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At least 919 records · Page 51Linked to original sources
PubMed1997

Nonunion of tibial fractures treated with external fixation. Contributing factors studied in 71 fractures.

We analyzed factors of importance for nonunion in a series of 39 closed and 32 open fractures of the tibia which were treated with external fixation. Factors analyzed included, age and sex of the patients, the mechanism of injury, the amount of soft tissue damage, the grade of comminution, the level at which the tibia was fractured, the presence of an intact fibula, the presence of multiple injuries, the type of external fixation used (Orthofix, STAR-90 or Hoffmann) and the need to supplement the stability of the reduction. We found that the type of open fracture, comminution of the fracture, extension the original wound for satisfactory reduction and fracture of the ipsilateral fibula, played a role in the development of nonunion.

Female↗
PubMed1998

Management of recurrent, complex instability of the elbow with a hinged external fixator.

We have treated 16 patients with recurrent complex elbow instability using a hinged external fixator. All patients had instability, dislocation or subluxation of the ulnohumeral joint. The injuries were open in eight patients and were associated with 20 other fractures and five peripheral nerve injuries. Two patients had received initial treatment from us; 14 had previously had a mean of 2.1 unsuccessful surgical procedures (1 to 6). The fixator was applied at a mean of 4.8 weeks (0 to 9) after the injury and remained on the elbow for a mean of 8.5 weeks (6 to 11). After treatment we found the mean range of flexion-extension to be 105 degrees (65 to 140). At a final follow-up of 23 months (14 to 40), the mean Morrey score was 84 (49 to 96): this translated into one poor, three fair, ten good and two excellent results. Complications included one fractured humeral pin, one temporary palsy of the radial nerve, one recurrent instability, one wound infection, one severe pin-track infection and one patient with reflex sympathetic dystrophy. Although technically demanding, the use of the fixator is an important advance in the management of recurrent complex elbow instability after failure of conventional treatment.

Adult↗
PubMed1993

[Internal hemorrhages associated with fractures of the pelvic girdle. Importance of early stabilization using an external fixator].

Pelvic ring injuries due to high-energy forces are among the most serious involving the musculoskeletal system. Life-threatening hemorrhage, local and distant associated injuries, deformity, pain and diminished functional capacity are all potential problems for a patient with a disrupted pelvis. There is a clear correlation between total blood loss, incidence of associated injuries, final functional result and the type of pelvic ring injury. Between January 1987 and December 1990, 66 patients with an unstable lesion, type B or type C in Tie's classification, were treated in the University Hospital Gasthusiberg of the Katholieke Universiteit Leuven. In 42 cases, primary stabilization was achieved by means of an external fixator, of the type "Monofixateur". The overall mortality rate was less than 7%, and 53 patients could be seen for follow-up 6 months to 4 years after injury. Our findings confirm that compared to type B lesions there is a higher incidence of pain, permanent deformity and diminished functional capacity in type C lesions (P < 0.05). The external fixator used in the immediate post-injury period provides an effective splint that reduces bleeding from bone and veins but cannot maintain reduction in lesions with rotational and vertical instability. In these cases, a semi-elective internal fixation, after defining the exact pathoanatomy by means of a CT-scan, should be performed in selected centers.

Activities of Daily Living↗
PubMed2001

Five-pin external fixation and early range of motion for distal radius fractures.

One of the continuing dilemmas in the treatment of distal radius fractures is how best to reduce residual dorsal angulation and impacted articular fragments. Although external fixation devices may maintain radial length, individual fracture fragments may still heal in a displaced or angulated position. The addition of a dorsal pin in combination with an external fixation device can easily correct the dorsal tilt found in many fractures of the distal radius. Although not necessary in all fractures, this additional pin helped with reduction of those fractures that would not improve with traction and with maintenance of reduction.

Biomechanical Phenomena↗
PubMed2000

Hybrid external fixation in high-energy elbow fractures: a modular system with a promising future.

BACKGROUND: Severe, high-energy, periarticular elbow injuries producing a "floating joint" are a major surgical challenge. Their reconstruction and rehabilitation are not well documented. Therefore, the following reports our experience with treating such injuries caused by war wounds. METHODS: Seven adults with compound open peri- and intra-articular elbow fractures were treated in hybrid ring tubular fixation frames. After debridement, bone stabilization, and neurovascular reconstructions, early controlled daily movements were started in the affected joint. RESULTS: These seven patients had together seven humeral, five radial, and six ulnar fractures. All fractures united at a median time of 180 days. No deep infection developed. The functional end results assessed by the Khalfayan functional score were excellent in two, good in one, and fair in four of these severely mangled upper extremities. None was amputated. CONCLUSIONS: The Mangled Extremity Severity Score has been shown to be unable to provide a reliable assessment for severe high-energy limb injuries surgically managed with the modular hybrid thin wire tubular external fixation system. This hybrid system is a very useful addition to the surgical armamentarium of orthopedic trauma surgeons. It both allows complex surgical reconstructions and reduces the incidence of deep infections in these heavily contaminated injuries. The hybrid circular (thin wire) external fixation system is very modular and may provide secure skeletal stabilization even in cases of severely comminuted juxta-articular fractures on both sides of the elbow joint (floating elbow) with severe damage to soft tissues. This fixation system allows individual fixation of forearm bone fractures, thus allowing the preservation of pronation-supination movements.

Adult↗
PubMed1996

Treatment of high-energy proximal tibial fractures using the Monticelli-Spinelli external fixator: a preliminary report.

Between 1990 to 1993, 21 patients with tibial plateau or proximal tibial fractures resulting from high-energy trauma were treated with the Monticelli-Spinelli external fixator. There were 13 men and 8 women (mean age, 45.2 years; range, 26 to 78). There were a total of 5 type A, 2 type B, and 14 type C fractures, using the Arbeitsgemeinschaft Fur Osteosynthesefragen (AO) classification system. Immediate postoperative reductions were good or excellent, according to strict radiographic criteria, in 16 of 21 patients. All patients obtained at least 90 degrees of knee flexion, and only one patient lost more than 5 degrees of full extension. Complications included seven superficial pin-tract infections and one deep vein thrombosis with resultant pulmonary embolism. Nineteen patients were available for follow-up (mean, 14 months). Clinically, 13 patients had satisfactory results where good or excellent radiographic reductions were maintained, knee extension was within 5 degrees of full, flexion was > or = 90 degrees, with < or = 5 degrees valgus/varus angulation. Six patients had unsatisfactory results, not meeting the above criteria. The Monticelli-Spinelli external fixator is a much-needed tool in the treatment of high-energy tibial plateau fractures that are not amenable to more extensive surgical procedures because of the associated soft-tissue injuries.

Adult↗
PubMed1993

Open reduction and circular external fixation of intraarticular calcaneal fractures.

Open reduction and internal fixation techniques do not allow early weight bearing. In an effort to develop a better method to obtain calcaneal fracture reduction and maintain it in the face of early weight bearing, a circular external fixator was applied to seven patients in combination with a limited lateral approach and open reduction and internal fixation of the depressed subtalar joint fragments. The operative technique uses the Ilizarov circular external fixator to obtain a ligamentotaxis reduction, following which the depressed subtalar joint fragments are elevated open; then, the fixator is used to reduce the lateral translation. All displacements of the fracture fragments are corrected. This method proved successful in six patients, all of whom achieved a satisfactory result with anatomic restoration of the subtalar joint and heel. One patient went on to late partial collapse of the posterior facet. Subtalar motion was greater than 50% in four of seven patients. None of the patients complained of heel pad pain, which was attributed to the desensitization of the heel by early weight bearing. This technique has produced encouraging preliminary results in two- to four-year follow-up evaluation.

Calcaneus↗
PubMed1992

External fixation of unstable Malgaigne fractures: the comparative mechanical performance of a new configuration.

An external fixator has been designed that is rigid enough to eliminate the need for skeletal traction in patients with unstable pelvic-ring fractures. This Wichita frame is similar to the Pittsburgh frame but is stiffened by the use of locked crossbars connecting the side triangles. The frame was tested in cadaveric specimens by techniques previously reported. In addition, finite-element modeling of the various frame designs was performed to ensure that the frame configuration was optimal and to supplement in vitro test results. Multiple variables that can influence frame failure loads were examined.

Equipment Design↗
PubMed1996

Open tibial fractures treated with the Ex-fi-re external fixation system.

Fifty open tibial fractures were treated with the Ex-fi-re external fixation system from 1987 to 1994. According to the Gustilo and Anderson classification, there were 12 Grade I, 14 Grade II, 10 Grade IIIA, 13 Grade IIIB, and 1 Grade IIIC injuries. Eight fractures were segmental. The average patient patient age was 39 years (range, 16-85 years). With the reduction unit of the system, displaced tibial fractures could be reduced by the functions of the device in contrast to the manual reductions needed with other unilateral devices. Compression could be applied even to oblique fractures. The reductions were performed by this unit in all cases and were classified as exact in 28 of 41 cases. Exact reduction was defined as a reduction in which there was no more than 2 mm of translational displacement. The 8 segmental fractures were not classified according to reduction. Forty-three fractures healed with no secondary procedure. Three secondary bone graftings, 4 fibulotomies, and 3 renamed intramedullary fixations were performed in 6 patients. Thirty-two skin grafts were performed. There was 1 fracture site infection, and 1 curettage and 1 sequestrectomy were performed after union. At 1 year followup there were no signs of infection. Median time to union was 20 weeks, and median time to full unprotected weightbearing was 22 weeks. Fractures with an exact reduction had a median time of union of 19 weeks, compared with a median of 31 weeks in reductions with greater than 2 mm translational displacement. The exact reduction and translational compression applied in oblique fractures appeared to contribute to early consolidation.

Adolescent↗
PubMed2005

Hybrid external fixation in complex tibial plateau and plafond fractures: an Australian audit of outcomes.

Hybrid external fixators are useful for the management of complex tibial plateau and plafond fractures, as they provide rigid fixation with relatively minimal soft tissue disruption. We reviewed the outcomes of patients with proximal (plateau) and distal (plafond) tibial fractures who were treated with hybrid frames at the Royal North Shore Hospital from 1998 to 2001. Twenty-four patients were identified from the hospital operating records and chart, X-ray and clinical reviews were performed. Follow-up periods averaged 13 months. Fractures were classified using the Ruedi classification for ankle fractures, and the Schatzker classification for the knee fractures. Clinical outcome was assessed using the Iowa knee score and the AOFAS ankle score. As one of the first Australian audits our outcomes were consistent with international standards.

Ankle Joint↗
PubMed1997

Adhesion of bacteria to stainless steel and silver-coated orthopedic external fixation pins.

Bacterial adhesion to silver-coated orthopedic external fixation pins was compared with stainless steel controls in an in vitro study. Using five bacterial isolates from wound infections, the silver coating was found to reduce adhesion for Escherichia coli, Pseudomonas aeruginosa, and two strains of Staphylococcus aureus while the converse applied for Staphylococcus haemolyticus. When placed in human serum, both surfaces were conditioned to a similar extent with serum proteins; this conditioning lead to further reductions in bacterial adhesion, ultimately approaching similar levels for both stainless steel and silver-coated samples.

Bacterial Adhesion↗
PubMed1998

Is the stability of a tibial fracture influenced by the type of unilateral external fixator?

OBJECTIVE: To examine whether the type of unilateral external fixator significantly influences the stability of a tibial fracture. DESIGN: Inter-fragmentary displacements were measured during walking while the fractures were stabilized, first with one type of fixator then with another. BACKGROUND: It is commonly claimed that one type of fixator exerts a different influence on mechanical stability at a fracture in comparison with another. METHODS: This study compares inter-fragmentary displacement, fixator displacement and weight bearing during walking, in four patients stabilized with an Orthofix DAF, which was replaced by a Howmedica International Monotube. RESULTS: The null hypothesis of no difference in fixator performance was unproved (P < 0.05) through insufficient data. Interpatient variability in inter-fragmentary displacement implies that anthropometry, gait and fracture type may influence fracture stability more than the type of fixator. CONCLUSIONS: Since weight-bearing and displacements were not substantially different, no basis was found for the claim that one fixator provides a mechanical environment substantially different to another. Sample size was not large enough to prove that a small but statistically significant difference exists. RELEVANCE: The influence on fracture stability of one type of unilateral fixator in comparison with another appears to be less than the influence of anthropometry, gait and the type of fracture.

Journal Article↗
PubMed2006

Treatment of Gustilo grade III B supracondylar fractures of the femur with Ilizarov external fixation.

Twenty patients who had been treated with Ilizarov external fixation for a Gustilo grade IIIB supracondylar fracture of the femur were functionally assessed 12 to 52 months after treatment. Fourteen fractures were type C3 and 6 were type C2 according to the AO classification. Fractures were united at an average of 39 +/- 9 weeks. There was a final knee extension deficit of 5 degrees to 10 degrees (12.2 degrees +/- 3.5 degrees) and flexion reached 110 degrees +/- 10 degrees in type C2 and 73 degrees +/- 36 degrees in C3 supracondylar fractures. Forty percent of the supracondylar fractures had 4cm shortening and 40% had 1.5 cm. Pin-track infection occurred in 21%. Half of the C3 fracture cases had problems with pain on walking, needed support and had pain at rest, whereas no patients had difficulty getting out of a chair, going up and down stairs. However, all C2 type fractures had problems with all types of function.

Adult↗
PubMed1990

[Indications and technic of external fixation in acute management of polytrauma].

The application of external fixation in the multiple injured patient permits rapid stabilisation of fractures and excellent preservation of soft tissue without an additional systemic load after traumatic shock. Acute fixation in the primary care is achieved by particular constructions for the pelvis and femur and modifications of standard-techniques for the tibia and joint-transfixation. In most cases secondary completions or alterations in the method of treatment are necessary.

Femoral Fractures↗
PubMed1989

External fixation of fractures and fracture dislocations of the pelvis.

External fixation of pelvic fracture dislocations is appropriate when reduction must be accomplished by noninvasive methods which are nonetheless capable of precise regulation. The corrective frames described can be applied with minimal trauma and are capable of orientating the necessary corrective forces in the required directions to reduce the wide variety of bony displacements and dislocations encountered in these injuries. The apparatus is flexible and the choice of particular technique and assemblies is determined by evaluating the biomechanics of the mechanism of injury and applying the appropriate antagonist forces. These forces operate in three fundamental planes: anteroposterior, lateral and vertical. The author describes and illustrates how the assembly may be used to operate in these planes and reduce and stabilise a variety of displacements encountered in fractures and fracture dislocations of the pelvis.

Biomechanical Phenomena↗