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The role of Esmarch bandage and percutaneous cannulated cancellous screws in tibial condylar fracture  [cached]
Shete Kiran,Sancheti Parag,Kamdar Rutuj
Indian Journal of Orthopaedics , 2006,
Abstract: Background : Proximal tibial fractures involving the condyles are often a matter of debate with regards to surgical management. The purpose of this study was to evaluate the efficacy of using closed reduction with an eschmarch bandage, gentle hammering, and use of percutaneous cannulated cancellous screws for fixation and buttressing the fracture, as a treatment modality for specific tibial condyle fractures. Methods : We evaluated 90 closed upper end tibia fractures, Schatzker types I, III, and IV, treated with closed reduction using an esmarch bandage and minimally invasive percutaneus fixation with cannulated cancellous screws. Results : We achieved excellent results in 33.3% of the cases, good result in 50%, a fair result in 13.3 %, and a poor result in 3.3 % cases. Conclusion : This minimally invasive modality of treatment of upper end tibia fractures gives satisfactory results. The use of esmarch bandage and gentle hammering to help achieve acceptable reduction has the advantage of being relatively simple and easily reproducible, without the use of any expensive extra medical equipment. The percutaneous fixation with cancellous screws has minimal morbidity. Thus, this is a good modality of treatment of tibial condlyle fractures of Schatzker types I, III and IV.
Efficacy of intermaxillary fixation screws  [PDF]
KP Biswas,A Ahuja,VP Singh
Health Renaissance , 2012, DOI: 10.3126/hren.v10i1.6013
Abstract: Intermaxillary fixation (IMF) is a technique which is basically used for management of fracture.This includes IMF screws and various dental wirings. However IMF may not be advantageous in case of edentulous or partially dentulous patients. The purpose of this article is to report a case of unilateral parasymphyseal and zygomatic arch fracture managed successfully by IMF screws and to list the difficulties faced during the surgery. DOI: http://dx.doi.org/10.3126/hren.v10i1.6013 HREN 2012; 10(1): 69-71
Fatigue strength of common tibial intramedullary nail distal locking screws
Lanny V Griffin, Robert M Harris, Joseph J Zubak
Journal of Orthopaedic Surgery and Research , 2009, DOI: 10.1186/1749-799x-4-11
Abstract: Fatigue tests were conducted to simulate a comminuted fracture that was treated by IM nailing assuming that all load was carried by the screws. Each screw type was tested ten times in a single screw configuration. One screw type was tested an additional ten times in a two-screw parallel configuration. Fatigue tests were performed using a servohydraulic materials testing system and custom fixturing that simulated screws placed in the distal region of an appropriately sized tibial IM nail. Fatigue loads were estimated based on a seventy-five kilogram individual at full weight bearing. The test duration was one million cycles (roughly one year), or screw fracture, whichever occurred first. Failure analysis of a representative sample of titanium alloy and stainless steel screws included scanning electron microscopy (SEM) and quantitative metallography.The average fatigue life of a single screw with a diameter of 4.0 mm was 1200 cycles, which would correspond roughly to half a day of full weight bearing. Single screws with a diameter of 4.5 mm or larger have approximately a 50 percent probability of withstanding a week of weight bearing, whereas a single 5.0 mm diameter screw has greater than 90 percent probability of withstanding more than a week of weight bearing. If two small diameter screws are used, our tests showed that the probability of withstanding a week of weight bearing increases from zero to about 20 percent, which is similar to having a single 4.5 mm diameter screw providing fixation.Our results show that selecting the system that uses the largest distal locking screws would offer the best fatigue resistance for an unstable fracture pattern subjected to full weight bearing. Furthermore, using multiple screws will substantially reduce the risk of premature hardware failure.Tibial fractures are the most common long bone injury. Various methods of managing tibial fractures have been described in the literature over the years, ranging from plaster, functional b
Surgical treatment of complex tibial plateau fractures by closed reduction and external fixation. A review of 32 consecutive cases operated
C. Faldini,M. Manca,S. Pagkrati,D. Leonetti,M. Nanni,G. Grandi,M. Romagnoli,M. Himmelmann
Journal of Orthopaedics and Traumatology , 2005, DOI: 10.1007/s10195-005-0107-4
Abstract: Complex tibial plateau fractures are a challenge in trauma surgery. In these fractures it is necessary to anatomically reduce the articular part of the fracture and to obtain stable fixation. The aim of this study is to review the results of a surgical technique consisting of fluoroscopic closed reduction and combined percutaneous internal and external fixation. Thirty-two complex tibial plateau fractures in 32 patients were included. Twenty-one fractures were closed, 4 were open Gustilo grade I, 3 were Gustilo grade II and 4 were Gustilo grade III. The mean age was 37.8 years (range 21–64 years). Surgery was performed with patients in transcalcaneal traction and the knee flexed at 30° was used. Through a 1-cm incision centred over the tibial metaphysis of the tibia, a 3.2-mm hole was drilled in the antero-medial tibial aspect. The tibial plateau fracture fragments were elevated using either 1 or 2 curved Kirschner wires under fluoroscopy to control the reduction. Then the fragments were fixed with 2 cannulated AO screws inserted through small incisions into the medial aspect of the tibial plateau. Knee rehabilitation started postoperatively. Weight bearing started after 8–12 weeks depending upon the radiographic appearance. All external fixators were removed in outpatient facilities. All patients were clinically and radiographically evaluated at a mean follow-up of 48 months (range 38–57 months). Clinical results were evaluated according to the Knee Society clinical score. Average healing time was 24 weeks (range 18–29 weeks). In 1 patient a non-union occurred. This patient was treated with open reduction and plate fixation. In 2 patients a varus knee deformity occurred and a surgical correction was performed. There were no surgical complications. Mean knee range of motion was 105° (range 75–125°) and mean Knee Society clinical score was 89. Twenty-five results were scored as excellent, 4 good, 2 fair and 1 poor. Using this technique there is limited soft tissue damage and virtually no periosteum damage to the fracture fragments. However anatomical reconstruction of the joint can be obtained. Furthermore knee rehabilitation can be started immediately after surgery. We think that these factors were responsible for the optimal clinical long-term results.
Are Two Screws Enough for Fixation of Femoral Neck Fractures? A Case Series and Review of the Literature
K.C. Xarchas, C.D. Staikos, S. Pelekas, T. Vogiatzaki, K.J. KazakosD.A. Verettas
The Open Orthopaedics Journal , 2007, DOI: 10.2174/1874325000701010004]
Abstract: There is still a controversy in literature regarding the treatment of subcapital fractures of the hip with internal fixation. Different methods have been tested and studies such as in cadavers mainly prejudge the three cannulated screws application. We present a series of 20 patients in which percutaneous fixation with two parallel cannulated screws under specific technical conditions has led to an uneventful fracture union. No complications were observed at a one year follow- up. Reviewing the literature we found no previous clinical studies on the subject.
Distal tibial metaphyseal fractures: the role of fibular fixation
R. Varsalona,G. T. Liu
Strategies in Trauma and Limb Reconstruction , 2006, DOI: 10.1007/s11751-006-0005-1
Abstract: Distal tibial extra-articular fractures are often a result of complex high-energy trauma, which commonly involves associated fibular fractures and soft tissue injury. The goal of tibial fixation is to maximise fracture stability without increasing soft tissue morbidity from surgical intervention. The role of adjunctive fibular fixation in distal tibial metaphyseal fractures has been controversial; although fibular fixation has been shown to improve stability of distal tibial fractures, there has been increased potential for soft tissue-related complications and a delay to tibial fracture healing. Adjunctive fixation of concomitant fibular fractures without associated syndesmotic or ankle pathology is not necessary in surgically stabilised extra-articular metaphyseal fractures of the distal tibia.
Photoelastic Analysis of the Vertebral Fixation System Using Different Screws
S. F. Fakhouri,M. M. Shimano,C. A. Araujo,H. L. Defino
Engineering, Technology & Applied Science Research , 2012,
Abstract: The purpose of this study was to compare using photoelasticity, the internal stresses produced by two types of pedicular screws (Synthes ) with three different diameters, when submitted to different pullout strengths. The fringe orders were evaluated around the screws using the Tardy compensation method. In all the models analyzed, the shear stress was calculated. Results showed that, independently of the applied load, the screw of smaller outer diameter had larger values of shear stress. According to the analysis realized, we observed that the place of highest stress was in the last thread, close to the head of the screws.
Tibial rotational osteotomy with intramedullary nail fixation
Alan K. Stotts,Peter M. Stevens
Strategies in Trauma and Limb Reconstruction , 2009, DOI: 10.1007/s11751-009-0076-x
Abstract: There are several theoretic advantages of using intramedullary rod fixation for tibial osteotomy fixation. We performed a retrospective review of patients who were treated with a mid-diaphyseal osteotomy of the tibia fixed with an intramedullary rod for isolated, symptomatic tibial torsion. Forty patients (59 tibias) were included in the study and were followed for a minimum of 12 months or until rod removal (average follow-up 22.6 months). Major complication rate was 8.5%, which is comparable to alternative methods of fixation. We believe that intramedullary rods are a safe alternative for fixation of tibial rotational osteotomy in patients with physeal closure.
Biomechanical Study of the Pullout Resistance in Screws of a Vertebral Fixation System  [PDF]
Sarah F. Fakhouri,Ariane Zamarioli,Célia R. G. Wichr,Cleudmar A. Araujo,Helton L. A. Defino,Ant?nio C. Shimano
Advances in Mechanical Engineering , 2011, DOI: 10.1155/2011/701263
Abstract: The purpose of this study was to investigate the effect of varying the outer diameter of screws of a vertebral fixation system by submitting them to mechanical tests and photoelasticity. The pullout mechanical test was performed in 20 swine lumbar vertebrae, divided into two groups based on the screw outer diameter: 5.0 and 6.0?mm. The maximal pullout strengths and stiffness were evaluated. For the photoelasticity, eight models were used and divided into the same groups. The maximal pullout strength was 974.12 ± 144.44 N in the 5.0?mm screws and 1537.42 ± 326.95 N in the 6.0?mm screws (P < 0.001). The stiffness was 418.60 ± 62.58 103N/m in the 5.0?mm screws and 502.12 ± 133.45 103N/m in the 6.0?mm screws (P = 0.09). The mean ± SD shear stress of the 5.0?mm screws was 12.90 ± 1.87?KPa and 11.99 ± 2.01?KPa for the 6.0?mm screws. Thus, the 5.0?mm screw had lower pullout and higher shear stress, suggesting that this screw is more susceptible to loosening. 1. Introduction Vertebral fixation system bone implants are used in the treatment of deformities, degenerative diseases, tumors, infections, and fractures of the spine [1–3]. The anchorage of the screws in the vertebrae is important for the performance of biomechanical movements. Screws can become displaced and give problems of instability to the fixed segment during the time that the screws are implanted in the bone tissue [4–6]. A failure in the anchorage of a fixation system may be related to the mechanical resistance of implants or the quality of the vertebral bone tissue [7]. The screws may have an appropriate mechanical resistance to pullout in order to avoid loosening during correction procedures. Screw loosening mainly happens in the vertebrae located in the extremities of scoliotic curves. The pullout strength is an important parameter that predicts the fixation and stabilization of fixed segments [8]. Under a pullout force, stress is formed around the implants, and its distribution can be evaluated by special techniques [9, 10]. Regardless of the many studies focused on technology and engineering to improve the pullout resistance of implants, fixation failure still occurs and causes the loosening of vertebral alignment and segment stability, generating severe complications [4]. The incidence of bone screw loosening ranges from 0.6 to 11% and can be even higher when the implants are inserted in osteoporotic bones. The pullout strength is influenced by many factors, including the outer diameter of screws [11]. Mechanical analyses are used to evaluate the mechanical resistance of implants by means
External fixation in the treatment of open tibial shaft fractures  [PDF]
Golubovi? Zoran,Stojiljkovi? Predrag,Ma?ukanovi?-Golubovi? Lana,Mili? Dragan
Vojnosanitetski Pregled , 2008, DOI: 10.2298/vsp0805343g
Abstract: Background/Aim. Besides the conquasant fractures, open tibia shaft fractures belong to the group of the most severe fractures of tibia. Open tibia shaft fracture is one of the most common open fractures of long bones. They most frequently occur as a result of traffic accidents caused by the influence of a strong direct force. Methods. Within the period from January, 2000 to December 31, 2005. at the Clinic for Orthopaedics and Traumatology, Clinical Center Nis, 107 patients with open tibial fractures were treated. We analyzed 96 patients with open tibial fracture. In the series analyzed, the male sex was prevalent - there were 74 men (77.08%). The mean age was 47.3 years. The youngest patient was 17 years old, while the oldest patient was 79. According to the classification of the Gustilo et al. in the analysed group there were 30 (31.25%) open tibial fractures of the I degree, 31 (32.29%) of the II degree, 25 (26.05%) of the III A degree, 8 (8.33%) of the III B degree and 2 (2.08%) of the III C degree. In 95 of the patients the treatment of open tibia shaft fractures consisted of the surgical treatment of wound and the external fixation of the fractured bone using "Mitkovic" type external fixator with a convergent method of pin applications. One primary amputations had been done in patients with grade IIIC open tibial fracture with large soft tissue defect. Results. Of the 96 open tibial fractures available for follow-up, 73 (76.04%) healed without severe complications (osteitis, pseudoarthrosis, valgus malunion and amputation). Ther were nine (9.38%) soft tissue pin track infections and six (6.25%) superficial wound infections. The mean time of union was 21 (14-36) week. Among severe local complications associated with open tibial fractures, in eight patients (8.33%) was registered osteitis, and in nine patients (9.38%) fracture nonunion and the development of pseudoarthrosis. Three of the patients (3.13%) had more than 10 degree valgus malunion. In one patients (1.04%) deep pin track infection developed. Two patients (2.08%) had below the knee amputation (one primary in patient with type III C open fracture and one secondary after the development of deep infections). Conclusion. Surgical treatment of wounds, external fixation, leaving the wounds open and performing necessary debridements, adequate drug therapy administration are essential for obtaining good results in patients with open tibial shaft fractures.
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