摘要:

SummaryTibial shaft fractures are prone to healing problems. The poor soft tissue envelope surrounding the tibia, in combination with the frequency of high-energy fractures, results in frequent problems with union and failed fixation. Infection and malalignment are associated with failure to heal. This chapter reviews the causes and treatment options for ununited tibial shaft fractures.

ISSN:0885-9698    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

SummaryDespite the best efforts of any orthopaedic surgeon, there are times when the standard methods of internal fixation fail. This failure can occur due to biological or mechanical means. When failure is due to mechanical issues, the goal is to preserve as much functional motion in the ankle joint as possible. Therefore, it is important to recognize the problem early and correct it before significant arthropathy develops. This article covers some general failure scenarios found around the ankle and provides some suggestions on correction to restore alignment and function. Many of these techniques can also be used initially to help avoid potential problems.

ISSN:0885-9698    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

SummaryFailure of internal fixation following treatment of a fracture or fracture nonunion presents a challenging clinical situation. In certain cases, Ilizarov external fixation may be the preferred method to treat bony injuries that have failed to unite following one or more attempts at internal fixation. This paper reviews the modes of failure following internal fixation, revision internal fixation as an option, and the application of the Ilizarov method following failure of internal fixation.

ISSN:0885-9698    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

SummaryProblems with fracture healing are not uncommon. Bone stimulators apply an electromagnetic or ultrasonic signal to the bone to promote healing. Both in vitro and in vivo studies demonstrate effects on bone cell physiology and fracture healing. Direct current stimulates bone formation in tissue and organ culture experiments and in animal studies in a dose-response fashion. Electromagnetic fields alter the effects of hormones on the cell membranes, and increase production of growth factors and receptors, affect calcium flux across membranes, and stimulate endothelial cell proliferation and capillary formation. Animal studies show that pulsed electromagnetic fields speed bone repair and prevent disuse osteopenia. Low intensity ultrasound promotes cartilage calcification and alters gene expression. Clinical series suggest that electromagnetic stimulation is equivalent to bone grafting for initial treatment of long bone nonunion, and better in cases of failed surgery. Prospective, randomized, double blind studies show that noninvasive electrical stimulation is an effective treatment for long bone nonunion, and that ultrasonic treatment speeds the healing of fresh fractures.

ISSN:0885-9698    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

SummaryPoor bone quality, bone loss, and holes secondary to prior fixation all pose difficult problems. Locking plates provide unique attributes that are specifically useful in failed fixation. These include the ability to recreate a cortex, to function as a fixed angled device, and to purchase a volume of bone. All of which can lead to solid fixation where standard plate constructs might fail. The use of locking plates in revision fixation and the evolution of locking plates will be discussed. Case examples are presented to illustrate the advantages and disadvantages of locking plates. Locking plates are not the answer to all revision fixation problems, but they are able to provide stable fixation where other fixation might fail.

ISSN:0885-9698    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

SummaryRevision-fracture surgery is a commonly encountered indication for hardware removal in an orthopaedic trauma practice and includes cases on nonunion, malunion, infection, peri-implant fracture, and pre-arthroplasty surgery. It is during these often technically demanding cases that broken hardware is encountered and special techniques are often required to facilitate implant removal. The operating surgeon should be knowledgeable on techniques for removing stripped or broken hardware and be equipped with the proper instruments to expedite the procedure. We review common problems and current techniques for removing broken and bent intramedullary nails, nails with broken or stripped extraction devices, broken and stripped screws, broken interlocking screws, and various cannulated screws.

ISSN:0885-9698    

出版商:OVID    

年代:2002

数据来源: OVID