SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
External fixation in arthrodesis of the midfoot offers a versatile alternative when internal fixation is contraindicated or impossible. Most often, the small wire fixator, such as the Ilizarov device, provides the stability that is necessary to achieve solid union. External fixation allows for continual compression and the ability to produce gradual deformity correction, if necessary.
OBJECTIVE: To evaluate hinged circular external fixation for correction of antebrachial deformities in dogs. STUDY DESIGN: Uncontrolled clinical trial. ANIMAL POPULATION: Seven client-owned dogs. METHODS: Six dogs had one radius corrected and one dog had both radii corrected. Preoperative planning included measurement of the craniocaudal and mediolateral angular deformities, rotational deformity, length deficit, origin of deformity, graphical or mathematical determination of the amplitude and direction of the actual limb deformity, and frame assembly. RESULTS: Preoperatively, function and cosmesis were assessed to be fair to poor in all dogs. Deformity correction started 48 to 60 hours postoperatively and ranged from 0.46 mm to 1.36 mm twice daily. Hospitalization time ranged from 4 to 6 days. Corrections were mostly made by the owners, at home. Lengthening and angular correction ranged from 3 to 38 mm and 18 degrees to 48 degrees. Mean residual deformities were 2.7% of radial length and 2.7 degrees. The time duration with the circular external fixators in place ranged from 29 to 71 days. Two additional surgeries were necessary in one dog because of wire breakage. Mean follow-up was 40 months. Long-term function and cosmesis were good to excellent in all dogs. CONCLUSION: Although complications were present in six of seven dogs, the outcome of hinged Ilizarov external fixation was successful in all dogs treated for deformities of the antebrachium. CLINICAL RELEVANCE: Despite complex preoperative planning, the placement of hinged circular external fixators is straightforward, and allows precise correction of complex antebrachial deformities with minimal tissue trauma.
The use of Hoffmann external fixation in the treatment of ankle and foot trauma in 26 patients is reviewed. There were 21 males and five females, ranging in age from 14 to 56 years. There were 22 fresh fractures and four arthrodeses. Fourteen of the 22 injuries were open fractures. Eight of 22 involved foot joint disruptions. This form of treatment required a complete set of external fixation equipment, sound knowledge of foot and ankle anatomy, and technical skill in frame construction and application. This fixateur allowed three plane stabilization of complex fractures, mobilization of unaffected joints, and access to wounds for soft tissue care. Follow-up evaluations from 24 to 48 months demonstrated good clinical results. The fractures healed and soft tissue and joint function were preserved. The arthrodeses fused. There were no neurovascular complications, pin tract infections, or equipment breakage. Foot trauma frequently combines soft tissue injury and complex skeletal instability, which makes external fixation particularly attractive. Although ideal indications for the use of this technique have not yet been determined, the theoretical advantages and initial results are encouraging. External fixation is a useful addition to the treatment armamentarium of the foot surgeon.
BACKGROUND: This study sought to define the role of transiliac sacral rods used in combination with an external fixator for the management of unstable pelvic fractures. METHODS: This retrospective study evaluated cases in which the surgical strategy was open reduction and internal fixation of posterior lesions with two transiliac sacral rods and closed reduction and external fixation of anterior lesions with an AO external fixator. The data for 65 cases were analyzed. Comprehensive Classification (AO) identified 42 C1 cases, 21 C2, cases and 2 C3 cases. Fractures with iliac bone involvement that impeded the application of an external fixator or transiliac sacral rods were excluded. The follow-up period was 85 months (range, 24-140 months). RESULTS: All the fractures/dislocations healed well. The complications involved 17 cases (26.2%) of persistent posterior pain, 16 cases (24.6%) of irreversible neurologic deficit, 2 cases (3.1%) of posterior wound infection, 3 cases (4.6%) of pin tract infection, and 4 cases (6.2%) of irreversible urologic deficit. The functional results showed that the surgical results were satisfactory in 42 cases (64.6%) and unsatisfactory in 23 cases (35.4%). CONCLUSIONS: For type C pelvic fractures without significant iliac bone involvement, surgical management with posterior transiliac fixation using sacral rods and anterior external fixation yields good radiologic results. The functional results correlated primarily with avoidance of complications and not necessarily with the radiologic results.
The application of a pelvic external fixator can be a vital stage in the management of patients with severe pelvic fractures, either as part of the resuscitation phase or as definitive treatment. This paper shows the complication rate of pelvic external fixation to be 47 per cent. This high rate increases the morbidity associated with the fracture, and may also interfere with the definitive management. The majority of complications were associated with pin placement and the pin-bone interface. An understanding of the principles of external fixation and knowledge of the correct methods of application should reduce this complication rate.
The proper techniques of external fixation are demanding regardless of the type of external fixator used. Attention to detail, including preoperative planning and strict postoperative care, is essential to maximize the advantages and minimize the disadvantages associated with external fixation.
From January 1987 to May 1989, a total of 38 adult cases were treated with 15 femoral and 25 tibial shaft shifting procedures from external fixation to reamed intramedullary nailing and followed up for at least 1 year (average, 23 months) at the authors' institution. The indications for the shifting procedures included routine sequential femoral external fixation and failed tibial external fixation treatment such as loss of reduction, atrophic healing process and inability of patients to tolerate casting. The delay period for the shifting procedure was 5 days in the femur and 48 days in the tibia. The union rate for the femur was 93% (14/15), and the tibia, 96% (24/25). The union period after the shifting procedure was 4.8 +/- 1.7 months in the femur, and 5.2 +/- 1.8 months in the tibia. Range of motion of the knee and ankle were satisfactory. Deep infection was the most serious complication, and the tibia was involved more often than the femur (20% to 13%) (p greater than 0.05). The most favorable management of deep infection was local drainage till bony union. We conclude that a shifting operation can be considered as one of the alternative procedures for several femoral or tibial shaft open fractures after fixation with external fixation. Wound and pin tract care, a shorter period of external fixation, a longer delay period before nailing, and perioperative antibiotic use may significantly lessen the infection rate.
The kinematic properties of a new dynamic external fixator device for treatment of distal radial fractures are described. Using a combination of data obtained from computed tomography scans and high-speed video images, a three-dimensional reconstruction of carpal motion was made. To describe carpal motion, the radiolunate, capitolunate, and scapholunate angles were measured during flexion and extension and during radioulnar deviation. During these types of motion, the device changed normal carpal kinematics to a limited extent although the differences in kinematic pattern with and without the device were small. The results for flexion and extension correspond with data from previously published studies with other dynamic external fixators. However, because the new device (Flexafix) allows flexion and extension and radioulnar deviation, in contrast to other dynamic external fixation devices, with its use normal carpal kinematics can be approached more closely.
OBJECTIVE: To review external fixation in the management of war injuries. METHOD: We prospectively followed up 15 external fixators (14 patients) applied in the management of war injuries. All these patients were treated at 202 Field Hospital during the 2003 Gulf Conflict. RESULTS: Of the 15 fixators, 13 (86.7%) required early revision or removal due to complications of the injury or the fixator. Instability was a problem with 10 fixators (67%), pin loosening was noted with 5 fixators (33%) involving twelve pins, and a significant pin track infection developed at 14 pin sites (3 fixators - 20%), which failed to resolve despite intravenous antibiotics. CONCLUSIONS: This study demonstrates a very high early complication rate of external fixation in the management of military injuries and cautions against its universal acceptance. If used, consideration must be given to the optimum time of frame application, whether at the time of initial debridement or at a later operation, and the optimal frame design, which will depend on the specific bone and fracture pattern. Pin site care must also be considered, particularly with the restrictions imposed by the military environment.
OBJECTIVE: To evaluate the long-term results of external fixation of distal radius fractures. METHODS: A retrospective follow-up study (median follow-up, 5.3 years) of 49 patients with 50 distal radius fractures treated with an external fixator was carried out. An external fixator (Minifixator, Stratec Medical, Waldenburg, Switzerland) was used. The operative procedure is described in detail. A personal evaluation including clinical and radiologic assessment of both wrists was performed. RESULTS: The functional results, including the parameters strength, daily activities, range of motion, and presence of pain, as well as an anatomic score, the presence of osteoarthritis, the quality of reduction, and complications were recorded. Functional and anatomic results indicated excellent to good ratings in more than 80% of the cases. CONCLUSION: The external fixator is a versatile tool in the treatment of intra-articular and extra-articular fractures of the distal radius. The rate of algodystrophy (reflex sympathetic dystrophy) was 6%, and wrist stiffness was not found in our series.
External fixation of unstable intra-articular fractures of the distal radius has become an effective tool in the management of these difficult injuries. Careful assessment of the fracture pattern, appropriate patient selection, meticulous surgical technique, the appropriate choice of fixation device and pins, recognition of the need for augmentation with limited internal fixation or bone grafting, and aggressive postoperative rehabilitation provide the foundation for successful management of these fractures while minimizing complications. The surgeon must remember that the pin-bone interface is the link between the patient and the fixator. He or she must ensure a stable environment for this interface by providing a clean, tight purchase of the pin in bone with minimal damage to the bone and its surrounding soft tissues at the time of operation. Postoperatively, the surgeon must convey to the patient the importance of maintaining a healthy environment for this pin-bone interface. An appropriately chosen external fixation device can be expected to provide overall stability while maintaining length as well as angular and rotational alignment. However, it cannot be expected to provide precise small fragment control and restoration of articular congruity. This must be achieved by precise reduction and limited internal fixation using Kirschner wires while prevention of late collapse is afforded by subarticular bone grafting of the metaphyseal defect. Adherence to these principles should provide a satisfactory outcome with a significant reduction in the rate of complications when external fixation is used for the management of complex fractures of the distal radius.
PURPOSE: To analyze the effect on mortality of a protocol for early mobilization with external fixation of patients with pelvic ring injuries. METHODS: From 1981 through 1988, 605 patients with pelvic ring fractures and dislocations were treated. In 1982, a protocol for early external fixation of hemodynamically unstable patients and those with structurally unstable pelvic fracture patterns to achieve early mobilization to an upright chest position was initiated. Mortality rates were compared between 1981 (pre-protocol), 1982 (transitional), and 1983 through 1988, after initiation of a protocol of care that included external fixation of the pelvic injury. No statistical changes occurred from 1983 through 1988. RESULTS: Mortality rates in pelvic ring injury patients fell from 26% in 1981, to 6% in 1983 through 1988 (p < 0.001), whereas during the study period the mean injury Severity Score (ISS), 23, did not change. The mortality rate of a group of consecutive patients with comparable ISSs, but without pelvic ring injuries did not change. The mortality rate in patients with systolic blood pressure < 100 mm Hg at admission fell from 41% in 1981 to 21% 1983 through 1988 (p = 0.0001). Mortality in patients with closed head injuries associated with pelvic ring injuries fell from 43% in 1981 to 7% from 1983 through 1988 (p = 0.0001). The proportion of patients undergoing external fixation rose from 3% in 1981 to 31% in 1983 through 1988 (p = 0.0001). CONCLUSIONS: An organized protocol including external fixation and early patient mobilization to an upright chest position reduced mortality associated with injuries of the pelvic ring. Orthopedic stabilization of major skeletal injuries should be viewed as part of patient resuscitation, not reconstruction.
OBJECTIVES: To evaluate the efficacy and patient satisfaction of office removal of tibial external fixators and to compare the cost of this procedure with the cost of removal of fixators in the operating room. DESIGN: A visual analog scale (VAS) and a questionnaire were answered by all patients after office external fixator removal. The treatment, complications, and costs were compared with those of patients having external fixator removal in the operating suite. SETTING: An urban orthopaedic trauma office with a Level I trauma center. PARTICIPANTS: Two similar groups of patients; thirty fixators removed in the office and twenty-nine fixators removed in the operating room. INTERVENTION: Office or operating room removal of tibial external fixators and application of a sterile dressing. A visual analog scale was answered by those patients who had office removal. MAIN OUTCOME MEASUREMENTS: Patient satisfaction and pain rating (VAS) with office removal of external fixators. Comparison of costs, infections, time in fixator, and surgical interventions between the office and operating room groups. RESULTS: Group I had thirty fixators (twenty-nine half-pin fixators) removed in the office. Group II had twenty-nine fixators removed in the operating room. Duration of time in the frame was not statistically different. Antibiotic usage during the fixator treatment period was 69 percent in both groups. On the visual analog scale, twenty-four members (80 percent) of the office fixator removal group rated the pain during removal as less than 25 percent of maximal, including nine (30 percent) who rated the removal as causing no pain. Cost analysis revealed an average cost of $248 for the office group versus $2,160 for the operating room group (p < 0.001). CONCLUSIONS: Due to the cost savings and patient satisfaction, without compromising clinical care, the office is our preferred location for tibial half-pin external fixator removal.
Carbon fiber rods were developed to provide radiolucent sidebars for external fixation. In the present study, a single-plane, half-pin, double-bar external fixator construct with either stainless-steel tubes or carbon fiber rods was applied on the anteromedial surface of an osteotomized synthetic human tibia and evaluated for fixation rigidity. Testing was performed with the bone fragments in cortical contact and with a 5-mm midshaft gap between the fragments. The sidebars then were loaded to failure in bending. The results of this study show (a) that the carbon fiber rods were 15% stiffer than the stainless-steel tubes (p = 0.009) and (b) that the external fixator with carbon fiber rods achieved approximately 85% of the fixation stiffness of the external fixator with stainless-steel tubes. The loss of stiffness of the external fixator with carbon fiber rods is most likely due to the clamps being less effective in connecting the carbon fiber rods rigidly to the Schanz screws.
Thirty-nine patients treated with the Hoffman external fixator for a diaphyseal fracture of the humerus, were clinically and radiologically assessed with an average follow-up of 3.2 years. Open fractures, failure of a previous treatment, secondary displacement, and polytraumatisms were the usual indications for external fixation. Clinical bone healing was obtained within an average delay of 10.5 weeks. One patient underwent a pseudarthrosis. Six patients with secondary displacement of the fracture were operated on again, and the fracture was easily reduced by simple manipulation of the device under general anesthesia. The enclosing of the fractured extremities statistically diminished the risk of secondary displacement. Twenty CT scan examinations were performed to assess the occurrence of rotational malunion. Fourteen patients were malunited in internal rotation of the distal fragment with an average diminution of the retrotorsion of 19.4 degrees. No iatrogenic vascular or neurological complication occurred. The Hoffman external fixation does not replace the orthopedic treatment of the diaphyseal fractures of the humerus. It is simple to use and ensure satisfactory contention of the fractures' extremities when they are enclosed. If a secondary displacement occurs, it is simple to modify the device to reduce the fracture. If necessary, an additional surgical procedure, such as cancellous bone grafting or radial nerve repair, can be performed without modification of the osteosynthesis.
OBJECTIVES: We assessed the effectiveness of external fixation in the treatment of unstable distal radial fractures. METHODS: Twenty-five patients (19 males, 6 females; mean age 39 years; range 20 to 71 years) with unstable distal radius fractures were treated by external fixation. Three patients had open fractures. According to the AO classification, the fractures were B1 (1 fracture), B2 (2), C1 (8), C2 (10), and C3 (4). External fixator was combined with K-wires or volar plates in 17 fractures. The fixator was used for a mean of 6.6 weeks, and the mean follow-up was 13.5 months. The earliest radiologic-anatomic and functional evaluations were based on the findings obtained at the end of six months. A modified Sarmiento scoring system was used for radiologic-anatomic assessment. For functional assessment, the scoring system proposed by Sarmiento et al. was used, which was based on the Gartland and Werley's system. RESULTS: Radiologic measurements indicated that anatomical results were excellent in 16 patients (64%), good in eight patients (32%), and fair in one patient (4%). Functional results were excellent in four patients (16%), good in seven patients (28%), fair in 11 patients (44%), and poor in three patients (12%). The complications encountered were pin tract infections in four patients, breakage of the fixator pin holder in one patient, and the development of reflex sympathetic dystrophy in five patients. CONCLUSION: Our data suggest that high success rates in anatomic results do not closely reflect satisfactory functional results. The protocol to be implemented after the application of the external fixator has to be determined according to the type of the fracture.
The results of external fixation of 66 unstable distal radial fractures were evaluated. In the majority, the radiological results were excellent or good. There was a clear correlation between an excellent or good clinical score and the subsequent radiological result. Upper limb dystrophy which caused a considerable morbidity was found in every third patient. Unstable distal radial fractures with severe initial displacement predispose to reflex dystrophy. External fixation obviously cannot prevent this severe complication, it is even possible that tension on soft tissues, capsules and ligaments caused by ligamentotaxis might induce reflex dystrophy. Therefore, the indication for using external fixation of unstable distal radial fractures has to be defined with due caution.
External fixators have been used effectively for a variety of traumatic, congenital, and neuromuscular conditions of the lower extremity for many decades. The transition to management of Charcot foot and ankle deformities in the diabetic neuropathic patient is a logical application. External fixation can address the unique challenges in the Charcot foot, including osteoporosis, osteomyelitis, wound healing, and compliance issues. The author's experience has lead to abandoning other methods of fixation in favor of external fixation for most infected and noninfected Charcot deformities of the foot and ankle.