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PubMedDate not supplied

[Experiences with external fixation of the cervical spine in the halo-yoke system].

The Halo-Yoke-System allows an external fixation, reposition and immobilisation of the cervical spine. Indications for application of application of Halo-Yoke exist in conservative or operative treatment of acute traumatic lesions and protection of results after surgical treatment in cases of instability of different etiology (tumour, spondylitis, rheumatoid arthritis, congenital deformities). The experience basing on 28 own cases is reported.

Cervical Vertebrae↗
PubMed1993

Fractures of the shaft of the radius after treatment of Colles fractures with pins and plaster or external fixation.

Refracture of the radius through a pin site after the removal of pins and plaster or an external fixator for Colles fracture is rarely mentioned in the literature. We present the details of three such cases and review two others reported in the literature. Our aim is to alert orthopedists to the potential for this complication. Patients with superficial or deep pin tract infections appear to be at greater risk.

Accidental Falls↗
PubMed1983

Halo external fixation of nasal fractures.

The halo, long in medical use for cervical traction, subsequently has been adapted as a method of external fixation for severe facial fractures. We have recently used a light-weight halo in four patients with severe mid-facial fractures and crushed nasal skeletons. External traction proved to be superior to any method we have previously used to support the repositioned nasal bones. We strongly recommend external traction for severe nasal fractures in which other methods may not give a complete and stable bony reduction.

Adult↗
PubMed2004

[Severe angular deformity of the humerus: unilateral external fixation for correction and bone lengthening].

We report the case of a 10-year-old child who presented a severely deformed upper limb due to post-traumatic partial proximal epiphysiodesis of the humerus. The goal of treatment was to correct the severe angular deformity, prevent recurrence, and lengthen the humerus 6 cm. We used the De Bastiani callotasis method with osteotomy of the humeral shaft and unilateral external fixation (Orthofix LRS). The bony deformations were corrected progressively. Angular correction induced a geometric lengthening sufficient to match the length of the healthy limb. Lengthening index was 22.7 days/cm. The functional and esthetic results were remarkable. Complementary epiphysiodesis of the proximal physis successfully prevented recurrent deformation.

Anthropometry↗
PubMed2004

Elbow fracture-dislocations: the role of hinged external fixation.

Fracture-dislocations of the elbow remain a complex problem in orthopaedics. The myriad of treatment protocols and methodologies focuses on precise articular alignment and restoration of the skeletal architecture. The goal is to re-establish function as quickly as possible so as to allow rehabilitation involving the full range of motion. Surgical management, primarily reconstruction of the secondary stabilizers of the elbow joint as well as preserving soft tissue structures, subsequently provides the possibility of a speedier recovery. If proper skeletal alignment does not confer enough stability, hinged external fixation becomes an integral part of the treatment strategy for the reconstructive and trauma surgeon.

Biomechanical Phenomena↗
PubMed2005

Complex tibial plateau fractures treated with Ilizarov external fixator with or without minimal internal fixation.

We treated 30 tibial plateau fractures (Schatzker Type VI) in 29 patients, with a mean age of 41.4 (20-76) years, with the Ilizarov fixator. In 18 fractures, we combined the treatment with minimal internal fixation. All fractures were the result of high-energy trauma, and 20 patients had associated injuries. Twenty-eight fractures were available for follow-up after 27 (16-36) months. Using The Knee Society clinical rating system, 18 knees were rated as excellent, seven as good, one as fair, and two as poor. There was a direct correlation between the presence of associated injuries and the final outcome. The most significant concomitant injuries were distal femoral fractures and extensive soft-tissue injury. This study emphasizes the clinical success and low morbidity associated with the use of external fixation and minimal internal fixation.

Adult↗
PubMed2004

Surgical treatment of femoral fractures in children. Comparison between external fixation and elastic intramedullary nails: a review.

Femoral fractures represent about 2% of all fractures in childhood. Children with femoral fractures always need to be admitted to hospital and the use of resources is much higher than for other childhood fractures. During the past decade, there has been a trend towards surgical treatment of these fractures, one advantage being the shorter time required in hospital. Two common surgical treatment options are external fixation (EF) and elastic stable intramedullary nails (ESIN). Both methods have their advantages and disadvantages, and neither of them solves all of the problems. Used in a complementary manner, they are safe and reliable for the treatment of femoral fractures in children, and they give good long-term results and few serious complications.

Bone Nails↗
PubMedDate not supplied

Application of external fixators in major foot contractures.

Extremity contractures are one of the most common deformities faced by the reconstructive surgeon. Major deformities with ankylosis of the related joint have to be managed by both soft tissue and bone operations. Contractures existing for a long period of time cannot be brought into anatomic position easily because of shortened tendons, nerves, and vessels or ankylosed joints. Although tendons can be lengthened in one operation, this is not the case for neural and vascular structures. The authors use external fixators associated with soft tissue procedures to gradually correct major foot dorsiflexion contractures.

Adult↗
PubMed1993

Tibial external fixation, weight bearing, and fracture movement.

Axial fracture movement and loading has been measured during weight bearing in 45 patients with tibial diaphyseal fractures treated with unilateral external skeletal fixation. Mean axial fracture displacement reached a maximum of 0.6 mm between seven and 12 weeks postfracture. Very little movement occurred during the first five weeks after fracture. A micromovement module attached to the fixator increased axial movement at the fracture site by 50% during walking. Weight bearing reached 75% of mean body weight by ten weeks after the fracture. Weight bearing was not decreased by any biofeedback mechanism. A randomized prospective clinical study of diaphyseal tibial fractures treated with external fixation showed a significant reduction in time to healing when micromovement was imposed. Controlled fracture site movement can be imposed very early after fixator frame application when mechanical stimulation may be most effective, and the active loading by the patient is least.

Bony Callus↗
PubMed2003

Ilizarov external fixator for open fractures of the tibial shaft.

Between December 1993 and 1999 we treated 34 open tibial diaphyseal fractures. Thirty patients were available for evaluation with a mean follow-up after fracture union of 40.5 (24-80) months. Patient average age was 33.1 (15-71) years. Two fractures were grade I, 16 grade II, six grade IIIA, five grade IIIB and one grade IIIC. The wound was debrided and the bone fixed with Ilizarov device. Soft-tissue healing was achieved through Z-plasty, delayed primary closure, split-thickness skin grafting, pedicle flaps and skin traction, and all fractures united with an average 5.6 (3-15.4) months. In 28 patients the results were excellent and good, in one fair and in one poor. Despite numerous complications the use of Ilizarov external fixator provides initial and definitive fracture stability.

Adolescent↗
PubMedDate not supplied

Toxic shock syndrome in patients with external fixators.

Toxic shock syndrome (TSS), first described by Todd et al. in 1978, can be a life-threatening entity. Familiarity with the pathogenesis and clinical presentation of TSS may help achieve early diagnosis and prompt appropriate intervention. TSS is not a septicemia, but a toxemia. The most extensively described pathogenesis involves a focus of specific Staphylococcus aureus strains capable of producing an exotoxin (TSST-1). We report two patients who developed TSS while in external fixators and describe their initial symptoms, management, and subsequent problems. This report will serve to alert pediatric orthopaedic surgeons to this entity and enable them to recognize its rather precipitous presentation and initiate appropriate treatment.

Bone Nails↗
PubMed1990

The vascular repair of an experimental osteotomy held in an external fixator.

The vascular repair of a lower tibial transverse osteotomy in the New Zealand white rabbit held in an external fixator was studied in three groups. In the first group, composed of 18 animals, the osteotomy gap was maintained throughout repair. Three animals were killed every two weeks up to 12 weeks postoperatively. In the second group, composed of three animals killed at six weeks, the fragments were brought into contact. In a third and similar group, the osteotomy was compressed. Plain roentgenograms were taken weekly, and intraarterial perfusion with Micropaque was performed when the animals were killed. Roentgenography using fine-grain film, microradiography, and histology were carried out on a midsagittal tibial slice. The results showed that following transverse osteotomy in which the gap was maintained, vascular union of the proximal and distal cortices and associated external callus masses had usually occurred by ten weeks postoperatively. However, an occasional hypovascular zone at the osteotomy site at 12 weeks was associated with fibrous delayed union. In contrast, when apposition or compression of the fragments was used, repair was accelerated, and cortical bone union was established at six weeks. Vascular union of the fragments occurred predominantly through the medullary vessels. The results emphasize the overriding clinical importance of abolition of a fracture gap to achieve rapid revascularization of a fracture and its union by bone.

Angiography↗
PubMed2006

Hybrid external fixation for arthrodesis in knee sepsis.

Several techniques for knee fusion have been described with success rates ranging from 29% to 100%, with worse results occurring in patients with joint sepsis. We treated 21 patients with persistent infections using knee arthrodesis with a hybrid Ilizarov frame at our institution. There were 13 men and eight women ranging from 21 to 75 years (mean, 49.7 years). Sixteen patients had chronic osteomyelitis and five had previous fusion trials. Two patients required bone transport using the same arthrodesis frame. We corrected associated malalignment in three patients. Solid knee fusion was achieved in all but one patient after a mean external fixation time of 22.7 weeks (range, 11-47 weeks). Limb shortening averaged 2.8 cm (range, 1.5-5 cm). No patients required secondary bone grafting to achieve fusion. Nine patients had complications develop, three of whom required reresection and frame application to treat persistent infection or delayed union. Our results emphasize the clinical success of using the Ilizarov fixator for knee arthrodesis after persistent sepsis.

Adult↗
PubMed1993

[Treatment of radial club hand with double articulated external fixators].

Congenital absence of the radius is a rare malformation, characterized by radial deviation of the hand to more than 90 degrees. Early treatment with plaster cast use to be enough to correct radial deviation, making easier surgical correction on several years later. We report a case of a newborn with radial club hand absence of the thumb of the right hand, bilateral hydronephrosis and bilateral cryptorchidism. Was treated with a new procedure, permitting wrist centralization, coupled with osteotomy and callostasis of the ulnar diaphysis using external fixation. We obtained an important success with this serial lengthening of the ulna.

Child, Preschool↗
PubMed1998

Ilizarov external fixation in the management of bilateral, highly complex blast injuries of lower extremities: a report of two cases.

Because of their complexity, war injuries inflicted by a blast mechanism often require tailoring of treatment to attain a more individualized solution. We report two cases of bilateral, severely mangled lower limbs with open tibial fractures and crush injuries to the feet. In each case, one limb had to be amputated below the knee, but the other limb was saved by immediate stabilization in a tubular external fixation frame crossing the knee; the frame was later replaced by a hybrid ring fixation frame with a freely moving knee. Such incidences are rare, and the particular management detailed here has not previously been reported in the literature.

Adult↗
PubMed2007

Deformity correction with external fixator in pseudoachondroplasia.

Patients with pseudoachondroplasia have complex, difficult to correct deformities including angular deformity, rotational deformity, and ligament laxity. We retrospectively reviewed seven patients (two children, five adults) with 26 segmental deformities (12 femora, 14 tibiae). We performed bilateral femoral and tibial osteotomies in six patients and bilateral tibial osteotomies in one patient. Distraction osteogenesis was used in 20 segments and acute deformity correction was done in six segments. External fixation was applied to all segments. Of 26 segments, there were five good, 12 fair, and nine poor radiographic results with nine major and 12 minor complications. Recurrent deformity in children and refracture in adults were related to poor results. Of 14 limbs, there were four good, five fair, and five poor clinical results with five major and 14 minor complications. Knee stiffness was the most common complication related to poor results in our series, and occurred particularly in patients with simultaneous correction of the ipsilateral tibial and femoral deformities. Therefore, two-stage surgery including bilateral tibial osteotomies first and then bilateral femoral osteotomies is recommended instead of simultaneous correction of the ipsilateral tibial and femoral deformities to avoid knee stiffness.

Adolescent↗
PubMed2006

Graft-supplemented, augmented external fixation in the treatment of intra-articular distal radial fractures.

This article compares the functional and radiographic outcomes of intraarticular distal radial fractures treated with augmented external fixation in which autologous cancellous bone grafting or Norian SRS (Norian Corp, Cupertino, Calif) was used for filling the metaphyseal void. Thirty non-randomized patients, 15 in each group, with AO type C distal radius fractures (20 men and 10 women; average age: 48 years) were operatively treated between 1998-2000 and retrospectively evaluated. Radial inclination, radial length, volar tilt, and Modified Mayo Wrist Score were assessed at the most recent follow-up evaluation (average: 33.3 months). Overall, 12 (80%) patients in the Norian group had an excellent or good result, 2 had fair, and 1 had poor. In the autologous iliac bone graft group, the results were excellent or good in 11 (73.3%) patients, fair in 1, and poor in 2. No statistical difference between the two types of grafting was noted. Norian SRS is equally effective to cancellous bone as supplementary graft in comminuted distal radial fractures treated by external and Kirschner-wire fixation.

Adult↗
PubMed2004

The Ilizarov external fixation frame in compression arthrodesis of large, weight bearing joints.

Solid bony fusion of large joints affected with active chronic infections, is still the most effective surgical solution to establish a useful function of the affected limb. Even with extensive peri-articular bone loss and severe deformities, arthrodesis in a functional position can provide effective stability. The reported fusion rates in such patients are not encouraging however, and secondary amputations have been reported. Compression arthrodesis using an Ilizarov external fixation frame was performed for 17 destroyed feet (14 tibiotalar and 3 subtalar joints) and 6 badly disrupted knees in a series of 20 patients. Evaluation of the results was based on the clinical and radiological joint alignment, achievement of fusion, presence or absence of infection, and functional outcome. One patient after knee joint arthrodesis was lost to follow-up, and two knees had developed a clinically stable fibrous union. Solid fusion was obtained in all other joints. All joints were in anatomical alignment and the patients were fully functional at the time of review. Our experience of using the Ilizarov fixation frame for achieving joint fusion is very rewarding. The results reported hereby justify the further use of this hybrid frame as an effective mechanical method to achieve bony joint fusion without bone grafts, and to ensure a low failure rate.

Adolescent↗