Stability of maxilla downgrafting after rigid or wire fixation

PURPOSE: This article compares the long-term outcomes of rigid internal fixation with wire fixation. PATIENTS AND METHODS: In this retrospective study, nine cases of vertical midface augmentation in which rigid fixation was used were compared with 11 cases with wire fixation. One surgeon completed all cases for the rigid fixation group, and another surgeon completed the cases in the wire fixation group. RESULTS: Follow-up was 16 +/- 11 months for the rigid fixation group and 20 +/- 12 months for the wire fixation group. Inferior movement at the anterior portion of the maxilla was 7.0 +/- 2.9 mm with rigid fixation and 4.5 +/- 3.6 mm with wire fixation (P < .05). Postsurgical superior movement (relapse) was 0.4 +/- 0.4 mm with rigid fixation and 2.4 +/- 2.4 mm with wire fixation (P < .01). Inferior movement at the posterior maxilla was 3.1 +/- 0.2 mm with rigid fixation and 2.8 +/- 2.3 mm with wire fixation. Postsurgical superior movement (relapse) was 0.8 +/- 0.4 mm with rigid fixation and 0.5 +/- 2.3 mm with wire fixation, which was not significantly different. CONCLUSION: This comparison showed downgrafting of the maxilla using autogenous bone harvested from the iliac crest and rigid internal fixation to be a predictable and stable procedure.     

Isolation: analysis and properties of three bradykinin-potentiating peptides (BPP-II, BPP-III, and BPP-V) from Bothrops neuwiedi venom

Several methods of external and internal fixation are used in urgent situations to lessen intrapelvic bleeding associated with unstable pelvic fractures. Pelvic stabilization limits pelvic expansion and thereby restricts the space for potential blood loss. This study compared several fixation methods using cadaveric pelves to determine which method best prevents pelvic expansion. Three methods of internal fixation and three methods of external fixation were compared. Anteroposterior fixation provided the greatest control against pelvic expansion; however, it is clinically impractical for emergency use. Therefore, external fixation provided the most reliable control of pelvic expansion in the emergency setting.     

Lateral inhibitory interactions in the intermediate layers of the monkey superior colliculus

The intermediate layers of the monkey superior colliculus (SC) contain neurons the discharges of which are modulated by visual fixation and saccadic eye movements. Fixation neurons, located in the rostral pole of the SC, discharge action potentials tonically during visual fixation and pause for most saccades. Saccade neurons, located throughout the remainder of the intermediate layers of the SC, discharge action potentials for saccades to a restricted region of the visual field. We defined the fixation zone as that region of the rostral SC containing fixation neurons and the saccade zone as the remainder of the SC. It recently has been hypothesized that a network of local inhibitory interneurons may help shape the reciprocal discharge pattern of fixation and saccade neurons. To test this hypothesis, we combined extracellular recording and microstimulation techniques in awake monkeys trained to perform oculomotor paradigms that enabled us to classify collicular fixation and saccade neurons. Microstimulation was used to electrically activate the fixation and saccade zones of the ipsilateral and contralateral SC to test for inhibitory and excitatory inputs onto fixation and saccade neurons. Saccade neurons were inhibited at short latencies following electrical stimulation of either the ipsilateral (1-5 ms) or contralateral (2-7 ms) fixation or saccade zones. Fixation neurons were inhibited 1-4 ms after electrical stimulation of the ipsilateral saccade zone. Stimulation of the contralateral saccade zone led to much weaker inhibition of fixation neurons. Stimulation of the contralateral fixation zone led to short-latency (1-2 ms) excitation of fixation neurons. Only a small percentage of saccade and fixation neurons were activated by the electrical stimulation (latency: 0.5-2.0 ms). These responses were confirmed as either orthodromic or antidromic responses using collision testing. The results suggest that a local network of inhibitory interneurons may help shape not only the reciprocal discharge pattern of fixation and saccade neurons but also permit lateral interactions between all regions of the ipsilateral and contralateral SC. These interactions therefore may be critical for maintaining stable visual fixation, suppressing unwanted saccades, and initiating saccadic eye movements to targets of interest.     

Traditional methods vs rigid internal fixation of mandible fractures

OBJECTIVE: To compare traditional methods (ie, intermaxillary fixation with interosseous wiring or external fixation) with newer techniques (ie, plating, use of lag screws) of open reduction and fixation of mandible fractures. DESIGN: Retrospective analysis of data from medical records. SETTING: Academic urban medical center. PATIENTS: Nonrandomized sample of 356 patients admitted to the hospital for treatment of mandible fractures from 1987 through 1991; 155 patients treated with open reduction and fixation were studied. INTERVENTIONS: Sixty-nine patients were treated with interosseous wire fixation or external fixation, 86 patients with rigid internal fixation. MAIN OUTCOME MEASURES: Presence of infection, nerve impairment, nonunion, malunion, operative time, and follow-up. RESULTS: No significant difference was noted between the two groups for sex, treating service, delay in presentation, antibiotic coverage, mechanism of injury, or type of fracture. The incidence of infection, nerve injury, and unavailability for follow-up were greater in patients treated by the newer techniques. Overall expense and operative time were greater in the group treated with plates and lag screws. CONCLUSIONS: We advocate traditional techniques for patients with mandible fractures requiring open reduction and fixation.     

Transpedicular fixation with Zielke instrumentation in the treatment of thoracolumbar and lumbar injuries

STUDY DESIGN: Sixty-five patients who underwent transpedicular fixation for thoracolumbar and lumbar injuries were studied for type of injury, the severity of paralysis, the degree of postoperative correction, and instrumentation failures. OBJECTIVES: To evaluate the surgical approaches and the selection of instrumentation to determine indications for using the transpedicular fixation procedure. SUMMARY OF BACKGROUND DATA: Various transpedicular fixation devices have been used for different type of injuries, and satisfactory postoperative results were not obtained in some studies. METHODS: Forty patients had burst fractures, 19 had fracture dislocations, and six had chance-type fractures. An anterior decompression procedure was used for most cases of burst fracture and some cases of fracture dislocation where anterior compression factors were present. The Zielke or modified Zielke system was used as an internal fixator for posterior segmental fixation. RESULTS: No patient had neurologic deterioration after surgery. Twenty of 28 patients with incomplete lesions improved postoperatively according to Frankel grades. The instrumentation failed in only one patient, in whom a nonunion developed. CONCLUSION: With transpedicular fixation, it is possible to provide solid internal fixation that is circumscribed to the injured vertebral segments. The elasticity of the Zielke rod makes it an excellent transpedicular fixation device because it is easily attached and reduction is easily performed. Anterior decompression with fusion needs to be used with transpedicular fixation in the treatment of injuries (especially burst fractures).     

Fixation of canine tendons to metal

For the purpose of developing a method to attach tendons directly to the prosthesis, canine supraspinatus tendons were attached in vitro to a metallic surface, using 3 different fixation devices: a spiked polyacetal washer (Synthes), a spiked soft tissue fixation plate (Synthes), and a newly designed Enhanced Tendon Anchor (ETA), which straddled the tendon with interlocking spikes oriented at a 20-degree angle. 2 methods were used: 1) the tendon was fixed directly to the metallic surface, or 2) a bone block containing the tendon insertion was fixed to the metallic surface. The specimens were tested for initial fixation strength in tension to failure; intact bone-muscle-tendon-bone units were used as controls. Bone block fixations were stronger than direct tendon fixations when the spiked washer or the ETA was used; this was not true of the fixation plate. The ETA was stronger than the other techniques in ultimate strength in both direct tendon fixation and bone block fixation. The soft tissue fixation plate was found to be weaker than the other techniques in bone block fixation.     

Fixation cells in monkey superior colliculus. I. Characteristics of cell discharge

1. We studied the role of the superior colliculus (SC) in the control of visual fixation by recording from cells in the rostral pole of the SC in awake monkeys that were trained to perform fixation and saccade tasks. 2. We identified a subset of neurons in three monkeys that we refer to as fixation cells. These cells increased their tonic discharge rate when the monkey actively fixated a visible target spot to obtain a reward. This sustained activity persisted when the visual stimulation of the target spot was momentarily removed but the monkey was required to continue fixation. 3. The fixation cells were in the rostral pole of the SC. As the electrode descended through the SC, we encountered visual cells with foveal and parafoveal receptive fields most superficially, saccade-related burst cells with parafoveal movement fields below these visual cells, and fixation cells below the burst cells. From this sequence in depth, the fixation cells appeared to be centered in the deeper reaches of the intermediate layers, and this was confirmed by small marking lesions identified histologically. 4. During saccades, the tonically active fixation cells showed a pause in their rate of discharge. The duration of this pause was correlated to the duration of the saccade. Many cells did not decrease their discharge rate for small-amplitude contraversive saccades. 5. The saccade-related pause in fixation cell discharge always began before the onset of the saccade. The mean time from pause onset to saccade onset for contraversive saccades and ipsiversive saccades was 36.2 and 33.0 ms, respectively. Most fixation cells were reactivated before the end of contraversive saccades. The mean time from saccade terminatioN to pause end was -2.6 ms for contraversive saccades and 9.9 ms for ipsiversive saccades. The end of the saccade-related pause in fixation cell discharge was more tightly correlated to saccade termination, than pause onset was to saccade onset. 6. After the saccade-related pause in discharge, many fixation cells showed an increased discharge rate exceeding that before the pause. This increased postsaccadic discharge rate persisted for several hundred milliseconds. 7. The discharge rate of fixation cells was not consistently altered when the monkey actively fixated targets requiring different orbital positions. 8. Fixation cells discharged during smooth pursuit eye movements as they did during fixation. They maintained a steady tonic discharge during pursuit at different speeds and in different directions, provided the monkey looked at the moving target.(ABSTRACT TRUNCATED AT 400 WORDS)     

Stationary and pursuit visual fixation share similar behavior

Stationary and pursuit fixation may involve different fixation mechanisms that are reflected by differences in saccadic reaction times (SRTs). Gap, Simultaneous, and Overlap interval paradigms provided three distinct SRT ranges for comparisons between these two viewing conditions. SRTs following pursuit fixation were longer than following stationary fixation, but were similarly affected by the interval paradigms. The SRT increase with smooth pursuit was largely explained by additional demands for programming oblique saccades. The paradigm dependent SRT relationships also persisted after timing cues were minimized. These results indicate that stationary and pursuit fixation have similar responses to different fixation paradigms and do not implicate the existence of multiple fixation processes.     

Use of cervicothoracic junction pedicle screws for reconstruction of complex cervical spine pathology

STUDY DESIGN: A retrospective review of 21 patients in which cervical pedicle screw fixation was used at C7 with or without upper thoracic pedicle screw fixation. OBJECTIVE: To evaluate the use of pedicle screw placement in the lower cervical spine. SUMMARY OF BACKGROUND DATA: The use of posterior cervical spine fixation, including lateral mass fixation, has become increasingly popular in recent years. However, lateral mass fixation at C7 is often hindered by lack of substantial high quality bone. The end level of long cervical spine constructs is frequently C7 or T1. Dissatisfaction with lateral mass fixation at C7 and T1 led the authors to use lower cervical pedicle screw fixation for several cervical spine disorders. METHODS: Twenty-one patients who had undergone cervical pedicle screw fixation at C7 were reviewed retrospectively. There were 12 males and 9 females, with an average age of 52 years. All pedicle screws were placed, after direct palpation of the pedicle, with a right angle nerve hook after laminoforaminotomy at C7. RESULTS: There were no neurologic complications related to pedicle screw placement, and no patient was symptomatically worse after the operation. Six patients with root pathology improved. Of 14 patients with cervical myelopathy, 12 improved at least one Nurick grade, and 2 had no improvement. There were no failures of fixation or complications related to pedicle fixation at a minimum of 1 year follow-up. CONCLUSION: Pedicle screws in C7 placed with laminoforaminotomy and palpation technique appears to be safe and efficacious. Excellent fixation can be achieved.     

Intraoperative radiographic assessment of ankle fractures

This retrospective study was performed to determine whether three or two radiographic views are necessary for intraoperative evaluation of low energy, rotational ankle fracture reduction and fixation. Four orthopaedic surgeons independently reviewed two sets of radiographs of 93 low energy, rotational ankle fractures treated by open reduction and internal fixation. The reviewers judged reduction and fixation, without measurement, as if they had been the operating surgeons. Set 1 consisted of mortise and lateral views and Set 2 consisted of anteroposterior, mortise, and lateral views. There was a 2-month interval between the review of Set 1 and Set 2. Intraobserver consistency for Sets 1 and 2 for reduction ranged from 92% to 98% and consistency for fixation ranged from 85% to 94%. These results underwent statistical testing by calculation of the kappa value. With a 95% confidence interval, the kappa value for reduction ranged from 0.376 to 0.701; the kappa value for fixation ranged from 0.598 to 0.781. The interobserver consistency for Sets 1 and 2 also was calculated. The authors conclude that fracture reduction and fixation can be assessed adequately with lateral and mortise views. The anteroposterior view can be eliminated from the standard radiographic protocol, potentially resulting in cost savings.     

Re-evaluating split-fovea processing in word recognition: Effects of retinal eccentricity on hemispheric dominance.

Several studies have claimed that hemispheric asymmetries affect word recognition right up to the point of fixation because each fovea is split precisely at its vertical midline and information presented either side of this midline projects unilaterally to different, contralateral hemispheres. To investigate this claim, four-letter words were presented to the left or right of fixation, either close to fixation entirely in foveal vision (0.15, 0.25, and 0.35 degrees from fixation) or further from fixation entirely in extrafoveal vision (2.00, 2.10, and 2.20 degrees from fixation). Fixation location and stimulus presentation were controlled using an eye-tracker linked to a fixation-contingent display and performance was assessed using a forced-choice task to suppress confounding effects of guesswork. A left hemisphere advantage was observed for words presented in extrafoveal locations but no hemisphere advantage (left or right) was observed for words presented in any foveal location. These findings support the well-established view that words encountered outside foveal vision project to different, contralateral hemispheres but indicate that this division for word recognition occurs only outside the fovea and provide no support for the claim that a functional split in hemispheric processing exists at the point of fixation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Biomechanical comparison of posterior internal fixation techniques for unstable pelvic fractures

Early reduction and rigid fixation of unstable vertical shear pelvic fractures has been shown to decrease the incidence of late sequelae and facilitate early mobilization. The results of fixation of the posterior pelvic ring without anterior fixation are unknown. The purpose of this study was to perform a biomechanical comparison of the most frequently used techniques of posterior fixation for unstable pelvic sacroiliac dislocations in conjunction with ipsilateral rami fractures, i.e., an unstable vertical shear injury. The four methods of posterior fixation tested included sacroiliac (SI) screws, anterior SI plates, transiliac bars, and a combination of SI screws and transiliac bars. Six cadaveric pelvises were tested in axial compression and torsion on a biaxial servohydraulic testing machine. Compared to the intact pelvis, single posterior methods of fixation provided approximately 70-85% resistance to axial and torsional loading. By combining SI screws with transiliac bars, approximately 90% of intact pelvic stability was achieved. Our results suggest that rigid posterior fixation of sacroiliac dislocations alone may obviate the need for additional complex anterior surgical procedures to fix rami fractures.     

Operative treatment of fractures of the tibial plafond. A randomized, prospective study

We performed a randomized, prospective study to compare the results of two methods for the operative fixation of fractures of the tibial plafond. Surgeons were assigned to a group on the basis of the operation that they preferred (randomized-surgeon design). In the first group, which consisted of eighteen patients, open reduction and internal fixation of both the tibia and the fibula was performed through two separate incisions. An additional patient, who had an intact fibula, had fixation of the tibia only through an anteromedial incision. The second group consisted of twenty patients who were managed with external fixation with or without limited internal fixation (a fibular plate or tibial interfragmentary screws). Ten (26 per cent) of the thirty-nine fractures were open, and seventeen (44 per cent) were type III according to the classification of Rüedi and Allg?wer. There were fifteen operative complications in seven patients who had been managed with open reduction and internal fixation and four complications in four patients who had been managed with external fixation. All but four of the complications were infection or dehiscence of the wound that had developed within four months after the initial operation. The complications after open reduction and internal fixation tended to be more severe, and amputation was eventually done in three patients in this group. At a minimum of two years postoperatively (average, thirty-nine months; range, twenty-five to fifty-one months), the average clinical score was lower for the patients who had had a type-II or III fracture, regardless of the type of treatment. With the numbers available, no significant difference was found between the average clinical scores for the two groups. All of the patients, in both groups, who had had a type-II or III fracture had some degree of osteoarthrosis on plain radiographs at the time of the latest follow-up. With the numbers available, there was no significant difference between the two groups with regard to the osteoarthrotic changes. We concluded that external fixation is a satisfactory method of treatment for fractures of the tibial plafond and is associated with fewer complications than internal fixation.     

Scanning force microscopy of DNA molecules elongated by convective fluid flow in an evaporating droplet

Scanning force microscopy (SFM) was used to image intact, nearly fully elongated lambda bacteriophage DNA molecules, fixed onto freshly cleaved mica surfaces. Molecular elongation and fixation were accomplished using a newly characterized fixation technique, termed "fluid fixation." Here convective fluid flows generated within an evaporating droplet of DNA solution efficiently elongate DNA molecules for fixation onto suitably charged surfaces. SFM images of a very large bacteriophage genome, G, showed the presence of double-stranded bubbles. We speculate that these structures may contain putative replication forks. Overall, the experiments presented here demonstrate the viability of using fluid fixation for the preparation of DNA molecules for SFM imaging. The combination of largely automatable optically based techniques with the high-resolution SFM imaging presented here will likely produce a high-throughput system for detailed physical mapping of genomic DNA or clones.     

Dynamic axial external fixation in the surgical treatment of tibia vara

Osteotomy is the well-established treatment of Blount's disease (tibia vara), although the types of fixation used vary considerably. The use of dynamic axial external fixation to stabilize osteotomies for tibia vara until solid union occurs without the use of supplemental casting has not been reported by other authors. From 1985 until the present, we have used osteotomy with dynamic axial external fixation as treatment of 31 tibiae in 23 patients. All osteotomies healed and there was no postoperative loss of correction. There was an average correction of 20 degrees between the pre- and postoperative mechanical axis. Advantages of dynamic axial external fixation include ease of application, adjustability, early weight bearing, the ability to lengthen the extremity, and no second operation for removal of hardware. Based on our results, we believe that dynamic axial external fixation is an excellent form of osteotomy stabilization in the surgical treatment of tibia vara.     

Stabilization of an inserted tricalcium phosphate spacer enhances the healing of a segmental tibial defect in sheep

The effect of inserting a tricalcium phosphate (TCP) spacer stabilized by a rigid or non-rigid fixation technique on the healing of segmental tibial defects of critical size was established. The osteotomized tibiae, 11 with and 8 without TCP spacers, were fixed by an external circular device in 11 mature sheep and by plates in 8 mature sheep, respectively. Healing was evaluated roentgenographically 16 weeks after the operation. Compared with the defects without TCP spacers, enhanced stability and healing were observed in the defects with TCP spacers under an identical external fixation. Furthermore, a significantly higher incidence of healing was obtained with plate fixation than with external device fixation in the TCP-implanted defects (P < 0.04). An abundant bridging callus was roentgenograpically demonstrated in most of the healed defects, but none in the unhealed defects. The TCP spacer with its mechanical integrity enhances the stability of external fixation, and the stable immobilization provided by rigid fixation is essential for osteoconduction of an inserted TCP spacer in the healing of segmental diaphyseal defects in sheep.     

Screw fixation of the olecranon after fracture or osteotomy

For 10 years prior to the availability of the Olecranon Screw described in this article, oblique fixation using a regular Sherman bone screw was employed for displaced fractures (with a suitable fragment) by engaging the anterior ulnar cortex. Internal fixation was supplemented by a split for 3 weeks. The reason for a special olecranon screw is to eliminate the necessity for additional fixation and permit early motion. No instance of non-union or important restriction of motion or serious complication has been encountered.     

Delayed surgical fixation of femur fractures is a risk factor for pulmonary failure independent of thoracic trauma

A recent retrospective analysis of femur fractures concluded that early surgical fixation in patients who have sustained blunt thoracic trauma (AIS score for Thorax > or = 2) was a risk factor for postoperative pulmonary failure. We conducted a review of all femur fractures admitted to a level I trauma center from November, 1988 to May, 1993. Inclusion criteria were ISS > or = 18, mid-shaft femur fractures treated with reamed intramedullary fixation, and no mortalities secondary to head trauma or hemorrhagic shock. One hundred thirty-eight patients met these criteria. Four patient groups were created: N1--no thoracic trauma (AIS score for thorax < 2), and early surgical fixation (< 24 hours after injury, n = 49); N2--no thoracic trauma and delayed fixation (> or = 24 hours, n = 8); T1--thoracic trauma (AIS score for Thorax > or = 2) and early fixation (n = 56); T2--thoracic trauma and delayed fixation (n = 25). There were no significant differences in age, Injury Severity Score, or Glasgow Coma Scale score between the four groups. Mortality rate, length of stay (LOS), LOS in the TICU, and duration of mechanical ventilation tended to be greater in patients with delayed fracture fixation, however, this was not statistically significant. The N2 patients had a pneumonia rate of 38% compared with 10% in group N1 (p = 0.07). The T2 patients had a pneumonia rate of 48% compared with 14% in group T1 (p = 0.002).(ABSTRACT TRUNCATED AT 250 WORDS)     

Opsite spray: its use for fixation of meshed skin grafts. Simple and low tech

The fixation of skin grafts often poses a problem, particularly in patients who have undergone tangential excision and grafting for burns. Sutures, staples, fibrin glue and other adhesives have been used for graft fixation. We present the use of Opsite spray as a simple method for graft fixation and stabilization. Opsite markedly reduced pain and discomfort at the time of first graft dressing and obviated the necessity for an anaesthetic which is often required for the removal of staples.     

Some temporal characteristics of processing during reading.

14 college students read passages displayed on a CRT as their eye movements were being monitored. During occasional fixations, all letters to the left of the directly fixated letter or all letters more than 4 to the right of the fixated letter were replaced by other letters. This replacement occurred either for only the 1st 100 msec of the fixation or only after the 1st 100 msec of the fixation. Eye movement data indicate that the eyes could respond to change in the visual stimulus within less than 100 msec and to orthographic irregularity in the test within less than 160 msec. No evidence was found for a left-to-right attentional scan during a fixation. Results are interpreted within the framework of a chronology of processing events occurring during a fixation in reading. Eye movement patterns and the determination of fixation durations are discussed. (37 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)