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PubMed2002

Indications, alternatives, and complications of external fixation about the elbow.

External fixation around the elbow is a concept as complex as the pathology that it treats. A myriad of potential pitfalls await the surgeon who casually applies a frame to any extremity, let alone a portion of one as complicated as the elbow. A careful understanding of the anatomy, specific technique, applications of the various devices commercially available, and rational alternatives to each problem is crucial for the judicial use of external fixation around the elbow. The potential benefits of the external fixator, however, are worthy of the surgeon's time to understand and pass on to his or her next patient.

Cartilage, Articular↗
PubMed1991

The role of supplemental lag-screw fixation for open fractures of the tibial shaft treated with external fixation.

Ninety-nine open fractures of the tibial shaft were treated with unilateral external fixation with or without supplemental lag-screw fixation. We compared the results in forty-four fractures in which only external fixation was used (control group) with those in fifty-five fractures that were stabilized with lag-screws and external fixation, and we found no statistically significant differences between the two groups with respect to the time to full weight-bearing, the time to union, or the rates of delayed union, osteomyelitis, malunion, superficial or deep pin-track infection, or loosening of the pins. The limbs in which the fracture was treated with external fixation and supplemental lag-screws had more than twice the rate of refracture of the control limbs (11 compared with 5 per cent), and the percentage of fractures having supplemental lag-screw fixation that needed bone-grafting to achieve union was more than twice that in the group treated with external fixation alone. We concluded that the routine use of supplemental lag-screw fixation is not indicated in patients who have an open fracture of the tibial shaft that has been stabilized with external fixation.

Adolescent↗
PubMed1985

External fixation. Its use in podiatric surgery.

Rigid fixation of osseous fragments with the ability to supply additional compression or distraction at will is achieved only by external fixation. Of course, the treatment of nonunions, infections, fixation of osteotomies, fusion of joints, and lengthening of bone can be accomplished by other satisfactory means with and without fixation. External fixation is only one method of fixation. From this list the practitioner can choose the method of fixation best suited to the contemplated procedure and the one with which the surgeon feels most comfortable. However, a good surgeon will have prepared alternative methods of fixation if, in fact, the first and preferable method of fixation fails. It would be wonderful if our plans became a reality; quite often they do not and this is what one must prepare for. External fixation in many of the cases presented was not the original form of fixation to be used; in a few cases it had not been seriously considered. Fortunately, however, it was considered and allowed a difficult situation to be remedied with relative ease. Although elaboration of the categories in which external fixation was employed has been brief, the numerous presentations lend themselves to further investigation into external fixation.

Adult↗
PubMed1995

Open fractures of the femoral shaft, treated with osteosynthesis or temporary external fixation.

Controversy surrounds the treatment of open femoral shaft fractures, especially in the multiply injured. We report on 54 patients with 57 open femoral shaft fractures. They were treated according to our policy which deals with the severity of the soft-tissue damage. Low-grade open femoral fractures were primarily treated with internal fixation. A temporary external fixator was used for high-grade open fractures and in multiply injured patients where primary intramedullary nailing was contra-indicated. The external fixator was converted into an intramedullary nail as soon as the local soft-tissue disorders and the general condition of the patient permitted. There were no cases of deep infection. There was one case of malunion. Functional outcome was good to excellent in all cases. The aim of this paper is to show that low-grade open femoral fractures can be safely treated with primary intramedullary nailing and that temporary external fixation of severe open fractures followed by conversion into an intramedullary nail can be done without deep infection.

Adolescent↗
PubMed1986

Effects of fixation stiffness on fracture healing. External fixation of tibial osteotomy in the rabbit.

In rabbit tibial osteotomies, the effects on bone healing of three different degrees of stiffness of external fixation were investigated. Redislocation occurred in one third of the osteotomies with the least rigid fixation, and the amount of external callus was greater in this group. At 6 weeks there were no significant differences between the groups regarding bending strength and stiffness of the bones.

Animals↗
PubMed1994

[Stable joint-bridging extension of malleolar dislocations and pilon fractures with the AO pinless external fixator].

The pinless external fixator, introduced into clinical practice for open tibial fractures, suggested itself for use as a traction substitute because of its pinless frame. The aim of this feasibility study was to replace the conventional calcaneal pin traction by a joint-bridging pinless fixator, inserted under local anesthesia. 10 patients with 6 malleolar dislocation fractures, 3 pilon tibial and 1 open distal tibial fracture were immobilised by a joint-bridging pinless fixator during 10.4 days (5-16 days) till swelling had subsided and definitive fracture treatment, consisting of plate fixation, took place. The implantation of the joint-bridging pinless fixator in local anaesthesia was well tolerated by all patients. This traction substitute offered good patient comfort and easy care. Although the provided stability was less than a conventional fixator, all patients were able to lift up their fractured extremity without pain.

Aged↗
PubMed1996

Biological fixation of subtrochanteric fractures by external fixation.

Fifty-one subtrochanteric fractures have been stabilized by external fixation over the last 9 years. Union occurred in all types of fractures, usually within 6 months. Soft tissue interposition led to non-union in three patients. Refracture in one patient and significant limb-length discrepancy in two patients was seen. The technique is versatile, easily reproducible and 'biological'. Protected weight-bearing is not necessary after removal.

Adult↗
PubMedDate not supplied

The child with an Ilizarov external fixator.

The Ilizarov External Fixator is gaining popularity as the most effective method to correct limb length deficiencies, correct angular deformities, and aid in the restoration of a limb compromised by traumatic injuries. Nurses caring for a child having this procedure need an understanding of the device application and appropriate nursing strategies.

Adolescent↗
PubMed1992

Classification and nomenclature of external fixators.

Classification of external fixators has graduated from simple device names to a more descriptive system based on frame configuration. Fixators are of the simple pin, clamp, or ring type. Two classification systems are currently being used to categorize fixators. In one, they are defined as type I, type II, or type III fixators. In the second classification system, the categories are more descriptive. Fixators are broadly defined either as unilateral or bilateral. Within each of these categories, there are one-plane or two-plane frames. In veterinary orthopedics, further adjectives, such as double-clamp, single-bar, two-pin single-bar, and double-bar, are employed to describe some of the more popular configurations. Many configurations are not easily definable because complex arrangements of pins and clamps are sometimes necessary to adapt the frame to the fracture bone successfully.

Animals↗
PubMed1983

External fixation. Yesterday, today, and tomorrow.

External fixation is a method of immobilization that uses percutaneous pins placed in bone and linked with external connectors. The concept of external fixation appears in works of Malgaigne from the mid-19th century. Since Malgaigne's invention many other external fixation systems have been introduced, and external fixation is currently a standard method for treating fractures.

Bone Nails↗
PubMed1995

External fixation as a primary and definitive treatment of open limb fractures.

This paper analyses the medical records of 5024 injured persons treated and operated on at the Surgical Clinic of the Clinical Hospital in Osijek, during the war against Croatia (1991 and 1992). There were 1653 (33.0 per cent) admitted, while the rest were treated as out-patients. Of the admitted patients 82.7 per cent (1372) had limb injuries. In 760 (15.0 per cent) of the wounded, 1320 limb fractures caused by explosives were diagnosed, out of which 856 were of the lower and 464 of the upper limbs. One hundred and ninety-two (3.9 per cent) were treated by external fixation. External fixators were applied to 147 lower and 68 upper open long bones, respectively. Adequate reconstructive operations were performed on 106 (2.1 per cent) patients with associated injuries to important blood vessels. The stabilization of the open and unstable external fractures was achieved by external fixation, mostly at one level, regardless of the wound size. The importance of good wound cleaning has been particularly stressed as well as bone fragment reposition. Special attention has been given to the preoperative and intra-operative assessment of the limbs. In 20 patients (9.3 per cent) treated with external fixation, osteitis occurred. Twenty-one more patients (9.7 per cent), because of bad fracture healing after external fixation, were submitted to secondary internal bone fixation combined with bone grafts. Out of these, nine (42.8 per cent) developed osteitis as a consequence of the additional treatment.

Arm Injuries↗
PubMed1986

Dynamic axial fixation. A rational alternative for the external fixation of fractures.

Conventional external fixation systems neither inhibit motion at the fracture site sufficiently to permit primary bone healing, nor do they allow sufficient motion to encourage adequate external callus formation. Healing with such systems is therefore prolonged. These methods are usually reserved for the most severe fractures when internal fixation may be contraindicated. A unilateral, dynamic axial fixation system (Orthofix - registered trademark) is described which allows for simple conversion from a rigid to a dynamic mode, and so can be readily adapted to the changing physiological patterns of fracture repair. In 288 fresh fractures a success rate of 94% was achieved, with an average time to healing of 4.4 months. The incidence of pin-track infection was only 0.6%. The contribution which the mechanical and design features of the apparatus make to the results obtained is discussed. It is suggested that the system is capable of extending the range of indications for an externally mounted system to include many cases which would formerly have been treated by internal fixation, plaster cast or traction.

Adult↗
PubMed1984

[Improvement of Hoffmann external fixation apparatus].

The resurgence of external fixators for the management of skeletal and joint injuries has generated an increasing number of reports. In addition, many types of fixators have been developed in the last ten years. Of these, the Hoffmann external fixator is the most popular one. Is it possible for the patient with a tibial comminuted fracture to walk with the fixator? This study has been pursued to investigate this question and to improve on the fixator. Bone models were made from tubed polyester resin strengthened by glass fiber (elastic module: 9.46 kg/mm2, outside diameter: 35 mm, inside diameter: 30 mm). Each bone model was transfixed by two Steinmann pins (phi: 4.5 mm) with 43 mm between, and a pair of models was framed with two straight bars, with 30 mm from model to bar. The Steinmann pins and straight bars were connected to each attachment. The experiment focused on four main studies: Measurement of the Young's modulus of the Steinmann pin. Compression load test and bending load test framed bone models with each attachment. Observation and measurement of the ground reaction force of ambulation on stilt framed with experimental external fixator. Determination of S-N curve of the Steinmann pin. Results were as follows: The Young's modulus of the Steinmann pin were 1.8 X 10(4) kg/mm2. 0.2% proof of the pin was 110 kg/mm2. The bone models framed with the conventional method were destructed at the universal ball joint at 68 kgf in the compression load test, and 6.8 kgf in the bending load test. The models framed with the conventional method fitted with spring washers at ball joints were not destructed until 203 kgf in compression load, but after several trials the spring washers were crushed. The models fabricated by using a vice with rods and articulation coupling were not damaged until 210 kgf in compression load and were not damaged until 15 kgf in bending load even after several trials. The displacement between the models were 2.8 mm at 80 kgf and 8.5 mm at 210 kgf in compression load. The models fabricated by experimental external fixators were not damaged until 250 kgf in compression load and were not damaged until 30 kgf in bending load, and the displacement between the models were 2.1 mm at 80 kgf and 6.9 mm at 210 kgf in compression load.(ABSTRACT TRUNCATED AT 400 WORDS)

Biomechanical Phenomena↗
PubMed1995

Safety and image artifact of external fixators and magnetic resonance imaging.

External fixators commonly used in orthopaedic trauma and reconstruction may pose a potential safety hazard to patients exposed to magnetic resonance imaging. This interaction with the scanner depends on fixator composition, magnetism, and geometry. Image artifact produced by devices during scanning may diminish the diagnostic quality of the image. A mail survey of 91 radiologists' and 167 radiological technologists' current practices identified an absence of consensus regarding protocols for scanning patients who had external fixators in place. Eighteen external fixators were tested. Force was measured during exposure to the magnetic field at 30 cm from the magnetic resonance imaging portal, at the portal, and 30 cm inside the portal. The recordings ranged from 0 to 2.2 kg. Three fixators did not generate measurable forces and therefore are considered safe for the magnetic resonance imaging based on previously published safety standards. Ten devices did not produce measurable forces until placed at the portal, indicating that these fixators may be considered safe, providing the scanned area is distant to the fixator. To investigate image artifact, the fixators were placed on a phantom model and scanned. There was substantial variation among the fixators and image quality produced, depending on fixator composition and geometry.

Artifacts↗
PubMed2000

Advantages and disadvantages of pinless external fixation.

The AO pinless external fixator (PEF) uses trocar tipped clamps to grip the outer tibial cortex rather than pins to transfix it. Its main advantage is to avoid further contamination of the medullary canal in open tibial fractures where a nail may subsequently be used. We tested the anatomical safety of this device and its effect on plastic surgical procedures compared with a standard unilateral external fixator (UEF).The PEF and UEF were placed on two amputated limbs which were then dissected. Structures at risk were traced on ten cadaver limbs. We found that important anatomical structures were endangered by the PEF and that safe zones could not always be defined. The UEF avoided these structures. Plastic surgical approaches were made more difficult by the PEF which imposed limitations on local flap design and endangered the arterial perforators which supply them. We conclude that safety is compromised by the PEF because margins for error are small. It poses additional problems in soft tissue reconstruction and highlights the need for co-operation between plastic surgical and orthopaedic teams in choice of fixation device.

Cadaver↗