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Orthopaedics
Published in Roy Palmer, Diana Wetherill, Medicine for Lawyers, 2020
There are two other groups of fixation devices: internal fixation and the use of external fixators as a sort of ‘half-way house’. The fracture is reduced and two or more screws are passed through the skin and deep into the bone above and below the fracture site; this is external fixation. The fracture is reduced and the screws are attached to a rigid bar connecting all of them. If this is not sufficient to stabilize the fracture another series of screws and connectors are inserted at right angles. Not all fractures can be treated like this but it is a very useful method for fixing a fracture if access to the limb is required, e.g. for skin grafting. Fractures can be fixed internally with wires drilled across the fracture site, screws, plates and screws with or without compression, and nails passed down the medulla (marrow) of the bone. These nails can be inserted into the bone, which is unreemed or reemed; a reemed bone is one that has been drilled out to prepare it to receive the nail. These nails can be locked or unlocked. A locked nail has one or two screws passed through the bone at the top and bottom of the nail to prevent the fracture sliding up and down.
Controlled and Reproducible Fixation of the Lung for Correlated Studies
Published in Joan Gil, Models of Lung Disease, 2020
The purpose of fixation is to stabilize and preserve tissue, a goal which is not difficult to achieve unless we are dealing with an organ of continuously changing morphology. When this is the case, the morphologist must attempt to define the prevailing conditions at the instant of fixation and fix in such a way that these conditions are not altered or lost before fixation is complete. Several organs and tissues require this treatment if quantitative correlations between structure and function are to be studied (heart, smooth and striated muscle cells, transitional epithelium), but the lung is particularly vexing. The lung lacks a fixed, or standard volume, and even worse, it collapses following opening of the chest and the morphology of the air spaces changes depending on whether they are reinflated with air or fluid (Gil, 1985; Gil et al., 1979).
Tissue Preparation For Autoradiography the Autoradiographic Process
Published in Lelio G. Colombetti, Principles of Radiopharmacology, 2019
Alicia S. Ugarte, Lelio G. Colombetti, Dieudonne J. Mewissen
The time required for fixation will depend on the size and density of the tissue and on the rate of penetration of the fixative. After the tissue is properiy fixed, the excess fixative must be removed from it by special treatment or washing. If Bouin’s is used, the sections should be treated with lithium carbonate to eliminate the yellowish color of the picric acid which will desensitize the emulsion. If 10% formalin is used, the tissues should be thoroughly washed with water and then placed in 70% alcohol. Carnoy’s fixative, being mostly absolute alcohol, does not require washing,
Distraction plating for bilaterally severely comminuted distal radius fracture: a case report
Published in Case Reports in Plastic Surgery and Hand Surgery, 2023
Yuta Izawa, Hiroko Murakami, Tetsuya Shirakawa, Kazuo Sato, Toshiki Yoshino, Yoshihiko Tsuchida
The goal of treating distal radius fractures is to obtain a stable and movable wrist joint. Various treatment options are available, including conservative treatment, but open reduction and internal fixation are required in cases with severe instability or high disposition. The gold standard for internal fixation is volar locking plate fixation [1,2], and fragment-specific fixation is recommended when the articular surface is severely comminuted [3,4]. However, high-energy trauma may be accompanied by severe comminution and soft tissue damage, which are difficult to treat using a traditional internal fixation strategy. In such cases, external fixation is generally regarded as the next best treatment option [5,6]. External fixation spans the wrist joint continuously to maintain alignment until bone union; however, pin site infection and inconvenience owing to the fixation apparatus that the patient has to wear are common problems with this approach. Distraction plating is a method of bridging fixation from the radial shaft to the third metacarpal bone subcutaneously on the dorsal side and is used as an alternative to external fixation [7–10]. Although there is concern that the limitation of range of motion will remain due to the fixation of the wrist joint until implant removal, it has been reported that an acceptable range of motion of the wrist joint will eventually be obtained. Herein, we report a case in which distraction plating was performed for a bilateral highly comminuted distal radius fracture, with acceptable results obtained in the wrist joint’s range of motion and function.
Perinatal pubic symphysis separation combined with pubic fracture: a case report and literature review
Published in Journal of Obstetrics and Gynaecology, 2022
Liang Deng, Liang-Yu Xiong, Ji-Huan Zeng, Qiang Xiao, Yuan-Huan Xiong
In terms of the treatment, for pubic symphysis separation with separation distance ≤ 40 mm, conservative treatment can be performed with a pelvic correction belt. The elasticity of the pelvic correction belt can fix the crotch, tighten the separated pelvis, protect the pubis, and relieve the pain of pubic. Hence, the mechanical distribution of pelvis, back and buttock can be further improved, and the pubic symphysis can be recovered and maintained in the normal anatomical position (Culligan et al. 2002). For the parturient with a separation distance > 40 mm or combined with the persistent pain and pelvic instability, the active surgical intervention may be a sensible choice. With regard to this, the common surgical methods include external fixation and internal fixation, in which the internal fixation is the preferred method (Sujana et al. 2017). The internal fixation mainly includes the screws and steel plates fixation, which can provide sufficient mechanical stability and effective compression resistance and anti-rotation ability. In recent years, the minimally invasive surgeries represented by percutaneous cannulated screws have obtained remarkable results, which can effectively reduce the surgical trauma, shorten the operation time, and further contribute to the rapid postoperative recovery (Saeed et al. 2015). In this case, we have applied the conventional open reduction and internal fixation, and fixed with screws and steel plates. After one year of follow-up, the screws and steel plates were still fixed firmly and the separation distance of pubic symphysis was also effectively controlled.
Bone fracture healing within a continuum bone remodelling framework
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2022
Ina Schmidt, Jacob Albert, Marina Ritthaler, Areti Papastavrou, Paul Steinmann
Unlike the theories and models described before, our work concentrates on the ends of long bone, which mainly consist of cancellous bone. As these regions are mostly close to joints, external callus formation is usually not desired in order not to hinder the mechanism of joint function. Fixation systems are therefore used to create the smallest possible gap between the fracture surfaces and to prevent motion at the fracture site in order to achieve primary bone healing. Any tissue differentiation is thus not considered in this context. Instead, this work is based on continuum bone remodelling, see Kuhl and Steinmann (2003) and Liedtke et al. (2017), with the aim of incorporating primary bone healing especially at the femur head. Previous studies have already shown that this type of modelling offers many opportunities to include various aspects that influence bone processes within the same model, for example age-dependency (Papastavrou et al. 2020a), the availability of nutrition and hormones (Papastavrou et al. 2020b) and the simultaneous consideration of cancellous and cortical bone (Schmidt et al. 2021). The modification to furthermore include bone healing would thus allow a broader application of the model also with regard to the design and simulation of implant integration.