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PubMed2003

The advantages of circular external fixation used in high tibial osteotomy (average 6 years follow-up).

We evaluated the midterm results of high tibial osteotomy in patients with medial compartment arthritis. This study included 53 patients treated with high tibial osteotomy accompanied by either internal fixation (group A, n=26) or Ilizarov-type external fixator (group B, n=27). Clinical assessment of patients was performed using Hospital of Special Surgery scoring. Radiography was based on orientation angles of the knee (medial proximal tibial angle, lateral distal femoral angle, posterior proximal tibial angle) and mechanic axis alignment test. We used the Insall-Salvati index to determine patellar height. The mean follow-up in group A was 77 months (range 63-118) and that in group B 72 months (range 61-113). The patients of group B demonstrated better results in terms of Hospital of Special Surgery score, alignment of lower extremity, and preventing of progression of arthritis. We believe that normal alignment and orientation of the knee could be precisely established with a circular external fixator, and that some disadvantages such as patella infera, failed correction, and loss of bone in proximal tibia as observed after classic high tibial osteotomy can be avoided. Furthermore, progression of arthritis can be prevented if the mechanical axis passes through the lateral compartment of the knee.

Adult↗
PubMed1996

Knee arthrodesis with a unilateral external fixator.

The operative fusion of the knee joint remains a valuable technique in posttraumatic and infectious destruction of the knee. External fixation is the technique of choice. Due to the benefits of the monofixator in regard to stability, limited damage of soft tissues and high patient comfort, arthrodesis of the knee joint using an anteriorly placed unilateral external fixator is the procedure routinely used at our institution. From 1985 to 1994, 19 knee arthrodesis procedures were performed with a monofixator. Indications for operative fusion of the knee were an infectious destruction of the joint following osteosynthesis (tibial plateau) in 12 cases, posttraumatic arthrosis of the knee joint with chronic infection in 4 cases, flexion ankylosis of the knee in 1 patient, and destructive osteoarthritis of the knee complicated by an empyema in one case. In one patient, a rearthrodesis was performed for a non-union, following an arthrodesis attempt for infected knee arthroplasty. In all cases, stable fusion of the knee joint in a correct position with complete eradication of infection was obtained. Mean fixation time was 22 weeks. The fixator did not need to be removed prematurely.

Adult↗
PubMed2000

Limb reconstruction surgery with external fixators--university hospital experience.

We are describing 21 limb reconstruction procedures performed in 18 patients with the use of external fixators from 1996 to 1998. The average age of patients was 21, ranging from 1 to 50 years old. Indications for surgery included short limb, non-union, pseudoarthrosis and bone or soft tissue deformities. Average length obtained for cases of limb lengthening was 6 cm. All the seven clubfoot deformities in five children were fully corrected. Equinus deformity recurred in one foot and was treated with supramalleolar osteotomy. Out of the seven cases with infected nonunion and bone loss, three failed to achieve union and required additional bone grafting procedures. One patient with unilateral external fixator for the correction of tibia shortening developed valgus deformity.

Adolescent↗
PubMed1990

External fixation of femoral fractures: experience with 15 cases.

We report our experience with external fixation in 15 femoral fractures in 14 patients. Follow-up times ranged from 4 to 56 months. Thirteen patients had multiple injuries. All but two fractures healed. In one patient with a supracondylar fracture, a knee arthrodesis had to be performed. One septic osteomyelitis of the femur led to amputation. The range of active knee joint motion was greater than or equal to 90 degree in 13 knees. Only six knees, however, regained a flexion of greater than or equal to 120 degrees. Pin tract infection occurred in one case and resolved uneventfully after revision and systemic antibiotics. External fixation should not be routinely used for fixation of femoral fractures, but may be considered in multiply injured and critically ill patients or in case of extensive soft tissue injury.

Adolescent↗
PubMed1994

War wounds of bones and external fixation.

Missile and explosive limb wounds associated with fractures are common in warfare. The retrieval of function is determined more by the nature of the wound and the wound management than by the method of fracture immobilization. The wound must be managed according to well-proven basic principles and then the advantages and disadvantages of the different methods of fracture immobilization considered for each individual patient. Before embracing external fixation as an indispensable tool for managing war wounds, one must recognize that its popularity in civilian practice is founded on its use for severe open tibial fractures from road trauma. Its principle advantage is to permit access to the soft tissue wound whilst the severity of possible disadvantages is not recognized; its effect on bone healing remains unclear. This review examines the role of external fixation in the management of war wounds and advises caution when considering its widespread or universal use. An approach to war wounds with fractures is described whereby external fixation can be combined with plaster splints or traction; this draws on the advantages of both operative and non-operative methods of fracture immobilization and eliminates many of the disadvantages.

Bone and Bones↗
PubMed1994

External fixation in arthrodesis of the ankle. A biomechanical study comparing a unilateral frame with a modified transfixion frame.

Arthrodesis of the ankle was performed on eight fresh-frozen human specimens, and four external fixator configurations were applied: a unilateral external fixator, a Calandruccio clamp alone, a Calandruccio clamp with two anterior struts, and a Calandruccio clamp with four struts (two anterior and two posterior). Each specimen was subjected to 4.0 newton-meters of internal-external tibial torque and 4.0 newton-meters of plantar flexion-dorsiflexion bending moment. The unilateral frame permitted the least tibiotalar motion during plantar flexion-dorsiflexion testing. The Calandruccio clamp allowed more than twice the motion allowed by the unilateral fixator in this testing mode, but the rigidity of the fixation with the Calandruccio clamp was improved with the addition of two interlocking struts, which connected fixator pins proximal and distal to the site of the arthrodesis. The addition of two more struts, to make a four-strut construct, resulted in a small (0.8-degree) additional decrease in the mean tibiotalar motion. There were no detectable differences in the mean tibiotalar motion due to torsional loading between the four fixation configurations.

Aged↗
PubMed1988

Open tibial fractures treated with Hoffmann external fixation.

Thirty-two open fractures of the tibial shaft were treated with external fixation between 1973 and 1981. Early amputation was necessary in one patient. In the remainder, including 14 with extensive soft-tissue lesions, wound healing was obtained within 18 weeks, and the median time until full weight bearing without pain was 32 weeks (range 8-60 weeks). Two deep infections healed during the observation period. Among 26 patients examined 1-9 years after the injury, the result was excellent in six, good in 11, fair in four, and poor in five patients (including the amputation). One fracture had not united during the observation period. Four poor results were due to the stiffness of the ankle and foot after compartment syndrome. In conclusion, alertness for early fasciotomy is necessary even in severe open tibial fractures. The external fixation should not be continued longer than the soft tissue and bone reconstruction make it necessary.

Adolescent↗
PubMed2001

Treatment of severely comminuted intra-articular fractures of the distal end of the radius by open reduction and combined internal and external fixation.

BACKGROUND: Severely comminuted AO type-C3 intra-articular fractures of the distal end of the radius are difficult to treat. Failure to achieve and maintain nearly anatomic restoration can result in pain, instability, and poor function. We report the results of a retrospective study of the use of a standard protocol of open reduction and combined internal and external fixation of these fractures. METHODS: Seventeen of twenty-five patients treated with the protocol were available for follow-up evaluation. Six had an AO type-C3.1 fracture; eight, type-C3.2; and three, type-C3.3. Eleven fractures required a dorsal buttress plate and/or a volar buttress plate, and eleven required bone-grafting. The mean time until the external fixator was removed was seven weeks. RESULTS: At a mean of thirty months postoperatively, the mean arc of flexion-extension was 72% of that on the uninjured side and the mean grip strength was 73% of that on the uninjured side. The mean articular step-off was 1 mm, the total articular incongruity (the gap plus the step-off) averaged 2 mm, and the radial length was restored to a mean of 11 mm. Thirteen patients had less than 3 mm of total articular incongruity. Arthritis was graded as none in three patients, mild in ten, moderate in three, and severe in one. According to the Gartland and Werley demerit-point system, ten of the patients had a good or excellent result. According to the modified Green and O'Brien clinical rating system, five had a good or excellent result. One patient had a fracture collapse requiring wrist fusion, one had reflex sympathetic dystrophy, and three had minor Kirschner-wire-related problems. Total articular incongruity immediately postoperatively had a moderately strong correlation with the outcome as assessed with both clinical rating systems (r = 0.70 and 0.74 for the Gartland and Werley system and the Green and O'Brien system, respectively; p<0.05). CONCLUSIONS: Open reduction and combined internal and external fixation of AO type-C3 fractures can restore radiographic parameters to nearly normal values, maintain reduction throughout the period of fracture-healing, and provide satisfactory functional results.

Adult↗
PubMed1993

[Use in the cat of the "small external fixator for hand and forearm" of the Association for Osteosynthesis Inquiry. I. Introduction].

In the first part general principles and indications for external fixator use in cats for treatment of fractures and luxations are described. This study considers only one of many external fixator systems. The results of the clinical use of this system in cats are described in the second part of this investigation. Technical aspects, post operative care, implants removal, possible complications and their therapy are discussed.

Animals↗
PubMed2002

Treatment of unreduced elbow dislocations with hinged external fixation.

BACKGROUND: The results of operative treatment of an unreduced elbow dislocation have been regarded with pessimism. Suggested procedures have included tendon-lengthening, tendon transfer, or reconstruction of ligament or bone. METHODS: Three women and two men (average age, forty-nine years) with an unreduced dislocation of the elbow without associated fractures were treated with open relocation of the joint and hinged external fixation at an average of eleven weeks (range, six to thirty weeks) after the initial injury. The lateral soft tissues, including the origin of the lateral collateral ligament complex, were reattached to the lateral epicondyle in three patients, but no attempt was made to reconstruct the ligaments, tendons, or bone. A passive worm gear incorporated into a hinged external fixator was used to mobilize the elbow initially, and active mobilization was gradually introduced. The hinge was removed at an average of five weeks after the procedure. RESULTS: At an average of thirty-eight months (range, twelve to ninety-eight months), a stable, concentric reduction had been maintained in all five patients, with radiographic signs of mild arthrosis in four. The average arc of flexion was 123 degrees, and all patients had full forearm rotation. The average score on the Mayo Elbow Performance Index was 89 points, with two excellent and three good results. The average scores on the Disabilities of the Arm, Shoulder and Hand (DASH) and American Shoulder and Elbow Surgeons outcome instruments (13 and 92 points, respectively) reflected mild residual pain and disability. CONCLUSIONS: Treatment of unreduced elbow dislocations with open reduction and hinged external fixation as much as thirty weeks after the injury can restore a stable, mobile joint without the need for tendon-lengthening or transfer, ligament reconstruction, or deepening of the trochlear notch of the ulna.

Adult↗
PubMed1990

Transfer of free vascularized bone and skin-bone autografts: experiences in the application of external fixation apparatus.

The results of transfer of free vascularized bone and skin-bone autografts in 95 patients with defects (54) and nonunions (41) of tubular bones of different genesis are presented. In 71 cases, an external fixation apparatus was used for purposes of osteosynthesis. In 50 cases, the Ilizarov apparatus was applied prior to osteoplasty to correct deformity and fully or partially to correct a shortening of the extremity bone segment. In seven cases, lengthening of the bone segment was performed using an external fixation apparatus after osteoplastic reconstruction of the defect. Treatment was completed in 76 cases (80.0 percent); of these, the outcome was positive in 89.5 percent of cases. Failure was recorded in 10.5 percent of cases. The advantages of using an external fixation apparatus in combination with vascularized bone and osteocutaneous autografts are discussed.

Adolescent↗
PubMed2005

Supra-acetabular placement of external fixator pins: a safe and expedient method of providing the injured pelvis with stability.

Applying a stable anterior pelvic external fixator frame is a skill that should be mastered by all orthopedic surgeons who treat acutely injured patients. Splinting of an unstable pelvis during resuscitation can help to reduce the volume of the true pelvis, pending definitive surgical stabilization of the pelvic ring. Supra-acetabular pin placement, less familiar to most surgeons than iliac wing pin placement is, can provide a more reliable pin-bone interface and thus allow improved reduction ability with fewer soft-tissue complications. Because of their location, supra-acetabular pins also seem to be better tolerated than iliac crest pins when used for definitive management of the pelvic ring disruption. A young man who sustained a type II anteroposterior compression injury in a motor vehicle accident presented with symphyseal disruption (7 cm wide) and left anterior sacroiliac joint disruption. During resuscitation, the pelvis was anatomically reduced and stabilized with a supra-acetabular pin-based external fixator. Pin locations, chosen using palpable and cutaneous landmarks, were inserted without additional imaging guidance. The fracture was reduced anatomically, and the frame was used for definitive management of the pelvic ring injury.

Accidents, Traffic↗
PubMed2005

Role of Ilizarov external fixator in the management of proximal/distal metadiaphyseal pediatric femur fractures.

Given the constraints of a short metaphyseal fragment and adjacent growth plates, there are limited options for operative fixation of metadiaphyseal fractures of the femur in children. This article outlines the surgical technique and reports early results of metadiaphyseal pediatric femur fractures treated with an Ilizarov external fixator by a single surgeon. Ten skeletally immature males with 5 proximal and 5 distal metadiaphyseal femur fractures underwent closed reduction and application of an Ilizarov external fixator. Time in the fixator averaged 138 (range, 104-180) days. At a mean follow-up of 26 months, there were no cases of loss of reduction, refracture, malalignment, leg length inequality, or loss of knee and hip mobility. Although superficial pin tract infections were common, no patient developed deep infection or required premature pin removal. One patient developed a transient foot drop after external fixation for a distal metadiaphyseal fracture, which recovered after revision of the pin construct. A low profile Ilizarov fixator can be effective in the management of certain metadiaphyseal pediatric femur fractures that may be difficult to manage by traditional methods.

Child↗
PubMed2004

Can external fixation maintain reduction after distal radius fractures?

BACKGROUND: The purpose of this study was to assess the effectiveness of external fixation and percutaneous pinning in maintaining distal radius fracture reduction over a 6-month period and to identify factors that might predict loss of fracture reduction. METHODS: Seventy cases had complete radiographic evaluation before surgery; at surgery; and at 6-week, 3-month, and 6-month follow-up. Radiographic parameters measured included volar tilt, dorsal displacement, radial inclination, radial height, radial shift, and ulnar variance. RESULTS: Dorsal tilt averaged 17.5 degrees from neutral before surgery; this value was corrected to 0.9 degree at surgery, but then progressed to 4.2 degrees by the 6-month follow-up. At 6-month follow-up, 49% of cases had lost more than 5 degrees of initially reduced volar tilt. However, none of these patients went from an acceptable initial reduction to an unacceptable reduction at 6 months. Initial deformity, patient age, use of bone graft, and duration of external fixation were not predictors of loss of reduction. CONCLUSION: Loss of reduction of volar tilt was seen for a period of up to 6 months after fixation, despite the use of pinning to hold the reduction. No specific predictor of loss of reduction was noted, although there was a trend toward loss of reduction in younger patients.

Adult↗
PubMed2001

Radiostereometric analysis of distal radial fracture displacement during treatment: a randomized study comparing Norian SRS and external fixation in 23 patients.

In a randomized study, we included 23 osteoporotic patients with a distal radial fracture and loss of reduction after 1 week. The facture was re-reduced. In one group, a self-setting hydroxyapatite, Norian SRS, was injected into the fracture and the wrist was immobilized for 2 weeks with a dorsal splint (n 12). In the other group, the fracture was immobilized for 5 weeks with an external fixator (n 11). During the operation, the fracture fragments were marked with tantalum markers, so that loss of reduction during the immobilization and after mobilization could be studied with radiostereometric analysis (RSA). We found some recurrence of compression in the fracture in both groups during immobilization. After mobilization, the motion of the fracture, measured by displacement of the fragments along the longitudinal axis, was less than 2 mm, except in 3 cases treated with Norian SRS. A compression along the longitudinal axis of less than 2 mm is not likely to cause any problem in the long term. From the first to the last investigation, 7/12 patients with Norian SRS and 4/11 with external fixation lost more than 2 mm of the reduction along the longitudinal axis. We conclude that 5 weeks of immobilization is sufficient for healing with external fixation in this age group. This immobilization time might be reduced to 2 weeks for fractures treated with Norian SRS, but additional hardware should be used to ensure stability of the fracture system.

Age Factors↗
PubMed2000

External fixation of the distal radius: to predrill or not to predrill.

Using both clinical and laboratory studies we investigated whether predrilling before insertion of external fixation pins is necessary for use in treating distal radius fractures. Our clinical study included 50 consecutive external fixators (4.0- and 2.5-mm pins) using 100 predrilled and 100 direct-drilled pins placed in a randomized manner. There was no increased incidence of pin track infection or other pin problem with the direct-drilled technique. There were, however, significantly elevated temperatures with the direct-drilled technique. We therefore recommend predrilling even though the temperature differences in this bone with this fixator were not clinically evident.

Adolescent↗
PubMed1999

Lengthening of the tibia over an intramedullary nail, using the Ilizarov external fixator. Major complications and slow consolidation in 9 lengthenings.

We lengthened 9 tibial segments over a nail to reduce the time in the external fixator in 5 patients with constitutional shortness. The median lengthening was 7 (5.5-7.3) cm and the external Ilizarov frame was removed after median 99 (63-125) days. In spite of a short time in the external fixator, consolidation was slow, with a median lengthening index of 4.4 (2.4-6.1) months/cm. The procedure resulted in 3 fatigue fractures of the intramedullary nail or interlocking screws that needed revision and bone grafting. In 1 patient, a deep intramedullary infection occurred. After the experience of these major complications we have returned to the traditional callotasis lengthening method described by Ilizarov.

Achilles Tendon↗
PubMed2003

Nonbridging external fixation in the treatment of unstable fractures of the distal forearm.

INTRODUCTION: Unstable fractures of the distal forearm often require surgical treatment to restore the normal anatomy and function. We have used a relatively new technique, nonbridging external fixation, in the treatment of these fractures in our hospital during the past few years. Our results are presented here. MATERIALS AND METHODS: Fifty-two patients (41 female, 11 male) with an unstable fracture of the distal forearm were treated using nonbridging external fixation at Oulu University Hospital during 1996-1999. The patients' mean age was 57 years. There were 45 Colles-type fractures, and 7 distal radius fractures had a concomitant distal ulna fracture. Forty-three patients were reviewed after a mean of 16 months of follow-up to assess radiological, functional, and subjective results. RESULTS: The fixation device maintained reduction well during healing, and the final radiological result was good. Range-of-motion and grip strength were restored to levels of 87-98% compared with the uninjured forearm. The subjective result was rated as 8 (mean) on a scale of 0-10. Pin-tract infection was a common complication (19%), but such cases were easily treated with antibiotics. CONCLUSION: Nonbridging external fixation offers an easy, minimally invasive, and reliable technique in the treatment of unstable fractures of the distal forearm.

Adolescent↗