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Results with four different external fixation frames were analyzed in a consecutive series of 100 unstable distal radial fractures of the Colles type. Overall, the numbers of good to excellent results, range of motion, and incidence of complications were similar for each group. Quadrilateral frame fixation of unstable distal radial fractures provides effective immobilization and produces good to excellent results in 86% of patients.
The Hoffmann external fixator has proved to be an effective means of stabilizing complex femoral fractures in patients in whom prolonged traction or internal fixation is not advisable. It provides for the prompt mobilization of multiple-trauma victims and assists in the evaluation of the "floating knee." Pin tract infections and lack of stability or adaptability of the frame are not major problems. Increased risks of delayed union or nonunion are often attributed to this mode of therapy. Within the limits of the present study these difficulties could not be directly related to the use of the fixator. In four patients nonunions were not unexpected and could have occurred with any form of therapy. Improved results may be achieved by earlier recognition of situations in which healing potential is compromised so that bone grafts may be applied at an early stage for prevention of nonunion.
Six configurations of the Monticelli-Spinelli external fixator were tested for axial compression, bending, and torsion. The ring wire clamp unit was separately tested under repeated cyclic loading and retightening of the clampnuts. The configurations studied were the following: 3 standard (4-ring and 3-ring with 5-mm between the wires and 3-ring with 40 mm between the wires); and 3 hybrid (3-ring and 1 pin, and 2-ring and 2 pins with the rings either placed closer or distant to the fracture). For each configuration, 5 frames were constructed. Axial stiffness was nonlinear for both fixator types. Four-ring fixators and 2-ring 2-pin fixators had similar stiffness, yet were stiffer than 3-ring configurations. Anteroposterior bending stiffness was highest in the 4-ring configurations, whereas oblique bending for standard fixators was similar to lateral bending stiffness for the hybrid configurations. Torsion was higher in the 4-ring construction and in hybrid frames compared to the standard 3-ring frames. For the ring wire clamp unit, stiffness increased and hysteresis diminished after each retightening of the clampnuts because of the increase of contact between clamps and ring. The hybrid configurations provide an alternative that enables more simple configurations with less transfixing elements and sufficient stiffness.
Twenty-five tibial shaft fractures were treated by primary Hoffman external fixation and secondary locked nailing with reaming. The indications were: aseptic non union (12 cases) and the original plan of treatment (13 cases) (early delayed nailing). The septic risk factors were the initial opening of the fracture site (19 sites) and, in all cases, the pin-tracts with, in 5 cases, an intolerance to pins marked by a drainage or an osteolysis. Union was achieved in the 25 cases in an average time of 3.3 months. The restoration of alignment was anatomic in 19 cases. The risk of infection was confirmed with the onset of 4 deep infections which occurred each time when risk factors existed: prolonged bone exposure and intolerance to pins. Infection was treated by a selected antibiotherapy with the nail kept in place and union was obtained primarily: secondary removal of the nail was necessary in 2 cases to obtain drying up. The risk of infection after secondary nailing has thus been confirmed but its frequency and severity didn't appear excessive when compared to the advantages of locked intramedullary nailing.
Bony tissue of an average of 13.6% of the original length (OL) was resected from the tibia shaft in 26 mature goats. The fracture ends were compressively fixed with skeletal external fixation (SEF). Simultaneously, upper metaphysiotomy was performed to lengthen the tibia with a lengthening rate of 1.0 mm/d and a total lengthening 20.14% of OL. The restoration of blood circulation and the hemodynamic changes during the repair process of the compressively fixed bone ends and the metaphysiotomy site were studied with angiography, microvascular cast, Chinese ink permeated transparent thick slide, and radioactive microsphere measurement of regional blood flow (RBF). It was found that there were abundant vascular networks in the lengthened zone. The blood vessels not only could keep up with the same lengthening rate of growing, but also were gradually converted into the Haversian system in the newly formed cortex of the lengthened area. In the 2nd week after the cessation of bone lengthening, the RBF of the lengthened zone reached the maximum (54.56 +/- 8.53 ml/mm/100 g). It was also found that in the 7th postoperative week, the vessels of the cortex of the osteotomy shortening ends could grow across the space between them and anastomose with each other. The RBF at this time was 31.82 +/- 2.85 ml/mm/100 g. In the 12th week after operation, the RBF was still 2 times higher than that of the normal cortex (3.02 +/- 0.13 ml/mm/100 g). The primary healing could be observed under the wellreduction and stable compressive external fixation. These findings provide a theoretical basis for the clinical application of SEF for the treatment of tibial shaft defects or nonunion associated with limb shortening.
An in vitro assessment of the mechanical performance of 10 types of external femoral stabilization allowed the amplitudes of fracture site displacements during the initial loading phase of a comminuted fracture treated by external fixation to be established. The largest displacement to load ratios were observed in the sagittal plane for all tested configurations. The highest fixator stiffnesses were obtained by using large diameter tubes and pins. The most rigid fixators have a derigidification system which creates the problem of choosing the ideal time to change the rigidity.
A total of 23 infected or previously infected non-unions were treated by the Vidal-Adrey modification of the Hoffmann apparatus. The external fixators were applied after decortication and bone grafting either immediately in cases with no evidence of infection or later in cases of draining, infected wounds. The average healing time for these non-unions, that is time when no external support was required, was 12 months after the initial application of the Vidal-Adrey external fixators. The results were considered good or acceptable in 21 of 23 cases. Union occurred in 21, although union did not necessarily mean a good result overall when all other factors (shortening, etc.) were considered. This fixation device, when correctly applied and in conjuction with adequate debridement and bone grafting is an excellent method for the treatment of severe non-unions where infection is or was a problem.
In a series of 20 tibial fractures and ten radial fractures treated by external fixation, no association was found between the development of non-union and degree of soft tissue injury, delay in fixator application, or diaphyseal versus metaphyseal fracture site. Although the absence of fracture callus on roentgenograms of long bones immobilized by external skeletal fixation portends nonunion, no obvious cause-and-effect relation could be determined.
The construction and use of new external fixator broadening the use and increasing efficacy of Zespol system is presented. The apparatus may be used primarily or may replace Zespol plate. It enables controlled interfragmental compression, limb elongation, correction of angular and translational dislocations. After bony union occurs the fixator may be replaced with Zespol plate and reapplied to another patient. It is also compatible with Schanz pins.
Pelvic ring disruption is often accompanied by severe, multiple injuries to the organs, vessels, and nerves within the true pelvis. Mortality in the acute resuscitative period is usually due to hemorrhage and hemodynamic instability. Establishing rapid, provisional pelvic stability with external fixation is of immediate importance in the hemodynamically unstable patient, because fixation contributes to hemostasis. Orthopaedic surgeons should anticipate the likelihood of hemorrhage in patients with pelvic ring disruption and should apply external fixation immediately to minimize morbidity and mortality.
OBJECTIVE: To introduce a new way of treatment for elbow stiffness and instability. METHODS: 30 cases of elbow trauma were treated with mobile hinged Orthofix elbow fixator, 26 of them were followed up. There are 15 male patients and 11 female patients. The average age is 32.6 years old. The 26 injured elbows involved 12 cases on left side and 14 cases on right side; Sixteen cases on the dominant side and 10 cases on the non-dominant side. Sixteen cases had elbow stiffness, 5 cases had acute radial head fracture and posterior dislocation of the elbow, 3 of cases had Monteggia's fracture dislocation, and 2 cases had neglected posterior dislocation of the elbow. RESULTS: The average follow up time was 6 months (3 - 12 month). The mean time of fixation with fixator was 8.5 weeks (6 - 11 weeks). The mean ROM of the 16 cases of elbow stiffness was (37.5 +/- 0.8) degrees before operation, and (96.5 +/- 0.6) degrees operation, with a significant difference (P < 0.05). The mean Mayo elbow score was (69.5 +/- 1.7) before operation, compared with (82.8 +/- 1.6) after operation, with a significant difference (< 0.05). For the other 10 cases (5 cases with acute radial head fracture and posterior dislocation of the elbow, 3 cases with Monteggia's fracture dislocation, 2 cases with neglected posterior dislocation of the elbow), the average ROM of the elbow flexion-extension was 95 degrees (65 degrees - 150 degrees ); The average range of flexion was 117 degrees; the average loss of extension was 22 degrees; the average pronation was 76 degrees (20 degrees - 90 degrees ), the average supination was 75 degrees (15 degrees - 90 degrees ). Nine of the cases achieved anatomic reduction and proved by X-ray. The mean Mayo elbow score was 84 (49 - 96). Three cases were rated excellent, 4 good, 2 fair and 1 poor. The rate of excellent and good was 70% (7/10). Nine cases had no pain or mild pain, and did not need analgesic. Eight cases returned to their former work, 5 of the cases had complications. CONCLUSIONS: The mobile hinged elbow external fixator have following advantages: (1) distraction of the articular space and enhance fracture healing; (2) allow early movement of the elbow during healing; (3) provide stable environment for the healing after arthrolysis and reconstruction. Mobile hinged elbow external fixator can achieve successful result in the treatment of elbow stiffness or unstable fracture dislocation of elbow.
We reviewed 15 patients, nine girls and six boys, with chronic anterior dislocation of the radial head which was treated by ulnar osteotomy, external fixation and open reconstruction of the elbow joint but without repair of the annular ligament. Their mean age was 9.5 years (5 to 15) and the mean interval between the injury and reconstruction was 22 months (2 months to 7 years). All radial heads remained reduced at a mean follow-up of 20 months (6 months to 5 years). Normal ranges of movement for flexion, extension, pronation and supination were unchanged in 96.1% (49/51) and worse in 3.9% (2/51). Limited ranges of movement were improved in 77.8% (7/9), unchanged in 11% (1/9) and further decreased in 11% (1/9).There were two superficial pin-track infections and two cases of delayed union but with no serious complications. Reconstruction of the radiocapitellar joint is easier using external fixation since accurate correction of the ulna can be determined empirically and active functional exercises started immediately. Only patients with a radial head of normal shape were selected for treatment by this method.
A series of 14 cases of open fractures of the shaft of the femur and another group of 13 cases of infected non-union of the shaft of the femur are reported. They were treated with the AO tubular external fixator. The complications and results are assessed and it is concluded that the AO external fixator system has a valuable part to play in these difficult cases.
Management of severe laryngotracheal stenosis requires treatment with open laryngeal surgical approaches. Performing the necessary anterior, and possibly posterior, incisions to expand the cricoid and tracheal rings causes instability of the segments. Placing an intraluminal stent has several disadvantages, ranging from injury of healthy tissue to airway obstruction. The availability of an external stent would avoid many of these complications. We performed expansion laryngeal surgery in dogs and explored the use of microplates for external fixation and determined the surgical outcome if no fixation is used. The results show that microplates are very effective in maintaining external fixation and that a need for placing an intraluminal stent when a posterior cricoid split is performed exists.
Distal radial fractures are common, and many methods of treatment have been reported but there are no studies that compare the different treatment methods. This randomized prospective study demonstrated no advantage in using an external fixator to immobilize reduced distal radial fractures over closed reduction and plaster cast immobilization in patients less than 60 years of age. The external fixator group had a significant complication rate.
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The paper illustrates the characteristics of external fixators (EF) (Wagner, FEA, Ilizarov) regularly used in pediatric surgery. Attention is focused on the indications for their use in orthopedics and traumatology during the developmental age. In conclusion, their use, even though in traumatology this is more restricted than in adults, reduces many complications which may arise from traditional treatment. In addition, it is well tolerated and allows pathologies to be treated which were difficult to cure in the past.
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