DOI: 10.1148/rg.236035159
Fracture Fixation1
Mihra S. Taljanovic, MD,
Marci D. Jones, MD,
John T. Ruth, MD,
James B. Benjamin, MD,
Joseph E. Sheppard, MD and
Tim B. Hunter, MD
1 From the Departments of Radiology (M.S.T., T.B.H.) and Orthopaedic Surgery (M.D.J., J.T.R., J.B.B., J.E.S.), University of Arizona College of Medicine, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724-5067. Received July 2, 2003; revision requested July 17 and received August 12; accepted August 15. Address correspondence to M.S.T. (e-mail: mihrat@radiology.arizona.edu).
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Figure 1. External traction device. Lateral radiograph of the knee shows a Kirschner wire inserted through the distal femoral metaphysis with an external metallic traction device.
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Figure 2a. Casts and splint. (a) Radiograph shows a plaster of paris cast that overlaps the wrist; no fracture is visible. (b) Radiograph of another patient shows a fiberglass cast that overlaps the wrist; a distal radial fracture is seen through the cast. (c) Radiograph of a different patient shows a plastic splint that overlaps the volar aspect of the wrist; no fracture is visible.
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Figure 2b. Casts and splint. (a) Radiograph shows a plaster of paris cast that overlaps the wrist; no fracture is visible. (b) Radiograph of another patient shows a fiberglass cast that overlaps the wrist; a distal radial fracture is seen through the cast. (c) Radiograph of a different patient shows a plastic splint that overlaps the volar aspect of the wrist; no fracture is visible.
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Figure 2c. Casts and splint. (a) Radiograph shows a plaster of paris cast that overlaps the wrist; no fracture is visible. (b) Radiograph of another patient shows a fiberglass cast that overlaps the wrist; a distal radial fracture is seen through the cast. (c) Radiograph of a different patient shows a plastic splint that overlaps the volar aspect of the wrist; no fracture is visible.
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Figure 3a. Standard uniplanar external fixator. Frontal (a) and lateral (b) radiographs of the wrist show a standard uniplanar external fixator. The device was placed to treat a comminuted distal radius fracture, with pins in the second metacarpal and radial shaft. An ulnar styloid fracture is also present.
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Figure 3b. Standard uniplanar external fixator. Frontal (a) and lateral (b) radiographs of the wrist show a standard uniplanar external fixator. The device was placed to treat a comminuted distal radius fracture, with pins in the second metacarpal and radial shaft. An ulnar styloid fracture is also present.
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Figure 4. Ring external fixator. Radiograph shows a ring external fixator (Ilizarov) that transfixes a healing proximal tibial fracture. A healing proximal fibular osteotomy is also seen.
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Figure 5a. Hybrid external fixator. Frontal (a) and lateral (b) radiographs of the left leg in a patient who sustained gunshot injury to the leg show a hybrid external fixator. The device was placed to treat severely comminuted open proximal tibial and fibular fractures.
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Figure 5b. Hybrid external fixator. Frontal (a) and lateral (b) radiographs of the left leg in a patient who sustained gunshot injury to the leg show a hybrid external fixator. The device was placed to treat severely comminuted open proximal tibial and fibular fractures.
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Figure 6. Greater trochanter clamp. Frontal radiograph shows the greater trochanter, which is attached to the proximal femur by a clamp, and a unipolar hip hemiarthroplasty. A subsequent periprosthetic fracture through the femoral midshaft was transfixed with a reconstruction plate.
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Figure 7. Fixation pins. Frontal radiograph of the wrist shows a comminuted intraarticular distal radius fracture transfixed with three Kirschner wires and a standard uniplanar external fixator with Steinman pins in the distal radius and in the second metacarpal bone.
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Figure 8a. Tension band wire. Frontal (a) and lateral (b) radiographs of the knee show a transverse patellar fracture that is transfixed with a tension band wire (combination of two cancellous screws and two wires).
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Figure 8b. Tension band wire. Frontal (a) and lateral (b) radiographs of the knee show a transverse patellar fracture that is transfixed with a tension band wire (combination of two cancellous screws and two wires).
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Figure 9. Cerclage wires used in revision noncemented total hip arthroplasty. A proximal femoral shaft osteotomy was performed for ease of removal of the femoral component. Frontal radiograph of the hip shows three cerclage wires placed over the proximal femoral shaft for additional stabilization of the osteotomy site. Multiple drains are overlying the soft tissues.
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Figure 10. Photograph shows a variety of screws used in internal fixation: the Schanz screw (A), cannulated cancellous screws (B), partially threaded cortical screw (C), and cortical screws (D) (the first two of which are self tapping and the third is non-self tapping).
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Figure 11. Diagram illustrates screw "anatomy."
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Figure 12a. Interfragmentary screw. Mortise (a) and lateral (b) radiographs of the ankle show a low-contact DCP (note small indentations on the undersurface of the plate in the mortise projection) and five cortical screws that transfix a distal fibular shaft fracture. The third screw placed through the plate is obliquely oriented crossing the fracture site (interfragmentary screw). A fully threaded syndesmotic screw is also present.
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Figure 12b. Interfragmentary screw. Mortise (a) and lateral (b) radiographs of the ankle show a low-contact DCP (note small indentations on the undersurface of the plate in the mortise projection) and five cortical screws that transfix a distal fibular shaft fracture. The third screw placed through the plate is obliquely oriented crossing the fracture site (interfragmentary screw). A fully threaded syndesmotic screw is also present.
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Figure 13. Cannulated screw with a washer. Frontal radiograph shows a cannulated, partially threaded cancellous screw and a washer that transfix the distal clavicle and coracoid. The patient had a distal clavicular fracture and reduced acromioclavicular joint subluxation with disruption of the coracoclavicular ligament.
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Figure 14. Cannulated screws. Frontal radiograph of the hip shows three cannulated cancellous screws that transfix a subcapital proximal femoral fracture.
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Figure 15. Dynamic compression screw. Frontal radiograph of the hip shows a dynamic compression screw device that transfixes the intertrochanteric fracture.
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Figure 16. Herbert screw. Frontal radiograph of the foot shows a Herbert screw transfixing the proximal fifth metatarsal (Jones) fracture.
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Figure 17. Anchor screws. Frontal radiograph of the wrist shows two suture anchors (Mitek Worldwide, Norwood, Mass) in the base of the proximal phalanx of the thumb in a patient with surgical fixation of an ulnar collateral ligament injury (gamekeeper thumb).
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Figure 18a. Interference screws. Frontal (a) and lateral (b) radiographs of the knee in a patient treated for prior knee dislocation show interference screws in the lateral femoral condyle and proximal medial tibial metaphysis related to ACL reconstruction. Bone irregularity in the posterior tibial plateau in the lateral projection is related to posterior cruciate ligament reconstruction. Multiple suture anchors are present in the distal femur and proximal tibia, consistent with medial collateral ligament and capsular repair. A Hoffman uniplanar external fixator is also present.
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Figure 18b. Interference screws. Frontal (a) and lateral (b) radiographs of the knee in a patient treated for prior knee dislocation show interference screws in the lateral femoral condyle and proximal medial tibial metaphysis related to ACL reconstruction. Bone irregularity in the posterior tibial plateau in the lateral projection is related to posterior cruciate ligament reconstruction. Multiple suture anchors are present in the distal femur and proximal tibia, consistent with medial collateral ligament and capsular repair. A Hoffman uniplanar external fixator is also present.
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Figure 19a. ACL reconstruction with bioabsorbable interference screws. Frontal (a) and lateral (b) radiographs of the knee in a patient after ACL reconstruction with bioabsorbable screws. Femoral and tibial tunnels with proper orientation are seen in both projections.
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Figure 19b. ACL reconstruction with bioabsorbable interference screws. Frontal (a) and lateral (b) radiographs of the knee in a patient after ACL reconstruction with bioabsorbable screws. Femoral and tibial tunnels with proper orientation are seen in both projections.
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Figure 20. Photograph shows a variety of plates used in internal fixation: tibial condylar plate (A), blade plate (B), reconstruction plate (C), calcaneal plate (D), dynamic compression plate (E), and LISS plate (F).
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Figure 21. Low-contact DCP. Oblique radiograph of the wrist shows a low-contact DCP used for wrist arthrodesis.
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Figure 22. Blade plate that transfixes the humerus in a patient with a pathologic fracture from renal cell carcinoma metastasis. Frontal radiograph shows multiple metallic embolization coils and polymethylmethacrylate cement at the proximal humeral metaphyseal fracture site. A blade plate with multiple cortical screws and an additional low-contact DCP with screws that was placed intramedullary transfix the fracture site. Peripherally inserted vascular catheter overlies the medial upper arm.
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Figure 23. Reconstruction plate in a patient with ipsilateral right sacral and pubic rami fractures. Frontal radiograph of the pelvis shows a reconstruction plate and multiple cortical screws that transfix the symphysis pubis, right superior pubic ramus, and anterior column of the right acetabulum. A fully threaded cannulated screw with a washer transfixes the right sacroiliac joint.
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Figure 24. Reconstruction plate in the elbow. Frontal radiograph shows a small reconstruction plate and multiple cortical screws that transfix the radial head and neck fracture. A suture anchor is present in the lateral epicondyle related to capsular/ligamentous repair.
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Figure 25a. LISS plate in a patient with a periprosthetic distal femoral fracture. Frontal (a) and lateral (b) radiographs of the knee show a periprosthetic distal femoral fracture that is transfixed with a LISS plate.
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Figure 25b. LISS plate in a patient with a periprosthetic distal femoral fracture. Frontal (a) and lateral (b) radiographs of the knee show a periprosthetic distal femoral fracture that is transfixed with a LISS plate.
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Figure 26. Anatomically shaped plate. Frontal radiograph of the knee shows a specially designed short plate that transfixes a high proximal tibial osteotomy site. The knee is in a hinged brace. A drain is seen overlying the lateral soft tissues.
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Figure 27. Oblique radiograph of the wrist in a patient with a nonunited scaphoid fracture shows a spider plate used for partial carpal fusion. Two suture anchors are seen in the proximal scaphoid.
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Figure 28. Frontal radiograph of the wrist shows a 3.5 T-plate that transfixes a distal radial healed fracture. A cannulated screw and a threaded washer transfix a healed scaphoid fracture.
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Figure 29a. Intramedullary nails. (a) Frontal radiograph of the femur shows a comminuted midfemoral shaft fracture that is transfixed with an antegrade intramedullary nail with one proximal and two distal interlocking screws. (b) Frontal radiograph of the femur in a different patient shows a distal femoral shaft fracture that is transfixed with a retrograde intramedullary nail with one proximal and two distal interlocking screws.
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Figure 29b. Intramedullary nails. (a) Frontal radiograph of the femur shows a comminuted midfemoral shaft fracture that is transfixed with an antegrade intramedullary nail with one proximal and two distal interlocking screws. (b) Frontal radiograph of the femur in a different patient shows a distal femoral shaft fracture that is transfixed with a retrograde intramedullary nail with one proximal and two distal interlocking screws.
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Figure 30. Frontal radiograph of the leg shows a tibial shaft fracture that is transfixed with an antegrade intramedullary nail with two proximal and two distal interlocking screws. A fibular shaft fracture is present at the same level.
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Figure 31. Frontal radiograph of the humerus shows an antegrade intramedullary nail with one proximal and three distal screws (poorly visualized on this single projection) that transfix a pathologic distal humeral shaft fracture from renal cell carcinoma metastasis. Multiple metallic embolization coils and polymethylmethacrylate cement are present at the fracture site.
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Figure 32. Photograph shows a variety of nails used in internal fixation: antegrade femoral reconstruction nail (A), retrograde femoral nail (B), and dynamic compression hip screw device (C).
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Figure 33. Flexible intramedullary rods. Frontal radiograph of the femur shows two flexible intramedullary nails (Ender) that transfix a proximal femoral shaft fracture.
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Figure 34. Short intramedullary rod. Frontal radiograph of the hip shows a short antegrade intramedullary femoral rod with an interlocking dynamic compression screw device that extends into the femoral head and transfixes an intertrochanteric fracture.
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Figure 35. Autogenous bone grafts. Oblique radiograph of the knee shows two autogenous osteochondral grafts (arrows) at the articular site of the patella. Donor sites (arrowheads) are seen in the medial femoral condyle. Two cortical screws transfix the tibial tubercle osteotomy site.
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Figure 36. Allograft. Lateral radiograph of the knee shows a distal femoral cadaveric allograft approximated to the native femoral stump by a retrograde intramedullary nail. Two interlocking cannulated screws are placed through the distal nail. Two interference screws and two staples in the proximal tibia, and a single staple in the posterior allograft metaphysis, are all related to cruciate ligament and capsular reattachment.
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Figure 37. Calcium phosphate cement as a bone graft substitute. Frontal radiograph reveals calcium phosphate (SRS cement; Norian, Cupertino, Calif), which was used to augment the site of a previous enchondroma complicated by a pathologic fracture in the base of the proximal phalanx of the right fourth digit.
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Figure 38. Calcium sulfate cement as a bone graft substitute. Frontal radiograph of the forefoot reveals calcium sulfate pellets (OsteoSet; Wright Medical Technology, Arlington, Tenn), which were used to pack a previous aneurysmal bone cyst in the second metatarsal bone. A Kirschner wire transfixes the first and second metatarsals. A plaster cast is applied.
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Figure 39. Antibiotic beads. Radiograph of the distal tibia and fibula shows antibiotic beads at a previously infected resected distal tibial site. Screw tracks are seen in the distal fibula from removed fixation hardware.
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Copyright © 2003 by the Radiological Society of North America.
