Application Of External Fixator Research Articles

Which pin site dressing is the most optimal? A systematic review on current evidence

Background: Pin site infection is a frequent complication after external fixation. However, no consensus on the optimal pin site care protocols exists. Objectives: This study aimed at providing an overview of currently applied pin site care protocols and evaluating their efficiency in terms of infection rates. Data Sources: A systematic search of PubMed, Medline, Embase, and Cochrane Library databases was performed. Study eligibility criteria, participants, and interventions: Comparative studies of pin site care protocols reporting the infection rate as complication related to external fixator application as an outcome were eligible for inclusion. Study Appraisal and Synthesis Methods: The ROBINS-I tool was used to assess the risk of bias in nonrandomized studies. The Effective Public Health Practice Project (EPHPP) tool and Coleman Methodology Score were applied for publication quality assessment. Results: A total of 380 manuscripts were screened, yielding an inclusion of 20 articles reporting on 1428 patients. Of these, 17 (85%) studies compared different materials and antimicrobial agents, whereby 9 of these found significant differences. Three studies compared pin site care with no pin site care, and the optimal pin site care frequency was addressed in three studies. None of them reported a statistically significant difference between daily or weekly pin site care. Limitations: Pin site care protocols in the literature are heterogeneous. Conclusions and Implications of Key Findings: No recommendation can be drawn regarding the optimal cleansing solution and dressing type. However, based on this review, a benefit of pin site care compared to no pin site care is suggested. Further, minimal pin care was not associated with significantly worse outcomes, and hence, the need of laborious protocols including frequent cleaning or the use of antimicrobial agents remains questionable.

Impact of Early Rehabilitation in a Complex Case of Non-union of Tibial Plafond Fracture with Osteosynthesis Associated Infection – A Case Report

Background: Fractures of distal end of tibia associated with soft tissue injuries and fracture of distal fibular end are very complex and forms a total of 1-2% of all fracture of lower limb. These fractures are widely termed as plafond fractures.
 Case Presentation: A 26- year-old male, a follow up case, gave a history of road traffic accident following which he underwent corticotomy and application of external Ilizarovring fixator. At present due to non-union of the fracture segments patient got readmitted after a year. Further management through a three-step surgical approach was carried out. Rehabilitation program began from post-operative day 1 and was continued for a period of three weeks.
 Investigations: On the day of examination, the patient’s pain was severe on movement with presence of disuse trophy of lower limb musculature of the affected extremity. Ranges on the right lower limb at all joints were reduced due to pain. The X-ray showed presence of 9-hole recon plate fixed distally over talus and proximally to tibia.
 Management: Physiotherapeutic intervention began with educating the patient and the caregivers about the condition, the precautions to be taken, the expected time of healing and extent of healing. The exercise program was based on the principles of variability and individuality. The protocol was changed weekly with the observed progression in the patients range, muscles strength and ability to perform more challenging in bed activities.
 Conclusion: Early rehabilitation in complex cases of tibial plafond fracture facilitates the process of healing as well as maintain the patients level of functioning by maintain muscle properties. Post-operative complications are also reduced.

Analysis of Clinical Application of External Fixator in the Treatment of Traumatic Orthopaedic Patients

Analysis of Clinical Application of External Fixator in the Treatment of Traumatic Orthopaedic Patients

3D-printed models improve surgical planning for correction of severe postburn ankle contracture with an external fixator.

Gradual distraction with an external fixator is a widely used treatment for severe postburn ankle contracture (SPAC). However, application of external fixators is complex, and conventional two-dimensional (2D) imaging-based surgical planning is not particularly helpful due to a lack of spatial geometry. The purpose of this study was to evaluate the surgical planning process for this procedure with patient-specific three-dimension-printed models (3DPMs). In this study, patients coming from two centers were divided into two cohorts (3DPM group vs. control group) depending on whether a 3DPM was used for preoperative surgical planning. Operation duration, improvement in metatarsal-tibial angle (MTA), range of motion (ROM), the American Orthopedic Foot and Ankle Society (AOFAS) scores, complications, and patient-reported satisfaction were compared between two groups. The 3DPM group had significantly shorter operation duration than the control group ((2.0±0.3) h vs. (3.2±0.3) h, P<0.01). MTA, ROM, and AOFAS scores between the two groups showed no significant differences pre-operation, after the removal of the external fixator, or at follow-up. Plantigrade feet were achieved and gait was substantially improved in all patients at the final follow-up. Pin-tract infections occurred in two patients (one in each group) during distraction and were treated with wound care and oral antibiotics. Patients in the 3DPM group reported higher satisfaction than those in the control group, owing to better patient-surgeon communication. Surgical planning using patient-specific 3DPMs significantly reduced operation duration and increased patient satisfaction, while providing similar improvements in ankle movement and function compared to traditional surgical planning for the correction of SPAC with external fixators.

Open tibial fracture with severe soft tissue injury and bone loss managed with ipsilateral fibular transport and its complications: a case report

&lt;p class="abstract"&gt;Massive segmental bone defects of tibia present as a challenging task to manage specially when associated with extensive soft tissue injury. A 30 year old male presented to Paras HMRI hospital, Patna, post road traffic accident with Gustilo Anderson 3B comminuted open tibia shaft fracture and with an external fixator in situ with a grossly inflamed and infected wound. Initially patient was managed with serial wound debridement and skin grafting was done early to obtain adequate soft tissue coverage. The patient then underwent application of Ilizarov external fixator with plan of one level fibular osteotomy for ipsilateral fibular transport. With good outcome of the procedure clinically and radiologically, Ilizarov fixator was removed after time duration of about 1.3 years and limb was immobilized in plaster of Paris (POP) cast which was removed after 8 weeks. Within 1 month of removal of POP cast the patient presented to hospital again with complaints of pain and instability when his leg was run over by his child’s bicycle while playing. Diagnosed as fracture of proximal (transported) fibula he was managed then with locking plates; one of which was used as an internal fixator and the other as external fixator which was outside the body and acted as a support to the operated limb. After about 1 year the external locking plate was removed and patient was able to bear weight on his extremities. Despite various modalities to treat massive tibial gap, fibular transport procedure with Ilizarov external fixator seems to be the most viable option.&lt;/p&gt;

Application of unilateral external fixation by the \u201cjoystick technique\u201d in the treatment of pediatric tibia shaft fractures: technical note

BackgroundThe aims of current study were to present the clinical outcomes in patients with pediatric tibia shaft fractures who were treated with unilateral external fixation combined with joystick for fracture reduction and describe the details of our technique.MethodsWe retrospectively analyzed the patients with pediatric tibia shaft fractures who were treated with unilateral external fixation combined with joystick for fracture reduction between July 2018 and March 2020. The clinical outcomes were evaluated.ResultsA total of 23 patients were included in the current study with the average age of 8.0 years (ranged 4–14 years). The average duration of hospital and follow-up were 5.9 days (ranged 4–8 days) and 17.4 months (ranged 8–27 months), respectively. At postoperative 3 days, the visual analog scale (VAS) score was 3.1 ± 1.43, which was significantly lower than the preoperative score of 7.3 ± 1.5. Of these, 2 cases showed redness and swelling of pin-tract and exudation at postoperative 1 month, who improved after oral antibiotics without causing fixation failure. The average time to full weight-bearing without crutches was 5.1 weeks (ranged 3–8 weeks). All patients achieved fracture healing and good functional recovery. No complications including fixation failure, reoperation, epiphyseal injury occurred, infection around implants, vessel damage, nerve damage, and limitation of joint movement were observed. The Johner-Wruh scores showed that 21 cases (91.3%) were “excellent” and 2 cases (8.7%) were “good.”ConclusionsThis procedure had advantages of simple operation, minimum trauma, early recovery of lower limb function, and no risk of complications. It may provide a new choice for children with tibia shaft fractures who require surgical treatment.

Modified traveling traction a novel external fixator for provisional stabilization of tibial fractures

External fixators have been used for temporary stabilization as a part of damage control orthopedics. Watson et al in 2000 described “traveling traction”, a simple external fixator for provisional stabilization of pilon fractures. We have tried to analyze the wide applicability of this simple external fixator and its modification (Ez-fix) for provisional stabilization of all tibial fractures: proximal, diaphyseal and distal tibial. This was a 18-month prospective hospital based study in which 91 skeletally mature patients with tibial fractures (proximal, middle, distal 1/3rdand pilon) provisionally stabilized with Ez-fix external fixator application were enrolled. Ez-fix, with one distal femoral/ proximal tibia pin and other calcaneal pin was applied. Posterior splint was given for added stability. The patients were followed up till a definitive fixation or trans-fixation cast was applied. Out of 91 fixators 56 were shaft, 28 proximal and 7 were distal tibial fractures. The average duration in the Ez-fix across all the fracture patterns was 22 days. 71 of the 91 fractures had associated fibula fractures too. 25 Ez-fixes were applied in the ER/ICU. Satisfactory initial reduction in the Ez-fix was achieved in 92% of the proximal, 71% distal and 57% shaft fractures. The place of external fixation did not affect the initial reduction as there were comparable rates of satisfactory reduction in Ez-fixes applied in OT and ER/ICU. There was a significant association between duration and loss of reduction with p-value of

Outcome of Infected Nonunion of Long Bones Treated by Single-Stage Bone Grafting and External Fixation at Northwest General Hospital, Peshawar, Pakistan

Background: Infected nonunion of long bones after fractures is one of the most challenging complication to treat in clinical practice. It is commonly treated by a two-stage approach; controlling infection initially and then application of external fixator and bone graft. Treatment with Ilizarov had been the gold standard but is associated with few complications. The objective of the study was to evaluate the clinical, radiological and functional outcomes of infected non-union of long bones treated with single-stage bone grafting and external fixation.Material and Methods: This retrospective study was carried out at Orthopedics Department of Northwest General Hospital, Peshawar Pakistan from 2014 to 2019. Medical records of 17 patients, aged 32 years and treated with Single-stage bone grafting and external fixation were reviewed. Nonunion included 7 humerii, 5 femurs, 3 tibias and 2 radius/ulna. Preoperative plain radiographs for any sequestrum or sclerosed bone margins and baseline investigations (like CBC, ESR, CRP and Vitamin-D status) were reviewed. All patients underwent radical debridement, reaming of intramedullary canals, external fixation and autogenous bone grafting. The outcomes evaluated were union of the bone (clinically and radiologically), resolution of infection, complication rate and number of re-intervention surgeries.Results: Among 17 patients, 10 were males and 7 were females. After treatment, mean follow-up duration was 9.414.48 months (4–18 months). None of the patients were lost to follow-up, had recurrence of infection or required further surgery. The mean duration of bone union was 8.4  4.48 months (range 3 to 17 months) and all of the patients achieved infection free union with satisfactory functional outcome.Conclusions: Single-stage bone grafting and external fixation is an effective technique in terms of resolution of infection and satisfactory bone union without any complications and can be used as an alternative to Ilizarov for treating cases of infected nonunion of long bones.

Refracture after Ilizarov fixation of infected ununited tibial fractures-an analysis of eight hundredand twelve cases.

Refracture of the tibia after union is a challenging problem for the patients and the surgeons. The purpose of the current study is to present our experience in conservative management of such patients with refracture of infected ununited tibia after successful treatment by Ilizarov external fixator and bone transport. We reviewed the files of 812 patients with infected ununited tibia who were treated by debridement, corticotomy, and bone transport using Ilizarov methods in our institute between 1997 and 2017. Inclusion criteria were patients with refracture after union and removal of the Ilizarov apparatus. Twenty-two patients with 23 refracture tibia were included in the study. All the 23 tibias were treated conservatively by above knee cast that was converted to Sarmiento below knee cast after early callus formation, except in the case of upper tibial fracture that continued in above knee cast till union. Afterwards, a protective splint was used for additional twomonths. There were 19 males (86.4%) and three females (13.6%), the mean age of the patients was 38.39years, the mean time of Ilizarov external fixator application was 10.86months (range, 6-17), and the mean time of refracture after fixator removal was 2.33months. Union was achieved in 19 tibias (82.6%), with a mean time of 7.2months (range, 4-12). Complications included five cases of skin irritation that was treated by large windows in the cast and changing the casts more frequently, three cases developed DVT (deep venous thrombosis), and axial deviation occured in four tibias (17.3%). Conservative treatment of refractured tibia after removal of Ilizarov external fixator following treatment of infected non-union tibia by above knee cast is effective in achieving union. However, complications as skin irritation, DVT (deep venous thrombosis), and axial deviation can be anticipated.

Neglected Elbow Dislocation treated with Hinged External Fixator-A Case Report

Elbow dislocations are treated in emergency. Neglected elbow posterior dislocations are very rarely seen and the treatment for neglected cases is more complicated than acute cases. We present a case of. Neglected posterior dislocation of the elbow treated with open reduction and hinged external fixator. 23-year-old male patient presented with neglected posterior dislocation of left elbow without neurological deficit following fall from height. Patient was initially treated by an osteopath for two months and came to our hospital . Patient underwent open reduction of left elbow and hinged external fixator application under general anaesthesia. Post-operative rehabilitation was started after 6 weeks and after 3 months of surgery patient attained full range of movements in left elbow without any residual instability. The treatment for neglected elbow dislocation is quite challenging. Open reduction and hinged external fixation have satisfactory results with the possibility of early rehabilitation. This method can be considered as an option for such cases. Keywords: Elbow joint, Posterior dislocation, Hinged external fixator

Masquelet technique for management of posttraumatic bone defect in a patient of chronic osteomyelitis of long bone

&lt;p class="abstract"&gt;Masquelet technique, which is the use of a temporary cement spacer followed by staged bone grafting, is a treatment strategy for reconstruction of large, infected, bone defects. This paper describes a patient treated with this technique to successfully manage postinfective or posttraumatic osseous long bone defect. Sequestrectomy was done and the injured limb was stabilized and aligned with application of external fixator at the time of initial antibiotic cement spacer placement. After 6 weeks of proper antibiotic coverage, all antibiotics were stopped for next 2 weeks. Clinical evaluation and investigations were done to rule out any residual infection. Osseous consolidation was successfully achieved with staged bone grafting and internal stabilization of long bone defect.&lt;/p&gt;

Congenital Insensitivity to Pain and Anhidrosis: A painful experience by a painless child

A three-year-old boy with congenital insensitivity to pain and anhidrosis (CIPA) was first presented with transphyseal separation of distal left humerus. Surgical treatment with closed reduction and k-wiring of transphyseal separation of distal humerus resulted in devastating surgical site infection and osteomyelitis. Multiple surgical debridement and application of external fixator to eliminate infection were futile. At the age of four years, he refused to bear weight as a result of left hip dislocation. Closed reduction and spica cast was unsuccessful, resulting in recurrent left hip dislocation. He has since not been able to walk. At the age of five years, the right hip was dislocated followed by ipsilateral subtrochanteric femur fracture. Appropriate treatments such as hip spica and titanium elastic nail were not possible due to extensive bruising and skin ulceration over the right thigh. This child ended up with a functionless left upper limb, bilateral hip dislocation and malunited right femur fracture. Conservative treatment and watchful neglect might be the ideal treatment for patients with CIPA.

Clinical Faceoff: The Complex Tibial Plafond Fracture: ORIF or Circular External Fixation?

Clinical Faceoff: The Complex Tibial Plafond Fracture: ORIF or Circular External Fixation?

Correction outcomes of the postoperative malalignment salvaged by the temporary application of the hexapod external fixator in tibial diaphyseal fractures treated by monolateral external fixation

BackgroundPostoperative malalignment in fractures treated by monolateral external fixation is not uncommon in clinical practice. Accurate reduction without excessive tissue disruption caused by surgical intervention and sequentially manage the fractures using monolateral external fixation for definitive treatment is still a challenge for surgeons. The purpose of our study was to evaluate the feasibility and effectiveness of the temporary application of the hexapod external fixator (HEF) for the postoperative malalignment correction in tibial diaphyseal fractures treated by monolateral external fixation. MethodsWe carried out a retrospective analysis of 23 trauma patients with tibial diaphyseal fracture treated by the monolateral external fixation at our institution from January 2016 to May 2019. There were 21 males and 2 females with a mean age of 38 years (range 18-60 years). The hexapod external fixator was temporarily applied due to postoperative malalignment within two weeks and who unwilling to undergo a secondary surgical intervention. For patients with postoperative malalignment requiring correction, the HEF components were installed on the original existing half pins of the monolateral external fixator after removing the connecting rod. The standard anteroposterior and lateral X-rays of the injured limb combined with the temporary HEF were conducted to measure the hexapod external fixator parameters. Any residual deformities were corrected by gradual struts adjustment with the aid of computer-based software. When satisfactory alignment was achieved, the HEF was removed, and the monolateral external fixator was sequentially used as the definitive structure. ResultsAll patients acquired functional reduction, which was evaluated by radiographs. The mean correction time was 4 days (range 2 to 8 days). The mean coronal plane translation (1.3±1.0 mm), coronal plane angulation (0.9±0.7°), sagittal plane translation (1.4±1.1 mm), and sagittal plane angulation (0.7±0.7°) after correction were all less than those (7.0±4.9 mm, 4.7±2.3°, 5.6±3.6 mm, 3.2±2.5°) before correction. ConclusionsThe temporary application of the hexapod external fixator is an alternative and feasible method for the postoperative malalignment correction in tibial diaphyseal fractures treated by monolateral external fixation.

Clinical Study of Functional Outcome of External Fixator Device as a Primary Definitve Treatment of Open Tibia Fracture

Background: Open fractures of leg are quite common in Road traffic accidents. The ideal protocol for openfractures of leg is initial thorough debridement, soft tissue coverage and intramedullary nailing or externalfixator application. External fixator may be later converted to internal fixation with reamed or unreamedintramedullary nail or left as a definitive treatment.Methodology: This prospective study was conducted at Rohilkhand Medical College And Hospital fromJanuary 2019 to January 2020 on patients presenting with open tibial fracture. Tubular External Fixator wasused. Total 30 patients were enrolled in this study.Results: In our study 30 patients were included in which 20 were male and 10 were females with meanage 32.2 years including children and elderly age group there was no age bar. Mean operative time was 60minutes. Average time for union was 24 weeks.Conclusion: External fixation as a primary definitive treatment for open tibial fracture is a cost effectiveprocedure in developing country with minimal morbidity and mortality.

Outcome of Distal radius fracture managed by MIPO - A case series

Introduction: Various treatment options for management of distal radius fracture include close reduction and application of cast, K wire fixation, external fixator application and open reduction and plating. The current study is aimed to assess the outcome of distal end radius fracture managed by minimally invasive plate osteosynthesis by evaluation of clinical results, radiological features and functional outcome. Materials and Methods: This was a prospective study conducted in Orthopedics department of SGRRIMHS, Dehradun 80 patients were enrolled. Evaluation was done on the basis of clinico- radiological and functional assessment. The parameters were measured preoperatively and on 4, 12 and 24 weeks. Chi square test was used to compare proportions and T-test was used to compare means of groups. P-value

Fabrication of Low-cost Artificial Tibia Bone Using Polyurethane Rigid Foam and Epoxy Resin for Orthopedic Surgical Skills Training

Introduction. Skills training using artificial bones became more critical in response to the Orthopedic surgical training restriction caused by the COVID-19 pandemic. To cut the expenses of buying commercial artificial bones, the Ilizarov Limb Reconstruction Service has decided to fabricate its artificial bones for surgical skills training. Objective. To determine if resin-coated polyurethane (PU) rigid foam is a suitable, low-cost alternative to commercial artificial bone. Methods. Tibiae were fabricated using PU rigid foam coated with epoxy resins. Three randomly selected fabricated tibia, and one standard artificial tibia was subjected to drilling with drill bits and K-wires. The time to penetration of one cortex of the three segments of the tibiae was recorded in seconds. An actual circular external fixator was applied. The actual cost of production was calculated. Results. Each fabricated tibia costs ₱456.93. The fabricated tibiae mean time to penetration was 2.15s and 3.37s using drill bits and K-wires. The commercial artificial bone mean time to penetration was 3.41s and 3.57s with drill bits and K-wires. The fabricated tibia was able to withstand the application of a circular external fixator and corticotomy. Conclusion. The fabricated tibia is a suitable and more affordable simulation model for surgical skills training.

Application of epoxy putty external skeletal fixator for stabilization of tarsocrural arthrodesis in small dogs and cats

Application of epoxy putty external skeletal fixator for stabilization of tarsocrural arthrodesis in small dogs and cats

THE SEMI-RIGID INDIVIDUAL FUNCTIONAL BANDAGES AS A FINAL STAGE IN THE TREATMENT OF THE TIBIAL BONE NONUNIONS AFTER TREATMENT WITH RING FIXATORS

Summary. The tibia non-unions after fractures require complex and durable treatment. One of the most common methods of variable osteosynthesis is the Ilizarov method. The long period of treatment causes the development of bone reaction to the immersion parts of the ring fixation (RF), osteoporosis, and as a result - reduction of the rigidity of the "fixator - bone fragments" system. All this is the basis for the application of the final stage of low-traumatic methods of fragments fixation with external bandages. Objective. The task of the study is to improve the results of tibial bone non-unions treatment after changeable osteosynthesis with ring fixators, based on the application of external individual fixation with semi-rigid bandages at the final stage of treatment. Material and methods. In our study, we had 36 patients with tibial bone non-unions under observation which have been treated with changeable osteosynthesis with RF. For the sake of prevention of displacement of the fragments, deformation of the regenerate, treatment of tissues inflammation in the area of pins implantation after disassembly of the Ilizarov device; and for the early rehabilitation of the calf functions - used individual semi-rigid fixation system Scotchcast/Softcast. The system allowed to create atraumatic conditions for regeneration and consolidation, full loading of the limb, its full usage during walking. The combination of rigidity (Sotshstast) and elasticity (Softstast) in the system of semi-rigid fixation with polymeric materials allowed the circular rounds of Softstast to change the shape of the bandage. In point of this, we were offered a method of pneumatic massage, which provided massage during the immobilization stage of treatment. Conducting kinesiotherapy and massage therapy was supplemented by medicament therapy. Results. The assessment also took into consideration the structure of non-unions with the Non-Union Scoring System - NUSS scale. The distribution of patients according to the total NUSS score indicated a very complex contingent of victims with a low probability of obtaining good results. Patients who needed standard methods of treatment, with a high probability of obtaining a positive result, were not observed; all required specialized treatments with the likelihood of achieving a positive result. In 20 cases, there was a need for complex specialized medical care with a possible positive result. 2 observation cases showed that even complex specialized medical care did not guarantee a positive result. Evaluation of the results of treatment of the victims with tibial bone non-unions after fractures were performed using the Modified Functional Evaluation System by Karlstrom-Olerud. Good results were obtained in 20 patients (30.45 ± 0.88 points, p &lt;0.001) - 55.6%. Satisfactory results were observed in 7 patients (28.0 ± 0.125 points, p &lt;0.001) - 19.4%. Moderate function impairment (4 patients - 13.9%) was 22.0 ± 1.323 p p &lt;0.001. Poor, unsatisfactory results were observed in 1 case (2.8%); excellent functional status - 3 (8.3%). Conclusions. The usage of semi-rigid fixation systems at the final stage of treatment of tibial non-unions after osteosynthesis with ring fixators should be considered reasonable and safe. The results of the treatment of 36 patients with tibial bone non-unions with preliminary fixation by ring fixators according to the Ilizarov method, using semi-rigid fixation systems at the final stage of treatment -indicate high efficiency.

Design and biomechanical study of slide-poking external fixator for hip fracture

BackgroundFemoral head collapse and coxa vara lead to internal fixator failure in elderly patients with hip fracture. External fixator application is an optimal choice; however, the existing methods have many disadvantages.MethodsType 31-A1.3 hip fracture models were developed in nine pairs of 1-year-old fresh bovine corpse femur specimens. Each left femur specimen was fixed by a dynamic hip screw (control group), and each right femur specimen was fixed by the slide-poking external fixator (experimental group). Vertical loading and torsion tests were then performed in both groups.ResultsIn the vertical loading experiment, a 1000-N load was implemented. The mean vertical downward displacement of the femoral head in the experimental and control groups was 1.49322 ± 0.116280 and 2.13656 ± 0.166374 mm, respectively. In the torsion experiment, when the torsion was increased to 10.0 Nm, the mean torsion angle in the experimental and control groups was 7.9733° ± 1.65704° and 15.4889° ± 0.73228°, respectively. The slide-poking external fixator was significantly more resistant to compression and rotation than the dynamic hip screw.ConclusionThe slide-poking external fixator for hip fractures that was designed and developed in this study can provide sufficient stability to resist compression and rotation in hip fractures.