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PubMed1993

Pilon fractures: treatment with combined internal and external fixation.

The purpose of this study was to prospectively evaluate the use of limited internal fixation and the application of a hybrid external fixator (tensioned wires distally and 5.0 mm half pins proximally attached to a semicircular frame without crossing the ankle joint) in the treatment of severe distal tibia fractures. This technique involves accurate reduction and fixation of the intraarticular component through an incision based over a fracture site followed by stabilization of the metaphysis with the hybrid external fixator. We studied 26 patients 15-55 years of age who were followed for 8-36 months. All fractures were within 5 cm of the joint. Seventeen fractures were intraarticular, nine extraarticular, and six open. Eleven patients required bone grafting. The average time to healing was 4.2 months. Using clinically based criteria, there were 81% good and excellent results overall, 70.5% for the 17 intraarticular fractures, and 69% for Ruedi type III fractures. Complications included one superficial and one deep infection, one 10 degrees varus malunion, and three pin tract infections. This method yielded results comparable with previous studies while reducing the amount of soft tissue dissection necessary for the placement of large plates. Soft tissue complications were infrequent and the goals of early motion and fracture stability were not sacrificed.

Adolescent↗
PubMed1989

External fixation of the pelvic girdle as a test for assessing instability of the sacro-iliac joint.

External fixation of the pelvic girdle was used in a consecutive series of ten female patients suffering from suspected chronic instability of the sacro-iliac joint. The condition was attributed to pelvic relaxation after pregnancy in seven patients and to trauma in three. External fixation of the pelvis with a trapezoid frame reduced the average radiographic displacement of the symphysis from 5.0 to 2.4 mm in eight patients, relieved the dorsal pain in seven, and markedly improved walking ability in five. Seven of the ten patients were subsequently subjected to an anterior sacro-iliac joint arthrodesis in which square compression plates and autogenous bone grafts were used. At follow-up examination five of these patients were improved, and two unchanged. The results suggest that external fixation of the pelvis is useful in assessing painful sacro-iliac joint instability and should precede surgical intervention.

Adult↗
PubMed2003

Bone realignment with use of temporary external fixation for distal femoral valgus and varus deformities.

BACKGROUND: Correction of a distal femoral deformity may prevent or delay the onset of osteoarthritis or mitigate its effects. Accurate correction of deformity without production of a secondary deformity depends on precise localization and quantification of the deformity. We report a technique to correct distal femoral deformities in the coronal plane. METHODS: Fourteen femora in thirteen skeletally mature patients with a distal femoral deformity underwent operative reconstruction. The preoperative deviation of the mechanical axis ranged from 90 mm laterally (genu valgus) to 120 mm medially (genu varus). The mechanical lateral distal femoral angle was abnormal in all fourteen knees. The technique consisted of application of an external fixator, performance of a percutaneous distal femoral dome osteotomy, correction of the deformity, and locking of the external fixator. A statically locked retrograde intramedullary nail was inserted following reaming, and the external fixator was removed. The mean duration of follow-up was thirty-three months (range, six to forty-seven months). RESULTS: The mean time until healing was thirteen weeks (range, six to thirty-nine weeks). Nine of the thirteen patients reported an improvement in walking, and none needed an assistive device. All nine patients with preoperative knee pain were free of tibiofemoral pain at the most recent follow-up evaluation. The mechanical lateral distal femoral angle was within the normal range in twelve of the fourteen knees. The mechanical axis was within the normal range in ten lower extremities. In three of the four remaining limbs, the residual abnormal deviation of the mechanical axis was due to a residual tibial deformity. CONCLUSIONS: Percutaneous dome osteotomy combined with temporary external fixation and insertion of an intramedullary nail can correct distal valgus and varus femoral deformities. We attributed the early mobilization of patients and the rapid bone-healing to the limited soft-tissue dissection, the low-energy corticotomy, and the use of intramedullary fixation in our surgical technique.

Activities of Daily Living↗
PubMed1992

Principles of bone healing and biomechanics of external skeletal fixation.

External skeletal fixation is being used to treat an increasing number of orthopedic conditions in veterinary medicine. Study of the variables affecting the biomechanics of external fixation and bone healing is vital if patient morbidity is to be minimized. These are reviewed and incorporated into strategies that can be applied to decision making using external fixation in the clinical setting.

Animals↗
PubMed1982

[Indication, technic and results using the external fixator in infected fractures and infected pseudarthrosis].

Infected pseudo-arthrosis is the dreaded combination of chronic osteomyelitis and instability at the fracture site. Treatment consists in radical removal of sequestered bone and alloplastic implants, temporary implantation of Septopal chains for high-dose local antibiotic therapy and re-osteosynthesis with external fixator. The external fixator of Raoul Hoffmann is preferred because of its unlimited versatility. A total of 131 patients were treated in accordance with the method described. In 90.1% of the cases bone consolidation was achieved, and in 89.3% chronic osteomyelitis subsided.

Adolescent↗
PubMed1995

[External fixation of the lower limb in children].

18 children (13 boys, 5 girls) with displaced fractures of the femur (13 cases) and tibia (5) after road accidents were treated with Wagner external fixation. 5 fractures were open and 13 closed. 9 also had head injury and were unconscious. In 3 fractures the popliteal artery was torn, requiring arterial reconstruction. 15 were examined an average of 2.3 years after injury and there was full range of motion in 13. In 2 after severe injury, range of motion was 80% of normal. There was refracture after removal of external fixation in 1. We conclude that external fixation is stable and has minimal complications. We recommend it for children with comminuted fractures, multiple trauma and those in intensive care.

Accidents, Traffic↗
PubMed2004

Biomechanics of external fixation and limb lengthening.

Surgeons who use external fixators for foot and ankle conditions need to understand the biomechanical principles to ensure good outcomes. Fixators can be used for fracture fixation, correction of contractures, distraction osteogenesis, and distraction arthroplasty. A two-ring fixator with wire fixation remains the gold standard with which all other frames are compared. Small changes in mechanical characteristics can have major implications on new bone or cartilage formation.

Acute Disease↗
PubMed1986

External fixation shoulder arthrodesis.

Shoulder arthrodesis, while providing a useful and predictable solution to many problems associated with glenohumeral degeneration, has been less than desirable for many patients due to the frequent need for postoperative spica cast or airplane splint immobilization. A new technique of external fixation of shoulder fusions has been developed that provides many advantages, including strong, reliable fixation, obviating the need for bulky casts or splints, and immediate postoperative use of the involved arm. This technique of shoulder arthrodesis using the Hoffman external fixation device has been used on four patients, with a follow-up period of 30-36 months. The series includes patients with infected arthroplasty, osteoarthritis, tumor, and previous failed arthrodesis. Bony union was obtained in six to 10 weeks, and the external fixation frame was left in place seven to 14 weeks. In each case, the external fixation frame enabled the patient to use the involved arm immediately after operation.

Adult↗
PubMed2004

Inferior subluxation of the fibular head following tibial lengthening with a unilateral external fixator.

BACKGROUND: Inferior subluxation of the proximal part of the fibula has been reported to occur with distraction osteogenesis of the tibia; however, the clinical sequelae of this subluxation are unknown. The purpose of this study was to evaluate inferior subluxation of the proximal part of the fibula and its possible clinical implications in patients who had undergone tibial lengthening by distraction osteogenesis with use of a unilateral external fixator. METHODS: Thirty tibiae in seventeen patients with a variety of conditions underwent tibial lengthening by distraction osteogenesis with use of a unilateral external fixator and were followed clinically and radiographically for a mean of two years and ten months (range, two to four years). Ten patients were female and seven were male. Their mean age at the time of the surgery was seventeen years (range, eight to twenty-five years). The mean tibial lengthening was 8.1 cm (range, 3.5 to 13 cm). RESULTS: An inferior shift of the fibular head in relation to the tibia was evident in all cases. The shift, which ranged from 0.4 to 3.3 cm, was proportionally related to the amount of tibial lengthening. This type of subluxation is probably attributable to the tension that is exerted by the intact interosseous membrane during the distraction as well as to the tension of the regenerated bone of the fibula and the fact that the fibula itself is not fixed or directly lengthened by the external fixator. CONCLUSIONS: It appears that inferior subluxation of the fibula is a common phenomenon in patients undergoing tibial lengthening by distraction osteogenesis with use of a unilateral external fixator. However, no clinical symptoms or findings related to the inferior subluxation of the fibula were found in our series.

Adolescent↗
PubMed2004

A comparative study of mini-external fixation systems used to treat unstable metacarpal fractures.

We compared the biomechanical properties, clinical versatility, application ease, and financial cost of 7 mini-external fixation systems used to treat unstable metacarpal shaft fractures with segmental bone loss. Attached to a maple dowel fracture model, each fixator was tested in axial compression, lateral 4-point bending, 45 degrees apex-dorsal 4-point bending, and torsion. The EBI DynaFix system had the highest overall rigidity values and was highly versatile; the Synthes/AO Mini-External Fixator had intermediate rigidity values and was the lightest system tested; the Howmedica Mini-Hoffmann fixator was substantially less rigid than all the other tested constructs but was the most versatile. Devices constructed with polymethylmethacrylate and Kirschner wires were rigid, lightweight, and inexpensive. Routine use of these devices is discouraged, however, because of unacceptable loosening at the pin-cement interface during testing and because of difficulties encountered during construction and application. None of the external fixation systems tested was superior in all the parameters analyzed.

Biomechanical Phenomena↗
PubMed1997

Static external fixation in the hand and carpus.

Static external fixation in the hand and carpus remains a valuable part of the hand surgeon's armamentarium for the treatment of complex injuries. This article describes a brief history, indications, case examples, and complications using these constructs. Pertinent pitfalls are emphasized to avoid suboptimal outcomes.

Adult↗
PubMed2006

Wrist-bridging versus non-bridging external fixation for displaced distal radius fractures: a randomized assessor-blind clinical trial of 38 patients followed for 1 year.

BACKGROUND: Non-bridging external fixation has been introduced to achieve better fracture fixation and functional outcomes in distal radius fractures, but has not been specifically evaluated in a randomized study in the elderly. The purpose of this trial was to compare wrist-bridging and non-bridging external fixation for displaced distal radius fractures. METHOD: The inclusion criteria were women >/= 50 or men >/= 60 years, acute extraarticular or intraarticular fracture, and dorsal angulation of >/=20 degrees or ulnar variance >/= 5 mm. The patients completed the disabilities of the arm, shoulder and hand (DASH) questionnaire before and at 10, 26 and 52 weeks after surgery. Pain (visual analog scale), range of motion and grip strength were measured by a blinded assessor. RESULTS: 38 patients (mean age 71 years, 31 women) were randomized at surgery (19 to each group). Mean operating time was shorter for wrist-bridging fixation by 10 (95% CI 3-17) min. There was no significant difference in DASH scores between the groups. No statistically significant differences in pain score, range of motion, grip strength, or patient satisfaction were found. The non-bridging group had a significantly better radial length at 52 weeks; mean difference in change in ulnar variance from baseline was 1.4 (95% CI 0.1-2.7) mm (p = 0.04). Volar tilt and radial inclination were similar in both groups. INTERPRETATION: For moderately or severely displaced distal radius fractures in the elderly, non-bridging external fixation had no clinically relevant advantage over wrist-bridging fixation but was more effective in maintaining radial length.

Aged↗
PubMed2003

Radiological outcome after external fixation of 97 femoral shaft fractures in children.

The aim of this prospective, consecutive study was to assess overgrowth and malunion after anatomical reduction and external fixation of displaced femoral shaft fractures in children. Ninety-seven closed femoral fractures in 95 children aged 3-15 were fixed with a unilateral external fixator and followed with conventional radiographs and standardized orthograms for 1 year. To evaluate further overgrowth and remodelling a subgroup of 45 patients was also seen at 2 years. Parameters known to influence overgrowth and remodeling were recorded.Eighty-six percent of the femora had an angulation less than 10 degrees in varus/valgus or recurvatum at the time of healing. The remaining fractures remodeled nearly completely. Leg length discrepancy was on average 0.1cm at 1 year. The mean overgrowth was 0.3 cm at 1 year and 0.5 cm at 2 years. Overgrowth and remodeling was not correlated to whether the leg healed in a shortened or lengthened position, nor was it correlated to pin site infection or re-reduction.The overgrowth was far less than expected when compared with previous studies using traction. When external fixation is used in femoral fractures in children, we therefore, recommend fixing the fracture without shortening regardless of the age of the child, type of fracture, fracture level or injury.

Adolescent↗
PubMedDate not supplied

Biomechanics of external fixation of distal tibial extra-articular fractures: is spanning the ankle with a foot plate desirable?

OBJECTIVES: To compare the mechanical stability of external fixation with and without spanning of the ankle joint with a foot plate in an in vitro model of extra-articular distal tibia fractures. DESIGN: A laboratory investigation was performed to evaluate the mechanical behavior of external fixation of extra-articular distal tibia fractures using a fixator with and without a foot plate. Ten fresh-frozen lower extremities (5 pairs) with a simulated OTA 43-A3.3 fracture were stabilized with an Ilizarov hybrid fixator with and without a foot plate. SETTING: All mechanical testing was performed with a servohydraulic test frame (MTS Bionix 858, Minneapolis, MN). MAIN OUTCOME MEASUREMENT: Deformation characteristics as a function of load were compared for an Ilizarov fixator with and without a foot plate under identical conditions of forefoot loading from 0 to 100 N. Relative interfragmentary motions (vertical and horizontal translations and rotation) were measured. RESULTS: There was significantly more vertical translation (2.57 +/- 0.97 mm vs. -0.83 +/- 0.64 mm) and angular displacement (4.49 +/- 0.45 degrees vs. -1.15 +/- 0.61 degrees ) of the distal fragment in the arrangement without a foot plate compared with the construct with a foot plate. The anterior translation of the distal fragment was similar with (1.12 +/- 0.98 mm) and without a foot plate (1.19 +/- 1.23 mm). CONCLUSIONS: This study supports the mechanical importance of spanning of the ankle with a foot plate in most cases of external fixation for unstable extra-articular and periarticular distal tibia fractures. Further studies are needed to validate these results before widespread changes in clinical treatment can be recommended.

Aged↗
PubMed1992

Plaster cast versus Clyburn external fixation for fractures of the distal radius in patients under 45 years of age.

In this prospective study, 70 patients between the ages of 20 and 45 years with comminuted intra-articular fractures of the distal radius of types III to VIII (graded according to Frykman) were treated either by closed reduction and forearm plaster (35 patients) or by application of a Clyburn dynamic external fixator (35 patients). The external fixator was more effective at holding the manipulated position, and the roentgenographic loss of position during fracture union was minimal compared with that seen in patients treated in plaster. Functional results in the fixator group were 18 excellent, 10 good, 6 fair, and 1 poor. The plaster group showed the following functional results: 12 excellent, 8 good, 10 fair, and 5 poor. The external fixator generated significantly better anatomical and functional results than did treatment with forearm plaster. A good anatomic position combined with early rehabilitation of the wrist function produced very favorable functional results in patients less than 45 years of age.

Adult↗
PubMed1991

External fixation of intertrochanteric fractures of the femur.

External fixation was used in the treatment of 154 intertrochanteric fractures of the femur over a period of eight years. Good fixation and early ambulation was achieved in all cases. Blood loss was slight. There were 12 deaths due to medical causes unrelated to the surgical procedure. Deep pin-track infection occurred in six cases and late displacement of the fracture fragments in nine. The average time for union was 16 weeks. The technique is simple, quick and inexpensive, and causes minimal surgical trauma. All these features are particularly relevant where resources are limited.

Adult↗
PubMed1992

[The treatment of distal radius fractures using the external fixator].

This is a report on the stabilisation of fractures of the distal end of the radius type C2 and C3 and open fractures by external fixator. Between 1982 and 1989 38 patients with 43 fractures were treated. A follow-up was done 8 to 80 months after operation including 35 patients. 14 patients were polytraumatised. Especially in this group of patients, the advantages of this procedure can be seen. This advantages are a small stress for the patient, involving only a short time of assembling of the external fixator besides a high stability of the system. Our results show, as well as the results of the literature, that the external fixator has its place in a differentiated therapeutic concept of intraarticular fractures, open fractures and fractures with a defect of the distal radius.

Adult↗