Semirigid rod fixation for long-bone fracture.

Experiments on 119 New Zealand rabbits were performed to measure healing strength of femurs. Four pairs of normal rabbit femurs were also studied in vitro by use of a four-point bending test to measure bending rigidity. Rabbit-sized octagonal cross-sectioned intramedullary rods with 12%, 20%, 50%, 75%, and 100% of femoral bending rigidity were specially prepared. For each animal, one intramedullary rod was implanted in an osteotomized femur through a standard lateral approach, with the other femur serving as a control. The results from the 12% rigidity rods were widely variable. In the 20% and 50% rigidity groups, the callus diameter was increased over the 75% rigidity group through all phases of healing. The torque ratio in this group increased up to eight weeks and then converged to the ratios of the other rigidities. The 75% rigidity group had shown increase of angular displacement up to eight weeks, while the 20% and 50% rigidity groups continued to improve and reached control strength at 12 weeks of treatment. Furthermore, the 20% and 50% groups absorbed more energy to failure in the later stage of healing than the 75% and 100% rigidity groups. Rods of 20% and 50% rigidity stimulate external callus formation and improve the stability of healing bone.

The nonsurgical management of odontoid fractures in adults.

Twenty-five odontoid fractures that were treated nonsurgically at the University of Virginia Hospital in the last 5 years were reviewed. Motor vehicle accidents were the major cause of this injury in our series. Early recognition and firm external stabilization of Type I and Type III fractures of the odontoid resulted in union in 100% of our patients. There were 12 Type II fractures with a nonunion rate of 42%. Thus, an overall rate of union of 80% was obtained. It is suggested in the literature and by this series that early recognition, reduction, and rigid external immobilization of Types I and III fractures of the odontoid should promote bony union. Type II fractures may also be managed successfully by closed methods, although the outcome is less certain.

Nonclostridial gas gangrene: late infection after hip pinning.

An 86-year-old diabetic man had a late, gas-forming infection about Knowles pins. Although blood cultures were negative, a urinary tract infection followed by infection with the same organism in bone, muscle, and lung strongly supports hematogenous spread of E coli from the genitourinary system in this patient. The genitourinary system is well recognized as a source of bacteremia, and the skeletal system is the most often affected distant tissue when this occurs. A hematogenous cause of nonclostridial gas gangrene about an implant has not previously been reported.

Reconstruction after the Tikhoff-Linberg procedure.

The Tinhoff-Linberg operation is a limb salvage technique that permits intercapulothoracic resection of malignant neoplasms of the shoulder with preservation of neuromuscular function of the upper extremity. A metallic interpositional device can be used to fix the humerus to the second rib, thus increasing stability and function. This device was used in a patient with a proximal humeral osteosarcoma who was also treated with radiation and chemotherapy and who has reasonably good extremity functional and is free of tumor at one year postoperatively.