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At least 37 records · Page 2Linked to original sources
PubMed1993

Pin placement in pelvic external fixation.

Early external fixation of major pelvic fractures reduces haemorrhage and mortality. The best site and method for pin placement remains unresolved. The superior iliac crest is biomechanically disadvantageous and hinders access to the abdomen. Low pin placement between the anterior iliac spines has been proposed as a better solution. A case-controlled study was performed on cadavers using a jig designed to place external fixator pins accurately in the pelvis; the study tested the safety of pin placement and the mechanical strength of the two placement sites. The results showed that pins could be placed safely using this method and that low placement in cadaveric bone is as strong as that of the conventional placement.

Biomechanical Phenomena↗
PubMed1989

[Superior radio-cubital congenital synostosis. Computed tomographic scanning studies and value of osteotomy fixation using an external fixator].

The purpose of this case report was to describe the radiological features by computed tomography and a modification in the fixation of the rotation after the usual transverse osteotomy: an external fixation was used; it allows post-operative vascular assessment with the possibility to derotate the correction in case of circulatory or neural impairment.

Adolescent↗
PubMed1983

[Intramedullary nailing as secondary intervention following prior use of external fixation].

The external fixation has its clear indications. In some cases, however, healing up of the bone fails to appear. This is caused partly by the gravity of the primary injury, partly by biomechanical reasons. The failure of a perfect fracture healing can require a change of the osteosynthesis procedure. Under certain conditions nailing provides good success. By means of 13 own cases conditions, indications and results of secondary nailing after prior external fixation osteosynthesis will be discussed.

Adult↗
PubMedDate not supplied

[Stiffness of the AO spinal external fixator. Experimental results of stiffness of the AO spinal external fixator with 3 different pedicle screw systems].

The stiffness of the AO external pedicular fixator was analysed in an experimental laboratory study using three different sets of pedicle screws and different configurations of the implant. The experiments were performed with a wooden model as well as with bi-segmental human lumbar spine specimens with disc and ligaments intact. The capacity of the AO external pedicular fixator to compensate axial load, transversal- and torsion forces was compared to physiological requirements. Of particular interest was the effect of preload on the axial stiffness. It is demonstrated that the axial stiffness of the AO external pedicular fixator is so low that the axial load on the lumbar spine level in humans cannot be influenced by the fixator even when preloaded. However the resistance against torsion and transversal slipping is probably higher than required in vivo. No significant differences were found between the three types of pedicular screws. The effect of the triangular counter nuts of the AO external pedicular fixator on the transversal- and torsion stability was important. The presented results suggest that the AO external pedicular fixator can be of significant value in segmental rotation- and translocation pathologies of the lumbar spine and that the effect of isolated segmental distraction has probably been overestimated.

Bone Screws↗
PubMed1996

[Secondary internal osteosynthesis after external fixation for recent or old open fracture of the lower limb].

PURPOSE: The purpose of our study is to analyse the indications, results and limits of secondary internal fixation after external fixation for open fracture of the lower limb. MATERIAL: Our series covered 21 patients treated between 1991 and 1994. There were 17 men and 4 women. Tibia was affected 17 times and femur 5 times (one bifocal fracture). In Gustilo's classification, we had 1 case of type 1, 12 of type II and 8 of type III. METHODS: We used 15 times the FESSA External Fixator and 6 times a monotube external fixator in emergency. We have done secondary 11 intra medullary nailing and 11 patients were treated by plating (one patient had both) 13 patients had a bone graft (cortico-cancellous graft). In the first group of patients (10 cases), the initial treatment gave us good results for both skin and bone healing. The external fixation was replaced by an internal one in order to accelerate bone consolidation and to allow an early weight-bearing. Removal of the external fixation was made at an average of 4 months postoperative. In the Second group (11 cases) the internal fixation was proposed because of an insufficiency of the external fixation leading to complications as: non union, mal union and bone defects. External fixation was removed in a mean time of 8 months. Internal fixation was completed by local bone autograft. RESULTS: 17 patients have been reviewed. Consolidation occurred with an average of 6 months after internal fixation 1 to 24 months. We had no deep infection but only 2 superficial ones. DISCUSSION: We chose 2 types of indication, and we called them programmed and for necessity. The first group of 10 patients whose stain was moderate and whose initial setting up had permitted a perfect anatomic reduction with a rapid wound healing. Internal fixation was performed after a short duration of external fixator. An early weight bearing was allowed so that the functional recovery could be obtained quickly. The second group is represented by patients whose internal fixation was done for non union, malunion or bone defect. In such a case autogenous cancellous graft was used to fill the defect.

Adolescent↗
PubMed1996

[External fixation of bones (fixateur externe) in fracture treatment].

In traumatology, we differentiate between conservative and surgical treatment. External fixation of the bone lies somewhere between the two. When deciding on the most appropriate treatment for each patient, the advantages and disadvantages must be carefully evaluated. However, there are a series of single or multiple injuries which can't be optimally treated with conservative procedures nor with invasive surgery. External fixation has become the treatment method of choice in many of these cases. The fragments to be stabilised are fixed with (so-called Schanz screws) or with (Steinmann pins) or with wires. The section which lies outside the body are attached to longitudinal rods. External fixation is a noninvasive, surgical method of fracture stabilisation with many advantages is easy to handle, has a low complication rate, can be taught anywhere, and can be used everywhere. There are great advantages in cases of soft tissue damage, in polytraumatised patients and in septic orthopedic surgery.

Equipment Design↗
PubMed1994

Dynamic external fixation of unstable fractures of the distal part of the radius. A prospective, randomized comparison with static external fixation.

A prospective, randomized study was done to compare the results of dynamic external fixation (the Clyburn device) with those of static external fixation (the AO/ASIF device) in the treatment of fifty unstable fractures of the distal part of the radius. Mobilization of the wrist from neutral to 30 degrees of flexion was begun in the dynamic-fixator group at approximately two weeks, and full motion, allowing 30 degrees of extension, was started at approximately four weeks. The external fixation frames in both groups were kept in place for approximately ten weeks. Mobilization of the wrist in the dynamic-fixator group provided little gain in the mean motion of the wrist at the time of the removal of the fixator or at the one, six, or twelve-month evaluation. The static-fixator group had greater flexion of the wrist and radial deviation at the early and late follow-up examinations, while the dynamic-fixator group demonstrated only greater ulnar deviation one month after the fixator had been removed. Motion of the wrist in the dynamic-fixator group resulted in a statistically significant loss of radial length compared with that in the static-fixator group (four millimeters compared with one millimeter, p < 0.001). Complications were more frequent in the dynamic-fixator group. As evaluated with a modification of the scoring system of Gartland and Werley, 92 percent of the results at one year were excellent or good in the static-fixator group and 76 percent, in the dynamic-fixator group. The results of this study cannot support the concept of early mobilization with a dynamic external fixator for the treatment of unstable fractures of the distal part of the radius.

Adult↗
PubMed1985

External fixation of tibial shaft fractures. A review of 42 fractures by the Hoffman-Vidal-Adrey external fixation system.

Over a 6-year period (1977-1983), 59 patients with 61 tibial shaft fractures were treated by external fixation. Of these patients, 42 with 42 fractures were followed up until solid union. Thirty-seven fractures were caused by high-energy impact, mainly road accidents. Seventeen fractures were closed and 25 were open. In 33 patients an external quadrilateral frame system was applied primarily, and in the remaining nine within 1-2 weeks. No predrilling was done, and in 16 patients nonthreaded connection rods were used throughout the period in the fixator. The process of union was monitored by repeated noninvasive measurements of stability. Average time form injury to dismantling of the external fixation was 5.2 months (range 2-12.5 months) and time-to-union for the whole series was 10.0 +/- 5.5 months (range 4-31 months). Sixteen fractures failed to unite. Compared with other published series treated by external fixation, the incidence of non-union in the present series is high. On the basis of the present findings it is concluded that a compression device should be mounted either primarily or as soon as possible during the process of union, and that compression should be applied at regular intervals. If an external fixator is used, the surgeon must bear in mind the possible complications. It is probably safer to reduce rather than to prolong time-to-removal of the external system.

Adolescent↗
PubMed1982

Experience with the Sukhtian--Hughes external fixation system.

External fixation of fractures is now used frequently in orthopaedics. This paper reviews the results of 30 fractures treated by a single bar system, the Sukhtian-Hughes, over a period of 4 years. The results are encouraging, particularly in compound tibial fractures and in patients with non-union of fractures.

Adolescent↗
PubMed1976

[High tibial osteotomy--fixation by means of external fixation--indication, technique, complications (author's transl)].

High tibial osteotomy has proved its value in the treatment of gonarthrosis with or without axis deformity. The thrust of weight-bearing and other stresses is lessened on the degenerated tibial condyle and transferred to the more normal condyle. The stable fixation by means of external fixation allows early movement of the knee joint.-R-ferences to operative technique, indication, complications and after-treatment.

Arthrodesis↗
PubMed1997

[Treatment of metaphyseal fractures of the tibia by the Ilizarov external fixator].

PURPOSE: This external fixation was used for 46 of 60 cases of proximal tibial metaphyseal fractures, over a 10 years period. The choice of an external fixation was determined by the poor reputation of internal fixation for even complex closed fractures. The reasons for the choice of the Ilizarov device were: the possibility of fitting the fixation pins close to the knee joint if necessary, the circular nature of the system, and finally the possibility of adding an intrafocal mounting (I.F.M.) which can bring the displaced bone fragments together using shaped blockstops pins. The program theoretically foresaw an initial sequence using external fixation until bone continuity was achieved, followed by a complementary plaster for one or two months. MATERIALS: 7 of the 46 fractures were lost for follow-up. Of the remaining 39 cases, there were 5 early complications: one knee septic arthritis which led to stop the method before the second month. Each of these 5 failures were due to improper use of the method. 34 cases have been followed for more than two years. RESULTS: 29 cases of consolidation of which 3 initial displacements were wrongly considered as acceptable. There was no case of displacement while the fixation was in place. There were 5 nonunions: 2 at the diaphyseal level in long metaphyso-diaphyseal fractures, 2 were comminutive metaphyseal fractures in which the fixation had been removed by error before the third month. With this fixation, neither the traumatic opening, nor the presence of a fibular fracture significantly affected consolidation. The healing period was however longer when the fracture was more extensive and comminutive. The bone gaps were treated by interfocal mounting (I.F.M.) but loss of bone stock persisted; they affected the occurrence of nonunion. CONCLUSION: Each failure of the method is explained by its improper use. The Ilizarov fixation is an excellent mechanical response to these fractures: on condition that the technical rules are respected, that an intrafocal mounting is used to remove interfragmentary gaps, and that the fixator is kept in place long enough, according to the size and comminutive nature of the fracture. This fixation is reliable in these conditions but does not compensate intrafocal bone loss exceeding 40 per cent of the metaphyseal bone mass.

Adult↗
PubMed1989

Treatment of unstable tibial diaphyseal fractures with minimal internal and external fixation.

We prospectively studied 20 patients whose selected unstable tibial diaphyseal fractures were treated with the combined techniques of minimal internal fixation and external fixation. Five fractures were closed and 15 were open (six Grades I and II, nine Grade III). Seventeen were due to high-energy injuries. The minimum followup was 2 years. All fractures healed, one with malalignment. Time to union averaged 12 weeks in closed fractures and 19 weeks in open fractures. All high-energy fractures underwent bone grafting. The external fixation was removed by dynamization. Thirteen complications occurred in nine patients, all with open fractures. Three of 120 pins became infected (2.5%). Early bone grafting and dynamization of the external fixation prevented the malunions and nonunions reported previously with this technique.

Adolescent↗
PubMed1994

Limited internal fixation of the tibia with external fixation: an in vivo canine study.

This study reports the results of the healing of canine tibial osteotomies with external fixation alone or in combination with a single lag screw. Twelve dogs had a midshaft tibial osteotomy performed at a 45 degree obliquity. Half of the dogs had a six-pin, unilateral, medial, external half-frame applied after the osteotomy. The remaining six had an identical frame plus a lag screw placed perpendicular to the osteotomy site. When compared with their contralateral controls, the fixator-alone group had a 16.3% (p < 0.05) decrease in bone density, whereas no significant density change was seen in the group with the additional lag screw. Torsional stiffness was 29% higher in the osteotomies treated, and tested, with the lag screw, but this did not achieve statistical significance. Computed tomography scanning revealed that the surface area was increased by an average of 30-40% in both groups, relative to contralateral controls, but there was no difference between the two treatment groups. Three tibias in the group with external fixation alone, and two tibias in the screw group showed primary bone healing without evidence of callus formation. The combination of a semirigid external fixation construct with a lag screw resulted in increased torsional stiffness but healing equal to that seen with external fixation alone.

Animals↗
PubMed1992

Biomechanics of the Ilizarov external fixator.

The Ilizarov external fixator exhibits more isotropic mechanical properties in bending and nonlinear axial stiffness than do unilateral and bilateral external fixators. Each frame element--wire size, tension, and orientation, as well as ring type--contributes to overall frame rigidity and stability. These factors and the specific clinical situation must be considered for the successful application of the Ilizarov fixator.

Biomechanical Phenomena↗
PubMed1996

External fixation of the wrist.

External fixation for fractures of the distal radius has been used for almost 80 years. The main objective is to gain reduction and maintain the reduction throughout the treatment period. Several fixator concepts are available and selection is based on the complexity of the case to be treated as well as the surgeon's experience. Periarticular application of the fixator with immediate use of the wrist joint is recommended whenever possible. In intra-articular fractures transarticular application is advisable. External fixation in complex fractures has to be supplemented by bone grafting, fixation wires and stabilization of the radioulnar joint. Associated injuries in distal radius fractures need to be identified and treated. The possible complications of external fixation are discussed and means to prevent them are referred to. External fixation of the distal radius has found its place as an established method in treating certain types of this common fracture.

Colles' Fracture↗
PubMed1990

A preliminary experience: the Ilizarov external fixator.

The Ilizarov external fixator, though developed over 35 years ago in the Soviet Union, is only now gaining popularity in the United States. Its design and versatility allow the physician to treat a wider range of limb maladies than other external fixation systems (eg, the Hoffmann device). The Ilizarov method of fixation also permits treatment of some orthopedic conditions that were previously considered to be untreatable, such as dwarfism. The device can be used to correct limb length discrepancies, manage open and closed fractures, nonunions, and bony or soft tissue deformities. A review of the first 25 cases performed at the University of Louisville revealed 15 which have been successfully completed with significant, but manageable complications, and 10 cases which are still in progress.

Adult↗
PubMed1984

Healing of rabbit tibial fractures using external fixation. Effects of removal of the fixation device.

Bone healing after external fixation of rabbit tibial osteotomies was studied in order to throw light on the problem of the optimal time for removal of external fixation. The animals were divided into various groups according to different periods of time for removal of external fixation and sacrifice. The strength and stiffness of the healing bones at 12 weeks were greater in tibiae where the external fixator was removed at 4, 6 or 9 weeks than in those with the continuous presence of the fixator for 12 weeks. Although fixation is essential in the early healing period, it seems that bone healing is stimulated by the removal of the fixation after a certain period of time. The optimum time for removal of external fixation in the rabbit tibia was at 6 weeks of healing, when the bone had regained normal stiffness and about 50 per cent of normal strength. The clinical relevance of this investigation is that it might be rational to remove the external fixator before bone healing has been completed. If it is felt that healing is not secure when the fixator is removed, a tibial brace might subsequently be used for a short period.

Animals↗