shaft in coronal plane. Finally, fixation of the screws was achieved with an external fixator which was made of carbon fiber rods. Patient was allowed to sit in the bed and move around with a wheelchair as of the day of surgery. No infection or loosening of fixator occurred. PMID:27499322

  7. Is Loss of Fixation Following Locked Plating of Proximal Humeral Fractures Related to the Number of Screws and Their Positions in the Humeral Head?

    PubMed Central

    Maddah, Mohammad; Prall, Wolf C.; Geyer, Lucas; Wirth, Stefan; Mutschler, Wolf; Ockert, Ben

    2014-01-01

    The aim of the study was to examine the correlation between the chosen position of screws and the complications observed in patients who underwent locked plating of proximal humeral fractures. We evaluated radiographs of 367 patients treated by locked-plating for proximal humeral fractures. Radiographs were taken at one day, 6 weeks, 3 months and 6 months after surgery, and were analyzed for secondary fracture displacement, loss of fixation, cutting out of screws and necrosis of the humeral head. Secondary loss of fixation occurred in 58 cases (15.8%) and among those cutting out of screws was observed in 25 cases (6.8%). In cases of secondary loss of fixation a mean of 6.7 screws were used to fix the fracture (vs 6.6, P=0.425). There was neither significant correlation between position of screws and the occurrence of postoperative loss of fixation in Spearman correlation nor relationship from backward logistic regression analysis. Loss of fixation following locked plating of proximal humeral fractures does not relate to the number of screws and their positions in the humeral head. In consequence, anatomic fracture reduction and restoration of the humeral head-shaft angle are still important factors and should not be disregarded. PMID:25002940

  8. Biplane double-supported screw fixation (F-technique): a method of screw fixation at osteoporotic fractures of the femoral neck.

    PubMed

    Filipov, Orlin

    2011-10-01

    The present work introduces a method of screw fixation of femoral neck fractures in the presence of osteoporosis, according to an original concept of the establishment of two supporting points for the implants and their biplane positioning in the femoral neck and head. The provision of two steady supporting points for the implants and the highly increased (obtuse) angle at which they are positioned allow the body weight to be transferred successfully from the head fragment onto the diaphysis, thanks to the strength of the screws, with the patient's bone quality being of least importance. The position of the screws allows them to slide under stress with a minimal risk of displacement. The method was developed in search of a solution for those patients for whom primary arthroplasty is contraindicated. The method has been analysed in relation to biomechanics and statics. For the first time, a new function is applied to a screw fixation-the implant is presented as a simple beam with an overhanging end.

  9. Biomechanics of bone-fracture fixation by stiffness-graded plates in comparison with stainless-steel plates

    PubMed Central

    Ganesh, VK; Ramakrishna, K; Ghista, Dhanjoo N

    2005-01-01

    Background 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 of the layer of the bone underneath the plate can cause osteoporosis and decrease in tensile strength of this layer. Method In order to address this problem, we propose to use stiffness-graded plates. Accordingly, we have computed (by finite-element analysis) the stress distribution in the fractured bone fixed by composite plates, whose stiffness is graded both longitudinally and transversely. Results It can be seen that the stiffness-graded composite-plates cause less stress-shielding (as an example: at 50% of the healing stage, stress at the fracture interface is compressive in nature i.e. 0.002 GPa for stainless steel plate whereas stiffness graded plates provides tensile stress of 0.002 GPa. This means that stiffness graded plate is allowing the 50% healed bone to participate in loadings). Stiffness-graded plates are more flexible, and hence permit more bending of the fractured bone. This results in higher compressive stresses induced at the fractured faces accelerate bone-healing. On the other hand, away from the fracture interface the reduced stiffness and elastic modulus of the plate causes the neutral axis of the composite structure to be lowered into the bone resulting in the higher tensile stress in the bone-layer underneath the plate, wherein is conducive to the bone preserving its tensile strength. Conclusion Stiffness graded plates (with in-built variable stiffness) are deemed to offer less stress-shielding to the bone, providing higher compressive stress at the fractured interface (to induce accelerated healing) as well as higher tensile

  10. Osteosynthesis of ununited femoral neck fracture by internal fixation combined with iliac crest bone chips and muscle pedicle bone grafting

    PubMed Central

    Baksi, D D; Pal, A K; Baksi, D P

    2016-01-01

    Background: Ununited femoral neck fracture is seen commonly in developing countries due to delayed presentation or failure of primary internal fixation. Such fractures, commonly present with partial or total absorption of femoral neck, osteonecrosis of femoral head in 8–30% cases with upward migration of trochanter posing problem for osteosynthesis, especially in younger individuals. Several techniques for treatment of such conditions are described like osteotomies or nonvascularied cortical or cancellous bone grafting provided varying degrees of success in terms of fracture union but unsatisfactory long term results occurred due to varying incidence of avascular necrosis (AVN) of femoral head. Moreover, in presence of AVN of femoral head neither free fibular graft nor cancellous bone graft is satisfactory. The vascularied bone grafting by deep circumflex iliac artery based on iliac crest bone grafting, free vascularied fibular grafting and muscle pedicle periosteal grafting showed high incidence of success rate. Osteosynthesis is the preferred treatment of choice in ununited femoral neck fracture in younger individuals. Materials and Methods: Of the 293 patients operated during the period from June 1977 to June 2009, 42 were lost to followup. Seven patients with gluteus medius muscle pedicle bone grafting (MPBG) were excluded. Thus, out of 244 patients, 208 (85.3%) untreated nonunion and 36 (14.7%) following failure of primary internal fixation were available for studies. Time interval between the date of injury and operation in untreated nonunion cases was mean 6.5 months and in failed internal fixation cases was mean 11.2 months. Ages of the patients varied from 16 to 55 years. Seventy patients had partial and 174 had subtotal absorption of the femoral neck. Evidence of avascular necrosis (AVN) femoral head was found histologically in 135 (54.3%) and radiologically in 48 (19.7%) patients. The patients were operated by open reduction of fracture, cannulated hip

  11. A comparative study of internal fixation and prosthesis replacement for radial head fractures of Mason type III.

    PubMed

    Ruan, Hong-Jiang; Fan, Cun-Yi; Liu, Jun-Jian; Zeng, Bing-Fang

    2009-02-01

    Although several treatment options for radial head fractures are available, no clear solutions exist. In this study we therefore compare open reduction and internal fixation (ORIF) with bipolar radial head prosthesis replacement in treatment of radial head fractures of Mason type III. Cement stem and bipolar radial prosthesis were used to treat 12 fresh cases and two old cases of Mason type III radial head fracture. As a control group, another eight cases of radial head type III fracture were treated with ORIF with cannulated screws and Kirschner (K) wires. The 14 patients who received radial head prosthesis replacement were followed-up for 15.9 months (range 10-27 months). According to elbow functional evaluation criteria by Broberg and Morrey, we found excellent results in nine cases, good in four, and fair in one. Mean follow-up of the eight cases in the ORIF group was 14 months (range 10-21 months), with good results in one case, fair in four, and poor in three. The result was good or excellent in 92.9% of prosthesis replacement patients and in 12.5% of ORIF patients. This difference is statistically significant (P = 0.0004; Fisher's exact test). We concluded that bipolar radial head prosthesis replacement is better than ORIF in treatment of Mason type III radial head fracture. PMID:17938924

  12. Fixation of 3- and 4-part proximal humerus fractures using the PHILOS plate: mid-term results.

    PubMed

    Gaheer, Rajinder Singh; Hawkins, Amanda

    2010-09-07

    Treatment of unstable, displaced, and comminuted fractures of the proximal humerus remains challenging, and optimal treatment continues to be controversial. Fifty-six patients with displaced 3- and 4-part fractures of the proximal humerus had open reduction and internal fixation using the proximal humeral internal locking system (PHILOS) plate (Synthes, Stratec Medical Ltd, Mezzovico, Switzerland). Data were collected retrospectively, and clinical and radiological outcomes were assessed. Mean follow-up was 40 months (range, 18-62 months). The study shows that the PHILOS plate gives good results in the treatment of displaced 3- and 4-part fractures of the proximal humerus. Good fracture stability can be achieved early, allowing early mobilization without compromising fracture union. Most importantly, it requires minimal soft tissue dissection, does not need contouring, and gives good stability. No differences were observed in the functional outcomes of patients younger and older than 65 years. Few complications were associated with the plate, and the number of ≥2 surgeries was minimal. The complications noted were 1 case each of superficial wound infection, failure of the plate, and persistent stiffness. One patient had screw perforation of the humeral head articular surface, and 1 had subacromial impingement. Of the 32 patients who had been in active employment before the injury, 28 returned to their previous occupation.

  13. Biomechanical Comparison of Two Kinds of Internal Fixation in a Type C Zone II Pelvic Fracture Model

    PubMed Central

    Wu, Tao; Chen, Wei; Zhang, Qi; Zheng, Zhan-Le; Lyu, Hong-Zhi; Cui, Yun-Wei; Cheng, Xiao-Dong; Zhang, Ying-Ze; Yang, Yan-Jiang

    2015-01-01

    Background: Unstable pelvic fractures are complex and serious injuries. Selection of a fixation method for these fractures remains a challenging problem for orthopedic surgeons. This study aimed to compare the stability of Tile C pelvic fractures fixed with two iliosacral (IS) screws and minimally invasive adjustable plate (MIAP) combined with one IS screw. Methods: This study was a biomechanical experiment. Six embalmed specimens of the adult pelvis were used. The soft tissue was removed from the specimens, and the spines from the fourth lumbar vertebra to the proximal one-third of both femurs were retained. The pubic symphysis, bilateral sacroiliac joints and ligaments, bilateral hip joints, bilateral sacrotuberous ligaments, and bilateral sacrospinous ligaments were intact. Tile C pelvic fractures were made on the specimens. The symphysis pubis was fixed with a plate, and the fracture on the posterior pelvic ring was fixed with two kinds of internal fixation in turn. The specimens were placed in a biomechanical machine at a standing neutral posture. A cyclic vertical load of up to 500 N was applied, and displacement was recorded. Shifts in the fracture gap were measured by a grating displacement sensor. Statistical analysis used: Paired-samples t-test. Results: Under the vertical load of 100, 200, 300, 400, and 500 N, the average displacement of the specimens fixed with MIAP combined with one IS screw was 0.46, 0.735, 1.377, 1.823, and 2.215 mm, respectively, which was significantly lower than that of specimens fixed with two IS screws under corresponding load (P < 0.05). Under the vertical load of 500 N, the shift in the fracture gap of specimens fixed with MIAP combined with one IS screw was 0.261 ± 0.095 mm, and that of specimens fixed with two IS screws was 0.809 ± 0.170 mm. The difference was significant (P < 0.05). Conclusion: The stability of Tile C pelvic fractures fixed with MIAP combined with one IS screw was better than that fixed with two IS screws

  14. Reverse shoulder prosthesis as revision surgery after fractures of the proximal humerus, treated initially by internal fixation or hemiarthroplasty.

    PubMed

    Lollino, Nicola; Paladini, Paolo; Campi, Fabrizio; Merolla, Giovanni; Rossi, Paolo; Porcellini, Giuseppe

    2009-04-01

    Complex (3-4 fragments) fractures of the proximal humerus often have a bad outcome, whatever treatment is performed. When revision surgery is required, reverse shoulder prosthesis can improve function and reduce pain in these patients. We analysed whether the choice of the first treatment (hemiarthroplasty vs. reduction and fixation) can influence the outcome of revision surgery. Our data demonstrate that results are not significantly dependent on the choice of the first implant, even though there is a tendency for patients with previous hemiarthroplasty to have a worse outcome. PMID:19711168

  15. Finite element analysis of patient-specific condyle fracture plates: a preliminary study.

    PubMed

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

    2015-06-01

    Various patterns of internal fixation of mandibular condyle fractures have been proposed in the literature. This study investigates the stability of two patient-specific implants (PSIs) for the open reduction and internal fixation of a subcondylar fracture of the mandible. A subcondylar fracture of a mandible was simulated by a series of finite element models. These models contained approximately 1.2 million elements, were heterogeneous in bone material properties, and also modeled the muscles of mastication. Models were run assuming linear elasticity and isotropic material properties for bone. The stability and von Mises stresses of the simulated condylar fracture reduced with each of the PSIs were compared. The most stable of the plate configurations examined was PSI 1, which had comparable mechanical performance to a single 2.0 mm straight four-hole plate. PMID:26000081

  16. Possibility of Fixation of a Distal Radius Fracture With a Volar Locking Plate Through a 10 mm Approach.

    PubMed

    Naito, Kiyohito; Zemirline, Ahmed; Sugiyama, Yoichi; Obata, Hiroyuki; Liverneaux, Philippe; Kaneko, Kazuo

    2016-06-01

    The management of distal radius fractures has dramatically improved due to the development of a locking plate system. In addition, mini-invasive surgery has been performed in a lot of surgical fields in recent years. The aim of the present study is to investigate the possibility of fixation of a distal radius fracture with a volar locking plate through a 10 mm approach. Eighteen patients with distal radius fracture (mean age: 66 y; range, 28 to 88 y; 8 males and 10 females) were operated on using a volar locking plate. The incision for plating was always 10 mm long. The clinical, cosmetic, and radiologic outcomes were investigated. At 3 months' follow-up, the range of motion of the wrist joint was 67.5 degrees in flexion, 65.6 degrees in extension, 88.3 degrees in pronation, and 88.3 degrees in supination. The % grip strength compared to the healthy side ranged from 35% to 100%. The VAS, Q-DASH, and modified Mayo scores were 0.7, 8.5, and 93.3, respectively (excellent in all 18 patients). Bone union was achieved on plain x-ray radiography and cosmetic problems were satisfied in all patients. Our results suggest that it is possible to achieve fixation of a distal radius fracture with a volar locking plate through a 10 mm approach. However, its applicability to surgery must be carefully examined. If any difficulties in plate installation or approach occur during this intervention, it will be necessary to consider switching to a conventional approach. We believe that surgeons must not adhere to a mini-invasive approach. PMID:27015408

  17. Comparison of Surgical Outcomes Between Short-Segment Open and Percutaneous Pedicle Screw Fixation Techniques for Thoracolumbar Fractures.

    PubMed

    Fu, Zhiguo; Zhang, Xi; Shi, Yaohua; Dong, Qirong

    2016-01-01

    BACKGROUND This study aimed to compare the surgical outcomes between open pedicle screw fixation (OPSF) and percutaneous pedicle screw fixation (PPSF) for the treatment of thoracolumbar fractures, which has received scant research attention to date. MATERIAL AND METHODS Eight-four patients with acute and subacute thoracolumbar fractures who were treated with SSPSF from January 2013 to June 2014 at the Changzhou Hospital of Traditional Chinese Medicine (Changzhou, China) were retrospectively reviewed. The patients were divided into 4 groups: the OPSF with 4 basic screws (OPSF-4) group, the OPSF with 4 basic and 2 additional screws (OPSF-6) group, the PPSF with 4 basic screws (PPSF-4) group, and the PPSF with 4 basic and 2 additional screws (PPSF-6) group. The intraoperative, immediate postoperative, and over 1-year follow-up outcomes were evaluated and compared among these groups. RESULTS Blood loss in the PPSF-4 group and the PPSF-6 group was significantly less than in the OPSF-4 group and the OPSF-6 group (P<0.05). The OPSF-6 group exhibited significantly higher immediate postoperative correction percentage of anterior column height of fractured vertebra than the other 3 groups (P<0.05), and higher correction of sagittal regional Cobb angle and kyphotic angle of injured vertebra than in the PPSF-4 and -6 groups (P<0.05). In addition, there was no significant difference in the correction loss of percentage of anterior column height, and loss of sagittal Cobb angle and kyphotic angle of fractured vertebrae at final follow-up among the 4 groups (P>0.05). CONCLUSIONS OPSF with 6 screws had an advantage in the correction of injured vertebral height and kyphosis, and PPSF reduced the intraoperative blood loss of patients. PMID:27602557

  18. Comparison of Surgical Outcomes Between Short-Segment Open and Percutaneous Pedicle Screw Fixation Techniques for Thoracolumbar Fractures

    PubMed Central

    Fu, Zhiguo; Zhang, Xi; Shi, Yaohua; Dong, Qirong

    2016-01-01

    Background This study aimed to compare the surgical outcomes between open pedicle screw fixation (OPSF) and percutaneous pedicle screw fixation (PPSF) for the treatment of thoracolumbar fractures, which has received scant research attention to date. Material/Methods Eight-four patients with acute and subacute thoracolumbar fractures who were treated with SSPSF from January 2013 to June 2014 at the Changzhou Hospital of Traditional Chinese Medicine (Changzhou, China) were retrospectively reviewed. The patients were divided into 4 groups: the OPSF with 4 basic screws (OPSF-4) group, the OPSF with 4 basic and 2 additional screws (OPSF-6) group, the PPSF with 4 basic screws (PPSF-4) group, and the PPSF with 4 basic and 2 additional screws (PPSF-6) group. The intraoperative, immediate postoperative, and over 1-year follow-up outcomes were evaluated and compared among these groups. Results Blood loss in the PPSF-4 group and the PPSF-6 group was significantly less than in the OPSF-4 group and the OPSF-6 group (P<0.05). The OPSF-6 group exhibited significantly higher immediate postoperative correction percentage of anterior column height of fractured vertebra than the other 3 groups (P<0.05), and higher correction of sagittal regional Cobb angle and kyphotic angle of injured vertebra than in the PPSF-4 and -6 groups (P<0.05). In addition, there was no significant difference in the correction loss of percentage of anterior column height, and loss of sagittal Cobb angle and kyphotic angle of fractured vertebrae at final follow-up among the 4 groups (P>0.05). Conclusions OPSF with 6 screws had an advantage in the correction of injured vertebral height and kyphosis, and PPSF reduced the intraoperative blood loss of patients. PMID:27602557

  19. Clinical Evaluation of an Unsintered Hydroxyapatite/Poly-L-Lactide Osteoconductive Composite Device for the Internal Fixation of Maxillofacial Fractures

    PubMed Central

    Sukegawa, Shintaro; Kanno, Takahiro; Katase, Naoki; Shibata, Akane; Takahashi, Yuka; Furuki, Yoshihiko

    2016-01-01

    Introduction: OSTEOTRANS MX (Takiron Co, Ltd, Osaka, Japan) is a resorbable osteosynthetic material composed of an unsintered hydroxyapatite/poly-l-lactide composite, and its osteoconductive capacity has been documented. The authors here report their clinical experience using OSTEOTRANS MX. Methods: The authors treated 35 patients (19 men, 16 women; age, 14–88 years; mean ± standard deviation, 38.4 ± 19.9 years) with maxillofacial fractures. The authors used standard surgery to stabilize fractures in all patients, fitting resorbable plates (thickness, 1.0 or 1.4 mm) and screws (diameter, 2 mm) according to Arbeitsgemeinschaft für Osteosynthesefragen/Association (AO) for the Study of Internal Fixation guidelines. Results: All patients eventually achieved satisfactory healing with favorable restoration of form and function without foreign body reaction. Complications occurred in 3 patients—plate exposure in 2 and discomfort in 1. However, fracture sites healed in all patients. Scanning electron microscopy revealed that the devices bonded directly to the bone without interposition of nonmineralized tissue. Conclusion: OSTEOTRANS MX is a useful material with few complications. Its osteoconductive bioactivity is advantageous for the early functional improvement of maxillofacial fractures. PMID:27428913

  20. Clinical results of using the proximal humeral internal locking system plate for internal fixation of displaced proximal humeral fractures.

    PubMed

    Norouzi, Masoud; Naderi, Mohammad Nasir; Komasi, Mehdi Hemmati; Sharifzadeh, Seyyed Reza; Shahrezaei, Mostafa; Eajazi, Alireza

    2012-05-01

    Proximal humerus fractures are accounting for 4-5% of all fractures with increasing incidence. Proximal Humeral Internal Locking System (PHILOS) plate is a new plate which permits early mobility and lowers the risk of complications. The aim of this study was to evaluate the functional outcome and the complication rate after using this plate. Between 2006-2008, 37 patients with displaced 2-, 3-, and 4-part fractures of the proximal humerus underwent surgery using PHILOS plate. The mean range of follow-up was 12 months. Twenty patients were aged 60 years and younger, and 17 were aged older than 60 years. The average American Shoulder and Elbow Surgeons (ASES) score at the final follow-up was 77.62. According to Michener and colleagues classification, 5.4% of patients had an excellent outcome, 72.9% were minimally functionally limited, 16.2% were moderately functionally limited, and 5.4% were maximally functionally limited. The average ASES score between patients 60 years and older and those 60 years and younger was not different significantly. One patient developed avascular necrosis of the humeral head, 2 patients developed an infection, and no patients developed a nonunion. Fixation with PHILOS plate can be considered a good method with high union rates for this kind of fracture, especially in the older population with osteoporotic bone.

  1. Femoral neck-shaft angle in extra-capsular proximal femoral fracture fixation; does it make a TAD of difference?

    PubMed

    Walton, N P; Wynn-Jones, H; Ward, M S; Wimhurst, J A

    2005-11-01

    The effect of femoral neck-shaft angle and implant type on the accuracy of lag screw placement in extra-capsular proximal femoral fracture fixation was investigated. Radiographs of all extra-capsular proximal femoral fractures seen in one unit over 18 months were reviewed. Of 399 cases, 307 (237 female, 70 male) were included in the study as they had no contra-lateral proximal femoral metal work. Femoral neck-shaft angle (NSA) of the uninjured hip and magnification adjusted tip-apex distance (TAD) of femoral head lag screw were measured. Type of fixation implant was 135 degrees classic hip screw (CHS) (n=144) or 130 degrees intra-medullary hip screw (IMHS) (n=163). Mean contra-lateral NSA was 130.2 degrees (112.9--148 degrees ) and 64 patients (58 female, 6 male) had a NSA <125 degrees . Mean adjusted TAD was 18.7 mm (5.8--43.8mm) and 88.9% of cases had a TAD of less than 25 mm. TAD values were significantly greater using an IMHS if NSA was <125 degrees than if NSA was >125 degrees (p=0.028). This was not the case with the CHS. The use of the 130 degrees -IMHS in patients with a NSA <125 degrees leads to poorer lag screw placement than if NSA >125 degrees and caution is advocated when using this device in such cases.

  2. Conceptual finite element study for comparison among superior, anterior, and spiral clavicle plate fixations for midshaft clavicle fracture.

    PubMed

    Huang, Teng-Le; Chen, Wen-Chuan; Lin, Kun-Jhih; Tsai, Cheng-Lun; Lin, Kang-Ping; Wei, Hung-Wen

    2016-10-01

    Open reduction internal fixation technique has been generally accepted for treatment of midshaft clavicle fractures. Both superior and anterior clavicle plates have been reported in clinical or biomechanical researches, while presently the spiral clavicle plate design has been introduced improved biomechanical behavior over conventional designs. In order to objectively realize the multi-directional biomechanical performances among the three geometries for clavicle plate designs, a current conceptual finite element study has been conducted with identical cross-sectional features for clavicle plates. The conceptual superior, anterior, and spiral clavicle plate models were constructed for virtual reduction and fixation to an OTA 15-B1.3 midshaft transverse fracture of clavicle. Mechanical load cases including cantilever bending, axial compression, inferior bending, and axial torsion have been applied for confirming the multi-directional structural stability and implant safety in biomechanical perspective. Results revealed that the anterior clavicle plate model represented lowest plate stress under all loading cases. The superior clavicle plate model showed greater axial compressive stiffness, while the anterior clavicle plate model performed greater rigidity under cantilever bending load. Three model represented similar structural stiffness under axial torsion. Played as a transition structure between superior and anterior clavicle plate, the spiral clavicle plate model revealed comparable results with acceptable multi-directional biomechanical behavior. The concept of spiral clavicle plate design is worth considering in practical application in clinics. Implant safety should be further investigated by evidences in future mechanical tests and clinical observations. PMID:27423702

  3. A comparative study on the in vivo degradation of poly(L-lactide) based composite implants for bone fracture fixation

    PubMed Central

    Wang, Zongliang; Wang, Yu; Ito, Yoshihiro; Zhang, Peibiao; Chen, Xuesi

    2016-01-01

    Composite of nano-hydroxyapatite (n-HAP) surface grafted with poly(L-lactide) (PLLA) (g-HAP) showed improved interface compatibility and mechanical property for bone fracture fixation. In this paper, in vivo degradation of n-HAP/PLLA and g-HAP/PLLA composite implants was investigated. The mechanical properties, molecular weight, thermal properties as well as crystallinity of the implants were measured. The bending strength of the n- and g-HAP/PLLA composites showed a marked reduction from an initial value of 102 and 114 MPa to 33 and 24 MPa at 36 weeks, respectively. While the bending strength of PLLA was maintained at 80 MPa at 36 weeks compared with initial value of 107 MPa. The impact strength increased over time especially for the composites. Significant differences in the molecular weight were seen among all the materials and g-HAP/PLLA appeared the fastest rate of decrease than others. Environmental scanning electron microscope (ESEM) results demonstrated that an apparently porous morphology full of pores and hollows were formed in the composites. The results indicated that the in vivo degradation of PLLA could be accelerated by the g-HAP nanoparticles. It implied that g-HAP/PLLA composites might be a candidate for human non-load bearing bone fracture fixation which needs high initial strength and fast degradation rate. PMID:26857951

  4. Comparison of treatment of unstable intra articular fractures of distal radius with locking plate versus non-locking plate fixation

    PubMed Central

    Kumar, Sunil; Chopra, R.K.; Sehrawat, Sunil; Lakra, Akshay

    2014-01-01

    Introduction Unstable intra articular fractures of distal radius are frequently being managed with open reduction and internal fixation. Of late in some biomechanical studies locking plates have been shown to be better in terms of maintenance of radiological parameters in comparison to non-locking plates. We conducted this study to know whether this biomechanical superiority of locking plates is converted in to better clinical outcomes. Materials and methods A study was conducted in 60 patients (30 in each group) with unstable intra articular fractures of distal radius who were treated by open reduction and internal fixation with locking plates and non-locking plates. Patients were evaluated for radiological parameters (intra articular step off, radial height, radial tilt, volar tilt) and functional parameters (flexion, extension, radial deviation, ulnar deviation, pronation, supination grip strength) at two year follow up. Overall outcome was evaluated by scoring systems of Gartland and Werley and modified Green O' Brien. Results The change in radiological parameters from immediate post op to latest at two year in locking plate group was not significant for radial height, radial tilt, volar tilt, but ulnar variance whereas in non-locking plate there was significant change in radial height, volar tilt, ulnar variance but no significant change in radial inclination. In clinical and functional outcome no significant difference was found at two year follow up. Conclusions Locking plates maintain the radiological parameters better than non-locking plates but functional outcome are same for both plates at two year after surgery. PMID:25983474

  5. A comparative study on the in vivo degradation of poly(L-lactide) based composite implants for bone fracture fixation

    NASA Astrophysics Data System (ADS)

    Wang, Zongliang; Wang, Yu; Ito, Yoshihiro; Zhang, Peibiao; Chen, Xuesi

    2016-02-01

    Composite of nano-hydroxyapatite (n-HAP) surface grafted with poly(L-lactide) (PLLA) (g-HAP) showed improved interface compatibility and mechanical property for bone fracture fixation. In this paper, in vivo degradation of n-HAP/PLLA and g-HAP/PLLA composite implants was investigated. The mechanical properties, molecular weight, thermal properties as well as crystallinity of the implants were measured. The bending strength of the n- and g-HAP/PLLA composites showed a marked reduction from an initial value of 102 and 114 MPa to 33 and 24 MPa at 36 weeks, respectively. While the bending strength of PLLA was maintained at 80 MPa at 36 weeks compared with initial value of 107 MPa. The impact strength increased over time especially for the composites. Significant differences in the molecular weight were seen among all the materials and g-HAP/PLLA appeared the fastest rate of decrease than others. Environmental scanning electron microscope (ESEM) results demonstrated that an apparently porous morphology full of pores and hollows were formed in the composites. The results indicated that the in vivo degradation of PLLA could be accelerated by the g-HAP nanoparticles. It implied that g-HAP/PLLA composites might be a candidate for human non-load bearing bone fracture fixation which needs high initial strength and fast degradation rate.

  6. Influence of internal fixator flexibility on murine fracture healing as characterized by mechanical testing and microCT imaging.

    PubMed

    Steck, Roland; Ueno, Masaki; Gregory, Laura; Rijken, Noortje; Wullschleger, Martin E; Itoman, Moritoshi; Schuetz, Michael A

    2011-08-01

    Mechanically well-defined stabilization systems have only recently become available, providing standardized conditions for studying the role of the mechanical environment on mouse bone fracture healing. The aim of this study was to characterize the time course of strength recovery and callus development of mouse femoral osteotomies stabilized with either low or high flexibility (in bending and torsion) internal fixation plates. Animals were euthanized and femora excised at 14, 21, and 28 days post-osteotomy for microCT analysis and torsional strength testing. While a larger mineralized callus was observed in osteotomies under more flexible conditions at all time points, the earlier bridging of the mineralized callus under less flexible conditions by 1 week resulted in an earlier recovery of torsional strength in mice stabilized with low flexibility fixation. Ultimate torque values for these bones were significantly higher at 14 and 21 days post-osteotomy compared to bones with the more flexible stabilization. Our study confirms the high reproducibility of the results that are achieved with this new implant system, therefore making it ideal for studying the influence of the mechanical environment on murine fracture healing under highly standardized conditions.

  7. Correlation Between Residual Displacement and Osteonecrosis of the Femoral Head Following Cannulated Screw Fixation of Femoral Neck Fractures

    PubMed Central

    Wang, Chen; Xu, Gui-Jun; Han, Zhe; Jiang, Xuan; Zhang, Cheng-Bao; Dong, Qiang; Ma, Jian-Xiong; Ma, Xin-Long

    2015-01-01

    Abstract The aim of the study was to introduce a new method for measuring the residual displacement of the femoral head after internal fixation and explore the relationship between residual displacement and osteonecrosis with femoral head, and to evaluate the risk factors associated with osteonecrosis of the femoral head in patients with femoral neck fractures treated by closed reduction and percutaneous cannulated screw fixation. One hundred and fifty patients who sustained intracapsular femoral neck fractures between January 2011 and April 2013 were enrolled in the study. All were treated with closed reduction and percutaneous cannulated screw internal fixation. The residual displacement of the femoral head after surgery was measured by 3-dimensional reconstruction that evaluated the quality of the reduction. Other data that might affect prognosis were also obtained from outpatient follow-up, telephone calls, or case reviews. Multivariate logistic regression analysis was applied to assess the intrinsic relationship between the risk factors and the osteonecrosis of the femoral head. Osteonecrosis of the femoral head occurred in 27 patients (18%). Significant differences were observed regarding the residual displacement of the femoral head and the preoperative Garden classification. Moreover, we found more or less residual displacement of femoral head in all patients with high quality of reduction based on x-ray by the new technique. There was a close relationship between residual displacement and ONFH. There exists limitation to evaluate the quality of reduction by x-ray. Three-dimensional reconstruction and digital measurement, as a new method, is a more accurate method to assess the quality of reduction. Residual displacement of the femoral head and the preoperative Garden classification were risk factors for osteonecrosis of the femoral head. High-quality reduction was necessary to avoid complications. PMID:26632739

  8. The Use of the S-Quattro Dynamic External Fixator for the Treatment of Intra-Articular Phalangeal Fractures: A Review of the Literature

    PubMed Central

    Bhamra, J.S; Khan, W.S; Pastides, P

    2012-01-01

    Intra-articular phalangeal fractures are a common injury. If left untreated, these injuries can lead to poor functional outcome with severe dehabilitating consequences, especially in younger patients. The S-Quattro external fixator device (Surgicraft®, UK) can be used to treat such injuries. Its use has been widely documented and has shown many advantages in comparison to other conventional treatments. Advantages include reduced operative time, rigid fixation and early range of motion. We present a review of the current literature and use of the S-Quattro serpentine system in the management of intraarticular phalangeal fractures. PMID:22431950

  9. [Operative treatment of pediatric open fractures of the lower limb using the Taylor spatial frame fixator].

    PubMed

    Gessmann, J; Baecker, H; Graf, M; Ozokyay, L; Muhr, G; Seybold, D

    2010-05-01

    The operative management of open fractures of the lower limb requires a consistent treatment to avoid soft tissue complications. Acute angular shortening of the fracture enabling primary soft tissue closure is still an uncommon operative technique because of difficulties in correcting the secondary deformity. The case of a pediatric open fracture of the lower limb (Gustilo type IIIa) is described, which was treated with acute angular shortening followed by gradual correction using the Taylor spatial frame (TSF).

  10. No Higher Risk of CRPS After External Fixation of Distal Radial Fractures – Subgroup Analysis Under Randomised Vitamin C Prophylaxis§

    PubMed Central

    Zollinger, Paul E.; Kreis, Robert W.; van der Meulen, Hub G.; van der Elst, Maarten; Breederveld, Roelf S.; Tuinebreijer, Wim E.

    2010-01-01

    Operative and conservative treatment of wrist fractures might lead to complex regional pain syndrome (CRPS) type I. In our multicenter dose response study in which patients with distal radial fractures were randomly allocated to placebo or vitamin C in a daily dose of 200mg, 500mg or 1500mg during 50 days, an operated subgroup was analyzed. 48 (of 427) fractures) were operated (11.2%). Twenty-nine patients (60%) were treated with external fixation, 14 patients (29%) with K-wiring according to Kapandji and five patients (10%) with internal plate fixation. The 379 remaining patients were treated with a plaster. In the operated group of patients who received vitamin C no CRPS (0/37) was seen in comparison with one case of CRPS (Kapandji technique) in the operated group who received placebo (1/11 = 9%, p=.23). There was no CRPS after external fixation. In the conservatively treated group 17 cases of CRPS (17/379 = 4.5%) occurred in comparison with one in case of CRPS in the operated group (1/48 = 2.1%, p=.71). External fixation doesn’t necessarily lead to a higher incidence of CRPS in distal radial fractures. Vitamin C may also play a role in this. This subgroup analysis in operated distal radial fractures showed no CRPS occurrence with vitamin C prophylaxis. PMID:20309405

  11. Flexible intramedullary nailing had better outcomes than kirschner wire fixation in children with distal humeral metaphyseal-diaphyseal junction fracture: a retrospective observational analysis

    PubMed Central

    Ge, Yi-Hua; Wang, Zhi-Gang; Cai, Hai-Qing; Yang, Jie; Xu, Yun-Lan; Li, Yu-Chan

    2014-01-01

    The effectiveness evaluation of flexible intramedullary nailing (FIN) and kirschner wire fixation (K-wire) used for MDJ fractures fixation have been described in multiple reports. But there have been few reports about comparison between FIN and K-wire in children with distal humeral MDJ fracture. In our retrospective study, Nineteen children received K-wire and twenty children received FIN, during the follow-up, six children in the K-wire group and one children in the FIN group was found to have postoperative cubitus varus; fixation method was an independent risk factor for postoperative cubitus varus (P = 0.001), fixation methods contributed significantly to operation time (t = 6.519, P < 0.001), surgical blood loss (t = 5.349, P < 0.001) and postoperative fracture healing time (t = 4.940, P < 0.001). We can conclude that FIN was related with lower incidence of postoperative cubitus varus, shorter operation time, less surgical blood loss and shorter fracture healing time compared to K-wire in children with MDJ fractures of the distal humerus. PMID:25419399

  12. CYR61 (CCN1) protein expression during fracture healing in an ovine tibial model and its relation to the mechanical fixation stability.

    PubMed

    Lienau, Jasmin; Schell, Hanna; Epari, Devakara R; Schütze, Norbert; Jakob, Franz; Duda, Georg N; Bail, Hermann J

    2006-02-01

    The formation of new blood vessels is a prerequisite for bone healing. CYR61 (CCN1), an extracellular matrix-associated signaling protein, is a potent stimulator of angiogenesis and mesenchymal stem cell expansion and differentiation. A recent study showed that CYR61 is expressed during fracture healing and suggested that CYR61 plays a significant role in cartilage and bone formation. The hypothesis of the present study was that decreased fixation stability, which leads to a delay in healing, would lead to reduced CYR61 protein expression in fracture callus. The aim of the study was to quantitatively analyze CYR61 protein expression, vascularization, and tissue differentiation in the osteotomy gap and relate to the mechanical fixation stability during the course of healing. A mid-shaft osteotomy of the tibia was performed in two groups of sheep and stabilized with either a rigid or semirigid external fixator, each allowing different amounts of interfragmentary movement. The sheep were sacrificed at 2, 3, 6, and 9 weeks postoperatively. The tibiae were tested biomechanically and histological sections from the callus were analyzed immunohistochemically with regard to CYR61 protein expression and vascularization. Expression of CYR61 protein was upregulated at the early phase of fracture healing (2 weeks), decreasing over the healing time. Decreased fixation stability was associated with a reduced upregulation of the CYR61 protein expression and a reduced vascularization at 2 weeks leading to a slower healing. The maximum cartilage callus fraction in both groups was reached at 3 weeks. However, the semirigid fixator group showed a significantly lower CYR61 immunoreactivity in cartilage than the rigid fixator group at this time point. The fraction of cartilage in the semirigid fixator group was not replaced by bone as quickly as in the rigid fixator group leading to an inferior histological and mechanical callus quality at 6 weeks and therefore to a slower healing. The

  13. Closed antegrade intramedullary pinning for reduction and fixation of metatarsal fractures.

    PubMed

    Kim, Hyong-Nyun; Park, Yoo-Jung; Kim, Gab-Lae; Park, Yong-Wook

    2012-01-01

    The purpose of this study was to present the results of the metatarsal fractures treated with a closed antegrade intramedullary pinning technique. The records of 35 consecutive patients with metatarsal fractures operated on from August 2005 to June 2010 by the authors were retrospectively reviewed. Four patients were not contactable and 1 patient refused to participate. Accordingly, the study cohort was composed of 30 patients (24 male, 6 female) with 46 metatarsal head, neck, or shaft fractures. Inclusion criteria were metatarsal head, neck, or shaft fractures with a displacement of more than 3 to 4 mm or an angulation of more than 10° in the sagittal plane. Fractures combined with Lisfranc injury or metatarsal base fractures were excluded, as were bicortical comminuted fractures or long oblique fractures. Times to bone union, limitations of motion at affected metatarsophalangeal joints, and residual pain were evaluated at 6 weeks after surgery and at final follow-up. American Orthropedic Foot and Ankle Society scale was evaluated at final follow-up. Fracture union was obtained at an average of 7.1 (range 6 to 10) weeks. Two patients had moderate limitation of metatarsophalangeal joint at 6 weeks but recovered to full range at final follow-up. Average American Orthropedic Foot and Ankle Society score at final follow-up was 96.7 (range 83 to 100) points. Closed antegrade intramedullary pinning was found to be a useful method for treating displaced metatarsal fractures and to allow immediate joint motion and partial weightbearing in a stiff-soled shoe.

  14. Antimicrobial prophylaxis in open reduction and internal fixation of compound mandibular fractures: a collaborative regional audit of outcome.

    PubMed

    Singh, Rabindra P; Carter, Lachlan M; Whitfield, Paul H

    2013-07-01

    We conducted a regional 2-stage prospective audit involving 5 different maxillofacial units in the Yorkshire region of the UK to evaluate the effectiveness of perioperative antimicrobial prophylaxis in the treatment of mandibular fractures. In the first stage (145 patients) we surveyed current practice concerning antimicrobial prophylaxis and found out the current infection rate after open reduction and internal fixation (ORIF) of mandibular fractures. In the second stage (157 patients) we implemented a common antimicrobial protocol in all units and recorded the infection rates using the new regimen. In the first stage a wide range of antimicrobial prophylaxis was used in different units. The agreed perioperative antimicrobial protocol in the second stage was to begin amoxicillin or clarithromycin and metronidazole intravenously on admission and include 2 postoperative doses. The infection rates were 10.3% and 8.9%, respectively, and the difference between the two groups was not significant (χ(2)=0.051, df=1, p=0.83). The infection rate in the Yorkshire region was similar to results from other centres. We recommend short perioperative antimicrobial prophylaxis with a maximum of 2 postoperative doses after ORIF of mandibular fractures.

  15. Factors affecting the functional results of open reduction and internal fixation for fracture-dislocations of the proximal interphalangeal joint.

    PubMed

    Watanabe, Kentaro; Kino, Yoshitake; Yajima, Hiroki

    2015-01-01

    To clarify the factors affecting functional results of fracture-dislocations of the proximal interphalangeal (PIP) joint treated by open reduction and internal fixation (ORIF), 60 patients, including 38 patients with a dorsal fracture-dislocation and 22 with a pilon fracture, were analysed. The mean ratio of articular surface involvement was 48.5% and a depressed central fragment existed in 75.3% of the cases. ORIF was performed in 47 patients through a lateral approach using Kirschner wires and in 13 through a palmar approach using a plate or screws. The mean flexion, extension and range of motion (ROM) of the PIP joint was 89.5°, 11.5° and 78.0°, respectively. Stepwise regression analysis revealed that a delayed start of active motion exercise after surgery, elderly age and ulnar ray digit were factors affecting functional outcomes. Although ORIF allows accurate restoration of the articular surfaces, an early start of motion exercise is essential for good results.

  16. EVALUATION OF SURGICAL TREATMENT OF FRACTURES OF THORACOLUMBAR SPINE WITH THIRD-GENERATION MATERIAL FOR INTERNAL FIXATION

    PubMed Central

    Bortoletto, Adalberto; Rodrigues, Luiz Cláudio Lacerda; Matsumoto, Marcelo Hide

    2015-01-01

    Objective: To evaluate the functional results from patients with surgical fractures in the thoracolumbar spine. Method: A prospective study including 100 patients with spinal fractures in the thoracic and lumbar segments was conducted. The lesions were classified in accordance with the AO system, and the patients were treated surgically. The presence of early kyphosis and its evolution after the surgical intervention, and the presence of postoperative pain and its evolution up to the 24th week after the surgery, were evaluated. We compared our data with the literature. Results: One hundred surgical patients were analyzed, of which 37 were type A, 46 were type B and 17 were Type C. Patients who presented Frankel A kept their clinical status, but patients with Frankel B or higher evolved with some improvement. The average improvement in pain based on a visual analog scale was more than four points. All the patients were able to return to their daily routine activities, although we did not take the return to work to be an assessment criterion. Conclusion: Despite controversy regarding the indications for surgery in cases of fractured spine, we believe that the method that we used was satisfactory because of the good results and low complication rate. However, more randomized prospective studies with longer follow-up are needed in order to evaluate this type of fixation. PMID:27047822

  17. Comparison of nail-plate fixation and Ender's nailing for intertrochanteric fractures.

    PubMed

    Hall, G; Ainscow, D A

    1981-02-01

    Two comparable groups of patients with fractures of the trochanteric region of the femur were studied. One hundred and sixty-five fractures had been fixed with conventional nail-plates and 132 with Ender's nails. Ender's nails gave superior results in the treatment of trochanteric fractures. The operation was quicker and less traumatic than that using conventional nail-plates and both the mortality rate and the time in hospital were reduced. More patients in the group with Ender's nails who were initially independent returned to an independent existence.

  18. Biomechanical Evaluation of Interfragmentary Compression At Tibia Plateau Fractures In Vitro Using Different Fixation Techniques: A CONSORT-Compliant Article: Erratum.

    PubMed

    2015-02-01

    [In the article "Biomechanical Evaluation of Interfragmentary Compression At Tibia Plateau Fractures In Vitro Using Different Fixation Techniques: A CONSORT-compliant" article, which appeared in Volume 94, Issue 1 of Medicine, a line denoting dual authorship was omitted. K. Kojima and B. Gueorguiev contributed equally to the article.].

  19. Distal Radius Volar Rim Fracture Fixation Using DePuy-Synthes Volar Rim Plate.

    PubMed

    Kachooei, Amir Reza; Tarabochia, Matthew; Jupiter, Jesse B

    2016-03-01

    Background To assess the results of distal radius fractures with the involvement of the volar rim fixed with the DePuy-Synthes Volar Rim Plate. Case Description We searched for the patients with volar rim fracture and/or volar rim fractures as part of a complex fracture fixed with a volar rim plate. Ten patients met the inclusion criteria: three patients with type 23B3, six patients with type 23C, and one patient with very distal type 23A. The mean follow-up was 14 months (range: 2-26). Fractures healed in all patients. Of the three patients with isolated volar rim fractures (type 23B3), two patients had no detectable deficits in motion. These patients had an average Gartland and Werley score of 9 (range: 2-14). Of the other seven patients (six with type 23C and one with type 23A fracture), three patients healed with full range of motion and four had some deficits in range of motion. Two patients had excellent results, three had good results, and two had fair results using the Gartland and Werley categorical rating. One patient healed with a shortened radius and ulnar impingement requiring a second surgery for ulnar head resection arthroplasty. Literature Review Results after nonoperative treatment of volar rim fractures are not satisfactory and often require subsequent corrective osteotomy. Satisfactory outcomes are achieved when the fragments are well reduced and secured regardless of the device type. Clinical Relevance Volar rim plates give an adequate buttress of the volar radius distal to volar projection of the lunate facet and do not interfere with wrist mobility. Furthermore, the dorsal fragments can be fixed securely through the volar approach eliminating the need for a secondary posterior incision. However, patients should be informed of the potential problems and the need to remove the plate if symptoms develop.

  20. Fixation of sternal fracture using absorbable plating system, three years follow-up

    PubMed Central

    Katballe, Niels; Pilegaard, Hans

    2015-01-01

    Sternal fractures occur due to severe chest wall trauma in a small number of patients. They are often conservatively treated. The surgical intervention, although controversial, is indicated in case of deformity, severe pain, and ventilatory complications. We report the first case where absorbable plate has been used to fix a traumatic fracture in a 42-year-old female. After 3 years, the patient is still free of symptoms and CT scanning reveals intact sternal bone structure. PMID:26101659

  1. Vertebroplasty plus short segment pedicle screw fixation in a burst fracture model in cadaveric spines.

    PubMed

    Grossbach, Andrew J; Viljoen, Stephanus V; Hitchon, Patrick W; DeVries Watson, Nicole A; Grosland, Nicole M; Torner, James

    2015-05-01

    The current project investigates the role of vertebroplasty in supplementing short segment (SS) posterior instrumentation, only one level above and below a fracture. In the treatment of thoracolumbar burst fractures, long segment (LS) posterior instrumentation two levels above and below the fracture level has been used. In our study, burst fractures were produced at L1 in eight fresh frozen human cadaveric spines. The spines were then tested in three conditions: 1) intact, 2) after LS (T11-L3), 3) SS (T12-L2) instrumentation with pedicle screws and rods, and 4) short segment instrumentation plus cement augmentation of the fracture level (SSC). LS instrumentation was found to significantly reduce the motion at the instrumented level (T12-L2) as well as the levels immediately adjacent in flexion, extension and lateral bending. Similarly, SSC augmentation was found to significantly reduce the motion compared to intact at T12-L2 but still maintained the adjacent level motion. However, SS instrumentation alone did not significantly reduce the motion at T12-L2 except for left lateral bending. While LS instrumentation remains the most stable construct, SS instrumentation augmented with vertebroplasty at the fracture level increases rigidity in flexion, extension and right lateral bending beyond SS instrumentation alone. PMID:25769251

  2. A Simple Technique for the Positioning of a Patient with an above Knee Amputation for an Ipsilateral Extracapsular Hip Fracture Fixation

    PubMed Central

    Davarinos, N.; Ellanti, P.; McCoy, G.

    2013-01-01

    The positioning of the patient on the fracture table is critical to the successful reduction and operative fixation of hip fractures which are fixed using the dynamic hip screw system (DHS). There is a standard setup which is commonly used with relative ease. Yet the positioning of patients with amputations either above or below knee of the affected side can pose a significant challenge. We describe a novel positioning technique used on a 51-year old patient with a right above knee amputation who sustained an intertrochanteric extracapsular hip fracture. PMID:24416607

  3. Biomechanical properties of a structurally optimized carbon-fibre/epoxy intramedullary nail for femoral shaft fracture fixation.

    PubMed

    Samiezadeh, Saeid; Fawaz, Zouheir; Bougherara, Habiba

    2016-03-01

    Intramedullary nails are the golden treatment option for diaphyseal fractures. However, their high stiffness can shield the surrounding bone from the natural physiologic load resulting in subsequent bone loss. Their stiff structure can also delay union by reducing compressive loads at the fracture site, thereby inhibiting secondary bone healing. Composite intramedullary nails have recently been introduced to address these drawbacks. The purpose of this study is to evaluate the mechanical properties of a previously developed composite IM nail made of carbon-fibre/epoxy whose structure was optimized based on fracture healing requirements using the selective stress shielding approach. Following manufacturing, the cross-section of the composite nail was examined under an optical microscope to find the porosity of the structure. Mechanical properties of the proposed composite intramedullary nail were determined using standard tension, compression, bending, and torsion tests. The failed specimens were then examined to obtain the modes of failure. The material showed high strength in tension (403.9±7.8MPa), compression (316.9±10.9MPa), bending (405.3±8.1MPa), and torsion (328.5±7.3MPa). Comparing the flexural modulus (41.1±0.9GPa) with the compressive modulus (10.0±0.2GPa) yielded that the material was significantly more flexible in compression than in bending. This customized flexibility along with the high torsional stiffness of the nail (70.7±2.0Nm(2)) has made it ideal as a fracture fixation device since this unique structure can stabilize the fracture while allowing for compression of fracture ends. Negligible moisture absorption (~0.5%) and low porosity of the laminate structure (< 3%) are other advantages of the proposed structure. The findings suggested that the carbon-fibre/epoxy intramedullary nail is flexible axially while being relatively rigid in bending and torsion and is strong enough in all types of physiologic loading, making it a potential

  4. Biomechanical properties of a structurally optimized carbon-fibre/epoxy intramedullary nail for femoral shaft fracture fixation.

    PubMed

    Samiezadeh, Saeid; Fawaz, Zouheir; Bougherara, Habiba

    2016-03-01

    Intramedullary nails are the golden treatment option for diaphyseal fractures. However, their high stiffness can shield the surrounding bone from the natural physiologic load resulting in subsequent bone loss. Their stiff structure can also delay union by reducing compressive loads at the fracture site, thereby inhibiting secondary bone healing. Composite intramedullary nails have recently been introduced to address these drawbacks. The purpose of this study is to evaluate the mechanical properties of a previously developed composite IM nail made of carbon-fibre/epoxy whose structure was optimized based on fracture healing requirements using the selective stress shielding approach. Following manufacturing, the cross-section of the composite nail was examined under an optical microscope to find the porosity of the structure. Mechanical properties of the proposed composite intramedullary nail were determined using standard tension, compression, bending, and torsion tests. The failed specimens were then examined to obtain the modes of failure. The material showed high strength in tension (403.9±7.8MPa), compression (316.9±10.9MPa), bending (405.3±8.1MPa), and torsion (328.5±7.3MPa). Comparing the flexural modulus (41.1±0.9GPa) with the compressive modulus (10.0±0.2GPa) yielded that the material was significantly more flexible in compression than in bending. This customized flexibility along with the high torsional stiffness of the nail (70.7±2.0Nm(2)) has made it ideal as a fracture fixation device since this unique structure can stabilize the fracture while allowing for compression of fracture ends. Negligible moisture absorption (~0.5%) and low porosity of the laminate structure (< 3%) are other advantages of the proposed structure. The findings suggested that the carbon-fibre/epoxy intramedullary nail is flexible axially while being relatively rigid in bending and torsion and is strong enough in all types of physiologic loading, making it a potential

  5. Open reduction and internal fixation of two-part displaced fractures of the greater tuberosity of the proximal part of the humerus.

    PubMed

    Flatow, E L; Cuomo, F; Maday, M G; Miller, S R; McIlveen, S J; Bigliani, L U

    1991-09-01

    Twelve patients, ranging in age from thirty-four to seventy-two years (average, fifty-three years), were evaluated an average of five years (range, two to eight years) after open reduction and internal fixation of a two-part displaced fracture of the greater tuberosity of the proximal part of the humerus. The indication for operative reduction was one centimeter or more of displacement of the fracture as seen on the diagnostic radiographs. The anterosuperior deltoid-splitting approach, combined with rotation of the humerus, allowed adequate exposure of the retracted tuberosity. Internal fixation of the greater tuberosity with heavy, non-absorbable sutures and careful repair of the rotator cuff permitted early passive motion. All fractures healed without postoperative displacement. Six patients had an excellent result and six had a good result; active elevation averaged 170 degrees. There was one partial, transient palsy of the axillary nerve.

  6. Treatment of unstable distal radius fractures: non-invasive dynamic external fixator versus volar locking plate – functional and radiological outcome in a prospective case-controlled series

    PubMed Central

    Bajwa, Ali S.; Rammappa, Manju; Lee, Ling; Nanda, Rajesh

    2015-01-01

    Introduction: Distal radius fracture (DRF) is a common injury and various treatment modalities including open reduction and internal fixation (ORIF) with volar locking plate are available. More recently, a non-invasive external fixator has been used. Aims: To prospectively compare the use of a non-invasive external fixator with early dynamisation for DRF against ORIF with volar locking plate control group. Methods: Consecutive patients with closed DRF were included in a prospective case-controlled study. Patients were assigned to non-invasive external fixator or ORIF. Minimum follow-up was two years. Follow-up was at weeks 2, 4, 6, 8, 12, 26 and at one and two-year post-operatively. The outcome measures included demographic details, injury mechanism, AO fracture type, risk factors, body mass index (BMI), ulnar styloid fracture and dorsal comminution, radiographs, grip strength and DASH score. Results: Consecutive 50 patients were treated either with non-invasive external fixator (25/50) or with ORIF (25/50) and the mean age of the two groups was 53 years (SD 17.1) and 49 years (SD 19.5), respectively. Demographics were matched in two groups. In the non-invasive external fixator group, there were 10 AO Type-A, 5 Type-B and 10 Type-C fractures. The ORIF group included 8 Type-A, 6 Type-B and 11 Type-C fractures. The mean DASH score at three-months and one-year post-injury in non-invasive fixator group was 12.2 (SD 3.1) and 3.5 (SD 0.7), respectively, significantly greater than those of ORIF group 14.5 (SD 5.6) and 11.2 (SD 4.4), respectively (p < 0.05). Conclusion: DRF treated with non-invasive external fixator can give functional results superior to ORIF at three-months and the trend is maintained at one and two-year post-operatively. PMID:27163089

  7. Radial shaft stress fracture after internal fixation using a titanium plate.

    PubMed

    Nagoshi, Narihito; Yamanaka, Kazuyoshi; Sasaki, Takashi

    2015-05-20

    A 22-year-old man, a boxer, presented with acute right forearm pain after striking a punch mitt. The patient had sustained a diaphyseal fracture of the right radius 19 months previously and was treated by minimally invasive plate osteosynthesis using a titanium reconstruction plate. Radiography revealed stress fractures beneath a proximal screw hole of the plate. The forearm was protected in a splint for 6 weeks and the fracture healed. Titanium plates are superior to stainless steel plates, due to various properties of titanium including corrosion resistance and biocompatibility. Removal of such plates is not routinely performed in our hospital, but plate removal may be warranted for patients who actively participate in certain sports.

  8. The Efficacy of Transverse Fixation and Early Exercise in the Treatment of Fourth Metacarpal Bone Fractures

    PubMed Central

    Moon, Suk-Ho; Kim, Hak-Soo; Jung, Sung-No

    2016-01-01

    Background Several techniques have been designed to treat fifth metacarpal fractures reported to be effective. However, these methods cannot be easily applied to the fourth metacarpal due to its central anatomical position. In this study, we sought to analyze the functional outcomes of patients who underwent transverse pinning for a fourth metacarpal bone fracture. Methods A total of 21 patients were selected and their charts were retrospectively reviewed. After fracture reduction, two transverse Kirchner wires were first inserted from the fifth metacarpal to the third metacarpal transversely at the distal part of the fractured bone, and then another two wires were inserted at the proximal part of the fractured bone. The splint was removed approximately one week postoperatively and the Kirchner wires were removed four to five weeks postoperatively. Patients started active and passive exercise one week after the operation. Pain visual analog scores, total active and passive motion, and the active and passive range of motion of the metacarpophalangeal joint and grip strength were evaluated. Results Dorsal angulation improved from a preoperative value of 44.2° to a postoperative value of 5.9°. Six weeks after surgery, functional recovery parameters, such as range of motion and grip strength, had improved to 98% of the function of the normal side. No major complication was observed. Conclusions We suggest that the transverse pinning of fourth metacarpal bone fractures is an effective treatment option that is less invasive than other procedures, easy to perform, requires no secondary surgery, minimizes joint and soft tissue injury, and allows early mobilization. PMID:27019812

  9. A Prospective Study on Radiological and Functional Outcome of Displaced Tongue Type Intra-Articular Calcaneal Fractures Treated by Percutaneous Screw Fixation

    PubMed Central

    Hegde, Anoop; Mathias, Lawrence John; Shetty, Vikram; Shetty, Ashwin

    2016-01-01

    Introduction Calcaneal fractures have posed a challenge to orthopaedic surgeon for many years. The major problem is to reconstruct the fracture and improve healing of the fracture and also the surrounding tissues. Anatomic restoration of the three-dimensional anatomy of the calcaneum is the goal of surgical management of calcaneal fractures. Over the years, various techniques have been developed to accomplish this goal. Aim To determine the functional outcome in displaced tongue-type calcaneal fracture treated by percutaneous screw fixation. Materials and Methods A prospective study was conducted from October 2012 and September 2014. A total of 23 patients with intra-articular ‘tongue type’ calcaneal fractures were included in the study. Complete clinical and radiological evaluation was done. The surgical procedure encompassed closed reduction and fixation with two criss-cross 6.5 mm cannulated cancellous across the fracture site under fluoroscopic guidance. Postoperatively, on day three ankle and toe mobilization was begun. Non-weight bearing crutch mobilization was begun on postoperative day three. Reviews were done at 6 weeks, 12 weeks and 24 weeks postoperatively. At 6 weeks partial weight bearing mobilization was started. Full weight bearing was begun at 12 weeks. The patient was finally reviewed at 24 weeks and assessment of ankle function was done as per the Maryland foot scoring system. Radiographs were compared and preoperative and postoperative Gissane’s and Bohler’s angles were also compared. The results were analysed as per descriptive statistics (frequency, percentage). The complications noted were documented. Results Of the 23 patients under the study, three had excellent results with mean score of 90, 17 had good results with mean score of 82.94 and three had fair results with mean score of 74. Only one patient had subtalar arthritis as a complication. No other complications were seen. Conclusion Percutaneous screw fixation of tongue type

  10. Double threaded screw fixation for bilateral stress fracture of the medial malleolus.

    PubMed

    Kanto, Ryo; Fukunishi, Shigeo; Morooka, Takatoshi; Seino, Daisuke; Takashima, Takayuki; Yoshiya, Shinichi; Tanaka, Juichi

    2014-01-01

    An 18-year-old college basketball player presented with continued ankle pain. A radiographic examination showed bilateral medial malleolus stress fractures. Considering the prolonged history and refractory nature of this injury, surgery was adopted as a treatment option. At surgery, the fracture site was percutaneously fixed using two cannulated double threaded screws. Surgery for each side was sequentially performed two months apart. Prompt bony healing was attained after surgery, and the patient could return to his previous sports level six months after the first surgery without subsequent recurrence.

  11. Effects of Low-Dose Microwave on Healing of Fractures with Titanium Alloy Internal Fixation: An Experimental Study in a Rabbit Model

    PubMed Central

    Zhang, Han; Fu, Tengfei; Jiang, Lan; Bai, Yuehong

    2013-01-01

    Background Microwave is a method for improving fracture repair. However, one of the contraindications for microwave treatment listed in the literature is surgically implanted metal plates in the treatment field. The reason is that the reflection of electromagnetic waves and the eddy current stimulated by microwave would increase the temperature of magnetic implants and cause heat damage in tissues. Comparing with traditional medical stainless steel, titanium alloy is a kind of medical implants with low magnetic permeability and electric conductivity. But the effects of microwave treatment on fracture with titanium alloy internal fixation in vivo were not reported. The aim of this article was to evaluate the security and effects of microwave on healing of a fracture with titanium alloy internal fixation. Methods Titanium alloy internal fixation systems were implanted in New Zealand rabbits with a 3.0 mm bone defect in the middle of femur. We applied a 30-day microwave treatment (2,450MHz, 25W, 10 min per day) to the fracture 3 days after operation. Temperature changes of muscle tissues around implants were measured during the irradiation. Normalized radiographic density of the fracture gap was measured on the 10th day and 30th day of the microwave treatment. All of the animals were killed after 10 and 30 days microwave treatment with histologic and histomorphometric examinations performed on the harvested tissues. Findings The temperatures did not increase significantly in animals with titanium alloy implants. The security of microwave treatment was also supported by histology of muscles, nerve and bone around the implants. Radiographic assessment, histologic and histomorphometric examinations revealed significant improvement in the healing bone. Conclusion Our results suggest that, in the healing of fracture with titanium alloy internal fixation, a low dose of microwave treatment may be a promising method. PMID:24086626

  12. A novel 3D template for mandible and maxilla reconstruction: Rapid prototyping using stereolithography

    PubMed Central

    Kumta, Samir; Kumta, Monica; Jain, Leena; Purohit, Shrirang; Ummul, Rani

    2015-01-01

    Introduction: Replication of the exact three-dimensional (3D) structure of the maxilla and mandible is now a priority whilst attempting reconstruction of these bones to attain a complete functional and aesthetic rehabilitation. We hereby present the process of rapid prototyping using stereolithography to produce templates for modelling bone grafts and implants for maxilla/mandible reconstructions, its applications in tumour/trauma, and outcomes for primary and secondary reconstruction. Materials and Methods: Stereolithographic template-assisted reconstruction was used on 11 patients for the reconstruction of the mandible/maxilla primarily following tumour excision and secondarily for the realignment of post-traumatic malunited fractures or deformity corrections. Data obtained from the computed tomography (CT) scans with 1-mm resolution were converted into a computer-aided design (CAD) using the CT Digital Imaging and Communications in Medicine (DICOM) data. Once a CAD model was constructed, it was converted into a stereolithographic format and then processed by the rapid prototyping technology to produce the physical anatomical model using a resin. This resin model replicates the native mandible, which can be thus used off table as a guide for modelling the bone grafts. Discussion: This conversion of two-dimensional (2D) data from CT scan into 3D models is a very precise guide to shaping the bone grafts. Further, this CAD can reconstruct the defective half of the mandible using the mirror image principle, and the normal anatomical model can be created to aid secondary reconstructions. Conclusion: This novel approach allows a precise translation of the treatment plan directly to the surgical field. It is also an important teaching tool for implant moulding and fixation, and helps in patient counselling. PMID:26933279

  13. Open screw fixation of large anterior glenoid rim fractures: mid- and long-term results in 29 patients.

    PubMed

    Raiss, Patric; Baumann, Florian; Akbar, Michael; Rickert, Markus; Loew, Markus

    2009-02-01

    The aim of this retrospective study was to analyse the clinical, functional and radiographic outcomes of patients sustaining traumatic anterior dislocations of the shoulder in combination with large anterior glenoid rim fractures, treated by open reduction and internal screw fixation (ORIF). Twenty-nine patients with a mean follow-up of 6.5 years (2.5-12 years) were evaluated clinically using the Constant and DASH scores, radiographs in two planes and isokinetic muscle strength measurement (Biodex 3 PRO). Mean age was 41.6 years (17-68 years). There was no case of postoperative re-dislocation. Eight out of 29 patients (27.5%) underwent revision surgery to remove the screws. The mean age- and gender-adjusted Constant score was 93.3% (range 64-102%), and the mean DASH score was 10.1 points (range 0-71 points). On radiological examination, 6 patients had signs of osteoarthritis: Samilson type I (n = 3) and II (n = 3). Significant differences for maximal strength in external rotation and muscular endurance compared to the unaffected side were found (P < 0.035). Twenty-seven patients (93%) were satisfied or very satisfied with the result after surgery. ORIF seems to be a good treatment option in cases of large glenoid rim fractures to avoid re-dislocation in the mid-term. Prospective randomised studies are necessary to compare these findings with those after non-operative or arthroscopic treatment of these injuries. PMID:19039575

  14. Early Conversion of External Fixation to Interlocked Nailing in Open Fractures of Both Bone Leg Assisted with Vacuum Closure (VAC) - Final Outcome

    PubMed Central

    Raj, Manish; Kumar, Sunil; Singh, Pulkesh; Kumar, Dinesh; Singh, Jasveer; Deep, Akash

    2016-01-01

    Introduction Management of compound grade III fractures of both bone leg includes external stabilization for long period, followed by various soft tissue coverage procedures. Primary interlocking of tibia had been also done with variable results. External fixation for long time without any bone loss often leads to infected nonunion, loss of reduction, pin tract infection and failure of fixation, primary interlocking in compound grade III fractures had shown high medullary infection rate. We managed all cases of compound grade III A/B fractures with primary external fixation, simultaneous wound management using vacuum assisted closure (VAC) followed by early conversion to interlocking within 2 weeks of fixator application. Aim To determine the effectiveness of vacuum assisted closure (VAC) for the early conversion of external fixator to definitive interlocking in open fractures of the both bone leg. Materials and Methods In current study we selected 84 cases of compound grade IIIA/B diaphyseal fractures of both bone leg during period of May 2010 to September 2013. We managed these cases by immediate debridement and application of external fixation followed by repeated debridement, application of vacuum assisted closure (VAC) and conversion to interlocking within two weeks. Results Out of 84 cases union was achieved in 80(95%) of cases with definitive tibial interlocking. Excellent to good result were obtained in 77(91.8%) of cases and fair to poor result seen in rest of 7(8.2%) of cases according to modified Ketenjian’s criteria. 5 out of these 7 poor result group cases were from Compound Grade III B group to start with. Deep infection rate in our series were 7% i.e. total 6 cases and 4 out of these were from compound Grade III B group to start with. Conclusion Vacuum assisted closure (VAC) give a good help for rapid closure of the wound and help in early conversion to definitive intramedullary nailing. Reamed nail could well be used in compound grade IIIA

  15. Biomechanical evaluation of combined short segment fixation and augmentation of incomplete osteoporotic burst fractures

    PubMed Central

    2013-01-01

    Background Treating traumatic fractures in osteoporosis is challenging. Multiple clinical treatment options are found in literature. Augmentation techniques are promising to reduce treatment-related morbidity. In recent years, there have been an increasing number of reports about extended indication for augmentation techniques. However, biomechanical evaluations of these techniques are limited. Methods Nine thoracolumbar osteoporotic spinal samples (4 FSU) were harvested from postmortem donors and immediately frozen. Biomechanical testing was performed by a robotic-based spine tester. Standardized incomplete burst fractures were created by a combination of osteotomy-like weakening and high velocity compression using a hydraulic material testing apparatus. Biomechanical measurements were performed on specimens in the following conditions: 1) intact, 2) fractured, 3) bisegmental instrumented, 4) bisegmental instrumented with vertebroplasty (hybrid augmentation, HA) and 5) stand-alone vertebroplasty (VP). The range of motion (RoM), neutral zone (NZ), elastic zone (EZ) and stiffness parameters were determined. Statistical evaluation was performed using Wilcoxon signed-rank test for paired samples (p = 0.05). Results Significant increases in RoM and in the NZ and EZ (p < 0.005) were observed after fracture production. The RoM was decreased significantly by applying the dorsal bisegmental instrumentation to the fractured specimens (p < 0.005). VP reduced fractured RoM in flexion but was still increased significantly (p < 0.05) above intact kinematic values. NZ stiffness (p < 0.05) and EZ stiffness (p < 0.01) was increased by VP but remained lower than prefracture values. The combination of short segment instrumentation and vertebroplasty (HA) showed no significant changes in RoM and stiffness in NZ in comparison to the instrumented group, except for significant increase of EZ stiffness in flexion (p < 0.05). Conclusions Stand

  16. The curative effect comparison between prolonged third generation of gamma nail and prolonged dynamic hip screw internal fixation in treating femoral intertrochanteric fracture and the effect on infection.

    PubMed

    He, Wenye; Zhang, Wei

    2015-03-01

    The objective was to explore the curative effect of prolonged third generation of gamma nail (pTGN) and prolonged dynamic hip screw (pDHS) internal fixation in treating femoral intertrochanteric fracture, and analyze the incidence rate of infection for better clinical diagnosis and treatment. Sixty five patients with femoral intertrochanteric fracture during February, 2011-February, 2013 were selected and divided into two groups, with one receiving pTGN (control group) and the other one receiving pDHS internal fixation (observation group). The clinical effects of two groups were compared. In control group, the excellent and good rate was 78.13 %, the total effective rate was 87.5 %, and the total complication rate was 6.24 %; in observation group, the excellent and good rate was 78.79 %, the total effective rate was 90.91 %, the total complication rate was 6.06 %; there was no statistical difference between two groups (p > 0.05). The operation time, the intraoperative fluoroscopy time, and the total blood loss had statistically significant difference between two groups (p < 0.05); however, the differences of the total length of incision, the length of preoperative hospitalization, postoperative ambulatory episode, and the length of stay between two groups were not statistically significant (p > 0.05). Both pTGN and pDHS internal fixation were effective on femoral intertrochanteric fracture, with pDHS internal fixation having better overall efficiency.

  17. Polymer cable/grip-plate system with locking screws for stable fixation to promote healing of trochanteric osteotomies or fractures in revision total hip arthroplasty.

    PubMed

    Berend, Keith R; Willen, Jacob L; Morris, Michael J; Adams, Joanne B; Lombardi, Adolph V

    2014-11-01

    Multiple methods have been proposed to establish stable fixation to promote healing of trochanteric osteotomies or fractures in revision total hip arthroplasty (revTHA), from wiring techniques through cable-plate systems with or without supplemental locking screws. The purpose of this study is to report the clinical results of a single cable-plate system with locked screw fixation in revTHA. Between 2009 and 2012, 27 grip-plates (Supercable® System, Kinamed Inc., Camarillo, CA) were used in 26 patients in 27 revTHA procedures. Utilization was 12 1-hole (50 mm) grip-plates, 10 2-hole (135 mm) grip-plates, four 4-hole (190 mm) grip-plates, and one 6-hole (245 mm) grip-plate. There were 14 women and 12 men. Age averaged 63.2 years and BMI averaged 29.4 kg/m2. At average 2.5 year follow-up, grip-plate fixation was considered successful in 22 hips (81%) with five failures. Three failures consisted of 50 mm/short grip-plates used in one trochanteric slide, and two intraoperative trochanteric fractures during revTHA. The two additional failures were related to pre-revision trochanteric avulsion from bony necrosis of the proximal femur. An additional three grip-plates were removed electively for soft-tissue irritation and pain but with successful fixation and bony healing. Thus 70% of hips were free of reoperation related to the grip-plate. All other hips had successful fixation and the grip-plate was not symptomatic. In this study, the cable-grip system and isoelastic Supercables provided reliable fixation for adequate healing of difficult ETO and trochanteric fractures with an 81% rate of mechanical success with radiographic and clinical healing observed.

  18. Open reduction and internal fixation of extracapsular mandibular condyle fractures: a long-term clinical and radiological follow-up of 25 patients

    PubMed Central

    2014-01-01

    Background During the last 2 decades, many studies on the treatment of mandibular condyle fracture have been published. The incidence of mandibular condyle fractures is variable, ranging from 17.5% to 52% of all mandibular fractures. This retrospective study evaluated the long-term clinical and radiological outcomes after surgical treatment of 25 patients with a total of 26 extracapsular condyle fractures. Methods We used 2 types of surgical approaches, the retromandibular retroparotid or preauricular approach. Three kinds of rigid internal fixation plates were used—single plate, double plate, and trapezoidal plate. The following post-operative clinical parameters were evaluated: dental occlusion, facial nerve functionality, skin scarring, and temporomandibular joint functionality. All patients underwent post-operative orthopanoramic radiography and computed tomography. The patients were also monitored for complications such as Frey’s syndrome, infection, salivary fistula, plate fracture, and permanent paralysis of the facial nerve; the patient’s satisfaction was also recorded. Results Of the 25 patients, 80% showed occlusion recovery, 88% had no facial nerve injury, and 88% presented good surgical skin scarring. The patients showed early complete recovery of temporomandibular joint functionality and 72% of them were found to be asymptomatic. The postoperative radiographs of all patients indicated good recovery of the anatomical condylar region, and 80% of them had no postoperative complications. The average degree of patient satisfaction was 8.32 out of 10. Our results confirm that the technique of open reduction and internal fixation in association with postoperative functional rehabilitation therapy should be considered for treating patients with extracapsular condylar fractures. Conclusion The topic of condylar injury has generated more discussion and controversy than any other topic in the field of maxillofacial trauma. We confirm that open reduction and

  19. Cementless Titanium Mesh Fixation of Osteoporotic Burst Fractures of the Lumbar Spine Leads to Bony Healing: Results of an Experimental Sheep Model

    PubMed Central

    Roepenack, Paula; Roesner, Jan; Herlyn, Philipp Karl Ewald; Martin, Heiner; Reichel, Martin; Rotter, Robert; Vollmar, Brigitte; Mittlmeier, Thomas; Gradl, Georg

    2016-01-01

    Introduction. Current treatment strategies for osteoporotic vertebral compression fractures (VCFs) focus on cement-associated solutions. Complications associated with cement application are leakage, embolism, adjacent fractures, and compromise in bony healing. This study comprises a validated VCF model in osteoporotic sheep in order to (1) evaluate a new cementless fracture fixation technique using titanium mesh implants (TMIs) and (2) demonstrate the healing capabilities in osteoporotic VCFs. Methods. Twelve 5-year-old Merino sheep received ovariectomy, corticosteroid injections, and a calcium/phosphorus/vitamin D-deficient diet for osteoporosis induction. Standardized VCFs (type AO A3.1) were created, reduced, and fixed using intravertebral TMIs. Randomly additional autologous spongiosa grafting (G1) or no augmentation was performed (G2, n = 6 each). Two months postoperatively, macroscopic, micro-CT and biomechanical evaluation assessed bony consolidation. Results. Fracture reduction succeeded in all cases without intraoperative complications. Bony consolidation was proven for all cases with increased amounts of callus development for G2 (58.3%). Micro-CT revealed cage integration. Neither group showed improved results with biomechanical testing. Conclusions. Fracture reduction/fixation using TMIs without cement in osteoporotic sheep lumbar VCF resulted in bony fracture healing. Intravertebral application of autologous spongiosa showed no beneficial effects. The technique is now available for clinical use; thus, it offers an opportunity to abandon cement-associated complications. PMID:27019848

  20. [Analysis of the Cochrane Review: Pedicle Screw Fixation for Traumatic Fractures of the Thoracic and Lumbar Spine. Cochrane Database Syst Rev. 2013;05:CD009073].

    PubMed

    Linhares, Daniela; Neves, Nuno; Ribeiro da Silva, Manuel; Almeida Fonseca, João

    2016-05-01

    Traumatic fractures of the thoracic and lumbar spine are common causes of spine surgery. Pedicle screw fixation is usually chosen, using monosegmentar, short or long segment instrumentations, with or without bone graft. This review aims to evaluate the effect of transpedicular fixation in traumatic fractures of the thoracic and lumbar spine. A systematic search on controlled, randomized or quasi-randomized trials comparing different methods of surgical treatment of this fractures was performed, followed by a process of article selection, data extraction and bias assessment by 3 independent authors. Eight articles were included in a total of 5 comparisons, between different transpedicular fixation techniques. No significant differences on function or quality of life, neurologic status or limitation of motion were found. Only instrumentation with fracture level screw incorporation showed significant decrease of pain when compared with instrumentation alone. Several techniques resulted in significant improvements of different radiological parameters. Significantly, surgeries with smaller duration were associated with lesser blood loss. Bone graft use caused a significant raise in post-operative complications, namely donor site pain. So, this paper showed that significative improvements in radiological parameters do not associate with correspondent clinical benefits, and only instrumentation with level screw incorporation is associated with a clear benefit on pain. Moreover, the need for bone graft is questioned, since it leads to no clinic-radiological improvement with a raise of complications. However, a small number of controlled studies is available on this topic. PMID:27649012

  1. [Analysis of the Cochrane Review: Pedicle Screw Fixation for Traumatic Fractures of the Thoracic and Lumbar Spine. Cochrane Database Syst Rev. 2013;05:CD009073].

    PubMed

    Linhares, Daniela; Neves, Nuno; Ribeiro da Silva, Manuel; Almeida Fonseca, João

    2016-05-01

    Traumatic fractures of the thoracic and lumbar spine are common causes of spine surgery. Pedicle screw fixation is usually chosen, using monosegmentar, short or long segment instrumentations, with or without bone graft. This review aims to evaluate the effect of transpedicular fixation in traumatic fractures of the thoracic and lumbar spine. A systematic search on controlled, randomized or quasi-randomized trials comparing different methods of surgical treatment of this fractures was performed, followed by a process of article selection, data extraction and bias assessment by 3 independent authors. Eight articles were included in a total of 5 comparisons, between different transpedicular fixation techniques. No significant differences on function or quality of life, neurologic status or limitation of motion were found. Only instrumentation with fracture level screw incorporation showed significant decrease of pain when compared with instrumentation alone. Several techniques resulted in significant improvements of different radiological parameters. Significantly, surgeries with smaller duration were associated with lesser blood loss. Bone graft use caused a significant raise in post-operative complications, namely donor site pain. So, this paper showed that significative improvements in radiological parameters do not associate with correspondent clinical benefits, and only instrumentation with level screw incorporation is associated with a clear benefit on pain. Moreover, the need for bone graft is questioned, since it leads to no clinic-radiological improvement with a raise of complications. However, a small number of controlled studies is available on this topic.

  2. Compression-plate fixation of femoral shaft fractures in children aged 8 to 12 years.

    PubMed

    Fyodorov, I; Sturm, P F; Robertson, W W

    1999-01-01

    Twenty-one patients between the ages of 8 and 12 years with 23 femoral-shaft fractures underwent dynamic compression plating (DCP) between August 1993 and February 1996. Eleven patients had isolated femoral-shaft fractures, five had associated long-bone injuries, and five had multiple organ injuries. A 4.5-mm DCP plate was used in each case. Patients were kept non-weight bearing with crutches for an average of 8 weeks. Hardware failure occurred in two patients at 6 weeks. One was treated with revision plating, and the other, with spica casting. Both healed uneventfully. No other complications occurred. All patients were radiographically and clinically healed at last follow-up.

  3. Biomechanical testing of titanium self-tapping versus pretapped lag screw fixation of spiral metacarpal fractures.

    PubMed

    Prevel, C D; Morgan, R; Molnar, J; Eppley, B L; Moore, K

    1996-07-01

    Biomechanical tests of torsional loading and cantilevered bending were used to study the effects of varying screw size design of five different titanium miniscrews and microscrews in a metacarpal spiral oblique fracture model. Sixty-six fresh frozen human cadaveric metacarpal bones were subjected to torsional loading until failure, producing a spiral oblique fracture. The randomized fractured metacarpal bones were then repaired utilizing two 1.2-mm, 1.7-mm, or 2.3-mm self-tapping Leibinger lag screws; and 1.5-mm or 2.0-mm pretapped Synthes lag screws. Following repair, the specimens were then subjected to cantilevered bending or torsional loading. Failure torque and bending loads were then used to calculate failure stresses at the midshaft for torsional loading or at the proximal screw for cantilevered bending. Analysis of variance statistical analysis revealed that within the cortical thickness of bone studied, no significant difference in shear stress or axial stress was observed with increasing screw diameter and screw design. PMID:8826590

  4. Facial fractures.

    PubMed Central

    Carr, M. M.; Freiberg, A.; Martin, R. D.

    1994-01-01

    Emergency room physicians frequently see facial fractures that can have serious consequences for patients if mismanaged. This article reviews the signs, symptoms, imaging techniques, and general modes of treatment of common facial fractures. It focuses on fractures of the mandible, zygomaticomaxillary region, orbital floor, and nose. Images p520-a p522-a PMID:8199509

  5. Ag/SiO(x)C(y) plasma polymer coating for antimicrobial protection of fracture fixation devices.

    PubMed

    Khalilpour, Poroshat; Lampe, Kai; Wagener, Michael; Stigler, Brigitte; Heiss, Christian; Ullrich, Matthias S; Domann, Eugen; Schnettler, Reinhard; Alt, Volker

    2010-07-01

    Implant-related infections are often devastating situations in orthopaedic trauma surgery particularly if multiresistant bacteria are involved. Protection of the implant surface by an antimicrobial coating exhibiting activity against multiresistant bacterial strains is of high interest. Aim of this study was to investigate the antimicrobial effects of an Ag/SiO(x)C(y) plasma polymer coating for fracture fixation devices, such as nails, plates, and external fixators, including tests against methicillin-resistant Staphylococcus aureus (MRSA) and its biocompatibility. The antimicrobial activity of the coating deposited onto 12 x 3 mm(2) stainless steel implants was tested in vitro against Staphylococcus aureus, Staphylococcus epidermidis, and MRSA using different testing methods (ASTM E-2810, JIS Z 2801, proliferation assay). Additionally, the coated devices were implanted into the paravertebral muscle of rabbits and explanted after 2, 7, 14, and 28 days to test the remaining ex vivo antimicrobial activity. For biocompatibility assessment the Ag/SiO(x)C(y) plasma polymer coating was tested in vitro according to ISO 10993-5. The Ag/SiO(x)C(y) coating exhibited excellent antimicrobial activity against all tested bacterial strains in all three in vitro tests. Ex vivo testing proved suppression of more than 99.9 % of bacterial proliferation by the coating compared to non-coated samples even after 28 days. ISO 10993-5 showed good biocompatibility of the coating without any indications of cytotoxic effects. In summary, Ag/SiO(x)C(y) plasma polymer coating showed excellent antimicrobial activity including effectiveness against MRSA and good in vitro biocompatibility. Therefore, it possesses high potential as a prophylactic agent in orthopaedic trauma surgery.

  6. Amifostine Preserves Osteocyte Number and Osteoid Formation in Fracture Healing Following Radiotherapy

    PubMed Central

    Donneys, Alexis; Tchanque-Fossuo, Catherine N.; Blough, Jordan T.; Nelson, Noah S.; Deshpande, Sagar S.; Buchman, Steven R.

    2013-01-01

    Purpose Radiation is known to diminish osteocyte count and function leading to bone weakening. A treatment strategy to mitigate these consequences could have immense therapeutic ramifications. We have previously demonstrated significantly diminished osteocyte count and mineralization capacity in a rat model of fracture healing after radiotherapy. We hypothesize that amifostine (AMF) will preserve osteocyte number and function in this model. Materials and Methods Thirty-six rats were divided into three groups: fracture, radiated fracture, and radiated fracture with AMF. Radiated groups underwent human equivalent radiotherapy to the mandible prior to fixator placement and mandibular osteotomy. The AMF group received a subcutaneous injection prior to each dose of radiotherapy. After 40 days, mandibles were harvested for histologic processing. Quantification of osteocyte count (Oc), empty lacunae (EL) and osteoid ratio (OV/TV) was performed and the results were compared using ANOVA (p<0.05). Results Radiated fractures demonstrated significantly diminished Oc, increased EL and diminished capacity to produce new osteoid at the fracture site as measured with OV/TV when compared to non-radiated fractures. In mandibles treated with amifostine, these metrics were not statistically different than control, indicating a preservation of osteocyte number and function. Conclusions Our results support the hypothesis that amifostine preserves osteocyte number and function, thereby preventing the pernicious effects of radiotherapy on the cellular environment of fracture healing. Based on these findings, we encourage future investigation of this promising therapy for use in the prevention of pathologic fractures and osteoradionecrosis. PMID:24342580

  7. Multidetector CT of Mandibular Fractures, Reductions, and Complications: A Clinically Relevant Primer for the Radiologist.

    PubMed

    Dreizin, David; Nam, Arthur J; Tirada, Nikki; Levin, Martin D; Stein, Deborah M; Bodanapally, Uttam K; Mirvis, Stuart E; Munera, Felipe

    2016-01-01

    After the nasal bones, the mandible is the second most common site of facial fractures, and mandibular fractures frequently require open reduction. In the trauma injury setting, multidetector computed tomography (CT) has become the cornerstone imaging modality for determining the most appropriate treatment management, fixation method, and surgical approach. Multidetector CT is also used to assess the adequacy of the reduction and evaluate potential complications in the postoperative period. For successful restoration of the mandible's form and function, as well as management of posttraumatic and postoperative complications, reconstructive surgeons are required to have a detailed understanding of mandibular biomechanics, occlusion, and anatomy. To provide added value in the diagnosis, treatment planning, and follow-up of mandibular fractures, radiologists should be aware of these concepts. Knowledge of the techniques commonly used to achieve occlusal and anatomic reduction and of the rationale behind the range of available treatment options for different injury patterns-from isolated and nondisplaced fractures to multisite and comminuted fractures-also is essential. This article focuses on the use of multidetector CT for pre- and postoperative evaluation of mandibular fractures and outlines fundamental concepts of diagnosis and management-beginning with an explanation of common fracture patterns and their biomechanical underpinnings, and followed by a review of the common postoperative appearances of these fractures after semirigid and rigid fixation procedures. Specific considerations regarding fractures in different regions of the tooth-bearing and non-tooth-bearing mandible and the unique issues pertaining to the edentulous atrophic mandible are reviewed, and key features that distinguish major from minor complications are described. (©)RSNA, 2016. PMID:27618328

  8. Miniarthrotomy assisted percutaneous screw fixation for displaced medial malleolus fractures – A novel technique

    PubMed Central

    Saini, Pramod; Aggrawal, Abhinav; Meena, Sanjay; Trikha, Vivek; Mittal, Samarth

    2014-01-01

    Aim To describe here a technique of miniarthrotomy assisted percutaneous screw insertion for displaced Herscovici type B and C medial malleolar fractures. Method Incision was made centred over the superomedial angle of the ankle mortise, about half a cm medial to tibialis anterior. Arthrotomy was done and reduction obtained. Percuntaneously, two 4 mm cancellous cannulated screws were inserted through medial malleolus. Results and conclusion This approach allows direct visualization of reduction, removal of entrapped soft tissue and preservation of saphenous vein and nerve. PMID:25983507

  9. In Vivo Syndesmotic Over-Compression After Fixation of Ankle Fractures with a Syndesmotic Injury

    PubMed Central

    Cherney, Steven M.; Haynes, Jacob A.; Spraggs-Hughes, Amanda; McAndrew, Christopher M.; Ricci, William M.; Gardner, Michael J.

    2015-01-01

    Objectives The goals of this study were to assess syndesmotic reductions utilizing computerized tomography (CT) scans, and to determine if malreductions were associated with certain injury types or reduction forceps. Design Prospective cohort Setting Urban Level 1 Trauma center Patients Twenty-seven patients with operatively treated syndesmotic injuries were recruited prospectively. Intervention Patients underwent postoperative bilateral CT scans of the ankle and hindfoot to assess syndesmotic reduction. The uninjured extremity was used as a control. Main outcome measurement Side-to-side differences of fibula position within the tibial incisura were measured at several anatomic points and analyzed based on injury type, the presence of posterior malleolar injury, level of fracture, and type of reduction forceps used. Results On average, operatively treated syndesmotic injuries were over-compressed (fibular medialization) by 1mm (p < .001) and externally rotated by 5° (p = .002) when compared to the uninjured extremity. The absence of a posterior malleolar injury and Weber B (OTA 44-B) fractures seemed to have a protective effect against malrotation, but not against over-compression. There was no difference in malreduction based on type of clamp used. Conclusions It is possible, and highly likely based on these data, to over-compress the syndesmosis when using a reduction forceps. Care should be taken to avoid over-compression, as this may affect ankle motion and functional outcome. This is the first in vivo series of syndesmotic over-compression to our knowledge. PMID:26295735

  10. Evaluation of three-dimensional printing for internal fixation of unstable pelvic fracture from minimal invasive para-rectus abdominis approach: a preliminary report

    PubMed Central

    Zeng, Canjun; Xiao, Jidong; Wu, Zhanglin; Huang, Wenhua

    2015-01-01

    Objective: The aim of this study is to evaluate the efficacy and feasibility of three-dimensional printing (3D printing) assisted internal fixation of unstable pelvic fracture from minimal invasive para-rectus abdominis approach. Methods: A total of 38 patients with unstable pelvic fractures were analyzed retrospectively from August 2012 to February 2014. All cases were treated operatively with internal fixation assisted by three-dimensional printing from minimal invasive para-rectus abdominis approach. Both preoperative CT and three-dimensional reconstruction were performed. Pelvic model was created by 3D printing. Data including the best entry points, plate position and direction and length of screw were obtained from simulated operation based on 3D printing pelvic model. The diaplasis and internal fixation were performed by minimal invasive para-rectus abdominis approach according to the optimized dada in real surgical procedure. Matta and Majeed score were used to evaluate currative effects after operation. Results: According to the Matta standard, the outcome of the diaplasis achieved 97.37% with excellent and good. Majeed assessment showed 94.4% with excellent and good. The imageological examination showed consistency of internal fixation and simulated operation. The mean operation time was 110 minutes, mean intraoperative blood loss 320 ml, and mean incision length 6.5 cm. All patients have achieved clinical healing, with mean healing time of 8 weeks. Conclusion: Three-dimensional printing assisted internal fixation of unstable pelvic fracture from minimal invasive para-rectus abdominis approach is feasible and effective. This method has the advantages of trauma minimally, bleeding less, healing rapidly and satisfactory reduction, and worthwhile for spreading in clinical practice. PMID:26550226

  11. Intra-articular fractures of the distal radius: bridging external fixation in slight flexion and ulnar deviation along articular surface instead of radial shaft.

    PubMed

    Moradi, Ali; Ebrahimzadeh, Mohammad H; Jupiter, Jess B

    2014-03-01

    Forty-one patients with intra-articular fracture of the distal radius (AO Type C) were treated with a double joint-bridging external fixator placed radial side of the fracture site and the wrist placed in slight flexion and ulnar deviation equal to the palmar tilt and radial inclination of the uninjured wrist. The patients were evaluated according to the system of Gartland and Werley an average of 43 months (range, 34 to 53 mo) after surgery. There were 14 excellent, 18 good, 7 fair, and 2 poor results. The average flexion was 94% of the normal side, extension 91%, pronation 95%, and supination 84%. The average radial inclination was 22 ± 10 degrees, palmar tilt 8 ± 14 degrees, and maximum articular step or gap was 2 mm. Bridging external fixation with slight wrist flexion and ulnar deviation equal to preinjured palmar tilt and radial inclination provides acceptable clinical and radiologic results.

  12. Intramedullary Nailing Versus Plate Fixation for the Treatment Displaced Midshaft Clavicular Fractures: A Systematic Review and Meta-Analysis

    PubMed Central

    Hussain, Nasir; Sermer, Corey; Prusick, Parker J.; Banfield, Laura; Atrey, Amit; Bhandari, Mohit

    2016-01-01

    The two commonly performed surgical techniques used to repair displaced midshaft clavicle fractures are plate fixation or intramedullary nailing; however, despite recent evidence, the optimal method to treat such fractures remains a continued topic of debate. A meta-analysis of randomized controlled trials (RCTs) was conducted to evaluate long term function, complications, and operative duration in adult patients receiving intramedullary nailing in comparison to plating. Seven RCTs and three quasi-randomized trials were included. No significant difference was found in long-term function between the two groups (MD: −0.66, 95% CI: −2.03 to 0.71, I2 = 62%, p = 0.34). Patients who received plating had a 2.19 times increased risk of treatment failure, but this failed to reach significance (95% CI: 0.93 to 5.15, I2 = 0%, p = 0.07). The risk of non-operative complications was 2.11 times higher in patients who received plating and this reached statistical significance (95% CI: 1.38 to 3.23, I2 = 53%, p = 0.0006). Finally, plating significantly prolonged operative duration by 20.16 minutes (95% CI: 16.87 to 23.44, I2 = 56%, p < 0.00001). Our results suggest that intramedullary nailing and plating provide equivalent long-term functional outcomes; however, plating may lead to a higher risk of treatment failure and non-operative complications. PMID:27762393

  13. [Operative management and fracture care of the lower leg with the Ilizarov fixator in morbidly obese patients: literature review and results].

    PubMed

    Gessmann, J; Seybold, D; Baecker, H; Muhr, G; Graf, M

    2009-01-01

    Given the rising prevalence of obesity, surgeons and hospitals must become more familiar with the treatment and operative management of obese patients. Several additional pre- and postoperative considerations must be involved such as appropriate assessment of comorbidities and requirements for special equipment. There are still very few data regarding morbidly obese patients with BMIs >50 kg/m(2). After a general literature review of operative management of obese patients, we report on fracture care of the lower limb in such patients with custom-made Ilizarov ring fixators. We found them suited to bear enormous weight-loading but that associated comborbidities can limit successful fracture care.

  14. Intraoperative computed tomography navigation for transpedicular screw fixation to treat unstable thoracic and lumbar spine fractures: clinical analysis of a case series (CARE-compliant).

    PubMed

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

    2015-05-01

    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

  15. Biomechanical study of the sacroiliac fracture fixation with titanium rods and pedicle screws

    PubMed Central

    Ueno, Fabrício Hidetoshi; Pisani, Marina Justi; Machado, André Nunes; Rodrigues, Fábio Lucas; Fujiki, Edison Noburo; Rodrigues, Luciano Miller Reis

    2015-01-01

    OBJECTIVES: To assess biomechanically different fixations means of the sacroiliac joint with pedicle screws and to compare the traditional head height with reduced ones. METHODS: We used a polyethylene model representing the pelvic ring and simulated a unilateral sacroiliac dislocation. We set up three different constructions: 1) two screws attached to a rod; 2) two rods connected to two small head screws each; and 3) two rods connected to two average headed screws each. We conducted tests in a biomechanical testing and a mechanized processing laboratory. RESULTS: Group 1 supported an average maximum load of 99.70 N. Group 2 supported an average maximum load of 362.46 N. Group 3 endured an average maximum load of 404.15 N. In the assembly with one rod, the resistance decreased as compared with the one with two bars: 72.5 % compared to small-headed screws and 75.3 % to the traditional screw. CONCLUSION: The assembly with a single bar presented inferior results when compared to the double bar assembly. There was no statistical difference in the results between the screws used. Experimental Study. PMID:26207094

  16. [Clinical study of maxillofacial fractures sustained during sports and games].

    PubMed

    Tanaka, N; Hayashi, S; Suzuki, K; Uchide, N; Tomitsuka, K; Hirata, Y; Yoshimasu, H; Amagasa, T

    1992-09-01

    We performed a clinico-statistical study of the maxillofacial fracture due to sports during the period of 15 years between 1977 and 1991. Eighty-nine patients were seen with injuries resulting from 21 different sports. The incidence of the fracture was most common in rugby, followed by ski, baseball and soccer. Males were shown to be more prone to maxillofacial fracture than females (5.4:1) and the highest incidence of injuries involved the 20-29 age group followed by the 10-19 age group. The major parts of the fracture were the mandible and the alveolar process. Conservative therapy such as maxillomandibular fixation was usually performed and the clinical course was good. It was suggested that the prevention of the sports-related fracture and the time of returning to sports after the fracture will require further study.

  17. [Topographological-anatomic changes in the structure of temporo-mandibular joint in case of fracture of the mandible condylar process at cervical level].

    PubMed

    Volkov, S I; Bazhenov, D V; Semkin, V A

    2011-01-01

    Pathological changes in soft tissues surrounding the fracture site as well as in the structural elements of temporo-mandibular joint always occured in condylar process fracture with shift at cervical mandibular jaw level. Other changes were also seen in the joint on the opposite normal side. Modelling of condylar process fracture at mandibular cervical level by means of three-dimensional computer model of temporo-mandibular joint contributed to proper understanding of this pathology emergence as well as to prediction and elimination of disorders arising in adjacent to the fracture site tissues.

  18. Double plate fixation for correction of the malunited distal ulna fracture: a case report.

    PubMed

    Bessho, Yuki; Okazaki, Masato; Nakamura, Toshiyasu

    2011-01-01

    A 62-year-old woman visited our hospital one year after a motor vehicle accident complaining of ulnar wrist pain and restricted pronation and supination. Radiographs showed a 35° angular deformity at the ulnar neck. Closing wedge osteotomy was performed using two plates for stabilization. Twenty-four months postoperatively, the osteotomy site united without correction loss and the patient gained adequate pronation and supination. To the best of our knowledge, this represents the first report of corrective osteotomy for the treatment of malunited ulnar neck fracture. Although salvage operations such as ulnar head resection and the Sauvé-Kapandji procedure may provide reasonable results, anatomical repair can be considered as an option. PMID:22072470

  19. Brodie's abscess following percutaneous fixation of distal radius fracture in a child.

    PubMed

    Rajakulendran, Karthig; Picardo, Natasha E; El-Daly, Ibraheim; Hussein, Rami

    2016-04-01

    We report the case of a Brodie's abscess presenting five and a half years following closed reduction and percutaneous pinning of a distal radius fracture. The index surgery was complicated by a pin site infection that was treated successfully with antibiotics. The patient represented with forearm pain years later, and radiological investigations revealed a Brodie's abscess in the distal radius at the site of the previous Kirschner wires. The Brodie's abscess was managed through surgical curettage and antibiotics. Staphylococcus aureus and diphtheroid organisms were cultured from the intraoperative specimens. A Brodie's abscess is a form of localised subacute osteomyelitis, which usually occurs in the metaphysis of long bones and can mimic malignancy. Previous trauma or surgery has been implicated as predisposing factors. We have only identified one previously reported case of Brodie's abscess following percutaneous pinning. Ours is the first reported case in an adolescent. The aim of this paper is to raise awareness of this rare complication and review the current literature.

  20. Prophylactic radiotherapy against heterotopic ossification following internal fixation of acetabular fractures: a comparative estimate of risk

    PubMed Central

    Nasr, P; Yip, G; Scaife, J E; House, T; Thomas, S J; Harris, F; Owen, P J; Hull, P

    2014-01-01

    Objective: Radiotherapy (RT) is effective in preventing heterotopic ossification (HO) around acetabular fractures requiring surgical reconstruction. We audited outcomes and estimated risks from RT prophylaxis, and alternatives of indometacin or no prophylaxis. Methods: 34 patients underwent reconstruction of acetabular fractures through a posterior approach, followed by a 8-Gy single fraction. The mean age was 44 years. The mean time from surgery to RT was 1.1 days. The major RT risk is radiation-induced fatal cancer. The International Commission on Radiological Protection (ICRP) method was used to estimate risk, and compared with a method (Trott and Kemprad) specifically for estimating RT risk for benign disease. These were compared with risks associated with indometacin and no prophylaxis. Results: 28 patients (82%) developed no HO; 6 developed Brooker Class I; and none developed Class II–IV HO. The ICRP method suggests a risk of fatal cancer in the range of 1 in 1000 to 1 in 10,000; the Trott and Kemprad method suggests 1 in 3000. For younger patients, this may rise to 1 in 2000; and for elderly patients, it may fall to 1 in 6000. The risk of death from gastric bleeding or perforation from indometacin is 1 in 180 to 1 in 900 in older patients. Without prophylaxis risk of death from reoperation to remove HO is 1 in 4000 to 1 in 30,000. Conclusion: These results are encouraging, consistent with much larger series and endorse our multidisciplinary management. Risk estimates can be used in discussion with patients. Advances in knowledge: The risk from RT prophylaxis is small, it is safer than indometacin and substantially overlaps with the range for no prophylaxis. PMID:25089852

  1. Return-to-Work Following Open Reduction and Internal Fixation of Proximal Humerus Fractures

    PubMed Central

    Dietrich, Michael; Wasmer, Mathias; Platz, Andreas; Spross, Christian

    2014-01-01

    Objectives : Shoulder disorders have an important impact on a patient’s capacity to work. We investigated whether there is a relationship between subjective or objective outcome measures and the ability and time for returning to work (RTW) after a proximal humerus fracture (PHF). Design : Retrospective single-centre study from March 2003 to June 2008. Setting : City hospital, trauma level one centre. Intervention : All PHF stabilized with a PHILOS®. Main Outcome Measurements : Routine follow-up examinations (X-ray, Constant-Murley Score (CMS), Short-Form 36 (SF-36)) were performed prospectively after 1.5, 3, 6 and 12 months or until RTW. Primary interest was the comparison of the outcome scores with the time needed for RTW. Results : 72 patients (52 years (22-64), 37 (51%) women) fulfilled the inclusion criteria. We distinguished “office-workers” (OW) (n = 49, 68%) from patients who worked at a physically demanding job (PW) (n = 23, 32%). Although time for RTW was fundamentally different (42 (OW) vs 118 days (PW), p<0.001), CMS (64.7 vs 64.1) and SF-36 (66.8 vs 69.9) at time of RTW were almost identical. At follow-up, CMS and SF-36 were always lower in the PW group. Conclusion : Jobs which require higher physical demands were likely to influence and to delay RTW. This study identifies cut off values for CMS and SF-36 at which a patient feels capable or willing to RTW after PHF. These values show the importance and impact of a patient’s occupation or demands on RTW. We were able to show, that besides age, sex and fracture, the type of occupation might alter the scores in postoperative outcomes. PMID:25246994

  2. Combined medial column primary arthrodesis, middle column open reduction internal fixation, and lateral column pinning for treatment of Lisfranc fracture-dislocation injuries.

    PubMed

    Boffeli, Troy J; Pfannenstein, Ryan R; Thompson, Jonathan C

    2014-01-01

    Lisfranc fracture-dislocation can be a devastating injury with significant long-term sequelae, including degenerative joint disease, progressive arch collapse, and chronic pain that can be potentiated if not effectively treated. We present a case to demonstrate our preferred surgical approach, consisting of combined medial column primary arthrodesis, middle column open reduction internal fixation, and lateral column pinning, with the primary goal of minimizing common long-term complications associated with Lisfranc injuries. We present the case of a typical patient treated according to this combined surgical approach to highlight our patient selection criteria, rationale, surgical technique, and operative pearls. A 36-year-old male who had sustained a homolateral Lisfranc fracture-dislocation injury after falling from a height initially underwent fasciotomy for foot compartment syndrome. The subsequent repair 16 days later involved primary first tarsometatarsal joint fusion, open reduction internal fixation of the second and third tarsometatarsal joints, and temporary pinning of the fourth and fifth tarsometatarsal joints. He progressed well postoperatively, exhibiting an American College of Foot and Ankle Surgeons forefoot score of 90 of 100 at 1 year after surgery with no need for subsequent treatment. Lisfranc fracture-dislocations often exhibit primary dislocation to the medial column and are conducive to arthrodesis to stabilize the tarsometatarsal complex. The middle column frequently involves comminuted intra-articular fractures and will often benefit from less dissection required for open reduction internal fixation instead of primary fusion. We propose that this surgical approach is a viable alternative technique for primary treatment of Lisfranc fracture-dislocation injuries.

  3. Internal Fixation Versus Nonoperative Treatment for Displaced 3-Part or 4-Part Proximal Humeral Fractures in Elderly Patients: A Meta-Analysis of Randomized Controlled Trials

    PubMed Central

    Li, Jing; Chen, Aimin

    2013-01-01

    Background A few studies focused on open reduction and internal fixation (ORIF) or nonoperative treatment of displaced 3-part or 4-part proximal humeral fractures in elderly patients have been published, all of whom had a low number of patients. In this meta-analysis of randomized controlled trials (RCTs), we aimed to assess the effect of ORIF or nonoperative treatment of displaced 3-part or 4-part proximal humeral fractures in elderly patients on the clinical outcomes and re-evaluate of the potential benefits of conservative treatment. Methods We searched PubMed and the Cochrane Central Register of Controlled Trials databases for randomized controlled trials comparing ORIF and nonoperative treatment of displaced 3-part or 4-part proximal humeral fractures in elderly patients. Our outcome measures were the Constant scores. Results: Three randomized controlled trials with a total of 130 patients were identified and analyzed. The overall results based on fixed-effect model did not support the treatment of open reduction and internal fixation to improve the functional outcome when compared with nonoperative treatment for treating elderly patients with displaced 3-part or 4-part proximal humeral fractures (WMD −0.51, 95% CI: −7.25 to 6.22, P = 0.88, I2 = 0%). Conclusions Although our meta-analysis did not support the treatment of open reduction and internal fixation to improve the functional outcome when compared with nonoperative treatment for treating elderly patients with displaced 3-part or 4-part proximal humeral fractures, this result must be considered in the context of variable patient demographics. Only a limited recommendation can be made based on current data. Considering the limitations of included studies, a large, well designed trial that incorporates the evaluation of clinically relevant outcomes in participants with different underlying risks of shoulder function is required to more adequately assess the role for ORIF or nonoperative

  4. The Retroacetabular Angle Determines the Safe Angle for Screw Placement in Posterior Acetabular Fracture Fixation

    PubMed Central

    Tadros, Ayman M. A.; Oxland, Thomas R.; O'Brien, Peter

    2013-01-01

    Introduction. A method for the determination of safe angles for screws placed in the posterior acetabular wall based on preoperative computed tomography (CT) is described. It defines a retroacetabular angle and determines its variation in the population. Methods. The retroacetabular angle is the angle between the retroacetabular surface and the tangent to the posterior acetabular articular surface. Screws placed through the marginal posterior wall at an angle equal to the retroacetabular angle are extraarticular. Medial screws can be placed at larger angles whose difference from the retroacetabular angle is defined as the allowance angles. CT scans of all patients with acetabular fractures treated in our institute between September 2002 to July 2007 were used to measure the retroacetabular angle and tangent. Results. Two hundred thirty one patients were included. The average (range) age was 42 (15–74) years. The average (range) retroacetabular angle was 39 (30–47) degrees. The average (range) retroacetabular tangent was 36 (30–45) mm. Conclusions. Placing the screws at an average (range) angle of 39 (33–47) degrees of anterior inclination with the retroacetabular surface makes them extraarticular. Angles for medial screws are larger. Safe angles can be calculated preoperatively with a computer program. PMID:24959359

  5. Undiagnosed Brodie abscess in a gymnast after surgical fixation of a tibial fracture

    PubMed Central

    Knaap, Simone F.C.

    2007-01-01

    Abstract Objective This study presents a case of a posttraumatic subacute osteomyelitis in a child with leg pain. Clinical Features A 10-year-old female gymnast with leg pain presented to a chiropractic clinic after having been treated over the previous year for a leg fracture. The patient had leg pain associated with prolonged use of her right leg, restlessness at night, and tenderness over the right tibia. The history did not suggest a mechanical cause of the patient's pain. All available radiographs were reviewed by the chiropractor; a diffuse lytic lesion with bone thickening and sclerosis was clearly visible in the area of the patient's chief complaint, representing a Brodie abscess. Intervention and Outcome The doctor of chiropractic sent the patient back to the hospital. She was treated first with oral antibiotics, which were not successful. She underwent surgery and recovered well. Conclusion Subacute osteomyelitis may have a diagnostic delay; thus, it is possible for a chiropractor to see this condition in the office. A good case history, examination, and radiographs are important for the diagnosis and to make a proper referral. PMID:19674711

  6. Biomechanics of humerus fracture fixation by locking, cortical, and hybrid plating systems in a cadaver model.

    PubMed

    Sutherland, George B; Creekmore, Tina; Mukherjee, Debi P; Ogden, Alan L; Anissian, Lucas; Marymont, John V

    2010-08-11

    The goal of this study was to discover how locking or cortical screws or a hybrid of both would perform in stabilizing a simulated humerus fracture. We simulated stripping of screw threads or poor bone quality by overdrilling the screw hole, and also studied a control group with no overdrilling. A total of 38 fresh frozen cadaver humeri were divided into 2 groups: 16 undergoing overdrilling with a drill bit 0.3 mm less than the diameter of the screw and 22 undergoing no overdrilling. A 4-point bending test followed torsional fatigue of 1000 cycles with an amplitude of +/-10 degrees. The post-fatigued samples were retested in the same way after tightening the loose screws if necessary. Finally, each fatigued specimen was tested for failure in torsion at 0.5 Hz by applying a maximum rotational displacement of 60 degrees .The bending stiffness values (Nm/mm) of cortical and locking screws, with the exception of the hybrid system, were significantly higher for the overdrilled group than the non-overdrilled (cortical, 6.9 vs 5.6; locking, 9.1 vs 6.3; hybrid, 8.4 vs 6.8). Fatigue had no effect on the bending stiffness of all the screw/plate systems (cortical, 6.9 vs 7.4; locking, 9.1 vs 8.8; hybrid, 8.5 vs 8.1). The overdrilling had no effect on the failure loads and displacements for all the screws except cortical screws, where the failure displacement was significantly higher for the overdrilling group. The torsional stiffness retentions after 1000 cycles were significantly different for overdrilled specimens in the cortical screws group only.Overdrilling had a minimal effect on bending and torsional properties. The results of the locking and hybrid were close, and the cortical screw had only slightly lower bending stiffness.

  7. Dynamic Hip Screw with Trochanteric Stablization Plate Fixation of Unstable Inter-Trochanteric Fractures: A Prospective Study of Functional and Radiological Outcomes

    PubMed Central

    Shetty, Ashwin; Sadasivan, Anand Kumar; Hegde, Anoop

    2016-01-01

    Introduction Management of unstable intertrochanteric fractures have posed a unique challenge to orthopaedicians over years. Several surgical techniques and implants have been developed for the same. Fractures of the lateral wall have been considered as the major cause of femoral medialization after fixation by Dynamic Hip Screw (DHS). Studies have shown that supplementation of trochanteric stabilization plate reduces the incidence of femoral medialization. Aim To assess the radiological union and hip function after fixation of unstable intertrochanteric fractures with DHS and Trochanteric Stabilization Plate (TSP). Materials and Methods A prospective study was conducted with a total of 32 patients between age groups of 30-70 years with Evan Jensen unstable and very unstable type of intertrochanteric fractures, between August 2013 to March 2015 in the Department of Orthopaedics ARS Hospital, Tirupur, Tamil Nadu, India. They underwent open reduction and DHS and TSP fixation. They were started on full weight bearing mobilization on post op day three. They were reviewed at post-op weeks 3,6,12 and 24. Hip mobilization and rehabilitation exercises were instituted during course of reviews. Radiographs were taken to assess fracture union and hip function was evaluated during follow-ups. At the end of 24 weeks, degree of radiographic union was scored as per Radiological Union Score for Hip (RUSH). Hip function was scored with Harris hip score. Analyses were done using frequency and proportions. Chi-square tests were used to assess the test of association. Results Fifteen patients had RUSH scores between 10-20 and 17 patients had scores between 20-30 points. RUSH score had mean of 21.03+/- 2.132 points. 9 of 32 patients had excellent results as per Harris hip score, 10 had good, nine had fair and four had poor. On comparison of Harris hip score with RUSH score: Interval between 10-20 points, of 15 patients; two had excellent results, five had good, five had fair and three

  8. Mandible and Tongue Development

    PubMed Central

    Parada, Carolina; Chai, Yang

    2016-01-01

    The tongue and mandible have common origins. They arise simultaneously from the mandibular arch and are coordinated in their development and growth, which is evident from several clinical conditions such as Pierre Robin sequence. Here, we review in detail the molecular networks controlling both mandible and tongue development. We also discuss their mechanical relationship and evolution as well as the potential for stem cell-based therapies for disorders affecting these organs. PMID:26589920

  9. Mandible and Tongue Development.

    PubMed

    Parada, Carolina; Chai, Yang

    2015-01-01

    The tongue and mandible have common origins. They arise simultaneously from the mandibular arch and are coordinated in their development and growth, which is evident from several clinical conditions such as Pierre Robin sequence. Here, we review in detail the molecular networks controlling both mandible and tongue development. We also discuss their mechanical relationship and evolution as well as the potential for stem cell-based therapies for disorders affecting these organs.

  10. Evaluation of in vitro resistance of titanium and resorbable (poly-L-DL-lactic acid) fixation systems on the mandibular angle fracture.

    PubMed

    Bregagnolo, L A; Bertelli, P F; Ribeiro, M C; Sverzut, C E; Trivellato, A E

    2011-03-01

    The purpose of this study was to compare, by mechanical in vitro testing, a 2.0-mm system made with poly-L-DL-lactide acid with an analogue titanium-based system. Mandible replicas were used as a substrate and uniformly sectioned on the left mandibular angle. The 4-hole plates were adapted and stabilized passively in the same site in both groups using four screws, 6.0mm long. During the resistance-to-load test, the force was applied perpendicular to the occlusal plane at three different points: first molar at the plated side; first molar at the contralateral side; and between the central incisors. At 1mm of displacement, no statistically significant difference was found. At 2mm displacement, a statistically significant difference was observed when an unfavourable fracture was simulated and the load was applied in the contralateral first molar and when a favourable fracture was simulated and the load was applied between the central incisors. At the failure displacement, a statistically significant difference was observed only when the favourable fracture was simulated and the load was applied on the first molar at the plated side. In conclusion, despite more failure, the poly-L-DL-lactic acid-based system was effective.

  11. Biomechanics of the mandible.

    PubMed

    van Eijden, T M

    2000-01-01

    In this review the biomechanical behavior of the mandibular bone tissue, and of the mandibular bone as a whole, in response to external loading is discussed. A survey is given of the determinants of mandibular stiffness and strength, including the mechanical properties and distribution of bone tissue and the size and shape of the mandible. Mandibular deformations, stresses, and strains that occur during static biting and chewing are reviewed. During biting and the powerstroke of mastication, a combination of sagittal bending, corpus rotation, and transverse bending occurs. The result is a complex pattern of stresses and strains (compressive, tensile, shear, torsional) in the mandible. To be able to resist forces and bending and torsional moments, not only the material properties of the mandible but also its geometrical design is of importance. This is reflected by variables like polar and maximum and minimum moments of inertia and the relative amount and distribution of bone tissue. In the longitudinal direction, the mandible is stiffer than in transverse directions, and the vertical cross-sectional dimension of the mandible is larger than its transverse dimension. These features enhance the resistance of the mandible to the relatively large vertical shear forces and bending moments that come into play in the sagittal plane.

  12. The treatment of condylar fractures: to open or not to open? A critical review of this controversy

    PubMed Central

    VALIATI, Renato; IBRAHIM, Danilo; ABREU, Marcelo Emir Requia; HEITZ, Claiton; de OLIVEIRA, Rogério Belle; PAGNONCELLI, Rogério Miranda; SILVA, Daniela Nascimento

    2008-01-01

    The treatment of condylar process fractures has generated a great deal of discussion and controversy in oral and maxillofacial trauma and there are many different methods to treat this injury. For each type of condylar fracture, the techniques must be chosen taking into consideration the presence of teeth, fracture height, patient's adaptation, patient's masticatory system, disturbance of occlusal function, deviation of the mandible, internal derangements of the temporomandibular Joint (TMJ) and ankylosis of the joint with resultant inability to move the jaw, all of which are sequelae of this injury. Many surgeons seem to favor closed treatment with maxillomandibular fixation (MMF), but in recent years, open treatment of condylar fractures with rigid internal fixation (RIF) has become more common. The objective of this review was to evaluate the main variables that determine the choice of method for treatment of condylar fractures: open or closed, pointing out their indications, contra-indications, advantages and disadvantages. PMID:18974859

  13. Heterotopic Ossification around the Knee after Internal Fixation of a Complex Tibial Plateau Fracture Combined with the Use of Demineralized Bone Matrix (DBM): A Case Report

    PubMed Central

    Nota, Sjoerd P.F.T.; Kloen, Peter

    2014-01-01

    Demineralized bone matrix has been successfully commercialized as an alternative bone graft material that not only can function as filler but also as an osteoinductive graft. Numerous studies have confirmed its beneficial use in clinical practice. Heterotopic ossification after internal fixation combined with the use of demineralized bone matrix has not been widely reported. In this paper we describe a 39 year old male who sustained a complex articular fracture that developed clinically significant heterotopic ossification after internal fixation with added demineralized bone matrix. Although we cannot be sure that there is a cause-and-effect relation between demineralized bone matrix and the excessive heterotopic ossification seen in our patient, it seems that some caution in using demineralised bone matrix in similar cases is warranted. Also, given the known inter- and intraproduct variability, the risks and benefits of these products should be carefully weighed. PMID:25692153

  14. The biomechanics of plate fixation of periprosthetic femoral fractures near the tip of a total hip implant: cables, screws, or both?

    PubMed

    Shah, S; Kim, S Y R; Dubov, A; Schemitsch, E H; Bougherara, H; Zdero, R

    2011-09-01

    Femoral shaft fractures after total hip arthroplasty (THA) remain a serious problem, since there is no optimal surgical repair method. Virtually all studies that examined surgical repair methods have done so clinically or experimentally. The present study assessed injury patterns computationally by developing three-dimensional (3D) finite element (FE) models that were validated experimentally. The investigation evaluated three different constructs for the fixation of Vancouver B1 periprosthetic femoral shaft fractures following THA. Experimentally, three bone plate repair methods were applied to a synthetic femur with a 5 mm fracture gap near the tip of a total hip implant. Repair methods were identical distal to the fracture gap, but used cables only (construct A), screws only (construct B), or cables plus screws (construct C) proximal to the fracture gap. Specimens were oriented in 15 degrees adduction to simulate the single-legged stance phase of walking, subjected to 1000 N of axial force, and instrumented with strain gauges. Computationally, a linearly elastic and isotropic 3D FE model was developed to mimic experiments. Results showed excellent agreement between experimental and FE strains, yielding a Pearson linearity coefficient, R2, of 0.92 and a slope for the line of best data fit of 1.06. FE-computed axial stiffnesses were 768 N/mm (construct A), 1023 N/mm (construct B), and 1102 N/mm (construct C). FE surfaces stress maps for cortical bone showed Von Mises stresses, excluding peaks, of 0-8 MPa (construct A), 0-15 MPa (construct B), and 0-20 MPa (construct C). Cables absorbed the majority of load, followed by the plates and then the screws. Construct A yielded peak stress at one of the empty holes in the plate. Constructs B and C had similar bone stress patterns, and can achieve optimal fixation. PMID:22070022

  15. Facial Fracture Management in Northwest Nigeria

    PubMed Central

    Taiwo, Abdurrazaq Olanrewaju; Soyele, Olujide Oladele; Godwin, Ndubuizi Ugochukwu; Ibikunle, Adebayo Aremu

    2013-01-01

    Background: Facial fracture is gradually become a public health problem in our community due to the attendant morbidity and mortality. Hence, the aim of this study was to determine the pattern of facial fracture in Dental and Maxillofacial Surgery Department of Usmanu Danfodiyo University Teaching Hospital. This cross-sectional study was undertaken to provide information regarding gender, age, etiology, and diagnosis of patients with maxillofacial fractures. Materials and Methods: A 1-year review of patients diagnosed and treated for facial fractures in Usmanu Danfodiyo University Teaching Hospital between January 2011 and December 2011. The diagnosis was based on radiographic data and clinical examination. The main analysis outcome measures were etiology, age, gender, site, and treatment. Data were organized and presented by means of descriptive statistics and Pearson's Chi-square test. The level of significance adopted was 5%. Results: A total of 40 patients were treated in this period. Over 95% were male, 81% were caused by road traffic crash (RTC) and 86.4% were in the 21-30 years group. Most patients (52%) had mandibular fractures, and the most common site was the body. Most patients with midfacial fractures had fractures of the zygomaticomaxillary region (36%), while fractures of the parasymphyseal region were more common in the mandible 156 (31%). The most common treatment for jaw fractures was mandibulomaxillary fixation (MMF). Stable zygomatic complex fractures were reduced (elevated) intraorally, and unstable ones were supported by antral packs. Conclusions: This study highlights facial fractures secondary to RTC as a serious public health problem in our environment. Preventive strategies remain the cheapest way to reduce direct and indirect costs of the sequelae of RTC. It also bring to the fore the necessity to shift to open reduction and internal fixation (ORIF) of fractures. PMID:24741422

  16. An Isolated Displaced Fracture of the Coracoid Process Treated with Open reduction and internal fixation - A Case Report and Review of Literature

    PubMed Central

    Archik, Shreedhar; Nanda, Saurav Narayan; Tripathi, Sanjay; Choudhari, Ashlesh; Rajadhyaksha, Harshada

    2016-01-01

    Introduction: Isolated coracoid fractures are rare and few scattered cases are reported in literature. Coracoid fractures can be missed and the treatment for coracoid process fractures is still controversial. The case presented here is of an isolated coracoid process fracture which was treated surgically. Case Report: A 15-years old male presented after 4 days of injury complaining of persistent pain in the right shoulder following a jerk during bowling. Physical examination revealed tenderness in the left shoulder. There was pain on abduction and external rotation. The neurovascular examination was normal. Osseous avulsion of the distal tip of the coracoid process was confirmed by CT and MRI. The short head of the biceps and coracobrachialis was attached to the avulsed tip, while the pectoralis minor was attached to the coracoid base. The case was managed by open reduction and fixation with a 3.5mm cannulated screw and washer. Conclusion: Isolated coracoid fracture is a rare entity causing impairment of upper limb movement. It can be diagnosed more accurately by MRI scan and CT scan. In case of young highly demanding individuals like athletes surgical management may be a better option as compared to conservative treatment to achieve early use of the extremity, good radiological union and clinical function.

  17. Treatment of reducible unstable fractures of the distal radius in adults: a randomised controlled trial of De Palma percutaneous pinning versus bridging external fixation

    PubMed Central

    2010-01-01

    Background At present, there is no conclusive evidence regarding the best treatment method for reducible unstable fractures of the distal radius. This study compared the effectiveness of two methods used in surgical treatment of such fractures: percutaneous pinning and external fixation. Methods We randomly allocated 100 patients into two groups treated surgically with modified De Palma percutaneous pinning and bridging external fixation. Independent but not blinded evaluators administered the DASH quality-of-life questionnaire at postoperative months 6 and 24, performed functional assessment of pain, range of motion, and palm grip strength, and radiographic examinations (volar and radial angle, and height of the radius) before the operation, immediately afterwards, and at 6 and 24 months postoperative. Modified De Palma percutaneous pinning patients used an above-elbow cast whereas external fixation group had unrestricted elbow motion after surgery. Patients who for any reason demonstrated treatment failure or required additional interventions were followed up and their results were included in the group into which these patients had initially been randomised according to the intention-to-treat principle. A significance level of 5% (alpha = 0.05). was used for all statistical tests, such that tests presenting a p-value less than 0.05 were considered statistically significant. Results Ninety one (58.8 mean age and 66 participants were female) were included in the final assessment at 24 months. The DASH questionnaire evaluation showed a statistically significant result favouring the De Palma group (mean difference = -7.1 p = 0.044) after six months, but this was not maintained at 24 months. There were no statistically differences between the groups with respect to palm grip strength. Analysis of the range-of-motion limitation index (uninjured side minus affected side motion of) showed a statistical difference (mean difference = 2.4 p = 0.043) favoring the external

  18. Open reduction and internal fixation of osteoporotic acetabular fractures through the ilio-inguinal approach: use of buttress plates to control medial displacement of the quadrilateral surface.

    PubMed

    Peter, Robin E

    2015-01-01

    The number of acetabular fractures in the geriatric population requiring open reduction and internal fixation is increasing. Fractures with medial or anterior displacement are the most frequent types, and via the ilio-inguinal approach buttress plates have proved helpful to maintain the quadrilateral surface or medial acetabular wall. Seven to ten hole 3.5 mm reconstruction plates may be used as buttress plates, placed underneath the usual pelvic brim plate. This retrospective study presents our results with this technique in 13 patients at a minimum follow-up of 12 months (average, 31 months). 85% of the patients had a good result. The early onset of post-traumatic osteoarthritis necessitated total hip arthroplasty in two patients (15%) at 12 and 18 months follow-up, respectively. This treatment option should be considered in the surgeon's armamentarium when fixing these challenging cases.

  19. Occult internal iliac arterial injury identified during open reduction internal fixation of an acetabular fracture: a report of two cases.

    PubMed

    Chaus, George W; Heng, Marilyn; Smith, Raymond M

    2015-07-01

    We present two cases of occult internal iliac arterial injury identified during operative reduction of a widely displaced posterior column posterior wall acetabular fracture. This complication was not recognised until reduction of the column fracture. There were no preoperative signs or symptoms indicative of a vascular injury. These cases emphasise the heightened awareness one must have when treating widely displaced posterior column fractures of the acetabulum, especially those fractures with extension into the greater sciatic notch, as previously formed clot can become dislodged and hemostasis lost. We also present management options when this complication occurs. We believe any surgeon treating acetabular fractures should be aware of this serious and potentially fatal complication.

  20. External Fixation: Principles and Applications.

    PubMed

    Bible, Jesse E; Mir, Hassan R

    2015-11-01

    The modularity and ease of application of modern external fixation has expanded its potential use in the management of fractures and other musculoskeletal conditions. In fracture care, it can be used for provisional and definitive fixation. Short-term provisional applications include "damage control" and periarticular fracture fixation. The risk:benefit ratio of added stability needs to be assessed with each fixator. Soft-tissue management is critical during pin insertion to lessen the risk of loosening and infection. Although provisional fixation is safe for early conversion to definitive fixation, several factors affect the timing of definitive surgery, including the initial injury, external fixator stability, infection, and the physiologic state of the patient. PMID:26306568

  1. Crown Preservation of the Mandibular First Molar Tooth Impacts the Strength and Stiffness of Three Non-Invasive Jaw Fracture Repair Constructs in Dogs

    PubMed Central

    Lothamer, Charles; Snyder, Christopher John; Duenwald-Kuehl, Sarah; Kloke, John; McCabe, Ronald P.; Vanderby, Ray

    2015-01-01

    Repairing mandibular body fractures presents unique challenges not encountered when repairing long bones. Large tooth roots and the presence of the inferior alveolar neurovascular bundle limit safe placement for many types of orthopedic implants. Use of non-invasive fracture repair methods have increasingly become popular and have proven safe and effective at achieving bone healing. Non-invasive fixation constructs have not been tested in dogs using cantilevered bending. Furthermore, non-invasive fracture repair constructs have not been tested at the location of a common fracture location – the mandibular first molar tooth (M1). The objectives of this study were to test the strength and stiffness of three non-invasive mandibular fracture repair constructs and to characterize the impact that tooth crown preservation has on fixation strength for fractures occurring at the M1 location. Specimens were assigned to three treatment groups: (1) composite only, (2) interdental wiring and composite (IWC), and (3) transmucosal fixation screw and composite. For each pair of mandibles, one mandible received crown amputation at the alveolar margin to simulate the effect of crown loss on fixation strength and stiffness. Regardless of the status of crown presence, IWC demonstrated the greatest bending stiffness and load to failure. With the crown removed, IWC was significantly stronger compared to other treatments. All fixation constructs were stiffer when the tooth crown was preserved. In fractures at this location, retaining the tooth crown of M1 significantly increases stiffness of interdental wiring with composite and transmucosal screw with composite constructs. If the crown of M1 was removed, IWC was significantly stronger than the other two forms of fixation. PMID:26664947

  2. A multicenter, prospective, randomized, controlled trial of open reduction--internal fixation versus total elbow arthroplasty for displaced intra-articular distal humeral fractures in elderly patients.

    PubMed

    McKee, Michael D; Veillette, Christian J H; Hall, Jeremy A; Schemitsch, Emil H; Wild, Lisa M; McCormack, Robert; Perey, Bertrand; Goetz, Thomas; Zomar, Mauri; Moon, Karyn; Mandel, Scott; Petit, Shirlet; Guy, Pierre; Leung, Irene

    2009-01-01

    We conducted a prospective, randomized, controlled trial to compare functional outcomes, complications, and reoperation rates in elderly patients with displaced intra-articular, distal humeral fractures treated with open reduction-internal fixation (ORIF) or primary semiconstrained total elbow arthroplasty (TEA). Forty-two patients were randomized by sealed envelope. Inclusion criteria were age greater than 65 years; displaced, comminuted, intra-articular fractures of the distal humerus (Orthopaedic Trauma Association type 13C); and closed or Gustilo grade I open fractures treated within 12 hours of injury. Both ORIF and TEA were performed following a standardized protocol. The Mayo Elbow Performance Score (MEPS) and Disabilities of the Arm, Shoulder and Hand (DASH) score were determined at 6 weeks, 3 months, 6 months, 12 months, and 2 years. Complication type, duration, management, and treatment requiring reoperation were recorded. An intention-to-treat analysis and an on-treatment analysis were conducted to address patients randomized to ORIF but converted to TEA intraoperatively. Twenty-one patients were randomized to each treatment group. Two died before follow-up and were excluded from the study. Five patients randomized to ORIF were converted to TEA intraoperatively because of extensive comminution and inability to obtain fixation stable enough to allow early range of motion. This resulted in 15 patients (3 men and 12 women) with a mean age of 77 years in the ORIF group and 25 patients (2 men and 23 women) with a mean age of 78 years in the TEA group. Baseline demographics for mechanism, classification, comorbidities, fracture type, activity level, and ipsilateral injuries were similar between the 2 groups. Operative time averaged 32 minutes less in the TEA group (P = .001). Patients who underwent TEA had significantly better MEPSs at 3 months (83 vs 65, P = .01), 6 months (86 vs 68, P = .003), 12 months (88 vs 72, P = .007), and 2 years (86 vs 73, P = .015

  3. Comparing the Knotless Tension Band and the Traditional Stainless Steel Wire Tension Band Fixation for Medial Malleolus Fractures: A Retrospective Clinical Study.

    PubMed

    Downey, Michael W; Duncan, Kyle; Kosmopoulos, Victor; Motley, Travis A; Carpenter, Brian B; Ogunyankin, Fadeke; Garrett, Alan

    2016-01-01

    The traditional stainless steel wire tension band (WTB) has been popularized for small avulsion fractures at the medial malleolus. Despite the tension band principle creating a stable construct, complications continue to arise utilizing the traditional stainless steel WTB with patients experiencing hardware irritation at the tension band site and subsequent hardware removal. Coupled with hardware irritation is fatigue failure with the wire. The goal of this investigation was to retrospectively compare this traditional wire technique to an innovative knotless tension band (KTB) technique in order to decrease costly complications. A total of 107 patients were reviewed with a minimum follow-up of 1 year. Outcome measures include descriptive data, fracture classification, results through economic costs, and fixation results (including hardware status, healing status, pain status, and time to healing). The KTB group had a 13% lower true cost as compared to the WTB group while the fixation results were equivocal for the measured outcomes. Our results demonstrate that the innovative KTB is comparable to the traditional WTB while offering a lower true cost, an irritation free reduction all without the frustration of returning to the operating room for additional hardware removal, which averages approximately to $8,288. PMID:27293969

  4. Comparing the Knotless Tension Band and the Traditional Stainless Steel Wire Tension Band Fixation for Medial Malleolus Fractures: A Retrospective Clinical Study

    PubMed Central

    Downey, Michael W.; Duncan, Kyle; Kosmopoulos, Victor; Motley, Travis A.; Carpenter, Brian B.; Ogunyankin, Fadeke; Garrett, Alan

    2016-01-01

    The traditional stainless steel wire tension band (WTB) has been popularized for small avulsion fractures at the medial malleolus. Despite the tension band principle creating a stable construct, complications continue to arise utilizing the traditional stainless steel WTB with patients experiencing hardware irritation at the tension band site and subsequent hardware removal. Coupled with hardware irritation is fatigue failure with the wire. The goal of this investigation was to retrospectively compare this traditional wire technique to an innovative knotless tension band (KTB) technique in order to decrease costly complications. A total of 107 patients were reviewed with a minimum follow-up of 1 year. Outcome measures include descriptive data, fracture classification, results through economic costs, and fixation results (including hardware status, healing status, pain status, and time to healing). The KTB group had a 13% lower true cost as compared to the WTB group while the fixation results were equivocal for the measured outcomes. Our results demonstrate that the innovative KTB is comparable to the traditional WTB while offering a lower true cost, an irritation free reduction all without the frustration of returning to the operating room for additional hardware removal, which averages approximately to $8,288. PMID:27293969

  5. Mesenchymal chondrosarcoma of mandible

    PubMed Central

    Majumdar, Sumit; Boddepalli, Rajyalakshmi; Uppala, Divya; Rao, A Kameswara

    2016-01-01

    Mesenchymal chondrosarcomas (MC) are rare and aggressive forms of chondrosarcoma. They are distinct tumors arising in unicentric or multicentric locations from both skeletal and extraskeletal tissues. The most affected region is the facial skeleton, especially the jaws. In this report, we present a case of MC primarily involving the mandible in a 60-year-old female patient. PMID:27721626

  6. Orthodontic-surgical treatment after posttraumatic bilateral condylectomy of the mandible in an adult patient.

    PubMed

    Belli, Evaristo; Matteini, Claudio; Incisivo, Veronica

    2003-01-01

    A posttraumatic open bite associated with a bird face is reported. Condylectomy was indicated in relation to the plurifragmentary fracture of the condyles with limitation of mandibular movement. Condylectomies were mandatory as a result of delayed maxillofacial surgical treatment, which was related to the poor general condition of the patient after trauma. Functional disorder recovery and aesthetic deformity correction were planned by a team approach between orthodontists and maxillofacial surgeons with the support of a logopedist for the postural-related muscle problems. The main practical and theoretical problems presented by the clinical case were a result of the need to restore the occlusal relations and to avoid recurrence of open bite in this patient. The patient presented a wide alteration of muscular function and a strength fibrotic retraction with alteration in the relationship between upper and lower jaws and retrusion of the mandible associated to open bite. Orthodontic treatment was carried with no impact on the upper and lower axis, avoiding orthodontic correction of the open bite. Surgery corrected both the open bite and the bird face by means of bilateral sagittal split osteotomies. Wiring of the mandibular osteotomies and intermaxillary fixation allowed positioning of the mandibular ramus bilaterally because of the fibrosis and muscular action-related forces without resulting in a similar rotation of the mandible with the risk of recurrence. Myotherapy and logopedic support minimized the risk of recurrence, improved reduction of muscular tension with the resolution of the lip incompetence, and allowed functional recovery of mandibular movements. PMID:12544222

  7. Anterior D-rod and titanium mesh fixation for acute mid-lumbar burst fracture with incomplete neurologic deficits: A prospective study of 56 consecutive patients

    PubMed Central

    Huang, Zhe-yuan; Ding, Zhen-qi; Liu, Hao-yuan; Fang, Jun; Liu, Hui; Sha, Mo

    2015-01-01

    Background: Anterior decompression and reconstruction have gained wide acceptance as viable alternatives for unstable mid-lumbar burst fracture, but there are no mid and long term prospective studies regarding clinical and radiologic results of mid-lumbar burst fractures. Materials and Methods: An Institutional Review Board-approved prospective study of 56 consecutive patients of mid-lumbar burst fractures with a load-sharing score of 7 or more treated with anterior plating was carried out. All patients were evaluated for radiologic and clinical outcomes. The fusion status, spinal canal compromise, segmental kyphotic angle (SKA), vertebral body height loss (VBHL), and adjacent segment degeneration was examined for radiologic outcome, whereas the American Spinal Injury Association scale, the visual analog scale (VAS), and the employment status were used for clinical evaluation. Results: The patients underwent clinical and radiologic followup for at least 5 years after the surgery. At the last followup, there was no case of internal fixation failure, adjacent segment degeneration, and other complications. Interbody fusion was achieved in all cases. The average fusion time was 4.5 months. No patient suffered neurological deterioration and the average neurologic recovery was 1.3 grades on final observation. Based on VAS pain scores, canal compromise, percentage of VBHL and SKA, the difference was statistically significant between the preoperative period and postoperative or final followup (P < 0.05). Results at postoperative and final followup were better than the preoperative period. However, the difference was not significant between postoperative and final followup (P > 0.05). Thirty-four patients who were employed before the injury returned to work after the operation, 15 had changed to less strenuous work. Conclusion: Good mid term clinicoradiological results of anterior decompression with D-rod and titanium mesh fixation for suitable patients with mid

  8. Biomechanics of the weakened mandible: use of image correlation analysis.

    PubMed

    Yachouh, J; Domergue, S; Hoarau, R; Loosli, Y; Goudot, P

    2013-10-01

    Uninterrupted resection of mandibular bone is often necessary during maxillofacial operations for cancer. This weakens the mandible, and increases the risk of fracture. To our knowledge no biomechanical analysis has been made of deformations and strains that occur during chewing if this happens, so we have made such an analysis of the weakened mandible using a new technique: image correlation. Five fresh explanted human mandibles were prepared with black and white lacquer, and placed in a loading device that allowed replication of a physiological biting exercise. Calibrated pieces of bone were resected from the right body of each mandible. Images of the mandibular surface were recorded by 2 cameras and analysed with an algorithm to correlate them, which allowed us to confirm the distribution of strain on the body of the mandible, and to focus on the weak points. Before the bone was resected, we noted tensile strains on the alveolar border of the body, and compressive strains on the basilar border. The intensity of the strains in the posterior angle of the resected bony area then increased, with reduction in the height of the bone until fracture. The orientation of the fracture line started at the lower posterior angle of the resection area and spread in a lower posterior direction until it reached the basilar border of the mandible. Image correlation is a new technique for the study of mandibular biomechanics that provides accurate measurements on a wide bony surface with high definition images and without modification of the structure. Its application to weakened mandible provided reliable images of modifications to strains during simulated biting exercises.

  9. Transpedicular vertebral body augmentation reinforced with pedicle screw fixation in fresh traumatic A2 and A3 lumbar fractures: comparison between two devices and two bone cements.

    PubMed

    Korovessis, Panagiotis; Vardakastanis, Konstantinos; Repantis, Thomas; Vitsas, Vasilios

    2014-07-01

    This retrospective study compares efficacy and safety of balloon kyphoplasty (BK) with calcium phosphate (Group A) versus KIVA implant with PMMA (Group B) reinforced with three vertebrae pedicle screw constructs for A2 and A3 single fresh non-osteoporotic lumbar (L1-L4) fractures in 38 consecutive age- and diagnosis-matched patient populations. Extracanal leakage of both low-viscosity PMMA and calcium phosphate (CP) as well as the following roentgenographic parameters: segmental kyphosis (SKA), anterior (AVBHr) and posterior (PVBHr) vertebral body height ratio, spinal canal encroachment (SCE) clearance, and functional outcome measures: VAS and SF-36, were recorded and compared between the two groups. All patients in both groups were followed for a minimum 26 (Group A) and 25 (Group B) months. Extracanal CP and PMMA leakage was observed in four (18 %) and three (15 %) vertebrae/patients of group A and B, respectively. Hybrid fixation improved AVBHr, SKA, SCE, but PVBHr only in group B. VAS and SF-36 improved postoperatively in the patients of both groups. Short-segment construct with the novel KIVA implant restored better than BK-fractured lumbar vertebral body, but this had no impact in functional outcome. Since there was no leakage difference between PMMA and calcium phosphate and no short-term adverse related to PMMA use were observed, we advice the use of PMMA in fresh traumatic lumbar fractures.

  10. Comparison of Primary Radial Head Replacement and ORIF (Open Reduction and Internal Fixation) in Mason Type III Fractures: A Retrospective Evaluation in 72 Elderly Patients

    PubMed Central

    Liu, Run; Liu, Pengcheng; Shu, Hexi; Gong, Jinpeng; Sun, Qi; Wu, Jiezhou; Nie, Xiaoyang; Yang, Yong; Cai, Ming

    2015-01-01

    Background The aim of this study was to compare radial head prosthesis replacement with open reduction and internal fixation (ORIF) in the surgical treatment of Mason type III radial head fractures in 72 elderly patients. Material/Methods Seventy-two elderly patients (mean age, 67.1±1.25 years, range, 62–81 years) with Mason type III radial head fractures were treated from January 2001 to June 2012. Of these, 37 cases received radial prosthesis and 35 cases were treated with ORIF. All patients were followed up for 10 to 15.6 months. Results Based on the elbow functional evaluation criteria score by Broberg and Morrey, 29 cases achieved excellent results, 7 were good, and 1 was fair in the replacement group. In the ORIF group, excellent results were seen in 24 cases, good in 9, and fair in 2. The rates of good or excellent results were 78.4% and 68.6% for prosthesis replacement patients and ORIF patients, respectively (P<0.05). The Visual Analogue Scores (VAS) for replacement and ORIF groups were 2.25 and 1.67, respectively (P<0.05). Conclusions The radial head prosthesis replacement method is a relatively better surgical approach than ORIF in the treatment of elderly patients with Mason type III radial head fractures. PMID:25567738

  11. Surgical Fixation of Sternal Fractures: Preoperative Planning and a Safe Surgical Technique Using Locked Titanium Plates and Depth Limited Drilling

    PubMed Central

    Schulz-Drost, Stefan; Oppel, Pascal; Grupp, Sina; Schmitt, Sonja; Carbon, Roman Th.; Mauerer, Andreas; Hennig, Friedrich F.; Buder, Thomas

    2015-01-01

    Different ways to stabilize a sternal fracture are described in literature. Respecting different mechanisms of trauma such as the direct impact to the anterior chest wall or the flexion-compression injury of the trunk, there is a need to retain each sternal fragment in the correct position while neutralizing shearing forces to the sternum. Anterior sternal plating provides the best stability and is therefore increasingly used in most cases. However, many surgeons are reluctant to perform sternal osteosynthesis due to possible complications such as difficulties in preoperative planning, severe injuries to mediastinal organs, or failure of the performed method. This manuscript describes one possible safe way to stabilize different types of sternal fractures in a step by step guidance for anterior sternal plating using low profile locking titanium plates. Before surgical treatment, a detailed survey of the patient and a three dimensional reconstructed computed tomography is taken out to get detailed information of the fracture’s morphology. The surgical approach is usually a midline incision. Its position can be described by measuring the distance from upper sternal edge to the fracture and its length can be approximated by the summation of 60 mm for the basis incision, the thickness of presternal soft tissue and the greatest distance between the fragments in case of multiple fractures. Performing subperiosteal dissection along the sternum while reducing the fracture, using depth limited drilling, and fixing the plates prevents injuries to mediastinal organs and vessels. Transverse fractures and oblique fractures at the corpus sterni are plated longitudinally, whereas oblique fractures of manubrium, sternocostal separation and any longitudinally fracture needs to be stabilized by a transverse plate from rib to sternum to rib. Usually the high convenience of a patient is seen during follow up as well as a precise reconstruction of the sternal morphology. PMID

  12. Free-hand versus novel specialised jig guidance for the passing of intramedullary wires in olecranon fracture fixation: a comparative study.

    PubMed

    Molony, Diarmuid C; Kennedy, Jim; Gheiti, Adrian; Mullett, J Hannan

    2011-04-01

    The treatment of olecranon fractures frequently involves the use of tension-band fixation. Although associated with high union rates, this method has a high incidence of morbidity associated with soft tissue compromise and limitation of range of movement requiring frequent re-operation for removal of metal. We describe the use of a simple jig to ensure intramedullary placement of longitudinal K-wires and compare the accuracy of placement of Kirschner (K)-wires using this device with the traditional free-hand method. We found the distance from the centre of the medullary canal, the range and standard deviations of K-wire positions to be significantly more precise when the jig was used. This has applications for the use of the device, both with standard metallic radio-opaque wires and potentially with bio-absorbable pins.

  13. Biomechanical stability of a volar locking-screw plate versus fragment-specific fixation in a distal radius fracture model.

    PubMed

    Cooper, Ellis O; Segalman, Keith A; Parks, Brent G; Sharma, Krishna M; Nguyen, Augustine

    2007-04-01

    Eight matched pairs of cadaveric radii were osteotomized by removing a 4-mm dorsal wedge of bone at the level of the sigmoid notch designed to simulate dorsal comminution. They were then fixed with either a volar locking-screw plate or fragment-specific fixation. All constructs underwent biomechanical testing in a custom-designed, custom-fabricated 4-point bending device. No statistically significant difference in stiffness was noted between the groups. Linear displacement and angulation at the osteotomy site were significantly less in the group with fragment-specific fixation at loads expected to be encountered during postoperative rehabilitation. Angulation at the osteotomy site was significantly less in the locking-screw plate group at higher loads.

  14. One-stage partial vertebrectomy, titanium mesh implantation and pedicle screw fixation in the treatment of thoracolumbar burst fractures through a posterior approach

    PubMed Central

    Liu, Yueju; Li, Guangbin; Dong, Tianhua; Zhang, Yingze; Li, Heng

    2014-01-01

    OBJECTIVE: To analyze the clinical results of a partial vertebrectomy with titanium mesh implantation and pedicle screw fixation using a posterior approach to reconstruct the spine in the treatment of thoracolumbar burst fractures. METHOD: From January 2006 to August 2008, 20 patients with severe thoracolumbar fractures were treated.For vertebral bodies associated with one injured intervertebral disk, subtotal vertebrectomy surgery and single-segment fusion were performed. For vertebral bodies with two injured adjacent intervertebral disks, partial vertebrectomy surgery and two-segment fusion were performed. RESULTS: All 20 patients were followed up for 12 to 24 months (average of 18 months). There were no complications such as wound infections, hemopneumothorax or abdominal infections in any of the patients. The neurological status of all of the patients was improved by at least one American Spinal Injury Association grade by the last follow-up. The anterior vertebral body height was an average of 50.77% before surgery, 88.51% after surgery and 87.86% at the last follow up; the sagittal Cobb angle was improved, on average, from 26.15° to 5.39° and was 5.90° at the last follow up. The percentage of spinal stenosis was improved, on average, from 26.07% to 4.93%° and was 6.15% at the last follow up. There were significant differences in the anterior vertebral body height pre- and post-surgery and in the sagittal Cobb angle and the percentage of spinal stenosis (p<0) in all patients. CONCLUSIONS: This surgical procedure is simple and can accomplish decompression, reduction, fixation and fusion of the spine in one stage. This approach could be widely used in orthopedics. PMID:25627991

  15. Acid-resistant calcium silicate-based composite implants with high-strength as load-bearing bone graft substitutes and fracture fixation devices.

    PubMed

    Wei, Chung-Kai; Ding, Shinn-Jyh

    2016-09-01

    To achieve the excellent mechanical properties of biodegradable materials used for cortical bone graft substitutes and fracture fixation devices remains a challenge. To this end, the biomimetic calcium silicate/gelatin/chitosan oligosaccharide composite implants were developed, with an aim of achieving high strength, controlled degradation, and superior osteogenic activity. The work focused on the effect of gelatin on mechanical properties of the composites under four different kinds of mechanical stresses including compression, tensile, bending, and impact. The evaluation of in vitro degradability and fatigue at two simulated body fluid (SBF) of pH 7.4 and 5.0 was also performed, in which the pH 5.0 condition simulated clinical conditions caused by bacterial induced local metabolic acidosis or tissue inflammation. In addition, human mesenchymal stem cells (hMSCs) were sued to examine osteogenic activity. Experimental results showed that the appropriate amount of gelatin positively contributed to failure enhancement in compressive and impact modes. The 10wt% gelatin-containing composite exhibits the maximum value of the compressive strength (166.1MPa), which is within the reported compressive strength for cortical bone. The stability of the bone implants was apparently affected by the in vitro fatigue, but not by the initial pH environments (7.4 or 5.0). The gelatin not only greatly enhanced the degradation of the composite when soaked in the dynamic SBF solution, but effectively promoted attachment, proliferation, differentiation, and formation of mineralization of hMSCs. The 10wt%-gelatin composite with high initial strength may be a potential implant candidate for cortical bone repair and fracture fixation applications. PMID:27254281

  16. More than 5-Year Follow-up Results of Two-Level and Three-Level Posterior Fixations of Thoracolumbar Burst Fractures with Load-Sharing Scores of Seven and Eight Points

    PubMed Central

    Park, Sub-Ri; Kim, Jung-Mook; Eun, Dong-Chan; Son, Eui-Young

    2016-01-01

    Background The development of pedicle screw-based posterior spinal instrumentation is recognized as one of the major surgical treatment methods for thoracolumbar burst fractures. However, the appropriate level in posterior segment instrumentation is still a point of debate. To assesses the long-term results of two-level and three-level posterior fixations of thoracolumbar burst fractures that have load-sharing scores of 7 and 8 points. Methods From January 1998 to May 2009, we retrospectively analyzed clinical and radiologic outcomes of 45 patients with thoracolumbar burst fractures of 7 and 8 points in load-sharing classification who were operated on using two-level posterior fixation (one segment above and one segment below: 28 patients, group I) or three-level posterior fixation (two segments above and one segment below: 17 patients, group II). Clinical results included the grade of the fracture using the Frankel classification, and the visual analog score was used to evaluate pain before surgery, immediately after surgery, and during follow-up period. We also evaluated pain and work status at the final follow-up using the Denis pain scale. Results In all cases, non-union or loosening of implants was not observed. There were two screw breakages in two-level posterior fixation group, but bony union was obtained at the final follow-up. There were no significant differences in loss of anterior vertebral body height, correction loss, or change in adjacent discs. Also, in clinical evaluation, there was no significant difference in the neurological deficit of any patient during the follow-up period. Conclusions In our study, two-level posterior fixation could be used successfully in selected cases of thoracolumbar burst fractures of 7 and 8 points in the load-sharing classification. PMID:26929802

  17. [Comparison of the Ender's nailing and Dynamic Hip Screw (DHS) fixation in the treatment of trochanteric fractures in elderly patients].

    PubMed

    Sliwka, Andrzej; Zgoda, Marcin; Górski, Radosław; Purski, Karol; Wasilewski, Piotr; Górecki, Andrzej

    2006-01-01

    The aim of this study was an evaluation which operative method of treatment: stabilisation with the Dynamic Hip Screw or with Ender's nails is less invasive procedure in elderly patients with trochanteric fractures. 100 consecutive patients with trochanteric fracture were enrolled into the study, of which 53 patients (49 women, 4 men; mean age 89 years) were stabilised intramedullarily with the use of Ender's nails and 47 patients (26 women, 21 men; mean age 76 years) were treated operatively with the use of Dynamic Hip Screw. The factors compared the mean length of hospital stay, the mean duration of the surgery, post-operative blood loss, early local and general complication rate and mortality in both groups. We took into account their general health and coexisting illnesses according to the American Society of Anesthesiologists (ASA) classification, type of fracture according to AO and Evan's classifications and the surgeon's experience. The mean duration of the surgery was 27 minutes longer in the case of DHS stabilisation. The complication rate was higher and the mean length of postoperative hospital stay was longer after Ender nailing. The mean blood loss: the drop in Red Blood Cells (RBC), Haematocrit (Ht) and the Mean Haemoglobin Concentration (Hb) was also higher in patients treated with the use of Ender nails. The mean rate of blood units that had to be transfused postoperatively was also higher in "Ender" group. The difference was statistically significant, especially in the group of patients treated as emergency procedure at the day of admission (p < 0.05). The operative treatment of trochanteric fractures in elderly patients with the use of DHS device showed to be a less invasive procedure in comparison to Ender nailing. In conclusion, the indications for this method of trochanteric fractures' treatment should be expanded, especially in the case of unstable fractures. PMID:17455526

  18. Functional outcomes and cost estimation for extra-articular and simple intra-articular distal radius fractures treated with open reduction and internal fixation versus closed reduction and percutaneous Kirschner wire fixation

    PubMed Central

    Dzaja, Ivan; MacDermid, Joy C.; Roth, James; Grewal, Ruby

    2013-01-01

    Background We sought to compare direct costs and clinical and radiographic outcomes for distal radius fractures (DRF) treated with open reduction internal fixation with volar locking plates (VLP) versus closed reduction and percutaneous pinning (CRPP). Methods We identified patients with AO-type A and C1 DRFs from a prospective database. Outcomes were assessed at 6 weeks and at 3, 6 and 12 months, and surgical care costs were estimated. Results Twenty patients were treated with CRPP and 24 with VLP. There were no significant differences in patient-rated wrist evaluation (PRWE) scores between the 2 groups at any time point (mean 16.2 ± 23.1 in the CRPP group v. 21.5 ± 23.6 in the VLP group, p = 0.91). Overall alignment was maintained in both groups; however, there was a greater loss of radial height over time with CRPP than VLP (0.97 mm v. 0.25 mm, p = 0.018). The mean duration of surgery was longer for VLP than CRPP (113.9 ± 39.5 min v. 86.5 ± 7.8 min, p = 0.029), but there were fewer clinic visits (5.2 ± 1.4 v. 7.8 ± 1.3, p < 0.001) and fewer radiographs (7.4 ± 2.7 v. 9 ± 2.4, p = 0.031). The total cost per case was greater for VLP than CRPP ($1637.27 v. $733.91). Conclusion Based on PRWE scores, VLPs did not offer any significant advantage over CRPP in patients with simple fracture types between 3 and 12 months, but they were much more costly. Whether VLP offers any functional advantage earlier in recovery, thereby justifying their expense, requires further investigation in the form of a prospective randomized trial with a detailed cost analysis. PMID:24284144

  19. A Novel Guidewire Aiming Device to Improve the Accuracy of Guidewire Insertion in Femoral Neck Fracture Surgery Using Cannulated Screw Fixation.

    PubMed

    Yin, Wenjing; Xu, Haitao; Xu, Peijun; Hu, Tu; An, Zhiquan; Zhang, Changqing; Sheng, Jiagen

    2016-01-01

    BACKGROUND The aim of this study was to improve the accuracy of guidewire insertion in the femoral neck fracture surgery using cannulated screw fixation. MATERIAL AND METHODS A novel aiming device was designed and manufactured. Between January 2010 and June 2012, 64 femoral neck fracture patients were included into the study. All 64 patients were divided into 2 groups randomly. The aiming device was used during the operation for patients in the experimental group, but not in the control group. RESULTS There were no statistically significant differences in operative time or bleed volume between the groups (P>0.05). The frequency of guidewire drilling was significantly lower in the experimental group than in the control group (P<0.05). The angle between the first cannulated screw and the central axis of the femoral neck in coronal plane and sagittal plane, and the distance between the bottom cannulated screw and the medial calcar femorale rim, were significantly smaller in the experimental group than in the control group (P<0.05). CONCLUSIONS The aiming device is simple in structure and easy to use. It could help surgeons to accurately insert cannulated screw guidewires. The aiming device is suitable for broad clinical use. PMID:27529374

  20. A Novel Guidewire Aiming Device to Improve the Accuracy of Guidewire Insertion in Femoral Neck Fracture Surgery Using Cannulated Screw Fixation

    PubMed Central

    Yin, Wenjing; Xu, Haitao; Xu, Peijun; Hu, Tu; An, Zhiquan; Zhang, Changqing; Sheng, Jiagen

    2016-01-01

    Background The aim of this study was to improve the accuracy of guidewire insertion in the femoral neck fracture surgery using cannulated screw fixation. Material/Methods A novel aiming device was designed and manufactured. Between January 2010 and June 2012, 64 femoral neck fracture patients were included into the study. All 64 patients were divided into 2 groups randomly. The aiming device was used during the operation for patients in the experimental group, but not in the control group. Results There were no statistically significant differences in operative time or bleed volume between the groups (P>0.05). The frequency of guidewire drilling was significantly lower in the experimental group than in the control group (P<0.05). The angle between the first cannulated screw and the central axis of the femoral neck in coronal plane and sagittal plane, and the distance between the bottom cannulated screw and the medial calcar femorale rim, were significantly smaller in the experimental group than in the control group (P<0.05). Conclusions The aiming device is simple in structure and easy to use. It could help surgeons to accurately insert cannulated screw guidewires. The aiming device is suitable for broad clinical use. PMID:27529374

  1. [Reduction and fixation of fractures of the neck of the radious be centro-medullary pinning. Original technic].

    PubMed

    Métaizeau, J P; Prévot, J; Schmitt, M

    1980-01-01

    Fractures of the neck of the radius may cause considerable permanent limitation of elbow and forearm movement. This complications resulted from failure to achieve adequate reduction or from vascular disturbance. The authors make use of a Kirschner wire introduced in the medullary canal by its lower end. It is possible to reduce and stabilise the head of the radius without open reduction. PMID:6447340

  2. Biomechanical analysis of the acetabular buttress-plate: are complex acetabular fractures in the quadrilateral area stable after treatment with anterior construct plate-1/3 tube buttress plate fixation?

    PubMed Central

    Wu, Yong-De; Cai, Xian-Hua; Liu, Xi-Ming; Zhang, Hong-Xi

    2013-01-01

    OBJECTIVE: The acetabular buttress-plate has been widely used in treating difficult cases with satisfying clinical results. However, the biomechanical properties of a postoperative acetabular fracture fixed by the buttress-plate are not clear. The purpose of this study was to evaluate the biomechanical properties of stability after the anterior tube buttress-plate fixation of complex acetabular fractures in the quadrilateral area. METHODS: A construct was proposed based on anterior construct plate - 1/3 tube buttress plate fixation for acetabular both-column fractures. Two groups of six formalin-preserved cadaveric pelvises were analyzed: (1) group A, the normal pelvis and (2) group B, anterior construct plate-1/3 tube buttress plate with quadrilateral area fixation. The displacements were measured, and cyclical loads were applied in both standing and sitting simulations. RESULTS: As the load was added, the displacements were Afixation provided a better stable construct for early sitting. The standing mode yielded more significant differences between the groups. Placing a 1/3 tube buttress-plate via an anterior approach is a novel method of providing quadrilateral area support in this setting. PMID:23917670

  3. [Experience of systematization on the treatment of patients with upper jaws fractures, during the period 1991-2000].

    PubMed

    Khinkov, D

    2005-01-01

    A retrospecive analysis was done of the 128 patients with fractures in a upper jaw, treated during the period 1991-2000. The treatment of the patients with partial fractures in a alveolar part of maxilla and frontal wall of maxillary sinus, consist of debridement on the open wound, primery stiched and stabilization by arch bar of perspective teeth. In the cases with fractures of tuber maxilla and opening of maxillary sinus they tray to clouse it by Rhermann technique, with or without radical antrothomy by Caldwell-Luc technique. On the patients by total upper jaw fractures they try lead by princip of duble stage fixation: from one side-of intact upper bone structures and the other side-on a mandible. On the cases of upper jaw fractures, combine with barain traums. was treated conservativly - the specialize treatment of facial injures was postpoun until stabilization of brain status.

  4. Flap reconstruction for soft-tissue defects with exposed hardware following deep infection after internal fixation of ankle fractures.

    PubMed

    Ovaska, Mikko T; Madanat, Rami; Tukiainen, Erkki; Pulliainen, Lea; Sintonen, Harri; Mäkinen, Tatu J

    2014-12-01

    The aim of the present study was to determine the outcome for patients treated with flap reconstruction following deep ankle fracture infection with exposed hardware. Out of 3041 consecutive ankle fracture operations in 3030 patients from 2006 to 2011, we identified 56 patients requiring flap reconstruction following deep infection. Thirty-two of these patients could be examined at a follow-up visit. Olerud-Molander Ankle (OMA) score, 15D score, Numeric Rating Scale (NRS), and clinical examination were used to assess the outcome. A total of 58 flap reconstructions were performed in 56 patients with a mean age of 57 years (range 25–93 years) and mean follow-up time of 52 months. The most commonly used reconstruction was a distally based peroneus brevis muscle flap with a split-thickness skin graft. A microvascular free flap was required in only one patient. 22 (39%) patients required subsequent surgical interventions because of a flap-related complication. With flap reconstruction, hardware could eventually be salvaged in 53% of patients with a non-consolidated fracture. The mean OMA score was fair or poor in 53% of the patients, and only 56% had recovered their pre-injury level of function. Half of the patients had shoe wear limitations. The 15D score showed a significantly poorer health-related quality of life compared to an age-standardised sample of the general population. The mean pain NRS was 2.1 (range 0–6), and the mean satisfaction NRS was 6.6 (range 0–10). Our study showed that successful treatment of a soft-tissue defect with exposed hardware following ankle fracture infections can be achieved with local flaps. Despite eventual reconstructive success, complications are common. Patients perceive a poorer health-related quality of life, have shoe wear limitations, and only half of them achieve their pre-injury level of function. PMID:25458066

  5. EVALUATION OF PATIENTS UNDERGOING FIXATION OF DIAPHYSEAL HUMERAL FRACTURES USING THE MINIMALLY INVASIVE BRIDGE-PLATE TECHNIQUE

    PubMed Central

    Superti, Mauro José; Martynetz, Fábio; Falavinha, Ricardo Sprenger; Fávaro, Rodrigo Caldonazzo; Boas, Luis Felipe Villas; Filho, Salim Mussi; Martynetz, Juliano; Ribas, Bruno

    2015-01-01

    Objective: The aim was to describe the experience of our group in treating humeral shaft fractures using the bridge–plate technique via an anterior approach. Methods: Seventeen patients with acute diaphyseal humeral fractures with an indication for surgical treatment who were operated in 2006–2010 were evaluated. The AO and Gustilo & Anderson classifications were used. All the patients were operated using the anterior bridge-plate technique and completed a follow–up period of at least twelve months. Results: Sixteen men and one woman were treated. Their mean age was 31.8 years (18–52). Among the injury mechanisms found were: five motorcycle accidents, four car accidents, three fractures due to firearm projectiles, two falls to the ground and finally, with one case each, assault, crushing and being run over. Eight patients had open fractures: two grade I, one grade II, four grade IIIa and one grade IIIb, according to the Gustilo-Anderson classification. In relation to the AO classification, we found: one 12A1, three 12A2, four 12A3, one 12B1, four 12 B2, three 12B3 and one 12C2. The mean postoperative follow-up was 25 months (12–48). As complications, two patients had pain in the elbow and a ROM deficit and one had deep infection. The mean time taken to achieve consolidation was 17.5 weeks. There was no loss of reduction, pseudarthrosis or malunion in this series of patients. Conclusion: The authors believe that the technique described has low rates of complications and morbidity, with good initial results, although the series is limited by the small sample. PMID:27042639

  6. Percutaneous K-Wire Fixation for Femur Shaft Fractures in Children: A Treatment Concepts for Developing Countries

    PubMed Central

    Sahu, RL

    2013-01-01

    Background: Fractures shaft femur is a major cause of morbidity and mortality in patients with lower extremity injuries. Aims: The aim of this study was to evaluate the efficacy of intramedullary Kirschner wires for the treatment of femoral shaft fracture in children. Subjects and Methods: This prospective study was conducted in the Department of Orthopaedic surgery in M. M. Medical College from June 2005 to June 2010. Sixty eight children with a mean age of 7.7 years (range, 2-14 years) were recruited from Emergency and out patient department having closed fracture of femoral shaft. All patients were operated under general anesthesia. All patients were followed for twelve months. Results: Out of sixty eight patients, sixty four patients underwent union in 42 to 70 days with a mean of 56 days. Touch down weight bearing was started on 2nd post-operative day. Complications found in four patients who had insignificant delayed union which were united next three weeks. Intramedullary Kirschner-wires were removed after an average of five months without any complications. The results were excellent in 94.1% (64/68) and good in 5.8% (4/68). Conclusion: This technique is simple, quick to perform, safe and reliable and avoids prolonged hospitalization with good results and is economical. PMID:23919189

  7. Fixation using alternative implants for the treatment of hip fractures (FAITH): design and rationale for a multi-centre randomized trial comparing sliding hip screws and cancellous screws on revision surgery rates and quality of life in the treatment of femoral neck fractures

    PubMed Central

    2014-01-01

    Background Hip fractures are a common type of fragility fracture that afflict 293,000 Americans (over 5,000 per week) and 35,000 Canadians (over 670 per week) annually. Despite the large population impact the optimal fixation technique for low energy femoral neck fractures remains controversial. The primary objective of the FAITH study is to assess the impact of cancellous screw fixation versus sliding hip screws on rates of revision surgery at 24 months in individuals with femoral neck fractures. The secondary objective is to determine the impact on health-related quality of life, functional outcomes, health state utilities, fracture healing, mortality and fracture-related adverse events. Methods/Design FAITH is a multi-centre, multi-national randomized controlled trial utilizing minimization to determine patient allocation. Surgeons in North America, Europe, Australia, and Asia will recruit a total of at least 1,000 patients with low-energy femoral neck fractures. Using central randomization, patients will be allocated to receive surgical treatment with cancellous screws or a sliding hip screw. Patient outcomes will be assessed at one week (baseline), 10 weeks, 6, 12, 18, and 24 months post initial fixation. We will independently adjudicate revision surgery and complications within 24 months of the initial fixation. Outcome analysis will be performed using a Cox proportional hazards model and likelihood ratio test. Discussion This study represents major international efforts to definitively resolve the treatment of low-energy femoral neck fractures. This trial will not only change current Orthopaedic practice, but will also set a benchmark for the conduct of future Orthopaedic trials. Trial registration The FAITH trial is registered at ClinicalTrials.gov (Identifier NCT00761813). PMID:24965132

  8. Actinomycotic Osteomyelitis of Mandible.

    PubMed

    Abbaszadeh, Hamid; Sheibani, Mohammad Sina Arab

    2016-07-01

    Actinomycosis is an infection of filamentous, gram-positive anaerobic bacteria. Actinomycosis of jaw bone is rare and the diagnosis is often difficult. The aim of this patient report is to present an actinomycotic osteomyelitis of mandible in a 30-year-old male patient. The patient presented with a chief complaint of pain and unhealed dental socket after mandibular teeth extractions. Radiographs showed ill-defined radiolucencies and perforation of buccal and lingual cortical plate; several biopsies and different therapy could not improve the lesion because of fault diagnosis and improper treatment. Finally, the authors' histopathological examination revealed granulation tissue surrounded bacterial colonies compatible with actinomycotic colonies. Follow-up examinations showed that the patient was well 6 months after prolonged treatment without any pain and discharge from dental socket. PMID:27391512

  9. A Novel Murine Model of Established Staphylococcal Bone Infection in the Presence of a Fracture Fixation Plate to Study Therapies Utilizing Antibiotic-laden Spacers after Revision Surgery

    PubMed Central

    Inzana, Jason A.; Schwarz, Edward M.; Kates, Stephen L.; Awad, Hani A.

    2014-01-01

    Mice are the small animal model of choice in biomedical research due to the low cost and availability of genetically engineered lines. However, the devices utilized in current mouse models of implant-associated bone infection have been limited to intramedullary or trans-cortical pins, which are not amenable to treatments involving extensive debridement of a full-thickness bone loss and placement of a segmental antibiotic spacer. To overcome these limitations, we developed a clinically faithful model that utilizes a locking fracture fixation plate to enable debridement of an infected segmental bone defect (full-thickness osteotomy) during a revision surgery, and investigated the therapeutic effects of placing an antibiotic-laden spacer in the segmental bone defect. To first determine the ideal time point for revision following infection, a 0.7 mm osteotomy in the femoral mid-shaft was stabilized with a radiolucent PEEK fixation plate. The defect was inoculated with bioluminescent Staphylococcus aureus, and the infection was monitored over 14 days by bioluminescent imaging (BLI). Osteolysis and reactive bone formation were assessed by X-ray and micro-computed tomography (micro-CT). The active bacterial infection peaked by 5 days post-inoculation, however the stability of the implant fixation became compromised by 10–14 days post-inoculation due to osteolysis around the screws. Thus, day 7 was defined as the ideal time point to perform the revision surgery. During the revision surgery, the infected tissue was debrided and the osteotomy was widened to 3 mm to place a poly-methyl methacrylate spacer, with or without vancomycin. Half of the groups also received systemic vancomycin for the remaining 21 days of the study. The viable bacteria remaining at the end of the study were measured using colony forming unit assays. Volumetric bone changes (osteolysis and reactive bone formation) were directly measured using micro-CT image analysis. Mice that were treated with

  10. Evaluation of the Accuracy of Computer-Guided Mandibular Fracture Reduction.

    PubMed

    el-Gengehi, Mostafa; Seif, Sameh A

    2015-07-01

    The aim of the current study was to evaluate the accuracy of computer-guided mandibular fracture reduction. A total of 24 patients with fractured mandible were included in the current study. A preoperative cone beam computed tomography (CBCT) scan was performed on all of the patients. Based on CBCT, three-dimensional reconstruction and virtual reduction of the mandibular fracture segments were done and a virtual bone borne surgical guide was designed and exported as Standard Tessellation Language file. A physical guide was then fabricated using a three-dimensional printing machine. Open reduction and internal fixation was done for all of the patients and the fracture segments were anatomically reduced with the aid of the custom-fabricated surgical guide. Postoperative CBCT was performed after 7 days and results of which were compared with the virtually reduced preoperative mandibular models. Comparison of values of lingula-sagittal plane, inferior border-sagittal plane, and anteroposterior measurements revealed no statistically significant differences between the virtual and the clinically reduced CBCT models. Based on the results of the current study, computer-based surgical guide aid in obtaining accurate anatomical reduction of the displaced mandibular fractured segments. Moreover, the computer-based surgical guides were found to be beneficial in reducing fractures of completely and partially edentulous mandibles.

  11. Repair of Bovine and Equine Mandibular Fractures

    PubMed Central

    Murch, K. M.

    1980-01-01

    Clinical findings, surgical repair and postsurgical care of a unilateral fracture of the mandible of a bull and of a bilateral mandibular fracture in a horse are described. Compression plating limited the pain suffered by the animals and resulted in a quick return to function of the mandibles. ImagesFigure 1.Figure 1.Figure 3.Figure 4.Figure 5.Figure 6. PMID:7363268

  12. [A new type of emergency trauma fracture external fixator--the development of spraying dextran-based polyurethane external splints].

    PubMed

    Miao, Jianyun; Lian, Kejian; Liu, Hui; Lin, Kunshan; Ding, Zhenqi; Linbin; Zhai, Wenliang

    2012-01-01

    A new production method of spraying dextran-based polyurethane external splints is introduced in this paper. The main raw material components are polymethylene polyisocyanate (PAPI), mixed with surfactants, acetone, soluble starch, catalyst, and so on. The splint is used for temporary fixing after fracture, with small size, light weight, easy portability, fine air perviousness, completely transparent to the X-ray. It also needs a shorter fixed operating time. It can not only fix quickly and effectively the vertebral column and limbs, but also significantly shorten the time of pre-hospital care. PMID:22571158

  13. [The characteristics of the technical instrumental support for the osteosynthesis of femoral neck fractures using the Seppo fixator].

    PubMed

    Mel'tser, R I; Oshukova, S M; Ivanova, I U; Dudanov, I P

    1997-01-01

    Operative treatment of fractures of the femur neck is the method of choice. The authors prefer the A. Seppo construction out of great number of fixtures but it is difficult to introduce and remove this fixture due to its complexity. To make the procedure of such interventions easier the authors propose a marking device, a screwdriver and a device allowing the fixture's curvature to be regulated. The modification of the technique and using a specially developed extractor is explained by difficulties in removing the fixture by common methods. The variant of the improved instrumental tooling proposed by the authors makes the operation more handy and practicable.

  14. Fractures

    PubMed Central

    Hall, Michael C.

    1963-01-01

    Recent studies on the epidemiology and repair of fractures are reviewed. The type and severity of the fracture bears a relation to the age, sex and occupation of the patient. Bone tissue after fracture shows a process of inflammation and repair common to all members of the connective tissue family, but it repairs with specific tissue. Cartilage forms when the oxygen supply is outgrown. After a fracture, the vascular bed enlarges. The major blood supply to healing tissue is from medullary vessels and destruction of them will cause necrosis of the inner two-thirds of the cortex. Callus rapidly mineralizes, but full mineralization is achieved slowly; increased mineral metabolism lasts several years after fracture. PMID:13952119

  15. Metatarsal fractures.

    PubMed

    Rammelt, Stefan; Heineck, Jan; Zwipp, Hans

    2004-09-01

    Metatarsal fractures are relatively common and if malunited, a frequent source of pain and disability. Nondisplaced fractures and fractures of the second to fourth metatarsal with displacement in the horizontal plane can be treated conservatively with protected weight bearing in a cast shoe for 4-6 weeks. In most displaced fractures, closed reduction can be achieved but maintenance of the reduction needs internal fixation. Percutaneous pinning is suitable for most fractures of the lesser metatarsals. Fractures with joint involvement and multiple fragments frequently require open reduction and plate fixation. Transverse fractures at the metaphyseal-diaphyseal junction of the fifth metatarsal ("Jones fractures") require an individualized approach tailored to the level of activity and time to union. Avulsion fractures of the fifth metatarsal bone are treated by open reduction and tension-band wiring or screw fixation if displaced more than 2 mm or with more that 30% of the joint involved. The metatarsals are the most common site of stress fractures, most of which are treated nonoperatively. Symptomatic posttraumatic deformities need adequate correction, in most cases by osteotomy across the former fracture site.

  16. Assessment of the influence of Laser phototherapy on the bone repair process of complete fractures in tibiae of rabbits stabilized with semi-rigid internal fixation treated with or without MTA graft: a histological study

    NASA Astrophysics Data System (ADS)

    Soares, Luiz G. P.; Silva, Aline C. P.; Silva, Anna Paula L. T.; Neves, Bruno Luiz R. C.; Santos, Nicole R. S.; dos Santos, Jean N.; Pinheiro, Antonio L. B.

    2016-03-01

    Beside biomaterials, Laser phototherapy has shown positive effects as auxiliary therapy in bone repair process, especially when involving large bone losses. The aim of this histological study was to evaluate, by light microscopy, the influence of laser phototherapy on the repair of complete tibial fractures in rabbits treated or not with semi-rigid internal fixation and Mineral Trioxide Aggregate - MTA graft. Twelve Rabbits were randomly divided into four groups with three animals each. After general anesthesia, complete fractures were created in one tibia with a carborundum disk. All animals (groups I-IV) had the fracture stabilized with semi-rigid fixation (wire osteosynthesis - WO). Group I was routinely fixed with WO; groups II and IV fracture was filled by blood clot and MTA implant. In Groups III and IV fracture was filled by blood clot and further irradiated with laser (λ780 nm, 70 mW, CW, Φ = 0.04 cm2, 20.4 J/cm2, per session, t = 300s, 142.8 J/cm2 per treatment). The phototherapy protocol was applied immediately after the surgery and repeated each 48 hours during 15 days. Animal death occurred on the 30th postoperative day. After removal of the specimens, the samples were routinely processed, stained with HE and evaluated by light microscopy. Histologically, the group treated with MTA graft and irradiated with laser showed the fracture filled by a more organized and mature trabecular bone, when compared with all other groups. From the results of the present study, it may be concluded that the association of Laser phototherapy + MTA graft in fractures treated with WO improved bone repair when compared with fractures treated only with WO.

  17. Management of the edentulous/atrophic mandibular fracture.

    PubMed

    Aziz, Shahid R; Najjar, Talib

    2009-03-01

    Edentulous or atrophic mandible fractures are rare and potentially problematic for the oral and maxillofacial surgeon. With the loss of teeth, atrophy of the alveolar bony apparatus ensues, creating a mandible more prone to fracture. This article describes the management of edentulous/atrophic mandibular fractures.

  18. Onset of mandible and tibia osteoradionecrosis – a comparative pilot study in the rat

    PubMed Central

    Damek-Poprawa, Monika; Both, Stefan; Wright, Alexander C.; Maity, Amit; Akintoye, Sunday O.

    2012-01-01

    Objectives Osteoradionecrosis (ORN) is common in the jaws following radiotherapy. We hypothesized that mandible is more susceptible to ORN than tibia based on site-disparity in hypoxic-hypocellular-hypovascular tissue breakdown. Study Design Twelve rats received 50 Gy irradiation to mandible or tibia; 4 of 12 rats further received minor surgical trauma to the irradiated sites. Structural and cellular skeletal changes were assessed with computer tomography, histology and immunostaining. Results Mandible developed ORN with 70% mean bone loss 10 weeks post-irradiation (p < 0.05) while tibia was structurally and radiological intact for 20 weeks post-irradiation. Hypocellularity, hypoxia and oxidative stress were higher in irradiated mandible (p < 0.001) than tibia (p < 0.01) but vascular damage was similar at both skeletal sites. Combined effects of radiation and minor trauma promoted mandibular alveolar bone loss and tibial fracture Conclusion ORN has a more rapid onset in mandible relative to tibia in the rat PMID:23254371

  19. Fractures

    MedlinePlus

    ... commonly happen because of car accidents, falls, or sports injuries. Other causes are low bone density and osteoporosis, which cause weakening of the bones. Overuse can cause stress fractures, which are very small cracks in the ...

  20. Displaced patella fractures.

    PubMed

    Della Rocca, Gregory J

    2013-10-01

    Displaced patella fractures often result in disruption of the extensor mechanism of the knee. An intact extensor mechanism is a requirement for unassisted gait. Therefore, operative treatment of the displaced patella fracture is generally recommended. The evaluation of the patella fracture patient includes examination of extensor mechanism integrity. Operative management of patella fractures normally includes open reduction with internal fixation, although partial patellectomy is occasionally performed, with advancement of quadriceps tendon or patellar ligament to the fracture bed. Open reduction with internal fixation has historically been performed utilizing anterior tension band wiring, although comminution of the fracture occasionally makes this fixation construct inadequate. Supplementation or replacement of the tension band wire construct with interfragmentary screws, cerclage wire or suture, and/or plate-and-screw constructs may add to the stability of the fixation construct. Arthrosis of the patellofemoral joint is very common after healing of patella fractures, and substantial functional deficits may persist long after fracture healing has occurred.

  1. Anterograde Fixation Module for Posterior Acetabular Column Fracture: Computer-Assisted Determination of Optimal Entry Point, Angle, and Length for Screw Insertion

    PubMed Central

    Xu, Yongqiang; Lin, Chuangxin; Zhang, Lifeng; Lin, Miaoxiong; Lai, Jianqiang; Cao, Shenglu; Peng, Geng; Feng, Kai; Yan, Ge; Cai, Daozhang; Wang, Gang

    2016-01-01

    Background The aim of this study was to provide valid data for a plate-screw fixation model for fractured posterior-anterior columns of the acetabulum. Material/Methods Nineteen cadaveric bony hemi-pelvis specimens were obtained and 50 healthy adults were enrolled. The modified Stoppa approach and computed tomography (CT) imaging were used to collect the measured parameter data of the module. Results The measured parameter data were as follows: OP, 0.96±0.32 cm in females and 0.92±0.16 cm in males (P>0.05); PI, 0.98±0.28 cm in females, and 0.75±0.23 cm in males (P>0.05); ∠θ, 59.68°±6.28° in females and 56.75°±3.22° in males (P>0.05); and ∠ϕ, 41.27°±2.76° in females and 34.31°±2.78° in males (P<0.05). The corresponding CT image data were as follows: PI, 1.08±0.22 cm in females and 0.85±0.27 cm in males (P>0.05); OP, 1.06±0.29 cm in females and 1.12±0.24 cm in males (P>0.05); ∠θ, 55.33°±4.00° in females and 55. 50°±3.43° in males (P>0.05); and ∠ϕ was 39.21°±2.45°in females and 35.58°±2.31°in males (P<0.05). No significant difference with respect to sex and side existed between specimens and healthy adults (P>0.05). Conclusions The measured parameter data obtained in healthy adults and cadaveric specimens provided an anatomic basis for the designation of the guide module, and thus confirmed the accuracy and safety of screw placement in fractured columns of the acetabulum. PMID:27584820

  2. Anterograde Fixation Module for Posterior Acetabular Column Fracture: Computer-Assisted Determination of Optimal Entry Point, Angle, and Length for Screw Insertion.

    PubMed

    Xu, Yongqiang; Lin, Chuangxin; Zhang, Lifeng; Lin, Miaoxiong; Lai, Jianqiang; Cao, Shenglu; Peng, Geng; Feng, Kai; Yan, Ge; Cai, Daozhang; Wang, Gang

    2016-01-01

    BACKGROUND The aim of this study was to provide valid data for a plate-screw fixation model for fractured posterior-anterior columns of the acetabulum. MATERIAL AND METHODS Nineteen cadaveric bony hemi-pelvis specimens were obtained and 50 healthy adults were enrolled. The modified Stoppa approach and computed tomography (CT) imaging were used to collect the measured parameter data of the module. RESULTS The measured parameter data were as follows: OP, 0.96±0.32 cm in females and 0.92±0.16 cm in males (P>0.05); PI, 0.98±0.28 cm in females, and 0.75±0.23 cm in males (P>0.05); Ðϴ, 59.68°±6.28° in females and 56.75°±3.22° in males (P>0.05); and Ðφ, 41.27°±2.76° in females and 34.31°±2.78° in males (P<0.05). The corresponding CT image data were as follows: PI, 1.08±0.22 cm in females and 0.85±0.27 cm in males (P>0.05); OP, 1.06±0.29 cm in females and 1.12±0.24 cm in males (P>0.05); Ðϴ, 55.33°±4.00° in females and 55. 50°±3.43° in males (P>0.05); and Ðφ was 39.21°±2.45°in females and 35.58°±2.31°in males (P<0.05). No significant difference with respect to sex and side existed between specimens and healthy adults (P>0.05). CONCLUSIONS The measured parameter data obtained in healthy adults and cadaveric specimens provided an anatomic basis for the designation of the guide module, and thus confirmed the accuracy and safety of screw placement in fractured columns of the acetabulum. PMID:27584820

  3. A laboratory investigation to assess the influence of cement augmentation of screw and plate fixation in a simulation of distal femoral fracture of osteoporotic and non-osteoporotic bone.

    PubMed

    Wähnert, D; Lange, J H; Schulze, M; Gehweiler, D; Kösters, C; Raschke, M J

    2013-10-01

    The augmentation of fixation with bone cement is increasingly being used in the treatment of severe osteoporotic fractures. We investigated the influence of bone quality on the mechanics of augmentation of plate fixation in a distal femoral fracture model (AO 33 A3 type). Eight osteoporotic and eight non-osteoporotic femoral models were randomly assigned to either an augmented or a non-augmented group. Fixation was performed using a locking compression plate. In the augmented group additionally 1 ml of bone cement was injected into the screw hole before insertion of the screw. Biomechanical testing was performed in axial sinusoidal loading. Augmentation significantly reduced the cut-out distance in the osteoporotic models by about 67% (non-augmented mean 0.30 mm (sd 0.08) vs augmented 0.13 mm (sd 0.06); p = 0.017). There was no statistical reduction in this distance following augmentation in the non-osteoporotic models (non-augmented mean 0.15 mm (sd 0.02) vs augmented 0.15 mm (sd 0.07); p = 0.915). In the osteoporotic models, augmentation significantly increased stability (p = 0.017). PMID:24078541

  4. Gorham disease of the mandible.

    PubMed

    Zhao, Su-Feng; Wang, Yu-Xin; Yang, Xu-Dong; Tang, En-Yi

    2015-03-01

    Gorham disease, or massive osteolysis, is a rare condition of unknown etiology. The disease is characterized by spontaneous progressive osteolysis of 1 or more skeletal bones. The mandible is the most commonly involved bone in the maxillofacial region. This article reports a case of Gorham disease with mandibular involvement in a 46-year-old male patient with a 7-year follow-up. In this case, we performed lower right mandibular osteotomy and reconstruction with a phased titanium plate. Postoperative follow-up showed continued mandibular bone loss that was progressing to the contralateral mandible. Massive osteolysis of the mandible is a rare clinical condition that must be differentiated from mandibularosteomyelitis, benign and malignant tumors, as well as hyperparathyroidism. Improved differential diagnoses and disease follow-up are required to effectively manage massive osteolysis.

  5. Management of pediatric mandibular fractures using bioresorbable plating system – Efficacy, stability, and clinical outcomes: Our experiences and literature review

    PubMed Central

    Singh, Mahinder; Singh, R.K.; Passi, Deepak; Aggarwal, Mohit; Kaur, Guneet

    2015-01-01

    Aims The purpose of this study was to determine the efficacy and stability of the biodegradable fixation system for treatment of mandible fractures in pediatric patients by measuring the bite force. Methods Sixty pediatric patients with mandibular fractures (36 males, 24 females) were included in this study. The 2.5-mm resorbable plates were adapted along Champy's line of ideal osteosynthesis and secured with four 2.5 mm diameter monocortical resorbable screws, 8 mm in length. All patients were followed for 10 months. Clinical parameters, such as soft tissue infection, nonunion, malunion, implant exposure, malocclusion, nerve injury, and bite force for stability, were prospectively assessed. Results Adequate fixation and primary bone healing was achieved in 100% of the cases. Six minor complications (10%) were observed: 2 soft tissue infections (3%), 1 plate dehiscence (2%), 1 malocclusion (2%), and 2 paresthesia (3%). Conclusion 2.5-mm resorbable plating system along Champy's line of ideal osteosynthesis is a good treatment modality for mandible fractures in pediatric patients. PMID:27195206

  6. Characterization and management of mandibular fractures: lessons learned from Iraq and Afghanistan.

    PubMed

    Tucker, David I; Zachar, Michael R; Chan, Rodney K; Hale, Robert G

    2013-03-01

    Fractures of the mandible are among the most common facial injuries. Invasiveness of treatment should be determined by the extent of injury: degree of displacement, number of fractures, the patient's health status, and concomitant injuries. Complex, comminuted, and avulsive injuries frequently seen in combat will require coordination with multiple specialties to provide the best treatment. Stabilization treatment with arch bars or external fixators and splints is often desirable when fractures are highly comminuted or the soft tissue envelope is compromised by tissue loss or burns. In severe injuries, many times reconstruction will take several surgeries. Debridement of necrotic tissue and devascularized bone and skin grafting often are necessary before reconstruction. Microvascular or myocutaneous flaps should be considered with significant tissue loss and osteocutaneous flaps when large continuity defects are present. Most mandible fractures are repaired in a single operation. Those caused by explosives and high-velocity projectiles are more complex. Research should continue to focus on improving outcomes for these patients. Advances in tissue engineering, bone regeneration, and composite tissue allografting will have to continue if we hope to restore facial form and function for our combat wounded.

  7. A randomized controlled trial on cross-infection control in maxillofacial trauma surgery: a comparison of intermaxillary fixation techniques.

    PubMed

    Pigadas, N; Whitley, S P; Roberts, S A; McAlister, K; Ameerally, P; Avery, C M E

    2008-08-01

    Glove perforations and percutaneous injuries occur commonly during the treatment of facial fractures and reveal the need for safer techniques, especially in intermaxillary fixation. The Rapid IMF device does not use any wires and may provide better cross-infection control than wiring methods. The aim of this study was to test the hypothesis that Rapid IMF is associated with fewer glove perforations/ percutaneous injuries than traditional wiring techniques. The authors carried out a randomized controlled trial which included 120 patients with fractures of the mandible requiring open reduction and fixation. The participants were allocated either to the study group and treated with intraoperative Rapid IMF or to the control group and managed with intraoperative eyelet wire ties. Analysis of the results showed that the Rapid IMF group had significantly fewer glove perforations than the traditional method (0.67 per operation compared with 1.5), (P<0.0001). The incidence of skin-penetrating injuries was the same in both groups (rate 0.02/ procedure). The application of Rapid IMF was significantly faster than wiring (P<0.0001). Minor intraoperative complications were noted in both groups, but more in the Rapid IMF group. Most concerned loosening or fracture of the anchorage ties but the surgical outcome was not affected. Rapid IMF is a safer alternative to wiring methods with significant reduction in glove perforation rates and is quicker to apply than conventional wiring techniques.

  8. When Planning Screw Fracture Fixation Why the 5.5 mm Screw is the Goldilocks Screw. An Observational Computer Tomographic Study of Fifth Metatarsal Bone Anatomy in a Sample of Patients.

    PubMed

    Iselin, Lukas D; Ramawat, Sunil; Hanratty, Brian; Klammer, Georg; Stavrou, Peter

    2015-05-01

    We wanted to verify our clinical experience that the 5.5 mm screw was ideal in the majority of fifth metatarsal fracture fixation. The size of a screw is important for the successful surgical treatment of these fractures in order to obtain the maximal stability while reducing the risk for iatrogenic fracture.A sample of patients undergoing computer tomographic imaging of the foot for investigation other than fifth metatarsal pathology were recruited. The parameters of the fifth metatarsal bone anatomy were measured.These parameters of the 5.5 mm screw were correlated with this data. The upper parameter (the diameter of the threads) was 5.5 and the lower parameter (the diameter of the shank) was 4.0 mm.Twenty seven patients were recruited.The proximal third internal diameter ranged from 3.6 to 7.0 mm with a mean of 5.0 mm. 93% of the metatarsals could easily accommodate the 5.5 mm screw. Two of the metatarsals had an internal diameter of < 4 mm (7%).It is our belief that the 5.5 mm screw may be used safely in the majority of patients with fifth metatarsal fractures.

  9. Biomechanical Evaluation of a Mandibular Spanning Plate Technique Compared to Standard Plating Techniques to Treat Mandibular Symphyseal Fractures

    PubMed Central

    Richardson, Matthew; Hayes, Jonathan; Jordan, J. Randall; Puckett, Aaron; Fort, Matthew

    2015-01-01

    Purpose. The purpose of this study is to compare the biomechanical behavior of the spanning reconstruction plate compared to standard plating techniques for mandibular symphyseal fractures. Materials and Methods. Twenty-five human mandible replicas were used. Five unaltered synthetic mandibles were used as controls. Four experimental groups of different reconstruction techniques with five in each group were tested. Each synthetic mandible was subjected to a splaying force applied to the mandibular angle by a mechanical testing unit until the construct failed. Peak load and stiffness were recorded. The peak load and stiffness were analyzed using ANOVA and the Tukey test at a confidence level of 95% (P < 0.05). Results. The two parallel plates' group showed statistically significant lower values for peak load and stiffness compared to all other groups. No statistically significant difference was found for peak load and stiffness between the control (C) group, lag screw (LS) group, and the spanning plate (SP1) group. Conclusions. The spanning reconstruction plate technique for fixation of mandibular symphyseal fractures showed similar mechanical behavior to the lag screw technique when subjected to splaying forces between the mandibular gonial angles and may be considered as an alternative technique when increased reconstructive strength is needed. PMID:26649332

  10. Bone fracture repair - series (image)

    MedlinePlus

    The three main treatment options for bone fractures are: Casting Open reduction, and internal fixation- this involves a surgery to repair the fracture-frequently, metal rods, screws or plates are used to repair the ...

  11. A qualitative engineering analysis of occlusion effects on mandibular fracture repair mechanics.

    PubMed

    Katona, Thomas R

    2011-01-01

    Objectives. The purpose of this analytical study was to examine and critique the engineering foundations of commonly accepted biomechanical principles of mandible fracture repair. Materials and Methods. Basic principles of static equilibrium were applied to intact and plated mandibles, but instead of the traditional lever forces, the mandibles were subjected to more realistic occlusal forces. Results. These loading conditions produced stress distributions within the intact mandible that were very different and more complex than the customary lever-based gradient. The analyses also demonstrated the entirely different mechanical environments within intact and plated mandibles. Conclusions. Because the loading and geometry of the lever-idealized mandible is incomplete, the associated widely accepted bone stress distribution (tension on top and compression on the bottom) should not be assumed. Furthermore, the stress gradients within the bone of an intact mandible should not be extrapolated to the mechanical environment within the plated regions of a fractured mandible.

  12. Modified Labial Button Technique for Maintaining Occlusion After Caudal Mandibular Fracture/Temporomandibular Joint Luxation in the Cat.

    PubMed

    Goodman, Alice E; Carmichael, Daniel T

    2016-03-01

    Maxillofacial trauma in cats often results in mandibular symphyseal separation in addition to injuries of the caudal mandible and/or temporomandibular joint (TMJ). Caudal mandibular and TMJ injuries are difficult to access and stabilize using direct fixation techniques, thus indirect fixation is commonly employed. The immediate goals of fixation include stabilization for return to normal occlusion and function with the long-term objective of bony union. Indirect fixation techniques commonly used for stabilization of caudal mandibular and temporomandibular joint fracture/luxation include maxillomandibular fixation (MMF) with acrylic composite, interarcade wiring, tape muzzles, and the bignathic encircling and retaining device (BEARD) technique. This article introduces a modification of the previously described "labial reverse suture through buttons" technique used by Koestlin et al and the "labial locking with buttons" technique by Rocha et al. In cases with minimally displaced subcondylar and pericondylar fractures without joint involvement, the labial button technique can provide sufficient stabilization for healing. Advantages of the modified labial button technique include ease of application, noninvasive nature, and use of readily available materials. The construct can remain in place for a variable of amount of time, depending on its intended purpose. It serves as an alternative to the tape muzzle, which is rarely tolerated by cats. This technique can be easily used in conjunction with other maxillomandibular repairs, such as cerclage wire fixation of mandibular symphyseal separation. The purpose of this article is to demonstrate a modified labial button technique for maintaining occlusion of feline caudal mandibular fractures/TMJ luxations in a step-by-step fashion. PMID:27487655

  13. Internal fixation: a historical review.

    PubMed

    Greenhagen, Robert M; Johnson, Adam R; Joseph, Alison

    2011-08-01

    Internal fixation has become a pillar of surgical specialties, yet the evolution of these devices has been relatively short. The first known description of medical management of a fracture was found in the Edwin Smith Papyrus of Ancient Egypt (circa 2600 bc). The first description of internal fixation in the medical literature was in the 18th century. The advancement of techniques and technology over the last 150 years has helped to preserve both life and function. The pace of advancement continues to accelerate as surgeons continue to seek new technology for osseous fixation. The authors present a thorough review of the history of internal fixation and the transformation into a multibillion dollar industry. PMID:21944395

  14. Isolated Bilateral Mandibular Angle Fractures: An Extensive Literature Review of the Rare Clinical Phenomenon with Presentation of a Classical Clinical Model

    PubMed Central

    Elavenil, P.; Mohanavalli, S.; Sasikala, B.; Prasanna, R. Ashok; Krishnakumar, Raja V. B.

    2014-01-01

    Bilateral angle fractures are a rare clinical phenomenon in contrast to the incidence of unilateral angle fractures. However, the rarity has garnered less attention in spite of the uniqueness of fracture pattern and distinctive biomechanics. This article is a detailed review on the etiology, clinical presentation, and management of bilateral angle fractures with the presentation of an interesting case. The bilateral angle fracture reported is a untreated, malunited fracture representing an ideal clinical model to study its biomechanics. The clinical features were anterior open bite, increased facial height, and temporomandibular joint tenderness. The management included osteotomy at the malunion and miniplate osteosynthesis. Bilateral angle fracture presents mandible in three independent fragments (left angle, right angle, and intermediate corpus), each with strong muscles acting in different vectors. This makes the fracture vulnerable to severe displacing forces and unfavorable to achieve the optimal reduction, stability, and healing. This necessitates comprehension of the biomechanical forces involved to avoid malunion following fixation. The article details the complex biomechanics of mandibular angle and its clinical implications in the rare event of bilateral angle fractures. It describes the necessity for a systematic approach and ideal osteosynthesis principles to achieve maximal treatment outcomes and minimal complications. PMID:26000089

  15. Galeazzi fracture.

    PubMed

    Atesok, Kivanc I; Jupiter, Jesse B; Weiss, Arnold-Peter C

    2011-10-01

    Galeazzi fracture is a fracture of the radial diaphysis with disruption at the distal radioulnar joint (DRUJ). Typically, the mechanism of injury is forceful axial loading and torsion of the forearm. Diagnosis is established on radiographic evaluation. Underdiagnosis is common because disruption of the ligamentous restraints of the DRUJ may be overlooked. Nonsurgical management with anatomic reduction and immobilization in a long-arm cast has been successful in children. In adults, nonsurgical treatment typically fails because of deforming forces acting on the distal radius and DRUJ. Open reduction and internal fixation is the preferred surgical option. Anatomic reduction and rigid fixation should be followed by intraoperative assessment of the DRUJ. Further intraoperative interventions are based on the reducibility and postreduction stability of the DRUJ. Misdiagnosis or inadequate management of Galeazzi fracture may result in disabling complications, such as DRUJ instability, malunion, limited forearm range of motion, chronic wrist pain, and osteoarthritis.

  16. Mandible shape in hybrid mice

    NASA Astrophysics Data System (ADS)

    Renaud, Sabrina; Alibert, Paul; Auffray, Jean-Christophe

    2009-09-01

    Hybridisation between closely related species is frequently seen as retarding evolutionary divergence and can also promote it by creating novel phenotypes due to new genetic combinations and developmental interactions. We therefore investigated how hybridisation affects the shape of the mouse mandible, a well-known feature in evo-devo studies. Parental groups corresponded to two strains of the European mouse sub-species Mus musculus domesticus and Mus musculus musculus. Parents and hybrids were bred in controlled conditions. The mandibles of F1 hybrids are mostly intermediate between parental phenotypes as expected for a complex multigenic character. Nevertheless, a transgressive effect as well as an increased phenotypic variance characterise the hybrids. This suggests that hybridisation between the two subspecies could lead to a higher phenotypic variance due to complex interactions among the parental genomes including non-additive genetic effects. The major direction of variance is conserved, however, among hybrids and parent groups. Hybridisation may thus play a role in the production of original transgressive phenotypes occurring following pre-existing patterns of variance.

  17. Salivary duct carcinoma in the mandible.

    PubMed

    Shi, Shuang; Fang, Qi-Gen; Sun, Changfu

    2014-11-01

    We reported 1 case of salivary duct carcinoma (SDC) in the mandible. The patient complained of pain and a growing mass in the right submandibular area for approximately 2 months. On clinical examination, there was a mass under the right angle of the mandible with a size of approximately 3 × 3 cm, a smooth surface, a poor activity, and a hard texture. Panoramic radiograph revealed poorly circumscribed area. Computed tomography presented mandible central destruction. Biopsy examination showed a malignant tumor that originated in the central epithelium of the mandible. An operation of unilateral selective neck dissection and mandible subtotal ectomy was performed. Postoperative pathology reported SDC. The patient received postoperative radiation and stayed alive at last follow-up without disease recurrence. Ablative resection and postoperative radiotherapy were the standard treatment stratagem for SDC, but trastuzumab therapy might play a key role in treating the disease in future.

  18. Salivary duct carcinoma in the mandible.

    PubMed

    Shi, Shuang; Fang, Qi-Gen; Sun, Changfu

    2014-11-01

    We reported 1 case of salivary duct carcinoma (SDC) in the mandible. The patient complained of pain and a growing mass in the right submandibular area for approximately 2 months. On clinical examination, there was a mass under the right angle of the mandible with a size of approximately 3 × 3 cm, a smooth surface, a poor activity, and a hard texture. Panoramic radiograph revealed poorly circumscribed area. Computed tomography presented mandible central destruction. Biopsy examination showed a malignant tumor that originated in the central epithelium of the mandible. An operation of unilateral selective neck dissection and mandible subtotal ectomy was performed. Postoperative pathology reported SDC. The patient received postoperative radiation and stayed alive at last follow-up without disease recurrence. Ablative resection and postoperative radiotherapy were the standard treatment stratagem for SDC, but trastuzumab therapy might play a key role in treating the disease in future. PMID:25377985

  19. Treatment of oblique crown fractures in maxillary premolars using adhesive tooth fragment reattachment: 19 years of follow up.

    PubMed

    Ferraz, José Antonio Brufato; Pécora, Jesus Djalma; Saquy, Paulo Cesar; Sousa-Neto, Manoel Damião

    2011-12-01

    This report presents an oblique crown fracture in the maxillary right premolars of an adolescent because of fall, which was treated using adhesive tooth fragment reattachment. The impact of the mandible base to the floor caused minor fractures in multiple teeth, severe fracture of teeth 14 and 15, and condylar fractures. The fragments of teeth 43, 45, 46, and 16 were lost at the site of accident. The condylar fractures were managed with a non-surgical conservative approach combining mandibular immobilization and stabilization of temporomandibular joints with maxillomandibular fixation using acrylic splints. After 3 months, the interocclusal splints were removed, and the patient was referred for dental care. Teeth 14 and 15 presented complicated oblique crown fractures causing separation of the buccal and palatal fragments, which were in place, attached to the gingival tissue. Tooth 15 presented chronic hyperplastic pulpits. The fragments were banded for stabilization during the endodontic treatment, and the bands served as matrix for adhesive tooth fragment reattachment. The other fractured teeth received direct composite resin restorations. After 8 years, tooth 16 developed pulp necrosis and was treated endodontically and restored with composite resin. Clinical and radiographic examination 19 years after trauma showed a good adaptation of the tooth fragment/composite resin restoration, good periodontal health, no signs of root resorption, and intact lamina dura.

  20. Faciomaxillary fractures in a Semi-urban South Indian Teaching Hospital: A retrospective analysis of 638 cases

    PubMed Central

    Gali, Rajasekhar; Devireddy, Sathya Kumar; Kishore Kumar, R. V.; Kanubaddy, Sridhar Reddy; Nemaly, Chaithanyaa; Akheel, Mohammed

    2015-01-01

    Background and Objective: The incidence of maxillofacial trauma is increasing at a very fast pace in developing countries like India and poses a major health burden. Hence, the epidemiological data of maxillofacial trauma during a 6 year period, was analyzed to study the characteristics, factors predisposing, and aid in advocating strict guidelines to prevent the same. Materials and Methods: Data related to 638 cases with maxillofacial trauma, from January 2008 to December 2014 were reviewed retrospectively and the data regarding gender, age, etiology, anatomic location of fracture, alcohol consumption, associated head and other injuries, modality of treatment rendered and associated complications were analyzed with descriptive statistics. Results: A total of 638 patients presenting with 869 maxillofacial fractures were analyzed. Most of them [344 (53.9%)] were young adults aged 18-40, whereas, 123 (19.2%) were 11 to 17 years, and 97(15.2%) adults. Men (79.4%) were more affected than women. Road traffic accidents remain the main etiology causing fractures in 470 (73.6%), whereas 397 (62.2%) had history of consumption of alcohol. Those with alcohol intoxication had multiple injuries. Mandible was more frequently involved with 360 (41.4%) fractures, and condyle being the most common site. A total of 374 (58.6%) underwent open reduction with internal fixation under general anesthesia. Prevalence of other injuries was noted in 207 (32.4%) and complications of fracture treatment in 41(6.4%) cases. Conclusion: Road traffic accidents under alcohol influence were most commonly associated with comminuted facial fractures with head injuries, frequently leading to death. Mandible was the most commonly fractured facial bone followed by zygoma. PMID:26681862

  1. Transbuccal versus transoral approach for management of mandibular angle fractures: a prospective, clinical and radiographic study

    PubMed Central

    2016-01-01

    Objectives We compared the transbuccal and transoral approaches in the management of mandibular angle fractures. Materials and Methods Sixty patients with mandibular angle fractures were randomly divided into two equal groups (A, transoral approach; group B, transbuccal approach) who received fracture reduction using a single 2.5 mm 4 holed miniplate with a bar using either of the two approaches. Intraoperatively, the surgical time and the ease of surgical assess for fixation were noted. Patients were followed at 1 week, 3 months, and 6 months postoperatively and evaluated clinically for post-surgical complications like scarring, infection, postoperative occlusal discrepancy, malunion, and non-union. Radiographically, the interpretation of fracture reduction was also performed by studying the fracture gap following reduction using orthopantomogram tracing. The data was tabulated and subjected to statistical analysis. A P-value less than 0.05 was considered significant. Results No significant difference was seen between the two groups for variables like surgical time and ease of fixation. Radiographic interpretation of fracture reduction revealed statistical significance for group B from points B to D as compared to group A. No cases of malunion/non-union were noted. A single case of hypertrophic scar formation was noted in group B at 6 months postsurgery. Infection was noted in 2 patients in group B compared to 6 patients in group A. There was significantly more occlusal discrepancy in group A compared to group B at 1 week postoperatively, but no long standing discrepancy was noted in either group at the 6 months follow-up. Conclusion The transbuccal approach was superior to the transoral approach with regard to radiographic reduction of the fracture gap, inconspicuous external scarring, and fewer postoperative complications. We preferred the transbuccal approach due to ease of use, minimal requirement for plate bending, and facilitation of plate placement in the

  2. A randomized controlled trial of nonoperative treatment versus open reduction and internal fixation for stable, displaced, partial articular fractures of the radial head: the RAMBO trial

    PubMed Central

    2014-01-01

    Background The choice between operative or nonoperative treatment is questioned for partial articular fractures of the radial head that have at least 2 millimeters of articular step-off on at least one radiograph (defined as displaced), but less than 2 millimeter of gap between the fragments (defined as stable) and that are not associated with an elbow dislocation, interosseous ligament injury, or other fractures. These kinds of fractures are often classified as Mason type-2 fractures. Retrospective comparative studies suggest that operative treatment might be better than nonoperative treatment, but the long-term results of nonoperative treatment are very good. Most experts agree that problems like reduced range of motion, painful crepitation, nonunion or bony ankylosis are infrequent with both nonoperative and operative treatment of an isolated displaced partial articular fracture of the radial head, but determining which patients will have problems is difficult. A prospective, randomized comparison would help minimize bias and determine the balance between operative and nonoperative risks and benefits. Methods/Design The RAMBO trial (Radial Head – Amsterdam – Amphia – Boston - Others) is an international prospective, randomized, multicenter trial. The primary objective of this study is to compare patient related outcome defined by the ‘Disabilities of Arm, Shoulder and Hand (DASH) score’ twelve months after injury between operative and nonoperative treated patients. Adult patients with partial articular fractures of the radial head that comprise at least 1/3rd of the articular surface, have ≥ 2 millimeters of articular step-off but less than 2 millimeter of gap between the fragments will be enrolled. Secondary outcome measures will be the Mayo Elbow Performance Index (MEPI), the Oxford Elbow Score (OES), pain intensity through the ‘Numeric Rating Scale’, range of motion (flexion arc and rotational arc), radiographic appearance of the fracture

  3. Development of a Titanium Plate for Mandibular Angle Fractures with a Bone Defect in the Lower Border: Finite Element Analysis and Mechanical Test

    PubMed Central

    Goulart, Douglas Rangel; Kemmoku, Daniel Takanori; Noritomi, Pedro Yoshito

    2015-01-01

    ABSTRACT Objectives The aim of the present study was to develop a plate to treat mandibular angle fractures using the finite element method and mechanical testing. Material and Methods A three-dimensional model of a fractured mandible was generated using Rhinoceros 4.0 software. The models were exported to ANSYS®, in which a static application of displacement (3 mm) was performed in the first molar region. Three groups were assessed according to the method of internal fixation (2 mm system): two non-locking plates; two locking plates and a new design locking plate. The computational model was transferred to an in vitro experiment with polyurethane mandibles. Each group contained five samples and was subjected to a linear loading test in a universal testing machine. Results A balanced distribution of stress was associated with the new plate design. This plate modified the mechanical behavior of the fractured region, with less displacement between the fractured segments. In the mechanical test, the group with two locking plates exhibited greater resistance to the 3 mm displacement, with a statistically significant difference when compared with the new plate group (ANOVA, P = 0.016). Conclusions The new plate exhibited a more balanced distribution of stress. However, the group with two locking plates exhibited greater mechanical resistance. PMID:26539287

  4. Staged Columnar Fixation of Bicondylar Tibial Plateaus: A Cheaper Alternative to External Fixation.

    PubMed

    Perdue, Aaron; Greenberg, Sarah E; Sathiyakumar, Vasanth; Thakore, Rachel V; Mir, Hassan R; Obremskey, William T; Sethi, Manish K

    2016-01-01

    The objective of this study was to compare complication rates and costs of staged columnar fixation (SCF) to external fixation for bicondylar tibial plateau fractures. Patients who received SCF or temporary external fixation across a 3-year period at a major level I trauma center underwent a retrospective chart review for associated complications. Fisher's exact analysis was used to determine any statistical difference in complication rates between both groups. However, there was no significant difference in complication rates between the SCF and external fixator groups. Average medial plate costs for SCF were $2131 compared with an average external fixator cost of $4070 (p < .0001). Given that all patients with external fixation undergo eventual medial and lateral plating, savings with SCF include $4070 plus operative costs for removing the fixator. As our health care system focuses on cost-cutting efforts, orthopaedic trauma surgeons must explore cheaper and equally effective treatment alternatives. PMID:27082883

  5. The surgical treatment of supracondylar fractures of the humerus in children by percutaneous fixation using Kirschner wires: analysis of residual deformities.

    PubMed

    Zatti, G; Bini, A; De Pietri, M; Cherubino, P

    2001-01-01

    The authors report the results of the surgical treatment of supracondylar fractures of the humerus during childhood by closed reduction and percutaneous synthesis using Kirschner wires. A total of 16 patients were considered, who were re-examined at a mean follow-up of 57.9 months (24-84). The fractures were evaluated according to the Gartland classification modified by Wilkins. The results were classified based on Flynn criteria, and the duration of hospitalization and early and late complications such as neurovascular deficit and residual deformities were also taken into consideration. Final results were satisfactory in 94% of cases with no septic, vascular, or nervous complications. We observed remodeling of three fractures with defect in reduction of the distal fragment on a sagittal plane, and the absence of correction in a case of deficit in reduction on the frontal plane. Deformity persisted with no secondary displacement in 5 cases with correct postoperative reduction.

  6. Unusual presentation of a femoral stress fracture

    PubMed Central

    Ejnisman, Leandro; Wajnsztejn, Andre; Queiroz, Roberto Dantas; Ejnisman, Benno

    2013-01-01

    Stress fractures are common injuries in sports medicine. Among these fractures, femoral neck stress fractures frequently have a benign course, especially when it happens in the medial aspect of the neck. This case report describes a stress fracture of the medial aspect of the femoral neck that developed a complete fracture and underwent surgical fixation. PMID:23283621

  7. Iatrogenic Pseudo-aneurysm of Profunda Femoris Artery Following Fixation of Intertrochanteric Femur Fracture – A Case Report and Review of Literature

    PubMed Central

    Aggarwal, Rishi Anil; Purohit, Shaligram; Bandagi, Gokul; Marathe, Nandan

    2016-01-01

    The Profunda Femoris is a common site for arterial pseudo-aneurysms and these have been described in literature following fractures as well as orthopaedic procedures of the femur and hip region. These are an uncommon complication and a high index of suspicion is required for correct diagnosis and prompt management. We present a case of pseudo-aneurysm of the Profunda Femoris in an operated case of Intertrochanteric femur fracture with acute presentation. The case was managed successfully by angiographic coil embolization. PMID:27134957

  8. Biologic Fixation through Bridge Plating for Comminuted Shaft Fracture of the Clavicle: Technical Aspects and Prospective Clinical Experience with a Minimum of 12-Month Follow-up

    PubMed Central

    Park, Chang-Min; Kim, Jae-Do

    2013-01-01

    For comminuted shaft fracture of clavicle, the operative goal, aside from sound bone healing without complications of direct reduction, is maintenance of the original length in order to maintain the normal biomechanics of adjacent joint. Our bridge plating technique utilizing distraction through a lumbar spreader was expected to be effective for restoring clavicular length with soft tissue preservation. However, there are two disadvantages. First, there is more exposure to radiation compared to conventional plating; and second, it is difficult to control the rotational alignment. Despite these disadvantages, our technique has important benefits, in particular, the ability to preserve clavicular length without soft tissue injury around the fracture site. PMID:24340154

  9. Impacted third molars: a contributing factor in mandibular fractures in contact sports.

    PubMed

    Schwimmer, A; Stern, R; Kritchman, D

    1983-01-01

    Studies have shown that the presence of impacted third molars places the mandible at increased risk for fracture. Individuals participating in high contact sports are subject to maxillofacial trauma; therefore, participants with impacted third molars are at increased risk for fractured mandibles. Three cases are reviewed to illustrate this problem.

  10. A numerical simulation of the effect of using porous superelastic Nitinol and stiff Titanium fixation hardware on the bone remodeling

    NASA Astrophysics Data System (ADS)

    Raad, Bahram; Shayesteh Moghaddam, Narges; Elahinia, Mohammad

    2016-04-01

    The aim of this article is to investigate the effect of two different fixation hardware materials on bone remodeling after a mandibular reconstruction surgery and to restore the mandible's function, healthy appearance, mastication, swallowing, breathing, and speech. The hypothesis is that using fixation hardware with stiffness close to that of the surrounding bone will result in a more successful healing process in the mandible bone. The finite element model includes the material properties and forces of the cancellous bone, cortical bone, ligaments, muscles, and teeth. The reconstruction surgery is modeled by including the fixation hardware and the grafted bone. In the sectioned mandible, to best mimic the geometry of the mandible, two single barrel grafts are placed at the top of each other to form a double barrel graft set. Two different materials were used as the mandibular fixation parts, stiff Ti-6Al-4V, and porous superelastic Nickel-Titanium (NiTi) alloys. A comparison of these two alloys demonstrates that using porous NiTi alloy as the fixation part results in a faster healing pace. Furthermore, the density distribution in the mandibular bone after the healing process is more similar to the normal mandible density distribution. The simulations results indicate that the porous superelastic NiTi fixation hardware transfers and distributes the existing forces on the mandible bone more favorably. The probability of stress shielding and/or stress concentration decrease. This type of fixation hardware, therefore, is more appropriate for mandible bone reconstruction surgery. These predictions are in agreement with the clinical observations.

  11. Posterior malleolus fracture.

    PubMed

    Irwin, Todd A; Lien, John; Kadakia, Anish R

    2013-01-01

    Posterior malleolus fractures are a common component of ankle fractures. The morphology is variable; these fractures range from small posterolateral avulsion injuries to large displaced fracture fragments. The integrity of the posterior malleolus and its ligamentous attachment is important for tibiotalar load transfer, posterior talar stability, and rotatory ankle stability. Fixation of posterior malleolus fractures in the setting of rotational ankle injuries has certain benefits, such as restoring articular congruity and rotatory ankle stability, as well as preventing posterior talar translation, but current indications are unclear. Fragment size as a percentage of the anteroposterior dimension of the articular surface is often cited as an indication for fixation, although several factors may contribute to the decision, such as articular impaction, comminution, and syndesmotic stability. Outcome studies show that, in patients with ankle fractures, the presence of a posterior malleolus fracture negatively affects prognosis. Notable variability is evident in surgeon practice. PMID:23281469

  12. Nonunion of fifth metatarsal fractures.

    PubMed

    Solan, Matthew; Davies, Mark

    2014-09-01

    Metatarsal fractures are those most frequently encountered in the foot. More than half of these are of the 5th metatarsal. The incidence is increasing, along with the activity levels of the general population. Fractures of the 5th metatarsal require careful evaluation and classification to ensure selection of the optimum treatment plan. Distal fractures rarely require fixation, even when displacement is wide. Cases of established nonunion or refracture require fixation.

  13. Biomechanical response of the human mandible to impacts of the chin.

    PubMed

    Craig, Matthew; Bir, Cynthia; Viano, David; Tashman, Scott

    2008-10-20

    The purpose of this study was to determine the force-time and force-displacement response of the human mandible under direct loading at the chin. Sub-fracture response of the mandible and temporomandibular joint (TMJ) were analyzed from 10 cadavers that were impacted at the chin with a 2.8-kg mass at drop heights of 300, 400 and 500 mm and a 5.2-kg mass at 500 mm. Motion of radio-opaque markers adhered to the surface of the bone was recorded at 1000 Hz by a bi-planar X-ray and converted to three-dimensional coordinates. Peak force ranged from 0.90 to 4.54 kN causing chin displacement of 1.2-4.4 mm. A bi-linear response was observed with stiffness of 475.1+/-199.8 kN/m for chin displacement resulting from loading up to 0.6 kN and 2381.6+/-495.7 kN/m for loads from 0.6 to 3.25 kN. This defines the biomechanical response of the mandible for chin motion under impact loading. The response of different segments of the mandible and TMJ are also documented. Force-time and force-displacement response corridors for the mandible can be used for finite element model and/or the development and validation of a biomechanical surrogate.

  14. Amifostine Prophylaxis on Bone Densitometry, Biomechanical Strength and Union in Mandibular Pathologic Fracture Repair

    PubMed Central

    Tchanque-Fossuo, Catherine N.; Donneys, Alexis; Sarhaddi, Deniz; Poushanchi, Behdod; Deshpande, Sagar S.; Weiss, Daniela M.

    2013-01-01

    Background Pathologic fractures (Fx) of the mandibles are severely debilitating consequences of radiation (XRT) in the treatment of craniofacial malignancy. We have previously demonstrated Amifostine’s effect (AMF) in the remediation of radiation-induced cellular damage. We posit that AMF prophylaxis will preserve bone strength and drastically reverse radiotherapy-induced non-union in a murine mandibular model of pathologic fracture repair. Materials and Methods Twenty-nine rats were randomized into 3 groups: Fx, XRT/Fx, and AMF/XRT/Fx. A fractionated human equivalent dose of radiation was delivered to the left hemimandibles of XRT/Fx and AMF/XRT/Fx. AMF/XRT/Fx was pre-treated with AMF. All groups underwent left mandibular osteotomy with external fixation and setting of a 2.1mm fracture gap post-operatively. Utilizing micro-computed tomography and biomechanical testing, the healed fracture was evaluated for strength. Results All radiomorphometrics and biomechanical properties were significantly diminished in XRT/Fx compared to both Fx and AMF/XRT/Fx. No difference was demonstrated between Fx and AMF/XRT/Fx in both outcomes. Conclusion Our investigation establishes the significant and substantial capability of AMF prophylaxis to preserve and enhance bone union, quality and strength in the setting of human equivalent radiotherapy. Such novel discoveries establish the true potential to utilize pharmacotherapy to prevent and improve the treatment outcomes of radiation-induced late pathologic fractures. PMID:23860272

  15. External Fixation of Open Humerus Factures

    PubMed Central

    Marsh, JL; Mahoney, Craig R; Steinbronn, Dave

    1999-01-01

    Fifteen patients with open shaft of humerus fractures were treated with a monolateral external fixator. Nine patients presented with nerve palsies. Two radial nerves were disrupted and required grafting. Of the seven others, six spontaneously recovered and one brachial plexus partially improved. All fractures healed. The average duration of external fixation was 21 weeks. Four patients required additional procedures prior to healing (external fixator reapplication - 2, plating and bone grafting - 2). Two of these four experienced breakage of 4.5 mm external fixation pins. Eight patients developed pin tract infections, which all resolved with local care and antibiotics. Thirteen patients were contacted at an average of 63 months after injury. Eleven reported they were satisfied with their result, nine had no functional limits, and eight reported no pain. PMID:10847515

  16. Complications of rigid internal fixation.

    PubMed

    Campbell, Chris A; Lin, Kant Y

    2009-03-01

    Over the past 20 years, there have been many advances in the development of bone fixation systems used in the practice of craniomaxillofacial surgery. As surgical practices have evolved, the complications of each technologic advance have changed accordingly. Interfragmentary instability of interosseous wiring has been replaced by the risk of exposure, infection, and palpability of plate and screw fixation systems. The improved rigidity of plate fixation requires anatomic alignment of fracture fragments. Failure to obtain proper alignment has led to the phenomenon known as "open internal fixation" of