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A force measurement device has been designed to monitor the mechanical properties of fracture site with external fixation. Forces are measured through electric resistance strain gauges mounted on fixation framework and the measurement results are displayed on an LCD screen. The device features a force range of 0-10 kg with linearity and repeatability less than 1% and accuracy less than 0.1 kg.
Fifty consecutive comminuted leg fractures were treated by Ilizarov external fixation. Eleven were closed fractures, 37 were Grade II, and 2 were Grade III open fractures. Forty-five fractures healed within 6 months. In 5 fractures the Ilizarov device was removed and healing occurred by intramedullary nailing (2 cases) and decortication (3 cases). The causes of failure were: rapid peroneal union or bone fragment necrosis. Subjective tolerance and fracture stability are limited by septic loosening of the wires requiring frame removal after 6 to 8 months. Excellent results may be obtained (no leg length discrepancy, no angulation, no rotation, no joint stiffness), but the time required for union is long and additional surgery is required.
The choice of pin site in shoulder arthrodesis after brachial plexus injury is important for efficient external fixation. The pins are inserted into the coracoid process from the anterior aspect and the scapular spine from the acromion. This insertion method holds the scapula more rigid and allows the patient to lie supine. Moreover, it makes it possible to correct the fixation angle after the operation. In 11 cases of brachial plexus injury, solid bony arthrodesis was obtained within three months.
The rigidity, load to yield, and load to failure of ten configurations of the Hoffmann external fixator were investigated using a model of wooden pylons with a simulated fracture that consisted of either a reduced transverse cut or a ten-millimeter gap. The axial compressive, torsional, anterior-posterior bending, and medial-lateral bending characteristics of four forms of the single half-frame (half-pinned), four double half-frame, and two full-frame (transfixion-pinned) configurations were examined. Of the single half-frame configurations, a system with a second stacked connecting-rod proved to be superior; however, the system yielded at a mean axial compressive load of only 199 newtons and failed totally at 355 newtons. The delta frame (two rods connecting or triangulating two half-frames set at an angle of 45 degrees to one another) was as rigid as the quadrilateral full frame in axial compression; however, it exhibited low loads to yield and to failure, with means around 200 and 350 newtons, respectively. The use of only two pins in each pin-cluster did not significantly affect the performance of the delta frame. The two full-frame systems performed poorly in torsion and particularly poorly in anterior-posterior bending. The loads that caused a one-millimeter movement within the fracture gap in axial compression were notably low: for the stacked half-frames the load did not exceed a mean value of 174 newtons; for the double half-frame, 190 newtons; and for the quadrilateral frame, 412 newtons. We concluded that no frame had a good over-all performance with regard to rigidity.(ABSTRACT TRUNCATED AT 250 WORDS)
In a prospective study 40 consecutive patients with open tibial fractures were treated by the Hoffmann external fixator; the follow-up period was 18 months. All fractures were irrigated, debrided, and fixed rigidly with the Vidal-Adrey modification of the Hoffmann device as soon as the patients' condition allowed. The wounds were left open, to be closed secondarily with skin grafts, muscle flaps, and other plastic surgical procedures. The 40 wounds were all classified as Gustilo's Type II or III in relation to soft tissue damage; 36 injuries were due to motor vehicle accidents and four to gunshot wounds. At the 18-month follow-up examination there had been five amputations and five nonunions had healed after bone grafting; in addition, five patients had persistent pin drainage. Pin site drainage (80%) was the most common problem, but most cleared after removal of the fixator and five after curettage of ring sequestra. There was a high number of associated surgical procedures (2.4% per patient) related to the open fracture. At the 18-month follow-up examination bony healing was noted in all patients.
Extremity fractures frequently occur at the time of spinal cord injury. Fractures immobilized by external fixation devices interfere with patient positioning and predispose to trophic ulcers. The devices also interfere with joint motion. Incorrect application may delay rather than promote fracture union. Patients with spinal cord injuries require appropriate fracture management.
Charcot neuroarthropathy is a complex sequela of neuropathies associated with diabetes mellitus, syringomyelia, alcoholism, and other disorders. The treatment of deformities associated with Charcot neuroarthropathy is evolving from a passive approach to one in which an earlier recognition of the emergence of the event permits an avoidance of deformity. As the understanding of the etiology and natural history of Charcot neuroarthropathy deepens, it has become apparent that many of the deformities that do develop may be reconstructed expeditiously by the surgeon with a thorough understanding of the diabetic foot and experience in the use of external fixation.
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Genu recurvatum due to an osseous abnormality is a condition that rarely requires surgical intervention. When necessary, the operative solution usually considered is an opening wedge osteotomy using bone graft and plate fixation. The donor site (usually the iliac crest) has a well reported morbidity with a further procedure being required to remove the plate. We report two cases treated by a hemicorticotomy and callus distraction (hemicallotasis) of the tibia using an external fixator. Correction was performed under supervision as an out-patient. Hospital stay was short, the morbidity of the donor site was eliminated, further procedures for removal of the plate were unnecessary and mobility of both the patient and his joints was maintained throughout the period of treatment. Satisfactory correction of the deformity was obtained in both cases.
In a comminuted fracture, a unilateral plate doesn't always give enough stability because the contralateral cortex cannot be used as a buttress. New plate systems as the Locking Compression Plate (LCP) may solve this problem. Another method to stabilize the contralateral cortex is by using an External Fixator (EF) in addition to a conventional platte either on the opposite side of the plate or on the ipsilateral side over the plate. By doing so, a half frame of an EF acts as a substitute for the damaged cortex. This method is easily available and may also be considered when a conventional plate osteosynthesis must be mechanically improved after the conventional plate is already put in place. With this combination of a plate with a EF we treated twelve patients with comminuted fractures of the tibia, the humerus and the femur. Eleven fractures healed without further operations or complications. In one case, there was a superficial wound infection with Staph. epidermidis that lead to an early metal removal, but healing of the fracture was not impaired. We also tested this set-up in a model and found, that the additional EF increased the stiffness of the plate by 73% for axial load. The combination of a plate and a contralateral EP is a useful way to treat comminuted fractures biologically achieving enough stability to allow early motion of the adjacent joints and fast healing of the fracture. Especially for fractures adjacent to a joint, this method is an alternative to an intramedullary nail.
Fractures of the distal end of the forearm are common fractures treated at surgical departments with standard equipment. The results, when conservative procedures are used, are not always ideal and redislocation of fragments on the 14th-21st day spoils the satisfaction of the anatomical reposition immediately after the accident. The authors demonstrate the use of external fixation devices in these fractures and the advantages of the method, as compared with the conservative procedure, in particular in unstable fractures. The objective of the submitted paper is not a randomized study as this is beyond the possibilities of the authors department but to demonstrate a more radical "approach" to these fractures. The advantage of this method is the possibility of anatomical reposition and maintenance of this position throughout the time of healing of the fracture, and the possibility of earlier rehabilitation of the wrist.
Treatment of severely comminuted calcaneal fractures with soft tissue compromise is still a controversial issue among surgeons. Complications of open reduction internal fixation have been well reported in the literature with a fairly high incidence of posttraumatic osteoarthritis of the subtalar joint, symptomatic hindfoot stiffness (especially when fixed in varus), wound dehiscence, and potential for the development of osteomyelitis caused by the extensive soft tissue trauma inherent with these injuries. For these reasons, closed treatment techniques using minimally invasive reduction procedures with application of ring-type fine-wire external fixation have recently gained popularity.
High tibial osteotomy is a simple and safe method to correct the varus gonarthritic knee. Numerous follow-up studies have demonstrated that this procedure gives satisfactory functional results for 10-15 years after surgery, above all if a precise valgus hypercorrection of 8 degrees-10 degrees is carried out. The present study attempts to deal with another, less discussed topic: evaluation of the efficacy of external fixation after osteotomy synthesis with respect to the most common plate and screw synthesis as well as to the Insall procedure.
Alteration of tibial slope is one of the important anatomical changes of the proximal tibia after high tibial osteotomy. Increased or decreased tibial slope can effect further total knee prosthesis procedure. In this retrospective study, 18 knees of 17 patients (17 female, mean age 51 range 43-61, mean BMI is 33.6 +/- 4.6 kg/m2) who were applied high tibial osteotomy using circular external fixator due to medial compartment arthrosis of the knee were evaluated in terms of tibial slope changes. While mean correction about 12.3 degrees in mechanical femoro-tibial angle was obtained in frontal plan (P = 0.0001), significant change in tibial slope was not determined in sagittal plan (P = 0.127). The mean posterior proximal femoral angle values were measured as 79.5 +/- 2.1 degrees preoperatively and as 80.3 +/- 2.7 degrees postoperatively and found to fall into the normal range (80.4 +/- 1.6 degrees). As there is no significant alteration in tibial slope after high tibial osteotomy performed with the Ilizarov system, complications due to alteration in tibial slope will not be experienced in follow-up or in further total knee prosthesis procedure.
Thirty patients were managed with the use of a simple means of external fixation. Ten of these patients had multiple injuries. In 18 the fractures were open. Five cases had loss of bone length and infected wounds when first seen and were treated with the aid of microvascular surgical procedures. Eight cases required skin grafting. One case required a vein graft to the popliteal artery. The method described is simple to use. It requires little previous experience and is cost effective. We recommend its use in the initial treatment of grade 2 and 3 open fractures. It may also be used on closed unstable fractures, and will maintain limb length in severe injuries with loss of bone substance while further treatment is considered or performed.
The advantages of Ilizarov external fixation, allowing early motion of adjacent joints during fixation of periarticular fractures, have not yet been applied to distal radius fractures. A magnetic resonance imaging study of 10 normal volunteers evaluated the safety of passing percutaneous transfixion pins across the distal radius in 3 forearm positions. Even in the optimal forearm position, the safe zones between the transfixion pin, vessel, nerve, or tendon was small, suggesting that open placement would be required. A cadaver study in 8 specimens demonstrated that the pins could be placed with an open technique using an aiming device and that the pins could be placed without limiting forearm rotation. The proximity of vital structures to transfixion pins dictates open placement to safely apply Ilizarov fixation to distal radius fractures.