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At least 703 records · Page 39Linked to original sources
PubMed2005

Reconstructive procedures on lower extremities using Mitkovic external fixation system.

The results of limb lengthening, correction of limb deformities and solving of bone loss, by the use of Mitkovic external fixation system and minimally invasive technique on the series of 96 operations in 89 patients are shown. Only lower extremities were included in this series. The advantages of this external fixation system in comparison to other systems are pointed out. The main advantages are the optimal biomechanical conditions including unilateral but 3-dimensional frame, which provides conditions very similar to natural biomechanical features of the human long bones, simplicity of application and low cost. The received result was excellent or very good in 98.4%. Maximal limb lengthening was 18 cm (at the same time in the femur and the tibia). Angular deformity correction is extremely simplified with minimized possibility of complications. The frame for bone transport is very simple. It can be concluded that presented methods are suitable for routine use.

Bone Lengthening↗
PubMed1983

External fixation as a secondary procedure.

Twenty-two patients were treated by external skeletal fixation as a secondary procedure after failure of primary management with other modes of treatment. Fourteen of these cases were infected at presentation. The average duration from the time of injury to the application of external fixation was 17 months. Ninety-five per cent of fractures united with this treatment, and there have been no recurrent infections, with a minimum follow-up evaluation of one year. Pin tract problems were frequent and consisted of drainage, with or without pin loosening. All patients allowed unrestricted weight-bearing experienced some form of pin problem, whereas only 12% of patients restricted to touch-down weight-bearing with crutches developed pin tract problems; none has had residual pin tract infections. External fixation is an effective secondary measure for injuries that have failed to unite by primary treatment. Use of external fixation requires close supervision of postoperative treatment and, especially, close attention to pin insertion and management.

Adult↗
PubMedDate not supplied

Transfixion wire positioning within the bone: an option to control proximal tibia external fixation stiffness.

PURPOSE: The greatest angle that can be formed by the crossing wires at the proximal tibia level without altering safe corridors approaches only 60 degrees. Consequently, the wires are positioned more in the coronal than the sagittal plane. Looking for an increase in sagittal bending stiffness, we evaluated different wire positioning within the proximal tibia and their effect on the stiffness of external fixation of proximal tibia. STUDY DESIGN: A fiberglass composite tibia fixed into an idealized ring external frame was tested with a servohydraulic test frame. Load-deformation behavior was compared among the different wire positioning within the proximal tibia under identical conditions of central axial compression, medial compression-bending, posterior compression-bending, posteromedial compression-bending, and torsion. Stiffness values were calculated from the load-deformation and the torque-angle curves. RESULTS: The sample with 3 wires positioned within the bone-2 wires crossed 1 cm posteriorly from the center of the tibia and the third wire placed in coronal plane 1 cm anteriorly from the center of the tibia-was significantly (P < 0.05) stiffer in posterior, posteromedial, and torsional loading configurations compared with all other wire positions within the bone. CONCLUSIONS: This new wire positioning within the proximal tibia-2 wires crossed 1 cm posteriorly from the center of the tibia and the third wire placed in coronal plane 1 cm anteriorly from the center of the tibia-increased overall stiffness of external fixation, predominantly in sagittal plane. CLINICAL RELEVANCE: This work provides a rationale to control proximal tibia external fixation stiffness in sagittal plane.

Bone Wires↗
PubMed1996

[Management of unstable shaft fractures of the lower extremity in children using the external fixator].

METHOD: Since 1993 we have treated 30 children between 2 and 15 years with 31 unstable tibial and femoral shaft fractures. We perform closed reduction und X-ray control and stabilize the fracture using the monotube-fixator, system Howmedica. The advantages of this system are based on the self-drilling, self-cutting screws and the simple dynamization. DISCUSSION: The treatment of dislocated, instable fractures of the tibial and femoral shaft in children using traction method is related with a long hospital stay in an uncomfortable position. The traction method leads to bone healing, but with a high rate of deformity after reposition. We treat the shaft fractures of the lower extremity using the external fixation. This method allows to reach early weight bearing mobilisation, it is related to a shorter hospital stay. The child is already one day after initial treatment allowed to walk with full weight bearing. The treatment with the external fixation is a modification of the traction method. CONCLUSION: We think to have a good concept of treatment using external fixation in children with unstable fractures of the femur and tibia shaft. The disadvantages namely pin tract infections, general anesthesia for removal and difficulties with the reduction are overruled by the advantages as short hospital stay, early weight bearing mobilisation and early return of the child to his own environment.

Adolescent↗
PubMed2004

Distraction osteogenesis with conventional external fixator for tibial bone loss.

Between 1991 and 2002, we treated 21 patients with tibial bone loss using a conventional external fixator. Nine patients had an infected open fracture and 12 patients an infected nonunion. After corticotomy, the bone was distracted at the rate of 1 mm (1 mm/step) on alternate days or every 48 h. The mean follow-up period was 18.7 (6-108) months after fixator removal. The mean new bone gained was 7.4 (2-17) cm. The mean healing index was 44.7 (17-86) days/cm. Total wound infection was resolved in 19 limbs (90.5%), and 11/12 (91.6%) nonunions united. Union with acceptable alignment (< 7 degree of angulation) and limb-length difference (<2.5 cm) was achieved in 18 limbs (85.7%). The bone result was excellent in 17 tibiae, good in three, and poor in one. Eighteen limbs had an excellent and three a good functional result. This modified technique of distraction osteogenesis using AO/ASIF conventional external fixator is safe, cost effective, and a versatile tool in the management of tibial bone loss associated with infected nonunion and open fractures.

Adolescent↗
PubMed1998

A cheap, disposable external fixator for comminuted phalangeal fractures.

Reduction of a severely comminuted fracture of a long bone in the hand can be difficult to hold. An external fixator can be the best method of maintaining satisfactory reduction in such fractures. A small, disposable external fixator is described, made from a syringe barrel and K-wires. It allows accurate reduction with minimal soft tissue trauma and is easy to construct and apply. It allows early mobilization of the digit and is inexpensive.

Bone Wires↗
PubMed1989

Correction of complicated extremity deformities by external fixation.

Thirty-three limb segments with various deformities in 28 children were treated by external fixation. Sole bone lengthenings and trauma cases were excluded from this study. The Wagner device was used in six cases, the Ilizarov ring fixator in seven, and the Orthofix in 20. Indications, techniques, results, and complications are discussed. The results indicate that modern external fixation is an effective alternative method in the treatment of problem cases such as congenital pseudarthroses, severe relapsed or neglected clubfoot, high dislocated hips, and limb deformities with length discrepancies.

Adolescent↗
PubMed1999

Measurement of insertion torque of tapered external fixation pins: A comparison between two experimental models.

The aim of this study was to compare an in vitro versus an ex vivo experimental model to test the insertion torque of two different types of external fixation pins. A torque measuring machine was developed in order to perform accurate measurements. Forty tapered pins made of stainless steel were utilized. Half of the pins were plasma-spray coated with hydroxyapatite (HA) and the other half remained uncoated. For the in vitro model 20 cylinders were used that were made of synthetic polymer according to ASTM standards. For the ex vivo model 10 fresh femora harvested from adult sheep were used. All the pins were implanted after predrilling, and insertion torque was measured. Statistical analysis of the in vitro versus the ex vivo model showed significant differences in both coated (p < 0. 0005) and uncoated (p = 0.002) external fixation pins. These results may be due to the surface roughness that caused significant friction between the HA coating and the polyvinylchloride in the in vitro model. The significant difference between the in vitro and ex vivo results lead us to state that the in vitro model does not realistically simulate the behavior of external fixation pins implanted in bone.

Animals↗
PubMed1993

Unilateral external fixation for severe pilon fractures.

Twenty-one patients with severe tibial plafond fractures were treated by unilateral large screw external fixation. In 15 patients, this was combined with limited internal fixation. The fractures were classified according to the methods of Ovadia and Beals. There were nine type III, four type IV, and eight type V fractures, and according to the methods of Rüedi and Allgöwer, nine type II and 12 type III fractures. Seven fractures were open. In five fractures, no attempt was made at articular reconstruction due to severe comminution. Four of these fractures required ankle arthrodeses and one type IIIB fracture received a late amputation. All other fractures healed. There were no cases of wound infection, skin slough, or osteomyelitis. Large screw external fixation in the talus and calcaneus was not associated with significant early or late complications. The less extensive tissue dissection in an area prone to wound complications may account for the low rates of infections, wound complications, and nonunion.

Adult↗
PubMed1995

Results of combined internal and external fixation for the treatment of severe AO-C3 fractures of the distal radius.

Combined internal and external fixation for distal radius fractures has been previously reported, but the indications, technique, and results are not defined. This study reviews an experience with a specific surgical strategy for the treatment of a homogeneous population of AO-C3 fractures of the distal radius. The technique is composed of combined palmar and dorsal surgical approaches for open reduction and internal fixation of fracture fragments after neutralizing the wrist with a rigid external fixator. Thirteen fractures in 12 patients were followed an average of 27 months. Wrist motion averaged 60 degrees of flexion and 45 degrees of extension. The injured extremities had a mean grip strength that was 83% of the uninjured side. Follow-up x-ray films showed a dorsal tilt of 1 degree, radial inclination of 18 degrees, and radial length of 12 mm. Using the rating system of Green and O'Brien, the results were excellent or good in 10 wrists. The results indicate that this surgical strategy, though technically demanding, can be successfully used in this specific subset of difficult to treat distal radius fractures.

Adult↗
PubMed2006

Far-forward fracture stabilization: external fixation versus splinting.

With improvements in body armor, soldiers often survive previously fatal injuries but incur devastating extremity trauma. Orthopaedic and general surgeons in forward-deployed areas must be well-versed in the selection and application of both external fixation and splinting devices in order to best preserve life and limb of the wounded. The surgeon must consider tactical environment, injury severity, injury location, available resources, and his or her own level of experience. Advantages to using external fixation in the field include preventing future injury to the traumatized soft-tissue envelope, reducing the risk of infection, minimizing fracture hemorrhage, providing pain control, and facilitating medical evacuation. Splinting is reserved for closed, low-energy, stable fractures of either the upper or lower extremity and for unstable fractures that are not amenable to battlefield external fixation; because of the risks of compartment syndrome, casts are avoided.

Fracture Fixation↗
PubMed1992

Overdesign of external fixation systems.

This article reviews 850 cases of open fractures of the extremities caused by high velocity missiles and shell fragments, and treated by two varieties of external fixation devices. If a protocol for grading the severity of injury is followed, the results encourage avoiding sophisticated, expensive, and overdesigned external fixation systems.

Equipment Design↗
PubMed1992

Hand and wrist function after external fixation of unstable distal radial fractures.

Twenty-eight patients with 31 fractures of the distal radius were treated by closed external fixation. The complication rate for this series was 50%. Anatomic results were acceptable but hand function at final review was disappointing, particularly in the measurement of grip strength and the patient's ability to perform the activities of daily living. There was a highly significant correlation between complications and poor functional outcome. Although external fixation can achieve restoration of normal anatomy, functional outcome may be poor because of the severity of the associated soft tissue injury.

Activities of Daily Living↗
PubMed1993

Two-stage operative treatment of comminuted os calcis fractures. Primary indirect reduction with medial external fixation and delayed lateral plate fixation.

The indication for otherwise established lateral plate fixation in fractures of the calcaneus becomes relative when severe comminution (Sander's Type III and IV) of the bone involves concomitant massive soft-tissue swelling. The calcaneus is shortened, Böhler's angle flattened, and lateral bulging and varus deformity persist throughout the six or more days needed for soft-tissue compromise to recede. Intraoperatively, problems with anatomic reduction are encountered primarily because of soft-tissue shrinkage and muscle contraction, underscoring the rationale for conservative treatment modalities. A two-stage approach--primary medial external fixation and delayed lateral plate fixation--stabilizes the calcaneus in a nearly anatomic position by calculated distraction through medial external fixation, leaving joint congruency to be restored in a secondary procedure, when soft tissues pose no problem for a lateral approach. The two-stage procedure was used in 13 of 49 cases, in which soft-tissue compromise was severe. Anatomic primary reduction greatly facilitated delayed lateral plate fixation. Infection rates were not traced to the external fixation. Massive bone grafting was associated with a high occurrence of complications.

Ankle Injuries↗
PubMed1996

Clinical and biomechanical aspects of external fixation of the pelvis.

OBJECTIVE: The aim was to evaluate the mechanical stability of several traditional and modern external fixators in unstable pelvic ring disruption. DESIGN: In a laboratory study external and internal fixation techniques were tested in seven fresh and five embalmed human pelves with a disruption of the pubic symphysis and one sacroiliac joint (type C1.2 injury according to the Tile-AO classification). BACKGROUND: Stability provided by external fixation depends upon many factors, with the residual pelvic stability being the most important. METHODS: Simulating a single-leg stance, the load was applied quasi-statically to the acetabulum of the unstable hemipelvis. Device failure was defined as displacement >10 mm either at the symphysis pubis or the sacroiliac joint. RESULTS: The frame with the highest failure load (fresh versus embalmed specimens) was the Egbers configuration with the AO fixator (analysis of variance; P < 0.05). Failure was noted at 114.9 N versus 129.5 N. Augmentation of the Mono-Tube by additional internal posterior osteosynthesis gave the following results: sacral bars 325.4 N versus 217.8 N, plate fixation 294.3 N versus 215.8 N, lag screws 338.4 N versus 215.8 N. Failure loads of hybrid fixation of the Orthofix were as follows: sacral bars 257.9 N versus 213.9 N, plate fixation 333.5 N versus 245.3 N, lag screws 397.3 N versus 280.6 N. The differences between the two fixators were not statistically significant. CONCLUSIONS: No single external frame provided sufficient stability. The addition of a posterior internal fixation significantly increased failure loads and controlled the weight-bearing pelvic elements.

Journal Article↗
PubMed1991

The effect of devascularisation upon early bone healing in dynamic external fixation.

We examined the effect of periosteal devascularisation upon the early healing of osteotomies of sheep tibiae held in an instrumented external fixation system with an axial stiffness of 240 N/mm. At 14 days, cortical blood flow measured by the microsphere technique was 19.3 ml/min/100g in the well-vascularised osteotomies, but only 1.7 ml/min/100g in the devascularised osteotomies, despite an increase in medullary flow (p less than 0.0005). Delay in healing of the devascularised osteotomies was suggested by an in vivo monitoring system and confirmed by post-mortem mechanical testing. We suggest that the osteogenic stimulus of dynamic external fixation is dependent on the early restoration of cortical blood flow in devascularised fractures.

Animals↗
PubMed1992

Universal joint slippage as a cause of Hoffmann half-frame external fixator failure [corrected].

Slippage of the universal joints of external fixation devices is known to occur but its significance or incidence is often overlooked. In this study, controlled experiments were used to determine the relationship between joint slippage and the maximum loads a single half-frame could bear for the Hofmann device. The experiments showed that: (a) the joints slipped at minimal loads and (b) frame failure, i.e. loss of initial alignment of the frame components, was determined by joint slippage. The importance of the control of slippage cannot be overstated; the orthopaedic community must educate itself and its patients and guard against the problem in order to avoid complications secondary to slippage.

Biomechanical Phenomena↗
PubMed1993

Treatment of a central fracture-dislocation of the hip using external fixation with iliofemoral distraction.

Three patients were treated with external fixation with iliofemoral distraction as an alternative treatment of comminuted central fracture-dislocations of the hip. The patients were mobilized on the first postoperative day and discharged from the hospital an average of 10 days postaccident. The frame was left in place for 6 weeks while the traction was maintained. Full weight bearing was started 3 months after the injury. A full range of motion in the injured hip was achieved at 4 months postoperation. No signs of avascular bone necrosis were seen during follow-up for up to 2 years. The clinical results of the described method were good, and it can be used as an alternative method, especially when open reduction is contraindicated or complicated.

Adult↗