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PubMed2004

Hybrid thin wire external fixation: an effective, minimally invasive, modular surgical tool for the stabilization of periarticular fractures.

Hybrid thin wire external fixation is an effective, minimally invasive treatment for the stabilization of periarticular, supracondylar, and pilon fractures. The extent of bone and soft-tissue loss, high risk of infection, and further damage to the soft tissues precludes open reduction and internal fixation as a safe treatment method. External fixation preserves the soft-tissue envelope with minimal damage and allows fracture stabilization, early loading, and mobilization, which promote bone healing.

Adolescent↗
PubMedDate not supplied

External fixation and sequential nailing in the treatment of open diaphyseal fractures of the tibia.

Between September 1996 and April 1998 a total of 26 open fractures of the tibia (Gustilo Anderson grade I in 4 cases, grade II in 3, grade IIIA in 8, grade IIIB in 11) were treated by debridement and monoaxial external fixation followed by locked intramedullary nailing after healing of the soft tissues had been observed. Nailing by reamed Grosse Kempf nail was carried out in all of the cases. The mean duration of external fixation was 50 days (with a minimum of 18 days and a maximum of 6 months). Upon removal of the external fixator intramedullary osteosynthesis was performed during the same surgical session in 25 cases. Nailing was carried out 45 days after removal of the external fixator in 1 case. Healing was obtained in all of the patients an average of 6 months after trauma, and 3 and 1/2 months after the second operation. There were two cases of infection, one deep (3.8%) and the other superficial (3.8%). No cases of chronic osteomyelitis were ever observed. Poor consolidation with valgus equal to 10 degrees and 15 degrees was observed in 2 patients. This method of treatment, based on our experience, allows for healing in some open fractures of the tibia in a relatively short amount of time and with an acceptable risk of complications.

Adolescent↗
PubMed1995

[Treatment of septic arthritis of the hand using temporary intermittent immobilization with an external fixator].

OBJECTIVE: To evaluate the treatment of a bacterial infection of a finger joint with incision, drainage and intermittent immobilization using external fixation apparatus. DESIGN: Retrospective, descriptive. SETTING: Department of Surgery, St Elisabeth Hospital, Tilburg. METHOD: In eight males and two females (median age 37 years) with acute bacterial arthritis of a finger joint, this joint was opened surgically, washed out and then immobilized using mini-external fixation equipment, for about 3 weeks. The fixator was unscrewed daily so that the patient could move the finger in water, with the purpose of mechanical cleansing of the joint; the intermittent pressure that occurs in the cartilage during movement is supposed to promote the removal of debris. Subsequently, the finger was fixed in alternating positions to prevent adhesions. Mean duration of follow-up was 48 months (11-78). RESULTS: Arthrodesis had to be carried out in one patient because of persistent arthritis and tissue necrosis, while in one other, part of the finger was amputated. The other eight patients showed good final results, without symptoms. CONCLUSION: In bacterial arthritis of a finger joint, temporary intermittent immobilization using external fixation equipment is certainly worth consideration.

Adult↗
PubMed1994

[Complex distal radius fracture: value of spongiosa-plasty in combination with external fixator treatment].

22 Patients with complex fracture of the distal radius (Fernandez III/Frykman VII-VIII/AO 23.C) underwent treatment with external fixation and auxiliary autologous bone grafting in purpose to reconstruct and stabilize the radiocarpal articular surface, reset the radius length, obtain a quicker bone healing and avoid secondary radius shortening after removing of the external fixation. In spite of reassessment of radius length in 80% and reconstruction of the radiocarpal articular surface in 75%, late control showed the development of radiological signs of radiocarpal arthritis. 50% of the patients have a moderate loss of strength and motility in the wrist; this seems to be a good result for a very negative selection of complex fractures of distal radius. We recommend autologous bone grafting in treatment of complex fractures of the distal radius with external fixation.

Adult↗
PubMedDate not supplied

Impact of external fixation on adolescents: an integrative research review.

PURPOSE: To define the state of nursing knowledge about the psychological impact of treating adolescents with external fixation devices (EFDs). METHOD: An integrated research review was conducted on literature available from CINAHL, MEDLINE, and PsycINFO. Keywords used were external fixation, fracture fixation, orthopaedic or orthopaedic, limb lengthening, Ilizarov, halo traction, Orthofix, EBI fixator, pelvic fixator, ring fixator, body image, self-concept, self-esteem, self-perception, adaptation, emotional, behavior, and outcome. Inclusion criteria for studies were (a) publication from 1990 to 2003, (b) focus on psychosocial and functional outcomes of treating adolescents with EFDs, and (c) publication in English. Studies were categorized by author, year, discipline(s), design, focus, sample, measurement, findings, and research recommendations. Findings and recommendations were compared across publications. RESULTS: All studies reported psychological and behavioral changes after EFD treatment. Pain and pin-site infections were the most problematic physical findings. Depression was universally evident to varying degrees, with some suicidal ideation and self-destructive behaviors, although mostly reported as transient. This predominantly retrospective cohort of studies reported social isolation as well as eating and sleep disturbances. Family and nursing support, a multiple disciplinary approach, and better preoperative preparation were crucial to adolescents psychological health after EFD treatment. CONCLUSION: Adolescents treated with EFDs require significant psychosocial support. The findings reveal major gaps in the knowledge on adolescents treated with external fixation for traumatic injury and none focused on EFD treatment in the acute period.

Adaptation, Psychological↗
PubMed1989

Treatment of unstable Colles' fractures by external fixation.

Twenty-six patients with unstable comminuted fracture of the distal part of the radius were treated with external fixation using Hoffmanns external fixation device. The average follow-up was 29 months. The anatomical results were 85% good or excellent, 10% fair and 5% poor. Functionally, 60% were good or excellent, 25% fair and 15% poor. There were three major complications and nine minor complications, the overall complication rate being 60%, though only 15% were major. The method is recommended when dealing with fractures of type VII and VIII, but not as a general routine.

Adolescent↗
PubMed2003

Clinical results of external fixation for unstable Colles' fractures.

The objective of this study is to evaluate clinical and radiological outcomes of unstable or intra-articular Colles' fractures using the Pennig model of external fixation. The Pennig model of dynamic external fixation was used on 88 patients with 92 Colles' fractures. In 35 wrists, exercise was not performed during external fixation. In 57 wrists, exercise was initiated three weeks after surgery. Regarding radiological measurements, the degrees of volar tilt (VT), radial inclination (RI), radial length (RL) and ulnar variance (UV) were serially measured and evaluated. The clinical results were evaluated according to Sarminento's criteria. Favourable therapeutic outcomes (excellent and good) were obtained in 95.6% of the cases. However, when complicated by die-punch fractures, the outcome tended to be poorer. Postoperative re-displacement was often observed in patients over 50 years old. UV tended to increase and RL tended to decrease in the early motion group after the initiation of exercise. Neither VT nor RI significantly changed in either group during the postoperative observation period. Of patients in whom bone union of ulnar styloid fractures was not achieved, 32.2% complained of ulnar pain. Moreover, osteoarthritic changes were observed in two of 11 wrists with a step off of 1 to 2 mm or larger. In order to maintain the reduction position, it was important to determine the appropriate time for initiating exercise depending on the degree of fixation in each individual patients. The step off of the articular surface should be reduced to less than 1 mm and reductive fixation has to be performed additionally when complicated by ulnar styloid fractures.

Adolescent↗
PubMed2006

Tibial plafond fractures treated by articulated external fixation: a randomized trial of postoperative motion versus nonmotion.

OBJECTIVES: Assess whether postoperative ankle motion after fixation of a fracture of the tibial plafond, treated with articulated external fixation, leads to a better outcome when compared with similar treatment without postoperative ankle motion. DESIGN: Multicenter randomized trial. SETTING: Three Level I trauma centers. PATIENTS/PARTICIPANTS: Fifty-five patients were enrolled and entered into a Web-based database and randomized into 1 of 2 groups. Forty-one patients were evaluated at a 1-year follow-up visit, and 31 were seen at 2 years or longer after injury. INTERVENTION: Patients were treated with a hinged external fixator and limited internal fixation of the articular surface. They were divided postoperatively into two groups, 1 of which had a locked hinge and the other had a mobile hinge and a motion protocol. MAIN OUTCOME MEASUREMENTS: A general health status questionnaire, the SF-36 (short-form 36); a joint-specific ankle questionnaire, the Ankle Osteoarthritis Score (AOS); and range of motion (ROM) of the ankle joint. RESULTS: There were no significant differences between the two groups at either follow-up interval in the ankle ROM measurement, the AOS pain and disability scale, or the SF-36 physical component summary (PCS) and mental component summary (MCS) scales. CONCLUSIONS: These results indicate that treatment protocols that use long periods of cross-joint external fixation that immobilizes the ankle as definitive treatment result in similar patient outcomes compared to otherwise identical treatment protocols that incorporate and use an articulated hinge for ankle motion. However, the results should be interpreted with caution because the patient numbers were too small to detect potentially meaningful differences in outcomes and the follow-up was too short to assess for differences in the development of arthrosis.

Adult↗
PubMed1997

Sequential intramedullary nailing of open tibial shaft fractures after external fixation.

We reviewed 32 tibial shaft fractures in 31 patients treated with sequential intramedullary nailing after primary external fixation. There were 30 open fractures and 2 closed injuries with severe blunt trauma requiring fasciotomy. Fifty per cent of the fractures were classified as Gustilo type III A and B injuries. The mean external fixation treatment averaged 6.6 weeks, and secondary intramedullary nailing was done on average 7.4 weeks after injury. In 50% of the fractures, secondary nailing was done at the same procedure as removal of the external fixation. Overall, the incidence of osteomyelitis and non-union was 3.1% each and of malunion 19%. The time to full weight-bearing averaged 31.2 weeks. The results were separately analyzed according to Gustilo types and subtypes. In the Gustilo type III B injuries, the incidence of osteomyelitis and non-union was 11%, while malunion occurred in 33%. The time to full weight-bearing averaged 53 weeks. These results support the conclusion that this treatment modality is a valid alternative to other treatment options. However, previous pintract infections should be regarded as a contraindication for secondary nailing.

Adolescent↗
PubMed1999

Fracture healing of the sheep tibia treated using a unilateral external fixator. Comparison of static and dynamic fixation.

It is generally accepted that when a fracture is treated with external fixation, dynamization of the fixation accelerates formation of the bony callus by transferring part of the functional loads. The aim of the research presented here was to validate this principle using in vivo measurements of callus stiffness. We created a transverse fracture in the mid third of the tibial shaft in 12 sheep and maintained a 3 mm gap between the fragments for 3 weeks. Two types of unilateral external fixators were applied. Axial loading was permitted (dynamization) from the fourth week onwards in 6 animals. In the other 6 animals, fixation remained static for both types of fixation. Weekly measurements of callus stiffness were obtained using a goniometer and load cell to assess bending stiffness. Two slightly different fixators were used. Callus formed in all 12 animals. Callus stiffness increased exponentially to reach the degree of stiffness measured on the contralateral side. There was no clear difference in healing between the two types of fixations nor between dynamic and static fixation. If a unilateral fixator was applied which did not maintain absolutely rigid fixation, the fracture generally healed well even without contact between the fragment ends. If the process of callus formation had begun normally, dynamic fixation offered no further benefit. Measuring the stiffness of the callus with an adequate measurement apparatus in vivo indicated that the fixator could be removed earlier than would have been authorized on the basis of radiological evidence alone.

Animals↗
PubMed2004

Hydroxyapatite-coated external-fixation pins. The effect on pin loosening and pin-track infection in leg lengthening for short stature.

Pin loosening and infection are inherent complications of external fixation. This study deals with their effects of using either hydroxyapatite (HA)-coated or uncoated external fixation pins in leg-lengthening procedures on patients of short stature. We used HA-coated pins on one side and uncoated pins on the other (randomly determined) in 28 bilateral lengthenings undertaken in 23 patients. A total of 322 pins was used. The mean implantation time was 530 days and the mean lengthening achieved was 78% of initial bone length. Mean extraction torque was 7611.6 Nmm degree(-1) for HA-coated and 85.4 Nmm degree(-1) for uncoated pins (p < 0.001). The rate of pin loosening was 4% (7/161) for HA-coated and 80% (129/161) for uncoated pins (p < 0.001). There was no statistically significant difference in the incidence of pin-track infection between the two groups. The use of HA coating appears to be an effective method of reducing the incidence of pin loosening in external fixation with a long implantation time and for mechanically highly stressed procedures such as leg lengthening for short stature.

Adolescent↗
PubMed1993

Comminuted intra-articular fractures of the distal end of the radius treated with the Hoffmann external fixator.

In 1985 we began a prospective study of the use of external fixation in the treatment of intra-articular comminuted fractures of the distal end of the radius. A total of 30 patients have been treated by this method, representing 1.3% of the total number of patients treated in the Emergency Unit for a fracture of the distal epiphysis of the radius. The use of external fixation in instable fractures of the distal end of the radius improves the anatomic results. These correlate closely with the overall functional results obtained, which were excellent or good in 82.1% of cases, according to the rating system of Gartland and Werley. The main indications are fractures with a high degree of comminution, displacement, and articular affectation (unstable fractures) in young patients, corresponding to Frykman grades VII and VIII.

Adult↗
PubMed2005

[Functional results of the Ilizarov circular external fixator in the treatment of open tibial fractures].

OBJECTIVES: We evaluated functional results with the Ilizarov circular external fixator in the treatment of open tibial fractures. METHODS: Thirty-three patients (26 males, 7 females; mean age 38 years; range 16 to 69 years) with open tibial fractures were included. According to the AO/OTA classification, there were seven type A, 16 type B, 10 type C fractures; according to the Gustilo-Anderson classification, eight, 12, and 13 fractures were grade I, II, and III, respectively. The mean time to surgery was 5.7 days (range 3 to 12 days). Compression-distraction was applied in five patients to speed up union. Functional outcomes were assessed according to the Karlstrom-Olerud scoring system. The mean follow-up was 28 months (range 19 to 34 months). RESULTS: Time to union did not differ significantly between grade I and II fractures (p>0.05). However, there were significant differences between grade I and III (p=0.0001) and grade II and III (p=0.001) fractures with respect to union times. According to the Karlstrom-Olerud scores, functional outcome was good in 14 (42.4%), satisfactory in 11 (33.3%), and fair in eight (24.2%) patients. The most common complication was pin tract infections (28.4%). Seven K-wires were replaced. Two patients (6.1%) who developed osteomyelitis underwent sequestrectomy following removal of two K-wires. Peroneal nerve injury occurred in two patients associated with K-wires. Ankle and knee movements were adversely affected due to the external fixator in seven and four patients, respectively. CONCLUSION: Although the use of the circular external fixator is associated with a relatively high risk of pin tract infections, functional results may justify its use in the treatment of open tibial fractures, with an added advantage of early mobilization.

Adolescent↗
PubMed2006

Calcaneal fractures: indirect reduction and external fixation.

BACKGROUND: The current treatment of displaced intra-articular calcaneal fractures has been surgical fixation. The objective of this study was to evaluate the use of indirect reduction with Ilizarov external fixation as a viable alternative in the surgical treatment of certain calcaneal fractures. METHODS: Thirty-one patients with 33 fractures of the calcaneus (Sanders types II, III, and IV) were treated using small wire circular external fixation. A limited percutaneous plantar skin incision was used to improve reduction of the posterior facet. Fractures were evaluated by preoperative CT scans and classified by an independent observer. Patients were evaluated by physical examination as well as by the AOFAS hindfoot score questionnaire. Followup ranged from 6 months to 4 years. RESULTS: The average AOFAS score for 18 patients available for examination was 66 (42 to 92). The average score increased to 74 for patients with more than 10 months followup and to 77 for patients with isolated calcaneal fractures. Open fractures also had early debridement and soft-tissue coverage; no deep infections were seen in this subgroup. There were 11 complications, including nine superficial pin track infections, one superficial skin necrosis under an area of fracture blister, and one deep infection in a diabetic smoker with severe hemorrhagic fracture blisters. All superficial infections responded to local pin or wound care and oral antibiotics. No secondary reconstructive procedures, including osteotomies, subtalar fusions, or amputations, have been done. All open fractures healed and maintained soft-tissue coverage. CONCLUSIONS: Indirect reduction and external fixation is a viable surgical alternative for intra-articular calcaneal fractures. Particularly favorable results were obtained in open fractures when soft-tissue reconstruction also was done. Advantages include shorter time to surgery, immediate weightbearing, minimal invasiveness, few serious wound problems, and no residual hardware. Disadvantages include technical difficulty, incomplete reduction of fracture fragments, and the need for secondary surgery (fixator removal).

Adult↗
PubMed2003

Hydroxyapatite coating of external fixation pins to decrease axial deformity during tibial lengthening for short stature.

BACKGROUND: Tibial valgus, a known complication of leg lengthening with external fixation techniques, has been related to the stability of the bone-fixator system and, in particular, to pin loosening. A hydroxyapatite coating has been reported to enhance the quality of the bone-pin interface. The aim of this study was to compare the prevalence of axial deformity after tibial lengthening with hydroxyapatite-coated external fixation pins with the prevalence after tibial lengthening with uncoated pins. METHODS: We conducted a prospective study of thirty-four symmetrical tibial lengthening procedures in seventeen pathologically short patients. One limb of each patient was lengthened with use of hydroxyapatite-coated pins and the other, with standard uncoated pins; the sides of the operations were randomly selected. The bone angle in the frontal plane was measured before the operation and at the end of the fixation period, and the difference between these measurements was compared between the lengthening procedures performed with coated pins and those performed with uncoated pins. RESULTS: The mean valgus deviation of the tibia was 6.5 degrees in the group treated with hydroxyapatite-coated pins and 12.5 degrees in the group treated with uncoated pins (p = 0.023). With the numbers available, other factors previously related to the development of valgus deformity did not differ significantly between the two groups. CONCLUSION: Tibiae that are lengthened with the use of hydroxyapatite-coated external fixation pins are less prone to axial deviation in the frontal plane than are those treated with uncoated pins. LEVEL OF EVIDENCE: Therapeutic study, Level I-1a (randomized controlled trial [significant difference]). See Instructions to Authors for a complete description of levels of evidence.

Adolescent↗
PubMed1990

Ender rods versus external fixation in the treatment of open tibial fractures.

This is a retrospective nonrandomized study of 66 open tibial fracture patients that compares comparable population treated at one trauma center. The fractures were treated with either Ender rods or external fixation. Of these, 29 fractures were eliminated from the study due to incomparable variables. Thus, the study group consisted of a total of 37 tibial fractures: 20 treated by Ender rods and 17 treated by external fixation. Open tibial fractures treated with Ender rods had a significantly lower number of complications than those treated with external fixation. The group treated with Ender rods also had a significantly lower number of surgical procedures per patient in Grades I and II open tibial fractures. There were no statistical differences regarding weeks to union or hospital days. Ender rods are superior to external fixation removed early in the treatment of Gustilo's Grades I, II, and IIIA open fractures with either stable or unstable fracture configuration (Orthopaedic Trauma Association Grades IA-IC, IIA-IID, and IIIA-IIIC). Perhaps future study will allow sufficient numbers to determine whether Ender rods can be used in Grades IIIB and IIIC open tibial fractures, but there are no data at this time to support this conclusion.

Adult↗
PubMed2001

Forward surgical stabilization of penetrating lower extremity fractures: circular casting versus external fixation.

OBJECTIVE: There are two choices for the stabilization of penetrating lower extremity fractures in the forward surgical environment: bivalved circular casting and external fixation. The material and equipment requirements of these methods are of paramount importance in the austere forward surgical environment. METHODS: Casualties from the Battle of the Black Sea in Somalia 1993 were examined. Penetrating lower extremity fractures requiring immobilization were identified. The relative packing volume and weight for each method of immobilization were analyzed. Finally, the current literature concerning the treatment of penetrating lower extremity fractures sustained in combat was reviewed. RESULTS: The consumable material requirements of cast immobilization are 22.9 times greater by weight and 3.16 times greater by packing volume. Cast immobilization also has a greater durable equipment requirement. External fixation has multiple clinical advantages but is considerably more expensive. CONCLUSION: Based on these variables, the authors determined that external fixation is the treatment of choice for penetrating lower extremity fractures in the forward surgical environment.

Casts, Surgical↗
PubMed2002

Silver coated materials for external fixation devices: in vitro biocompatibility and genotoxicity.

The most significant complication in external fixation is pin tract infection causally related to the highly adaptive ability of bacteria to colonise the surfaces of "inert" biomaterials or of adjacent damaged tissue cells. The hypothesis that coating a pin with a silver-containing compound will decrease bacterial colonisation and/or pin tract infection has been confirmed in other studies in vitro and in vivo experiments. In this work, biocompatibility of silver-coated orthopaedic external fixation pins was compared with stainless steel controls in an in vitro study. Human peripheral blood lymphocytes were used to assess the possible genotoxic effect of silver, studying the frequency of sister-chromatid exchanges and micronuclei while fibroblasts (NIH 3T3) and osteoblast-like cells were used for cytotoxicity and cytocompatibility studies. These studies have shown that silver is neither genotoxic nor cytotoxic as compared to stainless steel, a material in wide use as a metal implant. At 4 days cells cultured on the silver-coated material evidenced good cell spreading and a higher cell count with respect to the uncoated material. It appears that the addition of silver onto implantable medical devices could be beneficial when specific biological properties, such as antibacterial behaviour, are required. Based on these and the previous bacterial studies it seems like the toxicity towards bacteria was quite a bit greater than that towards the human cells.

3T3 Cells↗