102 results match your criteria General Principles of Internal Fixation


Feline Femoral Fracture Fixation: What are the options?

J Feline Med Surg 2022 05 11;24(5):442-463. Epub 2022 Apr 11.

Department of Clinical Science and Services, Queen Mother Hospital for Animals, Royal Veterinary College, University of London, London, UK.

Practical Relevance: The femur is the most commonly fractured bone in cats. Femoral fractures usually result from high-velocity trauma such as a road traffic accident or fall from a height and, as such, are associated with a wide variety of concurrent injuries. The initial focus of treatment should always be on assessment and stabilisation of the major body systems. Read More

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Evidence-Based Surgical Treatment Algorithm for Unstable Syndesmotic Injuries.

J Clin Med 2022 Jan 10;11(2). Epub 2022 Jan 10.

Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 81377 Munich, Germany.

Background: Surgical treatment of unstable syndesmotic injuries is not trivial, and there are no generally accepted treatment guidelines. The most common controversies regarding surgical treatment are related to screw fixation versus dynamic fixation, the use of reduction clamps, open versus closed reduction, and the role of the posterior malleolus and of the anterior inferior tibiofibular ligament (AITFL). Our aim was to draw important conclusions from the pertinent literature concerning surgical treatment of unstable syndesmotic injuries, to transform these conclusions into surgical principles supported by the literature, and finally to fuse these principles into an evidence-based surgical treatment algorithm. Read More

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January 2022

[Fracture-related infections after intramedullary nailing : Diagnostics and treatment].

Unfallchirurg 2022 Jan 18;125(1):50-58. Epub 2021 Dec 18.

Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg (UKR), Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.

Intramedullary nailing is the treatment of choice for a large number of fractures requiring surgery. In cases of fracture-related infections (FRI) the treatment of nail infections requires special attention due to the closed situation of the osteosynthesis material in the intramedullary canal. This article gives an overview of the general principles and diagnostic criteria for FRI after nail fixation and discusses the treatment recommendations based on three case examples. Read More

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January 2022

Damage Control Orthopaedics in Spinal Trauma.

J Am Acad Orthop Surg 2021 Dec;29(24):e1291-e1302

From the Department of Orthopedic Surgery, McMaster University, Hamilton General Hospital, Hamilton, Ontario (Oitment, Thornley, and Pahuta), the Division of Orthopaedic Surgery, Toronto Western Hospital, University Health Network (Jentzsch) and Department of Surgery, University of Toronto (Jentzsch), Toronto, Ontario, Canada, and the Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland (Jentzsch).

There has been a shift in the management of the polytrauma patients from early total care to damage control orthopaedics (DCO), whereby patients with borderline hemodynamic stability may be temporized with the use of external fixators, traction, or splinting with delayed osteosynthesis of fractures. Recently, there has been an increasing trend toward a middle ground approach of Early Appropriate Care for polytrauma patients. The concepts of DCO for the spine are less clear, and the management of trauma patients with combined pelvic ring and spinal fractures or patients with noncontiguous spinal injuries present unique challenges to the surgeon in prioritization of patient needs. Read More

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December 2021

[Open fractures].

Unfallchirurg 2021 Aug 13;124(8):651-665. Epub 2021 Jul 13.

Unfallchirurgische Klinik, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.

Open fractures are associated with a higher rate of infections and delayed fracture healing; therefore, in addition to fracture fixation, infection prevention and soft tissue management are also important. Administration of antibiotics should be carried out as early as possible and over 24-72 h depending on the injury. The initial debridement and assessment of the severity of injury determine the treatment strategy. Read More

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Treatment of Monteggia-like-lesion in a young patient: A case report.

Medicine (Baltimore) 2021 May;100(19):e24928

Orthopaedic and Traumatology Department, Faculty of Medicine Universitas Brawijaya, Saiful Anwar General Hospital, Malang, Indonesia.

Introduction: A Monteggia fracture was described initially as a fracture of the proximal third ulna and anterior dislocation of the proximal epiphysis radius.[1] In 1967, Bado discovered "true Monteggia lesions" and classified them into 4 groups.[2] He also used the term "equivalents" or "Monteggia-like-lesions" to describe specific injuries with similar radiographic patterns. Read More

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A proposal of a new algorithm for decision-making approaches in open reduction and internal fixation of complex tibial plateau fractures - SOTA algorithm (Spanish Orthopaedic Trauma Association).

Injury 2021 Jul 1;52 Suppl 4:S87-S98. Epub 2021 May 1.

Hospital Universitario Canarias (HUC), Carretera Ofra s/n., 38320, La Laguna, Tenerife, Spain; School of Medicine, Universidad de La Laguna (ULL), Campus de Ofra, s/n, 38071, La Laguna, Tenerife, Spain; Spanish Orthopaedic Trauma Association - The Orthopaedic Surgery and Traumatology Spanish Society (SOTA-SECOT), Calle Fernández de los Ríos, 108, 28015, Madrid, Spain. Electronic address:

Introduction: The correct choice of surgical approaches in complex tibial plateau fractures is essential to achieve adequate reduction and fixation. Detailed fracture morphology and direction of columns displacement, that we have named the Main Deformity Direction (MDD), may aid in selecting the optimal surgical strategy. In this article we present a new algorithm based on MDD and column concepts. Read More

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In Memoriam : Robert Danis, an inspiration for Maurice Müller and origins of the AO Foundation.

Acta Orthop Belg 2020 Dec;86(4):577-579

Robert Danis (1880-1962) was a Belgian general surgeon mostly remembered for his contributions in the field of bone and joint surgery, a medical subdiscipline currently known as orthopaedic trauma surgery. He initiated this with his first book (1) on the subject in 1932. Danis was the first to develop a concept for biomechanically stable internal fracture fixation, creating and producing his own screws and plates with self-developed machine tools. Read More

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December 2020

[Open reduction and internal fixation of posterior malleolus fractures].

Oper Orthop Traumatol 2021 Apr 25;33(2):112-124. Epub 2021 Mar 25.

Sektion Fuß- und Sprunggelenkchirurgie Campus Großhadern & Innenstadt, Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Universität München, LMU München, Nussbaumstr. 20, 80336, München, Deutschland.

Objective: Stabilization of the syndesmotic complex by open reduction and internal fixation (ORIF) of the posterior malleolus, restoration of the tibial articular surface, stability of the ankle, posterior tibiofibular ligament and the incisura tibiae, reduction of the fibula into the incisura tibiae by ligamentotaxis.

Indications: Unstable ankle fractures (OTA/AO type 44-B3, C1.3, C2. Read More

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Posterior shoulder fracture-dislocation: A systematic review of the literature and current aspects of management.

Chin J Traumatol 2021 Feb 6;24(1):18-24. Epub 2020 Sep 6.

The Rowley Bristow Unit, Ashford & St Peter's Hospitals, NHS Foundation Trust, Chertsey, Surrey, United Kingdom; Shoulder and Elbow Centre - Reading Shoulder Unit, United Kingdom; Surrey Orthopaedic Clinic, United Kingdom. Electronic address:

Purpose: Posterior fracture-dislocation of shoulder is an infrequent traumatic event; however, most orthopaedic surgeons may face the challenge of treating it. The aim of this study is to review and summarise systematically the current principles of the management of this complex injury, and create a treatment algorithm.

Methods: Both PubMed and Scopus Databases were systematically searched for the terms "posterior shoulder fracture-dislocation" or "posterior glenohumeral fracture-dislocation" or "posterior glenoid fracture-dislocation" for articles written in English and published in the last decade. Read More

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February 2021

[External fixator: temporary fixation and soft tissue management of the ankle].

Oper Orthop Traumatol 2020 Oct 18;32(5):421-432. Epub 2020 Sep 18.

UniversitätsCentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Carl Gustav Carus, Fetscherstr. 74, 01307, Dresden, Deutschland.

Objective Of Surgery: Joint-spanning transfixation of the ankle joint aims at mostly temporary retention of the reduction, i.e. restoring length and axial alignment and stabilization of the ankle mortise in highly unstable fractures around the ankle and under critical soft tissue conditions. Read More

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October 2020

Indications and Clinical Results of Radial Head Replacement: Has Anything Changed?

J Orthop Trauma 2019 Dec;33 Suppl 8:S1-S6

Department of Orthopaedic Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, AZ.

Radial head fractures are common injuries comprising 1/3 of the fractures about the elbow. As a secondary valgus stabilizer of the elbow, radial head fractures can compromise elbow stability leading to long-term pain, dysfunction, and degenerative change. Furthermore, radial head fractures can be accompanied by associated injuries including ligamentous lesions that can further exacerbate elbow instability, leading to long-term sequelae. Read More

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December 2019

General treatment principles for fracture-related infection: recommendations from an international expert group.

Arch Orthop Trauma Surg 2020 Aug 29;140(8):1013-1027. Epub 2019 Oct 29.

Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA.

Fracture-related infection (FRI) remains a challenging complication that creates a heavy burden for orthopaedic trauma patients, their families and treating physicians, as well as for healthcare systems. Standardization of the diagnosis of FRI has been poor, which made the undertaking and comparison of studies difficult. Recently, a consensus definition based on diagnostic criteria for FRI was published. Read More

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Lessons Learned from Long-Term Management of Hip Fracture in Patients with Osteopetrosis: A Report of Nine Hips in Five Patients.

J Bone Metab 2019 Aug 31;26(3):201-206. Epub 2019 Aug 31.

Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.

Background: Treating patients with osteopetrosis is very challenging even in very skilled surgeons with many experiences. We present an account of 5 patients treated for hip fracture related problems occurring throughout their life due to this disease. Difficulties encountered during their treatment prompted us to present some general management principles. Read More

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Trauma to the medial ray of the foot: A classification of patterns of injury and their management.

Injury 2019 Aug 4;50(8):1483-1488. Epub 2019 Jun 4.

Department of Trauma & Orthopaedics, Northern General Hospital, Sheffield, UK.

Aims: Fractures and dislocations of the midfoot are relatively uncommon but can be life changing injuries. Within the literature, there has been scant specific reference to the identification and management of medial ray injuries in midfoot trauma. Moreover, it is appreciated that these injuries are associated with poor outcomes. Read More

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General principles for treatment of femoral head fractures.

J Clin Orthop Trauma 2019 Jan-Feb;10(1):155-160. Epub 2017 Jul 29.

Departamento de Radiologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.

Femoral head fractures occur almost exclusively as a result of a traumatic hip dislocation. Treatment is typically an emergency and includes the reduction of the dislocated hip under anesthesia. As a rule, the earlier the reduction, the better the outcome. Read More

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What Factors Are Associated With Outcomes Scores After Surgical Treatment Of Ankle Fractures With a Posterior Malleolar Fragment?

Clin Orthop Relat Res 2019 04;477(4):863-869

D. T. Meijer, B. D. J. G. Deynoot, S. A. Stufkens, G. M. M. J. Kerkhoffs, J. N. Doornberg, Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, The Netherlands D. T. Meijer, Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands I. N. Sierevelt, Slotervaart Center of Orthopedic Research and Education, Department of Orthopaedic Surgery, Medical Centre Slotervaart, Amsterdam, The Netherlands J. C. Goslings, Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands G. M. M. J. Kerkhoffs, Academic Center for Evidence-based Sports Medicine, Amsterdam Collaboration for Health and Safety in Sports, IOC Research Center, Amsterdam, The Netherlands J. N. Doornberg, Flinders University, Adelaide, Australia.

Background: Psychosocial factors, such as depression and catastrophic thinking, might account for more disability after various orthopaedic trauma pathologies than range of motion and other impairments. However, little is known about the influence of psychosocial aspects of illness on long-term symptoms and limitations of patients with rotational-type ankle fractures, including a posterior malleolar fragment. Knowledge of the psychosocial factors associated with long-term outcome after operative treatment of trimalleolar ankle fractures might improve recovery. Read More

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[Olecranon fractures].

Rev Med Suisse 2018 Dec;14(631):2264-2267

Service de chirurgie orthopédique et traumatologique, Département de l'appareil locomoteur, CHUV, 1011 Lausanne.

Olecranon fractures represent 5 % of all adult fractures. Management is most often surgical. Conservative treatment is recommended for non-displaced fractures or patients who would be poor surgical candidates. Read More

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December 2018

[Reduction techniques for osteosynthesis of intra-articular fractures].

Unfallchirurg 2019 Feb;122(2):110-119

Klinik für Unfallchirurgie, Departement Chirurgie, Kantonsspital Graubünden, Loëstr. 170, 7000, Chur, Schweiz.

The cornerstones for treatment of articular fractures are gentle handling of soft tissues and anatomical reconstruction of the articular surface with stable fixation, which enables a functional aftercare. By respecting these principles, satisfactory functional and radiological results with low complication rates can be achieved even for complex fracture patterns. Fracture complexity varies with the energy load during the trauma mechanism. Read More

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February 2019

Why and how do locking plates fail?

Injury 2018 Jun;49 Suppl 1:S56-S60

Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Jena, Germany.

Locking plates have led to important changes in bone fracture management, allowing flexible biological fracture fixation based on the principle of an internal fixator. The technique has its indications and limitations. Most of the typical failure patterns arise from basic technical errors. Read More

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Reconstructing a Traumatic Empty Orbit: Principles, Difficulties of Treatment, and Literature Review.

J Oral Maxillofac Surg 2018 09 21;76(9):1952.e1-1952.e4. Epub 2018 Apr 21.

Consultant Oral and Maxillofacial Surgeon, Northampton General Hospital, Northampton, UK.

Purpose: This report describes the case of a serious orbital injury in which the globe was completely displaced into the nasal cavity and the orbit was clinically empty. The authors discuss the difficulties encountered in the management of this patient and their principles in the reconstruction of a complex defect.

Materials And Methods: In this rare case of severe injury, the authors used a combined transconjunctival and ethmoidal approach to retrieve the displaced globe from the nasal cavity. Read More

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September 2018

Spinopelvic injuries. Facts and controversies.

Injury 2018 Mar;49(3):449-456

Academic Department of Trauma & Orthopaedic Surgery, University of Leeds, Clarendon Wing, Floor A, Great George Street, Leeds General Infirmary, LS1 3EX Leeds, United Kingdom.

Spinopelvic injuries result from high energy trauma with overloading through the sacrum. These lesions can accomplish either bone fractures, ligament injuries or, most commonly, both. They may be accompanied with other associated life threatening injuries and cause biomechanical instability with potential fracture non-union, mal-union and subsequent lifetime pain and disability. Read More

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Complex Tibial Plateau Fractures Treated by Hybrid External Fixation System: A correlation of followup computed tomography derived quality of reduction with clinical results.

Indian J Orthop 2018 Mar-Apr;52(2):161-169

Fourth Department of Orthopaedics and Traumatology, KAT Hospital, Kifissia, 2 Nikis Street, 145 61, Athens, Greece.

Background: Tibial plateau fractures are common due to high energy injuries. The principles of treatment include respect for the soft tissues, restoring the congruity of the articular surface and reduction of the anatomic alignment of the lower limb to enable early movement of the knee joint. There are various surgical fixation methods that can achieve these principles of treatment. Read More

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The principles and practice of open fracture care, 2018.

Chin J Traumatol 2018 Aug 21;21(4):187-192. Epub 2018 Feb 21.

Department of Orthopaedics, Harvard Medical School, Chief Orthopaedic Trauma Service, Massachusetts General Hospital, Boston, MA, USA. Electronic address:

The principles of open fracture management are to manage the overall injury and specifically prevent primary contamination becoming frank infection. The surgical management of these complex injuries includes debridement & lavage of the open wound with combined bony and soft tissue reconstruction. Good results depend on early high quality definitive surgery usually with early stable internal fixation and associated soft tissue repair. Read More

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A Review of Subbrow Approach in the Management of Non-Complicated Anterior Table Frontal Sinus Fracture.

Arch Craniofac Surg 2016 Dec 23;17(4):186-189. Epub 2016 Dec 23.

Department of Plastic Surgery, Konkuk University School of Medicine, Seoul, Korea.

Frontal sinus fractures, particularly anterior sinus fractures, are relatively common facial fractures. Many agree on the general principles of frontal fracture management; however, the optimal methods of reduction are controversial. The subbrow approach enables accurate reduction and internal fixation of the fractures in the anterior table of the frontal sinus by allowing direct visualization of the fracture. Read More

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December 2016

Current treatment of infected non-union after intramedullary nailing.

Injury 2017 Jun 9;48 Suppl 1:S82-S90. Epub 2017 May 9.

Department of Trauma and Orthopaedics, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK.

Non-union is a devastating consequence of a fracture. Non-unions cause substantial patient morbidity with patients suffering from loss of function of the affected extremity, increased pain, and a substantial decrease in the quality of life. The management is often associated with repeated, unsuccessful operations resulting in prolonged hospital stays, which has social and economic consequences to both the patient and the healthcare system. Read More

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Repair of comminuted fracture of the lower patellar pole.

Ulus Travma Acil Cerrahi Derg 2017 Mar;23(2):150-155

Department of Orthopaedic, Sohag Teaching Hospital, General Organization for Teaching Hospitals and Institutes, Egypt.

Background: Comminuted fracture of the lower patellar pole has characteristics of both patellar fracture and avulsion of the patellar tendon. Therefore, components of both injury types should be considered during treatment. None of the traditional techniques has proven sufficient alone. Read More

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Tension band wiring for simple olecranon fractures: evaluation of surgical technique.

J Orthop Traumatol 2017 09 28;18(3):275-281. Epub 2017 Feb 28.

Orthotrauma Research Center, University of Amsterdam Orthopaedic Residency Program (PGY 4), Amsterdam, The Netherlands.

Background: In some settings, specific techniques for open reduction and internal fixation are preferred based on the eminence of a surgeon or professional organization. An emphasis on technical aspects of surgery that are not proved superior and vary substantially from surgeon to surgeon can be confusing for trainees. This study applied a numerical grading of the technical aspects of tension band wire (TBW) fixation for olecranon fracture; assessed the interobserver agreement of each criterion; and measured the correlation of the technical grading and objective and subjective long-term outcomes. Read More

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September 2017

Current management of open fractures: results from an online survey.

Arch Orthop Trauma Surg 2016 Dec 15;136(12):1663-1672. Epub 2016 Sep 15.

Department of Trauma, Reconstructive Surgery and Rehabilitation Medicine, Ferdinand-Sauerbruch-Str., 17475, Greifswald, Germany.

Background: Open fractures are orthopaedic emergencies that carry a high risk for infection, non-union and soft tissue complications. Evidence-based treatment is impeded by the lack of high-quality evidence-based studies. The aim of this investigation was to elucidate the current practice of open fracture management in Germany and to determine major differences in treatment. Read More

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December 2016

Return to Sport After Tibial Shaft Fractures: A Systematic Review.

Sports Health 2016 Jul 18;8(4):324-30. Epub 2015 Aug 18.

Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Edinburgh, UK.

Context: Acute tibial shaft fractures represent one of the most severe injuries in sports. Return rates and return-to-sport times after these injuries are limited, particularly with regard to the outcomes of different treatment methods.

Objective: To determine the current evidence for the treatment of and return to sport after tibial shaft fractures. Read More

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