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At least 793 records · Page 44Linked to original sources
PubMed1984

External fixation in wartime limb surgery.

During the Lebanon War, 1982, limb stability was achieved by the use of external fixation in 45 severe limb injuries. The indications, advantages, techniques and results are reviewed. At follow-up after 1 year there were no cases of chronic bone infection. Two limbs had to be amputated for vascular insufficiency. The skillful, judicious use of external fixation in the treatment of war injuries is an important technical advance in the treatment of severe limb injuries.

Arm Injuries↗
PubMed1998

Transcutaneous reduction and external fixation for the treatment of noncomminuted zygoma fractures.

PURPOSE: This study evaluated the effectiveness of the treatment of noncomminuted monofragment zygoma fractures with closed reduction using transcutaneous threaded pins and an external fixation device instead of open reduction and internal rigid fixation. PATIENTS AND METHODS: In 46 patients, transcutaneous pin was inserted into the center of the fractured zygoma, and the segment was reduced by moving the pin to counteract the initial vector force of injury. After reduction, the fractured segment was immobilized by the external fixation device for 9 to 14 days. RESULTS: All patients except one showed accurate fracture reduction without malunion or any complications. CONCLUSION: This method has advantages over the conventional closed methods in the management of uncomplicated noncomminuted fractures of the zygoma.

Adolescent↗
PubMed1994

[Animal experiment study of tensile strength of hydroxylapatite-coated AO/ASIF Schanz screws for external fixators].

The removal torque and the loosening and infection rates of AO/ASIF 4.5 mm Schanz screws (MS) have been compared with those of hydroxyapatite-coated (HA) and hydroxyapatite/silver phosphate-coated (HA/P) AO/ASIF Schanz screws in vivo. In sheep, the left tibia was fixed after a midshaft osteotomy by means of unilateral fixator with 6 Schanz screws in an antero-lateral position. The osteotomy gap was filled with bone wax to avoid bony overgrowth. After operation, the animals were allowed to walk around immediately. The loosening rate was 2.8% at the site of the two HA-coated screws and 36% at the site of the metal screws. The removal torque after 2, 4 and 6 months was 6.2 +/- 2.8 MPa for HA/P, 4.7 +/- 2.7 MPa for HA screws and 1.2 +/- 1.1 MPa for metal screws. Histological and fluoroscopic evaluation revealed intimate bone-HA contact at the cortex near to the fixator, whereas at the site of the metal screws a fibrous tissue layer was constantly found. Only in the cortex opposite to the external fixator a direct bone-metal interface was observed. Fluoroscopic analyses confirmed new bone formation next to the HA surface especially in the cortex adjacent to the fixator, whereas such phenomena were not detected adjacent to the surface of the metal screws. Furthermore, bony resorption around the metal screws (21%) was significantly greater than around the two coated screws (2%). These experimental data suggest that pin loosening can be reduced in external fixators by coating the screws with hydroxyapatite, especially if a long-term fixation is indicated.

Animals↗
PubMed2005

Unilateral hinged external fixation frame for elbow compression arthrodesis: the stepwise attainment of a stable 90-degree flexion position: a case report.

We report a case of an elbow arthrodesis using a modular hinged external fixation device in a patient who sustained a complex high-energy injury. The extensive bone and soft-tissue loss and local infection precluded restoration of the articular anatomy. Other reconstructive options, including total elbow arthroplasty and allograft reconstruction, were not appropriate in this clinical situation. A transelbow hinged external fixator was applied with the elbow in extension. Subsequently, the hinge was brought gradually into 90 degrees of flexion as the elbow fused. Fixation and arthrodesis were successfully achieved by using this modular device, despite severe tissue loss and local septic complications. Furthermore, by gradually flexing the frame from full extension to 90 degrees , the need for flap coverage of the open wound was avoided.

Accidents, Traffic↗
PubMed2002

Dynamic external fixation of comminuted intra-articular fractures of the distal tibia (type C pilon fractures).

We report 26 patients with 28 type C3, distal intraarticular tibial (pilon) fractures treated by dynamic external fixation. Follow-up was at least two years, and the results (subjective and objective) were classified according to the Ovadia system. The mean to fracture union was 14 weeks (range: 12 to 20 weeks). There were three cases with angulation deformity (from 7 degrees to 20 degrees). There were no cases with nonunion or deep infection. Based on these results, this treatment with closed reduction and dynamic external fixation allowing early motion appears as a suitable method for treatment of comminuted intraarticular tibial pilon fractures.

Adult↗
PubMedDate not supplied

The use of external fixation for treatment of the acute Jones fracture: a retrospective review of 10 cases.

The purpose of this retrospective clinical study was to evaluate the clinical outcome of patients who underwent external fixation of acute Jones fractures. There were 10 patients with a mean age of 25.2 years; 9 of the patients were actively involved in athletics. Chart and radiograph review showed the mean clinical and radiographic healing times to be 5.7 and 6.5 weeks, respectively. Patients returned to preinjury activity levels at a mean 9 weeks postoperatively. Complications included 1 case each of localized cellulitis, asymptomatic nonunion, and refracture. Telephone inquiry performed at a mean 46 months postoperatively determined all patients to be pain-free and continuing to participate at their preinjury activity levels. External fixation is quick and easy to perform and provides a viable alternative to intramedullary screw fixation of Jones fractures in the young, active patient.

Acute Disease↗
PubMed1985

[Progress in external fixation].

The monofixateur opens up avenues in external skeleton fixation. Proceeding from Lambotte's groundwork and from the given anatomical conditions and biomechanical requirements, a system has been developed that ensures maximum effectiveness with a minimum of mechanical means and operative procedure. Of particular importance is the dual-application feature of the monofixateur system: it is equally indicated for static as well as dynamic fixation, and is quickly and easily adapted from one function to the other at any time as called for by the treatment process. This system provides for dynamic function when applied without fixation clamping jaws on one of the major bone fragments. It allows for functional axial compression to be exerted through muscle contraction and pressure, while simultaneously excluding the possibility of bending and rotation, thus effectively promoting the healing process. The monofixateur is indicated for treatment of closed, open and infected fractures, pseudarthrosis, osteotomy adaption, arthrodesis and joint transfixations. In brief, the advantages of external fixation by the monofixateur may be summarized as follows: Simple mechanical design affording precise function. High stability with small number of fixation components. Unilateral assembly of device in position biomechanically favorable. Static or dynamic fixation. Little patient impairment.

Femoral Fractures↗
PubMed1998

Temporary transarticular external fixation of the knee and ankle.

High-energy periarticular fractures of the lower extremity are frequently associated with soft tissue trauma that precludes safe surgical treatment in the early period. A technique of temporary transarticular external fixation is presented that allows stabilization at the appropriate length and alignment while awaiting resolution of soft tissue swelling. The use of these techniques in fifty-seven patients is reviewed and compared with outcome in patients having similar fracture patterns without the use of temporary external fixation.

Ankle Injuries↗
PubMed1998

Augmented external fixation of distal radius fractures: a biomechanical analysis.

An in vitro model of an unstable extra-articular distal radius fracture was created in 8 fresh-frozen cadaveric specimens and stabilized with an external fixator. Rotation and translation kinematics of the distal radial fracture fragment were measured in relation to the proximal radius during physiologic loading, using infrared light-emitting diodes and a 3-dimensional motion-sensing device. The effect of supplemental single and combination Kirschner wire (K-wire) fixation on fracture fragment stability was assessed. Fixation of supplemental K-wires to the fixator frame via a custom-developed outrigger assembly was also analyzed. Significant reductions in sagittal plane (flexion/extension) rotation and neutral zone were recorded when the fracture fragment was stabilized with a single styloid or dorsal transfixion K-wire. Equivalent stability was afforded by attachment of a nontransfixion K-wire to the fixator frame via the outrigger assembly. The dorsal constructs compared favorably to the styloid constructs in reduction of the sagittal plane neutral zone and coronal (radioulnar) rotation. These data lend biomechanical support to the concept of augmentation of distal radius external fixation and provide a physiologic model to test fixation methods for other fracture patterns.

Bone Wires↗
PubMed1994

Lumbar disc space heights after external fixation and anterior interbody fusion: a prospective 2-year follow-up of clinical and radiographic results.

Forty-two consecutive patients with severe spine problems were tested by temporary external fixation of the lower lumbar spine. Twenty-nine experienced marked relief of pain and were subjected to anterior interbody fusion. In 27 cases the scheduled clinical and radiographic 2-year follow-up could be completed. Disc height was measured on radiographs taken before the test, during the test with disc space distraction, after the anterior fusion, and 1 and 2 years postoperatively. The Oswestry disability score and the visual analog scale (VAS) for back and leg pain were also recorded. The 2-year clinical results were judged excellent in nine cases, good in ten, fair in three, and poor in five. Ten patients had a nonunion. Mean disc space height increased with external fixation and anterior interbody fusion but returned to the preoperative level during follow-up. These changes in disc space height did not statistically correlate with the clinical results or the occurrence of nonunion. A statistically significantly better clinical outcome, however, was found in patients with solid fusion than in patients with nonunion.

Adult↗
PubMed2001

Soft tissue injuries with the use of safe corridors for transfixion wire placement during external fixation of distal tibia fractures: an anatomic study.

OBJECTIVES: To determine which soft tissue structures are at risk and when joint violation can occur during small wire placement for hybrid external fixation of distal tibial fractures while adhering to published guidelines. DESIGN: Cadaver anatomic experiment. SETTING: University orthopaedic program. SUJBECTS: Five embalmed cadavers. INTERVENTION: Placement of small wire transfixion pins in the distal tibia. MAIN OUTCOME MEASUREMENTS: Dissection and measurements. METHODS: Four orthopaedic surgeons were shown diagrams that have been widely accepted as allowing for placement of transfixion pins in the distal tibia through safe corridors. Each of the orthopaedic surgeons was then asked to place two transfixion pins into each of five cadaver legs in a position that would provide stable external fixation of the metaphysis to the diaphysis with a circular fixator (forty pins total) for a distal tibial fracture within five centimeters of the plafond. The specimens were dissected, and pins impaling neurovascular structures, tendons, or the ankle capsule were recorded. The superior capsular synovial reflections were measured from the anterior joint line and the tip of the medial malleolus. These measurements were also performed on arthrograms of two extremities before their dissection. RESULTS: Fifty-five percent of the pins placed impaled at least one tendon that crosses the ankle joint. Neurovascular structures that were impaled included the saphenous vein (+/-10.5 percent) and the superficial peroneal nerve (+/-7.5 percent). One pin violated the superior capsular synovial reflection, which was an average of thirty-two millimeters (+/-1.58 millimeters) from the tip of the medial malleolus and twenty-one millimeters (+/-1.63 millimeters) from the anteromedial joint line. CONCLUSIONS: This study shows that tendons and neurovascular structures above the ankle are at risk during small transfixion pin placement, even when using safe corridors. Pins placed within two centimeters of the anterior joint line or three centimeters from the medial malleolus may be intracapsular.

Bone Nails↗
PubMed1996

Indications and techniques of external fixation of the injured pelvis.

High energy pelvic ring disruption represents a serious clinical problem with an overall reported mortality rate of approximately 10% (1). However, the mortality for open pelvic fractures approaches 50% (2). This alarmingly high rate has two major components. The first is death due to uncontrollable haemorrhage, often associated with terminal diffuse intravascular coagulation. The second is linked with the serious associated injuries. Improved resuscitation techniques have a direct bearing on both these components and should reduce morbidity and mortality (3,4). The external fixator has a major role to play during resuscitation and, in particular, in the control of bleeding. However, this primary function must not be confused with the more limited secondary role for the external fixator as a definitive form of treatment for certain pelvic fractures. This paper gives clear guidelines on the indications for the use of the external skeletal fixator with pelvic fractures and goes on to discuss pin placement and frame configuration in relation to the biomechanics and biology of the injury.

Adolescent↗
PubMedDate not supplied

Effects of static fixation and dynamization after interlocking femoral nailing locked with an external fixator: an experimental study in dogs.

OBJECTIVE: To determine bone healing at 20 weeks, after either static fixation (SG) or after dynamization (DG) at 4 weeks in osteotomized canine femurs repaired with an interlocking nail (ILN) secured with a type I external skeletal fixator (ESF). STUDY DESIGN: Experimental study. ANIMALS: Ten adult beagle dogs. METHODS: After mid-diaphyseal femoral osteotomy, femurs in 10 dogs were repaired with an ILN secured with 4 (2 proximal, 2 distal) threaded custom pins (TP; 2.7-mm-diameter cortical screw with a 2-mm shaft attached to the screw head) to which 2 parallel connecting bars were attached in a type I ESF configuration. In 5 dogs, dynamization was performed at 4 weeks by removing the connecting bars and 2 distal screws. Limb function, range of motion of the stifle joint (ROMSJ), radiographic evidence of bone healing, and complications were studied for 20 weeks. RESULTS: Full limb function was achieved between 8 and 10 weeks in SG dogs, but a decreased ROMSJ was observed from 5 to 8 weeks. In DG dogs, full limb function occurred between 5 and 6 weeks except in 1 dog, and ROMSJ was considered normal in all dogs. Bone healing was not affected by dynamization. Average healing time for SG was 12.8 weeks, and for DG it was 13.6 weeks. Periosteal reaction at TP insertion points, osteolysis around the thread and head of TPs were observed in both groups. A windshield-wiper effect was observed at the tip of 1 ILN. CONCLUSION: ILN locked with a type I ESF can be used for fixation of mid-shaft femoral fractures. Dynamization at 4 weeks did not affect bone healing but did prevent stifle ankylosis and promoted earlier limb function. CLINICAL RELEVANCE: ILN locked with a type I ESF is seemingly a feasible method for repair of mid-shaft femoral fractures and may decrease risk of nail failure.

Animals↗
PubMed2004

Hybrid external fixation of distal tibial fractures: new strategy to place pins and wires without penetrating the anterior compartment.

INTRODUCTION: Impalement of the anterior compartment musculature remains a problem in the hybrid external fixation of distal tibial fractures. The purposes of this study were to develop a tensioned wire configuration which does not violate the anterior compartment and to analyze the biomechanical implications of new wire configuration. MATERIALS AND METHODS: Thirty-seven adult volunteers without known pathology around either tibia were recruited. Axial computed tomography of the distal tibia was performed at 5-mm slices from the plafond to the upper margin of the syndesmosis. The wire convergence angle was measured at the 1-, 2-, and 2.5-cm levels using the following landmarks: tibialis anterior tendon (TA), tibialis posterior tendon (TP), peroneus brevis tendon (PB), anterolateral border of the lateral malleolus (LM). Two straight lines were drawn by connecting TA and PB and connecting TP and LM. The wire convergence angle was defined as an acute angle between these two lines. Then the orientation of the bisector axis of the wires was measured. As a second part of this study, a validated three-dimensional hybrid external fixator model was developed using finite elements modeling to analyze the stiffness of the frames constructed according to the measured wire convergence angle and orientation. Five simulated configurations were tested. The stiffness of each frame was analyzed under four load conditions: torsion, axial compression, side bending, and anteroposterior bending. RESULTS: The mean convergence angle was 30 degrees irrespective of the level. The bisector axis was oriented towards the anterolateral direction about 20 degrees from the coronal plane. The stiffness of the frame constructed with a wire convergence angle of 30 degrees and an anterolateral wire orientation of 20 degrees was 20-30% less than that of the frame constructed with 60 degrees wires oriented in a coronal plane. The addition of an anteromedial half-pin increased the stiffness significantly. CONCLUSIONS: Two tensioned wires may be placed without violating the anterior compartment by using the above four clinically identifiable landmarks. Addition of a half-pin on the anteromedial surface of the distal articular fragment makes the frame markedly stiffer than is possible using the standard wire configuration.

Adult↗
PubMed1993

External fixation of severely comminuted and open tibial pilon fractures.

Twenty patients with severely comminuted fractures about the ankle, either severely comminuted pilon fractures or open pilon fractures (three Grade II, seven Grade III), were managed with the use of a Delta-framed external fixator across the ankle joint. All fractures had open reduction and internal fixation (ORIF) with either screw fixation or small plates to stabilize the articular surface with minimal soft-tissue dissection. Average external fixator time was 2.5 months, and the time to union averaged 4.5 months. All fractures healed. Three delayed unions required bone grafting and two had plate stabilization. No infection occurred in the 12 open fractures. There was no infection of the closed injuries, no skin sloughs, and only two minor pin tract infections. Follow-up analysis averaged 12 months (range, six to 30 months). Range of motion (ROM) at last follow-up observation was excellent in six patients, good in nine, fair in three, and poor in two. Two patients required ankle arthrodesis because of posttraumatic arthritis. The ROM and outcomes of the severely comminuted or open fractures of the distal intraarticular tibia were very good.

Adult↗
PubMed2001

Treatment of the unstable distal radius fracture with external fixation and a hydroxyapatite spacer.

A prospective study was performed on 25 patients (15 women, 10 men) with unstable fractures of the distal radius selectively treated with a dynamic type of external fixation combined with a hydroxyapatite spacer. The fractures ranged from type VI to type VIII according to Frykman's classification. The patients' mean age at surgery was 49 years (range, 19-75 years). The mean follow-up period was 2.5 years, and overall outcome was assessed using Gartland and Werley's demerit point system as modified by Sarmiento. Radial inclination was 26 degrees +/- 4 degrees at the time of reduction and 26 degrees +/- 5 degrees at follow-up, palmar tilt was 9 degrees +/- 2 degrees at reduction and 8 degrees +/- 3 degrees at follow-up, and ulnar variance was 1.4 +/- 0.6 mm at reduction and 2.1 +/- 0.9 mm at follow-up. The mean range of motion at follow-up was 80 degrees +/- 10 degrees in flexion, 80 degrees +/- 10 degrees in extension, 85 degrees +/- 10 degrees in supination, and 80 degrees +/- 5 degrees in pronation. The outcome in 24 of 25 patients was evaluated as excellent. In the surgical treatment of unstable fractures of the distal radius using external fixator, the fracture reduction should be supported with bone graft or a bone substitute, and a hydroxyapatite spacer was considered to be a useful substitute for a bone graft.

Adult↗
PubMed2003

Hybrid external fixation of the proximal tibia: strategies to improve frame stability.

OBJECTIVE: To determine the specific frame construction strategies that can increase the stability of hybrid (ring with tensioned wires proximally connected by bars to half-pins distally) external fixation of proximal tibia fractures. DESIGN Repeated measures biomechanical testing. SETTING: Laboratory. SPECIMENS: Composite fiberglass tibias. METHODS: Using the Heidelberg and Ilizarov systems, external fixators were tested on composite fiberglass tibias with a 1-cm proximal osteotomy (OTA fracture classification 41-A3.3) in seven frame configurations: unilateral frames with 5-mm diameter half-pins and 6-mm diameter half-pins; hybrid (as described above), with and without a 6-mm anterior proximal half-pin; a "box" hybrid (additional ring group distal to the fracture connected by symmetrically spaced bars to the proximal rings) with and without an anterior, proximal half-pin; and a full, four-ring configuration. Each configuration was loaded in four positions (central, medial, posterior, and posteromedial). MAIN OUTCOME MEASUREMENTS: Displacement at point of loading of proximal fragment. RESULTS: The "box" hybrid was stiffer than the standard hybrid for all loading positions. The addition of an anterior half-pin stiffened the standard hybrid and the "box" hybrid. CONCLUSIONS: The most dramatic improvements in the stability of hybrid frames used for proximal tibial fractures result from addition of an anterior, proximal half-pin.

Biomechanical Phenomena↗
PubMed1999

Comparison of two systems for tibial external fixation in rabbits.

BACKGROUND AND PURPOSE: Use of rabbits in orthopedic investigations is common. In this study, focus is on factors that influence bone healing and on distraction osteogenesis. Biomechanical characteristics of two external fixator systems (Orthofix device and Hoffmann device) for long bones were tested. METHODS: Twelve freshly dissected tibiae were obtained from six skeletally mature New Zealand White rabbits, and four-point bending stiffness in two planes (90 and 180 degrees to the fixator pins) and torsional stiffness and strength of the bone-fixator complex were evaluated by use of a material testing machine. RESULTS: In four-point bending, Orthofix device had higher stiffness and strength, compared with Hoffmann device. When the load was applied 180 degrees to the pins, both devices had higher stiffness, compared with that at 90 degrees. In torsional testing, Orthofix device had significantly higher stiffness and strength. CONCLUSIONS: Significant differences in structural properties between the two systems were evident. Loading direction and gap conditions were important factors in determining properties of the systems. Therefore, type of external fixation system and fixation technique should be considered when designing experiments, using the rabbit long bone model.

Animals↗