Clinical orthopaedics and related research
-
Clin. Orthop. Relat. Res. · Nov 1996
Fixation of segmental subtrochanteric fractures. A biomechanical study.
Segmental subtrochanteric fractures have been associated with high rates of malunion, nonunion, and implant failure. Although the use of second generation intramedullary nails with proximal interlocking in the femoral head has been advocated for these fractures, shaft fractures at the tip of short second generation intramedullary rod nails in clinical studies raise concerns about the mechanical suitability of these implants. No biomechanical data are available on the strength of fixation and mode of failure of these newer implants. ⋯ The failure modes for the implants were: screw cut out of the femoral head for the reconstruction nail; fracture of the femoral shaft for the short intramedullary hip screw, and implant bending for the long intramedullary hip screw. This study suggests that the reconstruction nail is the superior implant for segmental subtrochanteric fractures of those tested. Implant bending and shaft fractures at lower loads make the 2 intramedullary rod hip screw implants less suitable.
-
Clin. Orthop. Relat. Res. · Nov 1996
Review Case ReportsArthroscopy assisted operative management of tibial plateau fractures.
In recent years the treatment of fractures has evolved from extensive open reduction and internal fixation to minimally invasive surgery and biologically benign internal fixation. The ultimate goal of treatment for tibial plateau fractures is to prevent the late development of degenerative osteoarthritis. Surgery is often required to restore joint congruity and alignment, to stabilize the knee, and to allow early joint motion. ⋯ Arthroscopic reduction and internal fixation offers the advantage of direct visualization of the fracture and its subsequent reduction without a formal arthrotomy or detachment of the anterior horn of the lateral meniscus. Not all types of fractures are amenable to arthroscopic reduction and internal fixation, such as severe bicondylar fractures. This technique is now evolving and some Schatzker Type 6 fractures have been treated with traction on the fracture table, arthroscopy assisted reduction, limited internal fixation of the articular surface, followed by rigid external fixation.
-
Clin. Orthop. Relat. Res. · Nov 1996
Flexible intramedullary nail fixation of pediatric femoral fractures.
The management of pediatric femoral shaft fractures gradually has evolved toward a more operative approach in the past decade. This is because of a desire for more rapid recovery and reintegration of the patients, and a recognition that prolonged immobilization can have negative effects even in children. Economic pressures also favor a treatment that does not require as prolonged a hospitalization as that required with the traditional traction method. ⋯ Likewise, minor limb length discrepancies were measured (range, -11- +14 mm) with no consistent pattern of overgrowth noted. There was no evidence of a complete trochanteric growth arrest on radiographic followup. Flexible intramedullary nailing seems to be a safe and effective method for the treatment of femoral shaft fractures in the child between 6 and 12 years of age.