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PubMed1989

[Change in external fixator and when in multiple trauma patients].

External fixation of fractures in polytraumatized patients normally should be regarded as temporary. After the patient's general condition is stabilized, in most cases it is necessary to change the procedure in order to provide sufficient mobility of joints, timely bony healing and early mobilisation. The earlier the transition toward internal osteosynthesis, the lower the complication rate. The follow up of 37 polytraumatized patients who were subjected to 50 changes of method after primary external fixation is described.

Adult↗
PubMed1995

External fixation and limited internal fixation for complex fractures of the tibial plateau.

Twenty-one complex fractures of the tibial plateau in twenty patients were treated with closed reduction, interfragmental screw fixation of the articular fragments, and application of a unilateral half-pin external fixator. The average duration of external fixation was twelve weeks (range, three to twenty weeks). The fixator was left in situ until the fracture had united in all but two patients. All of the fractures healed. The complications with this technique were attributable primarily to the proximal half-pins of the external fixator. Seven patients needed antibiotics for an infection at a pin site, and two had septic arthritis that necessitated arthrotomy and débridement. The average duration of follow-up was thirty-eight months. The range of motion of nineteen of the twenty-one knees was at least a 115-degree arc. Laxity was evident in seven knees, but no patient complained of instability of the knee. Radiographs showed malalignment of more than 6 degrees in three knees compared with the normal, contralateral knee and evidence of post-traumatic osteoarthrosis in five knees. The Iowa knee score, determined for nineteen patients, averaged 87 points (range, 55 to 100 points). The SF-36 general health survey demonstrated that most patients had function close to that of age-matched controls. We concluded that external fixation with limited internal fixation is a satisfactory technique for the treatment of selected complex fractures of the tibial plateau.

Adult↗
PubMed1989

Infection after intramedullary nailing of severe open tibial fractures initially treated with external fixation.

Twenty-four patients had a severe open fracture of the tibia that was initially treated by external fixation and subsequently by reamed intramedullary nailing. The external fixation had been maintained for an average of fifty-two days (range, seven to 230 days). The mean interval between removal of the external fixator and intramedullary nailing was sixty-five days (range, three to 360 days). In five of the seven patients who had had an infection at one or more of the pin sites, an infection later developed around the intramedullary nail. In comparison, only one of the seventeen patients who had not had a pin-site infection had an infection later around the nail (p = 0.003). An analysis of other variables, including the duration of external fixation, wound coverage, other injuries, and the type of fracture, showed that none was a predictor of infection either at the pin sites or around the intramedullary nail. We concluded that a pin-site infection that develops during external fixation is a contraindication to the subsequent use of reamed intramedullary nailing in patients who have a fracture of the tibia.

Adolescent↗
PubMed1989

External fixation of Colles' fracture.

Radiographic and functional results of external fixation of 32 Colles' fractures were compared with the results of plaster fixation of 189 Colles' fractures. Despite the fact that the fractures treated with the external device were more unstable and comminuted, the final results were equal in both groups, and the radiographic outcome of external fixation was superior. Pin loosening decreased with predrilling rather than self-tapping. We recommend external fixation for unstable fractures of the distal forearm.

Adolescent↗
PubMed1985

Treatment of unstable fractures of the distal radius by external fixation.

The Roger Anderson external fixator was used in the treatment of unstable fractures of the distal radius in 52 patients, and the results evaluated after a follow-up averaging 58 months. The indications for its use were failure to maintain adequate closed reduction using plaster, and instability of the fracture as determined by the initial radiographs. Our radiological criteria for instability included dorsal angulation of more than 20 degrees, fractures involving the joint, radial shortening of more than 10 mm, and severe dorsal comminution. Using the Lucas modification of the Sarmiento demerit point-rating system, we found that 46 patients (89%) had good or excellent results and six (11%) were classified as fair. There were no poor results. Seven patients (14%) developed complications. None of these affected the long-term results except in one elderly woman where the pins loosened and had to be removed.

Adult↗
PubMed1989

The use of the Manuflex disposable mini external fixator.

The Manuflex mini external fixator is an original device which is suitable for either provisional or definitive fixation of hand or foot fractures. The system is simple, disposable, relatively radiolucent, and inexpensive. It has been tested in an animal laboratory and has been used successfully in 27 human cases.

Animals↗
PubMed1990

External fixation of the femur.

External fixation of the femur remains a viable option in the acute treatment of fractures or in reconstructive procedures. As in any method of fixation, the surgeon must be familiar with the device used, the mechanical properties of the device, the application technique of such devices, and, most importantly, the postoperative management of the patient.

Bone Nails↗
PubMed1990

A cheap external fixator device.

A cheap external fixator made from readily available materials is described. This device should prove useful in the management of difficult compound fractures of the leg. Multiple staged procedures such as serial debridement, and bone and skin grafts can be carried out while maintaining the fracture fragments in position by means of this fixator.

Adult↗
PubMed1986

Structural changes in intact tubular bone after application of axial loads by external fixation.

The effects of external fixation on bone structure were studied in the intact tibiofibular bone of the rabbit using three types of fixation; distractive, compressive and neutralizing. In the diaphyseal bone subperiosteal new bone formation was noted after three weeks in all fixation types. This formation was succeeded by endosteal resorption and porotic transformation of the cortical bone. An ultimate result was a widening of the medullary cavity. Torsion tests revealed weakening of the bone specimens as an end result. Axial loads, either compressive or distracting had no additional effect on the bone changes observed.

Animals↗
PubMed1994

Stabilization of hand phalangeal fractures by external fixator.

The method of external fixation of phalangeal fractures provides a solution for extensive hand injuries where internal fixation may be prohibited due to compromised skin coverage or bone loss. Early mobilization of adjacent joints is possible with these devices and is fundamental for the preservation of hand function. This paper describes the proper selection of cases and the versatility of its application. Representative clinical uses are summarized.

Adolescent↗
PubMed1989

[External fixation in open fractures].

Author analyses 644 cases of compound fractures managed at the University Department of traumatology, Ljubljana from 1981. do 1987. He examines the incidence of compound fractures and fractures of other types. He analyses the fractures according to the Matter-Rittmann-Algöver classification. Various fixation techniques are described, especially reduction by external fixators used in nearly all grade III compound fractures. The most frequently applied tube-shaped fixator (Synthes) is presented. In 51% of cases external fixation was changed in first three months of treatment. The average length of external fixator application was 4 months, the full weight bearing in average after 7 months. Postoperative bone infection occurred in 4% of cases.

Fracture Fixation↗
PubMed2002

Fixation strength of tapered versus bicylindrical hydroxyapatite-coated external fixation pins: an animal study.

The purpose of this study was to comparatively measure the bone-pin interface strength in two types of hydroxyapatite-coated pins that differed in shape, diameter, and implantation technique. Both pin types are commonly used for tibia fixation. Thirty bicylindrical 5/4-mm stainless-steel pins (Group A) and 30 tapered 6/5-mm stainless-steel pins (Group B) were implanted in the left tibiae of 10 adult sheep. A monolateral fixator was mounted on the pins after implantation. A 5-mm-long bone segment was removed from the tibial mid-diaphysis to ensure high load at the bone-pin interface. Pin insertion torque was 830 +/- 446 N/mm in Group A and 3415 +/- 743 N/mm in Group B (p<0.0001, one-way ANOVA). Six weeks after surgery, the sheep were euthanized and pin extraction torque measured. Pin extraction torque was 1237 +/- 499 N/mm in Group A and 3367 +/- 1512 N/mm in Group B (p<0.0001, Mann-Whitney test). Morphological analysis performed at 60x magnification showed a direct bone-pin contact in both groups. Despite challenging biomechanical conditions, this study showed both pin types to be well-fixed and osteointegrated. Therefore, both pin types are recommended for tibial fixation. However, the tapered pins showed higher extraction torque, an important result for external fixation treatments.

Animals↗
PubMed1984

[Serial strain gauge measurement of bone healing in Hoffmann external fixation].

Since 1978, the author has applied Hoffmann external fixation to the treatment of open fractures and infected pseudoarthrosis of long bones in the lower limbs, but has some difficulties in determining when weight bearing should be started after operation, how much weight bearing should be and when the pin should be removed. As new method to mechanically analyze the callus strength, I tried to estimate the amount of strain at intervals of 2 to 3 weeks, beginning from the second week after operation, by bending or compressing the fracture site through the strain gauge glued to the middle of the external fixator's connecting rod. From a strength test by means of a model of fracture using a vinyl chloride pipe and also from a study of computer calculation using the model of plane beam structure for architectural design, it was found that the amount of the strain on the connecting rod decreased hyperbolically when the mechanical properties of the callus increased, and that it became constant when the mechanical properties of the callus reached 50% of the intact bone. The strength test using an cadaveric skin bone demonstrated that the callus volume was one of the most important and affecting factor. Twenty-three cases were treated by Hoffmann external fixation, and the bone healing was achieved in 20 of them. On the basis of the bone healing curve obtained by the serial strain gauge measurement in those cases, the bone healing process could be classified into 5 types: normal healing, slow healing, non-union, arrest in evolution and breakage of callus; and were employed as indexes in the post-operative rehabilitation program.

Adolescent↗
PubMed2001

[Evaluation of hydroxyapatite-coated Schanz screws in the Heidelberg external fixation system (HEFS)].

The use of monolateral external fixation systems for the correction of limb length and/or axial anomalies involves the implantation of Schanz screws in the long bones for periods of weeks or months. The loosening rate, which increases with duration of implantation, is a problem. In animal experiments/superior fixation and a reduced infection rate have been reported for hydroxyapatite-coated screws in comparison with conventional screws. We report on the clinical application of 59 hydroxyapatite-coated Schanz screws in 15 external fixation mountings. The performance of the screws was evaluated by clinical and radiological criteria. Infection was seen in 15 screws, necessitating the early removal of 6 of them. In patients with a second fixation system/the infection rate was lower, with infection developing in only 1 of 12 screws.

Bone Screws↗
PubMed1984

[Histologic finding of fracture healing using external fixation and its clinical significance].

The histology of bone healing under external fixation of fractures is studied in 2 human bone specimen and in the sheep's tibia. Primary bone healing occurs under absolute stable fixation. The regular course shows secundary bone healing by endosteal and periosteal callus formation, caused by motion in the fracture gap. Nonunion results, if motion is not big enough to induce callus formation and if motion is too big to allow primary bone healing. So one of the main problems in external fixation of fractures is to find out the adequate dose of stability and motion in the fracture gap. External fixation does not disturb the vascular supply of bone. Intramedullary vessels, that are cut during the osteotomy of the sheep's tibia, are perfectly regenerated 4-5 weeks later. In the surroundings of the Schanz' screws, cortical remodelling is the biomechanical response of bone to strees, which is generated by external fixation. This cortical remodelling can reduce compression, originally applied to the bone. The indication and the timing for a change to internal fixation is discussed.

Aged↗
PubMed1999

A biomechanical comparison of different wrist external fixators with and without K-wire augmentation.

To compare stability of wrist external fixation, simulated unstable extra-articular distal radius fractures were created in 7 fresh-frozen cadaveric upper extremities and stabilized using 4 different external fixators. Physiologic muscle tension across the wrist was simulated by application of 40-N load distributed among the wrist tendons. Alternating loads of up to 100 N in flexion and extension of the wrist were applied during stability testing and 3-dimensional kinematics of the proximal and distal fracture fragments were determined using attached infrared light-emitting diodes and a 3-dimensional motion tracking system. Fracture stability was reassessed for each of the constructs after augmentation of the fracture fragments with a single dorsal transfixion K-wire. K-wire augmentation demonstrated a significant reduction in motion of the distal radial fragment of at least 40% in all 3 rotational planes. For flexion/extension, the reduction in motion was from 4.5 degrees to 2.6 degrees. For radial/ulnar deviation, the range of motion decreased from 3.0 degrees to 1.5 degrees. Rotational motion declined from an average of 3.2 degrees to 1.2 degrees. The addition of the single dorsal transfixion K-wire significantly improved stability of each of the 4 fixators in at least 1 of the 3 planes in which motion was measured. While we compared the most rigid with some of the least rigid external fixators, the data do not support an important difference in fracture fragment stability among the 4 fixators. The data much more strongly support the concept of K-wire augmentation for increasing stability of an unstable extra-articular distal radius fracture regardless of the type of external fixator that is used.

Biomechanical Phenomena↗
PubMed2006

Deformity correction by external fixation and/or intramedullary nailing in hypophosphatemic rickets.

BACKGROUND: There are many modalities of treatment for complex lower extremity deformity in hypophosphatemic rickets. We evaluated the outcomes of deformity correction using an external fixation and/or intramedullary nailing in hypophosphatemic rickets. PATIENTS AND METHODS: 55 segmental deformities (20 femora, 35 tibiae) from 20 patients were examined retrospectively. There were 9 children and 11 adults. Distraction osteogenesis was used in 28 segments and acute deformity correction in 27. External fixation was applied in 24 segments, intramedullary nailing in 6, and external fixation and intramedullary nailing in 25. RESULTS: There were 18 major and 13 minor complications in 26 of 28 segments with distraction osteogenesis, and 13 major and 10 minor complications in 19 of 27 segments with acute correction. Recurrent deformity or refracture occurred in 10 of 21 segments with distraction osteogenesis by external fixation only, 4 of 6 with acute correction by intramedullary nailing, and 1 of 25 with distraction osteogenesis or acute correction by external fixation and intramedullary nailing. Nail-related complications occurred in 3 of 6 with intramedullary nailing and 2 of 25 with external fixation and intramedullary nailing. INTERPRETATION: External fixation and intramedullary nailing can be recommended to prevent complications during or after deformity correction in hypophosphatemic rickets.

Adolescent↗