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1
Milenkovic, Sasa, Milos Stanojlovic, Milorad Mitkovic, and Mile Radenkovic. "Dynamic internal fixation of the periprosthetic femoral fractures after total hip arthroplasty." Acta chirurgica Iugoslavica 51, no. 3 (2004): 93–96. http://dx.doi.org/10.2298/aci0403093m.
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Periprosthetic fractures of the femur after total hip arthroplasty are a big orthopaedic problem, particularly in elderly patients and quite a challenge for orthopaedic surgeons. There is no universal method in treating these fractures. Rigid plates fixation can be limited and aggravated especially in the proximal part of the femur where the endoprosthesis stem does not allow for an undisturbed fixation of both femur cortexes by means of screws. Mitkovic?s dynamic internal fixator is an original implant allowing for an undisturbed fixation of both femur cortexes regardless of the presence of the endoprosthesis stem. Fixation is made possible by means of movable clamps and a convergent possibility to place screws. A dynamic internal fixator can fix all types of periprosthetic femoral fractures. The paper shows the early experience in fixating periprosthetic femoral fractures after total hip arthroplasty in 14 patients, average age 69,7. According to Vancouver classification, 3 patients had the type A fracture, 9 patients had the type B fracture, and 2 patients had the type C fracture. All fractures were fixed by Mitkovic?s dynamic internal fixator. The fracture occurred 2-12 years after primary total hip arthroplasty. The follow- up of the operated patients was 12 months. The method is less invasive than the methods described in books. Mechanical complications are not likely to appear due to the fracture dynamics along the femoral shaft axis, which is made possible by this implant. Our initial experience in femur fracture fixation after hip arthroplasty ahows that it is modern and effective dynamic implant which will contribute significantly to the improving of the treatment of these often very complicated fractures.
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Stiffler, Kevin S. "Internal fracture fixation." Clinical Techniques in Small Animal Practice 19, no. 3 (August 2004): 105–13. http://dx.doi.org/10.1053/j.ctsap.2004.09.002.
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Mitkovic, Milorad, Marko Bumbasirevic, Z. Golubovic, D. Mladenovic, Sasa Milenkovic, Ivan Micic, Aleksandar Lesic, et al. "New biological method of internal fixation of the femur." Acta chirurgica Iugoslavica 52, no. 2 (2005): 113–16. http://dx.doi.org/10.2298/aci0502113m.
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One of the main goals in fracture treatment is preservation of both intramedular and periosteal vascularisation. The aim of this paper is to show a new method of internal fixation which accomplishes these goals. The paper presents the results of clinical application of Mitkovic Internal Fixator, new self-dynamisable device, which provides fixation of the femur using minimally invasive technique. This device has been investigated experimentally on 60 animals. It has been applied to 267 patients. Here is presented a series of 92 fixations of femoral diaphyses after fresh fractures and after unsuccessful treatment using other methods. Follow-up was 3.1 years (2 to 7 years). Bone healing was achieved in all patients within 3.5 months (2.7-9 months) with big amount of periosteal callus formation. There were no complications in all patients seen. It can be concluded that this method and device meet biological and biomechanical requirements for safe fracture treatment.
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Gaughan, E. M., and N. G. Duchar. "Secondary Fractures Following Internal Fixation in Two Horses." Veterinary and Comparative Orthopaedics and Traumatology 02, no. 03 (1989): 125–28. http://dx.doi.org/10.1055/s-0038-1633209.
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SummaryImplant associated fractures have not been reported in horses. Two horses were evaluated for fractures in the fore limbs, occurring subsequent to previous fracture repair. Previously, the horses had sustained fractures of unusual configurations which were repaired using internal fixation. Following repair and healing of the fractures, secondary fractures occurred in the same bone, but in a different (more common) configuration. The first horse was evaluated ten months following lag screw fixation of a longitudinal fracture of the proximal phalanx in a frontal plane. This horse presented with a more typical comminuted fracture in the sagittal plane with the screws from the first fixation lying in the fracture line. This fracture was successfully treated with a cast. The second horse was examined eightteen months after repair of a medial sagittal slab fracture of the third carpal bone. The horse presented with a more typical dorsal slab fracture of the third carpal bone with the previously placed lag screw lying in the fracture line. The screw was removed and a lag screw was placed perpendicular to the new fracture plane through the dorsal surface of the third carpal bone to repair the fracture.
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Akino, Hiromasa, Shunpei Hama, Masataka Yasuda, Kenta Minato, and Masahiro Miyashita. "Bone Resection for Isolated Ulnar Head Fracture." Case Reports in Orthopedics 2017 (2017): 1–4. http://dx.doi.org/10.1155/2017/3519146.
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Distal ulnar fractures often occur with distal radius fractures (DRFs), and ulnar styloid fractures commonly occur in the setting of DRF. However, isolated ulnar head fractures are rare. We report a case of isolated ulnar head fracture in which we performed bone resection because the ulnar head bone fragment fractured when internal screw fixation was attempted. His outcome at 18 months postoperatively was considered excellent. However, we do not advocate bone resection other than failure of fixation and the difficult case to perform internal fixation. Longer follow-up would be needed because bone resection might lead to osteoarthritis of the distal radioulnar joint in the future.
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Guo, Hui, Jiantao Li, Yuan Gao, Shaobo Nie, Chenliang Quan, Jia Li, and Wei Zhang. "A Finite Element Study on the Treatment of Thoracolumbar Fracture with a New Spinal Fixation System." BioMed Research International 2021 (April 10, 2021): 1–9. http://dx.doi.org/10.1155/2021/8872514.
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Objective. In this study, the mechanical properties of the new spinal fixation system (NSFS) in the treatment of thoracolumbar fractures were evaluated by the finite element analysis method, so as to provide a mechanical theoretical basis for the later biomechanical experiments and clinical experiments. Methods. T12-L2 bone model was constructed to simulate L1 vertebral fracture, and three models of internal fixation systems were established on the basis of universal spinal system (USS): Model A: posterior short-segment fixation including the fractured vertebra (PSFFV); Model B: short-segment pedicle screw fixation (SSPF); Model C: new spinal fixation system (NSFS). After assembling the internal fixation system and fracture model, the finite element analysis was carried out in the ANSYS Workbench 18.0 software, and the stress of nail rod system, fracture vertebral body stress, vertebral body mobility, and vertebral body displacement were recorded in the three models. Results. The peak values of internal fixation stress, vertebral body stress, vertebral body maximum displacement, and vertebral body maximum activity in Model C were slightly smaller than those in Model B. Conclusions. Compared with the traditional internal fixation system, the new spinal internal fixation system may have the mechanical advantage and can provide sufficient mechanical stability for thoracolumbar fractures.
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Atul, Parashar, K. Sharma Ramesh, and Makkar Surinder. "Rigid internal fi xation of zygoma fractures: A comparison of two-point and three-point fi xation." Indian Journal of Plastic Surgery 40, no. 01 (January 2007): 18–24. http://dx.doi.org/10.1055/s-0039-1699174.
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ABSTRACT Background:Displaced fractures of the zygomatic bone can result in significant functional and aesthetic sequelae. Therefore the treatment must achieve adequate and stable reduction at fracture sites so as to restore the complex multidimensional relationship of the zygoma to the surrounding craniofacial skeleton. Many experimental biophysical studies have compared stability of zygoma after one, two and three-point fixation with mini plates. We conducted a prospective clinical study comparing functional and aesthetic results of two-point and three-point fixation with mini plates in patients with fractures of zygoma.Materials and Methods:Twenty-two patients with isolated zygomatic fractures over a period of one year were randomly assigned into two-point and three-point fixation groups. Results of fixation were analyzed after completion of three months. This included clinical, radiological and photographic evaluation.Results:The three-point fixation group maintained better stability at fracture sites resulting in decreased incidence of dystopia and enophthalmos. This group also had better malar projection and malar height as measured radiologically, when compared with the two-point fixation group.Conclusion:We recommend three-point rigid fixation of fractured zygoma after accurate reduction so as to maintain adequate stabilization against masticatory forces during fracture healing phase.
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Nagi, Ahmed, Islam Mubark, Islam Sarhan, and Abdelaleem Ragab. "Management of Unstable Phalangeal Shaft Fractures Using External Minifixator." Ortopedia Traumatologia Rehabilitacja 21, no. 3 (June 30, 2019): 177–86. http://dx.doi.org/10.5604/01.3001.0013.2922.
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Background. Fractures of the hand are the most common fractures in the skeletal system and phalangeal fractures constitute about 46% of all hand fractures. Operative treatment of unstable phalangeal fractures should aim at anatomic fracture reduction and stable fixation that allows early mobilization of the affected finger’s joints . This study evaluates the results of fixation of unstable shaft fractures of finger proximal or middle phalanges using a non-spanning external minifixator. Material and methods. 32 men and 8 women aged 17 to 60 (median, 31.25) years suffering from fractures of 44 phalanges in 40 hands were included in the study. Four of the fractured phalanges were middle phalanges and 40 were proximal phalanges .All fractures were fixed using a mini external fixator. All procedures were done under regional anaesthetic block. The fixator was applied after closed reduction of fractures. Additional procedures included wound debridement in open fractures, and tendon repair was needed in 4 cases. We excluded fractures where intraarticular fracture extension mandates open reduction and internal fixation. Results. At the end of the follow-up period (mean follow-up 11.5 months), patients were assessed clinically and radiologically. 26 fingers (59.1 %) had “excellent” results , 14 fingers (31.8 %) had “good” results and 4 fingers (9.1%) had “poor” results as their P.I.P. flexion ranges were < 80˚. Conclusion. External fixation of displaced phalangeal shaft fractures is an effective method of treatment in terms of a minimally invasive technique with rigid fracture fixation allowing early mobilization after surgery.
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Mohiuddin, M., M. Hasan, M. Shohag, R. N. Ferdousy, M. M. Alam, and N. S. Juyena. "Surgical management of limb fractures in calves and goats." Bangladesh Veterinary Journal 52, no. 1-4 (December 25, 2018): 46–56. http://dx.doi.org/10.32856/bvj-2018.06.
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The study was conducted to determine the occurrence of fractures in calves and goats at Veterinary Teaching Hospital (VTH), Bangladesh Agricultural University (BAU) and to compare the efficacy of fracture treatment with external and internal fixation using splints and bone plate/wire suture respectively. Patients brought to VTH with the history of automobile accident, trauma and clinical signs suggestive of fractures were subjected to detailed physical, orthopaedic and radiographic examinations to confirm fractures. A total of 6 calves and 4 Black Bengal goats were presented to VTH with limb fractures. Fractures were treated with close reduction and external fixation with splints and bandage, and open reduction and internal fixation with wire suture and bone plate. 50% and 75% fracture cases healed properly in calves and goats respectively. Among the affected animals, 60% were females irrespective of species. Metacarpal bone was the most susceptible for limb fracture. Three were open fractures and 7 cases were closed fracture with the occurrence of 70%. The healing percentage of open fracture treated with external fixation was very poor and amputation was needed in the fractured limb. Overall treatment success rate was 60 %. Biochemical analysis revealed very significant (p<0.01) difference in serum calcium level before and after healing due to hard callus formation. This study shows that bone plating fixation give a satisfactory results to calves with fracture. Moreover, the study could help veterinarians to set up proper treatment method depending on location of fracture.
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Hayashi, Kamichika, Takeshi Onda, Hirona Honda, Mitsuru Takata, Hiroyuki Matsuda, Hidetoshi Tamura, and Masayuki Takano. "High Submandibular Anteroparotid Approach for Open Reduction and Internal Fixation of Condylar Fracture." Case Reports in Dentistry 2021 (July 9, 2021): 1–9. http://dx.doi.org/10.1155/2021/5542570.
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Aim. There are several techniques for the treatment of mandibular condylar fractures. This is the first report of the high submandibular anteroparotid approach for open reduction and internal fixation of condylar fracture. Materials and Methods. A 41-year-old woman fell indoors and injured her face. She was referred to our department for detailed examination and treatment of a suspected mandibular fracture. X-ray and computed tomography showed a right mandibular condylar base fracture and lateral dislocation of the fracture fragment. Open reduction and internal fixation procedures were performed for a right mandibular condylar fracture under general anesthesia. The mandibular ramus was reached by approaching from the inferior margin of the mandible, delaminating the masseter fascia posteriorly, and bypassing the anterior margin of the parotid gland. Once the fractured bone was reached, reduction and fixation were performed. Results. We have achieved good results by the high submandibular anteroparotid approach, which is minimally invasive and simple, to reduce and fix condylar fractures. With this approach, no facial artery or retromandibular vein was encountered, and the mental stress for the surgeon was minimal. Postoperative wound infection, parotid gland complications such as parotitis and salivary fistula, facial nerve dysfunction such as facial paralysis, and esthetic disorders such as scarring were not observed. Conclusions. Although it is necessary to examine more cases in the future, the high submandibular anteroparotid approach may be useful as a new approach for open reduction and internal fixation of condylar fractures.
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Manson, Paul N. "INTERNAL FIXATION OF MALAR FRACTURE." Plastic and Reconstructive Surgery 86, no. 4 (October 1990): 802. http://dx.doi.org/10.1097/00006534-199010000-00052.
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Martin, Kevin D. "Posterior Arthroscopic Reduction and Internal Fixation for Treatment of Posterior Malleolus Fractures." Foot & Ankle International 41, no. 1 (December 11, 2019): 115–20. http://dx.doi.org/10.1177/1071100719891978.
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Posterior malleolus fractures and pilon variants refer to a pattern of fractures involving the posterior weightbearing surface of the tibial plafond. The surgical indications for fixation of posterior malleolus fractures varies considerably throughout the literature, based on the size and/or displacement. There is controversy on how to best address fracture fixation, with the main workhorses being either the posterior-lateral approach or indirect anterior-posterior–directed screws. We present an alternative technique for posterior malleolus fracture fixation using a direct posterior arthroscopic-assisted reduction internal fixation method. With this method, posterior malleolus fractures are reduced arthroscopically and percutaneous fixation is placed through the arthroscopic portals. Level of Evidence: Level V, expert opinion
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Xu, Haining, Yan Nie, Lifang Han, Liang Li, and Haitao Sui. "Comparison of the effect of two internal fixation methods for proximal clavicle fractures." Revista da Associação Médica Brasileira 66, no. 5 (May 2020): 654–58. http://dx.doi.org/10.1590/1806-9282.66.5.654.
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SUMMARY OBJECTIVE To compare the effect of two internal fixation methods in the treatment of proximal clavicle fractures. METHODS Fifty patients with proximal clavicle fractures received surgical treatment. They were divided into a clavicular T-plate group and a double mini-plates group. The duration of the operation, blood loss during the operation, fracture healing time, and incision infection were evaluated between the two groups. RESULTS Operation time (t=2.063, P=0.058), intraoperative bleeding (t=1.979, P=0.062), and fracture healing time (t=1.082, P=0.066) were not statistically significant in the two groups. The patients were followed up for 12-18 months; one patient in the T-plate group had early removal of nails, but no clinical symptoms. At the 2-month follow-up, the ASES score in the double mini-plates group was significantly better than in the T-plate group (P<0.001); but at the 6-month follow-up, 1-week before removal of internal fixation and the final follow-up, the two groups had no significant differences (P>0.05). CONCLUSIONS Both internal fixations have similar clinical results in the duration of operation, blood loss during the operation, and fracture healing time. The double mini-plates fixation presents advantages by reducing complications and speeding fracture healing; thus it is a more effective method to treat proximal clavicle fractures.
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Golubovic, Zoran, Lana Macukanovic-Golubovic, Predrag Stojiljkovic, Jovica Jovanovic, Ivan Micic, Danilo Stojiljkovic, Dragan Milic, and Milorad Mitkovic. "External fixation combined with limited internal fixation in the treatment of pilon tibia fractures." Vojnosanitetski pregled 64, no. 5 (2007): 307–11. http://dx.doi.org/10.2298/vsp0705307g.
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Background/Aim. Intraarticular fractures of the tibial plafond (pilon fractures) belong to the group of most severe fractures. They are usually caused by high-energy trauma and frequently associated with a marked soft-tissue damage. Surgical treatment has replaced the traditional nonoperative treatment. The aim of this study was to present the results of the treatment of distal tibial intraarticular fracture by the use of internal fixation, as well as the combination of minimal internal fixation and external fixation. Methods. The study included 47 patients with pilon tibia fractures who went through at the Clinic for Orthopedics and Traumatology, School of Medicine, Nis (1995-2004). Within the analyzed group there were 33 (70.2%) males and 14 (29.8%) females. The patients mean age was 45.8 years. In the first group, which consisted of 22 patients, open reduction and internal fixation of both the tibia and the fibula was performed in the two separate incisions. The second group consisted of 25 patients managed with external fixation by external fixator "Mitkovic" with limited internal fixation. Besides external fixation, a minimal internal fixation was performed by the use of Kirschner wires and screws. The patients were followed-up inside a 24-months-period. Results. The obtained was a substantially high number of complications after open reduction and internal fixation in the group of patients. There was no difference in a long-term clinical outcome. Postoperative osteitis, as the most severe complication in the management of closed pilon tibia fractures, was not registered in the second group. Conclusion. Considering the results obtained in this study, it can be concluded that external fixation by the "Mitkovic" external fixator with the minimal internal fixation is a satisfactory method for the treatment of fractures of the tibial plafond causing less complications than internal fixation. .
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Sakai, Rina, Terumasa Matsuura, Kensei Tanaka, Kentaro Uchida, Masaki Nakao, and Kiyoshi Mabuchi. "Comparison of Internal Fixations for Distal Clavicular Fractures Based on Loading Tests and Finite Element Analyses." Scientific World Journal 2014 (2014): 1–6. http://dx.doi.org/10.1155/2014/817321.
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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.
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Milenkovic, Sasa, Milorad Mitkovic, Ivan Micic, Desimir Mladenovic, Stevo Najman, Miroslav Trajanovic, Miodrag Manic, and Milan Mitkovic. "Distal tibial pilon fractures (AO/OTA type B, and C) treated with the external skeletal and minimal internal fixation method." Vojnosanitetski pregled 70, no. 9 (2013): 836–41. http://dx.doi.org/10.2298/vsp1309836m.
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Background/Aim. Distal tibial pilon fractures include extra-articular fractures of the tibial metaphysis and the more severe intra-articular tibial pilon fractures. There is no universal method for treating distal tibial pilon fractures. These fractures are treated by means of open reduction, internal fixation (ORIF) and external skeletal fixation. The high rate of soft-tissue complications associated with primary ORIF of pilon fractures led to the use of external skeletal fixation, with limited internal fixation as an alternative technique for definitive management. The aim of this study was to estimate efficacy of distal tibial pilon fratures treatment using the external skeletal and minimal internal fixation method. Methods. We presented a series of 31 operated patients with tibial pilon fractures. The patients were operated on using the method of external skeletal fixation with a minimal internal fixation. According to the AO/OTA classification, 17 patients had type B fracture and 14 patients type C fractures. The rigid external skeletal fixation was transformed into a dynamic external skeletal fixation 6 weeks post-surgery. Results. This retrospective study involved 31 patients with tibial pilon fractures, average age 41.81 (from 21 to 60) years. The average follow-up was 21.86 (from 12 to 48) months. The percentage of union was 90.32%, nonunion 3.22% and malunion 6.45%. The mean to fracture union was 14 (range 12-20) weeks. There were 4 (12.19%) infections around the pins of the external skeletal fixator and one (3.22%) deep infections. The ankle joint arthrosis as a late complication appeared in 4 (12.90%) patients. All arthroses appeared in patients who had type C fractures. The final functional results based on the AOFAS score were excellent in 51.61%, good in 32.25%, average in 12.90% and bad in 3.22% of the patients. Conclusion. External skeletal fixation and minimal internal fixation of distal tibial pilon fractures is a good method for treating all types of inta-articular pilon fractures. In fractures types B and C dynamic external skeletal fixation allows early mobility in the ankle joint.
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Vakhshori, Venus, Alexis D. Rounds, Nathanael Heckmann, Ali Azad, Jessica M. Intravia, Santano Rosario, Milan Stevanovic, and Alidad Ghiassi. "The Declining Use of Wrist-Spanning External Fixators." HAND 15, no. 2 (August 7, 2018): 255–63. http://dx.doi.org/10.1177/1558944718791185.
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Background: External fixation has been traditionally used to treat comminuted or open distal radius fractures that are not amenable to open reduction internal fixation. This procedure is associated with a relatively high complication rate and has been used with decreasing frequency in recent years. However, trends in external fixation utilization for the treatment of distal radius fractures have not been described. Methods: Using the Nationwide Inpatient Sample, patients with a distal radius fracture treated with external fixation from 2003 to 2014 were identified. The annual incidence was reported, and hospital and demographic variables associated with external fixation use were determined. Results: During the study period, 593 929 patients with a distal radius fracture were identified, of which 51 766 (8.7%) were treated with a wrist-spanning external fixator. Wrist external fixation for the treatment of distal radius fractures declined steadily from 2003 to 2014. In 2003, external fixation use was highest, accounting for 17.4% of distal radius fractures. By 2014, only 4.9% of distal radius fracture were treated with external fixation. During this period, the incidence of distal radius fractures declined by 6.9% while external fixator utilization decreased by 73.7%. Patients receiving an external fixator were more likely to be male, low-income, and treated in a rural, nonteaching, privately owned hospital. Conclusions: External fixator use for the treatment of distal radius fractures steadily declined during the study period. Males and those with lower incomes treated in rural, nonteaching, and privately owned hospitals are more likely to receive external fixation.
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Stojiljkovic, Predrag, Zoran Golubovic, Desimir Mladenovic, Ivan Micic, Sasa Karalejic, and Danilo Stojiljkovic. "External skeletal fixation of femoral shaft fractures in polytrauma patients." Medical review 61, no. 9-10 (2008): 497–502. http://dx.doi.org/10.2298/mpns0810497s.
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Introduction. Polytrauma remains a major social, economic and medicine affliction. A successful surgical treatment of polytrauma patients requires an approach predicated on prioritizing injuries. An isolated femur fractures rarely poses any threat but in association with multiple injuries, this fracture assumes greater significance. The proper management of femur fractures in polytrauma can greatly reduce the mortality and morbidity. Material and methods. We present our results in the treatment of 24 femur shaft fracture in 22 polytrauma patients treated by Mitkovic external fixator in 5 year period (2000-2004) on Orthopeadic and Traumatology Clinic - Clinical Center Nis. The average of patients age was 32.8 years (ranging from 17 to 62). There were 11 (46%) closed and 13 (54%) open fractures. Results. Eighteen fractures were treated by external fixation until union. The remaining six fractures were treated by conversion of the external fixation to internal fixation. Sixteen fractures (88.88%), in which the external fixation was the definitive method of treatment, healed completely. The average healing time was 6.29 (4-9) months. There were three pin-track infections (16.66%), one nonunion (5.55%) and only one deep infection (5.55%). Conclusion. The external fixation by the use of Mitkovic external fixator in the treatment of femur fractures is a safe procedure to achieve temporary rigid stabilisation in polytrauma patients before the subsequent internal fixation (damage control orthopaedics). The external fixation using Mitkovic external fixator can be definitive method of choice in treatment of open and comminutiwe femur fractures in polytrauma patients until union.
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Lesic, Aleksandar, Bojan Karovic, Branislav Krivokapic, and Marko Bumbasirevic. "History and portraits in fracture treatment." Acta chirurgica Iugoslavica 62, no. 1 (2015): 19–25. http://dx.doi.org/10.2298/aci1501019l.
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During the human history there were many attempts to treat fractures and injuries of extremities. Since Mathijsen and his plaster cast there was many attempts to make immobilization at the fracture site, to protect obtained reduction. Hugh Owen Thomas invent traction which greatly decrease mortality in the patients with femoral fractures during the war. External fixation was used from the time of Malgaigne, Lambote, Parkhill in 19th century, and Anderson, Hofmann, Ilizarov in 20th century. This kind of fracture fixation still has place and role in the treatment of open, compound fractures, and in the patients with multiple fractures. Along with invention of antisepsis, antibiotics, X-rays, ant metallurgy, the internal fixation become widely used, from the Lane,s plate at the beginning of 20th century to the biogredable materials and new designed internal devices. Special problem of hip fracture treatment was solved by fixation dated from Hey Groves, Smith Petersen, while intramedullary fixation of long bones was introduced by Kuntscher. Clinical and biomechanical investigation during the 1950 and 1960 was established by members of AO group.
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Garcı´a, J. M., M. Doblare´, B. Seral, F. Seral, D. Palanca, and L. Gracia. "Three-Dimensional Finite Element Analysis of Several Internal and External Pelvis Fixations." Journal of Biomechanical Engineering 122, no. 5 (May 31, 2000): 516–22. http://dx.doi.org/10.1115/1.1289995.
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The Finite Element Method (FEM) can be used to analyze very complex geometries, such as the pelvis, and complicated constitutive behaviors, such as the heterogeneous, nonlinear, and anisotropic behavior of bone tissue or the noncompression, nonbending character of ligaments. Here, FEM was used to simulate the mechanical ability of several external and internal fixations that stabilize pelvic ring disruptions. A customized pelvic fracture analysis was performed by computer simulation to determine the best fixation method for each individual treatment. The stability of open-book fractures with external fixations at either the iliac crests or the pelvic equator was similar, and increased greatly when they were used in combination. However, external fixations did not effectively stabilize rotationally and vertically unstable fractures. Adequate stabilization was only achieved using an internal pubis fixation with two sacroiliac screws. [S0148-0731(00)00905-5]
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Dilogo, Ismail Hadisoebroto, Oryza Satria, and Jessica Fiolin. "Internal fixation of S1-S3 iliosacral screws and pubic screw as the best configuration for unstable pelvic fracture with unilateral vertical sacral fracture (AO type C1.3)." Journal of Orthopaedic Surgery 25, no. 1 (January 1, 2017): 230949901769098. http://dx.doi.org/10.1177/2309499017690985.
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Background: Although internal fixation is the definitive treatment in unstable pelvic fractures with disruption of the anterior arch and a vertical fracture of the sacrum (AO type C1.3), there have been no agreement of the best technique of internal fixation yet. We aimed to derive comparable objective data on stiffness and load to failure in this type of fracture fixations. Methods: Synbone was modified into AO type C1.3 fracture model, while treatments were divided into six internal fixation treatment groups using tension band plate (TBP), symphysis pubis plate (SP) with iliosacral screw at S1 and S2 (IS S1-S2), pubic screw (PS) with iliosacral TBP, PS and IS S1-S2, SP and IS S1-S3, PS and S1-S3 and finally PS and IS S1-S3. Sensor was applied to detect the shifting and rotation of fracture fragments. Mechanical strength test conducted with the application of axial force on the sacrum vertebra (S1). Results: The highest translational stiffness was observed in the group IS S1-S3 + PS (830.36 N/mm, p = 0.031) and there was no difference on the rigidity of the rotation between the groups posterior fixation using IS S1-S2 and IS S1-S3 ( p = 0.51). Meanwhile the highest load to failure was found in group IS S1-S3 + PS (1522.20 N). PS provided advantages compared to the use of plate. Conclusions: Group of PS and S1-S3 IS is the configuration of internal fixation with best translational and rotational stiffness and the largest load to failure compared to other techniques in AO type C1.3 fracture.
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Shnayder, Yelizaveta, Terance T. Tsue, E. Bruce Toby, Andreas H. Werle, and Douglas A. Girod. "Safe Osteocutaneous Radial Forearm Flap Harvest with Prophylactic Internal Fixation." Craniomaxillofacial Trauma & Reconstruction 4, no. 3 (September 2011): 129–36. http://dx.doi.org/10.1055/s-0031-1279675.
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We studied the efficacy of prophylactic plate fixation technique and a modified harvest of the osteocutaneous radial forearm free flap (OCRFFF) to minimize the incidence of postoperative donor radius pathological fracture. We retrospectively studied of the first 70 consecutive patients undergoing OCRFFF harvest by the University of Kansas Head and Neck Microvascular Reconstruction Team. Mean follow-up was 13 months. One of two patients undergoing OCRFFF harvest without prophylactic fixation developed a pathological radius fracture. The 68 subsequent OCRFFF patients underwent prophylactic fixation of the donor radius, and none developed a symptomatic radius fracture. Five of 68 patients did have a radiographically visible fracture requiring no intervention. The plate fixation technique was further modified to exclude monocortical screws in the radius bone donor defect (subsequent 39 patients), without any further fractures detected. One patient required forearm hardware removal for an attritional extensor tendon tear. The described modified OCRFFF harvest and prophylactic plate fixation technique may eliminate postoperative pathological fracture of the donor radius. Donor morbidity is similar to that of the fasciocutaneous radial forearm free flap , affording safe use of OCRFFF in head and neck reconstruction.
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Bogosavljevic, M., B. Ristic, D. Stranojlovic, Z. Pavlov, D. Stokic, S. Ilic, J. Kostic, et al. "Intracapsular fractures of the femoral neck: Internal fixation or arthroplasty." Acta chirurgica Iugoslavica 62, no. 1 (2015): 65–68. http://dx.doi.org/10.2298/aci1501065b.
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Objective: Significant advances in the surgical treatment of intracapsular fractures of the femoral neck began in the mid-twentieth century, because of the better understanding of the characteristics and biomechanics of the fractures. The aim of this study is to precisely identify the characteristics of the fractures, that will be taken into account in the individualization of treatment of intracapsular fractures of the femur. Materials and Methods: We analyzed, in a retrospective study, 148 patients with intraarticular fractures of the femoral neck from the registry of the Orthopaedic Department in Pozarevac, in the period from 2009 to 2014. Fractures were classified by the modified Garden?s classification. Garden type III fractures were divided into two sub-types. Garden type IIIa included fractures in which the distance between the fragments of the medial cortex was less than ? the diameter of the femoral neck. Garden type III b included fractures in which the distance of the medial cortex of the fracture fragments was larger than ? the diameter of the femoral neck. Patients with the Garden type I fracture (6 cases), Garden type II ( 22 cases), Garden type IIIa (35 cases) and Garden type IV (5 cases) were treated by closed reduction and internal fixation. Patients with Garden type IIIb (28 cases) and Garden type IV (52 cases) were treated by primary total hip replacement. Results : All fractures in patients with the fracture Garden type I (6 cases) and Garden type II (22 cases) have healed and avascular necrosis did not occur. In the group of patients with the Garden type III b fracture, 3 patients with non-union were treated with total hip arthroplasty. In the same group in two patients avascular necrosis occurred. In the group of patients with the Garden type IV fracture who were treated by closed reduction and inter- nal fixation (5 cases), two patients with non-union were treated with total hip arthroplasty. In patients with Garden sub-type III b, in the time of monitoring we found 4 dislocations after primary total hip arthroplasty. One patient underwent acetabular revision in the same group. In the group of patients with Garden type IV fracture, we found 7 dislocations after total hip arthroplasty and two patients underwent acetabular revision surgery. Conclusion: Our results indicate that fractures Garden type I, II and Garden type III a can be successfully treated with internal fixation. Fractures Garden type III b and IV should be treated by primary hip arthroplasty, because of internal fixation of these fractures lead to unsatisfactory results.
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Yue, James J., and Randall E. Marcus. "The Role of Internal Fixation in the Treatment of Jones Fractures in Diabetics." Foot & Ankle International 17, no. 9 (September 1996): 559–62. http://dx.doi.org/10.1177/107110079601700909.
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The purpose of this study was to evaluate the treatment of fractures of the proximal fifth metatarsal at the junction of the metaphysis and diaphysis (i.e., Jones fracture) in diabetics. Open reduction and internal fixation with bone grafting resulted in clinical and radiographic union 8 weeks after surgery in patients treated with either immediate or delayed open reduction and internal fixation. Open reduction and internal fixation with autologous bone grafting is an effective treatment regimen in the diabetic patient with a Jones fracture. An initial trial of casting can be attempted without any apparent deleterious effects on secondary open reduction and internal fixation.
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Khapilin, A. P., E. I. Solod, D. A. Snetkov, M. N. Kotova, A. B. Simonov, I. K. Eremin, R. S. Shaikhutdinov, K. S. Beltikov, S. D. Postnikov, and I. V. Gorelov. "Internal fixation of instability pelvic fracture." Journal of Clinical Practice 9, no. 1 (December 25, 2018): 18–22. http://dx.doi.org/10.17816/clinpract09118-22.
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Over the past 3 years, an analysis of surgical treatment of 48 patients with unstable fractures of pelvic bones has been performed. The study group included patients with type B3, C2, and C3 fractures according to AO classification. The average follow-up period after the operation was 1 year.
Evaluation of the results of treatment was carried out on the basis of clinical examination, the analysis of radiographs and Mattis evaluation scale. Good results (76%) were obtained in patients with pelvic fractures type B3, C2, according to the AO classification. The number of satisfactory and unsatisfactory results of 15% and 9%, respectively, was obtained in patients in the group with the heaviest damage type C3. Complications of festering, impaired stability of fixation with loss of reposition were observed in 5 people (9%), two patients from the 3rd group died.
The obtained data allows to draw a conclusion that submersible osteosynthesis using various designs performed at the earliest possible time (damage control) remains the gold standard for today in the treatment of unstable fractures of the pelvis. The greatest number of complications was observed in the group of vertically unstable fractures of the pelvis C3. The data obtained correlates to a certain extent with the data of domestic and foreign literature.
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Patel, Priyesh D., and Marc J. Richard. "Scaphoid Fracture: Open Reduction Internal Fixation." Operative Techniques in Sports Medicine 18, no. 3 (September 2010): 139–45. http://dx.doi.org/10.1053/j.otsm.2010.04.002.
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Trostle, Steven S., and Mark D. Market. "Fracture Biology, Biomechanics, and Internal Fixation." Veterinary Clinics of North America: Food Animal Practice 12, no. 1 (March 1996): 19–46. http://dx.doi.org/10.1016/s0749-0720(15)30435-7.
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RAMAKRISHNA, K., I. SRIDHAR, S. SIVASHANKER, V. K. GANESH, and D. N. GHISTA. "ANALYSIS OF AN INTERNAL FIXATION OF A LONG BONE FRACTURE." Journal of Mechanics in Medicine and Biology 05, no. 01 (March 2005): 89–103. http://dx.doi.org/10.1142/s0219519405001333.
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A major concern when a fractured bone is fastened by stiff-plates to the bone on its tensile surface is excessive stress shielding of the bone. The compressive stress shielding at the fracture-interface immediately after fracture-fixation delays bone healing. Likewise, the tensile stress shielding of the healed bone underneath the plate also does not enable it to recover its tensile strength. Initially, the effect of a uniaxial load and a bending moment on the assembly of bone and plate is investigated analytically. The calculations showed that the screws near the fracture site transfers more load than the screws away from the fracture site in axial loading and it is found that less force is required when the screw is placed near to fracture site than the screw placed away from the fracture site to make the bone and plate bend with same radius of curvature when subjected to bending moment. Finally, the viability of using a stiffness graded bone-plate as a fixator is studied using finite element analysis (FEA): the stiffness-graded plate cause less stress-shielding than stainless steel plate.
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Zivanovic, Dragoljub, Zoran Radovanovic, Andjelka Slavkovic, and Zoran Marjanovic. "Internal fixator "Mitkovic" in the treatment of fractures of femoral shaft: A possible solution for fractures in heavier children and adolescents." Acta chirurgica Iugoslavica 62, no. 1 (2015): 45–47. http://dx.doi.org/10.2298/aci1501045z.
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Background: Management of femoral shaft fractures in older and heavier children and adolescents is still challenging and controversial and includes several modalities of fixation. Aim of this study was to analyze single center experience in application of selfdynamisable internal fixator Mitkovic (SIF) for the treatment of fractures of femoral shaft in children and adolescents. Methods: Retrospective analysis of data of pediatric and adolescent patients treated for diaphyseal fracture in single center has been conducted. Results: Eleven patients, with 12 femoral shaft fractures were treated in ten-year-period with internal fixator ?Mitkovic?. Time to fracture healing ranged from 4-12 weeks (average 8.9 weeks). All fractures healed without complications. No rotational or angular mall-alignment was noticed. No external cast immobilization was applied in any patient. Conclusion: Selfdynamisable internal fixator Mitkovic may be considered as viable option for treatment of femoral fractures in older/heavier children and adolescents particularly with unstable fracture patterns.
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Rand, Nahshon, Ram Mosheiff, and Meir Liebergall. "Nonunion of a Fracture of the Lateral Malleolus: A Case Report and Review of the Literature." Foot & Ankle International 18, no. 1 (January 1997): 50–52. http://dx.doi.org/10.1177/107110079701800111.
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Nonunion of a fracture of the lateral malleolus is a rare condition. We present a case of established nonunion of a fracture of the lateral malleolus confirmed and treated surgically, using debridement and internal fixation with autologous bone graft. At 5-year follow-up, the fracture was united but the patient still showed clinical signs of reflex sympathetic dystrophy. Male gender, supination fractures, Weber type C fractures, and primary internal fixation are cited as possible risk factors. Prognosis is variable.
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Chen, Wei, Riquan Zhang, Xuan Wu, Zuwei Yang, Ziyuan Chen, and Houyi Wu. "Internal fixation treatment of multiple fractures in a dog." Agrobiological Records 3 (November 2020): 36–40. http://dx.doi.org/10.47278/journal.abr/2020.020.
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In order to learn the diagnosis and treatment of canine fractures, we treated a stray dog in a traffic accident. We observed and recorded the treatment process in detail with the purpose of providing reference for the treatment of fractures in dogs. The doctors conducted general examination, X-ray and a complete blood count (CBC) on the dog at a pet hospital at Nanchang, Jiangxi, China, and then immediately performed surgery on the site of the severe fractures. Intramedullary nail and bone plate, and intramedullary nail and steel wire were respectively used for internal fixation of transverse fracture of femur of left hind-limb and oblique fracture of tibia of right hind-limb. Subsequently, suitable splint was used for external fixation, and the rest of the fractures healed on their own. After three months of postoperative nursing and massage, the internal fixation material was removed. The results showed that the dog had a good recovery. This paper has provided case study and a clinical practical reference for the diagnosis and treatment of complex multiple fractures.
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Vakhshori, Venus, Ram Kiran Alluri, Milan Stevanovic, and Alidad Ghiassi. "Review of Internal Radiocarpal Distraction Plating for Distal Radius Fracture Fixation." HAND 15, no. 1 (July 13, 2018): 116–24. http://dx.doi.org/10.1177/1558944718787877.
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Internal radiocarpal distraction plating is a versatile tool in the treatment of distal radius fractures that are not amenable to nonoperative treatment or operative fixation with standard volar or dorsal implants. Internal distraction plates may also be indicated in the setting of polytrauma or osteopenic bone. The plate functions as an internal fixator, using ligamentotaxis to restore length and alignment while providing relative stability for bony healing. The plate can be fixed to either the second or the third metacarpal, and anatomic and biomechanical studies have assessed the strengths and weaknesses of each strategy. This operative fixation technique leads to acceptable radiographic results and functional outcomes. Following fracture union, the plate is removed, and wrist range of motion is resumed.
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Strecker, W., M. Elanga, and W. Fleischmann. "Indications for Operative Fracture Treatment in Tropical Countries." Tropical Doctor 23, no. 3 (July 1993): 112–16. http://dx.doi.org/10.1177/004947559302300307.
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In the period 1 January 1987 to 30 June 1989, 3003 operations were performed at the regional hospital of Gbadolite, northern Zaire. In 123 patients fractures were reduced operatively, in 86 patients by internal fixation and in 37 patients by external fixation. There was no additional bone infection after external fixation but six of 28 patients (21%) with internal fixation by plate and screws developed postoperative osteitis. Non-union was observed in 12% after intramedullary nailing, in 4% after screw fixation alone, and 14% after internal fixation by Kirschner wires. Based on these data, indications and contraindications for operative fracture treatment in tropical countries are defined.
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Taverna, Ettore, Vincenzo Guarrella, Michael Freehill, and Guido Garavaglia. "Arthroscopic Reduction with Endobutton Fixation for Glenoid Fracture." Joints 05, no. 02 (June 2017): 127–30. http://dx.doi.org/10.1055/s-0037-1603675.
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AbstractGlenoid rim fractures, accompanied by acute glenohumeral dislocation or subluxation usually results in persistent instability. Traditionally open reduction and internal fixation has been recommended in displaced intra-articular glenoid fractures. However, open reduction is difficult, and it may not be possible to address the associated intra-articular soft-tissue injuries. A few reports of arthroscopic-assisted fixation of these fractures have been recently published. The most anatomic method for addressing an acute glenoid rim lesion is a reduction (either open or arthroscopic) and internal fixation. We are reporting a case of arthroscopic reduction and fixation of a glenoid fracture utilizing Endobuttons with clinical and radiological results at 18 months follow-up.
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Singisetti, K., E. Aldlyami, and A. Middleton. "Early results of a new implant: 3.0 mm headless compression screw for scaphoid fracture fixation." Journal of Hand Surgery (European Volume) 37, no. 7 (January 30, 2012): 690–93. http://dx.doi.org/10.1177/1753193411436291.
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There has been a considerable evolution of screws used for internal fixation of scaphoid fractures. We discuss here, early results of a recently introduced implant Synthes 3.0 mm headless compression screw used for scaphoid fracture fixation. Twenty eight patients with scaphoid fractures (five acute and 23 nonunions) were treated with internal fixation by this non-variable pitch screw over a period of 18 months. All nonunions had pedicle vascularized bone grafting. All five patients with acute scaphoid fracture fixation had radiological healing at a mean of 8 weeks. Fifteen of 23 scaphoid fracture nonunions showed definite signs and a further seven showed probable signs of radiological healing at a mean of 8 months. One nonunion has failed to unite after surgery.
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Polfer, CPT Elizabeth M., CPT Matthew W. Kluk, MAJ Korboi N. Evans, LTC Wade T. Gordon, and COL Romney C. Andersen. "Subcutaneous Internal-External Fixation for Pelvic Fracture Fixation: A Novel Approach for Open Fracture Fixation." JBJS Case Connector 2, no. 2 (June 13, 2012): e24. http://dx.doi.org/10.2106/jbjs.cc.k.00100.
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Kadakia, Rishin, Jeff Konopka, Tristan Rodik, Samra Ahmed, and Sameh A. Labib. "Arthroscopic Reduction and Internal Fixation (ARIF) of a Comminuted Posterior Talar Body Fracture: Surgical Technique and Case Report." Foot & Ankle Specialist 10, no. 5 (January 9, 2017): 465–69. http://dx.doi.org/10.1177/1938640016685148.
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The talus is the second most common fractured tarsal bone. While their incidence may be low, talus fractures are severe injuries that can lead to long-term disability and pain. Displaced talar body fractures are typically treated through an open approach with the aim of obtaining anatomic reduction and stable fixation. There are several case reports in the literature demonstrating successful management of talus fractures arthroscopically. An arthroscopic approach minimizes soft tissue trauma, which can help decrease postoperative wound complications and infections. In this article, the authors describe a surgical technique of an arthroscopic reduction and internal fixation of a comminuted posterior talar body fracture. Compared with an open posterior approach with or without osteotomies, an arthroscopic technique improved visualization and allowed precise reduction and fixation. Levels of Evidence: Level V: Case report
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Zhang, Hongyi, Haoyu Feng, Chen Chen, Li Zhang, Qiang Li, and Haoliang Zhao. "X-ray and Computed Tomography Analysis of Spinal Joint Injuries." Journal of Medical Imaging and Health Informatics 10, no. 12 (December 1, 2020): 2959–64. http://dx.doi.org/10.1166/jmihi.2020.3242.
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Objective: The X-ray and CT features of minimally invasive percutaneous pedicle screw for open reduction and internal fixation and traditional open reduction and internal fixation for thoracolumbar fractures were compared. Methods: Sixty-two patients with thoracolumbar fractures were analyzed with single vertebral body injury without obvious osteoporosis. Patients were randomly divided into two groups. In group A, minimally invasive percutaneous pedicle screws were used for open reduction and fixation. Group B was treated with thoracolumbar vertebral fracture with traditional incision and reduction and internal fixation with posterolateral fusion. Both groups followed standard surgical methods and methods, the same postoperative treatment and functional exercise plan. Results: During a 9-month follow-up, X-ray and computed tomography were used to analyze fracture joint motion injuries. The recovery rate of vertebral height in group A was significantly better than that in group B. At 9 months after operation, the recovery rate of vertebral height in group A increased. The neural function was similar, but the improvement rate in group A was significantly better than that in group B. Conclusions: Minimally invasive percutaneous pedicle screws for open reduction and internal fixation are compared with traditional open reduction and internal fixation for thoracolumbar fractures. Vertebral body height, symptom improvement, and neurological recovery after a lumbar fracture. However, minimally invasive percutaneous pedicle screws for open reduction and internal fixation can immediately increase the compression stability of the anterior spine and reduce complications such as nail and rod rupture due to excessive fixation pressure.
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ALCÂNTARA JUNIOR, JOÃO EURÍPEDES DE, ROGGER AGUIAR DE AGUIAR, JOSE GILVAN LEITE SAMPAIO NETO, MATHEUS LEMOS AZI, DAVID SADIGURSKY, and DANIEL FIGUEIREDO DE ALENCAR. "FACTORS ASSOCIATED WITH THE DEVELOPMENT OF EARLY INFECTION AFTER SURGICAL TREATMENT OF FRACTURES." Acta Ortopédica Brasileira 26, no. 1 (February 2018): 22–26. http://dx.doi.org/10.1590/1413-785220182601173883.
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ABSTRACT Objective: Infection after the internal fixation of fractures is a major complication. Early infection is particularly challenging, because it occurs when the fracture is not yet united. The objective of this study is to identify possible factors related to the development of early infection in patients treated with internal fixation for fractures. Method: This retrospective observational study analyzed 24 patients with long bone fractures who underwent internal fixation and developed infections in the post-operatory period. The infections were classified as early (diagnosis in the first two weeks after surgery) or late (diagnosis after 2 weeks). Results: Of the 24 patients studied, 11 (46%) developed early infections and 13 (54%) were diagnosed with late infections. The early infection group was significantly younger (37.8 versus 53.1 [p = 0.05]) and underwent more surgeries prior to internal fixation (1.2 versus 0.2 [p < 0.00]). Conclusion: Risk factors for the development of early infection in the postoperative period should be considered when treating patients with internal fracture fixation in order to diagnose this condition as early as possible. Level of Evidence IV; Case series.
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O'Shea, MK, W. Spak, S. Sant'Anna, and C. Johnson. "Clinical perspective of the treatment of fifth metatarsal fractures." Journal of the American Podiatric Medical Association 85, no. 9 (September 1, 1995): 473–80. http://dx.doi.org/10.7547/87507315-85-9-473.
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The authors present a retrospective study of fifth metatarsal fractures. These fractures include Jones fractures, avulsion fractures, spiral and oblique midshaft fractures, and the author-termed "tulip" fracture (impaction fracture of the fifth metatarsal head). These fractures were fixated with the cannulated screw, Kirschner wires, and cerclage loop wires combined with Kirschner wires. A one-way analysis of variance (ANOVA) was performed on the data to test for any significant difference in the fixation type used and the overall healing time. The ANOVA was found to be nonsignificant, F(2,10) = 0.379, p < 0.05. Therefore, it can be concluded that all three types of fixation work equally well. Other analyses were performed on each of the three specific types of fractures to see if there was any difference in fixating the fracture versus no fixation and immobilization. This information was significant for only the Jones fracture, F(1,5)2.23, p < 0.05, meaning that Jones fractures heal in a significantly shorter amount of time when some type of open reduction internal fixation is used. Since there was no difference in healing time between the different types of fixation, the authors advise that the cannulated screw be strongly considered because of its efficiency of insertion. In addition, because of the vascularity, muscle insertions, and motion related to the fifth metatarsal, the authors recommend that most Jones fractures be fixated for a more rapid return to function.
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Shukla, Rajeev, Ravi Kant Jain, Shravan Patidar, Nikhil Jain, and Pranav Mahajan. "Cross-Sectional Study to Assess the Functional Outcome of Neglected Bimalleolar Fracture." Foot & Ankle Specialist 10, no. 6 (December 27, 2016): 509–12. http://dx.doi.org/10.1177/1938640016685149.
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Introduction. Ankle fracture is the most common intra-articular fracture of a weight-bearing joint and accounts for 9% of all fractures. Ankle fractures are classified into 3 subgroups: unimalleolar, bimalleolar, and trimalleolar fractures. Accurate reduction and stable internal fixation is necessary in bimalleolar fractures; otherwise, it may lead to posttraumatic painful restriction of movements or osteoarthritis. The purpose of this study is to assess the functional outcome and results of treatment of neglected bimalleolar fracture. Materials and Methods. Seventeen neglected bimalleolar fracture patients were treated with open reduction and internal fixation. Patients were followed-up at 1, 2, and 5 years and functional ability was assessed by using the modified Weber Rating Scale. Results. The mean age of patients was 41.4 ± 13.28 years. After 2 year of surgery, 13 out of 17 patients showed excellent results and 4 patients had fair results. Conclusion. Good to excellent functional results were observed after long-term follow-up in neglected bimalleolar fracture treated with open reduction and internal fixation, and we advise surgical intervention in all such patients. Levels of Evidence: Therapeutic, Level III: Retrospective Cohort study
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Sanjaya, Charlie, and I. Ketut Gede Arta Bujangga. "INTERNAL FIXATION OF TYPE I CAPITELLUM FRACTURE WITH HEADLESS SCREWS: A CASE REPORT." (JOINTS) Journal Orthopaedi and Traumatology Surabaya 10, no. 2 (September 8, 2021): 70. http://dx.doi.org/10.20473/joints.v10i2.2021.70-76.
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Background: Capitellum fractures are relatively rare. Distal humeral fractures that include capitellum and trochlea constitute approximately 6% of all distal humeral fractures and 1% of all elbow fractures. Despite the rarity of these injuries, an increasing number of clinical series have emerged, enhancing our understanding of these fractures.Case Report: A 26-year-old woman came to the emergency department with complaints of swelling and localized pain on the lateral side of her left elbow 2 hours after she fell off her motorcycle. Routine imaging such as plain radiographs and computed tomography scanning confirmed the fracture. She underwent open reduction and internal fixation surgery, stabilization of articular fragments with headless screws, and was fixated by a back slab and arm sling. The patient was also encouraged to do early elbow mobilization to avoid contractures and joint stiffness, routine follow-up every two weeks for a ROM evaluation. Preoperative Mayo Elbow-Performance Index score (MEPI) was 15, and postoperative 100.Discussion: The aim of capitellum fracture treatment is anatomical reconstruction and fixation to reduce the risk of non-union. In this case, we performed open reduction, secured two headless screws, which allow rigid fixation at the fracture site, provide fracture site compression through variable thread pitch design, and remained not removed later. These screws are suitable for use in anteroposterior and posteroanterior directions.Conclusion: The patient at two months follow-up has shown significant improvement. Accurate reduction, stable fracture fixation, and early postoperative mobilization were reported to provide good results with a MEPI score of 100.
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Caviglia, Horacio, Adrian Mejail, Maria Eulalia Landro, and Nosratolah Vatani. "Percutaneous fixation of acetabular fractures." EFORT Open Reviews 3, no. 5 (May 2018): 326–34. http://dx.doi.org/10.1302/2058-5241.3.170054.
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The objective of surgery for acetabular fractures is to achieve precise reduction to restore joint congruence, fix internal bone fragments, avoid displacement of the fracture and allow rapid rehabilitation. Open reduction and internal fixation is the benchmark method for displaced acetabular fractures, but open reductions can increase morbidity, causing neurovascular injury, blood loss, heterotopic bone formation, infection and poor wound healing. An anatomical reduction with a gap of 2 mm or less is a predictor of good joint function and reduced risk of post-traumatic osteoarthritis. The percutaneous approach is associated with fewer complications than open techniques, but acetabular geometry makes percutaneous screw insertion a challenging procedure. The percutaneous technique is recommended for non-displaced or slightly displaced fractures, and in obese, osteoporotic and elderly patients who cannot receive total joint arthroplasty. We recommend the use of intramedullary cannulated screws. Fracture reductions are achieved by manual traction of the affected bones. If some fracture displacement remains, accessory windows can be used to introduce a ball spike pusher, a hook or a Steinmann pin which can be used as a joystick to rotate the fracture. In this paper, we describe the accessory windows for the anterior column, the quadrilateral plate and the posterior column. We detail the position, direction and kind of screws used to stabilize the anterior and posterior columns. Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170054
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Orbay, Jorge L. "THE TREATMENT OF UNSTABLE DISTAL RADIUS FRACTURES WITH VOLAR FIXATION." Hand Surgery 05, no. 02 (December 2000): 103–12. http://dx.doi.org/10.1142/s0218810400000223.
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Stable internal fixation and early motion has not been routinely available for distal radius fractures. Difficulties with the dorsal approach discourage surgeons from internally fixing the most common fracture types. The introduction of a new volar plate with subchondral support fixation allows the treatment of most distal radius fractures with stable internal fixation and early motion while avoiding the complications inherent in the dorsal approach.
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Dash, Sunil Kumar, Manish Kumar Sharma, Sanket Mishra, Hatia Marandi, Aurobinda Das, Deepankar Satapathy, and Syed S. Ahmed. "Clinical outcomes in management of unstable distal radius fractures treated with external fixation and internal fixation: a prospective comparative study." International Journal of Research in Orthopaedics 3, no. 5 (August 24, 2017): 1004. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20173932.
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<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Management of Distal Radius fracture that are inherently unstable is still a matter of debate. There is no conclusive evidence that support one surgical fixation method over another. An attempt was made to analyze patients treated with Ex-Fix and Internal-Fixation for unstable distal radius fractures and evaluate the clinical efficacy of Ex-fix using principles of ligamentotaxis and Internal-fixation and compare functional recovery, fracture healing time and complications</span><span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">A prospective trial was undertaken at our hospital with 35 patients,all aged >20 yrs with closed distal radius fracture and divided into two groups: group I (Ex-fix with or without percutaneous k-wire, and JESS) and group II (Int-Fixation) including 14 and 21 patients, respectively. Periodic clinical examination and x-ray review was carried out to find out fracture union, and functional assessment. Patients were followed up for 1 year, 6 months average</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Group I consumed significant less operative time, fluoroscopic exposure, reduced hospital stay, quicker post-operative pain relief. Quick DASH score were significantly high in elderly treated with Ex-Fix in comparison to young in which DASH score was higher with internal-fixator. Functional recovery was early with int-fixation but post-operative wrist stiffness was also higher. 2 cases of delayed wound healing &1 case of pin tract infection with ex-fix application was observed</span><span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Internal-fixation remains the treatment of choice for unstable distal radius fracture involving the articular surface and in the young, while ext-fixation can be considered as a primary treatment modality in the extra-articular fractures in young or even intra-articular fractures in the elderly</span><span lang="EN-IN">.</span></p>
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RUTGERS, M., C. S. MUDGAL, and R. SHIN. "Combined Fractures of the Distal Radius and Scaphoid." Journal of Hand Surgery (European Volume) 33, no. 4 (August 2008): 478–83. http://dx.doi.org/10.1177/1753193408090099.
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Combined fractures of the distal radius and scaphoid are uncommon, are usually the result of a high-energy trauma and there is no consensus regarding their optimal management. We present a retrospective study of ten patients, out of whom nine underwent internal fixation of their fractures. Open reduction and internal fixation were performed in six of the eight intraarticular fractures of the distal radius. After a mean follow-up of 40 months, eight patients reported no pain and the mean range of wrist motion was 55° flexion and 71° extension. Our current management protocol is outlined. Emphasis on treatment of this combined fracture should be placed on the management of the distal radius fracture. Internal fixation of both fractures, followed by early rehabilitation, optimises outcomes. Cast treatment is indicated only in patients with completely undisplaced fractures of both the radius and the scaphoid.
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Kostic, Igor, Milan Mitkovic, and Milorad Mitkovic. "Results of the application of a new method of internal fixation of femoral neck fractures - self-tapping antirotation cannulated screws (SAF)." Acta chirurgica Iugoslavica 60, no. 2 (2013): 71–79. http://dx.doi.org/10.2298/aci1302071k.
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Introduction: Femoral neck fractures are one of the most common fractures primarily the elderly, coupled with a high degree of morbidity and mortality. The treatment is applied a number of methods of internal fixation (multiple cannulated screws available, DHS system, cefalomedullary). At the Department of Orthopedics and Traumatology of Nis developed a new method of fixation of femoral neck fracture, which allows stable fixation of dislocated and nondislocated femoral neck fracture. Self-tapping antirotation fixation (SAF) using two cannulated screws to initial compression fractures intraoperative and postoperative dynamic linear compression of the fracture with early full support to the patient. Matherial and methods: In the period between 2008 to 2012, 53 patients treated for femoral neck fracture in the Clinic for orthopedic and traumatology, Clinical center in Nis, Serbia, by SAF (the self-tapping cannulated screws antirotation; ORTOKON doo Nis). All patients were followed up after surgery in a minimum period of 13 weeks (13-106 weeks). The outcome was evaluated on the basis of clinical and radiological signs of fracture healing and the Harris hip score of functional recovery of the patient. Results: Of the total number of patients (53) treated with this method of fixation, 31 of them were females and 22 males, mean age 52.7 years (28-75 years). The average time of surgery was 36.4 minutes (19-70 minutes). During the postoperative follow-up of all patients (53) operated by this method, six patients were lost in the further postoperative monitoring, so that 47 patients remained for final evaluation. The total incidence of nonunion of femoral neck fracture after surgery this method was 6.4% (three patients). Shortening of the femoral neck after fixation by this method was recorded in 27 cases, and what amounted to an average of 2.8 mm (1, 2 mm in nondislocated to 4.55 with dislocated fracture) and did not affect the functional outcome. During radiographic follow-up was not detected fracture implants. Conclusion: Self-tapping screws cannulated antirotacioni (SAF method) represent a reliable method of fixation of dislocated and nondislocated femoral neck fracture. The main prerequisite for the proper healing of femoral neck fractures with this method is that anatomical fracture reduction is achieved by a closed or open method. This way of fixation allows the early full weight bearing patient operated limb and faster postoperative functional recovery of the fracture healing in optimal time.
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Lee, Patrick, Allison Z. Piatek, Michael J. DeRogatis, and Paul S. Issack. "Combined Ipsilateral Humeral Shaft and Galeazzi Fractures Creating a Floating Elbow Variant." Case Reports in Orthopedics 2018 (November 8, 2018): 1–5. http://dx.doi.org/10.1155/2018/7430297.
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“Floating elbow” injuries of the arm traditionally represent a combination of humeral shaft and forearm fractures which require anatomic rigid open reduction and internal fixation of all fractures to allow for early range of motion exercises of the elbow. There are published variants of the floating elbow injury which include ipsilateral diaphyseal humeral fracture, proximal ulna fracture with proximal radioulnar joint disruption, and ipsilateral diaphyseal humeral fracture with elbow dislocation and both bones forearm fracture. We present the case of a 21-year-old woman whose left arm became caught between the side of a waterslide and adjacent rocks at a park. She sustained a torsional and axial loading injury to her left upper extremity resulting in ipsilateral humeral shaft and Galeazzi fractures. The combination of ipsilateral humeral shaft and Galeazzi fractures resulted in a rare floating elbow variant. Prompt open reduction and internal fixation of both fractures and early range of motion of the elbow and wrist resulted in an excellent clinical and radiographic result. Floating elbow injuries and their variants should be promptly recognized as early anatomic reduction, and rigid internal fixation can allow for good elbow function with minimization of stiffness.
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Nienstedt, Frank, Markus Mariacher, Günther Stuflesser, and Wilhelm Berger. "Nascent Malunion of an Isolated Intraarticular Fracture of the Ulnar Head." Journal of Wrist Surgery 09, no. 03 (October 16, 2019): 240–43. http://dx.doi.org/10.1055/s-0039-1698453.
Full textAbstract:
Abstract Background Isolated fractures of the ulnar head are rare. Only few cases have been reported in literature. Case Description We report a case of a 16-year-old student who was treated for an ulnar styloid fracture conservatively. An associated displaced intraarticular fracture of the ulnar head has been overlooked. He presented late in our clinic with a symptomatic nascent malunion of the ulnar head fracture. A corrective osteotomy by a palmar approach was performed. Fixation by screws was used with an excellent result at 7-year follow-up. Literature Review The rare cases of isolated ulnar head fractures reported in literature were treated by open reduction and internal fixation only in case of fracture dislocation. Clinical Relevance The authors highlight the fact that even a nascent malunion of an isolated intraarticular fracture of the ulnar head may be treated successfully by open reduction and internal fixation.
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Mar, Winnie, J. Schilling, Laurie Lomasney, Eric Chen, Mihra Taljanovic, and Jason Lowe. "Radiologic Evaluation of Lower Leg, Ankle, and Foot Fracture Fixation Hardware." Seminars in Musculoskeletal Radiology 23, no. 02 (March 29, 2019): e36-e55. http://dx.doi.org/10.1055/s-0039-1681049.
Full textAbstract:
AbstractRadiologists should be familiar with basic principles of fracture fixation and the normal imaging appearances of implant constructs and their complications. The surgeon's selection of external fixation, intramedullary nail fixation, open reduction and internal fixation, or some combination depends on patient factors, fracture configuration, injury to the soft tissue envelope, and surgeon experience. Complications including loss of fixation with resultant malalignment, nonunion, infection, and posttraumatic osteoarthritis present additional challenges for the surgeon as well as the radiologist. This article reviews the rationale behind fracture fixation in fractures of the lower leg, ankle, and foot. Examples of postoperative complications are also reviewed.