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PubMedDate not supplied

The use of methylmethacrylate as an external fixator in children and adolescents.

Methylmethacrylate has been used as an external fixator on 52 bones in 36 children and adolescents. There were 36 osteotomies and 16 selected fractures of long bones. The application of the acrylic cement onto 229 half-pins was performed with the use of flexible plastic tubes, in all but two patients. Union in the desired position was achieved in 51 bones. Delayed union occurred in one and required internal fixation. In the rest of the cases, there were only a few minor complications. The methylmethacrylate appears to be a stable fixator for osteotomized and fractured bones in young patients. The method is practical, easily performed, and of low cost.

Adolescent↗

PubMed1991

The AO-plate for external fixation in 12 cases.

The AO-plate was used for external fixation in 12 patients. The main indications were severe open fractures of the forearm and infected pseudarthroses at several locations. In 10 cases, the fixation provided enough stability to allow bone healing. The technique is simple, is convenient for the patient, and is always available without additional special equipment.

Adult↗

PubMed1999

Arthrodesis of the hip joint using an external fixator.

Arthrodesis of the hip has been plagued by high rates of nonunion, and by complications associated with prolonged cast immobilization. To prevent these problems, we devised a procedure for hip arthrodesis using an external fixator in combination with internal fixation at the fusion site. We have treated nine patients with this technique. All of the arthrodeses were solidly united without wound infections at the most recent follow-up. Patients were able to leave their hospital bed and walk on the affected limb with a cane shortly after surgery. This was possible because the external fixator was low in profile, as it was applied from the anterosuperior iliac spine to the femoral shaft, and provided rigid stabilization of the arthrodesis. The technique resulted in a reduction in the period of bed rest, immediate postoperative mobilization, shorter periods of hospitalization, no limitation in the range of knee and ankle motion, improvement in the patient's ability to carry out the personal hygiene, and fewer complications.

Activities of Daily Living↗

PubMed1996

Early complications with external fixation of pediatric femoral shaft fractures.

A retrospective study of 27 pediatric patients with femoral shaft fractures treated by external fixation was made to identify complications and evaluate outcomes. The average age at the time of injury was 8 years, 9 months (range 5 years, 6 months to 13 years, 2 months). Sixteen fractures were isolated, and nine were associated with polytrauma. There was only one open fracture. Data obtained from chart review (n = 27), radiographs (n = 27), physical exam (n = 16), and questionnaire (n = 21) identified eight major complications (30%) in six patients and 29 minor complications (107%) in 20 patients. The major complications included two refractures, two fractures through pin sites, one postimmobilization supracondylar femoral fracture, one persistent pin-tract infection requiring early fixator removal, one malreduction, and one loss of reduction. Both the patient with malreduction and the one who lost reduction had > 10 degrees of varus deformity before adjustment of their frames. Five of the eight major complications (64%) were secondary to errors in operative technique or postoperative treatment. Only one major complication was noted among the 16 patients with isolated injuries. Of the patients with minor complications, 14 had pin-tract infections requiring oral antibiotics, five refused to go to school with the fixator in place, five were dissatisfied with scar appearance, and five had clinically insignificant malunions. A clinically insignificant malunion was considered to be angulation > or = 5 degrees varus or valgus or > or = 10 degrees procurvatum or recurvatum deformity that did not affect the patient's function. The minor complications were considered intrinsic to the procedure and difficult to avoid. Despite these problems, all patients with isolated injuries, except one with a slipped capital femoral epiphysis, had excellent function at the time of final review. If external fixation is chosen as the method of treatment for a pediatric femur fracture, careful attention must be paid to operative technique and postoperative treatment in order to minimize complications.

Adolescent↗

PubMed1993

Static external fixation of finger fractures.

In spite of its similar design constructs, external fixation of finger fractures differs greatly from that of long bones. Besides its common indications in massive, high-energy trauma, and contaminated fractures, it offers true alternatives to open reduction and internal fixation and represents a superior treatment modality in well-selected cases of extensive comminution. Further pending improvement in design will increase its application, although it apparently does not yet resolve long-standing controversies in elective fracture care.

Clinical Protocols↗

PubMed1991

Management of tibial fractures with the orthofix dynamic external fixator.

We report our experience with the use of the Orthofix external fixator for the management of closed and open tibial fractures. One hundred fractures were treated in 96 patients between May 1985 and December 1989. There were 47 closed and 53 open fractures. Of the open fractures, 11 were grade I, 16 were grade II and 26 were grade III. Forty-five closed fractures and 49 open fractures went on to solid bony union in an average of 15.2 and 20.5 weeks, respectively. Non-union requiring operative intervention occurred in two closed and four open fractures (6%). The other main complications were pin track infection (30% of cases) and malunion which occurred in 14% of closed fractures and 32% of open fractures. We concluded that dynamic axial fixation is a useful method of treatment for open and difficult closed tibial fractures. Our experience indicates that malunion and pin track infection remain common problems and have still to be overcome.

Adolescent↗

PubMed2006

Treatment of 2- and 3-part fractures of the proximal humerus using external fixation: a retrospective evaluation of 62 patients.

BACKGROUND: Treatment of fractures of the humeral head remains controversial. We reviewed the outcome of our treatment of 2- and 3-part fractures of the proximal humerus using external fixation as a way of preventing damage to the vascularity of the humeral head and of reducing the risk of infection associated with open techniques. METHOD: We retrospectively evaluated 2- and 3-part fractures of the humeral head, both clinically and radiographically, in 62 consecutive patients who were treated using external fixation. The mean follow-up time was 1.5 (1-2) years. RESULTS: The reduction was considered to be good in 50 cases, and 8 cases were consolidated in varus and 4 cases in valgus. The fracture healed in all patients. Except for 1 case of superficial infection around the screws and 1 redisplacement after a new fall, there were no early complications. Necrosis of the humeral head was not observed. 2 of the patients underwent shoulder replacement because of severe pain. The mean Constant score was 84 points, with satisfactory results (>or=80 points) in 49 of the 62 patients. Sex, age, side, or type of fracture had no influence on the outcome. INTERPRETATION: This procedure provides satisfactory early functional results, simplifies rehabilitation by limiting postoperative motion to a lesser degree than other techniques, is less aggressive than open reduction techniques and osteosynthesis, and leads to few complications.

Adult↗

PubMed2006

The management of acute Charcot fracture-dislocations with the Taylor's spatial external fixation system.

The surgical repair of acute diabetic neuropathic osteoarthropathy of the midfoot remains a challenge with little guidance available in the medical literature. The authors present a review of the diabetic Charcot neuropathic osteoarthropathy process and proposed surgical intervention techniques with a special emphasis on the available data regarding the use of external fixation. A detailed, step-by-step, guide through the foot-specific Taylor spatial external fixation system is provided. Finally, the authors' preferred technique for these difficult limb salvage cases is presented in detail.

Acute Disease↗

PubMed1981

External fixation of tibial fractures at Groote Schuur Hospital, Cape town.

The results of an 18-month prospective clinical trial of external fixation in the management of open tibial fractures at Groote Schuur Hospital, Cape Town, are reported. Liaison with the Department of Mechanical Engineering at the University of Cape Town has resulted in the development of significant improvements on the methods previously described. The value of external fixation in the management of tibial fractures is confirmed; problems encountered with this particular method are described.

Bacterial Infections↗

PubMed1989

Use of the Clyburn External Fixator in fractures of the distal radius.

A study was organized to evaluate the use of a one-plane external fixation device to treat comminuted fractures of the distal radius. Clinical and roentgenographic data were obtained in 20 patients with a followup ranging from 12 to 20 months. The results were graded 14 excellent, 4 good, 2 fair, and none poor. The use of the Clyburn External Fixation Device with supplemental radial styloid Kirschner wire fixation achieved acceptable results in the treatment of comminuted distal radius fractures and proved to be easily applied.

Adult↗

PubMed1991

Augmented external fixation of unstable distal radius fractures.

The technique of "augmentation" of external fixation employs the use of percutaneous Kirschner wires to secure the radial styloid fragment as a lateral buttress, elevate and fix in place the depressed lunate fossa fragment, and, when necessary, add support to the elevated articular surface by means of subarticular bone grafting. A series of 51 cases of comminuted, unstable intraarticular distal radius fractures has been managed using this technique. Detailed evaluation has demonstrated precise articular reconstitution with an overall satisfactory result rate of 92%.

Adolescent↗

PubMed1993

Bending stiffness of conical and standard external fixator pins.

The bending stiffnesses of a conical and a standard external fixator pin have been compared. The pins were inserted into pilot holes in a piece of teak hardwood and loads of different magnitudes were applied at a fixed moment arm. Force-deflection curves were obtained for each pin, and stiffness (newtons per metre) and percentage stiffness reduction were calculated for each pilot hole size. The results show that deflection increased (i.e. stiffness decreased) with increasing force or diameter of pilot hole. This loss of stiffness was linear for the standard pin but was bimodal for the conical pin.

Bone Nails↗

PubMed1999

Treatment of complex calcaneal fractures with bony defects from land mine blast injuries with a circular external fixator.

Four calcanei, which were massively destroyed as a result of blasting injuries from land mines, and 18 severely comminuted calcaneal fractures with bony defects (in one patient, both feet), also from land mines, were treated using a circular external fixator for reconstruction by osteogenic distraction. Because of the severe destruction of tissue to be treated, definitive orthopaedic treatment was delayed for 3 to 28 months (average, 10.1 months) after injury. Time from first use of the circular external fixator to removal of the apparatus ranged from 110 to 175 days (average, 143.7 days). Mean follow-up was 18 months. Of the 22 calcaneal injuries, 4 had excellent results, 11 good, 5 fair, and 2 had poor results. Better results were achieved in cases with lesser defects in bone and where definitive orthopaedic treatment was delayed until problems in soft tissue could be treated.

Adult↗

PubMed2000

[Use of the Dynastab-K (knee) external fixator technique for functional treatment of intra- and peri-articular fractures of the knee joint].

The aim of this study was to validate the results of treatment of articular fractures using a Dynastab-K (knee) external fixator, which gives a good stabilisation, while retaining motion in the knee joint. A group of 6 patients with articular fractures of the knee joint was evaluated. Two fractures were located within the distal femur and 4 within the tibial plateau. After anatomical reposition of the bone fragments primary stabilisation was achieved by means of the Dynastab-K fixator and maintained for a period of 8-10 weeks. Passive motion of the knee was implemented in the first post-op day and active motion was implemented in the third post-op day. In all cases proper healing of the fractures, full extension and a minimally limited flexion (100 degrees) were achieved. Flexion limitation was corrected by means of an intensive rehabilitation programme. Use of the presented technique allows proper stabilisation of the bone fragments with maintenance of joint motion throughout treatment. Basing on our observations we concluded that implementation of an articulated external fixator in articular fractures of the knee leads to proper fracture healing with minimal loss of motion, which can be resolved by rehabilitation procedures.

External Fixators↗

PubMed2006

Mini external fixation for hand fractures and dislocations: The current state of the art.

External fixation devices for the hand provide a versatile approach to various hand injuries. Some fractures and dislocations urge the use of an external minifixation; in other fractures, external minifixation must be seen as an alternative or companion to other methods of hand stabilization. MiniFix is useful to maintain or restore hand function and hand anatomy.

Adult↗

PubMed1983

Minimal internal and external fixation in the treatment of open tibial fractures.

The advantages of rigid internal fixation for open tibial fractures are well documented. There is also a large literature describing various forms of external fixation for open tibial shaft fractures. Because of the enthusiasm for internal and external fixation, the disadvantages and complications warrant new emphasis.

Biomechanical Phenomena↗

PubMed1988

External fixation of the clavicle for fracture or non-union in adults.

A technique of osteosynthesis of the clavicle with Hoffmann external fixation was used to treat twenty patients for selected indications, including an open fracture, inability of a patient to tolerate prolonged conservative treatment, or a painful non-union. No vascular or pleural complication was observed. The average time that the external fixator was retained was fifty-one days. All of the clavicles united well. Mobility of the shoulder returned to normal in all patients.

Clavicle↗

PubMed2006

[Fracture of the distal lower limb: two-stage surgical treatment with external fixator and locked-screw plate].

From January 1999 until October 2004 we treated 42 patients with closed fractures of the distal calf by a two-stage treatment plan: first the fracture was stabilized with an external fixator bridging the ankle joint. Second, after an average period of 8.3 days, an open reduction and internal fixation with a locked-screw implant followed. As complications we saw a superficial wound necrosis in 3 cases, 2 patients needed an early bone graft after insufficient bone healing and in one case a deep vein thrombosis of the thigh occurred. A deep infection or osteitis were not seen. 17 patients showed no deficit in the range of movement of the ankle joint compared to their opposite side, 21 patients had a deficit of movement of one third compared to the opposite side and 4 patients suffered from a deficit of (2/3). Radiologically we saw in 31 fractures of the pilon-tibiale in 19 cases no or only few arthrosis of the ankle joint, in 9 cases intermediate and in 3 cases advanced arthrosis. With a two-stage surgical treatment with external fixator and locked-screw implant we achieved a good functional result with only few complications.

Adult↗