External Fixation In Treatment Research Articles

Rehabilitation Techniques for Adults Undergoing External Fixation Treatment for Lower Limb Reconstruction: A Systematic Review.

External fixation devices are commonly used in orthopaedic surgery to manage a range of pathologies. In this patient population, there is currently no consensus on optimal rehabilitation techniques. There exists a large variation in practice, with a limited understanding of how these affect treatment outcomes. Following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, a systematic review was conducted of Allied and Complementary Medicine Database (AMED), Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, PEDro, and COCHRANE databases, grey literature sources and forward and backward searching of included articles. Studies were selected following rigorous screening with predefined inclusion criteria. Data quality was assessed using validated appraisal tools. Articles were synthesised by rehabilitation type and descriptive analysis was subsequently performed. From 1,156 articles identified, 18 were eligible for inclusion. The overall quality was low, with clinical commentaries and case studies being the most common study type. Studies were synthesised by rehabilitation type, the most common themes being gait re-education, strengthening, therapy-assisted, active exercises and weight-bearing exercises. There is a lack of high-quality evidence to support meaningful recommendations and guide rehabilitation practices for this patient cohort. Further research for patients being treated in external fixation, especially related to the potential effects of physical rehabilitation on bone healing, return of strength, mobility and independent function is likely to have transferability within wider orthopaedic populations. This systematic review is unable to provide clinical recommendations due to the poor quality of the available literature. However, it is hoped this paper will provide a foundation for further research to improve rehabilitation for patients being treated with external fixation. Pawson JR, Church D, Fletcher J, et al. Rehabilitation Techniques for Adults Undergoing External Fixation Treatment for Lower Limb Reconstruction: A Systematic Review. Strategies Trauma Limb Reconstr 2024;19(1):45-55.

PROBLEMATIC ISSUES OF THE TREATMENT OF DIAPHYSEAL GUNSHOT FRACTURES OF LONG BONES OF EXTREMITIES

Due to the military conflict in Ukraine, the problem of treating gunshot fractures has become acute, which requires an urgent solution. Objective. On the basis of own experience, to determine the primary problems in the treatment of gunshot diaphyseal fractures of the long bones of the limbs and evaluate the preliminary results. Methods. The treatment process and its results were analyzed in 128 victims with gunshot fractures of long limb bones for the period 08.2022–08.2023. Classical methods of clinical, X-ray and laboratory investigations were used. The assessment was carried out according to the AO classification, that was supplemented with new options for tangent and perforated bone injuries, as well as the volume of destruction of adjacent soft tissues. Wounds of all the patinets were treated using vacuum aspiration, the fragments were fixed with external devices manufactured by Biomet, Stryker, ТОВ «Ейч Ві Орто», ОРТОПАК. Results. The analysis showed that 64 (50 %) of the wounded had a need to take additional measures to preserve or improve the position of the fragments: improvement of the geometry of the external apparatus, replacement of the apparatus with a more perfected one, with a plate or intramedular osteosynthesis; replacement of the apparatus with a plaster bandage or orthosis. Conclusions. Based on the study, it can be argued, that most gunshot diaphyseal fractures of long bones are multifragmental and accompanied with destruction of predominantly peripherally located soft tissues. At the same time, the periosteum with a layer of adjacent muscles for the most part retains integrity, viability and connection with the surface of the fragments. The basic and rational method of fixation of fragments for diaphysical gunshot fractures it is necessary to consider external osteosynthesis with schanz-screws devices. According to our preliminary data, the use of external fixator treatment led to fracture healing in 84% of patients with gunshot hip fracture, 56 % — tibia fracture, 59 % — humerus fracture, and 44 % — forearm fractures.

Comparison And Analysis of Treatment Strategies for Radius Fractures: Internal Fixation Surgery Versus External Plaster Fixation Treatment

One of the most frequent forms of fractures is the radius fracture. This kind of fracture would have a significant negative impact on people's lives. There has been ongoing debate regarding the treatment options for radius fractures. This article conducts a comparative analysis of two treatment approaches for radius fractures: internal fixation surgery and non-surgical external plaster fixation treatment. This article provides a comprehensive elucidation and analysis of the principles, actual treatment outcomes, and various factors associated with these two treatment approaches. It separately outlines the treatment principles and real-world results for each of the two treatment methods, concluding with a summary and comparison. When viewed from a singular perspective, both treatment approaches demonstrate reasonable and excellent treatment outcomes. However, when these two approaches are compared, this article finds that surgical internal fixation typically outperforms non-surgical cast external fixation in a broader range of evaluations.

A practical definition of pin site infection

Pin Site Infection (PSI) is the most common complication of external fixation treatment. Several classifications and diagnostic approaches have been used with reported incidences varying widely from 1 to 100 %. The quality of the existing literature is limited by the absence of a definition. This renders comparing literature and developing evidence-based algorithms for prevention, diagnostics, and treatment difficult to impossible. Similar problems were identified with prosthetic joint infection (PJI) and fracture-related infection (FRI) in recent years, resulting in new, validated definitions.PSI is complicated by the complexity of the issue. Numerous factors in PSI need consideration. Factors may be related to the patient, the surgical technique, the pin-bone interface, the pin-skin interface, the choice of external fixation device and/or the material used and its properties. Reliably diagnosing PSI is one of the most pressing issues.New definitions for FRI or PJI have diagnostic criteria which can be either confirmatory or suggestive. Any positive finding of a confirmatory criterion constitutes an infection. Although PSI resembles PJI and FRI, distinct differences are present. The skin is never closed, and bacterial colonization is inevitable along the treatment duration. The external fixator is only temporarily in place; thus, the goal of all measures is to continue the external fixator until the intended indication is reached.This paper proposes the principles of a definition of PSI. This definition is not designed to guide any treatment of PSI. Its purpose is to create common ground for clinical investigations and publishing further research.

Treatment of unstable pelvic fractures in children with an external fixator: Retrospective study of 56 patients.

We retrospectively analyzed the data of patients who underwent external fixation treatment for unstable pelvic fractures and evaluated the clinical effects of this treatment and factors influencing pelvic function recovery. The data of patients with unstable pelvic fractures treated with an external fixator between January 2006 and December 2018 were retrospectively analyzed. The analyzed parameters included demographic data, fracture healing, pelvic asymmetry, deformity index, and complications. Fractures were categorized using the Tiles classification. Pelvic function was evaluated using the Cole score. Pelvic risk factors were identified using univariate and multivariate logistic regression analyses. Fifty-six patients (29 and 27 with type B and C fractures, respectively) were included. All fractures were healed at the time of the final follow-up. Nine and three patients had pin tract infections and loosened external fixators postoperatively, respectively. Pelvic asymmetry was reduced from 1.34 ± 0.15 cm to 0.70 ± 0.19 cm (p < 0.01), and the deformity index decreased from 0.13 ± 0.03 to 0.07 ± 0.02 (p < 0.01). The Cole score was excellent and good in 41 and 15 patients, respectively. Risk factors for pelvic function recovery included injury severity score > 25.5, age > 11.3 years, and lower-extremity fractures. External fixation is an effective method for treating unstable pelvic fractures in children, with the advantages of a simple operation, short surgical time, no interference with treatments for associated injuries, and avoidance of re-trauma caused by open reduction. An ISS > 25.5, patient age > 11.3 years, and associated lower-extremity fractures are predictors of pelvic function recovery. Level IV.

Comparison of the Clinical and Radiological Results of Volar Locking Plate and External Fixation Treatment of Intra-articular Fractures of the Distal Radius

Comparison of the Clinical and Radiological Results of Volar Locking Plate and External Fixation Treatment of Intra-articular Fractures of the Distal Radius

Axial external fixator in humerus shaft fractures

The causes of humeral shaft fractures are mostly high-energy traumas such as falling, hitting, traffic accident, and gunshot wounds. It may also occur as a result of simple falls due to osteoporosis in elderly patients. In surgical treatment, there are options such as intramedullary nail, plate-screw fixation and external fixator treatment. External Fixator Treatment it is the primary treatment option for soft tissue damage, open fractures, gunshot wounds, segmental bone loss, pseudoarthrosis, nonunion, and major vascular injuries. The purpose of the present study was to present the functional results of Axial External Fixator Treatment, which we often apply in humerus shaft fractures in our clinic. A total of 30 patients, who had gunshot wounds, multisystem injuries, open fractures, and advanced age comorbid problems, and who underwent Axial External Fixator Treatment due to humerus shaft fracture between January 2016 and January 2019 were included in the study. Disabilities of the Arm, Shoulder, and Hand (DASH) scores were used in clinical evaluations. Visual Analogue Scale (VAS) was used to evaluate the pain intensity in patients subjectively. Also, the results of patients with advanced age comorbid problems were compared with other patients. After a 12-month follow-up, significant improvements were detected in DASH scores. Although fracture union was later in patients with advanced age comorbid problems than in other patients, no differences were detected between union rates, clinical outcomes, and the surgical processes.We think that it is a more appropriate surgical technique than other surgical methods, due to its shorter surgical time and less invasiveness in patients with advanced age, high comorbidity and multisystem damage.

Limited internal fixation combined with a hinged external fixator in treatment of peri-elbow bone infection

To evaluate the effectiveness of limited internal fixation combined with a hinged external fixator in the treatment of peri-elbow bone infection. The clinical data of 19 patients with peri-elbow bone infection treated with limited internal fixation combined with a hinged external fixator between May 2018 and May 2021 were retrospectively analyzed. There were 15 males and 4 females with an average age of 44.6 years (range, 28-61 years). There were 13 cases of distal humerus fractures and 6 cases of proximal ulna fractures. All the 19 cases were infected after internal fixation of fracture, and 2 cases were complicated with radial nerve injury. According to Cierny-Mader anatomical classification, 11 cases were type Ⅱ, 6 cases were type Ⅲ, and 2 cases were type Ⅳ. The duration of bone infection was 1-3 years. After primary debridement, the bone defect was (3.04±0.28) cm, and the antibiotic bone cement was implanted into the defect area, and the external fixator was installed; 3 cases were repaired with latissimus dorsi myocutaneous flap, and 2 cases were repaired with lateral brachial fascial flap. Bone defects repair and reconstruction were performed after 6-8 weeks of infection control. The wound healing was observed, and white blood cell (WBC), erythrocyte sedimentation rate (ESR), and C-reaction protein (CRP) were reexamined regularly after operation to evaluate the infection control. X-ray films of the affected limb were taken regularly after operation to observe the bone healing in the defect area. At last follow-up, the flexion and extension range of motion and the total range of motion of the elbow joint were observed and recorded, and compared with those before operation, and the function of the elbow joint was evaluated by Mayo score. All patients were followed up 12-34 months (mean, 26.2 months). The wounds healed in 5 cases after skin flap repair. Two cases of recurrent infection were effectively controlled by debridement again and replacement of antibiotic bone cement. The infection control rate was 89.47% (17/19) in the first stage. Two patients with radial nerve injury had poor muscle strength of the affected limb, and the muscle strength of the affected limb recovered from grade Ⅲ to about grade Ⅳ after rehabilitation exercise. During the follow-up period, there was no complication such as incision ulceration, exudation, bone nonunion, infection recurrence, or infection in the bone harvesting area. Bone healing time ranged from 16 to 37 weeks, with an average of 24.2 weeks. WBC, ESR, CRP, PCT, and elbow flexion, extension, and total range of motions significantly improved at last follow-up ( P<0.05). According to Mayo elbow scoring system, the results were excellent in 14 cases, good in 3 cases, and fair in 2 cases, and the excellent and good rate was 89.47%. Limited internal fixation combined with a hinged external fixator in the treatment of the peri-elbow bone infection can effectively control infection and restore the function of the elbow joint.

A SYSTEMATIC REVIEW OF REHABILITATION TECHNIQUES FOR ADULT PATIENTS UNDERGOING EXTERNAL FIXATOR TREATMENT FOR LIMB RECONSTRUCTION OF THE LOWER LIMB

IntroductionExternal fixators are common surgical orthopaedic treatments for the management of complex fractures and in particular, the use of circular frame fixation within patients requiring limb reconstruction. It is well known that common complications relating to muscle length and patient function without rehabilitation can occur. Despite this there remains a lack of high-quality clinical trials in this area investigating the role of physiotherapy or rehabilitation in the management of these patients. We aim to complete a systematic review of rehabilitation techniques for patients undergoing external fixator treatment for Limb Reconstruction of the lower limb.Materials &amp; MethodsA comprehensive search of AMED, CINAHL, MEDLINE and COCHRANE databases was conducted to identify relevant articles for inclusion, using a search strategy developed in collaboration with a research librarian. Inclusion criteria consisted of adults aged 18 years and over who have experienced leg trauma (open fracture, soft tissue damage), elective leg deformity corrective surgery, bone infection or fracture non-union who have been treated with the use of an external fixator for fixation. Specific exclusion criteria were patients below the age of 18 years old, patients with cancer, treatment of the injury with internal nail, patients who underwent amputation, the use of external fixators for soft tissue contracture management, editorials, comment papers, review papers, conference proceedings and non-English papers.Titles, abstracts, and full texts were screened for suitability by pairs of reviewers according to the inclusion and exclusion criteria using Rayyan QCRI online software. Any conflicts were resolved through discussion with three independent specialist senior reviewers. Following full text screening, references lists of included articles were manually searched to ensure that all relevant studies were identified. Due to lack of evidence, forward searching was also completed for studies included in the review. Data quality was assessed using the mixed methods appraisal tool and the CERT assessment tool was utilised to look at completeness of reporting of exercise interventions.ResultsA total number of 832 articles were initially retrieved from our search once duplicate articles removed. After title and abstract screening, 45 articles remained for full text screening. Of these, 11 articles met our inclusion criteria and included for data extraction.ConclusionsWe expect high variability of results due to our inclusion criteria and therefore plan to conduct a narrative synthesis to summarise the findings whilst measing against the mixed methods appraisal tool and CERT assessment scores to assess the data quality. We anticipate lower assessment scores within the fewer articles found and therefore poorer-quality data. We currently are in the process of finalising this data extraction. This will be completed ready for submission and potential presentation at the BLRS conference in March 2023.

Temporary bridging trans-hip external fixation in damage control orthopaedics treatment after severe combat trauma: A clinical case series

The role of external fixation in Damage Control Orthopaedics has been well described. Temporary external fixation has been recommended to provide relative bone stability while the soft tissue heals, prior to formal open reduction and internal fixation. Temporary bridging external fixation, that spans the joint, is recommended as primary skeletal stabilization in complex intra-articular and peri-articular fractures, in extensive peri-articular soft-tissue damage around the knee, ankle, elbow and wrist joints. Works devoted to temporary trans-hip external fixation in treatment of complex high-energy injuries are relatively rare. The purpose of this article is to present our experience in using temporary hip spanning external fixation during primary treatment of six patients suffered from complex open intra-articular and peri-articular fractures of the proximal femoral bone with extensive soft tissue damage due to war blast or high-velocity gunshot trauma. Primary management was based on the concept of Advanced Trauma Life Support and Damage Control Orthopaedics. Conversion to definitive bone reconstruction was performed on the next stage of the treatment after general and local stabilization.

Possibility of Locking Compression Plate as the Treatment of External Fixation for Femoral Bone Based on Finite Element Method

Possibility of Locking Compression Plate as the Treatment of External Fixation for Femoral Bone Based on Finite Element Method

Editorial Comment on the Article by Belenkiy I.G. et al. “Strategies of Osteosynthesis: Problems and Perspectives”

The commentary critically analyzes the strategy proposed by the authors of the article for performing osteosynthesis and describes the system of care for patients with fractures in Moscow. Operating rooms are divided into planned and emergency. And they, in turn, are divided into conventional and hybrid, in which it is simultaneously possible to perform endoscopic, endovascular, and open surgery. Surgeries are performed in order of priority. Highest priority: extra-focal fixation of limb bones and/or pelvis with ex-fix devices; surgery on extremities with impaired blood supply in the distal parts; decompressive fasciotomies with simultaneous external fixation of fragments in ex-fix devices with suspected formation of compartment syndrome; surgeries performed in patients with severe combined or multiple trauma. High priority: open fractures of type 3A and 3B according to the Gustillo classification, requiring primary surgical treatment of wounds and external fixation; closed unstable fractures.

Application of Smart Healthcare in Comparative Analysis of Effect of Early External Fixator and Plate Internal Fixation Treatment on Postoperative Complications and Lower Limb Function Recovery of Patients With Unstable Pelvic Fracture.

ObjectiveTo comparatively analyze the effect of early external fixator and plate internal fixation treatment on postoperative complications and lower limb function recovery of patients with unstable pelvic fracture based on smart healthcare.MethodsThe clinical data of 98 patients with unstable pelvic fractures treated in our hospital from August 2018 to August 2021 were collected for retrospective analysis, and the patients were split into group A (plate internal fixation, n = 49) and group B (early external fixator treatment, n = 49) according to the surgical modalities. The time of operation, intraoperative blood loss, postoperative complications, etc. were compared between the two groups.ResultsBetween the two groups, group B had significantly better clinical indicators (P < 0.001), a greatly higher good rate of fracture reduction and postoperative Harris score (P < 0.05), and obviously lower VAS score and total incidence rate of postoperative complications (P < 0.05).ConclusionThrough the analysis based on smart healthcare, it is found that compared with plate internal fixation treatment, early external fixator treatment presents a better effect in treating patients with unstable pelvic fracture, because it is a reliable method to accelerate fracture healing, reduce postoperative complications, and improve lower limb function.

Retrospective clinical outcomes in the definitive treatment of high-energy tibial diaphyseal fractures using hexapod external fixator versus monolateral external fixator

BackgroundExternal fixation, which can preserve the biomechanical microenvironment of fracture healing, plays an important role in managing the high-energy fractures with poor surrounding soft tissues. The purpose of this study was to determine the differences of clinical outcomes, if any, between hexapod external fixator and monolateral external fixator in the definitive treatment of high-energy tibial diaphyseal fractures.MethodsA total of 53 patients with high-energy tibial diaphyseal fractures and definitively treated by the hexapod external fixator (HEF) or monolateral external fixator (MEF) were retrospectively collected and analyzed, from March 2015 to June 2019. There were 31 patients in the HEF treatment, and the other 22 patients were managed by the MEF. The demographic data, surgical duration, external fixation time, final radiological results, complications, and clinical outcomes were documented and analyzed. Difficulties that occurred during the treatment were classified according to Paley. The clinical outcomes were evaluated by the Association for the Study and Application of the Method of Ilizarov criteria (ASAMI) at the last clinical visit.ResultsThe mean surgical duration in the HEF group (62.4 ± 8.3 min) was shorter than that in the MEF group (91.4 ± 6.9 min) (P < 0.05). All patients acquired complete bone union finally. Patients in the HEF group (24.2 ± 3.1 weeks) underwent a shorter average external fixation time than that in the MEF group (26.3 ± 3.8 weeks) (P < 0.05). Satisfactory alignment was achieved in all patients without the need for remanipulation. The residual sagittal plane deformities in the HEF group were all less than that in the MEF group (P < 0.05). The complication rate was 35.5% in the HEF group, while 45.5% in the MEF group. There was no statistically significant difference between the two groups in ASAMI scores (P > 0.05).ConclusionThere is no statistically significant difference in finally clinical outcomes between hexapod external fixator and monolateral external fixator in the definitive treatment of high-energy tibial diaphyseal fractures. The hexapod external fixation treatment is a superior effective method, including advantages of stable fixation, less surgical duration, postoperatively satisfactory fracture reduction, and fewer complications.

Management algorithm of external fixation in lower leg arterial injury for limb salvages

PurposeThe aim of this study is to investigate the outcome of these limb-threatening injuries through external fixation treatment and to discuss the case of patients’ functional recovery after external fixation.MethodsDemographics, surgical treatment and outcomes in 88 patients with lower leg arterial injuries treated by external fixation at two trauma centers from 2009 to 2018 were reviewed. The primary outcome was the rate of successful lower leg salvage, while secondary outcomes were complications and functional recovery.ResultsEighty-eight patients were identified and 80 patients (90 legs) maintained a successful lower leg salvage. The mean age was 32.7 ± 10.8 years, and 81.8% were male. The primary outcomes included the following complications: pin-tract infection (8 legs), pins loosening (4 pins), wound superficial infection (7 legs), deep infection developed osteomyelitis (3 legs), bone nonunion or bone defect (17 legs) and amputation (8 legs). The average healing time of fracture was 5.6 ± 4.3 months. The maintain of external fixation average time was 5.8 ± 3.6 months. The improvement of scores of the pain, function and quality of life in our follow-up was statistically significant.ConclusionFor the lower extremity fracture patients with vascular injuries, using external fixation correctly can improve clinical outcomes and produce the improvement of pain, function and the quality of life.Level of evidenceRetrospective cohort, level IV.

Do pin site cleaning techniques and solutions affect pin site infection rate in external fixation? A systematic review of randomized and nonrandomized trials

Introduction: Infection at the pin site connecting an external fixator to the limb is a common and potentially serious complication of frame treatment. Impacted by many patient and injury factors, further variables exist in terms of the way in which pin sites are cared for. Timing and techniques used to clean pin sites vary substantially and are an attractive domain in which to intervene to decrease infection due to the extent of the associated complications and number of patients involved. Through this review, we explore the impact of cleaning techniques and solutions on pin site infection. Methodology: A systematic literature review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, MEDLINE, Cochrane Controlled Trials Register (1996–2022), and EMBASE (1974–2022) were searched in January 2022. Results: Thirty-two articles were identified and following eligibility criteria application 14 studies were analyzed. Nine hundred and fourteen adult and child patients undergoing external fixation treatment 2003–2021 in 12 countries were included. Nine studies used an outcome measure and of these, five different outcome measures were used. The literature was graded as having either some or high concerns of bias. No pooling of data was enabled. Discussion: The literature investigating variables impacting on pin site care in terms of solutions used, technique, and timing of care is poor. Variance in methodology, populations compared, interventions, and outcomes preclude meaningful analysis or conclusions. In particular, the lack of consensus on diagnosis and classification compromises studies relating to this question. Conclusions: Pin site infection is a significant issue in patients undergoing external fixation. The available literature cannot be used to guide care. We strongly recommend a consensus is derived on methodology for studies investigating pin site care. A well-designed randomized controlled trial would carry huge value due to the numbers of patients whose care could be improved through a reduction in pin site infection. Objective: To estimate the impact of pin site cleaning techniques and solutions in preventing pin site infection in patients treated with external fixation. The question which this systematic review address is: “Does pin site cleaning techniques and solutions affect pin site infection rate in external fixation?”

Conversion from Spanning External Fixation to Open Reduction Internal Fixation Contributes to Healing of Soft Tissues and Fractures in Open Distal Humeral Fractures.

BackgroundOpen distal humeral fractures (DHFs) often lead to loss of elbow function, thereby seriously affecting patient quality of life. The aim of this study was to evaluate the treatment outcomes of 2 surgical techniques to determine the better method for repairing open DHFs. Both groups were treated with immediate debridement first, and then group I had only internal fixation (IF), while group II underwent initial external fixation (EF) followed by IF surgery.Material/MethodsThis retrospective study included 32 patients who had open DHFs between 2013 and 2018. Twelve patients underwent thorough debridement and temporary EF treatment and converted to IF as the ultimate treatment. Twenty patients were treated with immediate open reduction and internal fixation (ORIF). Data of final treatment outcomes were analyzed at the latest follow-up. A comparative analysis of radiological results, function observations, and complications was performed for the 2 surgical groups.ResultsAll DHFs and osteotomized olecranon united after a mean of 5.2±1.21 months. No significant differences were observed in other preoperative demographic data between the 2 groups. Moreover, there was no significant difference in postoperative complications, elbow range of motion, or fracture healing time between the 2 groups.ConclusionsThe evidence provided by our study highlights the efficacy of definitive IF in treating open DHFs, which is recommended whenever possible. Furthermore, the combination of EF and ORIF, according to the type of soft tissue damage, may be a promising treatment option with a low revision rate for patients with open DHFs.

COMPARISON OF EXTERNAL FIXATION AND PLASTER CASTING RESULTS IN DISTAL RADIUS METAPHYSIS FRACTURES THAT ARE NOT SUITABLE FOR OPEN REDUCTION

Objective: We aimed to compare the radiographic and functional results of extra-articular metaphyseal fractures of the distal radius treated with closed reduction and plaster casting (CRPC) and bridging external fixation (EF).Material and Methods: This retrospective study included 65 patients with distal radius fractures. The mean age of the patients was 55 years. Patients were divided into two groups, which were called the CRPC group and bridging EF group. All fractures were AO/OTA type A3. All patients were evaluated with Green and O'Brien Score modified by Cooney, Mayo Wrist Score and The Disabilities of the Arm, Shoulder, and Hand (DASH) at the end of the first year.Results: The mean age was 54.32±8.61 years in the CRPC group and 56.65±8.31 years in the Bridging EF group. The mean follow-up time was 24.06±8.67 months in the CRPC group and 24.88±9.2 months in the bridging EF group. When the fractures were compared radiologically during the evaluation at the end of the first year, radial inclination and radial length results in the bridging EF group were statistically significant compared to the CRPC group. When the range of motions was compared in the fractures during the clinical examination, they were statistically significant in the bridging EF group compared to the CRPC group. There was no statistical significance in Green and Mayo scores in terms of the scoring between the groups. DASH score was 10.88±2.99 in the CRPC group and 5.73±2.57 in the bridging EF group, and it was statistically significant (p&amp;lt;0.001).Conclusion: Bridging EF treatment can be recommended as one of the primary treatment options in AO/OTA type A3 radius fractures, whose soft tissue does not allow open surgery, because it is a less invasive technique and provides successful clinical results.

Narrative review of ring fixator management of recurrent club foot deformity.

Despite the widespread use of the Ponseti method for treatment of clubfeet, there continue to be a significant number of patients who present with a severe, stiff clubfoot as a result of extensive intra-articular soft tissue release or lack of access to care. In such patients, circular external fixators can be utilized for deformity correction with distraction across soft tissues, joints, and osteotomies. Ilizarov or hexapod circular fixators may be utilized according to surgeon preference. Indications for soft tissue release and osteotomies to aid in correction of clubfoot deformity with Ilizarov and hexapod fixators are not standardized and are guided by patient age, joint congruity, soft tissue suppleness, and osseous deformity. Correction time varies according to clubfoot deformity severity. Following deformity correction, external fixators are left in place for several weeks to stabilize the soft tissues and allow for osteotomy healing. Complications range from relatively minor pin tract infections that resolve with oral antibiotics to tarsal tunnel syndrome, osteomyelitis, or disabling arthritis requiring revision procedures. At Scottish Rite Hospital for Children, we prefer to correct severe residual clubfoot deformity with a hexapod external fixator. Acute correction and gradual correction via distraction are considered for each segmental deformity and utilized to efficiently correct deformity while minimizing soft tissue trauma. The purpose of this article is to summarize the relevant literature related to circular external fixator treatment of recurrent clubfoot deformity and outline our approach to the segmental deformities of the foot and ankle in this patient population.

Bony callus stiffness indirectly evaluated by the axial load-share ratio in vivo as a guide to removing a monolateral external fixator safely

PurposeAs the monolateral external fixator is increasingly used in trauma-control and definitive management for high-energy long bone fractures, timing the fixator removal remains a challenge for surgeons. The purpose of this study was to determine the feasibility and effectiveness of the bony callus stiffness indirectly evaluated by the axial load-share ratio in vivo as a guide to removing a monolateral external fixator safely.MethodsA total of 131 patients with tibial shaft fractures treated by the monolateral external fixator in our institution were collected from January 2013 to July 2019. In group I, the fixators were removed based on the clinical and radiological assessment only by the treating surgeon. As for group II, the axial load-share (LS) ratio test was accomplished by another medical team without the knowledge of the clinical results. The external fixator was removed when the mechanical test outcome (LS ratio < 10%) was consistent with the conclusion drawn from the clinical and radiological assessment (bone union achieved) by the treating surgeon.ResultsThere was no statistical significance in demographic data between the two groups (P > 0.05). In group I, four patients suffered refracture (the refracture rate was 7.7%) after fixator removal and were successfully treated by an intramedullary nail. In group II, 71 patients underwent fixator removal after the first mechanical test, and another eight patients terminated the external fixation after the second test. None of the 79 patients in group II suffered refracture (the refracture rate was 0%). There was statistical significance in the refracture rate between the two groups (P < 0.05).ConclusionThe bony callus stiffness indirectly evaluated by the axial load-share ratio in vivo using the additional circular frame components is an effectively quantitative indicator to complement the clinical assessment of fracture healing in a monolateral external fixation treatment. Removal of the monolateral external fixator is safe when the axial load-share ratio dropped below 10%.