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At least 649 records · Page 36Linked to original sources
PubMed1994

[Can unreamed tibial nailing replace external fixators in management of open tibial fractures?].

The recently developed unreamed tibial nail (UTN) offers a new possibility for biological osteosynthesis by intramedullary stabilization for tibial fractures including those with severe closed and open soft tissue damage. In a retrospective study we compared the well established method of external fixation with unreamed intramedullary nailing for open tibial shaft fractures. The data of our first 15 cases treated primarily by UTN (Group 1) and another 15 cases comparable in etiology, severity of trauma, fracture classification, open soft tissue damage and the rate for myocutaneous flaps and skin-grafts, treated initially by external fixation (Group 2) were reviewed. Septic complications were only seen in group 2 and made necessary a lot of following additional operations. One angular deformity was seen in each group. Group 1 showed a mean hospital stay of 26.3 days compared to 75.7 days in group 2. Full weight-bearing was achieved after 1.8 months (group 1) whereas it took 4.5 months in group 2. The first clinical experience using the UTN shows an obvious advantage in comparison to fracture management by external fixation mainly due to a low complication rate and a much shorter over all surgical treatment period.

Adolescent↗
PubMedDate not supplied

Use of cross-extremity flaps stabilized with external fixation in severe pediatric foot and ankle trauma: an alternative to free tissue transfer.

Pedicled cross-extremity flaps for wound coverage have been replaced, in most cases, by free tissue transfer. Classically, cross-leg flaps have been problematic because of difficulties with immobilization and positioning of the extremities from the time of initial coverage to detachment. Three children with severe foot and ankle trauma had cross-extremity flaps using linkage of bilateral lower-extremity external fixators in place of traditional casting. Cross-leg flaps were used in two patients, and a cross-foot flap was applied in one. Each flap survived completely, and the linking fixators were disassembled at the time of flap detachment. No complications were related to the donor site or the flap itself or were caused by the fixation. Lower-extremity range of motion was regained rapidly, and each patient resumed essentially normal gait and activity. Addition of external-fixator stabilization aids greatly in wound care, as well as general ease of patient mobility and positioning. External fixation facilitates the use of cross-extremity flaps in pediatric patients in whom free tissue transfer may not be optimal.

Accidents, Traffic↗
PubMed1990

External fixation and delayed intramedullary nailing of open fractures of the tibial shaft. A sequential protocol.

Between 1983 and 1989, forty-one open fractures of the tibial shaft were treated with débridement and provisional external fixation, followed by delayed soft-tissue closure and subsequent intramedullary nailing with reaming. The average duration of external fixation was seventeen days (range, six to fifty-two days). The average time between removal of the fixator and intramedullary nailing was nine days (range, zero to twenty-four days). Of thirty-nine patients who had adequate follow-up, two (5 per cent) subsequently had a deep infection. Both infections healed, with retention of the nail and without chronic osteomyelitis. There were two nonunions and one delayed union. Satisfactory alignment was achieved in thirty-seven patients (95 per cent). This sequential protocol for treatment, which involved a short period of external fixation and thus minimized colonization of the pin tracks, yielded excellent results and a low rate of infection.

Adolescent↗
PubMedDate not supplied

Pin site care during external fixation in children: results of a nihilistic approach.

We prospectively followed 27 consecutive children with tibial circular external fixators applied between July 1, 1995, and June 30, 1997. A simple pin care system with no physical pin cleansing except that provided by daily showers was used. Children with inflamed or infected pin sites were placed on an oral antibiotic (cephalexin) for 10 days. Pin sites were graded according to the system of Dahl et al. on a 0 to 5 scale. A total of 4,473 observations was made. Patients developed 178 pin tract infections (4.0% per observation), with 151 (85%) grade 1 and 27 (15%) grade 2 infections. No pin was removed because of infection. Diaphyseal half pin sites were less commonly infected (1.6%) than periarticular wire or half pin sites (4.5%). We recommend only showering without other physical pin cleaning procedures in children undergoing external fixation procedures.

Administration, Oral↗
PubMed1989

Fixation of cancellous bone and physeal fractures in dogs and cats. A comparison of the use of self-reinforced biodegradable devices to the use of metallic devices and external fixations.

The use of self-reinforced biodegradable devices made of polyglycolide in the cancellous bone and physeal fractures of dogs and cats was compared to the use of metallic devices and external fixations on similar fractures. The series consisted of 64 dogs and 22 cats divided into 6 comparable groups. The patients in the 2 groups fixed with biodegradable devices started to use their operated limbs earlier than in the other groups. The same 2 groups also healed clinically (showed no lameness) earlier than the other groups. Radiographically there was no statistical difference between the 6 groups. On the basis of this study it may be concluded that the fixation with self-reinforced biodegradable devices is as suitable for the fixation of cancellous bone and physeal fractures of dogs and cats as the fixation with metallic devices or external fixation. This biodegradable technique has additional benefits allowing the patients to feel less pain in their operated limbs and making secondary operations to remove the devices unnecessary.

Animals↗
PubMed2003

An external fixation method and device to study fracture healing in rats.

We wished to establish a reproducible model for fracture fixation to be used in fracture healing research and therefore developed an external fixation construct and surgical procedure adapted to Sprague-Dawley rats. We evaluated the mechanical properties of the construct in brass rods and rat bone, in an Instron test machine with axial and transverse loading, and the in vivo performance. We found that the mechanical properties of the construct in brass rods were predictable and could be repeated in rat femora. In all tests, the axial load was about 10 times the transverse for the same degree of deformation. The stiffness among fixators was uniform. 1 mm pins caused about 50% less stiffness than 1.2 mm pins in axial loading of rat bone (p < 0.001) and brass rods (p < 0.001) as well as in transverse loading of brass rods (p < 0.001). Loosening of 1 or 2 screws that lock the pins to the fixator reduced stiffness by about 50% in axial loading of rat bone (p = 0.009) and brass rods (p = 0.05). A change in the distance between the bone surface and the fixator was linearly related to the stiffness in axial loading of rat bone (p < 0.001) and brass rods (p < 0.001) and in transverse loading of brass rods (p < 0.001). If the bone ends touched each other, the axial stiffness of the construct increased almost 10 times (265 N/mm), as compared to a fracture gap size of 2 mm (31 N/mm). In vivo experiments had a complication rate of less than 10% when we used 1.2 mm pins, 6 mm offset and rats weighing 350-450 g. Our method and device for experimental external fixation of rat femora are reliable and the findings are reproducible. These can be used in bone repair and fracture healing research.

Animals↗
PubMedDate not supplied

The external fixator for the treatment of wrist fractures.

The authors present 15 unstable fractures of the wrist treated by external fixation. The fractures were classified based on the AO system, while results were evaluated clinically (Gartland and Werley method modified by Sarmientio) and radiographically. In two cases stabilization with metal wiring was used in addition to external fixation. Results were excellent in 4 cases, good in 9, unsatisfactory in 2 (1 fair, 1 poor). Intraoperative complications included a compound fracture of the second metacarpus, and late complications included a case of algodystrophy.

Aged↗
PubMed1996

[External fixator or bone pin osteosyntheses in unstable distal intra-articular radius fractures in elderly patients].

Hyperdistraction with external fixation in the treatment of distal intraarticular fractures (Frykman types VII/VIII) in elderly patients results in a higher risk of secondary shortening and loss of the radius length with functional impairment. Using the modified K-wire technique of Kapandjii, a more sufficient restoration of articular congruency can be achieved. The overall score showed 87.5% excellent and good results in the Kapandjii group, compared to 76.5% in the external-fixation group.

Adult↗
PubMedDate not supplied

The use of circular wire external fixation in the treatment of salvage ankle arthrodesis.

The authors retrospectively reviewed their experience with circular wire external fixation in the treatment of salvage ankle arthrodesis during the past 9 years. The results of 43 cases in a difficult patient population are presented with an average follow-up of 27.0 months. Thirty-three patients (80.5%) went on to achieve a solid fusion or stable pseudarthrosis. A minimum of a 4-ring frame construct was applied for an average of 96.1 days. The major complication rate was 51.2%, including 3 below-knee amputations (7.3%), 7 unstable nonunions (17.1%), 7 cases of osteomyelitis and/or deep-space infection (16.3%), 3 malunions (7.3%), and 2 tibial stress fractures (4.7%). The incidence of complications occurred similarly in patients with Charcot arthropathy, failed total ankle arthroplasty, septic fusion, posttraumatic deformity, or avascular necrosis of the talus, whereas it was relatively higher in patients who were diabetics, smokers, or had an increased body mass index. In addition, the incidence of a nonunion tended to increase with longer follow-up, suggesting that early presumption of a solid union may be erroneous. Based on our defined criteria of a stable, well-aligned fusion without severe pain or activity restrictions, 28 patients (68.3%) had a good result. Circular wire external fixation can be a viable treatment for complex ankle salvage pathology; however, it is difficult to predict the prospects of success or failure.

Adult↗
PubMed1982

Tibial fractures treated with Hoffmann's external fixation: a comparative analysis of Hoffmann bilateral frames and the Vidal-Adrey double frame modification.

The results after treatment of 50 open and comminuted tibial fractures with Hoffmann's external fixation were analysed. Half of the fractures were treated with bilateral Hoffmann frames, the other half with the Vidal-Adrey double frame modification. The groups were found to be comparable. The results of the study confirm that Hoffmann's external fixation is a safe method for treating the bone and soft tissue lesions in such fractures. There was only one case of osteomyelitis, no definite pseudarthrosis and no leg amputation. The considerably increased stability of the Vidal-Adrey double frame modification did not reduce the length of the healing period compared to fractures treated with bilateral Hoffmann frames. The duration of external fixation was on average 24 weeks, and the radiological healing time 27 weeks. A slightly greater number of residual deformities were found in the group treated with bilateral Hoffmann frames. Most of the deformities were so minor, however, that they were of little practical consequence for the patients. Thus it seems that the original Hoffmann apparatus, if duplicated, is a stable enough fixation in most cases.

Adolescent↗
PubMed1991

Electrically-induced osteogenesis in external fixation treatment.

This animal model experiment is performed to evaluate how bipolar direct current of 20 microamp. affects osteogenesis once external fixation treatment is applied in different forms: stabilization, distraction, and compression. In all cases a secondary healing, typical of external fixation treatment, was found; but a more mineralized callus and an increase in osteoprogenitor cell proliferation and differentiation were obtained through the use of electrical stimulation especially in the compression group.

Animals↗
PubMedDate not supplied

External fixation of pediatric femur fractures.

One-hundred and thirty-two children with 139 femur fractures were treated with external fixation from 1984 to 1993. Average age at presentation was 8.97 years. All fractures were followed until union, with an average time of external fixation of 11.4 weeks. There were no nonunions. Of 18 patients with definitive radiographic measurements at 2-year follow-up, 15 patients developed overgrowth (average, 8.7 mm) and three demonstrated shortening (average, 7.7 mm). No patient required treatment for residual leg-length discrepancy. Although pin-tract inflammation was common, pin-tract infection requiring intravenous antibiotics occurred in only six patients (4.5%). No patient developed osteomyelitis. Two fractures (1.4%) were not healed at the time of elective fixator removal, necessitating additional time in the fixator. There were two refractures (1.4%) and one fracture through a healing pin tract after fixator removal (0.7%).

Adolescent↗
PubMed1997

Changes in knee kinematics after application of an articulated external fixator in normal and posterior cruciate ligament-deficient knees.

We studied how the location of an articulated external fixator, the EBI-Orthofix (EBI Corp, Persippany, NJ), affects the kinematics of the posterior cruciate ligament (PCL)-deficient knee. Ten unembalmed cadaver whole lower limbs were randomly divided into two groups of five limbs each: (1) fixator hinge located near the average knee flexion axis (the anatomic position group); and (2) fixator hinge located distal to the joint line and posterior to the flexion axis (the fibular styloid position group). Three loading conditions, passive flexion/extension, flexion/extension with anterior force of 100 N, and flexion/extension with posterior force of 100 N were used for each knee with the PCL intact and with the PCL cut. With the fixator located in the anatomic position, and after cutting of the PCL, posterior translation was reduced to normal limits only at flexion angles < or = 15 degrees. In this configuration, the fixator was ineffective at minimizing posterior translation at flexion angles > or = 30 degrees. With the fixator located at the fibular styloid position, however, posterior translation of the tibia in the PCL deficient knees was reduced to near normal limits at all flexion angles. These results were statistically different than the anatomic position group at all flexion angles > or = 30 degrees (P < .01). The external fixator appears to allow normal range of motion while effectively shielding the PCL graft from stress caused by posterior translational forces. Issues related to the potential complications and patient acceptance must be addressed thoroughly before this technique is applied in clinical practice.

Cadaver↗
PubMed2004

The role of AO external fixation in proximal femoral osteotomies in the pediatric neuromuscular population.

Internal fixation in proximal femoral osteotomies using traditional devices may be sub-optimal in children with neuromuscular disorders who have small or osteopenic bone. In this population, between 1988 and 2000, we performed 36 proximal femoral varus osteotomies in 28 patients. These were controlled by the AO external fixator. The average age at surgery was 7 years (range, 2-13 years). A mean varus correction of 34 degrees (range, 15-90 degrees) was obtained. Complications consisted of one superficial pin tract infection, one skin breakdown, and one non-union. Other than the non-union, all osteotomies were stable at the time of the fixator removal. The AO external fixator is an effective alternative in maintaining corrective proximal femoral osteotomies in children with fragile bones.

Adolescent↗
PubMed1993

Static external fixation of the wrist.

Historical evolution in concepts, indications, application, reduction techniques, and the rehabilitation program and complications of external fixation of the wrist are discussed. Indirect reduction techniques using overdistraction and flexion are recommended. Additional stabilization of the epiphysis allows immediate reduction of overdistraction, thus eliminating the potential complications related to overdistraction. Used with the due attention to detail, external fixation of the wrist is a rewarding and efficient treatment method.

Exercise Therapy↗
PubMed1999

[Radio-radial external fixation for correction of malunited distal radius fracture].

For correction of malunited distal radius fractures, the use of the external fixator in radio-radial application was assessed. The device has been used for one-stage correction with corticocancellous bone blocks as well as with hemicallotasis for correction of dorsal angulation. The technical application is described and the use of the external fixator defined. Fourteen patients were treated with radio-radial application, seven of those were corrected with callus distraction. The mechanical possibilities of the fixator allowed complete correction of the malunion.

Adolescent↗
PubMed1996

Hydroxyapatite coated external fixation pins: an experimental study.

A sheep model was developed for the implantation of 84 bicylindrical stainless steel external fixation pins. One-half of the pins were coated with hydroxyapatite, and the rest remained uncoated. A set of 6 pins with the same coating was implanted in the lateral side of the left tibias of 14 sheep, the final insertion torque was measured, and a monolateral external fixator was assembled on the pins. The medial tibial middiaphysis then was exposed and a 5-mm resection osteotomy was done. Sheep were euthanized 6 weeks after surgery, radiographs were taken, and the initial extraction torque was measured on 4 pins from each sheep. Undecalcified sectioning and histologic and histomorphometric analyses were done on the remaining 2 pins. Radiographic pin tract rarefaction was significantly lower in the hydroxyapatite coated pins compared with the uncoated pins. Group average insertion torque was 960 +/- 959 Nmm in the hydroxyapatite coated pins and 709 +/- 585 Nmm in the uncoated pins. Group average initial extraction torque was 1485 +/- 1308 Nmm and 298 +/- 373 Nmm, respectively. Bone pin contact was 85.7% +/- 8.9% and 50.3% +/- 20.4%, respectively, in hydroxyapatite coated and uncoated pins. Bone between the threads was 95.6% +/- 5.7% and 80% +/- 8.7%, respectively, in hydroxyapatite coated and uncoated pins. Hydroxyapatite coating was effective for improving the bone-to-pin interface.

Animals↗