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PubMed1989

External fixation or plaster for severely displaced comminuted Colles' fractures? A prospective study of anatomical and functional results.

We report a prospective, randomised, controlled trial of 50 severely displaced comminuted Colles' fractures treated by either external fixation or manipulation and plaster. Each patient was assessed radiographically throughout treatment, and functionally by an independent observer at three and six months. The functional result correlated with the anatomical result, which was significantly better in patients treated by external fixation. This resulted in significantly improved function especially in young patients, and also a lower complication rate. We recommend the use of external fixation for young patients with comminuted displaced Colles' fractures unless manipulation and plaster show excellent reduction.

Casts, Surgical↗
PubMed2005

Outcome after surgery of distal radius fractures: no differences between external fixation and ORIF.

The purpose of this study was to determine the most appropriate surgical treatment from three procedures used for fractures of the distal radius. In a retrospective comparative study, 166 out of 237 patients who underwent surgery for AO/ASIF A3 or C2 distal radius fractures were evaluated. Surgical procedures were external fixation or open reduction and internal fixation with either palmar or dorsal plates. Radiological outcomes were palmar tilt, radial angle, radial length and ulnar variance. Functional outcomes were range of motion and grip strength. In addition, outcomes according to Gartland and Werley and the Disabilities of the Arm, Shoulder and Hand questionnaire were compared. Further outcome criteria were the treatment time and the number of complications. Data were analysed using an analysis of variance statistical procedure respective of the chi2-test. Open reduction and internal fixation, in particular palmar plate fixation, demonstrated the best radiological and functional results. Subjective assessment of ORIF proved better than that of external fixation as treatment time was shorter and complications were more rarely seen. However, most of the differences between groups were not significant. Although there were no significant differences between groups, our data indicates that most dorsally displaced distal radius fractures can be treated successfully by open reduction and internal fixation. Palmar plate fixation seems to have slight advantages compared to both the external fixation and dorsal plate fixation surgical procedure.

Adult↗
PubMed1999

Early outcome of hybrid external fixation for fracture of the distal tibia.

OBJECTIVE: To evaluate the early results of treatment when using hybrid external fixation for fractures of the tibial plafond. DESIGN: Retrospective review of patients treated according to protocol. Patients treated with the hybrid fixator were compared with patients treated with open reduction and internal fixation. SETTING: Orthopaedic trauma service of a Level I trauma center, with a single surgeon directing care. PATIENTS/PARTICIPANTS: All patients with fractures of the distal tibia during a five-year period (n = 63) were treated according to protocol, with specific criteria determining method of treatment. Eleven patients were lost to follow-up, and three additional patients were not reviewed for other reasons. Follow-up period averaged twenty months. INTERVENTION: Fracture stabilization was accomplished with the use of a hybrid external fixator (n = 34) or with internal fixation (n = 27), as determined by patient or fracture criteria. Two patients did not receive planned treatment. MAIN OUTCOME MEASUREMENTS: Range of motion, clinical ankle score, and incidence of complications. RESULTS: Patients treated with hybrid fixation had lower clinical scores, slower return to function, a higher rate of complications, more nonunions and malunions, and more infections. CONCLUSIONS: Due to differences in patient populations, the superiority of either treatment method is uncertain; however, hybrid fixation did not seem to solve the problems inherent in severe pilon fractures. The sanguine results reported in the literature did not hold true in this group.

Adolescent↗
PubMed1994

Treatment of osteomyelitis of the spine using percutaneous suction/irrigation and percutaneous external spinal fixation.

External skeletal fixation is a well-known tool in the management of infection of long bones. However, the application of external skeletal fixation in the treatment of spinal infection has not been previously reported. We have used percutaneous external spinal fixation (PESF) for the treatment of osteomyelitis of the spine in 23 patients since 1981. The treatment consists of percutaneous vertebral biopsy for bacteriologic diagnosis, installation of a suction/irrigation system into the intervertebral disk space, and posterior stabilization (and reduction if indicated) with an external fixator placed percutaneously. This treatment was conceived in 15 patients as definitive treatment. One patient died due to pulmonary embolism. In 12 patients, the infection healed without further operative treatment. Preoperative kyphosis averaged 15 degrees (range 0-30 degrees). At follow-up, kyphotic deformity also averaged 15 degrees (range 0-30 degrees). Two patients required anterior debridement and bone grafting because of progression of bony destruction. In eight patients, PESF was performed emergently, followed by planned anterior debridement and interbody grafting. The treatment was successful in all patients. All fusions healed. Preoperative kyphosis averaged 18 degrees (range 0-40 degrees). At follow-up, kyphotic deformity averaged 10 degrees (range 0-22 degrees). Our present indications are listed below and comprise pyogenic and tuberculous osteomyelitis of the spine localized between T3 and S1. The procedure is an alternative to conservative or more invasive operative treatment modalities in the following conditions: (a) painful lesions of the spine with minimal bone loss, not amenable to efficient orthotic stabilization (thoracic spine from T3 to T9, lumbosacral junction, elderly patients, or presence of deleterious general conditions); (b) osteomyelitis of the spine from T3 to S1, when emergency decompression of the spine is mandatory because of neurologic deterioration due to the kyphotic deformity or to a noncapsulated epidural abscess and anterior decompression is not possible emergently; (c) pyogenic osteomyelitis of the spine at L5/S1, when operative treatment is indicated. In addition, percutaneous insertion of external skeletal fixation is indicated in the presence of infected wounds, making internal posterior stabilization unsuitable (e.g., after open decompression of epidural abscess, postoperative infections).

Adult↗
PubMed1992

The dynamic ASIF-BM tubular external fixator in the treatment of open fractures of the shaft of the tibia.

The dynamic ASIF-BM external fixator incorporates telescopic tubes for axial dynamization and angled bayonet screws to keep the tubes parallel to the bone axis, that is essential for gliding, and adjustment of rotation. The results after treatment of 70 type II and III open tibial fractures with static ASIF and dynamic ASIF-BM frames were analysed. Of the fractures, 32 were treated with the delta ASIF static frame, the other 38 with delta and uniplanar dynamic ASIF-BM frames. The groups were found to be comparable. The results of the study confirm that tubular external fixation is a safe method for treating the bone and soft tissue lesions in such fractures. The comparative study shows that axial compression, using the ASIF-BM device, with early weight bearing, gave a higher rate of union (97 per cent against 87 per cent with the ASIF frame), a shorter healing time (19 weeks against 29 weeks with the ASIF frame) and a decreased need for bone grafting (21 per cent against 84 per cent with the ASIF frame). The incidence of pin track infection was also decreased in dynamic frames. Thus it seems that the ASIF-BM dynamic fixator has a valuable part to play as a definitive mode of therapy for severe open fractures of the tibial shaft.

Adolescent↗
PubMed2001

Knee arthrodesis with circular external fixation.

Knee arthrodesis can enable limb salvage in patients with disability secondary to trauma, infected total knee arthroplasty, pyarthrosis, and other complications. Historically, intramedullary nailing has resulted in the highest overall knee fusion rates. However, intramedullary nailing is relatively contraindicated in the presence of active infection. Nineteen patients who underwent knee arthrodesis with circular external fixation were studied retrospectively. Postoperative radiographs were evaluated for evidence of bony fusion, which was defined as trabecular bridging between the femur and tibia. Patients were interviewed and graded using the functional assessment portion of the Knee Society clinical rating system. Fusion was successful in 13 of 19 (68%) patients. Overall, patients spent an average of 4 months 8 days wearing the circular external fixator. Average time to radiographic and clinical evidence of arthrodesis (defined as lack of motion across the fusion site) was 4 months 18 days. No patient with successful fusion considered himself or herself housebound. All but one of these patients require some form of assistive device for ambulation. Complications occurred in 16 of 19 (84%) patients overall. Superficial pin tract infection (55%) and nonunion (32%) were the most common. Circular external fixation is an effective method for obtaining knee arthrodesis in patients who are not good candidates for intramedullary nailing.

Activities of Daily Living↗
PubMed2003

Synthes tubular external fixation system for isolated subtalar arthrodesis.

The authors present the use of the AO/ASIF tubular system for isolated subtalar arthrodesis. Internal and external fixation are both acceptable means of promoting successful arthrodesis. Appropriate patient selection is vital when considering external fixation. Indications, operative technique, and a discussion are included as well as two case studies.

Arthrodesis↗
PubMed2001

Improvement of the bone-pin interface strength in osteoporotic bone with use of hydroxyapatite-coated tapered external-fixation pins. A prospective, randomized clinical study of wrist fractures.

BACKGROUND: Achieving adequate fixation strength in osteoporotic bone is a challenge. In this study, we examined the use of hydroxyapatite-coated tapered external-fixation pins for the fixation of wrist fractures in patients with osteoporosis. METHODS: Twenty female patients with osteoporosis and a fracture of the wrist were divided into two paired groups and randomized to receive either standard tapered pins or hydroxyapatite-coated tapered pins. Two pins were inserted in the distal part of the radius, two pins were inserted in the second metacarpal, and an external fixation device was mounted. All fixation devices were removed six weeks after surgery. RESULTS: The mean pin-insertion torque (and standard deviation) was 461 +/- 254 Nmm in the group managed with standard pins and 332 +/- 176 Nmm in the group managed with hydroxyapatite-coated pins (p = 0.01). The mean pin-extraction torque was 191 +/- 155 Nmm in the group managed with standard pins and 600 +/- 214 Nmm in the group managed with hydroxyapatite-coated pins (p < 0.0001, power 95%). The mean extraction torque was lower than the corresponding insertion torque at each pin position in the group managed with standard pins (p < 0.05), whereas the mean extraction torque was higher than the corresponding insertion torque at each pin position in the group managed with hydroxyapatite-coated pins (p = 0.001). Two patients managed with standard pins and no patient managed with hydroxyapatite-coated pins had a pin-track infection. Pain during pin removal did not differ between the two groups. CONCLUSIONS: The present study showed that hydroxyapatite-coated tapered external-fixation pins provided improved fixation in the treatment of wrist fractures in patients with osteoporosis.

Aged↗
PubMed1988

Internal stabilization after external fixation of fractures of the shaft of the tibia: sense or nonsense?

A series of 95 patients with fresh fractures of the shaft of the tibia, treated primarily with a Vidal-Adrey transfixation frame, was studied retrospectively. Only 20 fractures (21.0 per cent) attained clinical and radiological consolidation within 4 months after injury. Pseudoarthrosis was seen in 12 patients (12.9 per cent). The external fixator was attached for an average time of 25.0 weeks. Pin loosening was seen in seven patients (7.3 per cent), minor pin track infection in nine (9.4 per cent) and major pin track infection in three (3.1 per cent). In 31 patients (32.6 per cent) a second operative procedure was necessary to accelerate fracture healing. In 17 patients an autologous bone graft was carried out with the external fixator in place. Internal stabilization was performed after removal of the external fixator frame in 14 cases, at an average time of 9.4 months after injury. In difficult fractures we feel that change from external to internal fixation should be performed earlier; it makes early removal of the fixator pins possible and prevents the problems associated with prolonged use of fixator frames. The internal fixation, eventually combined with a transplantation of cancellous autografts, creates a mechanical and biological stimulus for bone consolidation. Functional recovery may also be improved because of a shorter healing time.

Adolescent↗
PubMed2000

Displaced intra-articular fractures of distal radius: a comparative evaluation of results following closed reduction, external fixation and open reduction with internal fixation.

Fractures of the distal end of the radius are common injuries and are the commonest bony injury around the wrist. Management of these fractures has remained controversial as far as modality of treatment is concerned. In this study 90 adult cases of acute displaced intra-articular fractures of the lower end of the radius were classified according to Frykman's and AO classifications after obtaining radiographs in antero-posterior and lateral planes. These were randomly treated by one of three methods: (1) closed reduction and plaster immobilisation, (2) external fixation and (3) open reduction and internal fixation, and were followed for an average of 4 yr. In the final functional assessment (Sarmiento) the results were (1) plaster 43% good and excellent, 50% fair and 7% poor, (2) external fixator 80% good and excellent, 20% fair and poor results, (3) open reduction and internal fixation 63% good and excellent, 26% fair, 11% poor. We recommend that displaced severely comminuted intra-articular fractures should be treated with an external fixator.

Adult↗
PubMed1986

External fixation of tibial shaft fractures with severe soft tissue injuries by Hoffmann-Vidal-Adrey osteotaxis.

The operative results in 65 patients with 66 tibial shaft fractures and severe soft tissue injuries, stabilized by an external fixation frame according to Hoffmann or Vidal-Adrey, are reviewed and the treatment principles are discussed. Four patients required secondary amputations. Fifty-three patients could be followed up for an average of 23.2 months. The infection rate was 9.2% and nonunion was found in 11.1% of cases. Two patients had a refracture after removal of the fixation device. Twenty-three patients (42.6%) required one or more secondary operations. Of the 65 patients, 70.4% had very good or good end results, 16.7% acceptable, and 12.9% poor. External fixation according to Hoffmann or Vidal-Adrey affords excellent definitive stabilization in simple fractures of the lower leg with soft tissue injuries. In comminuted fractures of the lower leg with loss of bone fragments and severe tissue damage, external fixation is better used as a means of temporary stabilization until soft tissues permit definitive rigid stabilization.

Accidents, Traffic↗
PubMedDate not supplied

Management of complex open fracture injuries of the midfoot with external fixation.

Ten patients (11 feet) with severe, high-velocity, open injuries to the midfoot were treated with uniplanar external fixation. The mean patient age was 38 years. Five wounds measured >10 cm, and 3 had extensive degloving of the foot extending into the lower leg. All had grossly comminuted fractures of the tarsal and metatarsal bones: 9 patients had a fractured cuboid; 6 had a fractured navicular; 7 had a fractured cuneiform; and all had metatarsal fractures. Lisfranc joint dislocations were present in 7 feet, and intertarsal dislocations were seen in 3 cases. Six patients underwent split-thickness skin grafting, and 1 required a myocutaneous flap. The average duration of fixator use was 9 weeks (range, 6-15 weeks). Clinically, patients were evaluated 1 year after fixator removal for any residual pain in the foot, ability to stand on tiptoe, presence of a limp, deformity of an arch, and range of motion at the ankle, subtalar, and metatarsophalangeal joints. Each parameter was graded as good, fair, or poor. All patients had sensate plantigrade feet, with 2 patients who experienced pain on weight bearing, 5 who had difficulty standing comfortably on tiptoe, and 2 who limped because of pain. Three patients exhibited flatfoot deformity, whereas 4 had cavus deformity. All demonstrated stiffness at the midfoot and restriction of subtalar and forefoot motion, with 5 also having restricted ankle motion. Radiographically, all fractures were healed at the time of follow-up; 4 were malunited, with 1 demonstrating ankylosis across the tarsometatarsal joint. These results suggest that crush injuries to the midfoot often result in persistent morbidity despite early comprehensive management with external fixation.

Adult↗
PubMed2003

Pin tract infection with contemporary external fixation: how much of a problem?

OBJECTIVE: To determine the incidence of pin tract infection.DESIGN Retrospective chart review. SETTING: Level 1 trauma center in an urban community. PATIENTS: A total of 285 patients with 285 fractures over a 4-year period (1997-2001). INTERVENTION: External fixation. MAIN OUTCOME MEASUREMENT: Incidence of pin tract infection. RESULTS: Of 285 fractures, 32 (11.2%) were complicated by infection. The incidence of infection according to montage was 3.9% (3/77) for ring fixators, which was significantly different (P < 0.04) from the 12.9% incidence (23/178) for unilateral fixators and the 20.0% incidence (6/30) for hybrid fixators (P = 0.004). The incidences of pin tract infection for the unilateral fixator group and the hybrid fixator group were not significantly different. CONCLUSIONS: Patients with hybrid external fixators had a similar risk of pin tract infection as patients who had unilateral fixators. The infection rate in the ring fixator group was significantly lower than the hybrid external and unilateral fixator groups.

Adolescent↗
PubMed2000

Hinged external fixation of the elbow: optimal axis alignment to minimize motion resistance.

OBJECTIVE: To establish an optimal single hinge axis position for application of hinged external fixation to the elbow joint. DESIGN: Cadaveric biomechanical investigation. SETTING: A customized motion transducer applied passive elbow motion to six cadaveric upper extremities. The instant rotation axis of the humero-ulnar articulation was determined from three-dimensional kinematic data acquired by an electromagnetic motion tracking system. For each specimen, an optimal fixator hinge position was calculated from these motion data. INTERVENTION: A prototype articulated external fixator was applied to the elbow, first with its hinge aligned along the computed optimal position. Then the fixator was mounted in sixteen distinct off-axis positions. MAIN OUTCOME MEASURE: Additional resistance to joint motion (in terms of energy) corresponding to deliberately introduced amounts of relative malalignment between the optimal elbow axis and the actual fixator hinge axis. RESULTS: Aligning the fixator hinge along the optimized axis position resulted in a minimal amount of energy (0.15 joules) needed to rotate the elbow through a prescribed range of motion. Malpositioning the hinge by ten millimeters caused up to ten times that amount of motion resistance. CONCLUSIONS: An optimal fixator hinge position can be determined to minimize the increase in motion resistance due to fixator application. The severely increased motion resistance associated with small amounts of malalignment between the fixator hinge and the anatomic elbow axis suggests the need for highly accurate fixator hinge application.

Cadaver↗
PubMed1997

Biomechanics of the Gazi type pelvis external skeletal fixator.

External skeletal fixation is an alternative method of treatment to conventional therapy and open surgical procedures in pelvis fractures. The appropriate type of frame and the configuration of the connecting bars of these fixators are under investigation. In the Gazi type pelvis external fixator (GPEF) which has been developed, a 70 degree angulation is applied to the connecting bars of the anterior quadrangular frame. This configuration, which is expected to improve the stability of the posterior column of the pelvis, was evaluated biomechanically on a phantom with various types of pelvic fractures and separations. The results suggest that the GPEF effectively controls anterior column pelvis fractures such as unilateral pubic ramus fractures, unilateral ischium pubis rami fractures and symphysis pubis separations under vertical loads. The fixator is partially capable of stabilizing the posterior column; however, loads above 700 N cause separation at the fracture site. Further studies and clinical trials are essential to determine the GPEF's effectiveness in reducing blood loss and in providing stability at the posterior column.

Adult↗
PubMed1991

Plating of the fibula. Its potential value as an adjunct to external fixation of the tibia.

There is added stability when plate fixation of the fibula supplements the external fixator used in treating tibial fractures associated with a segmental defect. An anatomic specimen model of a Grade III open fracture of the tibia with an associated fibular fracture was used in this study. Fibular internal fixation using an AO standard plate was performed on one of each of five matched pairs of legs. These were then subjected to identical loads in compression and torsion. The numeric values obtained during loading in all modes were converted to ratios between each of the tested pair to directly compare the effect of stabilization of the fibula. The final results showed that in each case, the preparation with fibular plating had improved resistance to deformation in axial loading. On average, the plated specimens were 2.2 times stiffer. In torsion, plating the fibula did not appear to affect the resistance of the construct to the applied load. Supplemental plate fixation of the fibula in fractures of the tibia with segmental defects may improve subsequent morbidity. The increased rigidity of the system may be sufficient to allow partial to full weight bearing immediately after surgery. This may have significant value in the management of the polytraumatized patient.

Biomechanical Phenomena↗
PubMed1989

Intrinsic problems with the external fixation device of Hoffmann-Vidal-Adrey: a critical evaluation of 117 patients with complex tibial shaft fractures.

In the 1978-1986 period, 117 patients with 119 fresh and complex fractures of the lower leg were secured primarily with a Hoffmann-Vidal-Adrey external fixation device. Ninety-five fractures could be followed until bony consolidation. In 12 fractures (12.7%) a pseudarthrosis developed, and a deep infection in four (4.2%). The external fixation device was attached for an average time of 25.0 weeks. Pin loosening was seen in seven patients (7.3%), minor pin-tract infection in nine (9.4%), and major pin-tract infection in three patients (3.1%). Fourteen fractures needed a secondary internal fixation; in 17 other fractures a secondary transplantation of cancellous bone autografts without internal fixation was carried out. After healing of the soft tissues, the tibial fracture can be regarded as a closed one and other therapeutic procedures to accelerate bony consolidation should be taken into account. The advantages and disadvantages of a second internal stabilization should be evaluated for every fracture with bone healing problems. The alteration from external to internal fixation makes an early removal of the external fixator possible and prevents in this way the intrinsic problems combined with this fixation type such as delayed union, nonunion, pin loosening, or pin-tract infection.

Adolescent↗
PubMed1997

Closed reduction and external fixation of unstable fractures of the distal radius.

The anatomical and functional outcome and complications after closed reduction and external fixation of unstable fractures of the distal radius were reviewed in 29 patients. The fractures were reduced by longitudinal traction and closed manipulation under fluoroscopic control, and the reduced position was retained by a standard half-frame Hoffmann external fixator for six to eight weeks. The mean follow-up time was four (3-7) years. The reduction failed in three patients after too early removal of the fixator (three to five weeks). For the rest of the patients the dorsal angulation, the radial length, the articular step-off, and the intra-articular gap between fragments were significantly improved. Twenty-two patients had excellent or good anatomical alignment and in seven it was fair. One patient had a superficial pin infection, six patients had transient paraesthesias, and one patient transient mild dystrophia. At follow-up one patient had some finger stiffness; this was the only persistent complication. The median Gartland and Werley functional score was 3. The functional end result was excellent or good in 22 patients, fair in four, and poor in three.

Adult↗