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PubMed1992

Compression plating for non-union after failed external fixation of open tibial fractures.

Fifty non-unions of the tibia that were present in forty-nine patients after external fixation and immobilization in a cast for a high-energy fracture were subsequently treated by compression plating. Initially, there were forty-six open fractures and four closed fractures with a compartment syndrome. Twenty-two non-unions (44 per cent) had early soft-tissue reconstruction (thirteen rotational and nine free flaps). The duration of external fixation averaged ten weeks, and the mean time from injury to plating was eight months. None of the non-unions were infected at the time of plating. The average preoperative deformity in the sagittal (anterior-posterior) plane was 8 degrees and in the frontal (medial-lateral) plane, 9 degrees; after plate fixation, the residual angulation averaged 3 and 2 degrees. Autogenous bone graft was used in thirty-nine of the fifty non-unions. The patients were followed for an average of twenty-four months. Forty-six (92 per cent) of the non-unions united, in an average of seven months, without further intervention. In four patients (8 per cent), the plate broke, necessitating re-plating in three and external fixation in one (the latter patient had an infected non-union). A deep infection developed in three patients (6 per cent). Ultimately, forty-eight non-unions (96 per cent) healed without evidence of infection. Plate osteosynthesis is an effective method of treatment for patients who have had an open fracture of the tibia that has failed to unite after external fixation and immobilization in a cast.

Adolescent↗

PubMed2004

Comparative study of nonbridging and bridging external fixators for unstable distal radius fractures.

The purpose of this study was to compare nonbridging external fixators (group NB) with bridging external fixators (group B) in the treatment for unstable distal radius fractures. The subjects consisted of 84 patients, 42 in each group. Mean patient age was 64.0 years in group NB and 59.6 years in group B. According to Saito's classification, most fractures were of the comminuted Colles type. No bone graft was made in group NB. Patients of group B showed serious reflex sympathetic dystrophy (RSD). On Saito's evaluation criteria, the proportion of patients evaluated as "good" or better was 100% in group NB and 95.6% in group B. This finding can be taken as evidence that group NB patients showed better results.

Adolescent↗

PubMed1994

[Use in cats of the "small external fixator for hand and forearm" of the Study Group for Osteosynthesis Inquiries].

Results and experience of 38 applications of the small AO/ASIF external fixator in cats are reported. Problems, limits with this fixation system and possible further indications are discussed. In this study the external fixator proved to be a helpful supplement of stabilisation methods for treatment of fractures and luxations in cats. The external fixator was well tolerated by the cats in this study.

Animals↗

PubMedDate not supplied

[External fixation of distal radius fractures: indication, technique and functional results].

A series of 56 consecutive patients with 59 fractures of the distal end of the radius, treated with an unilateral external fixator of Hoffmann between 1980 and 1988, is presented, 47 of these patients were examined clinically at home in the last months of 1989. We can distinguish two different groups of patients: the older females with an average of 59.2 years and the younger males with an average of 40.1 years. The fractures of the females were caused by a lower energy trauma than those of the males (p less than 0.05). The males had significantly more complex fractures (Frykman type VII or VIII) than the females (p less than 0.05). The indication for an external fixation was significantly different for males and females (p less than 0.01). The external fixator remained attached for an average time of 5.7 weeks. The traumatized wrist had an average power of 71% of the heterolateral side. 87% of the patients had no complaints in performing their daily activities. In 70% there was an anatomical reduction on the X-ray, in 64% an excellent cosmetic result and in 68% the functional end results were excellent or good. Functional end results can be ameliorated by paying more attention to the anatomical reconstruction of the wrist joint. Therefore, it can be necessary to complete the external fixation with an open reconstruction of the wrist joint and/or with a transplantation of cancellous bone. In some cases, a changing of procedure to a plate osteosynthesis could be the treatment of choice.

Adolescent↗

PubMed1998

Primary external fixation of rotationally unstable pelvic fractures in obese patients.

BACKGROUND: Patients with obesity who undergo surgery have an increased risk for perioperative complications. The purpose of this study was to determine the perioperative outcome of rotationally unstable pelvic fractures treated with initial external fixation in obese patients. METHODS: Review of clinical data and radiographs of 42 patients identified from a prospectively entered trauma database who had rotationally unstable fractures of the pelvis treated with initial pelvic external fixation. RESULTS: Inability of an anterior uniplanar external fixator to maintain adequate reduction of the pelvic ring disruption occurred with a greater frequency in obese patients compared with nonobese patients (p < 0.005). The anterior frame was unable to provide sufficient stabilization of the pelvic ring disruption in all obese patients with pure open-book-type fractures. For these patients, stabilization of the pelvic ring was achieved with early symphyseal plating. CONCLUSION: We report a significantly higher incidence of inability to obtain or maintain reduction of open-book pelvic fractures in obese patients using primary anterior uniplanar external fixation. Early symphyseal plating allowed early patient mobilization and maintained acceptable reduction throughout the follow-up period.

Adolescent↗

PubMed1986

Indications for the application of Wagner's method of external fixation across the knee joint.

External fixation with Wagner's apparatus can, because of its mechanical properties, be employed for temporary immobilization of the knee joint. This method is especially suitable for patients for whom immobilization in plaster is problematic or disadvantageous. It can be applied to the following categories of patients: Patients with injuries to the bones or ligaments of the knee which are associated with wounds or injuries of the blood vessels or nerves; Patients with multiple injuries of the leg (e.g., fractures of the tibia and femur) and concomitant intra-articular knee injuries; Patients with a septic arthritis of the knee joint.

Adolescent↗

PubMed1988

A simple and inexpensive external fixator.

A simple and inexpensive external fixator has been designed. It is constructed of galvanized iron pipe and mild steel bolts and nuts. It can easily be manufactured in a hospital workshop with a minimum of tools.

Bone Nails↗

PubMed1979

External fixation of facial fractures.

Although external fixation is not indicated in every type of facial fracture, its use alone or with intermaxillary or internal fixation may be of benefit with problems resulting from avulsed segments, infection, inadequate previous reduction, delayed reduction, severe displacement and comminution, non-union, cerebrospinal fluid leak or where a combination of these factors exists. The judicious application of extraskeletal fixation can save valuable anesthetic time as well as assure accesibility of the pharynx and maintenance of an airway and routes for nutrition when these might otherwise be compromised. Although extraskeletal fixation is not withou problems or contraindications, it must be weighed in view of the patient's physical, mental and neurological status, and the existence of concomitant injuries.

Accidents, Traffic↗

PubMed1984

[External fixation devices in maxillofacial surgery].

External fixation devices have relatively little application in stomatology, but they are indispensable in certain situations. Equipment presently available for use by maxillofacial surgeons is relatively reduced in number, and two new fixation devices are proposed : a Jacquet type miniaturized fixation device and one of the Sorem type particularly adapted for the mandible.

Equipment Design↗

PubMed2001

Tosic external fixator in the management of proximal tibial fractures in adults.

This retrospective clinical study assessed proximal tibial fractures managed with the Tosic external fixator. Nineteen patients with 21 proximal tibial fractures treated with the Tosic external fixator between July 1997 and October 1998 comprised the study population. Eleven fractures were graded as 41A2, 3 fractures as 41 A3, 4 fractures as 41C1, and 3 fractures as 41 C2. Fourteen fractures were closed, and 7 fractures were open. Average time to healing was 1 7 weeks. No revision of fixation was needed. There were five cases of pin tract infection. Average range of knee motion was 2 degrees-135 degrees. These results indicate the Tosic external fixator is an efficient and simple way to treat proximal tibial metaphyseal fractures.

Adult↗

PubMed1998

Treatment of closed femoral diaphyseal fractures with external fixators in children.

From August 1992 to July 1996, 57 patients with closed femoral fractures were treated by external fixator in the Orthopaedic and Traumatology Clinics, School of Medicine, Dicle University. The technique was applied to children with closed femoral fractures. Their mean age was 6 (range 4-12) years old. The mean hospitalisation period was 8 (range 5-15) days. Fixators were removed on an average of 55 (range 38-79) days. The mean follow-up period was 18 (range 9-36) months. Pintract infection was observed in 3 and refracture in 1 patient. Infection was controlled with oral antibiotics and local dressing. An external fixator was applied to a patient in whom refracture developed. No patient had malunion, nonunion, or leg length discrepancy. We propose that external fixation in closed femoral shaft fractures of children could be a rational alternative mode of therapy, since it has some advantages and can be easily removed without undergoing a second round of anaesthesia.

Child↗

PubMed2004

The effectiveness of pin site care for patients with external fixators.

The aim of this mini-review was to establish if cleaning, dressing and removing crusts from external fixator or skeletal pin sites affected the risk of infection. A systematic search was conducted using Cochrane, Medline, CINAHL and Embase databases. Inclusion criteria were orthopaedic patients with skeletal pins or external fixator devices applied to either upper or lower limbs. The databases were searched for controlled studies comparing at least one aspect of pin site care (cleansing, dressing or crust removal) with a control group of 'observation only'. Only one study met the inclusion criteria. It focused on cleansing external fixator pin sites. The study included two treatment groups, one using 0.9% normal saline and one using 70% alcohol, and a control group which had no cleansing. While the control group had a more favourable outcome than the treatment groups, there is still insufficient evidence from this one study to recommend no cleansing. It is also important to note that the most frequently recommended solution for cleansing pin sites in UK protocols (0.9% normal saline) had the worst outcome, therefore its efficacy in this population may need to be challenged.

Bandages↗

PubMed1998

Type-II external fixation, using new clamps and positive-profile threaded pins, for treatment of fractures of the radius and tibia in dogs.

A new external fixation system for repair of fractures of the radius and tibia was developed that uses positive-profile threaded pins. This system allows for addition of a fixation clamp between 2 installed clamps, predrilling of pin holes through a drill sleeve, use of positive-profile threaded pins in all locations, and easier application of full pins. Type-II external fixators were applied, using this system, to fractures in 10 client-owned dogs, and outcome was evaluated. All fractures healed without complications. Duration of surgery, mean time until radiographic evidence of a bridging callus, and mean time until removal of the external fixator were shorter, and frequency of pin loosening were less than with other techniques. Pin loosening was uncommon. This system provides an important improvement in external skeletal fixation.

Animals↗

PubMed2005

[Treatment of AO type C2-C3 fractures of the distal end of the radius with external fixation].

OBJECTIVES: We evaluated the results of combined treatment with closed reduction, grafting, K-wires, and external fixation in patients with fractures of the distal end of the radius. METHODS: Of 24 patients (15 males, 9 females; mean age 34 years; range 21-73), 16 patients had C2, eight patients had C3 fractures according to the AO classification. Three patients had open fractures, and four patients had signs of median nerve compression. Treatment included closed reduction, autologous grafting (16 cases) followed by fixation with 2 to 5 K-wires, and an external fixator. Clinical and radiographic results were assessed according to the Gartland-Werley's and Stewart's criteria, respectively, and degenerative changes to the Knirk-Jupiter's criteria. The mean follow-up was 35 months (range 25 to 52 months). RESULTS: All of the 19 patients who were employed returned to preinjury working conditions in a mean of 3.5 months. Radial length was preserved to a great extent. The mean amount of collapse of the joint surface was 1.4 mm. The mean loss was 6.7% in radial inclination, and 17.6% in the volar tilt. According to the Stewart's criteria, the results were good, moderate, and poor in 12, nine, and three patients, respectively. Flexion-extension (75%), supination-pronation (70%), and radial-ulnar deviation (75%) were preserved to a great extent. Grip force amounted to 70% of the healthy side. According to the Gartland-Werley criteria, three patients had excellent, eight patients had good, 10 patients had moderate, and three patients had poor results. According to the Knirk-Jupiter's criteria, degenerative changes were slight in 11 patients, moderate in six patients, and severe in one patient. Six patients had no signs of degeneration. Complications included pin track infections (n=4), early transient reflex sympathetic dystrophy (n=2), and hypoesthesia along the superficial branch of the radial nerve (n=2). CONCLUSION: Treatment of the distal end fractures of the radius (AO type C2-C3) with a combination of external fixation, grafting, and percutaneous K-wires provides almost normal radiologic and clinical parameters.

Adult↗

PubMed1987

[External fixation in open fractures of leg. Analysis of traps and complications of the method].

A consecutive series of 51 compound tibial fractures treated by external fixation have been reviewed. All the cases whose progress was marred by complications were analysed separately. From this analysis, the following conclusions have been reached: 1. A gap at the fracture site, due to loss of bone substance or to distraction of the fragments should be treated as soon as possible by bone grafts. 2. Inadequate reduction should be corrected at the time of primary treatment. 3. Pins inserted into the region of the fracture should be repositioned early to prevent infection along the pin tracks. 4. If a sequestrum is evident, it is often necessary to remove such a focus of infection. 5. Weight-bearing, whenever feasible, should be started as soon as possible. A patellar-tendon-bearing orthosis or unilateral semi-elastic external fixation are possible satisfactory solutions in this respect. 6. When the fracture site is infected and contains necrotic fragments, the superiority of external fixation over internal fixation is obvious. The method makes it possible to stabilise the fragments without interfering with local healing and allows the exposed bone to be covered in a stable environment. Because of this analysis of the complications and pitfalls of external fixation, we have been able to put forward a regimen of treatment that may improve results.

Adult↗

PubMed1993

Comparative study of the mechanical behaviour of Castaman external fixator in different mounting configurations.

The mechanical behaviour of the Castaman external fixator was determined using different mounting configurations in a system that simulated a long bone fracture during the formation of the bone callus. The first stage of the study was the determination of the stress-strain characteristics of the system with monolateral mounting. The second stage, the object of this study, is the analysis of the system with bilateral mounting and a comparison between the two configurations of the external fixator examined. Strain gauge analysis was used to determine the strains and stresses in the various elements of the system (fiches and external unit). Numerical techniques (FEM) were also used in order to confirm the results obtained using the simulation system. The results obtained show clearly the greater stiffness of the bilateral system. Combined bending and compressive stresses are present on both the screws and the external units, and reveal a little asymmetrical behaviour due to the conicity of the screws.

Bony Callus↗

PubMed1983

Treatment by external fixation of open fractures associated with severe soft tissue damage of the leg. Biomechanical principles and clinical experience.

External fixation is the treatment of choice for fractures of the leg involving severe damage to the soft tissue. Each of the various patterns of application has advantages and disadvantages. Based on various biomechanical studies and clinical experience, the authors use a right-angle arrangement for the screws. If the type of fracture permits, internal and external fixation may significantly increase stability. During the period from 1978 to 1980, 56 patients with second- and third-degree open fractures were treated. A combination of external and internal fixation was used in 42 patients. Of the 44 patients re-evaluated at follow-up examinations, 19 had returned to unrestricted weight-bearing within 19.8 weeks. If no signs of bony union are noted ten to 12 weeks after the initial operation, cancellous bone grafting and internal fixation instead of external fixation are indicated. Twenty-three patients were fully weight-bearing an average of 14 weeks after internal fixation and cancellous bone grafting. Two patients had difficult problems and did not return to full weight-bearing until about 45 weeks after operation.

Adult↗

PubMed2002

[Role of external fixators for treatment of humeral fractures: report of 23 cases using Orthofix fixators].

From 1991 to 1998, 23 humeral fractures has been treated using the Orthofix external fixator. Average age of the patient was 42 y and average follow-up 55.5 m. Initial trauma was: 13 traffic accidents, four falls at home, two devastating farming accidents, two sports accidents, one aggression and one gun accident. AO classification was used and location of the fracture was classified using Hackethal classification modified by de la Caffinière. Majority of fractures were located at the one-third distal humerus and the majority was also comminuted. At follow-up, elbow range of motion was 130 degrees, shoulder range of motion 161 degrees, external rotation 69.5 degrees and internal rotation 92.5 degrees. Using the classification of Stewart and Hundley, eight excellent, seven good, three fair and two bad results were obtained. There were no postoperative radial nerve palsy. Two external fixators had to be removed because of pin mobility. Failures were: non union and pin mobility in one patient which has to be reoperated on; two non unions have been grafted on and plated. There were no malunion in the postoperative X-rays. This device is our favourite for this type of injury because of its rigidity and the possibility of secondary dynamization. The external fixator was removed after union: this explains the long delay of union in our series.

Accidents↗