External Fixation In Management Research Articles

Hybrid external fixator as primary fixation in the management of proximal tibia fractures in low resource setting –our experience

Tibial plateau fractures consists of 1% of all fractures. The goals in management of such fractures are anatomical reduction and maintaining joint congruity,stable fixation of fracture fragments, restoration of joint alignment with minimal soft tissue dissection and early mobilization.The purpose of the study is to highlight the technique and assess the utility and functional outcome of hybrid external fixation in periarticular fractures of tibia.A prospective study to determine the functional and radiological outcome of hybrid external fixation in management of periarticular fractures of proximal tibia which included both open (Gustilo Anderson IIIA &B) and closed injuries(Shatzker 5 &6) at our institution. 81 patients with 36 months follow up showed excelled and good outcome in 88% with Rasmussen’s knee score using hybrid external fixator as primary modality of treatment with less than 20% of cases requiring additional procedures and all cases united and there was no case of non union.The hybrid external fixator provides proper osseous stability without compromising the soft tissue and allows early mobilization which results in good functional outcome.

A systematic Review to Compare between Bridging Plate and Spanning External Fixator in Management of Comminuted Distal End Radius Fractures

A systematic Review to Compare between Bridging Plate and Spanning External Fixator in Management of Comminuted Distal End Radius Fractures

Temporary external fixation in the management of orthopaedic trauma

Temporary external fixation is frequently employed nowadays in the immediate management of orthopaedic trauma. It is particularly effective in major trauma and in open fractures or periarticular fractures of the lower limb with soft tissue compromise. In addition it is used for more recent indications such as intraoperative adjuncts to internal fixation. Despite the associated complications and pitfalls described, in most cases the benefits of temporary external fixation in the initial management of injured bones and soft tissues outweigh the risks, and facilitate the eventual definitive treatment. The application of a stable external fixator construct is an essential skill for any orthopaedic surgeon who manages trauma; despite this, the skill seems to be in decline outside major trauma centres in the UK. Inclusion of external fixation in the mandatory indicative procedures of the trauma and orthopaedic curriculum serves as a useful reminder of its value.

Risk Factors for Revision Surgery Following Radial Head Arthroplasty without Cement for Unreconstructible Radial Head Fractures: Minimum 3-Year Follow-up.

Revision rates following radial head arthroplasty (RHA) for unreconstructible radial head fractures (RHFs) differ vastly in the literature, and little is known about the risk factors that are associated with revision surgery. The purposes of this study were to assess the revision rate following RHA and to determine the associated risk factors. A total of 122 patients (mean age, 50.7 years; range, 18 to 79 years) with 123 RHAs who underwent RHA for unreconstructible RHFs between 1994 and 2014 and were ≥3 years out from surgery were included. Demographic variables, injury and procedure-related characteristics, radiographic findings, complications, and revision procedures were assessed. Cox regression analysis was performed to identify the risk factors that were associated with revision surgery following RHA. The median follow-up for the study cohort was 7.3 years (interquartile range [IQR], 5.1 to 10.1 years). All of the patients had unreconstructible RHFs: Mason-Johnston type-IV injuries were the most prevalent (80 [65%]). One or more associated osseous or ligamentous injuries were seen in 89 elbows (72.4%). The median time to surgery was 7 days (IQR, 3 to 11 days). Implanted prostheses were categorized as rigidly fixed (65 [52.8%]) or loosely fixed (58 [47.2%]). A total of 28 elbows (22.8%) underwent revision surgery at a median of 1.1 years (IQR, 0.3 to 3.8 years), with the majority of elbows (17 [60.7%]) undergoing revision surgery within the first 2 years. The most common reason for revision surgery was painful implant loosening (14 [29.2% of 48 complications]). Univariate Cox regression suggested that Workers' Compensation claims (hazard ratio [HR], 5.48; p < 0.001) and the use of an external fixator (HR, 4.67; p = 0.007) were significantly associated with revision surgery. Revision rates following RHA for unreconstructible RHFs are high; the most common cause for revision surgery is painful implant loosening. Revision surgeries are predominantly performed within the first 2 years after implantation, and surgeons should be aware that Workers' Compensation claims and the use of an external fixator in management of the elbow injury are associated with revision surgery. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Reconstruction of infected nonunion of the distal humerus by Ilizarov external fixator.

Infected nonunion of the distal humerus represents a true challenge as the fragment is usually small and difficult for fixation. The aim of the present study is to assess the results of Ilizarov external fixator in management of infected nonunion of the distal third humerus. Twenty-three patients with infected nonunion of the distal humerus were included in this study. The ages ranged from 19 to 58 years with an average of 35 years. Seventeen cases were males and 6 were females. All patients were treated by radical debridement and application of Ilizarov external fixator in one stage surgery. Bony union was achieved in all cases. Bone graft was required in 12 patients with hypotrophic nonunion. The external fixation time ranged from 4 to 9 months with an average of 5.6 months. Infection was controlled in all cases without recurrence during the period of follow up. The complications included pin tract infection in 7 cases, radial nerve injury in one case, elbow stiffness in 4 cases and refracture after frame removal in one case. Ilizarov external fixator is effective in management of infected nonunion of the distal humerus. The thin tensioned wires produce good grip in the small or osteoporotic bone fragments.

Functional outcome in treatment of distal radius fractures using external fixator

Introduction and Background: Fractures involving the distal end of radius are one of the frequently encountered injuries in orthopaedics. Conventionally the fractures were treated with closed reduction and immobilization with casts. Even though union of these fractures occurs, it has very high incidence of going in for malunion and joint disability and instability especially those with comminution & intra articular extension. Moreover there is a changing trend in the age group, seen more commonly in the younger age group as a result of Road traffic accidents & trauma, leading to complicated fractures especially with intra articular extension & comminution. Over past few years, the importance of alignment correction, preservation of normal radial length and reconstruction of congruity of radiocarpal and radioulnar joints has been emphasized. Anderson and O’ Neil, were the first to introduce the use of external fixation in the treatment of these fractures. Since then there is a trend to use external fixators in management of these fractures as they give improved results both functionally as well as improved anatomic reconstruction. To be safe, effective and to give improved results the fixator chosen should be easy to use, allow re -reduction, low rate of complications and should be stiff enough to maintain the alignment. With better understanding of the principles of external fixation, this procedure has become an indispensable tool in the management of intra articular distal end of radius fractures.

External fixators in management of high energy distal third tibia fractures

Background: Outcomes of management of high energy distal third tibial fractures are not satisfactory and associated with complications. So use of external fixator is increased in recent years for distal third tibia fractures. We intend to study the utility of external fixators in high energy distal third tibial fractures.Materials and Methods: This is retrospective observational study included 38 patients who underwent close reduction and external fixation with Augmented Wagners external fixator or Aesculap external fixator(unilateral) or Hybrid external fixator for lower third tibial fractures in between 2009 and 2015.Results: The Olerud C and Molander H ankle score was excellent in 44.73% (n=17), good in 31.57% (n=12), fair in 15.78% (n=6) and poor in 7.89% (n=3). The ankle range of movement was near normal in 94.73% cases except in 2 patients where stiffness was encountered. The average duration of union was 6 months and 89% (n=34) of fractures united within 7 months. P value

Intra-articular fracture distal end radius external fixation versus locking volar radius plate: A comparative study

Introduction: The purpose of the present study was to compare the results obtained by management of intra-articular fractures of distal end radius with closed reduction and external fixation versus open reduction and internal fixation with locking distal radius volar plate. Material and Method: The present study included 60 patients of distal intra-articular radius fractures. Patients were randomly divided into two groups: group I (close reduction and external fixator) and group II (open reduction and internal fixation with volar plating). Periodic clinical examination and x-ray review was carried out to find out functional outcome,range of motion, radiological outcome and complication. Patients were followed up for 6 month. Mean of all the quantitative variables was compared between two groups by unpaired 'T' test. Functional outcome was measured with Quick DASH score. Result: In present study palmer tilt,radial length and radial inclination was significantly greater in volar plate group.ulnar varience was more(-1.18mm) in volar plate group than external fixator group(-1.28mm). The mean QuickDASH scores and time to return to work were similar in patients treated with a locking plate and external fixator (QuickDASH score 2.4 ± 3.0 and 2.9 ± 5.4; 1.9 ± 0.5 months and 2.1 ± 0.7 months, respectively; P > 0.05).In present study Quick DASH score in ext fix group was 9.71 compaired to volar plating group 6.79 at the final followup. Complication rate were higher in close reduction and external fixation group as compared to open reduction and volar plating group. Conclusion: Open reduction and internal fixation with plate fixation had better functional outcome with less complication rate than close reduction and external fixation in management of intra-articular fractures distal end radius.

Gradual fibular transfer by ilizarov external fixator in post-traumatic and post-infection large tibial bone defects.

Several reconstructive procedures have been used in management of large tibial bone defects including bone graft, bone transport (distraction osteogenesis) using various external fixators, and vascularized bone graft. Each of these procedures has its limitations and complications. The study describes gradual medial fibular transfer using Ilizarov external fixators in management of patients with large tibial defect, either following infection or trauma. Between May 2011 and June 2013, 14 patients were prospectively included in the current study. The inclusion criteria were large tibial defect due to trauma or infection with severe soft tissue compromise, and small or poor tibial bone remnants making bone lengthening difficult. Exclusion criteria were patients with vascular or nerve injuries. The average age of the patients was 31.64 (± 6.5) years. Medial fibular transfer was done for all patients using Ilizarov at a rate of 0.5mm twice daily. Iliac bone graft was used in all patients after the transfer. The average segmental bone defect of the tibia was (13.2 ± 2.6), ranging between 8 and 18.6cm. Union was achieved in all patients with average fixator time was 32.42(± 4.32) weeks. Average follow-up after removal of the fixator was 40.5 (± 6.9) months. Gradual fibular transfer by Ilizarov external fixator is a reliable technique in management of post-traumatic and post-infection large tibial bone defects with good clinical outcome, and with few complications.

Management of metacarpophalangeal bone defects after hand trauma by distraction osteogenesis with mini external fixation

Objective To evaluate the outcomes of distraction osteogenesis with mini external fixation in management of metacarpophalangeal bone defects after hand trauma. Methods From June 2010 to December 2015, 16 patients with metacarpophalangeal bone defects after hand trauma received distraction osteogenesis at our department. They were 11 men and 5 women, from 20 to 45 years of age (average, 32.5 years). There were altogether 20 bone defects: 8 cases had single metacarpal bone defect, 2 unilateral second and third metacarpal bone defects and 6 phalangeal shortening after repair of digital stump (involving thumb in 4 cases, index finger in one and index and middle fingers in one). The metacarpophalangeal bone defects averaged 1.8 cm (from 1.0 to 3.1 cm). Under the fluoroscopic guide, 4 or 6 mini half-pins in one line were directly drilled into the dorsal aspect of the involved metacarpophalangeal bone before the Orthofix fixator was mounted. The proximal (18 digits) or distal (2 digits) osteotomy between the second and third pinholes was performed via the dorsal approach. The external fixator and pins were removed without anesthesia after callus maturation. Results Average follow-up period was 12.2 months (range, from 9 to 26 months). All the metacarpal bone defects were reconstructed and all the phalangeal shortenings were lengthened; the bony callus was completely calcified at the lengthened part. The mean lengthening was 1.9 cm (from 1.0 to 3.1 cm); the percentage of lengthening ranged from 26% to 51% (average, 34%). The bone lengthening index (time cost by average 1 cm) was 70.9 d/cm (from 60.0 to 87.1 d/cm). According to the Tentative Assessment Criteria for Upper Extremity Function by Hand Surgery Society, Chinese Medical Association, the total activity of motion (TAM) was excellent in 13 cases, good in 4, fair in 2, and poor in one, yielding an excellent to good rate of 85.0%. Conclusion Distraction lengthening using mini external fixation is a valid option with a minor rate of complications which allows for early functional exercise to help restore the appearance and function of the affected fingers. Key words: Hand; Injury; External fixators; Bone lengthening; Bone defect

Use of recycled external fixators in management of compound injuries

ABSTRACTBackground: Compound fractures form a bulk of Orthopaedic Trauma cases in a developing country like India. External Fixation devices are the mainstays of treatment of these open fractures. They are generally used as a one use disposable device and add a great burden to the health care costs, especially in a developing country. In our study we evaluated the efficacy and complication rate of recycled external fixators with that of new external fixators.Materials and methods: This was a prospective randomised interventional study conducted in a tertiary care teaching hospital of a developing country. Patients who fulfilled the inclusion criteria were entered into the trial of new vs. recycled external fixators. Outcome indicators used were pin tract infections, loss of fixation and loosening of components.Results: Patients were evaluated at the time of removal of fixator components for outcome indicators. Of the 95 patients in our study (49 new frames and 46 recycled frames) no significant difference was found in the incidence of pin tract infection (8.16% in new vs. 8.69% in recycled), loss of fixation (10.2% in new vs. 13.04% in recycled) and loosening of components (6.12% in new vs. 8.69% in recycled).Conclusion: Around 17% of consentable patients did not want to have an external fixator system with recycled components. Our study concluded that recycling of external fixator components is safe and equally effective, with sizable cost saving.

Results of a compression pin alongwith trochanteric external fixation in management of high risk elderly intertrochanteric fractures.

Background:External fixation is a well-known procedure for the management of intertrochanteric fractures in very elderly high-risk patients. A new compression pin that can be adapted to all fixators was designed to provide inter fragmentary compression. In the present study, its effects on the fracture stability and healing were evaluated.Materials and Methods:Thirty-one patients treated using compression pin and thirty-six patients treated using standard pins were evaluated retrospectively between January 2009 and July 2014. Patients were evaluated according to age, gender, duration of preoperative period, duration of operation time, American Society of Anesthesiologists (ASA) scores, and immediate postoperative and final femoral neck angle measurements. The stability of the fixation was evaluated by calculating the secondary varus angulation after weight bearing.Results:Thirty one patients (82.1 ± 6.1 years old) comprised the compression pin group, and 36 patients (83.33 ± 6.24 years old) comprised the standard pin group. From the time of weight bearing to healing time, 1.0 ± 1.25° (0–4) and 2.5 ± 1.8° (0–9) of secondary varus angulation in the compression pin and standard pin groups were measured, respectively (P = 0.000). With weight bearing, 2 of 31 (6%) and 9 of 36 (25%) patients in the compression and standard pin groups, respectively, had >4° of secondary varus angulation. In the compression pin group, 13 fractures were unstable, but only 2 (15%) of them had >4° of secondary varus angulation. In the standard pin group, 19 fractures were unstable, and 7 (37%) of them had >4° of secondary varus angulation.Conclusions:Treatment of very elderly, high risk patients’ with intertrochanteric fractures with external fixation is effective. Compression pin maintained stability better than standard pins after weight bearing, especially for unstable intertrochanteric fractures.

Early Results of A Simple Distraction Dynamic External Fixator in Management of Comminuted Intra-Articular Fractures of Base of Middle Phalanx

Treatment for comminuted fracture dislocations of the proximal interphalangeal joint (pilon injuries) remains a challenge. We present our short term results of twelve pilon fracture dislocations treated by closed reduction and application of a distraction dynamic external fixator. The aim of the study was to assess the clinical outcomes and compare them to the original description by Hynes and Giddins. A cohort of 12 consecutive patients with pilon fracture of the proximal interphalangeal joint (comminuted fracture of the base of middle phalanx, longitudinally unstable with joint subluxation), were treated with this method over the study period. Data was collected by an independent observer at last follow-up appointment in the clinic. The outcome measures recorded were; level of residual pain, arc of motion, X-ray appearance, return to work and satisfaction with the procedure. The study group comprises of 7 male and 5 female patients at a mean age of 38.1years (range 21-70years). The average range of movement achieved was 13-87° at a mean follow-up of 16.4weeks (Range 12-42weeks). Early return to work, good pain relief and high level of patient satisfaction were achieved. No serious complication was noted during this period. We used the construct with slight modification of the original description and we feel this modification may help to reduce the pin site infection. We found the results reproducible and based on our experience we recommend this technique to treat these complex intra-articular fractures of base of middle phalanx.

Treatment of complex tibial plateau fractures using Ilizarov external fixator with or without minimal internal fixation

Background The tibial plateau is a critical weight-bearing area located on the upper end of the tibia. The lesion may be restricted to the tibia or associated with significant soft-tissue injury. The aim of the present study is to assess the results of closed reduction and Ilizarov external fixation in management of comminuted tibial plateau fractures. Patients and methods The study included 20 patients with high-energy tibial plateau fractures (Schatzker types V and VI). The ages ranged from 23 to 56 years, with an average of 30 years. The trauma was a road traffic accident in 11 cases and a fall from a height in nine cases. The fractures were closed in 16 cases and open in four cases. The open fractures were Gustilo–Anderson type I in one case and type II in three cases. Soft-tissue injuries associated with closed fractures were classified according to Tscherne system. The follow-up period averaged 31 months. The mean duration of surgery was 70 min (range: 40–120 min). The mean time to union was 10.4 weeks. At the final follow-up, the average total range of knee flexion was 112.5° (range: 0–170°). Results Results were satisfactory in 18 cases and unsatisfactory in two cases according to the Rasmussen knee functional score. Complications included pin-tract infection in 12 cases, an extension lag in two cases and varus deformity of about 15° in one case. Conclusion Hybrid external fixation is a good method for the treatment of comminuted tibial plateau fractures. It allows for early joint movement and reduces the risk of serious complications.

Stability of external fixators in management of complex lower limb fractures: A biomechanical study

Stability of external fixators in management of complex lower limb fractures: A biomechanical study

Application of an external fixator for acute displaced mid-clavicle fracture

Objective To evaluate clinic application of an external fixator in management of acute displaced mid-clavicle fracture and infected clavicle non-union.Methods From June 2002 to May 2009,7 cases of displaced mid-shaft clavicle fracture were treated in our department.They were 4 men and 3women,aged from 25 to 42 years(average,33.7 years).By Edinburgh classification,they were all type 2B1.Five acute cases complicated with multiple injuries received closed reduction and fixation with an Orthofix M511 external fixator on the day of injury.One open clavicle fracture and one infected clavicle nonunion received fixation with a Hoffman Ⅱ fixator at a proper time.Results All the patients were followed up for a mean time of 14.1 months (from 11 to 18 months).The mean duration of retaining the external fixator was 64.4days(from 53 to 90 days).Their mean Constant score was 94.3 points at the last follow-up.All the fractures healed in their anatomical position.All the patients were satisfied with the shape of their repaired shoulder and their treatment outcome.Complications were observed in 3 cases,one hypertrophic scar at the pin track,one loss of reduction and one superficial pin track infection.Conclusion External fixation is a reliable alternative for management of open clavicle fracture,infected clavicle nonunion and acute displaced mid-clavicle fracture with severe associated injury which does not tolerate standard open reduction and internal fixation. Key words: Clavicle; Fractures; External fixator

Hinged external fixators in management of post-trauma elbow stiffness

肘部外伤后导致创伤性肘关节僵硬与肘部本身结构特点或术后制动时间长有关,成为临床上棘手问题.我们自2004年3月-2006年12月采用铰链式外固定架(意大利Orthofix公司产品)应用于治疗创伤性肘关节僵硬29例,完整随访23例,疗效满意,现报告如下。

Versatility of Ilizarov external fixator in management of foot and ankle deformity

Traditional methods of correcting foot deformities may be difficult to apply in some conditions, especially in presence of other lower limb problems. This study discusses the versatility of Ilizarov external fixator (IEF) in such cases. It was performed in 34 foot deformities in 33 patients, treated with IEF between 1997 and 1999. The average age of the patients was 15 years. The aetiology of foot deformity was recurrent congenital talipes equinovarus (n=10), neglected congenital talipes equinovarus (n=3), poliomyelitis (n=9), post-traumatic deformity (n=6), post-burn deformity (n=1), arthrogryposis multiplex congenita (n=2), and cerebral palsy, fibular hemimelia and tibial hemimelia (1 case each). Unconstrained IEF was applied for the foot in all cases. The leg construct was applied according to the target: foot deformity alone or associated with other leg problems. IEF construct was extended to the femur in cases with flexion knee deformity and hinges were added. Follow-up continued until overcorrection was maintained for the same period of correction followed by an appropriate cast for 8 weeks. The mean time for deformity correction and Ilizarov stabilisation was 16 weeks, and follow-up period was 23.1 months. The results were good in 31, fair in 2 and bad in 1. Additional procedures were performed, most often in the same operating time. Primary arthrodesis was done for 5 feet and for one revision of failed previous arthrodesis. Open corrective osteotomy for arthrodesis was performed in 2 cases. Two females were treated for flexion knee with bloodless technique. Wire-site infections, wire cut-through a calcaneum and metatarsals and fracture post-IEF removal were observed. Although it is technically difficult, IEF can be considered an effective and versatile way of treating foot and other associated lower limb problems through one-reconstruction attack.