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PubMed1983

Soft-tissue reconstruction of the leg associated with the use of the Hoffmann external fixator.

Soft-tissue injuries and defects associated with severe fractures of the tibia treated with the Hoffmann external fixator were reviewed. Of 84 cases of open tibia fractures (classified as Gustilo's Type II and III), 54 patients with 55 injured limbs required soft-tissue reconstruction other than skin grafts or small rotational flaps. These 55 cases were constructed with 37 local musculocutaneous flaps (20 gastrocnemius, 17 soleus and other smaller muscle flaps), 15 free musculocutaneous flaps (14 latissimus dorsi, and one tensor fascia lata), and three medial gastrocnemius cross leg flaps. In all cases the soft-tissue reconstruction was done with the external fixator in place. All but three of the musculocutaneous flaps healed with no problems (94%). Bony healing was found in 30 cases (69.09%) at 18-month followup. There was one amputation after two failed local flaps and three late amputations due to patient's request (infected nonunion). There was a nonunion rate of 25.45% (14 cases) at 18 months postinjury. The Hoffmann external fixator has allowed bony stabilization and has not precluded the subsequent soft-tissue reconstruction or bone grafting. Muscle and musculocutaneous flaps, both local and free, have been employed in the reconstruction of the leg with minimal interference from the Hoffmann device.

Adolescent↗
PubMed1991

[The external fixator in unstable fractures of the distal end of the radius. Current literature review].

A recent review of the literature concerns instability of distal radius fractures and their treatment by external fixation. Redisplacement of distal radius fractures most often occurs chronically, and the severity can be predicted by initial deformity, axial shortening and dorsal comminution of the radius. The need for an anatomical reduction of these fractures is emphasized by different clinical and biomechanical studies. For many authors, external fixation provides good to excellent results in more than 75% of cases, both clinically and anatomically. Most of the complications are benign and do not affect long-term results. This study also discusses the different techniques and the best indications for external fixation.

External Fixators↗
PubMed1999

The radio-radial external fixator in the treatment of fractures of the distal radius.

The technique of radio-radial monobloc-fixation with the small AO external fixator device has been applied to 17 consecutive Colles' fractures. The fracture types were mainly A3 and C2, according to the AO classification. We found this technique to be easy and quick in application and stable in fixation. Direct, precise and atraumatic reduction can be achieved by using the distal pins as joy-sticks. Furthermore, disimpaction of the fracture to regain length is possible without bone grafting. Normal carpal mobility and load transfer is preserved during fracture healing and the injured hand can be used in daily life with certain restrictions. To prevent pin-track infections, early mobilization of the wrist should be avoided. We recommend this technique in the treatment of comminuted AO-type A3 fractures of the distal radius and in certain type C2 cases.

Adolescent↗
PubMed2001

The use of trans-articular and extra-articular external fixation for management of distal tibial intra-articular fractures.

Twenty-nine consecutive cases of distal tibial intra-articular fractures treated by trans-articular or extra-articular external fixation techniques have been reviewed. Eleven cases were treated initially with a trans-articular dynamic axial fixator. Of these seven were converted to an extra-articular SHF, for a combination of poor ankle motion and delayed healing of the metaphyseo-diaphyseal dissociation (MDD). Three of these cases (two patients) required bone grafting for delayed healing of the diaphyseal component of the fracture. Apart from one refracture through the MDD, no major complications were seen. No deep infections and no angular malalignments were noted. There were 11 pin track infections. Subjective assessment using short form-36 (SF-36) questionnaires, however, revealed significant differences compared to a normal population particularly in physical function and pain at a mean follow-up of 21 months. Using Bone's criteria for assessment of range of motion there were 62% excellent and good results, which dropped to 53% when fractures with a metaphyseo-diaphyseal extension were included. The use of minimally invasive techniques of internal fixation and stabilisation with a Sheffield hybrid frame in the management of distal tibial intra-articular fractures has minimal complications. Trans-articular external fixation is a good primary treatment for badly comminuted articular fractures with poor soft tissue condition. Conversion to extra-articular external fixation is recommended for slower healing fractures allowing ankle movement and early weight-bearing. The presence of a MDD dissociation lengthens the treatment time significantly, adds to the morbidity and affects final outcome.

Adult↗
PubMed1998

External fixation of tibial plafond fractures: is routine plating of the fibula necessary?

OBJECTIVES: To determine the advantages and disadvantages of plating an associated fibula fracture in tibial plafond fractures treated with external fixation that spans the ankle. STUDY DESIGN: Retrospective clinical review. METHODS: The incidence of treatment complications and the outcomes achieved were compared between two groups of patients with tibial plafond fractures and associated fractures of the fibula. Both groups were treated by a uniform technique of monolateral external fixation. One group, consisting of twenty-two patients with twenty-two fractures, had plate fixation of the distal fibula and the other group, thirty-one patients with thirty-two fractures, had no fibular fixation. RESULTS: The demographics of the two groups, including sex, fracture classification, and number of open fractures, were similar. The outcome of the two groups for radiographic arthrosis and clinical ankle score, measured at minimum two-year follow-up, showed no statistically significant difference. The total numbers of complications were not statistically different between the two groups (p = 0.15), but the types of complications varied. Group I had eight complications: five fibular wound infections, two fibular nonunions, and one angular nonunion. Group II had seven complications: six angular malunions and one tibial wound infection. CONCLUSION: Open reduction and internal fixation of the fibula fracture in tibial plafond fractures treated with external fixation that spans the ankle is associated with a significant rate of complications, and good clinical results may be obtained without fixing the fibula.

Adolescent↗
PubMed2001

High energy plafond fractures treated by a spanning external fixator initially and followed by a second stage open reduction internal fixation of the articular surface--preliminary report.

UNLABELLED: Early open reduction and internal fixation (ORIF) with plates and screws for plafond injuries caused by skiing initially reported by Ruedi and Allgower proved inadequate for the treatment of high-energy motor vehicle accident type injuries. The purpose of our study was to review our treatment protocol using a spanning external fixator placed semi-emergently medially across the joint and a later staged ORIF of just the articular surface to achieve and maintain anatomic reduction. METHODS: We preformed a retrospective study of 35 patients with 37 highly comminuted severe (OTA 43-B3 and -C3 or Ruedi type II or III) tibial plafond fractures treated by a single surgeon. All patients were treated with an initial spanning unilateral external fixator and subsequent ORIF. Radiographs were examined for: classification, number of pieces of the tibial dome, evidence of ground-glass comminution (more than three pieces <2mm in size on CT), anatomic reduction, alignment, and presence/absence of arthritis. RESULTS: Evidence of ground glass comminution existed in 26/37 patients (70%). Following ORIF, articular reduction was perfect (0-1mm displacement) in 29/36 (81%), imperfect (1-3mm) in 6/36 (17%) and poor (>3mm) in 1/36 (3%) cases. Joint alignment was anatomical in 35/37 (96%), with 15 degree anterior angulation in one patient and 5 degree valgus angulation in another patient. Radiographic arthritis was present in 10/36 patients (28%) at latest follow-up. Joint distraction at time of reduction was present in 27/37 patients (73%). A total of 25/37 patients (65%) had no post-operative complications, while 3/37 (8%) had a joint infection requiring one patient to have hardware removed. A total of 4/37 (11%) showed loss of reduction at latest follow-up. A total of 3/37 (8%) had a secondary arthrodesis; A total of 1 (3%) had a primary arthrodesis; 1 (3%) diabetic man had a below-knee amputation after a failed arthrodesis. DISCUSSION AND CONCLUSION: We treat severe tibial plafond fractures with a spanning external fixator at the time of injury, wait between 10 and 21 days to allow for soft tissue healing, and then perform a limited ORIF of the articular surface with canulated screws. In a group of high-energy plafond fractures, we achieved 81% good to excellent results with this protocol. We conclude that use of a spanning external fixator with delayed ORIF compares favorably with the literature.

Adult↗
PubMed2006

External fixation in patients with age over 65 years with distal radius fracture.

AIM: This study evaluates the final outcome of the treatment of the distal radius fractures with external fixation in patients older than 65 years. PATIENTS AND METHODS: Thirteen patients over the age of 65 years with a distal radius fracture were treated with external fixation. The fracture type was determined according the Frykman classification. For evaluation of the outcome six months after the operation were used: Stewart Score System; Gartland and Werley; and PRWE (Patient-rated wrist evaluation). RESULTS: According to the Stewart score system one patient has excellent; nine good; and tree have fair result. Gartland and Werley score showed that four patients have excellent; six good; and three have fair result. According to the PRWE two patients have no pain and no functional disability; five have minimal; five have mild pain and functional disability; and one has moderate degree and frequency of pain and moderate functional disability. Statistically there is strong correlation between Gartland and Werley score and PRWE score (r=0.657) and weak correlation between Stewart score and PRWE score (r=0.431). CONCLUSION: The external fixation of the distal radius fractures in the patients with advanced age enables high degree of functioning of the injured wrist and high level of daily activity. Judging from the benefit of enabling an "independence" of these persons, the risk for the operative treatment is sustained.

Aged↗
PubMed2004

Cast vs external fixation: a comparative study in elderly osteoporotic distal radial fracture patients.

AIM: This study compared fracture treatment with plaster cast vs external fixation. METHODS: Forty elderly female osteoporotic wrist fracture patients were randomized to be treated with either plaster cast (Group A) or external fixation (Group B). Bone mineral density less than -2.5 T-score was among the inclusion criteria. RESULTS: In Group A, four redisplacements occurred, whereas in Group B there were none (p = 0.005). Horesh score was higher in Group B (p < 0.006) than in Group A. Volar angle deformity (p < 0.0005) and radial angle deformity (p = 0.008) were lower in Group B. CONCLUSIONS: This study shows that external fixation improves stability in elderly osteoporotic wrist fracture patients.

Aged↗
PubMed2004

Treatment of refracture occurring after external fixation in paediatric femoral fractures.

With a mean follow-up of four years, we assessed the outcomes of 11 refractures which occurred following paediatric femoral fractures treated by external fixation; the refractures were treated conservatively with simple immobilisation in a spica cast. A total number of 104 children with a femoral fracture were treated with external fixation between 1993 and 2000 in our institution. Refracture occurred in 11 cases after fixator removal. These patients were immediately placed in a hip spica cast. All 11 patients were boys, with a mean age of 7.3 years (range: 6 to 9), and the mean follow-up time was 4 years (range: 2 to 7). Mean hospitalisation time after refracture was 2 days (range: 0 to 4). Refractures occurred an average of 8 days (range: 1 to 21) after fixation removal. The mean time to union after refracture was 55 days (range: 35 to 62). On final evaluation, a mean limb length discrepancy of 0.9 cm (range: 0 to 2.5) was noted. Radiological study showed a mean lateral angulation of 5.6 degrees (range : 0 to 17) and a mean anterior angulation of 7.4 degrees (range: 0 to 20). Based on these findings, we believe that closed reduction and spica cast immobilisation is sufficient in cases with refracture of the femur after external fixation, but the option of surgical treatment should be considered when satisfactory anatomic reduction is not achieved.

Accidental Falls↗
PubMed2002

Distraction osteogenesis by Ilizarov and unilateral external fixators in a canine model.

We studied distraction osteogenesis in canine experimental model using two types of external fixators, Ilizarov (n=6) or AO unilateral (n=9) external fixator. Distraction started 1 week after surgery (2 x 0.5 mm/day) and lasted for 3 weeks. Specimens were harvested from weeks 7 through 12. The outcome was assessed by X-ray, histology, histomorphometry and microradiography. Bone regeneration as observed by X-rays was satisfactory and similar in both groups. Both endochondral ossification and intramembranous ossification were found simultaneously in both groups. In both groups, bone formation parameters were significantly higher in the area of consolidating bone. No differences in histomorphometric parameters existed between the groups. In the study period, the bone formation was enhanced and prevailed in the distraction area. This study demonstrated the utility of the canine experimental model for the study of distraction osteogenesis.

Animals↗
PubMed1984

Comparison of osteotomy healing under external fixation devices with different stiffness characteristics.

The aim of this study was to investigate the effect of the rigidity of external fixation on osteotomy healing based on radiographic, morphological, histological, and biomechanical analyses of canine tibial osteotomies treated with more rigid (six half-pins) and less rigid (four half-pins) unilateral external fixators. Successful healing was obtained in all tibiae, but the bone-healing mechanisms appeared to be different depending on the rigidity of the device used. On the side with more rigid fixation, early clinical union was observed thirty days after osteotomy. Periosteal callus formation was significantly increased on the less rigidly fixed side at both ninety and 120 days (p less than 0.05). Fixation stiffness was found to affect the incidence of pin loosening (p less than 0.01) and of bone porosity (p less than 0.05) at the osteotomy site. However, new-bone formation and the structural strength of the bone were not significantly different between the four-pin and six-pin sides. These results seem to indicate that a longer period is required for fracture repair and remodeling when external fixation with less rigidity is used.

Animals↗
PubMed1996

Closed reduction and type-II external fixation of comminuted fractures of the radius and tibia in dogs: 23 cases (1990-1994).

OBJECTIVE: To describe a technique for closed reduction of and application of a type-II external fixator to comminuted fractures of the radius and tibia in dogs and to evaluate outcome of the technique in a series of client-owned dogs. DESIGN: Retrospective case series. ANIMALS: 23 dogs that underwent closed reduction of severely comminuted (> or = 5 fragments); mid-diaphyseal radial (n = 9); and tibial (n = 14) fractures and stabilization with a type-II external fixator. PROCEDURE: Radiographs were made postoperatively and every 4 to 6 weeks until the fixator was removed. The effect of type of fracture (open vs closed), type of pins (threaded vs smooth), and number of fixation pins on surgery time, time between surgery and development of bridging callus, and time between surgery and removal of the fixator was evaluated using one-sided Student's t-tests. RESULTS: 21 fractures healed after a single surgery. Two dogs with radial fractures required a second procedure because of complications. All fractures healed with the original fixation device in place. Mean time between surgery and the development of bridging callus was 11.4 weeks (range, 4 to 22 weeks), and mean time between surgery and fixator removal was 14.7 weeks (range, 4 to 27 weeks). Type of fracture, type of pins, and number of fixation pins did not have a significant effect on surgery time, time to development of bridging callus, or time to fixator removal. CLINICAL IMPLICATIONS: Closed reduction and application of a type-II external fixator was an effective method of treating severely comminuted radial and tibial fractures.

Animals↗
PubMed2002

Temporary external fixation for the management of complex intra- and periarticular fractures of the lower extremity.

Complex intra-articular and periarticular fractures of the lower extremity are challenging injuries to treat. Recently, the concept of utilizing a staged approach with temporary external fixation, a delay to allow soft-tissue healing followed by open reduction and internal fixation, has gained popularity. Historically high complication rates appear to be significantly improved with this strategy. Temporary external fixation is also useful in other settings, such as in the initial management of polytraumatized patients with multiple complex fractures, augmentation of internal fixation in osteoporotic bone, etc. This article reviews current indications, techniques, potential complications, and results of temporary external fixation for complex fractures of the lower extremity.

Clinical Protocols↗
PubMed2000

External fixation of select intertrochanteric fractures with single hip screw.

Since 1994, external fixation using a long hip screw was used for osteosynthesis of trochanteric fractures in 41 patients (27 women and 14 men) 76 to 94 years of age (mean age, 85 years) to minimize the risks associated with an open surgical procedure and general or long lasting spinal anesthesia. The patients were operated on under short duration spinal anesthesia, and intraoperative blood transfusion was not required in any patient. The hip screw was inserted on a guide pin within a protective sleeve in such a way as to achieve impaction at the fracture site as compression was applied in 35 patients. The hip screw was left free for sliding and dynamization in six patients. Diaphyseal distraction by the fixator was used in three of nine unstable fractures to correct varus deformity. The range of times to apply the external fixator was 20 to 45 minutes (mean, 35 minutes). The mean hospital stay was 6 days (range, 3-12 days) and the time to fracture union was 12 weeks (range, 11-13 weeks). Five patients died within 3 months. There were no nonunions or deep infections, but in 18 patients superficial skin reactions were seen around the pins and the screw. No material failure occurred. The method is thought to offer easy and safe stabilization of these fractures with the exception of temporary skin problems, which do not create a major problem.

Aged↗
PubMed1990

Delayed intramedullary nailing after failed external fixation of the tibia.

Thirteen patients (11 males, two females) with 16 tibia fractures (three segmental) were initially treated with external fixation and secondarily had delayed intramedullary nailing after fixator removal. There were six closed injuries and two Grade I, five Grade II, one Grade IIIA, and two Grade IIIB open soft-tissue injuries. The average patient age was 40 years (range, 19-84 years). The external fixator was removed at an average of 12 weeks (range, three to 25 weeks) for malreductions in six case, atrophic segmental fractures in two, and atrophic/unstable fracture patterns in five. Intramedullary nailing was performed at an average of 13 days (range, five to 30 days) after fixator removal. There were 12 reamed nails and one self-broaching nail. Preoperative antibiotics averaged eight days, and postoperative averaged 11 days. All patients healed with bridging callus; full weight bearing occurred at an average of 2.7 months. Follow-up evaluation averaged 22.5 months. Weight bearing began within the first three weeks in 12 of 13 patients. Results were rated as excellent in eight and good in five. There were no complications related to infection or non-union. Delayed intramedullary nailing, after excluding potential high-risk patients, is an option for the treatment of tibia fractures that have failed treatment with external fixation. However, it is not recommended as a routine procedure.

Adult↗
PubMed2003

External fixators for pelvic fractures: comparison of the stiffness of current systems.

We evaluated the stiffness of external fixation (EF) systems with a reproducible, standardized human pelvic replica of aluminum and perspex in which a type C pelvic ring injury was created. 12 EF systems were analyzed in 2 situations that necessarily occur during a walking cycle. Endpoints were defined as 15 mm of dislocation or tolerance of the maximum load in each situation. In the no weightbearing situation, all except 2 fixators failed; in the weightbearing situation, all fixators failed. Single bar systems performed better than frame configurations. Stability provided by any external fixator is low, and in the case of a type C pelvic ring injury, it is insufficient for patient mobilization and weightbearing. Single bar systems provide more stability than frames.

Biomechanical Phenomena↗
PubMedDate not supplied

An inexpensive and available external fixator.

This article introduces a simple and inexpensive external fixator device which has been designed and manufactured from materials readily available in this country. It is called the Doxa Fixator.

Biomechanical Phenomena↗
PubMed1992

Repair of a proximal diaphyseal femoral fracture in a calf, using intramedullary pinning, cerclage wiring, and external fixation.

Repair of a comminuted, spiral oblique, proximal diaphyseal femoral fracture in a 7-day-old calf was achieved by use of an intramedullary pin, cerclage wires, and external fixator. Six stainless steel wires were used for full cerclage to secure a long butterfly fragment and multiple incomplete and complete nondisplaced fragments to the femur in order to create 2 principal fragments. Axial alignment and resistance to bending was provided by a round, double-pointed, end-threaded intramedullary pin (6.35 mm in diameter), which was inserted in a retrograde fashion. A type-1, double-connecting-bar external fixator, using 4 round pins (4.8 mm in diameter), was used to provide supplemental stabilization against shear and torsional forces. At 45 days after surgery, healing at the fracture site was seen on radiography of the limb, and the external fixator was removed. Eight months after surgery, the calf had a normal gait.

Animals↗