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PubMed1991

Management of extremity injuries with external fixator or Ilizarov devices. Cooperative effort between orthopedic and plastic surgeons.

Major advances in the last decade have improved the treatment and outcome of patients with moderate to severe lower extremity injuries. Better transport and emergency room facilities, which allow more prompt repair of injuries, advances in bone stabilization, and better methods of soft-tissue reconstruction have led to a significant decrease in amputation and infection rates. This article presents the Mangled Extremity Severity Score (MESS) index and Gustilo's classification to evaluate injuries. Orthopedic, plastic, and vascular surgeons collaborate to manage these injuries in five categories: limb viability, timing, debridement, fixation, and secondary reconstruction. Finally, two cases are presented to demonstrate practical application of these steps, and guiding principles are outlined.

Adult↗
PubMed1982

[Possibilities of application and advantages of the external fixator made from polymer materials (author's transl)].

The "fixateur externe" made from polymer engineering materials offers the following advantages over systems made from metal: it is largely transparent to x-rays; the weight is significantly lower; shape and surface are body-compatible; manipulation is easy; and production can be effected at a reasonable price. A multitude of variants in respect to mounting can be employed to change the well-known spectrum of complications is not extended. The individual construction components are described and examples of mountings at various segments of the extremities are demonstrated.

Arthrodesis↗
PubMed1991

[Three-dimensional rigidity of the Ilizarov external fixator (original and modified) implanted at the femur. Experimental study and clinical deductions].

The application of the Ilizarov device to the femur creates several problems: anatomical (transfixion of the thigh), mechanical (asymetrical assembly) and clinical (patient acceptability and duration of treatment). Geometric modifications of the original fixator are proposed. These comprise the use of threaded pins proximally and special connecting pieces. Two large fixators were tested under load and after the introduction of certain variables led the authors to experiment with 18 different assemblies. Four loads were used (compression, flexion in the sagittal and coronal planes and torsion) and stiffness calculated in three dimensions. Three linear and three angular displacements were defined for each type and magnitude of external load. The following sequence of analysis was followed to select the best type of assembly; increased ridigity in torsion; moderate displacement in flexion and axial elasticity. These considerations also apply to the mechanics of fracture healing. After testing under load it was concluded that the original assembly gave the best compromise. The modified assemblies gave a slightly inferior mechanical performance but their geometrical configuration should give better patient tolerance if the following items are used: a proximal arc of 120 degrees, 5 mm diameter threaded pins for the adult and 4 mm diameter for the child.

Biomechanical Phenomena↗
PubMed1993

[Distal femoral fractures treated by external fixation with Orthofix].

In the period from November 1987 to March 1990 17 supracondylar femoral fractures were treated a.m. Orthofix at the orthopaedic departments in Roskilde and Køge, Denmark. The fractures were classified according to Müller et al. There were 13 in group 2A and four in group 3A. In 16 cases the fractures occurred after minimal trauma. Time of operation was 55 minutes (30-150). The patients were fully mobilized after 16 days. The dynamizising procedure took place after six weeks, and the fixator was removed when the fracture was healed after 11 weeks. According to Neer's scoring system the results were good or excellent in 12 cases, and fair on one case. In all patients we found solid bony union. In seven cases we found pin infection. It was not necessary to operate because of the infection in any of these cases. Four cases were complicated with dislocation of the fracture because of bad locking at the ball joint of the fixator. We find this method easy to use in contrast to traditional osteosynthesis. The patients are quickly mobilized. It is easy to correct the fracture and the method gives solid bony healing.

External Fixators↗
PubMed1992

External fixation of fractures with a new frame in managing patients with multiple trauma.

The use of a new modular frame with the AO tubular fixator in managing the cases of severely injured patients is reported. The simplicity in design, the versatility, and the ease of insertion make this frame very useful in managing a patient with multiple injuries in the emergency department when stable fixation of a variety of fractures is needed. Our clinical experience with 23 patients, all with an ISS of 16 or greater, is reported and four representative cases are described.

Adolescent↗
PubMedDate not supplied

An in vitro biomechanical study of a multiplanar circular external fixator applied to equine third metacarpal bones.

The biomechanical characteristics of a 4-ring circular multiplanar fixator applied to equine third metacarpal bones with a 5 mm mid-diaphyseal osteotomy gap were studied. Smooth Steinmann pins, either 1/8 inch, 3/16 inch, or 1/4 inch, were driven through pilot holes in the bone in a crossed configuration and full pin fashion and fastened to the fixator rings using cannulated fixation bolts. The third metacarpal bone fixator constructs were tested in three different modes (cranial-caudal four-point bending, axial compression, and torsion). Loads of 2,000 N were applied in bending and axial compression tests and a load of 50 N x m was applied during testing in torsion. Fixator stiffness was determined by the slope of the load displacement curves. Three constructs for each pin size were tested in each mode. Comparisons between axial stiffness, bending stiffness, and torsional stiffness for each of the three different pin sizes were made using one-way analysis of variance. There was no visually apparent deformation or permanent damage to the fixator frame, and no third metacarpal bone failure in any of the tests. Plastic deformation occurred in the 1/8 inch pins during bending, compression, and torsion testing. The 3/16 inch and 1/4 inch pins elastically deformed in all testing modes. Mean (+/-SE) axial compressive stiffness for the 1/8 inch, 3/16 inch, and 1/4 inch pin fixator constructs was: 182 +/- 16 N/mm, 397 +/- 21 N/mm, and 566 +/- 8.7 N/mm; bending stiffness was 106 +/- 3.3 N/mm, 410 +/- 21 N/mm, and 548 +/- 12 N/mm; and torsional stiffness was 6.15 +/- 0.82 N x m/degree, 7.14 +/- 0.0 N x m/degree, and 11.9 +/- 1.0 N x m/degree respectively. For statically applied loads our results would indicate that a 4-ring fixator using two 1/4 inch pins per ring may not be stiff enough for repair of an unstable third metacarpal bone fracture in a 450 kg horse.

Animals↗
PubMed1990

[Treatment of open fractures of the foot using external fixation].

The authors give an account of their experience with the use of compression--distraction for the treatment of open dislocation fractures of the foot. The device was designed by the authors and the results are satisfactory when the apparatus is used in the mentioned indications.

External Fixators↗
PubMed2005

[Treatment of chronic knee dislocation with an external fixator].

Chronic knee dislocations are rare but represent a therapeutic challenge. A staged concept is necessary to correctly address the pathological components. This article uses a case study to provide an algorithm for the successful treatment of chronic knee dislocations.

Adult↗
PubMedDate not supplied

The unilateral external fixator (Monofixator) in acute fracture treatment: experience in 50 fractures.

From 1988 to 1992, 50 fractures with associated soft tissue lesions were treated with an unilateral fixator (Monofixator). The location of the fracture was the tibia in 39 cases, the pelvis in 5 cases, the femur in 4 cases, the ankle and the humerus in one patient respectively. Twenty-two tibial fractures (56%) were open. Unproblematic healing with the monofixator was achieved in 71.8% of tibial fractures after a mean healing time of 18.2 weeks. Axial dynamic compression was performed in 18 tibial fractures. Planned reosteosynthesis was performed in 7 tibial fractures (18%). After secondary internal osteosynthesis, no late problems were seen. Complications with the monofixator in acute tibial fracture treatment consisted of refracture in 3 patients, pin track infection in 2 patients and hypertrophic pseudarthrosis in one patient. The monofixator provides a safe and stable fixation in tibial fractures with important associated soft tissue damage. In haemodynamically unstable patients with severe associated lesions, pelvic ring and femoral fractures can be reduced and stabilized satisfactorily with a monofixator, mostly until better condition permits definitive osteosynthesis.

Adolescent↗
PubMedDate not supplied

Soft-tissue distraction with a ring external fixator before centralization for radial longitudinal deficiency.

PURPOSE: To review the techniques and evaluate the use of soft-tissue distraction with a ringed fixator for radial longitudinal deficiency (RLD) before centralization. METHODS: Eight extremities in 6 patients with severe RLD were treated with ring fixator distraction followed by centralization. A clinical examination was performed and radiographic data were obtained prospectively and at an average follow-up period of 17 months. The techniques and the early objective (range of motion, position) and radiographic outcome were evaluated. RESULTS: The preoperative ring fixator accomplished an average of 16 mm of distraction and allowed the centralization procedure to be performed effectively and without tension. Clinical alignment was improved markedly. The hand-forearm angle improved from 72 degrees radial to 8 degrees ulnar after surgery. The volar carpal subluxation improved by an average of 6 mm. CONCLUSIONS: Precentralization ring fixator distraction allows the performance of a tensionless centralization procedure with good early radiographic and clinical outcome in patients severely affected with RLD. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.

Adolescent↗