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PubMed1998

External fixation for phalangeal and metacarpal fractures.

From 1987 to 1993 we treated 33 patients with 29 phalangeal and seven metacarpal fractures by external fixation using a mini-Hoffmann device. There were 27 open and 25 comminuted fractures. In 12 patients one or more tendons was involved. The mean follow-up was 4.4 years. Complications occurred in ten fractures; two required repositioning of the fixator. All the fractures healed. The functional results after metacarpal fractures were better than those after phalangeal fractures and fractures of the middle phalanx had better recovery than those of the proximal phalanx. Twenty-eight of the 33 patients were satisfied with their result. External fixation proved to be a suitable technique for stabilising unstable, open fractures with severe soft-tissue injuries.

Adolescent↗
PubMed1999

The use of the external fixator in the treatment of intra-articular fractures of the distal radius.

BACKGROUND: A study to assess the use of the external fixator in the treatment of intra-articular fractures of the distal radius was initiated in late 1994. METHOD: Thirty patients with these fractures have been treated at our hospital between 1991 and 1994 with the use of either the AO or the Pennig external fixator. The patients were assessed at least one year post-operatively (mean 90.2 weeks) after a course of physiotherapy. RESULTS: The majority of patients (65%) had either good or excellent results, based on objective and subjective criteria. The common complications included early finger stiffness, pintract infections and loss of reduction.

Adult↗
PubMedDate not supplied

The external fixator in the treatment of closed diaphyseal fractures of the lower limb during childhood. Indications and limits.

The authors successfully used an external fixator in 10 children affected by one of the following pathologies: fracture of the femur with poor consolidation and marked shortening of the limb; fracture in a hypoplastic segment; severe multiple trauma; delay in consolidation of pathologic bone; fracture in bone regeneration. On the basis of the results obtained, it is affirmed that the external fixator is the ideal means of osteosynthesis for use in any of the above-described situations.

Adolescent↗
PubMed1992

[The use of external fixation apparatus in injuries to the hand bones].

An analysis of experimental studying the stability of osteosynthesis and clinical application of apparatuses of external fixation in 282 patients with fractures and sequellae of traumas of the bones and joints of the hand is presented. Main conditions influencing stability of fixation of the hand bones were determined. A universal complex of details is recommended which allows to make the optimum construction of the device as applied to the specific kind of trauma. It was proved that choice of the individual construction of the apparatus considerably widened the scope of using the method of external fixation and improved results of the treatment.

Equipment Design↗
PubMed2006

External fixation of open subtalar dislocation.

Subtalar dislocation is a rare and severe injury, caused by high-energy trauma such as fall from a height or traffic accident. Infection and avascular necrosis are not rare sequelae of open subtalar dislocation, and the outcome may be poor. External fixation allows complete wound care, and moderate distraction of the ankle joint should unload the talus, which may reduce the risk of avascular necrosis. We treated 11 open subtalar dislocations by distractional external fixation. The series involved nine males and two females, of average age 30.39 years. In nine cases the injury was caused by falling from a height, and in two by a traffic accident. The follow-up period ranged from 18 to 28 months. The final functional results were good, with no infection and one case of avascular necrosis of the talus. Pain after a longer period of walking or standing was experienced by eight patients, and movement of the subtalar joint was limited in nine patients. Immediate distractional external fixation of open subtalar dislocation may prevent infection and avascular necrosis of the talus.

Adult↗
PubMed2004

Unilateral hinged external fixator of the elbow in complex elbow injuries.

We present the outcome of treating complex injuries of the elbow with the "Orthofix" external fixator in patients where the condition of the soft tissues did not permit extensile surgical approach or where the internal fixation would not be stable enough to permit safe early joint mobilization postoperatively. Eight patients were treated, three with supra-intercondylar fracture in the presence of marked osteoporosis and five with fracture-dislocation of the elbow and excessive soft tissue impairment. The fixator was applied for a mean of 8.5 weeks (5-13 weeks). Great care was taken to use the appropriate technique in applying the fixator, especially to define the correct centre of rotation. All the fractures were united, and no instability of the joint was noted. All the patients maintained a functional range of motion, with lack of extension less than 30 degrees and flexion more than 120 degrees . One patient who developed transient palsy of the radial nerve and two patients who developed pin track infection were treated with oral antibiotics. Despite the technical difficulties, external fixation of the elbow could be a salvage procedure in difficult cases of elbow trauma, where open procedures are not indicated.

Adult↗
PubMed2004

Comparison of unreamed nailing and external fixation of tibial diastases--mechanical conditions during healing and biological outcome.

Locked intramedullary nailing and external fixation are alternatives for the stabilization of tibial shaft fractures. The goal of this study was to determine to what extent the mechanical conditions at the fracture site influence the healing process after unreamed tibial nailing compared to external fixation. A standardized tibial diastasis was stabilized with either a locked unreamed tibial nail or a monolateral fixator in a sheep model. Interfragmentary movements and ground reaction parameters were monitored in vivo throughout the healing period. After sacrifice, the tibiae were examined mechanically and histologically. Bending angles and axial torsion at the fracture site were larger in the nail group within the first five weeks post-operatively. Unlike the fixator group, the operated limb in the nail group did not return to full weight bearing during the treatment period. Mechanical and histomorphometrical observations showed significantly inferior bone healing in the nail group compared to the fixator group. In this study, unreamed nailing of a tibial diastasis did not provide rotational stability of the osteosynthesis and resulted in a significant delay in bone healing.

Animals↗
PubMed1994

Twelve years follow-up of fractures of the distal radius treated with the AO external fixator.

From 1977 to 1982 a total of 55 patients suffering comminuted fracture of the distal radius were treated with the external fixator. Fifty of these were followed up in 1983/85 and 32 of them were available for assessment in this study (1992). The follow-up period was 11.6 years on average. All patients had suffered an intra-articular fracture (91% a C-fracture, 9% a B-fracture according to the AO classification), 27 patients had also fractured the ulnar styloid process and in 11 a dye-punch fragment was present. Both wrists were assessed on the basis of case history, clinical examination, radiographs in two planes and visual analogue scales (VAS). The results were evaluated using established scoring systems. On the Gartland and Werley scale 75% of the results were good or very good, 63% according to Castaing. In general, there was no statistically significant difference between the results of this study and those of 1983/85. It could be demonstrated that there was a relationship between arthritis as a late complication and the existence of an intra-articular step-off of at least 2 mm at implant removal. This also has a negative influence on the range of motion and strength. Radial shortening affects the functional result whereas a die-punch fragment does not. On VAS patients identified performance restriction and disability as the worst consequences of the accident; these criteria correlated best with the results of objective evaluations. In contrast, patients were more satisfied with the result of treatment than would be expected from the objective analyses. The overall results indicate that exact reduction was extremely important. Long-term follow-up showed that the use of the external fixator in the treatment of comminuted intra-articular fractures of the distal radius was an adequate method. Prospective and possibly multicentric studies would be required to investigate more detailed relationships between treatment and long-term results.

Adult↗
PubMed1998

A biomechanical analysis of unilateral hooked-sulcated external fixator on osteomined tibia.

Four tibiae removed from 30-40 years males, who died of accidents in less than 12 hours, were osteomized at medium part. Then these tibiae were fixed by an unilateral hooked-sulcated external fixator (UHSEF), and the bone-fixator system was used as a model of external fixation of tibial fracture. The axial compression, distraction, torsion, antero-posterior and lateral bending rigidity and the strain of the pins were determined in this system. Based on the results, we found that compared with the configuration of four paralleled pins, the rigidity of the fan-like configuration didn't decrease significantly if the angle between lateral and medium pins was less than 45 degrees. But the reverse was true when the frame separation increased from 5 to 8 cm. What' more, the pin strain decreased if the rigidity of the system was improved. These data provided a theoretical basis of biomechanics for the improvement of UHSEF.

Adult↗
PubMedDate not supplied

Management of tibial bone defects due to high energy trauma using the locally manufactured external fixator by segmental bone transport.

BACKGROUND: Bone defect in long bones is a problem in orthopaedic which needs proper treatment to restore limb length and function of the limb. There are various treatment modalities available to fill the detect like bone grafting, vascularised bone graft, allograft and bone transport through fixators (Ring or Uniplanner). This study was done to determine the outcome of locally manufactured External Fixator (Naseer and Awais ) in the management of tibial bone defect due to trauma. METHODS: This descriptive study was conducted on 20 patients in orthopedic department in Lady Reading Hospital Peshawar and Ayub Teaching Hospital Abbottabad, from Nov 1997 to Nov 2002. Patients from either gender aged between 20 to 50 years, having tibial bone defect of more than five centimeter due to trauma were included in the study. Follow up was done for two years. Outcome measures were adopted according to the classification of the Association for the Study and Application of the Method of llizarov (ASAMI) based on clinical (functional) and radiological findings (defect filling). RESULTS: Out of 20 patients 14 (70%) were males and 6 (30%) were female patients. Right tibia was involved in 12 patients (60%) and left tibia in 8 patients (40%). Bony defects due to firearm injury were in 14 patients (70%) and road traffic accidents were in 6 patients (30%). Radiological (bony) results were excellent in 12 patients (60%), good in 2 patients (10%), fair in 3 patients (15%) and poor in 3 patients (15%). Clinical (functional) results were excellent in 7 patients (35%), good in 8 patients (40%), fair in 4 patients (20%,) and poor in 1 patients (5%,). Post operative complications after distraction osteogenesis were pin tract infections in 8 patients (40%), Axial deviations in 6 patients (30%), foot equinus in 4 patients (20%) and refracture in 1 patient (5%). CONCLUSION: Uniplanner locally manufactured (NASEER & AWAIS) External Fixator for distraction osteogenesis is cheap, easy to apply and gives excellent and comparable results in tibial bone defects.

Adult↗
PubMed1986

Severely comminuted distal radial fracture as an unsolved problem: complications associated with external fixation and pins and plaster techniques.

Seventy-six patients with severely comminuted distal radial fractures were treated at two institutions, of which the overwhelming majority were Frykman class VIII. Fifteen fractures were open. Thirty patients were seen at the University Hospital; 17 had pins and plaster and 13 had external fixation. Forty-six patients were seen at Kaiser Hospital; all had pins and plaster treatment. The complication rate for those with pins and plaster at the University Hospital was 53%; the complication for external fixation rate was 62%. The affiliated-hospital complication rate was 52%. All patients with ipsilateral forearm shaft and carpal fractures developed a nonunion of the carpal fracture. Few patients maintained anatomic reduction, and many had significant intra-articular malalignment. External fixation with threaded half pins did not obviate pin problems in our series. These methods may help manage severely comminuted distal radial fractures, but complications should be anticipated and alternative treatment considered, especially when ipsilateral carpal or forearm shaft fractures are present.

Adult↗
PubMed2002

[Acute carpal tunnel syndrome after distal radius fractures--long term results of surgical treatment with decompression and external fixator application].

Acute Carpal Tunnel Syndrome (ACTS) is a relatively rare sequel of distal fractures of the radius. This paper is an analysis of the causes of ACTS and of long-term results of treatment by surgical decompression combined with use of external fixators. Out of 128 patients with distal radius fractures treated in our department 11 cases required surgical treatment because of ACTS. Fractures were classified according to the AO classification as C2 and C3. CTSA was diagnosed basing on typical clinical signs: pain numbness over the radial three and a half fingers. All patients were treated surgically by reduction of the fracture, external fixation and decompression of the median nerve, all performed simultaneously. The results were assessed within 11 months (on average) postoperatively. It was found that ACTS depends on the severity of the fracture (comminuted, dislocated) and on method of treatment (local anaesthesia, multiple reductions, Cotton-Loder position). Long term results: pain was absent the two-point discrimination test was within norm, light sensation was within norm in 9 cases and slightly decreased in 2 cases. There were no positive Phalen tests and no Tinel signs. Grip strength raged from 17 to 120 kg (mean: 38 kg). According to Gartland-werley classification 5 excellent, 3 good, and 3 acceptable results were obtained. This indicates that early recognition and prompt treatment by surgical decompression and external fixation results in significant improvement of symptoms and prevents persistence of symptoms.

Acute Disease↗
PubMed2002

The external fixator compared with the sliding hip screw for pertrochanteric fractures of the femur.

In a prospective, randomised study we have compared the pertrochanteric external fixator (PF) with the sliding hip screw (SHS) in 100 consecutive patients who were allocated randomly to the two methods of treatment. Details of the patients and the patterns of fracture were similar in both groups. Follow-up was for six months. Use of the PF was associated with significantly less blood loss, a shorter operating time, reduced postoperative pain, shorter hospitalisation (p < 0.001), earlier mobilisation (p < 0.001) and a reduced rate of mechanical complications (p < 0.01). Superficial infection was significantly more common with the PF (p < 0.01), but without long-term adverse consequences. There were no differences in the healing of the fracture, mortality or final functional outcome. Our results indicate that the external fixator is an effective and safe device for treating pertrochanteric fractures and should be considered as a useful alternative to conventional fixation with the sliding hip screw.

Aged↗
PubMed1995

The effect of laparotomy and external fixator stabilization on pelvic volume in an unstable pelvic injury.

OBJECTIVE: Determine if laparotomy further destabilizes an unstable pelvic injury and increases pelvic volume, and if reduction and stabilization restores pelvic volume and prevents volume changes secondary to laparotomy. DESIGN: Cadaveric pelvic fracture model. MATERIALS AND METHODS: Unilateral open-book pelvic ring injuries were created in five fresh cadaveric specimens by directly disrupting the pubic symphysis, left sacroliac joint, and sacrospinous and sacrotuberous ligaments. Pelvic volume was determined using computerized axial tomography for the intact pelvis, disrupted pelvis with both a laparotomy incision opened and closed, and disrupted pelvis stabilized and reduced using an external fixator with the laparotomy incision opened. MEASUREMENTS AND MAIN RESULTS: The average volume increase in the entire pelvis (from the top of the iliac crests to the bottom of the ischial tuberosities) between a nonstabilized injury with the abdomen closed and then subsequently opened was 15 +/- 5% (423 cc). The average increase in entire pelvic volume between a stabilized and reduced pelvis and nonstabilized pelvis, both with the abdomen open, was 26 +/- 5% (692 cc). The public diastasis increased from 3.9 to 9.3 cm in a nonstabilized pelvis with the abdomen closed and then subsequently opened. Application of a single-pin anterior-frame external fixator reduced the pubic diastasis anatomically and reduced the average entire and true (from the pelvic brim to the ischeal tuberosities) pelvic volumes to within 3 +/- 4 and 8 +/- 6% of the initial volume, respectively. CONCLUSIONS: We believe that the abdominal wall provides stability to an unstable pelvic ring injury via a tension band effect on the iliac wings. Our results demonstrate that a laparotomy further destabilized an open-book pelvic injury and subsequently increased pelvic volume and pubic diastasis. This could potentially increase blood loss from the pelvic injury and delay the tamponade effect of reduction and stabilization. A single-pin external fixator prevents the destabilizing effect of the laparotomy and effectively reduces pelvic volume. These data support reduction and temporary stabilization of unstable pelvic injuries before or concomitantly with laparotomy.

Aged↗
PubMedDate not supplied

Axial vibration of threaded external fixation pins: detection of pin loosening.

The hypothesis of this study was that a nondestructive vibrational method could detect bone lysis at the external fixation pin-bone interface prior to current clinical and radiographic methods. In vitro models were used to simulate changes observed during pin loosening in vivo. Fixation pin axial natural frequency decreased with decreasing tensile modulus of the material into which it was implanted. In a live animal study the right tibia of 12 dogs was fractured and stabilized with a four-pin unilateral external fixation frame. The axial natural frequency of each pin was measured and radiographs were taken at 0, 2, 4, 6, 8, and 10 weeks after surgery. The natural frequency did not change when the first radiographic changes around the interface were observed. Pins were palpably stable at this point. As loosening progressed, the natural frequency did decrease. Frequency and quasistatic tests of dissected pin-bone structures revealed a good correlation between natural frequency and pin-bone interface stiffness. In addition, the measurement of natural frequency was more sensitive to bone structure changes at the pin-bone interface than low-load quasi-static stiffness. Therefore, a nondestructive vibration technique could be used instead of low-load quasistatic tests for assessing the pin-bone interface ex. vivo.

Animals↗
PubMed2005

Functional outcome of unstable distal radius fractures: ORIF with a volar fixed-angle tine plate versus external fixation.

PURPOSE: The purpose of this study was to compare the outcomes of 2 treatments for unstable distal radius fractures: open reduction internal fixation (ORIF) through a volar approach with a fixed-angle implant and a standard external fixation (EF) method. METHODS: This study included patients with comminuted unstable intra-articular and extra-articular distal radius fractures treated by a single surgeon. Data were gathered retrospectively on 11 patients treated with EF who had been followed up for an average of 47 months (range, 12-84 mo). Prospective data were gathered on 21 patients who were treated with ORIF through a volar approach with a fixed-angle implant. Follow-up evaluation for this group averaged 17 months (range, 12-24 mo). The 2 groups were compared for range of motion (ROM), strength, and functional outcome as measured by the Patient Rated Wrist Evaluation (PRWE) and the Disability of the Arm, Shoulder, and Hand Questionnaire (DASH). Fracture reduction was evaluated from radiographs taken at the last follow-up visit and compared between groups. RESULTS: The mean passive wrist ROM at the final follow-up evaluation in EF patients was 59 degrees extension and 57 degrees flexion, compared with 63 degrees extension and 64 degrees flexion in patients treated with ORIF. Passive pronation/supination arc of motion was similar for the 2 groups, as were the DASH and PRWE scores. Grip strength as a percentage of the opposite wrist was significantly greater in the external fixation group, a possible consequence of longer follow-up evaluation. Final radiographic measurements for the EF group averaged 5 degrees volar tilt and 25 degrees radial inclination, with 2.2-mm ulnar-positive variance. The ORIF with volar plating group averaged 10 degrees volar tilt and 22 degrees radial inclination, with .5-mm ulnar-negative variance. Radial length and volar tilt were significantly greater for the ORIF group. The average final intra-articular step-off was significantly different, with 1.4-mm step-off in the EF group and .4 mm in the ORIF group. CONCLUSIONS: The use of ORIF with a volar fixed-angle implant resulted in stable fixation of the distal articular fragments, allowing early postsurgical wrist motion. The PRWE and DASH scores for the groups were equivalent, whereas intra-articular step-off, volar tilt, and radial length were better in the ORIF group. There were few complications, implant removal was not necessary, and early postsurgical wrist ROM was initiated without loss of reduction.

Adult↗
PubMed1993

Pin-site radioulnar synostosis after external fixation of a distal radial fracture: two case reports.

Complications of distal radial fracture and external fixation are common, but the authors report, in two patients, a previously unrecognized complication, that of radioulnar synostosis. In both cases the proximally placed pins extended across the interosseous region, and the distal ends were adjacent to the ulna. Hematoma and osseous debris were introduced into the interosseous region. Several weeks after the external fixator was removed, the patients were noted to have a restricted range of pronation and supination. A radioulnar synostosis had formed across the interosseous region. Resection of the synostosis restored pronation and supination. With careful pin placement this complication will be avoided.

Adult↗
PubMed2003

Stiffness characteristics and inter-fragmentary displacements with different hybrid external fixators.

OBJECTIVES: To determine how the different approaches of constructing a hybrid external skeletal fixator affect the mechanical environment at the fracture site. DESIGN: A comparative biomechanical analysis of external fixators that represent a spectrum of designs from unilateral to circular fixators. BACKGROUND: The most pertinent parameter that affects fracture healing is the inter-fragmentary displacement. Most studies on the mechanical performance of external fixators have concentrated on the overall stiffness of the fixators. METHODS: Mechanical testing was performed on four types of hybrid fixators in which the overall stiffness of the fixator as well as the axial, transverse shear and angular displacements at the fracture site were measured. RESULTS: The Ilizarov hybrid fixator with one wire and one screw on each ring behaved more like a unilateral fixator than a circular fixator. The bar-ring hybrid fixator that simply connected a unilateral fixator body to a wire/ring assembly was too flexible. Reinforcing the bar-ring hybrid system with diagonally placed struts eliminated the deformation associated with the unilateral body and the resulting construct performed considerably better. The two-ring hybrid fixator most closely resembled the Ilizarov fixator. CONCLUSIONS: Depending on the construction characteristics hybrid fixators possess a spectrum of mechanical characteristics of both unilateral and circular fixators. The constructions using two rings in which at least one bone segment is supported entirely by wires appears to have the best mechanical characteristics. RELEVANCE: Understanding how the different approaches of constructing a hybrid fixator affect the mechanical environment at the fracture site will enable surgeons to chose or build the most appropriate fixator for each clinical situation.

Bone Screws↗