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PubMed1998

[Change in procedure to reamed intramedullary nail in diaphyseal femoral fractures after stabilization with external fixator].

Due to the special pathophysiological condition of the polytraumatized patient, intramedullary nailing of the femur is not generally recommended. Fracture treatment by traction is not suitable because of the poor intensive care and the persisting instability. The external fixator is able to stabilize the fracture without additional burden to the patient. The stability is sufficient for the first set of treatment. Stabilization requires a changing procedure to an internal osteosynthesis. It is possible to reduce the danger of pin-tract infections with a differentiated concept. The principle of permanent drainage secures the healing of diaphyseal fractures of the femur. 43 diaphyseal femoral fractures were treated with a changing procedure from external fixator to reamed intramedullary nailing. In 1 case (2.3%) we saw an osteitis. The others healed without severe complications. The occurrence of complications depends on the time of the changing procedure.

Adolescent↗
PubMed1998

Small wire external fixation of high energy tibial plateau fractures.

Open plate osteosynthesis for high energy tibial plateau fractures with dissociation between the metaphysis and diaphysis has been plagued with frequent soft tissue complications. The Harbor-University of California at Los Angeles Medical Center's experience with small wire external fixation supplemented by limited internal fixation is examined. This alternative method of adequate stable fixation offers the advantage of minimal soft tissue compromise. Twenty-four patients with Schatzker Type VI tibial fractures were treated with small wire external fixation. Supplementary limited internal fixation was used with percutaneous screws in 10 patients and with open reduction in one patient. Sixteen patients had isolated fractures, and eight others suffered multiple injuries. Minimum followup was 12 months. All fractures healed. Complications included one septic knee, two infections at screw sites, and one 10 degrees knee flexion contracture. One knee had Grade 3 radiographic arthrosis, five had Grade 2, 10 had Grade 1, and eight showed no arthrosis. The outcomes (Knee Society clinical rating system) of this study compare favorably with outcomes described in reports published previously for this type of fracture, despite inclusion of eight multiply injured patients. This technique preserves the goals of early range of motion and stable fixation for these devastating injuries, while decreasing the observed major wound complications and nonunion rates. However, longer followup may reveal higher arthrosis rates, specifically in those fractures that were not anatomically reduced.

Adolescent↗
PubMed1991

Ipsilateral open fracture of the femur and tibia treated using the dynamic ASIF-BM tubular external fixator: case reports.

Two cases of ipsilateral open fracture of the femur and tibia treated using the dynamic ASIF-BM tubular external fixator are described. Results were very good, with short periods of occupational disability. These cases support primary stable osteosynthesis of these simultaneous fractures and the value of dynamic axial external fixation as a definitive treatment of open fractures of the femur and tibia shaft, either isolated or simultaneous.

Accidents, Occupational↗
PubMed1996

External fixation and cancellous bone grafting for Kienböck's disease: a preliminary report.

Between 1985 and 1990, 17 patients with histologically proven Kienböck's disease (Lichtman stages I, II, and III) underwent a combination of cancellous bone grafting to the lunate and external fixation across the wrist. All 17 patients were available for review with a minimum follow-up of 2 years (average, 47 years). Based on pain, functional status, range of motion, and grip strength (Mayo wrist score), there were 6 excellent, 6 good, 2 fair, and 3 poor results (2 of whom required further surgery). An overall success rate of 71% (12 of 17) was achieved. Ten patients underwent postoperative magnetic resonance scanning, and in 5, some improvement in signal intensity was demonstrated. The combination of cancellous bone grafting and external fixation is an alternative treatment for Kienböck's disease.

Adult↗
PubMed1997

External fixation of children's fractures: use of the Orthofix Dynamic Axial Fixator.

We have reviewed 48 children's diaphyseal fractures of the femur and tibia managed with the Orthofix Dynamic Axial Fixator between 1987 and 1994. The indications for external fixation included open fractures, multiple injuries, failed conservative management, and unstable fracture configurations. All fractures healed without further surgical intervention, and the incidence of serious complications was low. Although pin track sepsis was common, compromise of the fixation as a result of this occurred in only one case. We conclude that use of the Orthofix for children's fractures is a safe and effective management option.

Adolescent↗
PubMed1997

External fixation versus percutaneous pinning for unstable Colles' fracture. Equal outcome in a randomized study of 60 patients.

60 patients > 20 years of age, with comminuted distal radial fractures of type Older 3 or 4, were randomly allocated to two treatment groups: external fixation a.m. Hoffmann or percutaneous Kirschner wire pinning combined with immobilization in a plaster cast. The groups were similar in age, gender, fracture type and dislocation. All patients were immobilized for 6 weeks and the outcome was assessed after 6 months. The groups showed similar results with respect to radiographic parameters and function. All fractures healed and no difference in complication rate was observed. We conclude that most unstable distal radial fractures, classified as Older's type 3 and 4, can be treated with percutaneous pinning and a plaster cast, which is simpler and cheaper than external fixation.

Adult↗
PubMed1995

Effect of dynamization on gap healing of diaphyseal fractures under external fixation.

We asked whether dynamization of externally fixed diaphyseal fractures could improve bone healing in comparison to rigid fixation of fractures having similar remaining gap sizes. To answer this question we evaluated metatarsal osteotomies in 12 sheep. The osteotomy with a 0.6-mm gap was stabilized with a specially designed high bending and torsional stiffness external ring fixator. Osteotomies in six sheep were stabilized rigidly (axial movement < 0.06 mm) or dynamically (axial movement 0.15-0.34 mm). The cyclical axial interfragmentary movement was caused by the load-bearing of the operated limb. With increasing healing time, the initially allowed movement was decreased by callus formation around the osteotomy. The reduction in interfragmentary movement was measured and monitored by a linear variable displacement transducer at the external fixator and a telemetry system. After 9 weeks the sheep were sacrificed and the healed bones were investigated biomechanically and histomorphologically. Compared to the rigidly fixed osteotomies, the dynamized osteotomies showed significantly (P < 0.05) greater (+41%) callus formation and 45% greater tensile strength of the newly formed bone in the cortical osteotomy gap. Histological analysis indicated that the effect of dynamization occurred mainly after the 5th week. RELEVANCE: From these results we conclude that dynamic fixation of diaphyseal gaps is advantageous in comparison to stable external fixation.

Journal Article↗
PubMedDate not supplied

Biomechanical comparison of hybrid external fixators.

OBJECTIVES: To determine the stiffness characteristics of the hybrid ring fixator in the treatment of (OTA 41-C) proximal metaphyseal and shaft tibial fractures. DESIGN: Five identical composite tibiae were fixed with a Synthes, ACE Fischer, Howmedica Monticelli-Spinelli, or Smith & Nephew Trauma Ilizarov hybrid external fixator or with the conventional Ilizarov wire fixator. The Synthes and Monticelli-Spinelli fixators were tested twice, the first time with the connectors on the outside of the ring and the second time with the connectors on the inside of the ring. MAIN OUTCOME MEASUREMENTS: A materials testing machine was used to apply pure compression, anterior and posterior bending, medial and lateral bending, and torsion. Stiffness values were calculated from the load deformation and torque angle curves. RESULTS: Overall, the Synthes and Monticelli-Spinelli fixators were the most rigid of the fixators when the wire-to-ring connectors were placed inside the ring. In general, the fixators were stiffest in axial compression and least stiff in posterior bending. Wire length had a significant effect on overall stiffness. CONCLUSIONS: This study suggests that the four hybrid external fixators in standard configuration have stiffness characteristics similar to those of the conventional Ilizarov fixator when used to treat proximal metaphyseal and shaft fractures of the tibia.

Biomechanical Phenomena↗
PubMed1990

Biomechanical analysis of pin placement and pin size for external fixation of distal radius fractures.

A series of biomechanical analyses were performed to explain the recent reduction in treatment-related complications of external fixation of distal radius fractures using a limited open approach for pin placement and larger 4-mm self-tapping half pins. A comparison of pull-out strength, stress concentration effect, and inherent bending strength of 3- and 4-mm half pins was performed. The effect of proximal pin placement in the radius or in the ulna and the effect of distal pin placement in four, six, or eight metacarpal cortices were determined. These analyses demonstrate that the 4-mm self-tapping half pins result in a significantly higher pull-out strength and only a small decrease in torsional load strength of the bone. They also demonstrate that proximal pin fixation in the radius produces the most stable fixation and that distal pin fixation into six metacarpal cortices produces a strong configuration that does not violate the interosseous muscles of the second intrinsic compartment. The rate of treatment-related complications in the external fixation of distal radius fractures (specifically, pin loosening, bending and breakage, fracture through pin sites, collapse at the fracture site, and intrinsic contracture) are addressed in this study. Such complications can be minimized by using 4-mm pins after central predrilling, with proximal placement in the radius and distal placement through six cortices of the bases of the second and third metacarpals.

Animals↗
PubMed2003

External fixation in lumbar segmental instability.

Identification of the source of pain in patients with chronic low back pain remains a challenging subject. The non-invasive investigations lack specificity. The value of invasive tests has also been controversial. At one time discograms used to be considered as the only specific investigation identifying the source of pain prior to fusion surgery; many studies however proved that this is not true. Recently, external fixation of the spine has become a popular invasive investigation in patients with low back pain. In the current review, published articles in the field are discussed. There is unfortunately not enough data to support the use of spinal external fixation.

Bone Screws↗
PubMed1996

External fixation in unstable intertrochanteric fractures of femur.

Forty elderly patients aged 50-94 years old with unstable intertrochanteric fractures were treated by external fixation at The Central Institute of Orthopaedics, Safdarjang Hospital, New Delhi, India from June 1993 to January 1995. Fracture union was achieved by an average time of 14 weeks in all the patients. Postoperative varus was increased in nine and deep pin-track infection was found in three cases. External fixation minimizes surgical damage and blood loss, and has an added advantage of early mobilization. This technique is simple, safe and economical. It is effective wherever early elective surgery is not possible due to limited resources. It is the method of choice for high-risk geriatric patients.

Aged↗
PubMedDate not supplied

Intraoperative SSEP monitoring during external fixation procedures in the lower extremities.

The efficacy of somatosensory evoked potentials (SSEPs) to detect acute peripheral nerve injury during external-fixator application in the lower extremities was evaluated in 40 children with 42 Ilizarov surgical procedures. The study included patients who were either clinically normal or who had preexisting neuropathy but consistent and reliable SSEP responses preoperatively. SSEPs were recorded from the popliteal fossa and lumbar regions after alternating stimulation of the peroneal and posterior tibial nerves at the ankle. SSEP changes due to anesthesia, Ilizarov apparatus application, and other intraoperative variables are described. Significant deterioration or total loss of SSEP response during surgery occurred in four cases. Two of these patients were normal preoperatively and had symptoms of neurologic deficit postoperatively; the other two had exacerbations of pre-existing neuropathy. In general, the peroneal nerve was at greater risk for injury during surgery. SSEP monitoring proved to be technically feasible in external-fixation procedures on the lower extremities and may be a practical tool for detection of intraoperative nerve compromise.

Acute Disease↗
PubMed1987

External fixation of Colles' fractures. An anatomical study.

In a prospective, controlled study 58 patients aged under 60 years with Colles' fractures were treated either by a forearm plaster or by the application of an external fixator. In 94% of those treated by a fixator it was possible to insert the distal pins of the frame into the fracture fragment, the fixation obtained being sufficient to forgo additional splintage. The external fixator proved more effective at holding the manipulated position, and the radiological loss of position during fracture union was minimal compared with that seen in patients treated in plaster.

Adolescent↗
PubMed1997

[Primary closed, stabilization of type C 3 pilon fractures with external fixator without bridging the ankle joint].

The necessity for a short operative procedure that does not cause additional stress to the soft tissue overlying pylon fractures and at the same time enables the surgeon to reconstruct the distal articular surface of tibia and fibula, which includes achieving the correct length, led us to develop a new procedure in the acute treatment of such fractures. Therefore our operative procedure starts with indirect reduction and stabilization of the fibula by means of intramedullary Kirschner wires. For a precise analysis of the main fracture fragments of the distal tibia, we continue with reduction of the articular surface by means of ligamentotaxis and stabilization with angular external fixator without bridging the ankle joint. Special positioning of the external fixator allows an almost completely percutaneous procedure under X-ray control, and furthermore, control of the alignment of the articular surface of the tibia. At the same time, additional surgical measures, such as spongious bone transfer, grafting of skin flaps or secondary correction of the axis, are possible. In three cases of type C2 pilon fracture reported, healing was achieved within 12 weeks without complications. The range of motion of the ankle joint was preserved by physiotherapy under epidural anesthesia for a period of 5 days postoperatively.

Adult↗
PubMed1994

Comparison of the mechanical performance of three types of unilateral, dynamizable external fixators. An experimental study.

Due to the increasing popularity of unilateral dynamizable external fixators for treating tibial shaft fractures, many new devices are being introduced onto the market. Especially in such half-frame fixators, the choice of any particular device depends above all on the stability of its construction. This study compares the biomechanical stability of three systems tested in axial compression, torsion, and both anterior-posterior and medial-lateral bending. In terms of the nondynamized phase, the AO/ASIF tubular fixator (as a one-plane, double-tube, unilateral frame) and the Martin Mono-Dynafix are, in general, less stable than the Orthofix fixator. After dynamization, the AO/ASIF system becomes particularly weak and offers low resistance especially to torque and any force that is perpendicular to the plane of assembly. The other two tested devices evinced much more stability; the Orthofix fixator seems superior to the Dynafix due to the different diameter of its screws.

Biomechanical Phenomena↗
PubMed1993

Cortical bone reactions at the interface of external fixation half-pins under different loading conditions.

The pin-bone interface is the weakest link in the mechanical stability of external skeletal fixation. In this investigation, a canine model was used to characterize the nature of cortical bone reactions at the pin-bone interface. Unilateral external fixators were applied to the tibiae of 61 dogs using six tapered cortical half-pins. The pins were inserted after predrilling both cortices, and pin insertion torque was measured. A transverse or oblique osteotomy was performed in each tibia and stabilized under different gap conditions. Unrestricted weight bearing was allowed immediately after surgery. Sequential functional evaluations of the animals and biweekly roentgenograms of the pin tracks were done. Pin removal torques were recorded at the time the animals were killed at different time periods. Pin tracks were analyzed using quantitative tetracycline histomorphometry and microradiography. The results showed that cortical bone undergoes extensive creeping substitution around external fixation half-pins. New bone accounted for approximately 43% of the intracortical space along the pin track, and cortical bone porosity showed a fourfold increase compared with intact bone value. This cortical bone remodeling resulted in a time-related decrease of pin removal torque (p < 0.001). In inherently unstable oblique osteotomies, and less in stable rigidly fixed transverse osteotomies, immediate postoperative weight bearing caused bone thread resorption and adverse cortical bone remodeling at the entry cortex of external fixation half-pins. The unicortical loosening of half-pins that became evident during the first month of fixation obviously represents a consequence of micromotion and local bone yielding failure caused by high dynamic stresses of the pin-bone interface. Effective precautions should be taken to reduce such stresses.

Animals↗