Injury
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At our institution, the small AO external fixator has been utilized on the wrist and hand on over 200 patients since 1979. Disregarding fractures of the distal radius, the main indications were fracture dislocations of the wrist, Kienböck's disease, combined injuries with bone defects of the wrist and metacarpals, and basilar fractures of the thumb metacarpal. In this paper, five well-established applications will be described with respect to treatment concept, indication, technique, and personal results. Furthermore, recommendations and reservations are listed to help in the prevention of the most frequent complications.
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An experimental model of a contaminated open fracture has been developed. This model has been used to test the hypothesis that stable fixation of a contaminated open fracture will reduce its susceptibility to infection. The tibiae of male New Zealand white rabbits were fractured and then fixed with either a dynamic compression plate (stable group) or a loose-fitting intramedullary rod (unstable group). ⋯ There were 20 rabbits in the stable group and osteomyelitis developed in seven (35 per cent); in the unstable group 15 (71 per cent) out of 21 animals developed osteomyelitis. This difference in infection rates was statistically significant (P < 0.02). This experimental study supports the concept of stabilization of open fractures in man.
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Comparative Study
Prediction of fracture union after internal fixation of intracapsular femoral neck fractures.
This study was based on a series of 470 patients with an intracapsular proximal femoral fracture treated by internal fixation; the characteristics of those patients with non-union were contrasted with those of patients in which union occurred, to determine which variables would predict bony union of the fracture. Radiological factors studied included measurements of fracture displacement, anatomical site and degree of osteoporosis. Patient characteristics studied were age, sex, prefracture mobility and mental state. Patient age and pre-operative fracture displacement were found to be of the greatest value in predicting non-union.