Fixation of subtrochanteric fractures

The subtrochanteric region has certain anatomical and biomechanical features that can make fractures in this region difficult for the treating surgeon. The preferred type of device is a matter of debate. Increased understanding of mechanical characteristics of the dynamic hip screw (DHS) has reduced the incidence of complications. Our hypothesis is based on the technical optimization of the DHS application. We prospectively studied 37 patients with subtrochanteric fractures with a mean age of 42.9 years. We utilized a two-stage protocol: initially, conversion of the comminuted fractures into two part fractures; then application of the implant with a technique that allowed dynamization of the DHS. Clinical and radiographic data were used to assess the outcome at 12 months. Fracture healing was obtained for all cases in a mean time of 11.64 weeks. One patient had 1.5 cm shortening of the injured limb. No implant failure was reported. All patients resumed pre-injury activities of daily living. It was concluded that the patients who were treated with the technical optimization of the DHS application achieved a close-to-normal anatomy following surgery and maintained this state throughout the follow-up period.     

A portable traction device for cervical fractures. Technical note.

A lightweight and completely self-contained traction device is described. It has been used to immobilize the cervical spine during radiographic evaluation and treatment of patients with cervical fracture, and for therapeutic traction in patients with a ruptured disc. Other applications are possible, but have not yet been investigated.     

Fixation versus hemiarthroplasty for undisplaced intracapsular hip fractures

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

Targeting device for pinning finger fractures

An inexpensive targeting system for pinning phalangeal fractures is described.     

A device for producing experimental fractures

A device is reported for the production of transverse fractures of canine tibiae by a three-point bending technique. With strain-gauged load arms, the device enables simultaneous measurement of the bend strength of the intact bone. Results from a series of 14 dogs confirm the reproducibility of this technique.     

A device for producing experimental fractures

A device is reported for the production of transverse fractures of canine tibiae by a three-point bending technique. With strain-gauged load arms, the device enables simultaneous measurement of the bend strength of the intact bone. Results from a series of 14 dogs confirm the reproducibility of this technique.     

Fixation of osteochondral fractures. Fibrin sealant tested in dogs

Standardized osteochondral fractures in the left femoral condyle in 19 adult mongrel dogs were fixed with either fibrin sealant or Kirschner wire. Adaptation and mechanical strength after 4, 7 or 8, and 14 days were compared with an in vitro study of the initial strength of the fibrin sealant in osteochondral fractures. After 4 days, the maximum tensile strength was increased in the fibrin sealed group, whereas no difference in energy absorption at failure was found. Although the initial strength of the fibrin bond was low, the tendency to displacement was less in this group. Our results suggest that fibrin sealant can be used for fixation of small osteochondral fragments, provided that immobilisation is sufficient.     

Fixation of basicervical and related fractures

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

Fixation of fractures by twisted plates

Summary A new twisted plate has been designed for biplane fixation of diaphyseal fractures of long bones. Comparative mechanical testing of the new twisted plate and conventional flat plates showed that the twisted plate was 40% stronger when a bending moment was applied and 132% stronger to a twisting moment. The overall improvement in strength was 90.5%. Clinical trials have been carried out and this paper describes the use of the new plate.

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Résumé Une nouvelle plaque en cornière a été mise au point dans le but de fixer dans deux plans les fractures diaphysaires des os longs. Les tests mécaniques comparatifs avec les plaques ordinaires ont montré un gain de 49% pour les contraintes en flexion et de 132% pour les contraintes en rotation. L'augmentation totale de résistance atteignait ainsi 90.5%. Des essais cliniques ont été effectués avec succès sur des fractures du tiers moyen du tibia, de l'humérus, du cubitus, du radius et du fémur. L'auteur discute les divers arguments pour et contre l'utilisation de cette nouvelle plaque. Il envisage également l'extension du concept de cornière en vue de renforcer d'autres types de plaques déjà existantes.

     

Fixation of fractures of the sacrum

Fractures of the sacrum are infrequent injuries; however, they comprise a wide spectrum of injury types.Classification of the injuries are predominantly by fracture line direction (vertical, transverse, and oblique). The direction of the fracture line dictates both the most effective type of surgical management as well as the biologic consequences of the fracture. Most vertical fractures are associated with pelvic injuries and rarely have severe neural conpromise. Fixation of the sacral fracture is often a part of the more complex restoration of pelvic stability. Transverse and oblique sacral fractures are less often part of a pelvic injury complex; and they more often have associated neural deficits. Surgical treatment is most often indicated for neural decompression and stabilization for optimal recovery.     

Fixation failure in femoral neck fractures

Fixation of femoral neck fractures is associated with a higher incidence of complications than any other fracture. The rates of nonunion and avascular necrosis with open reduction and internal fixation continue to be unacceptably high. These complications are the main reason for resorting to primary endoprosthetic replacement of the femoral head in the presence of displaced fractures in elderly patients. However, with the increasing life span of the patients with these prostheses, late complications of endoprosthetic replacement of the femoral head are becoming significant. With these complications, it may be argued that the most cost-effective solution to the femoral neck fracture in the majority of patients is open reduction and internal fixation, with elective conversion, when necessary, to total hip arthroplasty in patients who have a complication. Because the literature does not contain a systematic review of reasons for failure of internal fixation, the authors will attempt to review the common means of failure of internal fixation in young and older patients in an attempt to better understand and prevent these complications.     

1/3半管型双钢板内固定治疗Pilon骨折

目的 介绍一种1/3半管型钢板内固定治疗Pilon骨折的治疗方法,评价其临床疗效.方法 29例Pilon骨折患者,复位后采用1/3半管型双钢板固定. 结果 本组29例均获随访,时间18～43个月,平均(24.6±4.3)个月.按照Mazur标准评定疗效,本组优19例,良4例,可6例,优良率为79.3％.有2例切口延迟愈合,经换药后愈合.无感染、骨髓炎、骨不连、关节僵硬等并发症.结论 1/3半管型双钢板内固定治疗Pilon骨折具有疗效佳,并发症少的优点.     

介绍一种管状骨骨折复位维持器

目的 改进设计一种新的管状骨骨折复位维持器。方法 改进设计新型管状骨骨折复位维持器并应用到26例胫骨、股骨骨折切开复位交锁钉内固定手术中。结果 所有病例骨折均解剖复位，一次交锁成功并牢固固定。结论 该复位维持器具有设计合理、操作简单、维持复位关系牢固的特点，适宜于管状骨骨折切开复位交锁钉内固定手术。