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PubMed1987

Anatomic factors in the femoral implantation of the Ilizarov external fixator.

Ilizarov's method of external fixation with compression or distraction for lesions of the limbs demonstrates new possibilities in osteogenesis. Its performance with double horizontal pinning on several external rings calls for precautions to avoid lesions of the vessels, nerves and joints. This study, based on anatomic sections radiographed after opacification of the arterial system, makes it possible to propose rules for insertion of the pins. Insertion of the anteromedial pins of the thigh should be made 2 cm in front of the line of projection of the femoral artery, between the middle of the inguinal ligament and the posterior margin of the medial condyle. Insertion of the posterolateral thigh pins should be made 2 cm lateral to the line of projection of the sciatic nerve, between the center of the ischiotrochanteric interval, the apex of the popliteal fossa and the posterior aspect of the head of the fibula.

Bone Nails↗
PubMed2000

Conversion of external fixation to intramedullary nailing for fractures of the shaft of the femur in multiply injured patients.

BACKGROUND: From 1989 to 1997, 1507 fractures of the shaft of the femur were treated with intramedullary nailing at The R Adams Cowley Shock Trauma Center. Fifty-nine (4 percent) of those fractures were treated with early external fixation followed by planned conversion to intramedullary nail fixation. This two-stage stabilization protocol was selected for patients who were critically ill and poor candidates for an immediate intramedullary procedure or who required expedient femoral fixation followed by repair of an ipsilateral vascular injury. The purpose of the current investigation was to determine whether this protocol is an appropriate alternative for the management of fractures of the femur in patients who are poor candidates for immediate intramedullary nailing. METHODS: Fifty-four multiply injured patients with a total of fifty-nine fractures of the shaft of the femur treated with external fixation followed by planned conversion to intramedullary nail fixation were evaluated in a retrospective review to gather demographic, injury, management, and fracture-healing data for analysis. RESULTS: The average Injury Severity Score for the fifty-four patients was 29 (range, 13 to 43); the average Glasgow Coma Scale score was 11 (range, 3 to 15). Most patients (forty-four) had additional orthopaedic injuries (average, three; range, zero to eight), and associated injuries such as severe brain injury, solid-organ rupture, chest trauma, and aortic tears were common. Forty fractures were closed, and nineteen fractures were open. According to the system of Gustilo and Anderson, three of the open fractures were type II, eight were type IIIA, and eight were type IIIC. Intramedullary nailing was delayed secondary to medical instability in forty-six patients and secondary to vascular injury in eight. All fractures of the shaft of the femur were stabilized with a unilateral external fixator within the first twenty-four hours after the injury; the average duration of the procedure was thirty minutes. The duration of external fixation averaged seven days (range, one to forty-nine days) before the fixation with the static interlocked intramedullary nail. Forty-nine of the nailing procedures were antegrade, and ten were retrograde. For fifty-five of the fifty-nine fractures, the external fixation was converted to intramedullary nail fixation in a one-stage procedure. The other four fractures were associated with draining pin sites, and skeletal traction to allow pin-site healing was used for an average of ten days (range, eight to fifteen days) after fixator removal and before intramedullary nailing. Follow-up averaged twelve months (range, six to eighty-seven months). Of the fifty-eight fractures available for follow-up until union, fifty-six (97 percent) healed within six months. There were three major complications: one patient died from a pulmonary embolism before union, one patient had a refractory infected nonunion, and one patient had a nonunion with nail failure, which was successfully treated with retrograde exchange nailing. The infection rate was 1.7 percent. Four other patients required a minor reoperation: two were managed with manipulation under anesthesia because of knee stiffness, and two underwent derotation and relocking of the nail because of rotational malalignment. The rate of unplanned reoperations was 11 percent. The average range of motion of the knee was 107 degrees (range, 60 to 140 degrees). CONCLUSIONS: We concluded that immediate external fixation followed by early closed intramedullary nailing is a safe treatment method for fractures of the shaft of the femur in selected multiply injured patients.

Adolescent↗
PubMed1991

Complications of external fixation. A problem-oriented approach.

External fixation is an effective method of stabilizing many fractures in veterinary orthopedics, however, it is not foolproof. Although careful attention to the principles of fixator selection and application is the optimal way to minimize complications, they do still occur. Prompt recognition of these complications and appropriate treatment, however, will minimize their effects and result in the successful outcome of fracture healing and normal limb function.

Animals↗
PubMed1997

Cancellous grafting and external fixation for unstable Colles' fractures.

We present a prospective study of the treatment of 32 unstable Colles' fractures by external fixation and cancellous grafting with minimal exposure. We inserted an external fixator between the radius and the second metacarpal, and maintained ligamentotaxis for five weeks. In 27 patients the result was good or excellent, but five fractures healed with malunion. All patients made a satisfactory functional recovery. At a mean follow-up of three years (1 to 5) after injury none had pain in the wrist and all were satisfied with the result. The average grip strength was 95% of normal. Seven patients had algodystrophy with mild impairment of finger movements in four. We conclude that the combination of cancellous grafting and external fixation is effective for the treatment of unstable Colles' fractures.

Aged↗
PubMed2003

Articulating external fixation to overcome nerve gaps in lower extremity trauma.

This report describes the use of articulating external fixation in patients with lower extremity trauma with segmental nerve defects. Four patients who would otherwise require nerve grafting underwent application of an articulated external fixator, allowing optimal positioning for end-to-end, tension-free nerve repair followed by gradual lengthening. After three weeks of immobilization, the fixator was gradually advanced through the arc of the hinge. At an average follow-up of 44 months, motor function testing revealed gastroc-soleus function in all cases with a median motor grade of M4. Sensory function testing with Semmes-Weinstein monofilaments demonstrated protective plantar sensation in all cases with a median monofilament size of 3.84 on the injured limb compared with 3.22 on the contralateral side. This series of patients demonstrates that joint positioning through external fixation may be used safely and effectively to facilitate primary neurorrhaphy and subsequent limb salvage.

Adult↗
PubMed2004

Bactericidal activity of antimicrobial coated polyurethane sleeves for external fixation pins.

This study was conducted to assess the potential of gentamicin coated polyurethane sleeves to inhibit bacterial colonization on external fixation pins and wires. These antimicrobial sleeves have been designed to be fitted over the pins and wires, at the time of surgery, as a prophylactic approach to combat the major complication of external fixation treatment, pin tract infection. Elution testing was conducted to estimate the amount of gentamicin released into the pin tract. These gentamicin concentrations were compared to the gentamicin minimal inhibitory concentration (MIC) level for common pin tract pathogens. Elution testing revealed that the gentamicin coated polyurethane sleeves released significant quantities of the antibiotic for up to 26 weeks. The initial bolus release was characterized by predicted pin tract gentamicin concentrations of >80 microg/ml at the 2 h and 1 day elution time points. These amounts of gentamicin, delivered directly to the pin tract, are far beyond those that could be achieved via oral or intravenous administration. Furthermore, the expected concentration of gentamicin in the pin tract remained above the National Committee for Clinical Laboratory Standards (NCCLS) MIC breakpoint of 4 microg/ml, [Performance standards for antimicrobial susceptibility testing: twelfth informational supplement M100-S12, NCCLS, Wayne, PA, 2002], for at least 20 weeks. Data from the SENTRY antimicrobial surveillance program (1997-2002) established a high level of bactericidal activity for gentamicin, with 83.1% of the common pin tract pathogen isolates found to be susceptible to the antibiotic. The initial burst and subsequent long-term sustained local delivery of effective amounts of gentamicin from the antimicrobial sleeves would be expected to inhibit bacterial colonization on external fixation pins and wires. This inhibition of bacterial colonization should substantially reduce the incidence of pin tract infection, and improve the overall outcome and cost effectiveness of external fixation fracture management.

Bacteria↗
PubMed1995

Use of an articulated external fixator for fractures of the tibial plafond.

We performed a prospective study of forty-nine displaced fractures of the tibial plafond in forty-eight patients managed, at three centers, with an articulated external fixator placed medially across the ankle joint. Forty ankles had interfragmental screw fixation of a reduced articular fracture, and fourteen ankles had bone-grafting. The average duration of external fixation was twelve weeks. All of the fractures healed (one after delayed bone-grafting). There were no infections in any of the operative or traumatic wounds over the tibia. Two wound infections over the fibula resolved with treatment. Eight patients were managed with antibiotics for a pin-site infection, and two patients had curettage and débridement of a pin site in the hindfoot after removal of the fixator. Thirty patients (thirty-one ankles) completed two-year data sheets at an average of thirty months after the injury. The average ankle score was 67 points. Twenty-one patients had grade-0 or 1 osteoarthrosis and nine had grade-2 or 3. One ankle had been treated with an arthrodesis. These data suggest that the prevalence of early complications associated with severe fractures of the tibial plafond and their treatment can be decreased with use of an articulated external fixator combined with limited internal fixation. We concluded that this technique of external fixation is a satisfactory technique for the treatment of these fractures.

Adolescent↗
PubMed1998

Treatment of tibial bone defects with the Ilizarov circular external fixator in high-velocity gunshot wounds.

One of the applications for circular external fixators is the treatment of large-bone defects which may be difficult to manage with conventional methods. Successful results have been reported with the use of circular external fixators, particularly in the treatment of infected tibial pseudoarthroses and those with bone loss. In this study, a total of 43 cases with tibial bone defects (18 infected) as a result of high-velocity gun-shot injuries were treated with circular external fixators between January 1, 1988 and December 31, 1995. The mean follow-up period was 50 months (range: 28-98 months) after the removal of the Ilizarov device. Satisfactory union was obtained in 40 cases without any major complication or additional surgical intervention, in spite of the large and in some cases infected defects. We conclude that this is a safe method for the treatment of infected or noninfected tibial bone defects.

Adolescent↗
PubMed2004

External fixation in close comminuted femoral shaft fractures in adults.

OBJECTIVE: To evaluate the role of external fixation in the management of highly comminuted femoral shaft fractures in adults. DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Agency HQ Hospital, Landikotal and Saidu Group of Hospitals, Swat, from April 1999 to March 2002. PATIENTS AND METHODS: Fourteen adults with close Winquist Type III and IV comminuted fractures of the shaft of the femur were treated with external fixation. The fixator was applied until the fracture became stable and was followed by the application of a femoral cast-brace till consolidation. All patients were followed for a minimum period of one year after the index procedure. RESULTS: Thirteen patients (93%) achieved fracture consolidation in an average time of 5.2 months (range 4-8). Eight patients had pin-tract infections and 3 developed shortening and 11 lost an average of 34 (0-75) degrees of range-of-motion in their knees. On the basis of this loss, there were 4 excellent, 6 good, 3 fair and 1 poor result. CONCLUSION: External fixation is a useful technique for the stabilization of close comminuted femoral shaft fractures where modern technology is not available. Pin-tract infection and knee stiffness are problems inherent with the use of this method but can be easily minimized with good pin hygiene and knee exercises.

Adolescent↗
PubMed1997

[Treatment of trochanteric fractures by external fixator].

INTRODUCTION: The goal of this study was to report and evaluate the place of external fixation in the treatment of trochanteric fractures in patients with high unacceptable operative risk to withstand conventional osteosynthesis. MATERIAL AND METHODS: From January 1990 to December 1991 (2 years period), 42 patients, 13 males and 29 female, mean age 84.1 years, suffering from trochanteric fracture and considered preoperatively as "poor medical status" were treated by external fixation and immediate mobilisation. The average operative time was 18 minutes and no blood transfusion was necessary per or post-operatively. The mean hospital stay was 19 days. RESULTS: All patients were followed up for 6 months post-operatively. During this time 8 patients (19 per cent) died due to medical problems unrelated to the fracture. All fractures united in an acceptable position at an average time of 10.4 weeks with no loss of reduction, no pin breakage, no deep infection. All hips were painless. COMPLICATIONS: proximal pin migration occurred in 3 patients (7 per cent) due to fracture impaction and superficial pin tract infection in 16 (38 per cent) with no further consequence. DISCUSSION: External fixation in trochanteric fractures has been applied since 1957 with good results. This series confirms the advantages of the method in patients with a high operative risk; these are short operative time, minimal blood loss, early mobilisation and acceptable morbidity and mortality rates, considering the old and senile age group with poor medical condition, not allowing conventional treatment. The minor complications such as superficial pin tract infection and proximal pin migration are easily controlled.

Aged↗
PubMed2005

[Use of a hybrid external fixator for treatment of tibial fractures].

PURPOSE OF THE STUDY: The study deals with treatment of the articular ends of the tibia, using a hybrid external fixator. A group of patients treated in the years 2001-2003 is retrospectively evaluated. MATERIAL: Between 2001 and 2003, 21 patients (16 men and 5 women) with a fracture of either the distal or the proximal end of the tibia were treated, using a Synthes external hybrid fixator, at the Department of Orthopedics and Traumatology, Faculty of Medicine, Charles University, Plzen. The average age of the patients was 49.2 years. The fractures, evaluated by the AO classification, included five type A3 fractures and 16 type C1 or C2 fractures. In 14 patients the fracture was associated with multiple trauma or polytrauma and in seven it was a single injury. Open fractures were treated in five patients (grade 2 in two and grade 3 in three patients), closed fractures in 16 patients (Type CII in 12 and type CIII in four patients, as assessed by Tscherne's classification). Fifteen patients had fracture of the proximal tibia and six had distal tibial fracture. A hybrid external fixator was used alone in six patients, and in combination with miniosteosynthesis in 15 patients. METHODS: The first aim was to perform closed reduction or reduction from a minimal approach with an intraoperative image intensifier. Subsequently, the fracture was temporarily stabilized with pelvic reduction forceps or Ki wires and, if indicated, the articular ends were stabilized by miniosteosynthesis. When the outer ankle was fractured, plate osteosynthesis was carried out. Finally, a hybrid external fixator was applied. In the case of an open fracture, this procedure was preceded by soft tissue debridement. RESULTS: The evaluation, based on clinical and radiographic findings and subjective complaints of the patients, was made with the use of the Rasmussen and Bray scoring system. Nineteen patients were followed up, two failed to turn up. The results were excellent in five, very good in six, satisfactory in five and poor in three patients. Two repeat operations were necessary. DISCUSSION: The treatment of injury to the articular ends of the tibia, with the use of a hybrid external fixator, is one of the options for stabilization of both open and closed fractures. This method enables us to stabilize fractures of the tibial metaphysis as well as intra-articular fractures. Application of a hybrid external fixator is indicated in type A and type C fractures (AO classification). The state of crural soft tissues must be taken into consideration. The advantage of this method is the use of Kirschner wires, as fixation components, stretched in a circular frame. The fixation components require only minimum space for insertion in the metaphysis or epiphysis, the implant is stable and permits easy treatment of soft tissues. Another advantage is the possibility of early rehabilitation of the adjacent joints and loading of the extremity. Relatively frequent "pin infection" and therefore more frequent visits to the outpatient department can be considered a disadvantage. CONCLUSIONS: The method described here is, in addition to other options of fracture osteosynthesis, suitable for treatment of fractured ends of the tibia. External fixator application can be used with advantage for treatment of supra or infra-articular fractures of the tibia and fractures associated with marked swelling of soft tissues, for which internal osteosynthesis is not indicated, and in open fractures as well.

Adolescent↗
PubMed1990

External fixation of the injured pelvis. The functional outcome.

External fixation was used in 42 patients as the sole definitive treatment for their unstable pelvic fractures. At an average follow-up of 40 months, the anatomical outcome was related to the functional outcome using defined criteria. The functional results were better than the anatomical results. Function improved during the first 18 months and thereafter was stable. The stab and percutaneous techniques for pin insertion had lower rates of infection than the incisional technique. External fixation has a definite role in the treatment of unstable pelvic fractures. In contrast to internal fixation, this method has two major advantages: safety and simplicity.

Adolescent↗
PubMed1987

External fixation for skeletal stabilization of severe open fractures of the hand.

The successful use of external fixation to stabilize severe open fractures elsewhere in the body has led to its adaptation in the hand. It is particularly useful when extensive wounds prohibit internal fixation and when comminution and bone loss render the fracture difficult to control by other methods. External fixation permits simultaneous wound access and fracture management. It can be used alone or adjunctively with other methods of fixation such as Kirschner wires, screws, or plates for definitive fracture management. Alternatively, external fixation can be used for provisional fracture management until wound conditions permit the application of other means of osteosynthesis.

Adolescent↗
PubMed1991

Healing patterns of transverse and oblique osteotomies in the canine tibia under external fixation.

Healing patterns were compared between transverse and 60 degrees oblique osteotomies in canine tibiae stabilized under external fixation. Under similar in vitro testing conditions (osteotomy ends in contact), the axial stiffness of the oblique osteotomy under external fixation was 45% of the paired transverse osteotomy. Under torsion and bending, the two sides exhibited similar fixation rigidity. The animals put significantly less weight on the oblique side than on the transverse side in the early phases of bone healing (p less than 0.05 for static and p = 0.024 for dynamic weight bearing). The osteotomy bending stiffness at 60 days (in vivo) and the torsional stiffness of osteotomy union measured after sacrifice at 90 days were significantly higher on the transverse side (p = 0.013 and p = 0.016, respectively). Intracortical new bone formation was significantly higher on the transverse side (p less than 0.01), indicating a difference in the rate of cortical healing and remodeling. The average pin removal torque was significantly lower on the oblique side (p less than 0.05), a sign of increased pin loosening. In the clinical situation, unstable oblique or spiral fractures should be protected from weight bearing even under stable external fixation due to the delayed recovery of bone union stiffness property as well as increased pin tract problems.

Animals↗
PubMed1983

External fixation of severe open tibial fractures with the Hoffmann frame.

Extensive experience with stable external fixation of open tibial fractures has confirmed the observation that this method promotes healing of skin and soft tissue damage, reduces the risk of infection, and facilitates the treatment of patients with multiple injuries. In cases of very severe open fractures the method seems to be the treatment of choice and can reduce the frequency of amputation. Recently, complete long-term follow-up results showed that healing times can be reduced if the period of rigid external fixation is reduced. Functional end results after stable external fixation compare favorably with results of internal fixation with AO plates.

Accidents, Traffic↗
PubMed1983

[Treatment of intra-articular metacarpal and phalangeal fractures with an external fixation minidevice].

Open reduction of intraarticular fractures involving the metacarpals and phalanges and fixation with the small external fixation apparatus is a promising new method which fulfills a need. Full return of function in seven patients and a small limitation of function in three patients can be regarded as a satisfactory result. All patients returned to work after a short time without any complications. The external mini-fixation device which has already been useful in the treatment of open and closed fractures, infected nonunions and in performing arthrodeses has now found another application in the treatment of fractures involving finger joints.

Adult↗
PubMed2005

[Treatment of two-part proximal humeral fractures with external fixators].

BACKGROUND: We aimed to evaluate the results of the closed manipulation or transcutaneous reduction and external fixation in the treatment of two-part fractures. METHODS: Eight patients with two-part proximal humerus fractures who had been treated in our clinic with closed manipulation or transcutaneous reduction and external fixation between 1996-2001 were evaluated for this study. We evaluated the final functional status according to the Neer's classification system. RESULTS: Mean age of the patients was 42 (21-75) years. The major aetiologic factor was motor vehicle accident (in 5 cases). Follow-up time was 2 to 4.5 years. Mean union time was 16 weeks (10 to 24). Nonunion and avascular necrosis of the humeral head have not been observed in none of the cases. Superficial pin tract infection was developed in three cases. All of them were treated successfully with antibiotics. Functional results according to Neer's classification were as follows: 5 good. 2 fair and 1 failed. Mean score 77, 25 (50 to 89). CONCLUSION: External fixation of displaced two-part fractures of proximal humerus can be assessed as a reliable method with respect to satisfactory fracture reduction and stability, low rate of complications and good early functional results-obtained with this technique.

Accidents, Traffic↗
PubMed2005

Non-reducible, open tibial plafond fractures treated with a circular external fixator (is the current classification sufficient for identifying fractures in this area?).

While some researchers advocate primary arthrodesis for the treatment of open, severely comminuted tibial plafond fractures, others argue that an external fixator is an alternative. In this study, we obtained intermediate clinical and radiological outcomes on treating such fractures with a circular external fixator. Twelve patients with non-reducible, open tibial plafond fractures were treated with a circular external fixator and minimal osteo-synthesis. The fractures were grouped using a modification of the Ruedi and Allgower classification: eight, two, and two of the patients had Type III, IVA, and IVB fractures, respectively. The bone transport technique was applied in the patients with a Type IVB fracture. Four parameters were tracked in the patients: the reduction score of the joint surface, early complications, and the radiological and clinical findings of the ankle. The average follow-up period of the patients was 54.5 months. In the postoperative radiological examinations, the reduction score of the joint surface exceeded 15 in four patients and was 12-15 in eight patients. Type III and IVA fractures united with an average healing time of 4.25 months. Surface wound infection was observed in three patients. One patient each developed fibular osteomyelitis, claw toe, and 2cm shortness. Among the patients with Type IVB fractures, nonunion and malunion in the newly forming callus was observed in one patient, and nonunion alone was observed in another patient. On the final check, both the clinical and radiological findings were poor for all of the patients, with a reduction score exceeding 15. High-energy and poor joint surface reduction scores are two important factors affecting both the clinical and radiological results. For the fractures with reduction scores below 15, it is particularly difficult to predict the clinical results. Therefore, we recommend that such fractures be treated with a circular external fixator and believe that arthrodesis in accordance with the patient's choice is a desirable treatment method.

Accidental Falls↗