ISSN:0885-9698    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

SummaryOperatively treated humeral fractures do not always heal. Failure of healing may result from technical errors, injury severity, infection, or limited patient regenerative capacity. Treating the humeral nonunion after failed initial fixation is often complicated by the original procedure. Fractured implants, bone loss, postoperative scarring, and osteopenia are all commonly present in these situations. Successful treatment requires solutions to all of these formidable problems in addition to a strategy that introduces stable fixation and osteogenesis. In the majority of situations, this is best accomplished with plate stabilization and cancellous bone grafting. Successful plate stabilization often requires modified techniques to deal with bone loss and osteopenia. These modifications include additional plate length, screw augmentation, bridge plating, and the use of fixed angle devices. Employing these strategies usually results in significantly improved function in these compromised patients.

ISSN:0885-9698    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

SummaryThe treatment of distal humeral fractures has evolved over the past several decades. Due to advances in surgical techniques, as well as internal fixation devices, open reduction and internal fixation for an adult distal humeral fracture is now the rule rather than the exception. As the number of operative cases increases, so does the number of postoperative complications. One complication that can occur is failure of the implanted device intended to provide stability to the fracture. Multiple causes including osteopenia, infection, comminution, and poor initial fixation have all been identified. Loss of fixation at the fracture site often leads ultimately to nonunion. The treatment of fixation failure in the elbow can be especially difficult as soft tissue problems frequently contribute to the dilemma. In an effort to achieve a stable, pain-free range of motion in the elbow, several different options exist for the practicing orthopedist who chooses to treat these challenging situations. Revision osteosynthesis with bone grafting, semiconstrained total elbow arthroplasty, arthrodesis, allograft reconstruction, and the “bag-of-bones” technique have all been described as ways to obtain a satisfactory outcome for both the patient and the treating orthopedist.

ISSN:0885-9698    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

SummaryThe forearm is a unique anatomic unit that in the presence of chronic disorders results in a lack of rotation, impairs strength and stability of the hand, and affects functional motion of the wrist and elbow. Despite outstanding results using open reduction techniques, complications and failures continue to occur and can be divided into problems produced during the perioperative surgical period and complications occurring postoperatively. By addressing injuries in a timely manner, using appropriate surgical techniques and implants, and limiting malposition of the fragments, perioperative problems can be controlled. If other postoperative complications are identified, efforts should be made to reduce the length of the patient’s disability. When anatomic reductions are performed, union rates approaching 98% with excellent outcomes can be expected.

ISSN:0885-9698    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

SummaryInstrumentation failure in the surgical treatment of thoracolumbar spine fractures can usually be avoided with detailed preoperative planning, thorough understanding of the injury, and careful technique. However, even with appropriate instrumentation selection and application, loss of fixation or need for revision occur. Revision of internal fixation of the spine is a complex undertaking. Successful revision with modern posterior segmental instrumentation systems usually requires extension of the instrumented area to use new anchor sites. Specialized instrumentation may be required especially if extension to the pelvis or cervical spine is needed. With careful technique, stabilization of the spine can usually be achieved.

ISSN:0885-9698    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

SummaryTotal hip arthroplasty after failed open reduction internal fixation of acetabular fractures can be challenging surgery. Recent studies reported that operative time, blood loss, and complication rates are higher than with primary total hip arthroplasty. Soft tissue scarring, heterotopic bone, fracture nonunion, and retained hardware contribute to this increased complexity of the reconstruction. Despite perioperative difficulties with total hip arthroplasty in this patient population, excellent outcome with modern cementless acetabular components can be expected.

ISSN:0885-9698    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

SummaryNonunion is a frequent complication following femoral neck fracture. While healing of the femoral neck fracture and preservation of a viable femoral head appear to offer the best outcome for managing femoral neck nonunions, the choice of treatment depends on patient age, congruity of the femoral head, quality of existing bone, and expertise of the surgeon. For patients less than 60 years of age with a congruent femoral head, procedures to stimulate union are preferable. Nonunion, with or without displacement, and associated shortening should be treated with a valgus intertrochanteric wedge osteotomy in younger patients. In the absence of displacement or shortening, refixation is indicated. Avascular necrosis without collapse is not in itself a contraindication to osteotomy, as acceptable results have been reported. Patients 60 years of age or older with a femoral neck nonunion are best managed by total hip arthroplasty. Available literature supports a cemented hip done through an anterior approach to decrease potential complications.

ISSN:0885-9698    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

SummaryRevision surgery of failed intertrochanteric fractures is a challenging problem. The mode of failure is usually loss of fixation of the hardware with varus angulation and collapse at the fracture site. Concerns at the time of surgery include proximal femoral deformity, bone loss, compromised bone quality, and limb length discrepancy. Treatment options include revision internal fixation versus arthroplasty. The decision-making is primarily based on the status of the articular cartilage, the bone quality, and the activity level of the patient. Careful preoperative planning of the surgical procedure is extremely important and a good functional outcome can be anticipated in these patients.

ISSN:0885-9698    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

SummaryThe acute treatment of femoral shaft fractures with reamed intramedullary nailing results in high union rates and low morbidity. Unfortunately, treatment failures do occur and can be devastating to the patient. Fixation failure can result from technical errors, severe injuries, systemic morbidity, and local biologic damage. In many cases, successful treatment is complicated by associated injuries, functional and psychologic disability incurred as a result of the initial trauma, infection, and broken hardware. Strategies to salvage failed femoral fixation must begin with careful elucidation of causes to not repeat initial errors or exacerbate existing complications. While exchange reamed nailing is a familiar procedure for delayed or hypertrophic nonunion, a variety of methods including biologic plating, bone grafting, distraction osteogenesis, and vascularized fibular transplantation may be required in specific cases. The goal of the surgeon should be to develop a logical framework for diagnosis and treatment decision-making and to have access to the complete armamentarium of reconstructive techniques.

ISSN:0885-9698    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

SummaryContemporary treatment of fractures of the distal femur, proximal tibia, and patella involves the use of internal fixation. Although most fractures heal uneventfully, failures of internal fixation about the knee do occur. Factors that contribute to failure include large physiologic forces, concomitant ligamentous injuries, limb malalignment, joint malorientation, bone stock deficiency, arthrofibrosis, patella infera, infection, avascular necrosis, and technical errors. Understanding these factors is necessary for successful revision surgery. This paper reviews the factors that contribute to the failure of internal fixation of fractures about the knee joint (distal femur fractures, tibia fractures, and patella fractures) and presents practical techniques of revision surgery.

ISSN:0885-9698    

出版商:OVID    

年代:2002

数据来源: OVID