title: [Spinal internal fixator--analysis of problems in 28 cases].
abstract: Problems encountered in the management of thoracolumbar and lumbar spinal fractures with the "fixateur interne" are reviewed. 28 patients were treated between 1986 and 1988. Retrospective analysis identified the following problems: a. Loosening of nuts at the longitudinal rod and/or clamp ends--b. Major corrosion defects of Schanz screws and clamps--c. Large implant volume--d. Non-availability of intermediate rod lengths. Earlier problems, i.e. the absence of an effective press-fit (transverse stabilizer) between the 2 longitudinal rods and the non-availability of a cutter for trimming the Schanz screws, have meanwhile been resolved. Loosening of the nuts at the clamp end may cause substantial loss of reduction and jeopardize the outcome of treatment. The problem of how to identify loosening, which is usually recognizable within 27 days, is discussed at length. Since loosening occurs irrespective of fracture type and site, instrumentation length, ancillary surgical procedures, type of postoperative care, preoperative neurological status and operating surgeon, it appears to be inherent in the system. Alterations in neighbouring vertebral segments attributable to rebundant rod lengths cannot altogether be excluded. The potential occurrence of corrosion defects should prompt implant removal after radiologically confirmed fracture healing.
authors.affiliation: Unfallkrankenhaus Wein-Meidling.
authors.forename: E
authors.initials: E
authors.lastname: Sim
mesh_terms: D000328:Adult; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016268:Internal Fixators; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D012086:Reoperation; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery
vernacular_title: Der Wirbel-Fixateur Interne--Problemanalyse in 28 Fällen.