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Management of osteoporotic pelvic fractures
Published in Peter V. Giannoudis, Thomas A. Einhorn, Surgical and Medical Treatment of Osteoporosis, 2020
Pol M. Rommens, Daniel Wagner, Alexander Hofmann
Different techniques, devices, and implants are available. The choice of which osteosynthesis is the most appropriate depends on the localization of the instability fracture and the extent of displacement. Whenever possible, a minimally invasive procedure is preferred.
Orthopaedic surgery
Published in Harold Ellis, Sala Abdalla, A History of Surgery, 2018
The risks of osteosynthesis, the open fixation of fractures, which include infection, delayed union and tissue reaction to the metal employed, created a longstanding debate between the conservative school, who would try where possible to use closed methods, and those surgeons advocating open surgery. A leader of conservatism was Lorenz Böhler (1885–1973) of Vienna, who preached careful reduction of the fracture and strict immobilisation of the limb, combined with simultaneous exercises of all non-involved joints. His organisation methods at the Vienna Accident Hospital set an example for the development of specialist accident units worldwide.
Bone Injury, Healing and Grafting
Published in Manoj Ramachandran, Tom Nunn, Basic Orthopaedic Sciences, 2018
Peter Bates, Andrea Yeo, Manoj Ramachandran
The concept of ‘biological osteosynthesis’ emphasizes the role of soft tissue integrity in bone healing and a ‘less than rigid’ fixation of fractures. The goals of biological fracture fixation are to restore the overall length and alignment of the bone whilst minimizing manipulation of fracture fragments. This principle governs the surgical techniques of minimally invasive plate osteosynthesis (MIPO) and circular frame fixators; whilst newer devices like the dynamic locking screw or far cortical locking screw allow for micro-motion and a less rigid construct. Construct stiffness can be further decreased by increasing the implant’s working length or decreasing the number of screws.
Interosseous wiring for fragmented proximal phalangeal fractures
Published in Case Reports in Plastic Surgery and Hand Surgery, 2022
Hidetoshi Teraura, Hideki Sakanaka, Hiroyuki Gotani
In conclusion, the present study describes cases of proximal phalangeal fractures involving more than three fragments that were challenging to treat with percutaneous pinning or screw fixation and were treated with IOW. Plate and screw can be used as an osteosynthesis in suitable cases. However, although IOW certainly requires proficiency in the procedure, it is possible to fix small bone fragments that are difficult to fix with plate and screw, and so I think that it is a good option for fragmented proximal phalangeal fractures. The treatment outcomes were positive without deformity or the patient complaining of pain, with a mean TAM of 237° and mean %TAM of 94%; all five cases were assessed as having excellent outcomes, based on the ASSH criteria. A good range of TAM was achieved by starting ROM training for the DIP and PIP joints immediately after surgery and fixing the MP joints in the flexion position.
Prediction of interfragmentary movement in fracture fixation constructs using a combination of finite element modeling and rigid body assumptions
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2021
M. Mühling, M. Winkler, P. Augat
An artificial tibia bone model (SKU 3402, 4th Gen. large left, Sawbones Europe AB, Malmö, Sweden) was scanned by computed tomography (140 kV, 96 mA, slice thickness 0.75 mm, SOMATOM 86 AS+, Siemens AG, Erlangen, Germany) and segmented using Amira (6.0.0, Zuse Institute Berlin, Berlin, Germany & Thermo Fisher Scientific, Waltham, USA). The scan was then separated into a cortical and a cancellous bone model. For fracture fixation a 3 D scanned (accuracy 0.06 mm (0.05%), HP Pro S3 with 3 D Scan Software Pro v5, HP Inc., Palo Alto, USA) large fragment locking compression plate (LCP 4.5/5.0 broad 10 holes, Synthes GmbH, Oberdorf, Switzerland) and 6 locking screws (5 mm x 40 mm), modelled as cylinders via Solidworks (2015 × 64, Dassault Systmes, Vlizy-Villacoublay, France), were placed on the distal and proximal end of the LCP. The model was created as a locked construct with 2 mm of space between tibia and LCP. Each model was processed using Geomagic Studio (12.1.0 64-Bit, Geomagic, North Carolina, USA) to achieve volume type models out of surface type ones. A 20 mm transverse fracture gap (AO/OTA type 42-A3) was virtually induced to achieve a fracture without touching fragments in the middle of the shaft. The osteosynthesis was configured and placed according to the expertise of an experienced surgeon using Solidworks. The experimental setup of the mechanical test (Figure 1) was transferred into a digital model by including the distal embedding resin block into the model.
The Adipo-Fascial ALT Flap in Lower Extremities Reconstruction Gustillo IIIC-B Fractures. An Osteogenic Inducer?
Published in Journal of Investigative Surgery, 2021
Mario Cherubino, Martina Corno, Mario Ronga, Giacomo Riva, Pietro G. di Summa, Davide Sallam, Federico Tamborini, Francesca Maggiulli, Michele Surace, Luigi Valdatta
When dealing with lower extremities reconstruction, a valid bone union and a full weight bearing is the final gold to be achieved. In this paper we report a series of Gustillo IIIB-C open fractures with soft tissue defect, treated with an early reconstruction with a fascial ALT free flap as a vascular inducer of osteogenesis. When dealing with bone fractures/bone loss, tissue engineering can help allowing the reconstruction in an anatomically functional three-dimensional morphology. Bone tissue is known for its capacity to regenerate after injury and for its intrinsic potential to reestablish a complex structure during regeneration. However, osteosynthesis and reconstruction of complex fractures and large defects remain a daunting challenge. It is widely recognized that successful bone grafting and bone healing is strictly dependent on the host bed condition, in particular on an adequate vascularization and absence of infection. Vascularity has been identified as a central component in influencing bone healing, and hence, plays a key role in achieving an efficient graft repair. In cases of decreased blood supply, the surgical option of a vascularized bone transfer appears to be inevitable, as bone grafts with their intrinsic blood supply can lead to higher success rate and to a repair process acceleration [16].