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At least 109 records · Page 6Linked to original sources
PubMed2003

Treatment of tibial defect and bone nonunion with limb shortening with external fixator and reconstituted bone xenograft.

OBJECTIVE: To explore the effect of external fixator and reconstituted bone xenograft (RBX) in the treatment of tibial bone defect, tibial bone nonunion and congenital pseudarthrosis of the tibia with limb shortening. METHODS: Twenty patients (13 males and 7 females) with tibial bone defect, tibial bone nonunion or congenital pseudarthrosis of the tibia with limb shortening were treated with external fixation. Two kinds of external fixators were used: a half ring sulcated external fixator used in 13 patients and a combined external fixator in 7 patients. Foot-drop was corrected at the same time with external fixation in 4 patients. The shortened length of the tibia was in the range of 2-9 cm, with an average of 4.8 cm. For bone grafting, RBX was used in 12 patients, autogenous ilium was used in 3 patients and autogenous fibula was implanted as a bone plug into the medullary canal in 1 case, and no bone graft was used in 4 patients. RESULTS: All the 20 patients were followed-up for 8 months to 7 years, averaging 51 months. Satisfactory function of the affected extremities was obtained. All the shortened extremities were lengthened to the expected length. For all the lengthening area and the fracture sites, bone union was obtained at the last. The average healing time of 12 patients treated with RBX was 4.8 months. CONCLUSIONS: Both the half ring sulcated external fixator and the combined external fixator have the advantages of small trauma, simple operation, elastic fixation without stress shielding and non-limitation from local soft tissue conditions, and there is satisfactory functional recovery of affected extremities in the treatment of tibial bone defects, tibial bone nonunion and congenital pseudarthrosis of the tibia combined with limb shortening. RBX has good biocompatibility and does not cause immunological rejections. It can also be safely used in treatment of bone nonunion and has reliable effect to promote bone healing.

Adolescent↗
PubMed1989

Structural stiffness of the Hoffmann simple anterior tibial external fixation frame.

Tibial external fixation frames were constructed on aluminum tube simulating tibia bone. A 20-mm gap was left at the fracture site in order to measure the structural stiffness of the frame rather than the aluminum tube. The performance of the frames were experimentally evaluated and quantified using tests which simulated the loading conditions encountered in normal walking. These included axial compression, anteroposterior (AP) bending, lateral bending and torsional loading of the frame. The parameters studied were (a) number of fixation pins, (b) number of connecting rods and (c) location of clamps on the pins. Four constants were evaluated from these tests using various structural configurations of the frames; these resulted in four stiffness coefficients in compression, AP bending, lateral bending and torsion. Stiffnesses of various frames with different geometric configurations were compared by comparing their appropriate stiffness coefficients. Such comparison can set forth a quantitative guideline in selecting a suitable frame configuration for the type of injury and condition of fracture pattern. This type of quantitative analysis can also be useful in modifying the frame during the postoperative bone healing process.

Equipment Design↗
PubMed1981

Which external fixation device?

Seven external fixation frames which are used for the treatment of fractures have been evaluated. The features of these devices are presented and some of the advantages and disadvantages of each are described.

Bone Nails↗
PubMedDate not supplied

Limb lengthening with the Ilizarov external fixator.

The Ilizarov External Fixator is used to lengthen or widen bones, to correct angular or rotational defects, or to immobilize fractures. This article discusses techniques of application and care of the device; physiology and mechanics of limb lengthening and bone regeneration; and nursing strategies to achieve patient compliance and prevent complications.

Bone Lengthening↗
PubMed1998

Sliding performance of unilateral external fixators for tibia.

Some unilateral external fixators have a sliding mechanism to achieve dynamic axial fixation. However, it has been reported that binding of this mechanism occurs during routine ambulation. The Hifixator, a unilateral external fixator, has been developed which has a new type of sliding mechanism. The mechanism of the Hifixator was tested by connecting it to a fractured bone model with pins, and applying dynamic axial loading. The conditions of connection between the pins and bone model were varied to simulate loosening of the pins. Two other external fixators commonly used for tibias, Orthofix and Monotube (blue), were tested for comparison. The amount of sliding motion of the Hifixator was maintained at more than 72% of the motion at the fracture site even when pins were loose and a torque of 4 N m was applied. The sliding mechanism of the Hifixator was shown to be more durable than those of the other fixators tested for conditions found in application to tibias.

Biomechanical Phenomena↗
PubMed1990

External fixation in multiply injured children.

External fixation treatment for selected fractures can be as readily applied to children as to adults, although only a small percentage of pediatric fractures require this method. The best situations for the use of external fixation in children are in cases of multiple organ system injuries and in fractures associated with skin loss or large wounds. In these situations, while the child's other problems are being treated, external fixation provides excellent temporary stabilization to facilitate fracture management.

Adolescent↗
PubMed1976

External fixation in maxillofacial surgery.

The role of external fixation in the treatment of facial fractures is well defined. If standard open reduction and internal fixation techniques do not yield a satisfactory result, external fixation techniques may be required. Open reduction has the advantage of effecting precise approximation of fragments. However, this type of fixation may be inadequate, either because no stable point is available or because the angle of traction involved in fixation may result in displacement of the reduced fracture and subsequent malunion. When the facial skeleton is fractured, it tends to collapse inward, and if injury is severe, an external traction point anterior, lateral, or superior to the facial skeleton may be required to obtain a satisfactory result. There are occasions when intermaxillary fixation may be inadvisable, and in these instances external fixation techniques may be an appropriate means of immobilization. Finally external fixation techniques may be required in instances in which massive tissue loss precludes the use of standard open reduction and internal fixation techniques. It must be reemphasized that the methods of external fixation described here are not meant to supplant the standard techniques of open reduction and interosseous wiring, but when judicially employed complement them in achieving the desired result of precise reduction and firm fixation of the fractured facial skeleton.

Fracture Fixation↗
PubMedDate not supplied

Transfer techniques of the lower extremity with an external fixator.

This article describes the uses of external fixation for lower extremity problems and addresses some issues related to the correct way to lift an extremity with an external fixator. The differences in opinions between nurses and among physicians is discussed, followed by suggestions for solving this confusion within the settings in which people work. The article then pictorially demonstrates how to lift an extremity with an external fixator. It proceeds through a series of photographs depicting how to transfer a patient into a chair by supporting the extremity, and again by supporting the external fixator itself.

Beds↗
PubMed2003

External fixation in trauma of the foot and ankle.

External fixation as a modality is a versatile and minimally invasive stabilization option that should not be forgotten even as new and specially designed implants for nearly each bone become more fashionable. As a temporary traction device, the external fixator can help condition the soft tissues and, if closed reduction was sufficient, it can stay in place for definitive treatment. The external fixator can be used as an intraoperative distraction device and as a helpful tool for reduction, which can stay in place as a temporary immobilization. External fixation instead of plaster cast allows for better care of skin and soft tissues. External fixation also has its advantages as a minimally invasive external compression device in specific indications for arthrodesis, especially in infected cases.

Ankle Injuries↗
PubMed1991

External fixation of metacarpal and phalangeal fractures.

External fixation is rarely employed in the treatment of hand fractures, and few reports describing this technique have been published. This is a report on 26 patients with 30 hand fractures (19 metacarpal and 11 phalangeal) treated by closed reduction and external fixation. The fixation consisted of percutaneous and transversely applied Kirschner wires that were fixed externally with methylmethacrylate rods. Active range of motion exercises were started 1 week after reduction with the external fixator in place. Percentage return of total range of motion in phalangeal fractures varied from 66% to 98% (mean, 84%), and in metacarpal fractures it varied from 77% to 100% (mean, 96%).

Adolescent↗
PubMed1988

[Combination of external fixator and internal synthesis in fractures and pseudoarthrosis of the leg. Principle indications and results].

A combination of internal and external fixation has been used on 58 occasions in fractures and pseudarthroses in the leg. In almost two-thirds of the cases, the fractures were compound. Several situations favour this combination of fixation: internal fixation complements an initial external fixation by stabilising the fracture site in the shaft or by allowing reconstruction of joint surfaces, external fixation complements any inadequate internal fixation due to comminution of the fracture or poor skin cover that only allows a minimum of internal fixation, external fixation secondarily comes to the help of internal fixation in cases of skin necrosis or secondary bone infection. The authors believe that a combination of internal and external fixation has real advantages and that, when used with good sense, it should not lead to any specific complications.

Adolescent↗
PubMed2001

Vascular complications after the treatment with Ilizarov external fixators.

Iatrogenic vascular injuries from external fixation in orthopaedics and traumatology are frequent. Three cases of vascular injuries after the treatment with Ilizarov external fixators were treated at our institution. These include two cases of pseudoaneurysms and one case of acute ischaemia of the lower limb. Two patients became symptomatic only after removal of the fixator. In all cases, the diagnosis was made by color flow duplex sonography. All vascular injuries needed surgical repair.

Adolescent↗
PubMed1996

[Osteosynthesis of tibial valgus osteotomies by goniometric CH-N external fixator].

INTRODUCTION: The authors present technique and results of a new external fixator, the < < goniometric > > external fixator CH-N for osteosynthesis of high tibial osteotomy for arthritic varus knee deformity on 86 kness (75 patients). MATERIALS AND METHODS: 86 knees in varus deformity with degenerative arthritis of the medial compartment (56 females and 16 males - age 63 +/-8 years) were treated for 5 years (1989-1993) by high tibial osteotomy stabilized by a < < goniometric > > external fixator CH-N. RESULTS: Clinical results were 65,9 per cent excellent, 17, 1 per cent good, 11,8 per cent fair and 5,2 per cent poor 1 year after osteotomy (86 cases analyzed), changing in 60 per cent excellent, 22,3 per cent good, 9, 1 per cent fair and 8,5 per cent at 3 years follow-up (61 cases). Radiological results were: - The preoperative mechanical axis of 13 degrees +/- 5 degrees in varus transformed to 4 degrees +/- 2 degrees in valgus at consolidation and to 2,5 degrees +/- 3 degrees in valgus at one year follow-up. At 3 years follow-up we founded a new loss of correction of 1 degree (mean) in 22 per cent of cases (61 cases). - Subchondral density decreased in 91 per cent of cases (86 cases) one year after and in 82 per cent of cases, 3 years after the osteotomy (61 cases). - In 12 per cent of cases we found a decrease of the overcorrectional angle of the varus deformity 1 year after, and in 22 per cent of cases 3 years after. Two cases needed total knee arthroplasty 4 years after ostcotomy. - Postoperatively, in 86 per cent of cases we did not found increase in both clinical and radiological (pathological) findings of the patellofemoral joint one year after, and in 75 per cent of cases 3 years after. DISCUSSION: The principle of this special < < goniometri > > external fixator is based on the < < goniometric > > central joint in the frontal plane, this allows to guide the screws during osteotomy in the predesigned position and to control the correction during and after the procedure, in contrary to the others current system either internal or external. Any faulty correction can be modified. With its distal screwing axis, it allows axial dynamization. There are only some but not serious incoveniences due to the application of pins (temporary neuromuscular problems and pin-track infections.

Aged↗
PubMedDate not supplied

Comparison of dynamic versus static external fixation for pediatric femur fractures.

External fixation of pediatric femoral shaft fractures has the advantages of minimal dissection and early weight bearing. However, it is associated with slow healing and potential for refracture. Some surgeons have proposed that axial dynamization may improve the speed and strength of callus formation. to test this hypothesis, we performed a randomized controlled trial using 53 femur fractures in 52 patients between 1995 and 1999. Patients were randomized to receive dynamic or static fixation. Average time until early callus formation was 23.2 days for dynamic fixation and 24.9 days for static fixation (P = 0.627). Average time until complete radiographic healing was 70.1 days for dynamic fixation and 63.1 days for static fixation (P = 0.370). Similarly, the differences in time to fixator removal and to full weight bearing did not reach statistical significance. The conclusion was that axial dynamization of external fixation for pediatric femur fractures has no significant effect on time to healing or frequency of complications.

Child↗
PubMed2002

Mechanical strength and wear of used EBI external fixators.

Thirty-one EBI external fixators (Dynafix; EBI, Parsippany, NJ) subjected to one or two clinical uses underwent static mechanical testing identical to that performed on new devices prior to market approval. No fixator exhibited catastrophic mechanical failure. For all fixators tested, the mean load to failure was not significantly different from that of identical testing of new devices. Although loss of material from serrated joints was observed in some joints, mechanical strength was not affected. Additional testing of fixators of a variety of designs is necessary to expand on the results of this investigation. The results of this study represent a first step in validating the safety of external fixator component reuse.

Equipment Failure↗
PubMed1995

Intramedullary nailing after external fixation of the tibia.

Intramedullary nailing after external fixation of fractures of the tibia has high complication rates including nonunion and infection. The authors review the literature regarding this technique and refine the indications for secondary IM nailing. The report distinguishes between sequential secondary nailing and reconstructive secondary nailing. Sequential secondary nailing, as defined, is done by protocol and is planned from the onset of treatment. The technique includes only a short period in the external fixator, a planned interval between removal of the frame and placement of the IM nail, and specific exclusion criteria. This technique essentially uses the external fixator as a temporary traction device while the soft tissue envelope is reconstructed. Reconstructive procedures, as defined, are not done by protocol and not planned from the onset of treatment. Patients are usually in the external fixator for extended periods of time. The indications are variable and include delayed union, nonunion, malunion, and infected nonunion. The authors conclude that when done by protocol sequential IM nailing is safe and effective. Reconstructive IM nailing, however, has strict contraindications that include: a history of or an active infection of the pin tract, wound, or bone; the presence of an open wound or pin tract; and the presence of a ring or halo sequestrum. Yet reconstructive secondary procedures can be effective in healthy individuals if the soft tissue envelope is completely reestablished, if antibiotics are administered preoperatively, and the nail is placed without reaming.

Adult↗
PubMed2000

External fixation in forearm shaft fractures.

External fixation for uncomplicated forearm fractures is rarely performed. The situation is different in a multiply injured patient or in a fracture with considerable soft tissue damage. In these cases the external fixator confers quick and efficient stabilisation which meets the requirements of adequate nursing and aids recovery of the general and local condition. Later change to an appropriate internal fixation procedure for definitive fracture treatment is recommended.

Adolescent↗
PubMed1993

Dynamic external fixation of distal radius fractures.

External fixation in fractures of the distal radius has been used for almost 80 years. The main objective is to achieve reduction and maintain the reduction throughout treatment. The fixator concept described as the dynamic fixator allows reduction in three planes and allows for the wrist to move after a period of rigid fixation. Fixator application is illustrated for fractures that necessitate bridging of the wrist joint and for extra-articular fractures. Indications for additional measures, including bone grafting, k-wire fixation, and stabilization of the radioulnar joint, are discussed. Associated injuries and postoperative management is described. The technique of correcting malunited fractures with the assistance of an external fixator is explained, with special emphasis on the correction of radial length, angle, and shift. The results of initial trials show a low complication rate and indicate that bone grafting should probably be used more than previously recommended.

Bone Screws↗