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At least 361 records · Page 20Linked to original sources
PubMed2005

The effect of increasing distraction on digital motion after external fixation of the wrist.

PURPOSE: Although several factors have been related to the development of digital stiffness after external fixation of distal radius fractures, distraction can be considered one of the most important. This study determined a threshold for distraction during external fixation of distal radius fractures and documented the effect of distraction of the wrist on metacarpophalangeal (MCP) joint motion. METHODS: Eight fresh-frozen cadaveric forearms were mounted on a testing frame and the flexor digitorum superficialis (FDS) tendon of each finger was pulled individually until a 90 degrees flexion at the MCP joint was generated. A load cell was used to record the force applied on the tendons. Tendon displacement was calculated by using a linear potentiometer. Sequential distraction across the wrist was applied through a distraction outrigger on the external fixator and was measured both on the external fixator in millimeters and on fluoroscopic images. Finger motion was captured by using a 2-dimensional motion tracking system. The experiment was repeated at different levels of wrist distraction (increments of 2 mm to a maximum of 14 mm). RESULTS: There was a significant difference in the effect of distraction on the individual fingers. For the index finger the load required for the FDS to produce a 90 degrees flexion at the MCP joint was increased linearly between 0 and 8 mm of wrist distraction. For the other fingers a threshold of distraction was found. A significant increase in the load was noticed after 5 mm of wrist distraction. CONCLUSIONS: More than 5 mm of wrist distraction increases the load required for the FDS to generate MCP joint flexion for the middle, ring, and small fingers. For the index finger, however, as much as 2 mm of wrist distraction significantly increases the load required for flexion at the MCP joint.

Cadaver↗
PubMed1994

Treatment of grade-IIIb open tibial fractures. A prospective randomised comparison of external fixation and non-reamed locked nailing.

Severe open fractures of the tibia have a high incidence of complications and a poor outcome. The most usual method of stabilisation is by external fixation, but the advent of small diameter locking intramedullary nails has introduced a new option. We report the early results of a randomised, prospective study comparing external fixation with non-reamed locked nails in grade-IIIb open tibial fractures. Of 29 patients, 15 were treated by nails and 14 by external fixation. Both groups had the same initial management, soft-tissue procedures, and early bone grafting. All 29 fractures healed within nine months, but the nailed group had slightly better motion and less final angulation. Complications included one deep infection and two pin-track infections in the external fixator group and one deep infection and one vascular problem in the nailed group. Although the differences in healing and range of motion were not statistically significant, we found that the nailed fractures were consistently easier to manage, especially in terms of soft-tissue procedures and bone grafting. It is the treatment preferred by patients and does not require the same high level of patient compliance as external fixation. The only factors against nailing are the longer operating time and the greater need for fluoroscopy. We consider that locked non-reamed nailing is the treatment of choice for grade-IIIb open tibial fractures.

Adult↗
PubMed1997

Temporary external fixation for low back pain: is it worth doing?

Thirty-three patients with low back pain underwent spinal fusion following a positively predicting external fixation test. Thirty-two spinal fusions and one sacroiliac joint fusion were performed. The complications following the use of the external fixator were significant. The results following spinal fusion were not related to the positive response to the external fixator. Multiple variables affect the results of spinal fusion. We feel that the external fixator test in low back pain management is very invasive, and its use cannot be justified.

Adult↗
PubMed1996

Mechanics of the external fixation test in the lumbar spine. A roentgen stereophotogrammetric analysis.

STUDY DESIGN: By implanting tantalum indicators percutaneously during application of pedicular screws, lumbosacral mobility could be studied with roentgen stereophotogrammetric analysis in seven patients having a diagnostic external fixation test. OBJECTIVES: To determine the mechanical effects on the segmental mobility during an external fixation test of the lumbar spine. SUMMARY OF BACKGROUND DATA: External pedicular fixation test of the lumbar spine has been reported a valuable prognostic instrument in fusion for low back pain. METHODS: A Magerl external fixation device was applied in seven patients with low-grade spondylolysis-olisthesis. By using roentgen stereophotogrammetric technique, the intervertebral translations in the lumbosacral segment were determined. Each patient had three separate examinations; with the frame fixed, with the frame loosened, and without frame 6 weeks after screw removal. RESULTS: With the external frame fixed, the sagittal intervertebral translations were significantly reduced, in three cases to a level beneath the accuracy of the measuring method. One patient had the same immobilizing effect even with the frame loosened while for the others loosening of the frame meant regained mobility of the segment. CONCLUSION: The properties of the external fixator give an adequate mechanical basis for the prognostic external fixation test in lumbar fusion.

Adult↗
PubMed1989

Mechanical performance of pin clamps in external fixators.

Insufficient holding strength on a pin within a clamp may result in the diminution of the overall fixation rigidity as well as pin movement at the pin-bone interface. In this study the holding strength of pin fixation clamps in two representative external fixators (Hoffmann and Orthofix) was evaluated by determination of the torque resistance of pins within a clamp. In the standard Hoffman clamp, the pin-clamping effect was satisfactory in the symmetric two-, three-, and four-pin configurations, whereas the standard Orthofix clamp provided higher holding strength in the symmetric two- and three-pin configurations. All other pin configurations in both clamps resulted in a high variation of pin torsional resistance, and sometimes one of the pins registered low or had no resistance to torsion. The results indicated that the holding power of the clamps was adequate only if certain guidelines were followed at the time of external fixator application. An instrumented torque wrench may be helpful to assess the pin-fastening strength within the clamp. This wrench should also be used to introduce appropriate and uniform tightening torques to the pin clamp screws. However, these results do not apply to those fixators in which each pin will be tightened individually.

Fracture Fixation↗
PubMed1991

Ankle arthrodesis. A comparison of internal and external fixation.

The authors reviewed the results of ankle arthrodesis in 68 ankles in 66 patients. The average follow-up period of the patients was five years (range, two to ten years). There were 40 ankles in which internal fixation was used and 28 ankles in which external fixation was used. The two groups were compared to determine the effect of mode of stabilization on outcome. Outcome was measured by time to union, development of complications, and clinical follow-up result. The groups were similar in regards to gender, age, and preoperative diagnosis. The external fixation group had a significantly higher prevalence of complications, including non-union, delayed union, and infection, than the internal fixation group. It was concluded that ankle arthrodesis with internal fixation is better tolerated and has fewer complications than techniques that use external fixation.

Adult↗
PubMed1999

External fixation of open humerus fractures.

Fifteen patients with open shaft of humerus fractures were treated with a monolateral external fixator. Nine patients presented with nerve palsies. Two radial nerves were disrupted and required grafting. Of the seven others, six spontaneously recovered and one brachial plexus partially improved. All fractures healed. The average duration of external fixation was 21 weeks. Four patients required additional procedures prior to healing (external fixator reapplication-2, plating and bone grafting-2). Two of these four experienced breakage of 4.5 mm external fixation pins. Eight patients developed pin tract infections, which all resolved with local care and antibiotics. Thirteen patients were contacted at an average of 63 months after injury. Eleven reported they were satisfied with their result, nine had no functional limits, and eight reported no pain.

Adolescent↗
PubMed2002

[Treatment of type II and III open tibial fractures with Ilizarov external fixation].

OBJECTIVES: We evaluated the results of patients who were treated with Ilizarov external fixation for type II and III open tibial fractures. METHODS: Forty-five patients (4 females, 41 males; mean age 33 years; range 8 to 65 years) with open tibial fractures were treated with the Ilizarov external fixator. According to the Gustilo-Mendoza classification, the fractures were type II, IIIA, IIIB, and IIIC in 12, 20, 9, and 4 patients, respectively. The mean follow-up was 58 months and 4 days (range 42 months and 10 days to 66 months and 11 days). The fixators were applied for a mean of 17.2 weeks (range 6.8 to 55.7 weeks). RESULTS: Union was achieved in all cases. A significant difference was observed between type II and III fractures in terms of time to union (p<0.05). Compared to type IIIA fractures, the time to union was significantly longer in type IIIB and IIIC fractures (p<0.05). The most frequent complication was pin-tract infections (27.1%). Refracture occurred in four cases (8.8%). Three patients developed late infections at the fracture site. Radiographically, the results were excellent in 14 patients (31%), good in 22 patients (48.8%), moderate in five patients (11.1%), and poor in four patients (8.8%). Functional results were excellent in 21 patients (46.6%), good in 20 patients (44.4%), and moderate in four patients (8.8%). CONCLUSION: Despite technical difficulties and problems associated with pin-tract infections, the Ilizarov external fixator may be the preferred technique in open tibial fractures because of high union rates, the use of thin K-wires with minimal traumatic effect, and more successful functional results.

Adolescent↗
PubMed2001

Extraarticular external fixation in distal radius fractures pinplacement in osteoporotic bone.

External fixation is a well accepted treatment option in distal radial fractures. The fixator can be used in two different ways: joint bridging or extraarticular. The extraarticular technique presumes that the fracture does not involve the radio-carpal joint and that the distal fragment is broad enough to accommodate two fixator screws. Taking into account that the majority of distal radius fractures occur in elderly female patients the question arises whether osteoporotic bone is an obstacle to extraarticular external fixation. Bone slices of 2mm thickness were cut out of six human cadaver radii with a mean age of 76 years (from 65 to 94 years) in the saggital plane. A radiograph of each slice was digitized and the distribution of gray values measured. It was found that the radiographic density was highest at the palmar side of the distal radius in a triangular area built by the palmar lip of the radius. In this region, even in severe osteoporotic bone, strong trabeculae are visible running parallel to longitudinal axis of the radius. Fixator screws inserted into the distal radial fragment especially in an osteoporotic situation should be securely anchored in the palmar lip of the distal radius.

Adult↗
PubMedDate not supplied

Monitoring peripheral nerve function during external fixation of upper extremities.

Limb lengthening of the upper extremity using external fixation devices is associated with a high risk of neurovascular impairment. To aid early detection of nerve injury, intraoperative monitoring of neural function was performed in five patients undergoing Ilizarov-type circular external-fixator application. The apparatus was applied to the humerus in two cases and to the forearm in the other three cases. The function of ulnar, median, and radial nerves was assessed continuously throughout the surgery by using sensory-evoked potential (SEP) monitoring technique. The responses were elicited by stimulation of these nerves in the distal forearm with recording at Erb's point and over the anterior cervical spine. During apparatus application, radial-response attenuation was identified in two instances. No corrective actions were performed in one case, and the patient had symptoms of radial nerve deficit postoperatively. In the other case, prompt removal of the offending half-pin after the detection of electrophysiologic abnormalities resulted in subsequent response restoration and the avoidance of postoperative nerve dysfunction. Sensory-evoked potential monitoring proved to be a reliable indicator of nerve compromise during external fixation of upper extremities and may be considered a valuable surgical adjunct.

Adolescent↗
PubMed1992

Vascular injury from external fixation: case reports.

The incidence of vascular injury from external fixation of fractures was studied retrospectively in two surgical departments during the period 1985-1990. A total of 1231 fractures of the lower limb were treated. External fixation was used in the initial stabilization of 28 femoral and 93 tibial fractures. In this series of 121 fractures four iatrogenic vascular injuries were seen: two arterial thromboses with distal ischemia and two incidents of the formation of a false aneurysm with bleeding along a pin. The diagnosis was made by angiography. Surgical intervention was necessary in all four cases. In one patient the injury resulted in amputation of the distal portion of the foot.

Adult↗
PubMed1982

[Theoretical principles and biomechanics of external fixator osteosynthesis].

It has become necessary to improve the technical properties of external fixation. To achieve this we tested different constructions based on the tubular system of ASIF for external fixation. By axial centric and eccentric loading we investigated the displacement of the bone fragments, the degree of bending of Steinmann nails and the pressure transmitted to the tubes. According to the investigations, certain basic rules and technical aspects have to be considered in external fixation. Knowledge of the pathophysiology of the damaged area is also a precondition in using this operative technique. Classification of different methods of osteosynthesis and their indications is proposed.

Biomechanical Phenomena↗
PubMed1994

[Experience with external fixation in treatment of shaft fractures in childhood].

In a retrospective study 89 shaft fractures sustained during childhood and treated by external fixation were analysed [80 fractures of the lower extremity (59 of the femur) and 9 of the upper extremity]. The operative investment (operating time, period of hospitalization, time for fluoroscopy, general anaesthesia, start of mobilization, number of X-rays) correlated with the success of the treatment. The overall complication rate was 19.1%. Technical errors occurred in 5.6% of all cases; the infection rate was 4.5%; refractures were seen in 4.5% of all patients and reinfarction also in 4.5%. The last 10 femur fractures were analysed separately and the overall complication rate was demonstrably reduced to 3.2%. All technical errors are avoidable and the infection rate could be minimized by better care of the pin, exit points, and by ensuring more stable anchorage of the screws. The consolidation time is longer than with plate osteosynthesis and medullary nailing. But in contrast to adults, in children the treatment was completed with external fixation, and no pseudarthrosis was seen. The consolidation time was shorter with dynamic external fixation. With dynamic systems healing took an average of 7 weeks, while rigid systems needed an average of 9 weeks. Refractures and reinfarction were caused by the rigidity of the external fixation system. In isolated dislocated shaft fractures in childhood the advantages of the fixateur externe are its easy application, low level of invasiveness and early mobilization. It was used in all kinds of fractures in children aged 4-13 years.

Child↗
PubMed2002

Temporary intraoperative external fixation in mandibular reconstruction.

OBJECTIVES: To describe the use of a temporary intraoperative external fixation device to assist in the optimal bony reconstruction of the mandible in the setting of vascularized bone grafts. STUDY DESIGN: A retrospective review of six patients who underwent composite resection of the mandible and subsequent reconstruction with osteocutaneous free tissue transfer in a tertiary care center. METHODS: Six cases of mandibular reconstruction using an intraoperative external fixation system to assist the positioning of vascularized bone grafts are presented. All patients had composite resection of the mandible and subsequent reconstruction with either a scapula or fibula osteocutaneous flap. Follow-up ranged from 2 to 16 months. RESULTS: Successful reconstruction as defined by acceptable contour, occlusion, and condylar position was achieved in all cases. Complications were limited to a postoperative cerebrovascular accident requiring anticoagulation and subsequent neck hematoma. CONCLUSIONS: Use of intraoperative external fixation maintains the proper alignment of mandibular segments without the use of a bridging reconstruction plate. This technique is particularly valuable with tumors involving the outer cortex of the mandible.

Aged↗
PubMed2000

Is there a place for external fixation in humeral shaft fractures?

There is a good indication for unilateral axial dynamic external fixation in fractures of the humeral shaft when the fracture appears in the distal third or in cases of bilateral fractures. A non-union or a posttraumatic paralysis of the radial nerve may be indications for external fixation as well as fractures associated with multiple injuries. Further indications include osteitis, infected non-union and comminuted fracture. There is maximum protection of the soft tissue with this method of treatment. External fixation combines the advantages of conservative and operative treatment by influencing callus formation by dynamizing, distraction or compression. Minimizing soft tissue damage facilitates the decision for early exploration of the radial nerve in cases of palsy. A safer positioning technique of the distal screws of the fixator is described.

Adult↗
PubMed2004

Intra-articular fractures of the tibial plafond. A comparison of the results using articulated and ring external fixators.

We retrospectively reviewed 60 fractures of the tibial plafond treated by either an ankle-sparing diaphyseal-epiphyseal technique using the Ilizarov ring fixator or by an ankle-spanning technique using a monolateral articulated external fixator. The Ilizarov ring fixator was applied in 24 fractures and the monolateral articulated transarticular external fixator in 20. Both techniques were combined with limited open reduction and internal fixation of the articular surface if necessary. Between three and nine years after the injury, all patients returned for clinical and radiological assessment and evaluation of ankle function using the modified Mazur score. There were no significant differences between the two groups in terms of age, gender, mechanism of injury, type of fracture or length of follow-up. The mean functional ankle score was 86 points for the Ilizarov group and 82 points for the articulated fixator group. The difference was not significant (p = 0.07). There were no significant differences between the groups with regard to the radiographic score and late complications. Patients treated with the Ilizarov ring fixator had significantly better ankle and subtalar movement. We conclude that both techniques of external fixation are satisfactory methods of treatment for fractures of the tibial plafond, but that the total arc of movement of the joint is preserved better without bridging the ankle.

Adult↗
PubMed2002

Stiffness characteristics of composite hybrid external fixators.

New composite hybrid fixators for fracture stabilization using single or multiple rings with monolateral bars and half-pin fixation may provide clinical advantages such as reduced bulk and easier skin access. However, the mechanical properties of these fixators are difficult to estimate from numerous design parameters. Addressing this problem the following research questions were asked: (1) Do composite hybrid fixators have similar stiffness properties to clinically proven triple-ring fixators; (2) How does the fixation mechanism affect the stiffness properties of external fixators, and, (3) Are there interferences between ring number and fixation method? An experimental study was done on simulated metaphyseal tibial fractures and stiffness of 12 fixators was measured for different loading conditions. The results showed that triple-ring fixators provide approximately 20% stiffer properties than double-ring and single-ring fixators. No influence of ring number on the AP bending properties was found and different fixation methods were associated with large differences in fixator stiffness, whereas significant interferences were found between ring number and fixation method. Although the mechanical properties investigated in the current study cannot predict directly the clinical performance of these fixators, the stiffness data provide useful information for making decisions regarding the treatment of fractures using external fixation.

External Fixators↗
PubMed2002

[Primary external fixation with consecutive procedural modification in polytrauma].

AIM OF STUDY: It is the purpose of the current investigation to determine whether immediate external fixation of fractures, which is a simple and fast procedure, followed by secondary planned conversion represents a safe and reliable procedure without additional trauma in multiply injured patients (ISS > 15). METHODS: With a prospective protocol, all data of multiply injured patients with fractures which required immediate osteosynthesis were registrated. Demographic data, severity of injury (AIS and ISS), data of primary surgery and osteosyntheses, course of intensive care (organ failure, local/systemic complications, infectious protocol), secondary conversion (time, duration, osteosynthesis related complications) and further course were analysed. RESULTS: Out of 679 mulitiply injured patients (ISS 22), 118 required immediate surgical procedures for intracranial injury and 175 for further indications. In 45 multiply injured patients (ISS 37), 83 external fixations were performed. According to 59 planned secondary conversions (13 days), one patient developed deep infection, no other local complication was registrated. The average time for conversion procedures lasted three times longer as in immediate external fixation (43 vs. 139 min). CONCLUSIONS: Immediate external fixation in multiply injured patients is fast and poor of complications. It is a expedient procedure which is safe and careful for critically ill patients. The required conversion procedure shows no raised rate of complications.

Adolescent↗