External Fixation Methods Research Articles

Biomechanical evaluation of a new technique for external fixation of unstable supracondylar humerus fractures in children.

Closed reduction and percutaneous pinning is regarded as the treatment of choice for unstable supracondylar humerus fractures, but there are cases in which the use of external fixation is preferable. The aim of this study was to investigate whether the method of external fixation could be considered as a stable alternative to percutaneous pinning and whether there was a difference in stability between two different external fixator constructs. Eighteen synthetic humeri were allocated to three groups of six bones each. The specimens of group 1 were fixed by crossed pinning, those of group 2 by a new variation of an external fixator and the specimens of group 3 by an established variation of it. Osteotomy displacement was measured under static loading in internal and external rotation, as well as in extension and flexion. The external fixators proved to be significantly more stable than crossed pinning in sagittal loading. In internal rotation loading the new variation of the external fixator showed the best results. In case of fractures that can't be replaced by closed reduction the new variation of external fixator should be preferred to the established variation or open reduction and crossed pinning.

Open distal tibial pilon fractures treated with "one-stage" external fixation method

Introdiction: Open distal tibial pilon fractures are considered as hard injuries, caused by high-energy axial load. Different treatment methods of these injuries are described in the literature. Authors of this paper are presenting own experience and results in the method of ?one-stage? external fixation with or without limited internal fixation of the fracture. Material and methods: All the patients had emergent surgical treatment in 4 to 8 hours after the hospitalisation. Surgical protocol included wound irrigation, debridement, fracture reduction and external fixation in type A fractures. Type B and type C fractures were treated by ?bridging? external fixation with limited internal fixation. In the cases where wound had not been possible to close primarily additional surgical procedures (soft tissue defects coverage) were performed. Results: Final functional outcome was excelent in 5(31,25%) patients, good in 6 (37,5%) patients, moderate in 3(18,75%) patients and bad in 2 (12,5%) patients (according Karlsson Score). Final anatomical and functional results were in correlation with the type of primary injury. One case of septic pseudoarthrosis and three cases of late ankle arthrosis were found as a major complication. Conclusion High-energy open distal tibial pilon fractures are still considered as a challange and significant surgical problem. The method of external fixation with or without limited internal fixation, as ?one-stage? method, was approved in clinical practice to give excelent and good final functional and anatomical results. Though final functional results were in correlation with degree of the injury, described method gives good outcome results and further clinical application will surely approve its clinical significance.

Treatment of high-energy pilon fractures with external fixation as a method of minimal invasive approach - long term results

High energy pilon fractures present a unique challenge to the patient and orthopaedic surgeon. Care for the soft tissue envelope is as important as management of this articular fracture. This article present long term results of patients suffered type C pilon fractures treated with the method of external fixation with minimal invasive approach,. We observe a total of fifty five patients, between August 2008 and January 2015, underwent external fixation of type C pilon fractures with minimal invasive approach at Clinic of Orthopaedic and Traumatology, Clinical center Nis, Serbia. Infectious complications secondary to wound healing problems are a major concern after open surgery for pilon fracture. Therefore, soft-tissue management is critical for successful operative treatment of these fractures. According to our long term results in the present study, it seems that external fixation represent a rational approach to obtain and maintain alignment of the distal tibia through ligamentotaxis, thereby avoiding formal open reduction for treatment of the patient with severe pilon fracture.

A novel external catheter fixation method for chemotherapy using inferior epigastric arterial catheterization for cervical cancer.

The aim of this randomized controlled study was to investigate the effects of a novel external catheter fixation method for chemotherapy using inferior epigastric arterial catheterization for cervical cancer.Patients diagnosed with cervical cancer were randomly divided into a control group (n = 32) and a treatment group (n = 33). Patients in the control group underwent a traditional fixation method using a haemostat, elastic band and abdominal bandage. Patients in the treatment group underwent an improved fixation method using an indwelling needle and membrane cover. We used a visual analogue scale (VAS) to evaluate each patient's comfort score and also recorded the incidence of needlestick injury and the length of injection time in each group. The VAS scores measured before and after chemotherapy in the treatment group were lower than in the control group. The incidence of needlestick injury in the treatment group was significantly lower than in the control group. The length of injection time in treatment group was significantly lower than in the control group. Compared with the traditional fixation method, the improved fixation method not only increased patient comfort but also reduced both the risk of needlestick injury and the length of injection time. This improved technique deserves increased clinical use.

Durations of Bone Consolidation and External Fixation After Distraction Osteogenesis in Dogs

To evaluate the influence of epidemiologic, surgical, and mechanical factors on the durations of bone consolidation and external fixation after distraction osteogenesis in dogs. Retrospective cohort study. Dogs (n = 115) that had corrective osteotomy with circular external fixation (CEF; n = 152) METHODS: Medical and radiographic records (1992-2012) of dogs that had corrective osteotomies were reviewed. Putative variables included age, weight, gender, and breed. Surgery date, delay before distraction, rate and duration of distraction, mechanical complications, and frame removal date were recorded. Radiographic data included bone operated, bone length, osteotomy site, bone and limb size at osteotomy site, distraction distance, and CEF frame size and stiffness. Mean ± SD bone consolidation period was 56 ± 33 days. Mean duration of external fixation was 77 ± 35 days. Twelve fixation failures occurred. Radii healed faster than tibiae (P < .001). Failure of fixation (P = .002) and stiff frames (P = .033) increased duration of bone consolidation. For the tibia, durations of bone consolidation and external fixation decreased with larger bone size relative to limb size (P = .004). For the radius, bone consolidation duration decreased as distraction amount increased (P = .03). Radii healed faster than tibiae. Wearing frames with low or moderate stiffness, the absence of mechanical complications, a larger distraction distance, and a larger bone size accelerated bone consolidation. Optimizing these factors should accelerate bone consolidation and reduce the duration of external fixation.

Efficacy of Various Arrangements of Pelvic External Rod Fixators in Polytraumatized Patients at Resuscitation Step

Application of external fixators (EF) in pelvic fractures is one of the important components of antishock therapy in patients with polytrauma. However various fixation techniques possess certain advantages and disadvantages. Comparative analysis of 4 most commonly used variants of pelvic EF mounting, i.e. classic - via upper flaring portion of the ilium, supra-acetabular, orthogonal - combination of screws passes through the wings and supra-acetabular region, and subcristal, that were applied in 32, 48, 13 and 3 patients, was performed. Results of the analysis showed that supra-acetabular pelvic fixation technique a preferable one due to its high efficacy and lower rate of complications as compared to other external fixation methods.

Efficacy of Various Arrangements of Pelvic External Rod Fixators in Polytraumatized Patients at Resuscitation Step

Application of external fixators (EF) in pelvic fractures is one of the important components of antishock therapy in patients with polytrauma. However various fixation techniques possess certain advantages and disadvantages. Comparative analysis of 4 most commonly used variants of pelvic EF mounting, i.e. classic - via upper flaring portion of the ilium, supra-acetabular, orthogonal - combination of screws passes through the wings and supra-acetabular region, and subcristal, that were applied in 32, 48, 13 and 3 patients, was performed. Results of the analysis showed that supra-acetabular pelvic fixation technique a preferable one due to its high efficacy and lower rate of complications as compared to other external fixation methods.

Ankle arthrodesis in tubercular arthritis using anterior bridge plating: A report of 2 cases

Ankle arthrodesis is a common procedure for tubercular arthritis in India. However, attaining fusion in osteoporotic bones is difficult to achieve by both external and internal fixation methods described in the literature. We report two cases for ankle arthrodesis using an anterior approach to the ankle and internal fixation with a bridging anteriorly placed AO L/AO T plate. Both ankles were fused. The surgical technique is simple, easily reproducible and gives excellent results.

Management of the proximal tibia fractures by mini external fixation: A case series of 30 cases

<b>Background:</b> Management of high velocity trauma is a challenging problem because of morbidity of trauma and sometime residual problems of failure of proper healing of fractures with the restriction of movements of knee, shortening, and added risk of compartment syndrome in the proximal tibia fracture. There is always risk of post-operative infection and infected non-union in extensive open surgical procedure and internal fixation. Hence, there is always look out for the middle path procedure for a solution to the above said problems with the added advantage of less hospital stay and early return to work by minimal invasive procedure and stabilization of fracture reduction by multiple K-wire fixation with a frame applied externally. Stabilization of fracture with reduced pain allows early movements of neighbouring joint knee and ankle; hence, reduces the chances of fracture diseases. With this we have been stimulated to take-up the study of managing the proximal tibia fracture by mini external fixator. <b>Aim:</b> The aim of this study was to manage proximal tibia fractures by mini external fixator and evaluate the results and efficacy of this method. <b>Material</b> <b>and</b> <b>Method:</b> A total of 30 patients having proximal tibial fractures admitted at our center between 2008 and 2010 were taken and the procedure carried out was closed manipulative reduction and stabilization with mini external fixator. All acute proximal tibia fractures including tibial plateau fractures above 17 years of age of either sex were included in the study. Fracture more than 3 weeks old were excluded from the study. <b>Result:</b> Out of 30 cases 13 were excellent, 14 cases good, and 3 showed fair. It was found that type 5 and 6 of Schatzker's classification have lesser outcome type of fractures <b>Conclusion:</b> We have found that management of the proximal tibia fractures by mini external fixation method has a better outcome. Early mobilization of knee in the proximal tibia fractures after stabilization with mini external fixator results in good functional outcome of the knee and reduces hospital stay. Complications associated with this method of treatment are minimal.

External wire-frame fixation of digital skin grafts: A non-invasive alternative to the K-wire insertion method

Background and AimThe current skin graft fixation methods for digits, including the Kirschner wire insertion technique, can be limited by inadequate or excessive fixation and complications such as infection or secondary injuries. Therefore, the external wire-frame fixation method was invented and used for skin grafting of digits. This study aimed to investigate external wire-frame fixation of digital skin grafts as a non-invasive alternative to the K-wire insertion method. MethodsIn 2005–2012, 15 patients with burn scar contractures on the hand digits received a skin graft that was then fixed with an external wire frame. The intra-operative time needed to make the wire frame, the postoperative time to frame and suture removal, the graft survival rate, the effect of contracture release and the complications were recorded. ResultsIn all cases, the contracture release was 100%. The complete graft survival rate was 98.6%. Four patients had epithelial necrosis in <5% of the total area. There were no other complications such as pressure ulcer or hypoxia of fingers. ConclusionsExternal wire-frame fixation is simple, minimally invasive and a custom-made technique for skin grafting of the fingers. It was designed for its potential benefits and the decreased risk it poses to patients with scar contractures on their fingers. It can be implemented in three phases of grafting, does not affect the epiphyseal line or subsequent finger growth and is suitable for children with multi-digit involvement.

External Fixation in the Management of Closed Segmental Tibial Fractures

Summary Segmental fractures represent the interruption of bone integrity at two or more levels. In these fractures, a wide zone of injury (damage of all structures of the lower leg) creates very unsuitable biological conditions for healing of the fracture. Because of the damage of both intramedullary and periostal vascularization, segmental fractures are predisposed to slow healing and development of pseudoarthrosis. The aim of the paper was to present the results of treatment of patients with closed segmental tibial fractures treated by external fixation. Within the period between January 1, 1998 and June 31, 2012 in the Clinical Center Niš, 26 patients with closed segmental fractures of the tibia were treated. The assessment of outcomes of treatment of closed segmental tibial fractures by external fixation was performed on a series of 24 patients. The mean age was 43.57 years. All the patients were treated by Mitković unilateral external fixator produced by “Trafix” firm. Fracture healing occurred in 20 (83.33%) patients; four (16.67%) patients reported significant complications in the course of treatment that required further surgical treatment. By applying the method of external fixation in the treatment of closed segmental tibial fractures, reposition of fragments is achieved through a small incision, with pins of exteranal fixator placed outside the fracture zone to prevent further damage of intramedullary and periosteal bone vascularisation, which is very important for fracture healing.

Behandling av distale radiusfrakturer

In light of the Norwegian Orthopaedic Association's wish to prepare guidelines for treatment of distal radius fractures, we have reviewed the knowledge base for the provision of such treatment. The paper is based on systematic reviews of treatment of distal radius fractures from literature search in the following databases: the Cochrane Library, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects (DARE Cochrane), the Health Technology Assessment (HTA) database, PreMedline, Medline and Embase. There is evidence for recommending percutaneous pinning of unstable, dorsally displaced distal radius fractures rather than conservative treatment, but which pinning method is best remains uncertain. There is also documentation to support the use of external fixation rather than conservative treatment. There is insufficient documentation available to draw conclusions regarding the relative efficacy of the various methods of external fixation, but external fixation in combination with adjuvant pinning of the fracture fragment enhances the result compared to external fixation alone. The evidence indicates that plates may enhance functional short-term results for unstable distal radius fractures compared to external fixation. There is evidence in support of differentiated treatment of distal radius fractures. However, many questions remain unanswered, and good prospective, randomised multi-centre trials are needed.

Knee angular deformity correction using unicorticotomy and callus distraction by external fixation method and presentation of new external fixation device for varus correction of proximal tibia

The main goal of this paper is to present clinical results of surgical correction of angular (varus and valgus) deformities of knee area. Goal is also to present new external fixation device for surgical treatment of varus deformity of proximal tibia. As material it has been used series of 70 patients treated during the period of 6.5 years in University Orthopaedic and traumatology clinic. Biomechanical investigation of 80% cut bone model fixed by new external fixation device was performed in the measurement laboratory of Mechanical Faculty University of Nis. Clinical results of treatment of 58 high tibial surgeries (49 varus and 9 valgus) and 12 distal femur surgeries (2 varus and 10 valgus) showed that unicorticotomy and callus distraction by the use of Mitkovic external fixation device leaded to correction and bone union. Superficial pin tract infection happened in 9 patients and has been successfully treated without pins removal. Biomechanical investigation of new device showed that during axial loading of bone model by 690 N (70 kg) movement of medial distal end of bone model was 0.30 mm while posterior distal end of bone model was 0.26 mm. From results obtained in can be concluded that unicorticotomy and gradual callus distraction by the use of external fixation is one reliable method. Biomechanical testing of new external fixation device showed that it is more stable in control of varus and posterior position of proximal tibial fragment.

Distal tibial pilon fractures (AO/OTA type B, and C) treated with the external skeletal and minimal internal fixation method

Distal tibial pilon fractures include extra-articular fractures of the tibial metaphysis and the more severe intra-articular tibial pilon fractures. There is no universal method for treating distal tibial pilon fractures. These fractures are treated by means of open reduction, internal fixation (ORIF) and external skeletal fixation. The high rate of soft-tissue complications associated with primary ORIF of pilon fractures led to the use of external skeletal fixation, with limited internal fixation as an alternative technique for definitive management. The aim of this study was to estimate efficacy of distal tibial pilon fratures treatment using the external skeletal and minimal internal fixation method. We presented a series of 31 operated patients with tibial pilon fractures. The patients were operated on using the method of external skeletal fixation with a minimal internal fixation. According to the AO/OTA classification, 17 patients had type B fracture and 14 patients type C fractures. The rigid external skeletal fixation was transformed into a dynamic external skeletal fixation 6 weeks post-surgery. This retrospective study involved 31 patients with tibial pilon fractures, average age 41.81 (from 21 to 60) years. The average follow-up was 21.86 (from 12 to 48) months. The percentage of union was 90.32%, nonunion 3.22% and malunion 6.45%. The mean to fracture union was 14 (range 12-20) weeks. There were 4 (12.19%) infections around the pins of the external skeletal fixator and one (3.22%) deep infections. The ankle joint arthrosis as a late complication appeared in 4 (12.90%) patients. All arthroses appeared in patients who had type C fractures. The final functional results based on the AOFAS score were excellent in 51.61%, good in 32.25%, average in 12.90% and bad in 3.22% of the patients. External skeletal fixation and minimal internal fixation of distal tibial pilon fractures is a good method for treating all types of inta-articular pilon fractures. In fractures types B and C dynamic external skeletal fixation allows early mobility in the ankle joint.

Successful treatment of congenital pseudarthrosis of the tibia: still a challenge

The congenital pseudarthrosis of the tibia (CPT) is one of the most challenging problems in pediatric orthopedics. The primary treatment goals are outlined as osteosynthesis, stabilization of the ankle mortise by fibular stabilization and lower-limb-length equalization. Despite the fact that each of the aforementioned goals is difficult to be achieved regardless the surgical option, the main biological consideration is the same: pseudarthrosis resection, biological bone bridging of the defect by stable fixation and the correction of any angular deformity. The external fixation method is suggested as valuable treatment of CPT because it can address not only pseudarthrosis but also all complex deformities associated with this condition. However, treatment of CPT is impaired with complications due to the complex nature of the disease thus failure is common. The most common of these are refracture, growth disturbance, poor foot and ankle function with stiffness. Of these, refracture is the most common and serious complication after primary healing and might result in the reestablishment of pseudarthrosis. Therefore, an effective, safe and practical treatment method that minimizes the residual challenges after healing and accomplishes the multiple goals of treatment is needed. In this article, we report a patient with CPT treated successfully with external fixation. Level of evidence IV retrospective.

Establishment of a femoral critical-size bone defect model in immunodeficient mice

BackgroundThe development of innovative therapies for bone regeneration requires the use of advanced site-specific bone defect small-animal models. The achievement of proper fixation with a murine model is challenging due to the small dimensions of the murine femur. The aim of this investigation was to find the optimal defect size for a murine critical-size bone defect model using external fixation method. MethodsAn external fixation device was attached to the right femur of 30 mice. Femoral bone defects of 1 mm (n = 10), 2 mm (n = 10), and 3 mm (n = 10) were created. Wounds were closed without any additional treatment. To investigate bone healing during the 12-wk observation period, x-ray analysis, histomorphology, immunohistochemistry, and μCT scans were performed. ResultsMicroCT analyses after 12 wk showed that 3/8 1-mm defects, 5/8 2-mm defects, and 8/8 3-mm defects remained as nonunions. The defect volumes were 0.36 ± 0.42 mm³ (1-mm group), 1.40 ± 0.88 mm³ (2-mm group), and 2.88 ± 0.28 mm³ (3-mm group; P < 0.001, between all groups). ConclusionUsing external fixation, a defect size of 3 mm is necessary to reliably create a persisting femoral bone defect in nude mice.

A Proposed Treatment Algorithm for Midfoot Charcot Arthropathy

Charcot arthropathy (CA) is an insidious, destructive, and disabling pathology of the foot and ankle. Efficient and effective treatment is therefore required to improve clinical outcomes and to reduce overall mortality risk. The purpose of this case series report is to propose a treatment algorithm for correcting deformity and restoring a plantigrade, shoeable foot in patients with midfoot CA. While there is no clear evidence in the literature favoring either internal or external fixation methods, it may be appropriate to use both techniques during most deformity correction cases. Depending on the presence of ulceration, single-stage and multi-stage reconstruction with either biplanar or aggressive resection can effectively address the presentation of nonviable tissue and a wide degree of variable deformity. Following midfoot reduction, medial column plating and circular external frame can be used together to effectively stabilize and protect the correction and construct. In all cases, the aim is to immediately place the patient into a Charcot Restraint Orthotic Walker boot, with the ultimate goal of transitioning to diabetic shoeing as quickly as possible.

Management of Combined Soft Tissue and Osseous Defect of the Midfoot with a Free Osteocutaneous Radial Forearm Flap: A Case Report

Extensive soft tissue and osseous defects of the foot are difficult to manage and often result in amputation. Most of these wounds are created by trauma, but other causes, such as infection and malignancy, can create similar defects. A variety of wound management options exist for the treatment of these challenging wounds, including negative pressure wound therapy, autogenous skin grafting, and the use of skin substitutes, as well as internal and external fixation methods. In the present report, we describe the use of a free osteocutaneous radial forearm flap to manage a 10-cm × 5-cm dorsal soft tissue defect and a 2.5-cm second metatarsal diaphyseal defect in an adult male.

Management of Aseptic Tibial Nonunion

Tibial nonunion remains a significant clinical challenge despite advances in surgical management. New techniques to help manage tibial nonunion include extracorporeal shock wave therapy and percutaneous application of bone marrow aspirate. Management strategies vary based on the type of nonunion: aseptic or infected, and atrophic or hypertrophic. Extracorporeal shock wave therapy has been shown to be as effective as surgical management in patients with stable hypertrophic nonunion. New fixation options include locked plates and intramedullary compression nails. Novel methods of external fixation have been developed for bone graft harvest from the intramedullary canal. Several biologic adjuncts also are available, including bone marrow aspirates, stem cells, and bone morphogenetic protein.

Adult tibial shaft fractures – different patterns, various treatments and complications

SummaryBackgroundTibial Fractures constitute a large number of emergency operations in most trauma centers. There are different approaches for tibial fractures. To our knowledge, there is insufficient evidence to consider post-operative complications in relation to both surgical methods and the types of fractures. Our purpose is to report our experience regarding the efficacy and complications associated with diverse surgical methods of different patterns of tibial shaft fractures in adults.Material/MethodsWe studied 387 adult patients. The patients’ information was registered from the charts and after examination. The methods used were intramedullary interlocking nails, simple intramedullary rods, plating and external fixation. Early and late complications were recorded and by applying the DELPHI method different treatments were compared. Finally, the safest mode of treatment is proposed.ResultsIn the intramedullary interlocking nails method the most noticeable complication was delayed union and the highest rate of complications was seen in open oblique fractures. In the simple intramedullary rods method the most frequent complication was pain, and in the with butterfly fractures the complications were the most. In the plating method the most frequent complication was pain, and most of the complications were seen in open comminuted fractures. Finally, in the external fixation method the most frequent complication was non-union and complications were the highest in the patients with oblique, comminuted and segmented fractures.ConclusionsThe proposed method to treat transverse, oblique and butterfly fractures is simple intramedullary rods; whereas intramedullary interlocking nails is the better method for comminuted, segmented and spiral fractures.