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Conservative treatment in intertrochanteric fractures of the high risk patient carries a high rate of mortality and morbidity. In the present study external fixation of the fracture was performed under local or light general anaesthesia. This is a safe procedure and permits immediate full weight bearing.
The average time for healing of open fractures treated by the Vidal-Adrey external fixation method was 9 1/2 months for the lower extremity and 4 months for the upper extremity injuries. In a series of 33 cases, the results were excellent or good in 21.
Twenty-two children with femoral shaft fractures, between the age of 10 and 14 years, were treated with the Hoffmann external fixation apparatus from 1980 to 1985. This method of treatment is very simple. It requires less surgical exposure and allows earlier ambulation and easy nursing care. In addition, it makes patients comfortable in multiple trauma conditions. The average time to union and removal of fixators was 72 days (range, 44 to 80 days). There were no deep wound infections, nonunions, or rotationary deformities. On followup, all patients regained the range of motion of knee joints in 3 months without significant leg length discrepancy or radiographic evidence of growth disturbance. The device may serve as an alternative method for femoral shaft fractures in prepuberty, especially in areas of tropical climate.
An in-vitro system has been devised to monitor the properties of an idealized fracture site immobilized with a Hoffman-Vidal external fixator. A dial gage was used to measure the relative pin displacements under controlled axial loading. The displacement measurements were then used in conjunction with a finite element model to predict the modulus of an idealized fracture site. Five fracture sites made of neoprene disks of different mechanical properties were monitored in order to simulate the increasing modulus of a healing fracture. Good agreement was observed between directly measured mechanical properties of the neoprene and those inferred from the combined finite element and pin displacement tests.
Our aim was to determine the clinical effectiveness and safety of Ilizarov external fixation for the acute treatment of severely comminuted extra-articular and intercondylar fractures of the distal femur. A total of 14 consecutive patients with complex fractures was treated. There were three type-A3, two type-C2 and nine type-C3 fractures according to the AO/ASIF system. The mean follow-up was 14 months. Most fractures (13) united primarily at a mean of 16 weeks. One patient with a type-IIIA open fracture had infection and nonunion. The mean range of flexion of the knee at the final follow-up was 105 degrees (35 to 130). We conclude that, in the treatment of comminuted fractures of the distal femur, the Ilizarov fixator is safe and effective in providing stability and allowing early rehabilitation.
From 1989 through 1994, we used a monolateral external fixator (Orthofix) to treat 39 femur fractures in 37 patients. The average age of the patients was 9.5 years (range, 5+11 to 18+8 years); 38 fractures were closed, and one was a grade I (Gustillo-Anderson classification) open fracture. Twenty-two fractures were treated by using the standard Orthofix pin configuration with two or three pins held in the pin clamps both above and below the fracture. We treated the remaining 16 fractures identically, except for the addition of an auxiliary pin, which was secured to the body of the fixator by using wire and methylmethacrylate. All patients were followed up to union and fixator removal at a mean of 97 days after fixator placement (range, 50-175 days). Thirty-one (84%) patients were followed up for 1 year after injury. Six of 22 femurs without an auxiliary pin required remanipulation for loss of reduction. Only one of 16 femurs treated with an auxiliary pin required remanipulation. Four of 22 femurs without an auxiliary pin went on to malunion. No femur with an auxiliary pin went on to malunion.
The authors present 12 cases of fractures of the lower forearm treated by Hoffmann external fixation. They discuss the indications for this method and its advantages over internal fixation and closed treatment by manipulation and plaster. The advantages are: simplicity and rapidity of treatment, good toleration of the instrumentation, constant control of the soft tissues, almost bloodless technique, complete freedom of joints not involved in the fracture, and the ability to adjust the position of the wrist and hand as union progresses so as to gradually restore the physiological position in the later stages.
Twenty-three knees in 22 patients with Schatzker type VI tibial plateau fractures were treated with a hybrid ring external fixator using tensioned wires proximally and half-pins distally. All but two injuries were secondary to high-energy trauma. Six were open injuries, and eight patients had other major musculoskeletal trauma. Eight patients were treated with limited open reduction and internal fixation before application of the frame. The remainder received percutaneous cannulated screw fixation to stabilize the articular surface without opening the fracture site. Twenty-three fractures were followed to complete healing. Average time to healing was 4.4 months. Arc of motion averaged 107 degrees, and there were four flexion contractures of 5-15 degrees. Complications consisted of three deep wound infections, one deep venous thrombosis (DVT), one malunion, and one pin tract infection. The average knee score and patient function score were 84.7 and 80.5, respectively (Knee Society Clinical Rating System). There were 13 excellent, three good, one fair, and six poor results. The poor results were in patients who either developed deep wound infections or in those who sustained multiple musculoskeletal trauma compromising the patients' function score and ultimately the average score. This method provides good stabilization and allows early range of motion for complex tibial plateau fractures where extensive dissection and internal fixation are contraindicated due to traumatized soft tissue, osteopenia, and fracture comminution.
Within the antagonism existing between the functional intention of treatment methods of the traditional Chinese medicine and the anatomic view of "occidental" medicine, an external fixation device has been developed which is most likely to become the method of choice in fractures of the leg and other bones under the medical conditions of China.
OBJECTIVE: To evaluate the clinical and functional outcomes of infected nonunion of the tibia by internal bone transport using the LRS mono-lateral external fixation. METHODS: From June 2003 to October 2005, twenty-eight patients who underwent internal bone transport for infected nonunion in the tibia were reviewed. Twenty-three cases were open fractures: grade IIIA, 5 cases; grade IIIB, 11 cases; grade IIIC, 7 cases. The other five cases were infected nonunion after internal fixation. The results were evaluated by the classification of the Association for the Study and Application of the Method of Ilizarove (ASAMI) which divided into bone and functional categories. RESULTS: Mean follow-up was 16 months. All the cases got primary bone union, and infection was controlled. Bone results were 14 excellent, 9 good, 2 fair and 3 poor. And functional results were 10 excellent, 13 good, 2 fair and 3 poor. The mean length of time in healing for all patients were 9 months. The mean length of regenerate bone were 6.6 cm. The most common complication was pin infection, and 2 cases refractured at the docking site. CONCLUSIONS: Tibial infected nonunion can be successfully treated using the internal bone transport technique.
The authors conducted a study to evaluate the effects of cigarette smoke on the healing of septic pseudarthrosis of the tibia treated by ilizarov external fixator. A total of 31 patients of both sexes were chosen, and the healing time in relation to the habit of smoking was examined. The results have shown that the healing time in non-smokers as compared to smokers was shorter by 33%. The difference is highly significant. This shows that abstention from smoking during treatment should be given maximum importance in prevention.
The authors report the results of a review of 25 cases of fracture of the tibial pilon, treated by external fixation and minimal internal synthesis. Fractures were classified according to Rüedi and Allgower; they were: type 2: 11 (of which one exposed); type 3: 4 (of which 6 exposed). Complications observed during treatment were: pseudarthrosis: 1; osteomyelitis: 2; healing in valgus at 10 degrees: 2; osteolysis of the distal screws of the fixator: 4; these were all resolved with further surgery, except for an osteomyelitis that required amputation. Follow-up ranged from 3 to 10 years and clinical and functional evaluation, based on the Olerud and Molander score system revealed 80% good (56%) and excellent (24%) results.
Based on a clinical material of over 100 cases treated between 1977 and 1982, indications and technique of external fixation of the wrist are reviewed. The basic indication is the comminuted intra-articular fracture of the distal radius. Due to the versatility of the fixateur used, indications have been extended for stabilization of complex carpal dislocations and combined injuries of the forearm and hand. Complications and pitfalls of the method are briefly discussed.
External skeletal fixators (ESF) have a reputation for causing problems. Effective solutions exist for some of these problems. Delayed union can be avoided by accurate reduction, early bone grafting, and early removal of the ESF. Nerve and vessel injury can be avoided by special attention to the anatomy of the lateral arm and forearm, the upper medial thigh, and the junction of the third and fourth quarters of the leg. Pin tract infections continue to haunt ESF systems but are minimized by special attention to necrosis of tissue at the pin-skin and pin-bone interfaces. Undue soft tissue or bone motion can be reduced by bulky pin wraps placed over mobile soft tissue area and by use of threaded rather than smooth pins.
A series of 179 patients with lower externally fixed has been reviewed. In 14 cases purulent exudation around Zespol implants occurred, in 37 cases non purulent infection was noted. Insufficient hygiene observation was identified as the chief cause. Management of these conditions is presented, 1 case of allergic reaction and 1 case of malignant neoplastic change are reported.
A comparison of the radiographical and functional results after displaced distal radius fractures in 41 patients treated by external fixation (EF), 36 patients treated by functional bracing in supination (FUSU), and 49 patients treated by dorsal plaster immobilization (DPI) was performed. The rate of initial complications after EF was 53%, compared with 22% after FUSU and 14% after DPI. The radiographical result after EF was significantly better than after nonoperative treatment, but the functional result after 3 and 6 months demonstrated no significant difference between the three series. Consequently, EF and FUSU do not restore wrist function faster than conventional plaster treatment (DPI), but EF improves the radiographical result, though the rate of complications is higher.
In an effort to reduce treatment-related complications, a surgical procedure has been developed for the insertion and application of an external fixation device in the management of unstable fractures of the distal radius. Clinical experience with this device has demonstrated its effectiveness in reducing complications associated with pin insertion. The surgical technique is presented together with a case example. Results of laboratory tests corroborate our clinical experience and demonstrate the effectiveness of this technique in minimizing complications. Clinical results in 66 cases document the efficacy and safety of this technique.
OBJECTIVES: The Ilizarov technique limits daily activities of patients and may cause psychiatric symptoms. We investigated psychiatric symptoms associated with the use of an Ilizarov circular external fixator (CEF) and the relationship between symptoms and duration of CEF application in adult patients. METHODS: The study included 40 adult male outpatients (mean age 26.4 years; range 20 to 40 years) who were treated with a CEF. The participants were administered a questionnaire on sociodemographic and clinical characteristics. Psychiatric symptoms were assessed using the Symptom Check List (SCL-90-R). Data were compared with those of a control group consisting of 30 healthy males with similar sociodemographic features. RESULTS: Significant differences were found between the patient and control groups with regard to somatization (p=0.03), interpersonal sensitivity (p=0.027), depression (p=0.003), anxiety (p=0.025), hostility (p=0.004), paranoid ideation (p=0.021), additional scale (p=0.000), and overall symptom (p=0.024) scores. There was at least one psychiatric symptom in 52.5% of the subjects treated with a CEF. Hostility, interpersonal sensitivity, sleep disturbances, obsessive-compulsive signs, and anxiety were detected in 37.5%, 35%, 32.5%, 20%, and 20%, respectively. The duration of CEF application was positively correlated with depression and interpersonal sensitivity (p=0.000), and negatively correlated with anxiety (p=0.001). CONCLUSION: Our data demonstrate that, during treatment with a CEF, psychiatric problems emerge, which warrant careful evaluation of the psychiatric condition of the patients.