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PubMed1992

The effect of wire configuration on the stability of the Ilizarov external fixator.

The stability of the basic unit for fixation of the Ilizarov external fixation system was tested in several loading modes. The effects of varying the number of wires and the orientation of wire placement were studied. The fixation units were mounted on a plastic, simulated, long bone and tested by loading in several directions. The Ilizarov fixation ring was found to be relatively stiff in axial compression and torsion. Its stiffness in this mode was directly proportional to the number of wires in the system and independent of the configuration of wire placement. Loading in bending and in shear provided much lower levels of stiffness, and this was dependent on the angles formed between the wires. The addition of a wire at a minimum distance of 4 cm from the primary ring significantly improved bending stiffness. The use of opposed olive wires also improved shear stiffness.

Equipment Design↗
PubMed2000

Treatment of isolated complex distal femoral fractures by external fixation.

Thirteen patients with isolated distal femoral fractures were treated by external fixation. There were seven males and six females with an average age of 45 years. Four were Type A3 fractures, one Type C1, five Type C2 and three Type C3 fractures. Seven of these were open. In seven cases the articular surface was first reduced and fixed. The fixation was extended across the knee to supplement the distal fixation in six severe cases. The average follow up was 30 months. There was one non-union in the study with the average time to union in the other patients being six months. Using the Mize criteria for assessing clinical results we found that nine patients obtained a good to excellent score and four were classed as failures. The average range of movement of the knee in the study was 100 degrees. Apart from the single non-union all the fractures healed and there were no other serious complications. Considering the severity of the fractures we did not find any evidence to suggest that temporary fixation of the lateral soft tissues by fixator pins was detrimental. The results suggest that external fixation may be used to treat these difficult fractures without the risk of serious complications.

Adult↗
PubMed1991

Induction and prevention of pin loosening in external fixation: an in vivo study on sheep tibiae.

In external fixation of fractures, pin loosening is a major concern. Preloading the pins is generally done to ensure their stability within the bone cortex. The effect of radial preload and bending preload in reducing resorption at the pin/bone interface was tested. Schanz screws were fixed to live sheep tibiae using a pneumatically operated external fixator frame. Evaluation was based on radiological observation and fluorochrome histology using sequential labels. Though not completely absent, bone resorption was minimal in the radial preload group, compared with the two other groups. More important, the bone-to-pin contact surface in the radial preload group was found to be almost intact after 5 weeks. In this study, radial preload appears to be superior to bending preload in terms of minimizing the problems of pin loosening.

Animals↗
PubMed1994

The pinless external fixator--relevance of experimental results in clinical applications.

The pinless external fixator was intended as a stable, temporary, minimally invasive fixator for severe tibial fractures ensuring safer conversion to an intramedullary nail. An in vitro study showed that the pinless fixator was mechanically not as stiff as the conventional AO tubular device, the main problem being low axial stiffness. This study involving initial clinical trials with the pinless fixator on tibial fractures in St. Gall is based on the experimental work and previous clinical experience of the main author. From June 1992 to June 1994 10 tibial fractures (eight II degrees and III degrees open, one closed with compartment syndrome, one infected non-union) were temporarily stabilized with a pinless fixator. In another patient a calcaneal traction device was applied. The pinless fixator was applied immediately in eight cases and three times as a secondary measure. All patients were scheduled for a secondary change of treatment. The tibiae were stabilized with four clamps and one anterior rod. The clamps were inserted via transverse stab incisions. Intraoperatively the pinless fixator was easy to handle and complications did not occur. Seven different surgeons needed an average of 20 minutes for insertion. Postoperative care was the same as for conventional fixators. Six patients were treated secondarily with an i.m. nail, three with an external fixator on average after 12 days. One patient died on day 1. The pinless fixator failed twice in one patient (incorrect insertion, fall). Reversible pain in the tendons of the foot extensor muscles was noticed. One superficial clamp track infection was seen. All clamps were reused more than three times. The pinless fixator is stable enough for temporary fracture fixation of the tibia in a four clamp one bar construction. A prerequisite for stability is the proper application technique ("grab test", rocking movements). Weight-bearing should be limited to a minimum and needs a compliant patient. The application technique is easy to learn suggesting that the pinless fixator could be an ideal tool for emergency stabilization. The primary application of this fixator leaves all further treatment modalities open (repeated debridements, evaluation of the open fracture). It may also be of particular value to many clinicians working with reamed nails as their only secondary treatment option for open tibial fractures.

Adult↗
PubMed1983

Bladder problems in pelvic injuries treated with external fixator and direct urethral drainage.

In the treatment of unstable pelvic fractures, external fixators provide the advantages of substantial pain relief, easier nursing care, early mobilization, decreased hospital stay, and direct access to open wounds. Urethral catheter drainage alone for ruptured bladders obviates the need for open surgical repair in a critically injured patient and reduces morbidity and pain. Three cases are reported with bladder complications arising from these recently advocated methods of management; two with external fixators and one with urethral catheter drainage. In one patient with an external fixator, stretching of the bladder over a bone fragment resulted in transient hematuria with activity. In a second patient, the protruding bladder wall was caught between opposing pubic rami. In an extraperitoneal bladder rupture with pubic rami fractures, urethral catheter drainage alone resulted in a pseudodiverticulum of the bladder with a bone fragment projecting through the hole in the bladder cavity. These cases illustrate some complications with these recently advocated methods of management of unstable pelvic fracture and ruptured bladder.

Adult↗
PubMed2001

Ankle arthrodesis: combined internal-external fixation.

This report documents the experience of using combined internal and external fixation in ankle arthrodesis. During the period from 1992 to 2000 a single surgeon used this method of fixation on 26 ankle fusions in 26 consecutive patients without exclusions. There were no nonunions and no delayed unions. The median time to union was 10.3 weeks and the mean time was 11.3 weeks (range, 7.4 to 23.2 weeks). Complications specific to this procedure included 3 (12%) minor pin tract infections which cleared with oral, out-patient antibiotics, 4 (15%) skin irritations from internal fixation pins sufficiently bothersome to require pin removal after union was obtained, and 1 (4%) painful pin tract which cleared spontaneously. Most of these complications occurred early in the series and subsequent changes in technique considerably decreased their incidence. This fixation technique produced excellent results. Combined internal and external fixation is recommended as a useful option in arthrodesis of the ankle.

Adult↗
PubMed1992

Biomechanical evaluation of the Pinless external fixator.

In open fractures especially in those with severe soft tissue damage, fracture stabilisation is best achieved by using external fixators. There are some intrinsic complications which occur during classical external pin fixation. To overcome the problem of pin track infection and vascular damage from drilling, the Pinless external fixator was developed. It is based on the idea of a forceps with trocar points, which only penetrate the bone cortex superficially. The function of the device was tested in two mechanical trials and two in vitro tests in which one pinless clamp was put under a controlled load of 50 N, 150 cycles/day and studied over a 5 week period in sheep. The loads and time range of the experiment were chosen to simulate a temporary fracture stabilisation in a patient not bearing weight. The main question to be answered was whether the Pinless external fixator would be able to maintain stable fixation. Furthermore, it was to determine the changes at the trocar-to-bone interface. The clamp was found to maintain 72% of the initially applied clamping force after 5 weeks of in vivo application and it was found to be tight at removal. Some decrease of clamping force was found during the first 20 days and then the force tended to level off. There was no slippage nor did the clamp penetrate the cortex. There were no obvious signs of infection around the trocar-holes and in the bacterial tests no pathological cultures were grown. Histology revealed very localised bone reactions, the indentation caused by the trocar tips being only 1.2 mm deep. The study concludes, as far as could be ascertained from these tests, that it is safe to use pinless external fixation for temporary fracture fixation.

Animals↗
PubMedDate not supplied

[External fixator by Mitkovic in the treatment of comminuted intraarticular fractures of the distal radius].

INTRODUCTION: Comminuted intraarticular fractures of the distal radius metaphysis are a major challenge for orthopedic surgeons. The aim of this study was to present results of the survey on treatment of these fractures using an external fixator. MATERIAL AND METHODS: 73 patients (30 females and 43 males) with closed comminuted intraarticular fractures of the distal radius, type C AO/ASIF (based on radiography at the moment of injury) were treated by a Mitkovic external fixator and followed-up for at least 2 years. An external fixator and Kirschner wires were used in 43 patients. An external fixator without Kirschner wires was used in 30 patients. RESULTS: At the end of treatment, functional results and outcomes were excellent in 39 (53.4%), good in 19 (26%), fair in 10 (13.7%), and poor in 5 (6.8%) patients according to Jakim score. Lesser degree of limitation of the movement of the wrist joint was established in 19 patients (26%). Joint incongruity of the distal radius, 0-2 mm, was observed in 22 patients (30%) and over 2 mm in 3 patients. A minimal degree of posttraumatic osteoarthrosis was recorded in 21 patients (28.7%) and moderate ostheoarthrosis in 5 patients (6.8%). CONCLUSION: The anatomic reduction of the articular surfaces and healing of the fracture in a proper functional position are prerequisites for adequate function of the wrist and hand. It appears that an external fixator, with or without Kirschner wires, can be a method of choice in treatment of these complex articular fractures.

Adult↗
PubMed1990

[External fixator in the district hospital].

Follow-up checks were performed on 59 cases of external fixation between 1 and 9 years after operation. Complications are not severe, and all patients of this group finally had achieved a good or very good functional end result. External fixator is found a favourite method for use in an ordinary hospital as the author's. The criteria of indication particularly found a new evaluation. The need of giving the external fixator in accurately defined instability is emphasized.

Adult↗
PubMedDate not supplied

Intramedullary osteosynthesis after external fixation.

The authors report the results of a retrospective study conducted on 30 cases of fracture of the tibia and femur submitted to external fixation and subsequently to intramedullary osteosynthesis, treated between 1991 and 1999. Intramedullary osteosynthesis was used in 24 cases (5 in the femur and 19 in the tibia) as treatment subsequent to external fixation for nonunion or delays in consolidation. Sequential nailing was used as planned treatment in the remaining 6 cases. In 83.3% of cases the fracture was open (Gustilo Anderson type I (30%), type II (20%), type III (33.3%). The mean duration of external fixation was 13.24 weeks, and infection occurred in 4 cases (13.33%) during that time. Removal of the external fixator and intramedullary osteosynthesis were carried out during the same surgical session in 40% of the cases, while nailing was preceded by a period in plaster lasting an average of 4 weeks in the remaining 60% of cases. All of the cases achieved consolidation an average of 31 weeks after trauma, and 14.7 weeks after intramedullary synthesis. We observed the occurrence of infection in 3 cases (10%), but this did not keep consolidation from occurring.

Adolescent↗
PubMed2001

[Treatment of diaphyseal pseudarthrosis by circular external fixator].

The aim of this retrospective study was to evaluate the effectiveness of circular external fixator according with Ilisarov technique for the treatment of diaphyseal pseudarthrosis. The union rate obtained in our serie was 91%. We assessed the complications related to surgery and analysed the reasons for failed technique. Between january 1986 and february 1996, 23 patients were included in this study with a mean follow-up of 65 months. The period of external fixation was 209 days on average. 21 patients had united fractures. The failures were attributed to inadequate interfragmentary contact. The main problem during treatment was pin tract infection. The late complications included axial deformities, re-fractures and joint stiffness. Circular external fixator proved to be useful for the treatment of diaphyseal pseudarthrosis, particularly those complicated by infection or post-traumatic shortening.

Adolescent↗
PubMed1993

Comparison of reamed and nonreamed solid core nailing of the tibial diaphysis after external fixation: a preliminary report.

From July 1982 to March 1990, 32 patients had an external fixator applied to treat a tibial diaphyseal fracture and subsequently underwent intramedullary nailing: 16 with reamed and 16 with nonreamed solid core nails. Indications for surgery were 12 atrophic and 1 hypertrophic nonunion in each group. The balance were either planned conversions or inadequate external fixators due to head injuries. All but one were seen by an author at a minimum of 1 year. Among the reamed nails, 3 fractures were grade III B. Two patients had pin tract infections, and there were no prenail wound infections. All infections were clinically inactive at the time of nail insertion. Postnail, 7 patients became infected, requiring 12 debridements and 2 procedures to achieve union. One patient had a plate applied 44 weeks postnail and was lost 48 weeks postnail with a persistent infected nonunion. The average time to union was 26 weeks. In the nonreamed solid core group, 2 fractures were grade III A and 5 grade III B. There were 2 pin and 5 prenail wound infections. One nail was inserted across an active pin tract infection. One tibia became infected postnail (p = .04). The fractures united at an average of 14 weeks postnail (p = .036). Two debridements to control infection but no further procedures to achieve union were necessary (p = .003). When tibial reconstructions following external fixation are required, nonreamed solid core nails are efficacious and may be preferable to reamed nails.

Adolescent↗
PubMed2003

External fixation of displaced femoral shaft fractures in children: a consecutive study of 98 fractures.

OBJECTIVE: To evaluate unilateral external fixation when applied as the standard treatment of children with displaced femoral shaft fractures. SETTING: Two county hospitals in central Sweden. DESIGN: A consecutive and prospective study including all children aged 3 to 15 years with displaced femoral fractures admitted to either of the two hospitals. Patients were followed clinically and radiographically until healing and at 1 year. RESULTS: A total of 96 children with 98 fractures were treated with the same kind of external fixator during the period 1993-2000. The mean age was 8.1 years (range 3-15 years). Average hospital stay was 8.7 days (median 7 days). Average time of external fixation was 61 days (range 37-127 days; median 56 days). Minor complications included pin track inflammation/infection in 36 of 98 (37%) fractures. In 18 of 36 fractures, a short treatment with oral antibiotics was given. Other minor complications were one heterotopic ossification, one patient with two rereductions, nine cases of clinically insignificant malunion (varus = valgus > 5 degrees or procurvatum > 10 degrees ), and one leg-length discrepancy greater than 2 cm. Major complications (6%) included two refractures, one through a pinhole and one at the fracture site, both after significant trauma. Three of the older children with transverse fractures after high-energy injury developed a bending due to premature removal of the fixator prior to healing and required corrective osteotomies. One boy had a third rereduction because of displacement after a fall. CONCLUSIONS: The use of external fixation as a standard treatment of uncomplicated displaced femoral shaft fractures in children gave satisfactory results. The surgical learning curve was short, and the advantages compared with nonsurgical treatment included shorter hospital stay, early mobilization, and fewer days out of school for the patient and out of work for the caregiver. We believe that the advantages far outweigh the complications, many of which can be avoided.

Adolescent↗
PubMed1995

Treatment of closed tibial shaft fractures with unilateral external fixation.

Sixty-eight closed tibial shaft fractures were treated with an anterior unilateral external fixator over a 5 year period (1986-1991). Pin tract drainage and/or infection was seen in 71/380 pins. The total number of secondary operations, excluding planned pin extraction, during fracture healing was 61 (including 22 due to pin tract problems and 25 secondary corrections of alignment). Delayed union was seen in 14 fractures and non-union in three. Healing disturbances were more frequent following high-energy trauma. Bone grafting was done in 11 fractures. Eventually, all fractures healed within an average of 22 weeks. There were three refractures. At follow-up, on average 3 years after injury, functional results were excellent in 41 per cent, good in 46 and acceptable in 13 per cent. Due to the high number of unplanned secondary operations and prolonged healing times we do not consider the use of unilateral external fixation to be an adequate method for the treatment of closed tibial shaft fractures. The poor results are probably due to weight-bearing being too high in these patients relative to the mechanical stability provided by the external fixator system.

Adolescent↗
PubMed2004

Augmented external fixation versus percutaneous pinning and casting for unstable fractures of the distal radius--a prospective randomized trial.

PURPOSE: Many outcome studies of various surgical techniques for unstable fractures of the distal radius have been published but applicability of the results remains limited because the majority of these trials were not done in a prospective and/or randomized manner. In this study we evaluated 2 common surgical techniques used in the treatment of unstable distal radius fractures in a randomized prospective fashion with a 1-year radiographic and clinical follow-up period. Our hypothesis was that external fixation with augmentation would provide superior results compared with percutaneous pinning and casting. METHODS: Fifty patients younger than 65 years of age with unstable fractures of the distal radius were randomized into 1 of 2 surgical treatment groups: percutaneous pins with casting or augmented external fixation. All surgery was performed by 1 of 3 surgeons within 10 days of injury. Over 80% of the fractures were classified as AO-ASIF C2 or C3 and there was a similar distribution of fracture types in each group. RESULTS: The use of augmented external fixation did not improve the mean radiographic parameters of radial length, radial angulation, or volar tilt. Restoration of volar tilt of highly comminuted fractures was difficult to achieve regardless of the technique. Improved articular surface reduction was realized with the use of an external fixator but overall only 3 patients were noted to have steps or gaps greater than 2 mm. No significant differences in mean Disabilities of the Arm, Shoulder, and Hand scores, total range of motion, grip strength, or health-related quality of life were observed between the groups. All 3 patients diagnosed with sympathetic dystrophy had had external fixation. CONCLUSIONS: Although augmented external fixation represents a popular first line treatment for unstable fractures of the distal radius this study suggests that for fractures with minimal articular displacement similar clinical results can be obtained with percutaneous pinning and casting.

Adult↗
PubMed1987

Comminuted Colles' fractures treated with external fixation.

In a prospective series of 75 patients the results of early external fixation of comminuted intraarticular Colles' fractures were studied. Comparison was made to a control group of 32 patients treated with plaster cast fixation. The groups were equal with regard to age, sex and fracture type. The treatment consisted of reduction in general anaesthesia or arm block followed by the application of a small external fixation device. The fixation lasted for five weeks after which the patients were allowed free exercises. For evaluation at the one year follow up the following variables were used: Radiographic appearance. Healing in of the styloid process of the ulna. Subjective evaluation according to the Lidström score. Objective evaluation including range of motion and grip strength. In all follow up variables the treatment group was significantly better than the control group. The prognosis of conservatively treated comminuted intraarticular Colles' fractures is poor. The results of after external fixation are, however, very encouraging and the method can be recommended.

Adult↗
PubMed1989

[External fixation for open fractures of the femur].

32 cases of severe open fractures of the femur were treated by external fixation in 1 lateral plane with either the Wagner apparatus or the A.O. tubular system. 2/3 of the cases were war injuries and 1/3 were due to traffic accidents. In 1 case the broken limb was severely burned. In half the cases external fixation was changed for P.O.P. or internal fixation because of pin tract infection or delayed union. There were no non-unions or amputations, but 1 case had chronic post-traumatic osteomyelitis. We conclude that the method of choice for 3rd degree open fractures of the femur is external fixation. In the case of severe multitrauma and complex wounds with vascular injury or burns, external fixation is mandatory.

Femoral Fractures↗
PubMedDate not supplied

Use of the Hoffman 2 compact external fixator in the treatment of redisplaced unstable distal radial fractures.

The aim of this study was to examine the use of a new joint sparing external fixation device for unstable redisplaced fractures of the distal radius. Participants were twenty consecutive patients with unstable redisplaced fractures of the distal radius with sufficient space in the distal fragment to allow use of a nonbridging technique. The patients had to be capable of cooperating with functional outcome measures. All patients underwent closed nonbridging external fixation of the distal radius using the Hoffman 2 compact external fixator. The main outcome measures were radiological determinations of dorsal angle, radial shortening, and carpal alignment; measurements of mass grip strength and range of movement; and rate of complications. Volar tilt was successfully regained and maintained (mean 4 degrees) at final review. Radial shortening was a mean of one millimeter at final review. Nineteen of twenty patients regained normal carpal alignment. Grip strength returned to a mean of 74 percent of the opposite (normal) side in the whole group and 88 percent in those who completed review for the longest periods. Ranges of movement were restored to around 80 percent, except flexion (66 percent). The rate of major complications was 15 percent. We conclude that nonbridging external fixation using the Hoffman 2 compact device reliably restores and maintains volar tilt and radial length after re-reduction of unstable fractures of the distal radius. Functional outcome and complications are comparable with findings in previous reports.

Adolescent↗