Internal Splint Research Articles

Periauricular Face Lift Incisions and the Auricular Anchor

There is one problematic part of the facialplasty procedure that has been addressed with relative infrequency in the plastic surgery literature. This is the aesthetic management of the periauricular incisions and the resultant wound. The following problems associated with the design and closure of the periauricular incisions are recognized: (1) wide, hypertropic, or hypopigmented scars; (2) excessively elevated temporal hairline and a postauricular hairline “step” deformity; (3) “hidden” or “buried” tragus; (4) low, visible mastoid skin scars; and (5) deformed ear lobule or “pixie ear” deformity. Prevention of these undesirable results of facialplasty and cosmetic enhancement of the periauricular area for the facialplasty patient is the surgical challenge about which this article is concerned. The author's approach to the management of the periauricular area has been used successfully on 770 patients since 1985. This approach includes a unique incision design as well as a technique for internally splinting the periauricular incision at the time of wound closure. The incision design can eliminate the problems of elevated temporal hairline, disruption of the postauricular hairline, and visible mastoid skin scarring. The incorporated internal splinting technique reduces skin level closure tension to improve the quality of the skin scar formation. This approach further allows for retaining a natural-appearing shape of both the tragus and the lobule of the ear. The biomechanical basis for the internal splinting technique was examined by measuring the forces required to transpose facialplasty flaps to the periauricular area. The auricular cartilage was demonstrated to be a remarkably stable structure to which these flaps could be anchored. (Plast. Reconstr. Surg. 104: 1508, 1999.)

Aging Nasolabial Fold and Treatment by Direct Excision

There is one problematic part of the facialplasty procedure that has been addressed with relative infrequency in the plastic surgery literature. This is the aesthetic management of the periauricular incisions and the resultant wound. The following problems associated with the design and closure of the periauricular incisions are recognized: (1) wide, hypertropic, or hypopigmented scars; (2) excessively elevated temporal hairline and a postauricular hairline "step" deformity; (3) "hidden" or "buried" tragus; (4) low, visible mastoid skin scars; and (5) deformed ear lobule or "pixie ear" deformity. Prevention of these undesirable results of facialplasty and cosmetic enhancement of the periauricular area for the facialplasty patient is the surgical challenge about which this article is concerned. The author's approach to the management of the periauricular area has been used successfully on 770 patients since 1985. This approach includes a unique incision design as well as a technique for internally splinting the periauricular incision at the time of wound closure. The incision design can eliminate the problems of elevated temporal hairline, disruption of the postauricular hair-line, and visible mastoid skin scarring. The incorporated internal splinting technique reduces skin level closure tension to improve the quality of the skin scar formation. This approach further allows for retaining a natural-appearing shape of both the tragus and the lobule of the ear. The biomechanical basis for the internal splinting technique was examined by measuring the forces required to transpose facialplasty flaps to the periauricular area. The auricular cartilage was demonstrated to be a remarkably stable structure to which these flaps could be anchored.

Mennen paraskeletal plate fixation for fracture of the femoral shaft in association with ipsilateral hip arthroplasty

We reviewed the results of Mennen paraskeletal plate fixation in 14 patients with fracture of the femoral shaft in association with a previously successful ipsilateral hip arthroplasty. Overall good results were obtained with undisplaced fractures but some of the results in those individuals with widely displaced and unstable fractures were disappointing leading to some serious complications including amputation. The paraskeletal plate appears then to be no more than an internal splint and caution needs to be exercised when this device is used in this situation.

Flexor tendon repair using a stainless steel internal anchor: Biomechanical study on human cadaver tendons

We have developed a stainless steel internal tendon anchor that is used to strengthen a tendon repair. This study tested its use in vitro to produce a repair that can withstand the tensile strength demands of early active flexion. Fresh human cadaver flexor digitorum profundus tendons were harvested, divided, and then repaired using four different techniques: Kessler, Becker or Savage stitches, or the internal tendon anchor. The internal splint repairs demonstrated a 99-270% increase in mean maximal linear tensile strength and a 49-240% increase in mean ultimate tensile strength over the other repairs. It is hoped that this newly developed internal anchor will provide a repair that will be strong enough to allow immediate active range of motion.

Treatment of infection associated with segmental bone loss in the proximal part of the femur in two stages with use of an antibiotic-loaded interval prosthesis.

Treatment of an infection at the site of a total hip replacement associated with extensive loss of the proximal part of the femur is a challenging problem. In the present preliminary report, we describe the results after use of a prosthesis of antibiotic-loaded acrylic cement (PROSTALAC) in thirty such hips. The purpose of the prosthesis, which acts as an internal splint, is to maintain the length of the femur as well as the range of motion of the joint and the mobility of the patient between stages. A local level of antibiotics is maintained by the antibiotic-coated surface. A PROSTALAC with a cement-on-cement articulation was used in the first fifteen hips (Group I) in the study, and a custom metal-on-polyethylene articulating PROSTALAC was inserted in the subsequent fifteen hips (Group II). One patient who had a recurrent infection was managed with a second two-stage exchange and was included in both groups. Between stages, the average limb-length discrepancy was twenty-five millimeters despite a loss of more than 25 per cent of the femur in nineteen limbs. Sixteen patients were discharged home and seven, to a community hospital between stages. Six patients in Group I and only one in Group II were hospitalized for the entire course of treatment. The total duration of hospitalization for both stages averaged thirty-eight days. Twenty-eight patients were mobile even though they did not bear weight on the involved limb between stages: three patients used a cane, fifteen used crutches, and ten used a walker. Twenty-six patients reported no, slight, or moderate pain in the thigh, groin, or buttock between stages. The average Harris hip score before the first stage of the operation was 23 points (range, 0 to 63 points), which improved to 74 points (range, 40 to 91 points) at an average of forty-seven months (range, twenty-four to 114 months) postoperatively. Two patients died of unrelated causes before two years (the minimum follow-up period) had elapsed and were excluded from the final analysis; they had no evidence of recurrent infection. Of the remaining twenty-eight hips, twenty-seven (96 per cent) had no evidence of infection at the most recent follow-up examination.

Use of Interlocking Intramedullary Nail in Treatment of Delayed Union or Nonunion of the Long Bone Fractures

Of the several nonoperative and operative options described for the treatment of delayed union and nonunion of the long bone, interlocking nailing with reaming offers the effect of internal splint, autogenous bone graft and early return to a normal way of life. The purpose of this study is to evaluate the usefulness and complication of intramedullary(IM) naling with reaming by retrospective method. We treated 34 patients with delayed union or nonunion of the tibia, femur, and humerus by interlocking nailing with reaming between January 1992 and December 1996. The results were as follows ; 1. Of the 34 cases, there were 13 tibia fracture, 17 femur fracture, 4 humerus fracture. Half of them were ununited and another half were delayed in fracture healing. 2. Previous methods of treatment were conservative treatment in 2 cases, external fixator in 2, plate & screws fixation in 8, Ender nail in 2, K.. untscher nail in 2 and interlocking nail in 7 among 24 cases of closed fracture and external fixator in 8 and interlocking nail in 2 among 대한골절학회지 제11권, 제4호, 1 9 98년 1 0월 The Journal of the Korean Society of Fractures Vol.11, No.4, October, 1998

Etymology of the Word “Stent”

Etymology of the Word “Stent”

Surgery of the Non-Indo-European Face

The severely deviated nose represents a complex cosmetic and functional problem. This article analyzes the types of deformities present in a severely deviated nose, reviews the existing methods of correction, and proposes a new method of internal cartilage splinting to correct the more severe deformities.

A practical and rapid method of histological processing for examination of coronary arteries containing metallic stents

A practical and rapid method was developed to study vascular pathology after implantation of metal endoprostheses (stents) that are used as internal splinting devices of tube-like structures. This method obviates the need for time-consuming grinding of thick sawing sections or removal of the prosthesis prior to histological processing, allowing for detailed analysis of the tissue in general, but especially of the stent-tissue interface. The vessels, with the metal stents still in place, were dehydrated in graded series of ethanol and embedded in methyl methacrylate. Using a motor-driven rotary microtome, 3- to 5-μm sections were easily cut. After deplastination, routine and special histological stainings were performed according to standard protocols for paraffin sections. This method proved to save time, compared with sawing sections, while allowing for a more complete examination of the stenttissue interface than is possible with routine paraffin techniques.

Bone-Graft Surgery

Bone-Graft Surgery

Radiological sequences of healing in internal plates and splints of different contact surface to bone. (DCP, LC-DCP and PC-Fix)

For several years our attention has been directed towards the damage to the blood supply brought about by implant contact. The disturbance of the blood supply results in necrosis and consequent remodelling which then results in early temporary porosis and potentially in bone sequestration. Reduced resistance to local infection may follow. Locally delayed remodelling may give rise to stress concentrations and thus increase the danger of refracture. With this in mind a new approach to periosteal splinting has been developed which realizes minimal implant contact to preserve the blood supply to the bone. In order to elucidate the sequence of events in healing, time-lapse cinematography has been used to facilitate the comparison of conventional and new plates and internal splints. Fractures of the sheep tibia were recorded radiologically at short intervals Samples of these radiographs are displayed for comparison. The healing process after application of an internal fixator (PC-Fix) results in earlier solid union and a more homogeneous bone structure.

Surgery in Osteogenesis lmperfecta

An analysis of 266 operations on 63 patients with osteogenesis imperfecta, mostly type III and IV, showed that about half had corrections of skeletal deformities and internal splinting with intramedullary stainless steel rods. The remaining operations were for other orthopaedic procedures as well as non-orthopaedic procedures such as hernia repairs. There were no major anaesthetic or post-operative complications. Mild pyrexia was common but without the features of malignant hyperpyrexia. Correction of long deformities and internal splintage of the bones with non-expanding rods effectively reduced the fracture rate but deformities and fractures recurred as the epiphyses grew off the ends of the rods. Expanding rods provided continuing splintage during growth but could not be used in children with very narrow or very fragile bones.

Radiological sequences of healing in internal plates and splints of different contact surface to bone. (DCP, LC-DCP and PC-Fix)

Radiological sequences of healing in internal plates and splints of different contact surface to bone. (DCP, LC-DCP and PC-Fix)

Internal splints for prevention of first web contracture following severe disruption of the first web space

Different internal spring-splint configurations were examined to determine the most effective in preventing adduction contracture after severe injuries disrupting the first web space.

Custom-Formed Splint for Septorhinoplasty

The author has done extensive research into the problems associated with nasal packing and internal splinting following septorhinoplasty. In an effort to come up with a better splint, multiple media were tried and in different formats. The finished product has met all of the criteria for an acceptable nasal splint and has been tried successfully in over five hundred cases.

Achilles Tendon Injuries: A Comparison of Surgical Repair Versus No Repair in a Rat Model

Controversy exists regarding the treatment of Achilles tendon ruptures. The aim of this study was to determine whether surgical repair of the rat Achilles tendon offered any biomechanical, functional, or morphological advantage over no repair. Thirty-two male Sprague-Dawley rats were randomly allocated into four groups: (1) sham operated (skin incision only), (2) no repair (complete division of the Achilles tendon and plantaris tendon without repair), (3) internal splint (plantaris left intact), and (4) Achilles repair (with a modified Kessler-type suture). Functional performance was determined from the measurements of hindpaw prints utilizing the Achilles Functional Index. On day 15, the animals were killed, and biochemical and histological evaluations were performed on both the injured and uninjured Achilles tendon constructs. All groups subjected to Achilles tendon division had a significant initial functional impairment that gradually improved so that by day 15 there were no functional or failure load impairments in any group. The injured tendons in all three groups subjected to Achilles tendon division had a 13-fold increase in the cross-sectional area and were less stiff and more deformable than uninjured and sham-operated tendons on day 15 (P < .001). The magnitude of the biomechanical and morphological changes at postoperative day 15 and the initial impairment and rate of functional recovery were similar for no repair, internal splint, and Achilles repair groups. In summary, this study demonstrates that surgical repair of the Achilles tendon in the rat does not offer any advantage over nonoperative management.

Polyethylene Oxide Gel: A New Intranasal Dressing After Septorhinoplasty

The purpose of intranasal dressings after septorhinoplasty is to absorb secretions, stop bleeding, act as an internal splint, discourage adhesions, and facilitate nasal hygiene. The ideal dressing should conform to the irregularities of the nasal cavity and resist adherence to the wounds of the nasal lining so it can be easily removed. It should be nonirritating, antiseptic, and economical. The failure of previously reported dressings in one or more of these requirements led us to evaluate a new alternative. Polyethylene oxide gel (Vigilon) was identified as a potential improvement and investigated in 48 patients over 17 months. There were no significant complications. Polyethylene oxide gel appears superior to previously described dressings, primarily because of comfort for the patient at removal.

Percutaneous nailing in the management of osteogenesis imperfecta

Marked deformities of the skeleton may develop in the severe form of osteogenesis imperfecta. Internal fixation can be effective in the treatment and prevention of fractures and deformities. Eight years ago, axial correction of deformities of the femora and tibiae by manual osteoclasis was carried out in a 7 year old girl in whom osteogenesis imperfecta had produced severe bowing of the long bones of the legs. Internal metal splints were introduced percutaneously to lie partially in, and partially alongside, the bone, to obtain fixation in the correct position. This treatment resulted in the prevention of refracture of the legs, while correction was maintained.

Femoral shaft perforation at arthroplasty: To treat or not to treat

Femoral shaft perforation at total hip arthroplasty is a complication that is being noted more frequently, and it is often associated with femoral shaft fracture below the prosthesis. This study examines the anatomic and biomechanical effects of femoral shaft perforation at arthroplasty, and the effects of supporting the perforated bone with Partridge plates and bands. Two models, pig femora and Pedilen cylinders, were employed. Testing the bone models to failure in tensile mode showed that the perforations weakened the bone and that the Partridge plates and bands decreased the weakening effects of the perforation. The strengthening effect of the Partridge plates and bands on the bone with a perforation, allied with the presence of an internal splint in the event of a fracture through the perforation, suggests the benefit of using Partridge plates and bands if a cortical perforation is found at arthroplasty and revision is not feasible.

Zur behandlung des frischen subkutanen strecksehnenausrisses im endgelenk der langfinger mit temporärer bohrdraht-arthrodese

Drop-finger at the distal joint or mallet-finger from injury occurs because of the extensor apparatus is so much weaker than the flexor tendon that it breaks under strain. We report on 100 cases treated by internal splinting with longitudinal applied Kirschner wire in the distal and middle phalanx of the finger. It affords an absolute immobilisation of the distal interphalangeal joint in slight hyperextension with relaxation of the extensor apparatus. The wire was removed after six weeks. The results evaluated in 76 patients by follow-up four to 84 months were classified as excellent in 86.8% (full range of motion), good in 11.9% (loss of motion 5 to 15 degrees), and poor in 1.3% (loss of motion more than 15 degrees). The excellent and good results emphasize that internal splinting in ruptures of the extensor apparatus near the distal interphalangeal joint.