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At least 343 records · Page 19Linked to original sources
PubMed1998

Treatment of type II, IIIA, and IIIB open fractures of the tibial shaft: a prospective comparison of unreamed interlocking intramedullary nails and half-pin external fixators.

OBJECTIVE: To compare unreamed intramedullary nailing (IMN) with external fixation (EF) in patients with Type II, IIIA, and IIIB open fractures of the tibial shaft. DESIGN: An inception cohort of consecutive patients with Type II, IIIA, and IIIB tibial fractures incurred between January 1988 and March 1993 were systematically allocated into one of two treatment groups. Patients were treated and followed with a prospectively designed protocol. PATIENTS AND SETTING: All patients were skeletally mature and had incurred a fracture of the tibial diaphysis within twenty-four hours of presentation to the tertiary care hospital, a Level I Trauma Center. One hundred seventy-four fractures in 168 patients were stabilized with either IMN (104) or half-pin EF (70). There were 132 men and thirty-six women, with an average age of thirty-three years (range, 14 to 77 years). INTERVENTION: Except for the selection of the fixation device, open fracture care was similar in the two treatment groups. All patients underwent emergent irrigation and debridement with concomitant skeletal stabilization. Cephalosporin antibiotics were administered perioperatively for twenty-four to forty-eight hours. No wounds were closed primarily. Delayed primary closure, skin grafting, and/or myoplasty were performed between three and ten days after injury. MAIN OUTCOME MEASURES: The main outcome measures were final fracture alignment, presence of infection or inflammation, hardware failure, time to union, and the number of operative procedures. RESULTS: The IMN group had significantly fewer incidences of malalignment than did the EF group [8 vs. 31 percent; p = 0.00005; confidence interval (CI) = 0.18, 0.76] and had significantly fewer subsequent procedures (mean of 1.7 vs. mean of 2.7 per fracture; p = 0.001; CI = 0.45, 1.59). IMN resulted in fewer infections/ inflammatory problems than did EF at the injury site (13 vs. 21 percent; p = 0.73; CI = -0.63, 0.45) and significantly fewer at surgical interfaces (i.e., pin sites, nail and interlocking screw insertion sites; 2 vs. 50 percent; p = 0.000; CI = 0.39, 0.60). No significant difference was found in the healing rates for the two implant groups. The more severe Gustilo injury types had longer healing times regardless of the type of fixation. CONCLUSIONS: Results suggest that unreamed interlocking intramedullary nails are more efficacious than half-pin external fixators, in particular with regard to maintenance of limb alignment. However, the severity of soft tissue injury rather than the choice of implant appears to be the predominant factor influencing rapidity of bone healing and rate of injury site infection.

Adolescent↗
PubMed2000

Treatment of intertrochanteric fractures by external fixation.

This study evaluates the results of intertrochanteric fractures of the femur treated by external fixation. One hundred and four intertrochanteric fractures of the femur were stabilized by external fixation over an 8 year period. Complete fracture healing was detected in all patients within 11.2 weeks. Varus malunions and more than 2 cm limb shortening were evaluated in 8 patients. Eight patients had permanent knee stiffness. A pin tract infection occurred in 13 patients. This technique is simple and safe. It allows the patients to mobilize earlier. External fixation in intertrochanteric fractures of the femur can be performed especially in elderly patients with stable and unstable fractures that can be reduced to anatomical or nearly anatomical position by closed methods.

Adult↗
PubMed1979

External fixation devices in fractures of the leg.

External fixation devices, of which there are many types, represent a new and extremely effective method of fixation in fractures of the leg. These are extremely common, frequently severe and often complicated by a variety of other lesions. The usefulness of this method lies in the fact that they can be applied immediately with minimal additional trauma, and the fracture can be immobilised whilst leaving the damaged area uncovered and thus available to carry out repairs and reconstruction of the soft tissues. Mobilisation of the patient is not impeded, and they can be replaced by other more traditional methods as and when these may become more appropriate. The author presents his own views based on some ten years experience with external fixation devices in traumatology, with special reference to fractures of the tibia.

Bone Nails↗
PubMed1998

Recurrent dorsal angulation of the distal radius fracture during dynamic external fixation.

Thirty-three fractures of the distal radius treated with a dynamic external fixator (that allowed for wrist motion between 2 to 4 weeks after surgery) were analyzed, focusing on loss of fracture reduction during external fixation. Fractures with preoperative dorsal angulation greater than 20 degrees and those involving the distal radioulnar joint had a significantly larger loss of reduction of dorsal angulation (8.9 degrees and 6.9 degrees, respectively) than fractures with less severe preoperative dorsal angulation or those with an intact distal radioulnar joint (3.0 degrees and 2.6 degrees, respectively). In contrast, preoperative radial shortening (>2 mm) and involvement of the radiocarpal joint did not significantly increase the loss of dorsal angulation. Neither of the 2 dynamic external fixation systems studied consistently stabilized Colles' fractures with preoperative dorsal angulation of greater than 20 degrees or involvement of the distal radioulnar joint.

Adult↗
PubMedDate not supplied

Half-ring external fixation in the management of tibial plafond fractures.

OBJECTIVE: To investigate the management of tibial plafond fractures with a half-ring external fixator using half pins. DESIGN: Prospective. SETTING: University teaching hospital. PATIENTS: Twenty-four patients with AO Type A or C tibial plafond fractures. OUTCOME MEASURES: Outcome was assessed by using standard criteria of time to union, incidence of infection and malunion, and incidence of pin-tract sepsis. Functional return was assessed by measuring hindfoot function. A scoring system, incorporating clinical and radiological results, was used to rate the results. RESULTS: When using closed or minimally open reduction techniques and interfragmentary screw fixation for the articular component of the fractures, the results of using a half-ring external fixator with half-pins were comparable with those of using small wire fixators. There was a 4.2 percent incidence of infection, and 75 percent of the patients had good or excellent results. CONCLUSIONS: A half-ring external fixator using half-pins produces results that are comparable to those obtained with small wire external fixation. However, the technique is easier and safer.

Adolescent↗
PubMed2003

External fixation indications and patient selection.

Since its modest beginnings in the mid-nineteenth century, external fixation has seen great changes in its design and application. Once thought of as chiefly a fracture management tool, this modality has found its way into the arenas of corrective osteotomies, Charcot management, limb lengthening, nonunion treatment, and malalignment correction. As external fixation has evolved, great improvements in associated complications have also occurred. This is attributed to evolving frame design, subsequent increased stability, and advances in pin/wire insertion techniques. Paley and Herzenberg describe three factors to consider when evaluating whether to use external or internal fixation [2]. 1. Risk versus benefit of the method used for that specific indication. 2. Surgeon's experience with the specific method. 3. Ability to treat the potential complications of the surgery. The authors agree with these factors but would also include psychological tolerance, compliance with postoperative self-treatment, and personal hygiene. In this article the indications for external fixation were described in terms of pathology and individual patient factors were discussed for the surgeon's consideration. The surgeon must consider the patient's bone quality, age, cognitive ability, psychological tolerance, and compliance level. With these factors kept in mind and evaluated appropriately, the surgeon should be able to select the patient and indications for which external fixation will yield a superior result.

Europe↗
PubMed2007

Biomechanical advantage of lengthening of the femur with an external fixator over an intramedullary nail.

The present experimental study investigated biomechanical differences in methods of femoral lengthening using a monolateral external fixator only and using an external fixator over an intramedullary nail. Three materials, namely polyvinyl chloride rods, composite synthetic bone, and cadaver-bone, were tested using the MTS machine. We evaluated the differences of axial stiffness according to the presence of a nail or the numbers of half-pins (two or three half-pins) that were fixed at each side of osteotomy. The addition of a nail may increase the axial stiffness of the frame of monolateral external fixator for limb lengthening. Additionally, it is enough to distract the femur with fixing two half-pins at each side, when using the technique of lengthening over a nail.

Biomechanical Phenomena↗
PubMed2000

External fixation for distal radius fractures: effect of distraction on outcome.

Few studies have examined the potential adverse effects of excess distraction and prolonged duration of external fixation for the treatment of distal radius fractures. In this study, 19 patients with distal radius fractures treated with external fixation and supplemental Kirschner wire fixation between August 1991 and November 1997 were studied retrospectively. Patients were evaluated by questionnaire, chart review, radiographs, and clinical examination an average of 161 weeks after injury. Although no significant correlation was found between amount of distraction, as measured by carpal height index, and scores for pain, function, radiographs, motion, grip, strength, and final result, a negative correlation was found of all categories with increasing carpal height index. A significant negative correlation was seen between duration of external fixation and scores for pain, motion, and total score, with motion scores being most affected. New York Orthopaedic Hospital grades of good or excellent were attained by 89% of the patients. The data suggest that external fixation with supplemental pin fixation is a satisfactory method of treating severe fractures of the distal radius. Outcome likely is improved with shorter duration of external fixation.

Adult↗
PubMed1995

An articulated ankle external fixation system that can be aligned with the ankle axis.

Aligning an articulated ankle external fixator with the ankle axis located using a mechanical axis finder has been shown to preserve normal ankle joint kinematics while the fixed hinge device is attached. However, several problems exist preventing the clinical application of this finding for fractures of the tibial plafond. We initiated a series of studies to resolve these issues. First, the accuracy of the mechanical axis finder in biological systems was quantified by comparing it to that of a computationally derived helical axis. Second, a prototype fixator design was developed in the biomechanics lab to increase the versatility of intraoperative fixator placement. Finally, a radiographic method of locating the ankle axis was developed which is based on talar morphology independent of the fractured tibia. The prototype fixator has been accurately aligned along the ankle axis in cadaveric specimens using this method. Open reduction and internal fixation (ORIF) is the accepted method of treatment for tibial plafond fractures. It holds the advantage of sufficient fracture fixation to permit early joint motion. Good results have been reported using this method, but some authors have reported complication rates up to 50%. The wide surgical approaches required, in conjunction with preexisting soft tissue injury, are thought to significantly increase the risk of soft tissue complications. In response to these problems, many investigators are beginning to utilize external fixation as an alternate treatment modality. One external fixation system which has shown particularly good results is a monolateral cross-ankle articulated fixator (Orthofix SRL., Verona, Italy) which allows motion at the ankle joint as the plafond fracture is healing (Figure 1).(ABSTRACT TRUNCATED AT 250 WORDS)

Ankle Joint↗
PubMed2005

Planned external fixation to locked intramedullary nailing conversion for open fractures of shaft of femur and tibia.

OBJECTIVE: To determine the outcome of initial external fixation and then conversion to intramedullary nailing in patients having open fracture of shaft of femur or tibia. DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Combined Military Hospital (CMH), Quetta, from July 2002 to July 2004. SUBJECTS AND METHODS: Out of 59 patients with fractures of shaft of tibia and femur, 16 were selected for the study who had open fractures in Gustilio type I, II and III. They were initially managed with external fixators and later on converted to planned locked intramedullary nailing. Interlocking nailing was done on routine operation list in the third week after Ex Fix (external fixator) was removed. Record of patients was kept, and was statistically analyzed on SPSS. RESULTS: Out of the 16 patients, 12 had fractures of femur and 4 had fractures of tibia. Male to female ratio was 7:1. Mean duration of external fixation was 6.22 weeks. Six patients underwent closed interlocking nailing and 10 patients with open method. Fifteen fractures (94%) united within 6 months, and one fracture had delayed union. Two patients had superficial wound infection and one patient had deep infection. CONCLUSION: Immediate external fixation followed by early closed interlocking nailing is a safe and effective treatment for open fractures of shaft of femur and tibia.

Adult↗
PubMed2003

Computer assisted pelvic surgery: registration based on a modified external fixator.

A fundamental step in Computer Assisted Surgery (CAS) is the registration, when the preoperative virtual data and the corresponding operative anatomy of the region of interest are merged. To provide exact landmarks for anatomical registration, a tubular external fixator was modified. Two intact pelvic bones (one artificial foam pelvis and one cadaver specimen) were used for the experimental setup. Registration was carried out using a standardized protocol for anatomy-based registration in the control group; anatomical registration was achieved using a modified external fixator in the study group. This external fixator had titanium fiducials wedged into the fixator carbon tubes serving as landmarks for paired-point registration. The tubes were used for surface registration. The standard anterior pelvis fixator assembly was augmented with additional bilateral tubes oriented towards the posterior, enabling registration of the sacroiliac areas. The accuracy of registration was checked by "reversed verification", where the examiner used only the screen display to control the virtual position of the pointer tip in relation to selected landmarks. By virtual matching, the real distance was measured with a digital caliper. We defined the verification as "accurate" when the residual distance was less than 1 mm; "acceptable" when it was between 1 mm and 2 mm; and "insufficient" when it exceeded 2 mm. The paired T-test with significance levels of p < 0.05 was used for statistical analysis. The anatomical registration based on the external fixator landmarks was statistically as accurate as that obtained using anatomical landmarks on the pelvic bone. This study concludes that the external fixator, a conventional tool in the management of acute traumatic pelvic instability, can also be useful for landmark registration in CAS.

External Fixators↗
PubMed1995

External fixation or closed medullary pinning for unstable Colles fractures?

Fifty patients with complex distal radial fractures treated by primary external fixation were compared with 50 with similar fractures treated by closed medullary pinning. All the patients had Frykman type-VIII injuries. The two groups were similar in regard to demographic characteristics and the method of treatment was randomly chosen. All the fractures healed within three months. In the external fixation group 92% of fractures healed in excellent alignment as did 88% of the medullary pinning group. Both groups had similar results with respect to eventual function, range of motion, and grip strength. Complications and complaints were fewer and the estimated costs of treatment were significantly less in the medullary pinning group. More patients were satisfied with closed medullary fixation than with external fixation.

Colles' Fracture↗
PubMed2006

ARM: a modular hinged joint for the AO tubular external fixator.

Certain complex traumatic elbow lesions challenge the orthopaedic and trauma surgeon. If they are not treated correctly, they cause a high rate of disability, arising from elbow instablility and stiffness, either by fibrosis or joint incongruity. Injuries such as complex fractures of the proximal third of the ulna, coronoid fractures associated with radial head fractures (the "terrible triad"), are even worse if they are accompanied by soft tissue lesions. Hinged external fixators, complemented by other surgical procedures, are, for many, a recommended alternative when dealing with irreparable lesions. The AO tubular external fixator, by virtue of its versatility, is a very important tool in orthopaedics and trauma, but there is not the possibility of using it as a hinged fixator. The authors describe a prototype of a hinged joint that can be applied easily to the AO tubular external fixator, converting it into a hinged one. This hinged joint, in conjunction with the AO tubular external fixator, has been applied in 5 patients; 2 "terrible triads", one posterior elbow fracture-dislocation with radial head fracture, one Monteggia fracture-dislocation and an anterior elbow dislocation that developed a forearm compartment syndrome. The patients' age range was between 20 and 72 years (median 45,6); 4 were male and 1 female. In 3 patients, either a type III coronoid fracture or a radial head fracture, could not be repaired. One radial head was totally removed and another one partially removed. The remaining indications were because of severe soft tissue lesions. Results were evaluated using the Mayo Elbow Score Scale and the Broberg and Morrey radiographic evaluation scale. The median follow up was 18 months(range 6 to 48 months). All 5 patients got a maximum score of 100 points in the Mayo's Elbow Score Scale, indicating excellent results. No patient suffered elbow pain, or any type of elbow instability. The median range of motion in flexion was of 127.5 degrees (max. 140 degrees and min. 120 degrees ) and the median extension loss was 20 degrees (max. 25 degrees and min. 15 degrees ). One patient had pronation limited to 70 degrees and one had supination limited to 70 degrees . Every patient was able to resume a normal daily life activity and returned to normal work. In 3 patients the radiographic evaluation was Grade 0 and in the other 2, Grade I. Two complications occurred, one was a distal ulnar Schanz screw loosening with osteolysis and the other was a superficial infection of one Schanz screw. It can be concluded that good results can be obtained in injuries with severe elbow instability and soft tissue lesions, using this hinged external fixator. With this new clamp, the AO tubular external fixator is transformed into a hinged one and a new use is added to this already very versatile system. This clamp is very easy to apply.

Adult↗
PubMed1995

Vascular impingement by external fixator pins: a case report.

Associated vascular injuries after external fixation of the tibia are rarely encountered. We report a case of impingement of the anterior tibial artery after application of an external fixator. The extrinsic compression disappeared after pin removal. Proper technique of pin placement is re-emphasized.

Adult↗
PubMed1990

Tibia nonunions treated by interlocked nailing: increased risk of infection after previous external fixation.

Eighteen patients, mean age 36 years (range of 22-76 years), with tibia-shaft nonunions were treated with interlocked nailing. There were 12 nonunions originally treated with either cast, lag screws, plate, or Ender nails (nine closed, two open grade I and one grade II injury). The remaining six nonunions, all open fractures (five grade II and one grade III injury) initially received external fixation. After removal of the fixator, 72 days postinjury (range of 58-111 days), there was a delay of 218 days (range of 112-449 days) before the nailing procedure in those patients primarily treated with external fixation. All 12 nonunions not primarily treated with external fixation healed without complications after nailing within 17 weeks (range of 12-24 weeks). All six nonunions primarily treated with external fixation had temporary pin-tract infections, which healed after pin extraction. Two of the nonunions healed without any complication, whereas four developed intramedullary infection with the same bacteria as from the pin-tract site. Although the number of patients is small in this report, there is an apparently high incidence of intramedullary infection in the group originally treated with external fixation. The sequential procedure of external fixation followed by intramedullary nailing is, therefore, not recommended in the treatment of open tibia fractures.

Adult↗
PubMed1996

External fixation for comminuted phalangeal fractures. A biomechanical cadaver study.

The mechanical rigidity obtained by external fixation in a comminuted phalangeal fracture model was assessed and the results compared with two other types of internal fixation commonly used (lateral plate and crossed Kirschner wires) in a biomechanical cadaver study. Each fixation technique was tested in apex palmar bending, compression and torsion. The results showed that lateral plating provided the best rigidity in apex palmar bending and compression and that external fixation and Kirschner wires showed the same mechanical properties. For the torque test, external fixation provided the best rigidity.

Biomechanical Phenomena↗
PubMed1999

Arthroscopic-assisted reduction and percutaneous external fixation of a displaced intra-articular glenoid fracture.

Arthroscopic reduction and percutaneous external fixation is a well-known technique for treating selected fractures. This is the first report of a method of treating intra-articular glenoid rim fracture using shoulder arthroscopy and percutaneous external fixation. The surgical trauma associated with open operative treatment of these fractures can be minimized using minimally invasive techniques under arthroscopic control. This technique not only allows for anatomic reduction with minimal surgical trauma but provides a valid diagnostic and treatment alternative for associated injuries. Arthroscopic reduction and percutaneous external fixation yielded excellent results with no complications. The authors describe the principles of the procedure and discuss its advantages compared with traditional surgery.

Adult↗
PubMed1993

[Change in the procedure from external fixator to intramedullary nailing osteosynthesis of the femur and tibia].

Shaft fractures of femur and tibia can be treated successfully by intramedullary nailing. In recent years the use of interlocking nails widened the indication for nailing fractures of the proximal and distal bone and more difficult fractures. There are still limits in polytrauma patients, chain fractures with or without participation of joints and in fractures with severe soft tissue injury (open or closed). In these cases primary treatment with external fixation has proved worthwhile. The main problems and risks of primary nailing osteosynthesis occur in the early phase of treatment, whereas complications in external fixation are more likely to occur in later phases of treatment. In changing from external fixation to intramedullary nailing one can see the advantages of both methods. In the literature only small studies have been made mostly with patient groups below 50 in number. The change of method was rarely standardised and the time period between procedures was either late (more than 3 weeks) or arbitrary. The advantages and disadvantages as well as the risk in changing methods are controversial. In a 2-year prospective study from August 1989 to July 1991, patients with II and III degree open and closed femur and tibia fractures as well as trauma patients with fractures were initially treated by external fixation. A change of method from external fixation to intramedullary nailing was performed at the earliest possible time under exact criteria. 61 femur and 106 tibia fractures were accordingly treated and followed. In comparison to early studies there were no differences in bone healing or in functional results. The infection rate in tibia fractures was 1.9% (2 of 106); no infection was seen in femur fractures. The contamination rate at the time of method change was substantially higher at 14%. The difference between contamination and infection rate can be explained by experience in the technique of nailing, considering biological aspects (no or little reaming), the standardized change of method and the prophylactic use of antibiotics. In a follow-up of additional 37 femur and 58 tibia fractures that were treated accordingly, a total infection rate of 1.9% was achieved (2% in femur fractures [n = 98], 1.8% in tibia fractures [n = 164], 1.9% total [n = 262]). In femur and tibia fractures with open or closed soft tissue damage and in multiple trauma patients the treatment with initial stabilisation by external fixation and secondary change to intramedullary nailing can be recommended under certain conditions.

Adolescent↗