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PubMedDate not supplied

Comparison of multistage versus one-stage destabilization of a type II external fixator used to stabilize an oblique tibial osteotomy in dogs.

OBJECTIVE: To compare the biomechanical effects of multistage versus one-stage destabilization of a type II external skeletal fixator (ESF) used to stabilize an oblique unstable tibial osteotomy in dogs. STUDY DESIGN: In vitro, in vivo, and ex vivo experimental study. ANIMAL POPULATION: Twelve healthy adult dogs. METHODS: The biomechanical characteristics of the type II ESF used in this study were determined. This fixator was applied to both tibiae of two groups of 6 dogs to stabilize a 2-mm-wide oblique osteotomy. One fixator on each dog remained unchanged throughout the 11-week study (control group). The fixator on the opposite limb was destabilized late and acutely in one group of dogs (single-stage) and early and progressively in the other (multistage). Clinical examination, radiographic examination, and force-plate analysis were used to evaluate the results. All dogs were euthanatized at 11 weeks. All tibiae were scanned to determine the cross-sectional area of the callus in the center of the osteotomy and subjected to biomechanical tests to determine mean pull-out strength of pins and callus strength and stiffness. RESULTS: Stiffness of the type II ESF used in this study was 578 N/mm in axial compression, 0.767 Nm/deg in torsion, 261 N/mm in medio-lateral bending, and 25 N/mm in cranio-caudal bending. Peak vertical forces of the hindlimbs were significantly lower at 2.5 and 5 weeks than before surgery. Peak vertical forces of the hindlimbs did not change before and after destabilization. No significant differences could be detected between the two destabilization sequences or between all control tibiae and pooled destabilized tibiae with regards to radiographic evaluation of the healing osteotomy, cross-sectional periosteal callus area, mean pull-out strength of transfixation pins, callus strength, and callus stiffness. CONCLUSIONS AND CLINICAL RELEVANCE: Bone healing of unstable osteotomies stabilized with a type II ESF is not significantly enhanced by staged destabilization of the fixation as performed in this study.

Animals↗
PubMed1993

External fixation. Technical advances based upon multiplanar ligamentotaxis.

The principle of ligamentotaxis obtained by longitudinal traction is useful in restoring skeletal length to distal radial fractures. Using external skeletal fixation to translate the hand in radial-ulnar and dorsal-palmar directions, ligamentotaxis in two additional planes aligns and tilts the distal radial fragment and its articular surface. Following restoration of palmar tilt by palmar translation, wrist position can be adjusted into neutral or extension to help avoid finger stiffness and carpal tunnel syndrome without compromising fracture reduction.

Biomechanical Phenomena↗
PubMed1986

External fixation as a test for instability after spinal fusion L 4-S 1. A case report.

A case presented with severe backache after fusion of the L 4-S 1 levels; the patient became immediately painfree after external transpedicular fixation between L 4 and the sacrum. The device was kept in place for 10 weeks. After an additional 4 weeks the patient was able to return to his work after several years of sick-leave. The case indicates instability as a cause of backache. Painful nonunion of a fusion can be present in spite of signs of healing on radiographs and CT-scan. External transpedicular fixation may be a good tool in assessing instability of the lower lumbar spine.

Adult↗
PubMed2002

Is there a connection between the clinical response after an external fixation test or a subsequent lumbar fusion and the pre-test intervertebral kinematics?

STUDY DESIGN: Evaluation of a possible correlation of clinical symptoms of chronic low back pain (LBP) patients before and after application of external spinal fixation (ESF) with three-dimensional motion patterns. OBJECTIVE: To determine whether the intervertebral kinematics in chronic LBP patients correlate with pain relief after stabilization of the suspected painful segments. SUMMARY OF BACKGROUND DATA: Chronic LBP is a complex clinical entity with mechanical, biochemical, and psychosocial components. Although clinically controversial, ESF has been shown to reduce intervertebral motion, and thus, it provides a mechanism to investigate the mechanical aspect of LBP. METHODS: Thirty-four chronic LBP patients were tested with ESF of the suspected painful segments. The subjective pain relief experienced by the patients during the test and 2 years after spinal fusion surgery was determined, along with the Oswestry Disability Index. Before removal of ESF, the three-dimensional intervertebral kinematics of the painful segments (specifically range of motion, coupling patterns, and motion asymmetries) were analyzed with a precision optoelectronic camera system during active trunk motions. A series of linear correlations were performed between the clinical measures and the motion parameters. RESULTS: The subjective pain relief during the ESF test was nominally, but not significantly, associated with lateral bending asymmetry ( = 0.22) and "abnormal" axial rotation-lateral bending coupling ( = 0.13). The improvement in the Oswestry Disability Index both post-test and at 2 years after lumbar fusion surgery was significantly correlated with the extension range of motion ( = 0.049 and = 0.036, respectively) and the extension-to-flexion range of motion ratio ( = 0.035 and = 0.044, respectively). CONCLUSIONS: The "abnormal" motion patterns of chronic LBP patients did not correlate with subjective pain relief after ESF of the suspected symptomatic levels or with the midterm outcome of subsequent lumbar fusion surgery. The results suggest that preserved motion of the symptomatic segments before surgery is positively correlated with the clinical result of the subsequent spinal fusion in case of a positive ESF test result.

Adult↗
PubMed1990

[External fixation in the treatment of cervical fractures].

A report is given on the application of external fixateurs for the treatment of complicated fractures of the cervical vertebral column and fractures of the dens. Basic principles of application and construction are represented. The effectiveness of the method if an intraspinal space occupation is excluded is proved by means of X-ray pictures.

Cervical Vertebrae↗