Application Of External Fixator Research Articles

Infected Non-union of Tibia Treated with Ilizarov External Fixator: Our Experience.

Introduction: Tibia is the most common long bone fractured due its vulnerable subcutaneous location and most often associated with acquired complications of delayed union or non-union due to infection. Amongst the various treatment options to treat them, the Ilizarov external fixator application is considered superior due to its multiple advantages. The objective of this study was to analyse the role of Ilizarov fixation in infected tibial non-union, as well as to assess bony union and associated functional outcomes.Materials and Methods: A retrospective review was conducted for the duration between 1st January 2005 to 31st December 2016. Total of fifty-one patients with tibial non-union associated with infection who treated with the Ilizarov fixator were included in the study. Patient records were reviewed for union of bone, bone and functional outcomes and complications.Results: The most common organism for infection was identified to be Staphylococcus Aureus. At the time of final follow-up all patients had achieved union except two, one of whom had to undergo amputation due to non-union and sepsis. Majority of the patients had an excellent score as per ASAMI grading system for bone and function results. The most common complication noted was pin track infections.Conclusion: In our experience, Ilizarov external fixator is better suited for infected non-union of tibia because it can provide a stable mechanical environment, bone transport, correct deformities, and enable weight bearing and hence we recommend its use for the same.

Effect of Nursing Management on Pin Site Infection Among Incidence Patients with External Fixators

Background: Pin site infection is the most common complication of external fixator. Aim of the study: To evaluate the effect of nursing management on pin site infection incidence among patients with external fixators. Subjects and Methods: A sample of 80 patients (males and females) attended to the trauma department that their ages ranged from 18 to 65 years old, had open or closed fracture in lower and/or upper limbs that were indicated for external fixation application. The study was conducted in traumatology department at Assiut University Hospital. Tools: (I): Patient assessment sheet. Tools: (II) Checketts and Otterburn's Grading System. Results: Only four (5.0%) patients developed pin site infection, whose grade was grade I. There was highly statistical significant relation between pin site infection and smoking p 0,001. Conclusion: After providing nursing management for patients with external fixators most of studied patients didn't develop pin site infection. Recommendation: Increase patients’ awareness about the importance of pin site care and periodic check up to prevent developing any complications which can effect on their quality of life.

Surgical treatment strategies in pediatric trauma patients: ETC vs. DCO-an analysis of 316 pediatric trauma patients from the TraumaRegister DGU®.

External fixation within the damage control concept in unstable multiple trauma patients is widely accepted. Literature about its usage in the pediatric trauma population, however, is rare. The aim of the present study was to elucidate the factors associated with the application of external fixation in the severely injured child. Patients with severe trauma aged 0-54years documented in the TraumaRegister DGU® were included in this study. Demographic data, pattern of injury, injury severity, use of the damage control orthopedics (DCO) or early total care (ETC) concept, duration of mechanical ventilation, intensive care stay, and total hospital stay as well as the occurrence of complications and mortality were evaluated. Statistical evaluation was performed using SPSS (Version 21.0.0) using Chi square tests and linear regression models. While injury severity was comparable between children and adults, type of accident and injury patterns showed significant differences, Overall, the majority of surgical fracture stabilization in AISExtremity ≥ 3 injuries followed the DCO concept in adults (60.3%) and the ETC protocol in children (49.4%). Conservative treatment was chosen for only 11.6% of all children and 9.6% of all adults. An increasing injury severity, AISExtremity ≥ 3 and AISExtremity ≥ 3 in ≥ 2 body regions, and a more advanced age were found to be independent factors in the use of the DCO concept in children. Use of external fixation increases with age and plays a minor role in the very young trauma population. However, this does not produce a difference in outcome between children and adults.

Clinical outcome of conversion from external fixation to definitive internal fixation for open fracture of the lower limb

IntroductionFew reports have examined the outcomes and complications of temporary bridging external fixation (EF) in open fracture of the lower limb followed by conversion to open reduction internal fixation (ORIF). The purpose of this study was to evaluate healing rates and complications in patients treated with conversion from external fixation to definitive internal fixation for open fracture of the lower limb. MethodPatients who underwent temporary bridging EF and subsequent conversion to internal fixation (IF) for open fracture of the lower limb, with follow-up period ≥12 months were included in this study. Demographic data, Gustilo-Anderson classification, fracture type, duration to definitive surgery, surgical procedure, perioperative complications, and additional procedures for cases with complications were obtained. ResultsIn total, 58 patients (43 males, 15 females), 63 fractures were included in this study. Four fractures (6.3%) were Gustilo grade I, 11 fractures (17.5%) were grade II, 34 fractures (54.0%) were grade IIIa, 12 fractures (19.0%) were grade IIIb, and two fractures (3.2%) were grade IIIc. Mean duration of the application of EF was 12.4 days (range, 3–45 days) until conversion to definitive IF. Rates of deep infection and nonunion were both 9.5%, with two cases showing concomitant infection and nonunion. Rates of infection were 8.8% (3/34) in grade IIIa and 25% (3/12) in grade IIIb. Rates of nonunion were 9.1% (1/11) in grade II, 2.9% (1/34) in grade IIIa and 33% (4/12) in grade IIIb. ConclusionTemporary EF for open fracture of the lower limb followed by conversion to IF, as early as soft tissue and general condition permit, may be a safe and effective procedure for patients with lower-limb open fracture of Gustilo grade IIIa or less. Level of evidenceLevel IV, Case series.

Evaluacija rezultata ugradnje endoproteze i pertrohanternog spoljašnjeg fiksatora kod intertrohanternog preloma femura kod starijih pacijenata

Objective: In this study, 14-month clinical outcomes of the endoprosthesis and pertrochanteric external fixator application are retrospectively evaluated in elderly patients with pertrochanteric fractures. Patients and Method: A total of 45 patients of 65 years old and older (25 females and 20 males) with a mean age of 78.1, who were treated due to intertrochanteric femur fracture between November 2013 and December 2014 and whose controls could be made were included in this study. The deaths that occurred within the postoperative 1 year were not included in the study. 28 patients with endoprosthesis as Group I, and 17 patients with pertrochanteric external fixator as Group II were evaluated. Results: Table 2 shows the clinical evaluation results of the patients according to different criteria by the groups. The mean operation time was 45 min in Group I and 20 min in Group II. The external fixator application time is significantly shorter. The mean hospital stay was 14 days for Group I and 10 days for Group II. The hospital stay period of the external fixator group is 4 days shorter. While 7 patients were taken into the intensive care unit in Group I postoperatively, only 1 patient was taken into the same unit in Group II. This difference was significantly in favor of the external fixator group. While 14 patients in Group I needed a preoperative and postoperative blood transfusion, no patient needed blood transfusions in Group II. External fixator application is significantly more advantageous in terms of patient hemodynamics. The mean time to postoperatively move the extremity independently in the bed was 24 hours in Group I and 36 hours in Group II. All patients were exposed to the Harris hip scoring in the postoperative 12. month (the fixator was removed for the external fixator group). Conclusion: In addition to internal fixation options and endoprosthesis applications in elderly intertrochanteric femoral fractures, an external fixator may also be a good treatment alternative with appropriate patient selection and proper application in accordance with the technique thanks to its short surgical time, less blood loss and easy applicability.

Functional outcome of comminuted intra-articular distal radius fractures managed by Ligamentotaxis

Distal radius fracture is one of most common fractures seen in clinical practice. Comminuted intra articular fractures are usually associated with road traffic accidents, fall from height in young patients. In old age groups it is associated with severe osteoporosis due to trivial fall. All intra articular fractures need good reduction for better functional outcome. K-wire fixation with plaster application, open reduction and internal fixation with locking plate, external fixator application (Ligamentotaxis) are various described methods for treating this fractures. When there is severe commination k-wires and screws cannot perch age the small fragments and there is high chances of loss of reduction. Also when there is severe soft tissue swelling and in case of open fractures open reduction and internal fixation is not possible. Materials and Methods: This is a prospective study conducted in our hospital from January 2017 to October 2018. Inclusion criteria include close and open comminuted intra-articular fractures of distalradius in skeletally mature patients. All patients treated by Ligamentotaxis (external fixator application). Exfix removal done after six weeks and started on physiotherapy. Every patient functional outcome assessed 4months after exfix removal using Mayo wrist scoring. Results: Overall 30 patients of comminuted intra-articular distal radius fractures treated by Ligamentotaxis. Non dominant hand involved in 10 patients and dominant hand involved in 20 patients. All patients under went removal of exfix after 6 weeks of application. All patients subjected to vigorous physiotherapy after exfix removal for 3 weeks. Functional outcome of every patient measured using mayo wrist score 4 months after exfix removal. Overall together the average mayo wrist score of operated wrist was 82 with excellent results in 46.66% of cases, good results in 36.66% of cases and satisfactory results in 10%of cases, poor results in 6.66% cases with a very significant p-value of

Functional results of judet’s quadricepsplasty in the management of fixed flexion deformity of knee

Introduction: Prevalence of Fixed flexion deformity (FFD) of the Knee is more prevalent in Indian scenario due to prolonged immobilisation following indigenous method of treatment of fractures around knee. Quadricepsplasty has been described by Thompson and Judet to improve flexion in severely deformed knees. Judet’s technique has potential advantages because it is less damaging to the quadriceps mechanism and addresses the problem of external fixator pin site tethering on the lateral side of the thigh. Methodology: This is a prospective study conducted in Omanthurar Multispecialty Hospital from 2013-2018. Patients presenting with FFD of any reason due to post op immobilisation or conservative management of the fractures around the knee are included in the study while patients with previous history of surgery to improve flexion deformity were excluded. All the patients were evaluated clinically to measure the available range of movement preoperative and Judets Quadricepsplasty was carried out in a standard fashion and intraoperative flexion range achieved is recorded and their function results at final follow-up is categorised based on Judet’s criteria.Results: We included 32 patients into the study and the M: F ratio 1.42:1 with male preponderance. Etiology of the FFD being 18 patients due to indigenous management fractures around knee while 9 were due to external fixator for compound injuries and 5 due to post op immobilisation. Mean preoperative flexion was 33o while intraop immediate mean flexion achieved was 112o and flexion at final follow-up was 108o. One case of superficial infection settled with antibiotics and one case required manipulation under anaesthesia to regain flexion which was lost in the initial follow-up since the patient was not adherent to the postop protocol. Mean follow up of the patients under study was 2.6 yrs (Range 2-5 yrs). Out of 32 cases we achieved 22 cases with excellent results and Good in 9 case and Fair in 1 case based on criteria by Judet.Conclusion: Judet’s technique of Quadricepsplasty by disinsertion and muscle sliding is a useful technique in fixed flexion deformity of knee extension commonly seen in patients undergoing indigenous method of treatment and limb reconstruction surgery after a prolonged immobilisation of Knee due to conservative management of fractures around knee or application of external fixators.

The use of twin-ring Ilizarov in the treatment of periarticular or intra-articular fractures of the tibia

Objective The aim of the present study was to report the results of using the twin-ring (TR) module in treatments of juxta-articular fractures of the tibia and the merits of this technique in Menoufia University Hospitals and El-Obour Insurance Hospital over 3 years. Background In juxta-articular fractures of the tibia, the presence of short metaphyseal bone fragments may make the application of an Ilizarov external fixator (IEF) challenging. It may be necessary to bridge the adjacent joint to ensure stable fixation. The TR module is proposed as an alternative method that avoids joint bridging, without compromising the stability of fixation. Patients and methods This is a descriptive retrospective study with data collected from the analysis of medical records of 20 patients admitted in Menoufia University Hospitals and El-Obour Insurance Hospital with a diagnosis of juxta-articular fractures of the tibia over a 3-year period from May 2013 to July 2016. The patients studied were retrospectively analyzed for sociodemographic data, clinical parameters, duration of hospitalization, the application of TR IEF, and clinical outcome according to the knee society scoring system and the clinical rating system for the ankle and hind foot. Results The TR IEF shows more stability, less joint stiffness, and less time needed for both fracture union and physiotherapy. Conclusion When treating selected trauma patients, the application of the TR IEF is suggested as a promising surgical alternative, offering satisfactory outcomes and reduced patient morbidity.

Hexapod orthogonal periarticular slack-wire stabilization technique: Surgical tip for accurate orthogonal metaphyseal frame mounting

Introduction: The use of hexapod circular external fixators in the treatment of various orthopedic conditions has become more common in recent years. One of the principle mounting requirements is that the fixator is orthogonally aligned to the mechanical axis of the limb. This creates the optimal mechanical environment for bone formation as any forces exerted on the fixator are transmitted as axial forces to the limb while eliminating unwanted motions such as rotation and shear. We describe a method to reliably obtain orthogonal mounting of periarticular rings during hexapod circular external fixator application. The technique is fast, accurate, and uses components readily available on all hexapod external fixator systems. Methods: The “hexapod orthogonal periarticular slack-wire stabilization (HOPSS) technique” uses a untensioned/slack wire as the second fixation element following the transverse reference wire. A wire fixation bolt is attached to the ring, and a second wire (slack wire) is placed through the wire fixation bolt to allow insertion in an antero–posterior direction. The wire is advanced through the near cortex and onto the far cortex after which the wire fixation bolt can be tightened and a final image intensifier check can be done. The technique can be used for the application rings to the metaphysis of long bones. Discussion: Orthogonal mounting for Ilizarov all-wire frames has been a crucial part of the surgical technique and has long been accepted as it promotes axial micromotion that supports callus formation and union and eliminated parasitic motion at the bone ends. The described technique uses readily available instruments and components to assist with perfect orthogonal mounting. Conclusions: The hexapod orthogonal periarticular slack-wire technique is a simple method for obtaining more accurate orthogonal mounting. It is quick and effective and does not require any additional equipment.

Results of external fixator treatment in distal radius intra-articular fractures

Objectives: Assessing the outcomes of treatment of the radius distal end joint fractures by using the closed reduction external fixation method. Methods: 41 intra-articular distal radius fractures of 38 patients treated in the Department of Orthopedics and Traumatology in the Medical Faculty of Trakya University between September 1997 and December 2004 were retrospectively examined. All of the fractures were treated by using closed reduction and uniplanar radiocarpal external wrist fixator. The affected limbs were assessed functionally and radiologically during the follow-up period. Results: Mean duration of external fixation application was 7.3 weeks. Mean follow-up time was 41.6 months. From the functional aspect, very good outcomes were obtained in 10 cases, good outcomes in 14 cases, medium outcomes in 15 cases, and bad outcomes in 2 cases. In radiologic scoring, very good outcomes were reported in 3 cases, good outcomes in 28 cases, medium outcomes in 8 cases, and bad outcomes in 2 cases. In total, 22 complications were observed. Reflex sympathetic dystrophy was observed in 15 cases, pain in the distal radioulnar joint in 8 cases, pain in distal radioulnar joint, and eburnation in 4 cases. In some cases, multiple complications were observed. There were also cases with early-stage sensation disorder and nail tip sensitivity. However, the complaints ended after the removal of the fixator. Conclusion: In intra-articular distal radius fractures, successful outcomes might be achieved by treating with external fixation without opening the fracture line.

Deformity and Clinical Outcomes Following Operative Correction of Charcot Ankle.

Deformity associated with Charcot foot arthropathy leads to a poor quality of life in affected individuals. Deformity in the midfoot appears to be predictive of clinical outcomes following operative correction. The goal of this retrospective study was to determine if that same methodology could be applied to patients treated for Charcot foot arthropathy involving the ankle joint. Fifty-six consecutive patients underwent operative reconstruction of Charcot foot deformity involving the ankle joint by a single surgeon over a 14-year period. Preoperative patient characteristics and tibiotalar alignment, were recorded. Surgical treatment included single-stage debridement of active infection and ankle arthrodesis with application of a circular external fixator when infection was present (39 of 56, 69.6%) or retrograde locked intramedullary nailing in the absence of infection (17 of 56, 30.3%). Clinical outcomes were graded based on limb salvage, resolution of infection and chronic wounds, and the ability to ambulate with therapeutic footwear or accommodative orthoses. The average follow-up was 7.5 (range 1.1-14.0) years. One patient died at 134.3 weeks following surgery of unrelated causes and 8 underwent amputation. Twenty-eight of 56 patients (50.0%) achieved a favorable (excellent or good) clinical outcome. There was no significant association between pre- or postoperative alignment and clinical outcomes. Insulin-dependent diabetics were approximately 3 times more likely to have a poor clinical outcome. Operative correction of Charcot deformity involving the ankle joint was associated with a high complication rate and risk for failure. The lessons learned from this highly comorbid patient population with complex deformities can be used as a benchmark for applying modern surgical techniques. Level IV, case series.

Knee Stiffness After Tibial Plateau Fractures: Predictors and Outcomes (OTA-41).

What patient characteristics and injury factors predict decreased knee range of motion (ROM) after operative management of tibial plateau fractures? Prospective cohort study. Academic medical center. Over 11 years, tibial plateau fractures at a single academic institution were prospectively followed. A total of 266 patients were included in this study. Surgical repair of tibial plateau fractures and secondary interventions due to arthrofibrosis. Clinical outcomes were evaluated using the Short Musculoskeletal Function Assessment and ROM at 3-month, 6-month, and long-term follow-up. Secondary outcomes were considered as the need for a subsequent procedure due to arthrofibrosis. At 3-month follow-up, the mean ROM was 113 degrees. By long-term follow-up (mean = 17 months), the mean ROM improved to 125 degrees. Independent predictors of decreased knee ROM were the following: at 3-month follow-up, open fractures (P = 0.047), application of a knee-spanning external fixator (P = 0.026), orthopaedic polytrauma (P = 0.003), and tibial spine involvement (P = 0.043); and at long-term follow-up, nonwhite ethnicity (P = 0.003), increasing age (P = 0.003), and a deep infection (P = 0.002). Ten patients (3.7%) required a secondary procedure for arthrofibrosis. There was a significant improvement in the knee ROM (P < 0.001) and functional outcomes (P = 0.004) following the intervention. At long-term follow-up, independent predictors of decreased knee ROM were nonwhite ethnicity, increasing age, and sustaining a postoperative complication of a deep infection. Secondary interventions were reliable treatments for arthrofibrosis. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Treatment of infected nonunion by external fixation

Objective To explore the curative effects of external fixation in the treatment of infected nonunion. Methods From June 2009 to December 2016, 45 patients with infected nonunion were treated by external fixation at Department of Orthopaedics, West China Hospital. They were 36 males and 9 females with an average age of 45.3 years (range, from 14 to 65 years). The sites of fracture included tibia in 31 patients, femur in 12, humerus in one, and ulna-radius in one. The median time from injury to application of external fixation was 16.8 months and the average number of previous operations was 2.3 times. After debridement, 24 cases had a bone defect of 6.0 cm in length on average (range, from 3.5 to 10.4 cm). After discharge, the patients were regularly followed up at the outpatient department and any of their complications was recorded in detail. At the final follow-ups, the protocol of ASAMI (Association for the Study and Application of the Method of Ilizarov) was used to evaluate their bone and functional results. Results All the 45 patients were followed up for 16 to 106 months (average, 43.9 months). One patient had to receive amputation because of uncontrollable infection and all the other 44 cases achieved bony union. The bone defects were successfully reconstructed by external bone transport in 24 patients. The time for external fixation averaged 20.5 months. According to the evaluation by ASAMI at the final follow-ups, the bone was rated as excellent in 28 patients, as good in 12, as fair in one and as poor in 3, giving an excellent to good rate of 90.9%; the function was rated as excellent in 11 patients, as good in 21, as fair in 8 and as poor in 4, giving an excellent to good rate of 72.7%. Conclusion In eradication of infection and treatment of fracture nonunion, external fixation can be used not only to avoid the infection risk due to internal fixation but also to correct a complex deformity and repair a large bone defect, allowing early weight-bearing for the patients. Key words: Fractures, ununited; Infection; External fixation; Bone transport

Paediatric humeral supracondylar fractures

The supracondylar humeral fracture is the most common elbow fracture in children accounting for just under one-fifth of all paediatric fractures and 60% of paediatric elbow fractures. Modifications of the Gartland classification have been made over the years. The mainstay treatment option is that of closed reduction and percutaneous wiring. However, there remains no gold standard in the management of this injury. Outcomes from other treatment options, including traction and external fixator application have been described and report good results. There remains controversy in the wiring configuration used, and there is no consensus on the approach to be used when faced with an irreducible fracture. This article aims to provide an up-to-date overview of the current practices in the management of this common injury, including the ‘pink pulseless’ hand, ‘poorly perfused white’ hand, surgical techniques, and the associated complications that can ensue.

Standards for external fixation application: national survey under the auspices of the German Trauma Society.

External fixation is widely accepted as a provisional or sometimes definitive treatment for long-bone fractures. Indications include but are not limited to damage control surgery in poly-traumatized patients as well as provisional bridging to definite treatment with soft tissue at risk. As little is known about surgeon's habits in applying this treatment strategy, we performed a national survey. We utilized the member database of the German Trauma Society (DGU). The questionnaire encompassed 15 questions that addresses topics including participants' position, experience, workplace, and questions regarding specifics of external fixation application in different anatomical regions. Furthermore, we compared differences between trauma centrelevels and surgeon-related factors. The participants predominantly worked in level 1 trauma centres (42.7%) and were employed as attendings (54.7%). There was widespread consensus for planning and intra-operative radiographical control of external fixation. Surgeons appointed at a level I trauma centre preferred significantly more often supra-acetabular pin placement in external fixation of the pelvis rather than the utilization of iliac pins (75.8%, p = 0.0001). Moreover, they were more likely to favor a mini-open approach to insert humeral pins (42.4%, p = 0.003). Overall, blunt dissection and mini-open approaches seemed equally popular (38.2 and 34.1%). Department chairmen indicated more often than their colleagues to follow written pin-care protocols for minimization of infection (16.7%, p = 0.003). Despite the fact that external fixation usage is widespread and well established among trauma surgeons in Germany, there are substantial differences in the method of application.

Combined free flap and ilizarov bone reconstruction in complex lower limb trauma: our experience

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Reconstruction of complex lower limb trauma is a major concern for both plastic and Orthopedic surgeons. The use of free flap with Ilizarov method for soft tissue coverage and bone reconstruction not only gives the patient near normal shape and function but also allows early mobilization of the patient, even during the process of distraction with Ilizarov method.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; In this study patients with bone and soft tissue defects of the lower leg were included in the study. Our protocol was immediate wound debridement along with application of external fixator and early free flap coverage within 48-72 hours. After 3-4 weeks of the free flap transfer definitive bone reconstruction is done with Ilizarov method.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 122 flaps survived fully and distal flap necrosis occurred in 4 patients. Necrosis of flap occurred before the start of bone reconstruction with Ilizarov and was managed conservatively or with skin graft. Pin tract infection occurred in 45 (35.71%) patients and was treated by pin care and antibiotics. Other complications in treated patients included pain due to distraction (33.33%). delayed union at docking site (11.90%), discrepancy of limb size (9.52%) and union with deformity (6.35%). The functional outcome was satisfactory in majority of the cases.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Combined use of free flap and Ilizarov provides a more reliable soft tissue coverage and bone reconstruction with almost near normal shape and function. It has advantages like regenerating same quality bone and allowing the early mobilization of the patient with acceptable rate of complications.&lt;/p&gt;

New progress in the treatment of chronic wound of diabetic foot

Diabetic foot is one of the serious complications of diabetic patients. It is caused by diabetes combined with different degrees of lower extremity vascular lesions and neuropathy, and the wound can not heal for a long time. The serious results can cause bone marrow infection, bone destruction, and have high disability and death rate. At present, there are various treatment methods for diabetic foot chronic wound. On the basis of internal medicine controlling blood sugar, anti infection, lowering blood lipid, improving microcirculation and nourishment nerve, the surgical method is adopted, including the debridement of the necrosis in a short time to prevent the infection from spreading; maggot biological debridement and ozone chemical debridement will promote the growth of granulation tissue while controlling infection. Skin grafting, skin flap transplantation, skin distraction closure can be used to repair soft tissue defects, or fat transplantation, platelet-rich plasma, and rich blood are used for the refractory wound after infection control. In patients with diabetic foot, the reconstruction of lower limb blood supply is beneficial to the recovery of chronic ischemic wounds. It is feasible to improve the blood supply of the lower extremities, improve the blood supply of the lower extremity artery bypass grafting, and improve the microcirculation of the peripheral vessels around the lower extremities. Lower extremity vascular bypass pressure perfusion therapy for vascular network expansion, tibia lateral moving technique for lower limb microcirculation reconstruction. For diabetic foot ulcer caused by peripheral neuropathy, such as Charcot foot, while the application of external fixator, total contact cast technology of affected foot for reducing treatment to promote wound healing; the preparation of orthopedic shoes can play a maximum protective effect on the healing of diabetic foot wound healing.

Hot spots of recent research in bone lengthening

Bone lengthening technique is one of the core surgical technique for skeletal lengthening and reconstruction. It is widely used in the treatment of nonunion, segmental bone defect, bone infection, congenital or post-traumatic limb length differences, and hand-foot deformity correction. Until today, the surgical techniques and devices of bone lengthening are improving over time, and it is to improve the quality of treatment and reduce complications. However, the bone lengthening technique is different from the treatment for other orthopedic diseases, and it has the following feature, including requiring multiple steps, longer treatment course, and application of external fixator. This article will summarize the hot research in the field of bone lengthening treatment in recent years and provide reference for future clinical treatment.

Using Three-Dimensional Printing to Enhance Cross-Sectional Anatomy Instruction.

The increased use of external interventions to diagnose and treat podiatric medical pathologies has warranted a greater understanding of the lower extremity in the transverse plane. Films, prosections, and plastinated cross sections have long been used alongside traditional instruction to assist students in anatomical studies. These methods, however, often fail to provide the tactile component of anatomical dissection and may obscure or exclude the requisite structures for identification by medical students. Such teaching techniques prove costly, time sensitive, and dated compared with the relatively less expensive and customizable nature of three-dimensional (3-D) printing. Limb length was measured on a cadaveric specimen, and eight cross sections of equal width were excised. Manual sketches of these sections were then digitized and 3-D printed. Three-dimensional printing provides a safe and reproducible means to construct customizable cross sections of the lower extremity. Moreover, this method proves to be relatively inexpensive. Advancing traditional didactic teaching with the use of cost-effective 3-D printing can facilitate the visuospatial comprehension of lower-extremity anatomy. The evolution of 3-D printing enhances the clinical skills essential for the interpretation of imaging studies as well as planning for surgical procedures such as external fixation application.

Deformity and Clinical Outcomes for Surgical Correction of Charcot Ankle

Category: Diabetes Introduction/Purpose: Charcot Foot is a complex neuro-arthropathy associated with acquired progressive deformity and a significant impact to patients’ quality of life. Recent reports have suggested that preoperative deformity is predictive of clinical outcomes following surgical correction of the acquired deformity associated with midtarsal diabetes-related Charcot Foot arthropathy. Methods: A retrospective analysis was performed of 56 patients who underwent surgical reconstruction of Charcot ankle arthropathy by a single surgeon over a 14-year time period. Preoperative tibiotalar alignment was reviewed in the coronal and sagittal plane. Preoperative patient characteristics including age, sex, hemoglobin A1c, BMI, insulin use, and presence of a wound or infection at the time of surgery were also recorded. Preoperative coronal plane deformity was observed as valgus 16/56 (28.6%), varus 31/56 (55.4%), and neutral 9/56 (16.1%). Surgery included debridement of active infection when present, corrective osteotomies, and an attempt at ankle arthrodesis with application of a ringed external fixator (39 of 56, 69.6%) when infection was present or retrograde intramedullary nail (17 of 56, 30.3%). Clinical outcomes of excellent, good, or poor were based on limb salvage, resolution of infection and chronic wounds, and the ability to ambulate with either a CROW, AFO, or therapeutic diabetic footwear. Results: The average total patient follow-up time from index surgery was 115.4 weeks. One patient died after 134.3 weeks of follow-up and 8 underwent amputation. The post-operative complication rate was 69.6% (39 of 56), 79.5% (31 of 39) of which underwent re-operation. Ultimately, only 25 of 55 patients (45.5%) achieved a favorable (excellent or good) clinical outcome. There was no meaningful association between surgical outcome, post-operative complication, reoperation, and amputation and patients’ pre-operative alignment, final alignment, treatment with either ex-fix or IMN, the presence of a wound or infection, age, HgA1c, or BMI. However, compared to insulin dependent diabetics, those not taking insulin were only 0.34 times as likely to have a poor outcome. Conclusion: Operative fixation of Charcot ankle arthropathy was performed with a goal of achieving a plantigrade post for ambulation void of infection or chronic wounds and easily accommodated with a supportive orthosis. This retrospective case series demonstrates a high complication rate in this complex patient population. Clinical outcomes of Charcot ankle can be used to counsel patients on the risks of surgical correction and as a benchmark for improved treatment strategies.