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At least 469 records · Page 26Linked to original sources
PubMed1991

External fixation of Smith's fracture. 16 patients followed for 2 years.

External fixation of 16 Smith's fractures was evaluated after 22 (6-42) months. In 15 patients, the radiographic results were satisfactory. There was a definite correlation between the radiographic and clinical end results. However, 6 patients had residual signs of an upper limb dystrophy. Although external fixation of Smith's fractures results in good function, this method should be used with caution because it cannot prevent reflex dystrophy; indeed, it may even initiate it.

Adult↗
PubMed1998

Intraarticular fractures of the distal radius treated with metaphyseal external fixation. Early clinical results.

Twenty-two patients with unstable Frykman grade 7 or 8 intra-articular fractures of the distal radius were treated with an external fixator. The distal pins were inserted into the distal radial fracture fragments, permitting movement of the wrist and hand. Eleven patients were male and 11 female, with a mean age of 50 years. All patients had regained full function with good range of motion at mean final follow-up of 12 months. However function, pain and range of motion had returned to acceptable levels 4 weeks after removal of the external fixator. This method of external fixation provides a reliable method of maintaining fracture reduction whilst allowing early return of function.

Adult↗
PubMed1983

[Necessary stability and biomechanics of fracture healing in external fixation osteosyntheses].

In recent years, many investigators have concerned themselves with improving the construction of the external fixator in order to achieve even greater stability. Clinical observations demonstrate a moderate callus formation and an often considerably delayed fracture healing resulting from such an extreme rigid mounting of the external fixator. This report presents biochemical considerations which indicate that extreme rigidity in the external fixator is not only unnecessary, but may even interfere with fracture healing and the formation of functionally stable bone.

Biomechanical Phenomena↗
PubMedDate not supplied

The use of external fixators in femur fractures in children.

Between 1988 and 1993, 81 children with 82 femur fractures were treated with external fixators at the Santobono Children's Hospital of Naples. This technique was reserved for children older than 6 years with open fractures, multiple fractures, multiple trauma, and unstable fractures. The patients were placed in skin traction on admission, and after 24-48 h, the external fixator was applied under general anesthesia. Therefore, within 1 week the children were able to take care of themselves and to attend school. The fixator was very well tolerated and was removed 8-9 weeks later. The fractures healed with good alignment, no complications with few cases of superficial infections, and less overgrowth. The use of external fixation is recommended for its simplicity and lack of complications.

Child↗
PubMed1992

External fixation of the distal end of the radius: the same technique for different patient populations?

A series of 56 consecutive patients with 59 fractures of the distal end of the radius, treated with a unilateral Hoffmann external fixator between 1980 and 1988, is presented. Forty-seven of these patients underwent clinical re-examination at home. We could distinguish two different groups of patients: an older female group with an average age of 59.2 years and a younger male group with an average age of 40.1 years. The fractures in the women were caused by lower energy trauma than those in the men (P less than 0.05). The men had significantly more complex fractures (Frykman type VII or VIII) than the women (P less than 0.05). The indications for external fixation were significantly different in men and in women (P less than 0.01). The external fixator remained in place for an average of 5.7 weeks. The injured wrist had on average 71% of the strength of the contralateral wrist. Eighty-seven percent of the patients had no complaints in performing their daily activities. In 70% X-ray showed anatomical reduction, in 64% there was 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 anatomical reconstruction of the wrist joint. It may be necessary to supplement the external fixation with open reconstruction of the wrist joint and/or a cancellous bone transplant. In some cases, a change of procedure to plate osteosynthesis could be the treatment of choice.

Adolescent↗
PubMedDate not supplied

Secondary fractures associated with external fixation in pediatric femur fractures.

Sixty-six femur fractures sustained by children ages 4-14 years and treated with external fixation were reviewed retrospectively to assess factors influencing the incidence of refracture. The total rate of secondary fracture was 12% (eight patients) including five recurrent fractures at the original fracture site and three fractures through the pin sites. After removal of the external fixator, five patients refractured at the original fracture site and one patient fractured through a pin tract. Two patients fractured at pin sites while the fixator was still in place. Multivariate linear-regression analysis showed no correlation between the incidence of refracture and fracture pattern, percentage of bone fragment contact after fixator application, type of external fixator, or dynamization. A statistically significant association (p < 0.05) was found between the number of cortices demonstrating bridging callus [on both anteroposterior (AP) and lateral views] at the time of fixator removal and the rate of refracture. Fractures showing fewer than three cortices of bridging callus had a three (33%) in nine rate of refracture, whereas fractures with three or four cortices of bridging callus had a two (4%) of 57 rate of refracture.

Adolescent↗
PubMed2001

Treatment of intertrochanteric fractures by external fixation.

In this study, we aimed to evaluate the results of treatment of intertrochanteric fractures of the femur by external fixation in 33 patients with an average age of 65.9 years. Patients in the study had Evans stable type 1 intertrochanteric fractures and unstable type 1 fractures that could be reduced to anatomical or nearly anatomical position by closed manipulation under fluoroscopy. The average follow-up period was 24 months (range, 12 to 40 months). There was no mortality in the early postoperative period, but the mortality within six month following surgery was 39%. Complete fracture healing was achieved in all patients. The fixator was removed after an average of 94 days (75 to 130 days) at the outpatient clinic. Varus malalignment of more than 20 degrees and limb shortening greater than 2 cm were noted in 3 patients. Pin-tract infection was seen around 10 pins (7%). Osteomyelitis was not noted in any patients. Treatment of intertrochanteric fractures by external fixation is simple and can be done under local anesthesia together with narcotic analgesic support. It allows early mobilization, and implant removal is easy. Therefore we think that external fixation is a valuable alternative in high-risk geriatric patients.

Age Factors↗
PubMed2002

Pelvifemoral external fixation for the treatment of open fractures of the proximal femur caused by firearms.

Seventeen patients with open fractures of the upper third of the femur were treated using a pelvifemoral external fixation device. All of them had grade III open fractures resulting from high-velocity missile and explosive injuries with massive foreign body contamination. Sciatic nerve injury was present in five (29.4%); abdominal viscera and thoracic wall injuries were present in two patients (11.8%). There were no major arterial injuries. Full weight bearing was allowed after clinical and radiological bone healing (average 11.5 months). Chronic osteitis with fistula and sequestra developed in two (11.8%) patients. There were no nonunions and no refractures. Minor painless limitation of hip motion persisted in all patients. Upper-third femoral open fractures due to firearms are a unique type of open fractures. They are usually highly comminuted; therefore, stable fixation is difficult or impossible to achieve using external fixation with transfixation of the fracture site. On the other hand, the risk of infection is high following intramedullary nailing. Pelvifemoral external fixation allows adequate management of the soft tissue wounds, provides stable bone fixation and allows early patient mobilization.

Adult↗
PubMed2000

The treatment of complex carpal dislocations by external fixation.

This article presents the treatment of complex carpal dislocations and fracture dislocations by external fixation. Twenty-four patients were treated with external fixation after complex carpal trauma. Operative technique, aftertreatment, complications and long-term results are presented and discussed.

Adolescent↗
PubMed2006

Operative treatment by external fixation for polyostotic fibrous dysplasia in the elbow joint. A case report.

Fibrous dysplasia is a condition in which normal skeletal bone changes into fibroblastic stroma and immature bone. We report our experience of a unilateral external fixator applied for the treatment of polyostotic fibrous dysplasia arising in the elbow. The patient was a 38 year-old man. His main complaint was left elbow pain and a mass, which increased in size. The histological diagnosis from the needle biopsy was fibrous dysplasia. An articulated unilateral external fixator was used for immobilization. The lesions in the left distal humerus and proximal ulna were curetted and cancellous bone was packed into the cavity. An external fixator (Elbow Fixator, Orthofix Inc., McKinney, USA) was applied from the proximal humeral shaft to the distal ulnar shaft for postoperative tentative immobilization and preservation of the affected elbow joint movement. At two years after the operation, the range of motion of the affected elbow was 90 degrees in flexion and -35 degrees in extension. The range of motion in pronation and supination of the left forearm was normal. No evidence of recurrence was noted at two years after surgery. The merits of using an external fixator were: an earlier start of range of motion exercises, and a decrease in the risk of tumor dissemination.

Adult↗
PubMed1991

Piroxicam-induced reduction in osteopenia after external fixation of rabbit tibia.

Twelve rabbits were treated with a unilateral external fixator in one tibia for 12 weeks, while the other tibia served as an intact control. Half of the animals were also treated with 10 mg/kg/day of piroxicam, given in two daily oral doses. Changes in bone mineral content were determined using single photon absorptiometry. After 12 weeks, we found a 3 percent decrease in the bone mineral content in the tibia of the animals treated with piroxicam versus 9 percent in the nonpiroxicam group (P = 0.04). In the femurs, there was an insignificant decrease in bone mineral, 2 percent (piroxicam) and 1 percent (nonpiroxicam) respectively. The results indicate that piroxicam may reduce the osteopenia caused by external fixation.

Absorptiometry, Photon↗
PubMed1991

Treatment of femoral shaft fractures in children by external fixation.

Non-operative management is still the treatment of choice for closed fractures of the femoral shaft in children. Indications for operative intervention would include: children with multiple injuries; severe soft tissue damage; cases where reduction is difficult to maintain; and children not suitable for management by traction. Since 1984, 16 children (mean age 10.3 years) have had stabilization of their femoral shaft fractures by external fixation (Monofixateur) in the Trauma Department of the Hannover Medical School. The external fixation remained in place for a mean of 63 days. Of the 16 children, 15 have been reviewed, with a mean follow-up of 28.2 months. No children who were completely managed with this fixation had any clinically relevant malalignment, but six cases had up to 2 cm difference in leg length. Our observations and experience show that external fixation is a useful alternative for the operative management of femoral shaft fractures in children. It produces good stability, is less invasive, and allows early mobilization. In order to avoid differences in leg length, we recommend a good anatomical reduction with the external fixation being carried out as early as possible.

Adolescent↗
PubMedDate not supplied

Three-dimensionally corrective external fixator system for proximal femoral osteotomy.

The authors introduce a technique of proximal femoral osteotomy using three-dimensionally corrective external fixator systems for treatment of Legg-Calvé-Perthes disease and slipped capital femoral epiphysis, and describe the results of 47 hips in 44 children. Postoperative casting immobilization was not performed. All osteotomies gained the correction angle as planned. All osteotomies healed with no nonunions, malunions, device failures, or avascular necrosis. Complications occurred in 7 (15%) of 47 hips. Pin tract infection occurred in six (13%) hips; one of these (2%) needed debridement. The bulky external fixator caused slight inconvenience, but the current results indicate that the proximal femoral osteotomy using the external fixator system provided an easily repeatable intraoperative varus/valgus and flexion/extension correction compared with other internal fixation devices, and sufficient fixation for children without significant complications.

Child↗
PubMed2002

External fixator in the management of trochanteric fractures in high risk geriatric patients--a friend to the elderly.

The best treatment option for trochanteric fracture in a geriatric high risk patient with all associated medical and surgical problems remains debatable. Conservative methods of treatment are associated with dangerous complications of prolonged recumbency while open reduction and internal fixation under anaesthesia significantly increases the mortality and morbidity rates. We treated 110 elderly patients who were unfit or high risk cases for anaesthesia and major surgery for internal fixation due to associated medical and surgical conditions, by external fixation under local anaesthesia. The average age was 65 years and mean follow up was 18 months. 83.3% were ambulatory with support and 97.2% were able to manage activities of daily living at the time of discharge. At 18 months post surgery, 74% were ambulatory with a stick or better. The fracture united in an average of 16.4 weeks. Overall satisfaction rate was 80% at end follow up. The mortality rates were comparable to series of open reduction and internal fixation. Pin tract infection and knee stiffness were the major complications. External fixation done under local anaesthesia offers advantages in the form of a quick, simple relatively inexpensive procedure with negligible blood loss, preserves fracture haematoma, can be easily removed as an out patient procedure, besides it provides earliest possible ambulation and day care to the elderly high risk patient.

Aged↗
PubMed2003

The value of external fixation for unstable pelvic ring injuries.

Unstable pelvic ring injuries are severe injuries, with high morbidity and mortality rates. Since 1994, the authors have been using external fixation to treat these injuries. They present the results achieved in a series of 22 cases of unstable pelvic ring injuries admitted to their institution between 1994 and 2001. External fixation was performed in all cases with pins inserted between the anterior superior and the anterior inferior iliac spine. Posterior injuries were treated operatively in four cases and non-operatively in others. The average age of the patients was 32 years (range: 22 to 56 years). According to Tile's classification, there were 10 type B and 12 type C injuries. Functional evaluation using Majeed's score at the time of review showed a mean score of 75.6 (range: 12-100). The pain score was 22.7/30. Radiological results were good in horizontal injuries, with satisfactory reduction of the symphyseal disruption. In vertical shear injuries however, skeletal traction alone did not achieve accurate posterior reduction in four cases, in which internal fixation was required. Anteroinferior placement of external fixation pins appears as a safe technique with a potential for increased stability of fixation. Associated posterior injuries must be treated with direct internal fixation in cases with vertical instability in which heavy skeletal traction has failed to achieve reduction.

Adult↗
PubMed2005

Treatment of war injuries of the shoulder with external fixators.

In this retrospective study, 18 patients with war injuries of the shoulder were reviewed to evaluate the technical problems associated with external fixation and to analyze the incidence of infection and late functional results. The average patient age was 28.5 years. All patients were male. Thirteen patients had explosive wounds, whereas five wounds were caused by gunshot missiles. All injuries were extensive in terms of bone and soft tissue defects. Six patients presented with complex injuries involving neurovascular structures. Sixteen patients were treated with external fixation. Application of the proximal pins of the external fixator through the humeral head was possible in eight patients, the scapula served as the site of proximal fixation in four patients, only the clavicle was available for placement of pins in two patients, and both the scapula and the clavicle had to be pinned to achieve proximal stabilization in two patients. In two patients, fixation was not possible and early amputation was performed. Infection was eventually eradicated in all patients, allowing for adequate soft tissue coverage of the wounds. Analysis of functional results at an average of 6 years after the injury showed a considerable degree of functional deficit in most patients.

Adult↗
PubMed2005

Distal radius fractures: a comparison of tension band wiring versus ulnar outrigger external fixation for the management of distal radioulnar instability.

PURPOSE: To retrospectively compare the results of immobilization of the forearm in supination with the results of tension band fixation of the ulnar styloid in 35 patients with distal radius fractures, fracture of the base of the ulnar styloid, and distal radioulnar joint instability treated with external fixation. METHODS: Thirty-five patients with fractures of the distal radius, fracture of the base of the ulnar styloid, and unstable distal radioulnar joint had external fixation with adjunctive percutaneous pins and allograft bone to reduce and stabilize the distal radius fracture anatomically. Only those patients with an associated ulnar styloid base fracture displaced over 2 mm with gross distal radioulnar joint instability relative to the contralateral wrist were included in this study. Group 1 consisted of patients in whom the ulnar styloid base fracture was treated with conventional tension band wiring techniques. Group 2 patients were treated with a supplemental outrigger from the external fixator to the ulna and locked in 60 degrees of forearm supination. Groups 1 and 2 had an average follow-up period of 40 and 36 months, respectively. RESULTS: Group 2 had significantly better supination than group 1. In terms of functional outcome it was found that there was no significant difference for the Disabilities of the Arm, Shoulder, and Hand and the Gartland and Werley scores between the 2 treatment groups. There was a lower rate of complications and fewer secondary procedures were required in group 2. The incidence of distal ulna resection was 4 of the 35 patients (2 patients in each group). CONCLUSIONS: Our results indicate that patients in whom the ulnar styloid can be reduced and maintained in supination can be treated effectively with fixed supination outrigger external fixation. This method resulted in a statistically significant improvement in supination and a lower rate of distal radioulnar joint complications, and it required fewer secondary procedures.

Adult↗