Treatment of ruptures of Achilles' tendons by an external fixator.
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Achilles Tendon↗
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The correct positioning and role of an external fixation device on a PEG.
A percutaneous endoscopic gastrostomy tube (PEG) is the means by which long-term artificial enteral nutrition can be provided to patients. PEGs differ in design and length of use but have one device common to all--the external fixation device or boister. This is a small piece of polyurethane or silicone that is usually circular or triangular in shape. It encircles the PEG and is designed to anchor the PEG externally and 'prevent it from being pulled into the stomach' (Colagiovanni, 2001) (Fig 1).
Bandages↗
External fixation in patients with panvertebral osteomyelitis and paraplegia.
Vertebral osteomyelitis is a difficult problem in the spinal cord injured patient. We present three such cases treated with extensive debridement followed by grafting and stabilization with external fixation. In all three patients the infection resolved. We feel this is a viable option for treating this condition.
Abscess↗
[Special utilization potentials of the external fixator in severe complex hand injuries].
Complex injuries to the hand may cause considerable problems in the aftertreatment. Two possibilities are described, which may facilitate and optimize the postoperative care of the severely injured hand: 1. In case of an inguinal pedicle flap, the temporary stabilization of the hand against the pelvis by means of external fixation is advocated. 2. After multiple extensor tendon repair, the temporary immobilization of the wrist, leaving the fingers free to move, by means of a small fixateur externe is suggested.
Adolescent↗
Efficacy of external fixation following nasal manipulation under local anaesthesia.
Nasal fractures are one of the commonest reasons for patients being referred to ENT departments, but few studies have been published about the management of this condition. In particular, the efficacy of external splintage following manipulation has not been assessed. This was a prospective randomized study, which examined the results of manipulation under local anaesthetic and the benefit to be gained from external fixation with Plaster of Paris (POP) following this procedure. Accurate measurements of the degree of deviation of the nose pre- and post-manipulation were obtained using a camera mounted on a specially designed frame. Thirty-three out of 241 consecutive patients seen at a research clinic over the course of 12 months were included in the study. The mean deviation of the nasal bridge at presentation was 4.12 mm. Manipulation under local anaesthetic significantly improved the degree of deviation (mean 2.47 mm, P = 0.0011, 90% CI, 1-2 mm). Randomization of the patients, following manipulation, into POP/none-POP groups showed that external splintage of the nose appeared to be of little practical benefit.
Anesthesia, Local↗
External fixation arthrodesis of the ankle joint following trauma.
Arthrodesis is currently the treatment of choice for symptomatic degenerative arthropathy of the ankle. Thirty-seven patients underwent arthrodesis for post-traumatic disorders using either a Hoffmann external fixator or a Calandruccio frame. There was degenerative joint disease in 19 (51%), septic arthritis in 11 (30%), severe comminution in five (14%), and uncontrollable equinus in two (5%). The patients were divided into two groups. Twenty-six (70%) were considered to have sustained high energy open or comminuted injuries and 11 (30%), low energy injuries. Twenty-nine (78%) achieved a radiologic fusion following one operation. Four eventually united with further surgery for a final arthrodesis rate of 89%. In the high energy group 18 of 26 (69%) achieved primary fusion. Four united with additional surgery for a final arthrodesis rate of 85%. Two of these required subsequent amputations and two others, a triple arthrodesis which also failed to control chronic pain. Thus, a total of 18 of the 26 patients (69%) achieved a successful result. Also included in the high energy group were three patients with uncontrolled sepsis who underwent amputation before union occurred and one with a painful non-union. All 11 of the patients (100%) who originally sustained low energy injuries achieved a successful arthrodesis. The most common complication was in pin tract infection requiring incision, drainage, and oral antibiotics in 16 patients (43%). None of these progressed to chronic osteomyelitis.
Adolescent↗
Unstable fractures of the pelvis treated by external fixation.
Forty-five patients with an unstable fracture of the pelvic ring, for whom the conventional treatment would have been bed rest with skeletal traction or with a pelvic sling, were treated with the Hoffmann external-fixation apparatus. In eighteen fractures of the lateral compression type and fourteen fractures of the anteroposterior compression type, the treatment was successful. Proximal migration of the hemipelvis occurred in four of the eleven patients with a fracture of the unilateral shear type. There were two deaths from associated injuries.
Adolescent↗
Salvage of contaminated fractures of the distal humerus with thin wire external fixation.
Fractures and osteotomies of the distal humerus that are contaminated or infected represent a difficult management problem. Stable anatomic fixation with plates and screws, the acknowledged key to a good result in the treatment of bicondylar fractures, may be unwise. A thin wire circular (Ilizarov) external fixator was used as salvage treatment in such complex situations in five patients. The fixator allowed functional mobilization of the elbow while allowing achievement of the primary goal of eradicating the infection or colonization. Two patients required a second operation for fixation of a fibrous union of the lateral condyle. One patient with a vascularized fibular graft later required triple plate fixation for malalignment at the distal host and graft junction. Four of five patients ultimately achieved complete union. The fracture remained ununited in one patient who has declined additional intervention. All five patients achieved at least 85 degrees ulnohumeral motion, two after a secondary elbow capsulectomy performed after healing was achieved. This experience suggested that the Ilizarov construct, although not a panacea, represents a reliable method of skeletal stabilization that allows functional mobilization while elimination of infection or colonization is ensured. If necessary, stiffness and incomplete healing can be addressed with an increased margin of safety at subsequent operations.
Adolescent↗
Management of late-onset tibia vara in the obese patient by using circular external fixation.
Previously published series of surgery for late-onset tibia vara reported a significant number of complications and fair or poor results. Obesity in many of these patients makes surgical intervention an even more daunting prospect. Circular external fixation is applicable to almost any limb size and allows weight bearing as tolerated, with gradual adjustment of alignment. Twenty-five tibiae in 17 patients who exceeded their ideal body weight by > or =50% underwent correction of late-onset tibia vara with the Ilizarov technique. Average age at surgery was 11 years 7 months (range, 7 years 8 months to 15 years 11 months). Mean varus deformity was 27 degrees (range, 10-55 degrees). Treatment time averaged 12 weeks in patients without lengthening and 16.9 weeks in those requiring lengthening (mean, 3.5 cm). All patients achieved alignment within 5 degrees of normal. Complications included one delayed union, premature consolidation in one, and two residual limb-length inequalities. There were no cases of osteomyelitis, compartment syndrome, or nerve palsy. These results are a significant improvement over reports of traditional methods in these difficult patients.
Adolescent↗
Fractures of the femoral shaft treated by external fixation with the Wagner device.
The Wagner external skeletal-fixation system was used to treat twenty complex fractures involving the femur, and nineteen of the fractures healed. Chronic osteomyelitis did not develop in any of the patients.
Adolescent↗
Internal fixation of scaphoid fractures with an AO mini-fragment lag screw, using temporary interoperative AO mini external fixation.
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Adolescent↗
External fixation of the sternum after infected dehiscence due to a shotgun wound: case report.
Pulmonary dysfunction and subsequent ventilator dependence may result after dehiscence of a median sternotomy if there are other complicating injuries. We report a case in which external fixation was used to achieve thoracic stability after infected dehiscence of a median sternotomy, following shotgun wound to the epigastrium.
Adult↗
Hinged external fixation and closed reduction for distal humerus fracture.
Elbow fractures are relatively rare in extremity injuries. Functional deficits often comprise the outcome. We report of a 77-year-old diabetic lady with a distal humerus fracture. She was treated with external fixation and closed reduction. Special emphasis was directed to early motion exercises. Follow-up after 1 year demonstrated a range of motion of 0-30-130 degrees for extension and flexion of the elbow joint. No neurovascular deficits were seen. The use of a hinged device was successful in re-establishing a good function. Although there are no earlier reports using this technique in acute treatment, we consider this strategy as an alternative option in carefully selected cases.
Accidental Falls↗
External fixation of displaced fractures of the proximal humerus. Technique and preliminary results.
A new technique for the treatment of displaced fractures of the proximal humerus is described. Twelve fractures in 11 patients were managed by transcutaneous reduction using a Steinmann pin, and external fixation with a Hoffmann-type neutralising bar connected to two half-pins in the humeral head and three half-pins in the shaft. The pins were removed after four weeks. Two patients sustained redisplacement after a further injury, but in the others reduction was maintained. Two cases of pin-track infection resolved after antibiotics, but delayed union resulted. There were no neurovascular injuries and at follow-up of 6 to 12 months no refractures had been seen. The early functional results were excellent or satisfactory in nine cases.
Adult↗
[Arthrodesis and external fixation].
Though operative arthrodesis is less often indicated than before, in the knee and upper-ankle joints it is more successful than artificial joints. In cases of irreparable neuro-paralysis it is often the only alternative for the lower extremities. Today's external fixation and the standardization of its operative technique make good stability possible, thus improving preconditions for consolidation of the resected articular surfaces, above all for the knee and upper-ankle joints. On the basis of 158 arthrodeses performed over a period of 10 years indications, technique and success rate are described.
Ankle Joint↗
Severe tetanus complicating an open femoral fracture successfully managed using intrathecal human tetanus immunoglobulin and external fixation.
We report here a case of severe tetanus, complicating a compound fracture of the femur, successfully managed without intensive care facilities, using intravenous sedation and intrathecal Human Tetanus Immunoglobulin (HTI). Substitution of conventional traction (Transtibial Steinman Pin and Thomas Splint) for a Day Frame External Fixation Device (EFD) provided excellent fixation and stability of the fracture in spite of severe tetanic spasms.
Adolescent↗
Late reconstruction of patellar ligament ruptures using Ilizarov external fixation.
Chronic patellar ligament ruptures, on which failed reconstruction attempts have been made, cause structural changes in the quadriceps mechanisms with marked fixed proximal migration of the patella. Before reconstruction, the position of the patella must be normalized. When using Ilizarov principles and an Ilizarov external fixator to treat these ruptures, full weightbearing and range of motion can be maintained throughout the pre- and postreconstruction period. This previously unreported technique has been used in 2 patients with chronic patellar ligament ruptures in whom reconstruction attempts had failed. Successful results obtained with this procedure warrant its consideration for this rare but disabling problem.
Adult↗
Opening base wedge osteotomy of the first metatarsal utilizing rigid external fixation.
The authors describe their operative approach to metatarsus primus adductus deformity when present in conjunction with a congenitally short first metatarsal. Hallux abducto valgus correction in this clinical setting has traditionally advocated use of a crescentic or opening wedge osteotomy in order to prevent further shortening of the first metatarsal. Fixation of opening base wedge osteotomies has been fraught with problems in the past, with possibilities for displacement or eventual loss of initial correction. The authors have found the mini-Hoffmann external fixation device useful for this purpose.
Adolescent↗