Hybrid External Fixator Research Articles

Hybrid external fixator for proximal tibia fractures-tips and tricks

Proximal tibia fractures are usually caused by high energy mechanisms. These fractures are associated with many problems; one of the most common being contusion or crush injury to the soft tissues. One of the recommended methods of management is the Hybrid external fixator as a definitive management in these complex fractures, where soft tissue compromise may limit open reduction as a modality. Wire introduction under C-arm and confirmation using different conventional and modified views to check their placement has been discussed in this paper. To check the exact placement of wires within the joint even when the antero-posterior view may show the wires to be away from the joint, this modified view is more confirmative.

Outcome of tibial plateau fractures treated by hybrid and Ilizarov external fixation

<p class="abstract"><strong>Background:</strong> Tibial plateau fractures pose a challenge to the treating surgeon especially in cases with compromised soft tissue envelope. External fixation achieves good results with minimal complications. The objective of our study was to evaluate the functional outcome of tibial plateau fractures treated by Ilizarov and hybrid external fixation.</p><p class="abstract"><strong>Methods:</strong> 46 patients with tibial plateau fractures were analysed. 6 were lost to follow-up. 20 patients were treated by Ilizarov method and 20 by hybrid external fixation.<strong></strong></p><p class="abstract"><strong>Results:</strong> Mean time for union was 24.5 weeks in Ilizarov fixator group and 28 weeks in hybrid fixator group. Mean Lysholm’s score was 86.1 in Ilizarov cases and 83.4 in hybrid fixator cases. The mean knee society score in Ilizarov fixation cases was 78.5 and 77.3 in hybrid fixator cases. At one year by Lysholm score 6 patients had fair, 10 had good and 4 had excellent result in Ilizarov group and 1 had poor, 8 had fair, 8 had good and 3 had excellent results in hybrid group. 15 patients in Ilizarov method had good and excellent knee society scores and 12 patients had good and excellent results and 1 patient had poor score in Hybrid fixator group.</p><p class="abstract"><strong>Conclusions:</strong> External fixation in complicated tibial plateau fractures gives acceptable outcomes. Ilizarov external fixator has an advantage of earlier mobilization and earlier union but requires longer operation time and a bulky apparatus. Hybrid fixator on the other hand has lesser operating time and simpler construct but has less stability and longer union time.</p>

Functional outcome of 59 patients of bicondylar tibial plateau fractures treated with internal vs external fixation: Selection criteria

Background: The purpose of this prospective study was to evaluate the Functional results of Internal versus External fixation of bicondylar tibial plateau fractures decided on specific selection criteria.Materials and Methods: Fifty nine patients with tibial condyle fractures (Schatzker type V and VI) were recruited in the study between Nov 2013 and Dec 2015 at our tertiary care hospital in Bengaluru, India. Open reduction and internal fixation with Dual Buttress plates, Buttress plate and CC screws was done in 38 patients (closed, Type I & II open with good skin conditions). Hybrid External fixation was done in 21 patients (closed, Type I & II open with bad skin conditions, Impending compartment syndrome). They were followed up at six weeks, six months and twelve months and was evaluated for the functional outcomes by Hospital for special surgery knee scoring system (HSS). Result: 86% of our patients had good to Excellent results according to HSS score. The outcomes between both modes of fixation were not significantly different at 1 year follow up. There was no difference in total arc of knee motion. Mean range of knee flexion in internal fixation was 115.79 + 21.290, External fixation was 115.24 + 13.370. Average HSS Score at final follow up for internal fixation was 78.87 + 10.94 and external fixation was 78.71 + 9.05. 2 patients needed flap surgery due to wound complications, 3 patients experienced infection following internal fixation compared to external fixator. 1 patient experienced non union following external fixation.Conclusion: Both methods of fixation in Bicondylar tibial plateau fractures gives a favourable functional outcome provided selection criteria is followed strictly. Level of Evidence: Level 3.

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

Accordion technique in the treatment of tibial delayed union or nonunion

Objective To assess the clinical curative effect of accordion technique in the treatment of tibial delayed union or nonunion. Methods From February 2016 to December 2017, data of 11 patients with tibial delayed union (n=8) or non-union (n=3) who had been treated by accordion technique with an Ilizarov ring external fixator were retrospectively analyzed. 10 males and 1 female were included in our study, with an average age of 41.9 years (range, 21-63 years). There were 5 cases of docking site delayed union after Ilizarov transport for chronic tibial osteomyelitis. There were 3 cases of fracture site delayed union after external fixation for open tibia comminuted fracture. There were 3 cases of nonunion after tibia closed fracture, including 2 cases who had hybrid external fixation treatment, and 1 case who had conservative treatment. All the cases received accordion technique using Ilizarov ring external fixators. First, gradual compression at the fracture site was conducted until the bony contact was seen on a radiograph. After bony contact, compression was continued at a rate of 0.85 mm/d for a week, followed by distraction of 0.85 mm/d for 2-3 weeks. Afterward, a second compression was conducted using same rate and time with the distraction procedure. And there was a 7-day latent period between compression and distraction. One or two cycles of compression-distraction were needed before union was present radiographically. Results Bony union was obtained in all 11 patients after a mean time of 5.4 months (from 3 to 9 months). The mean follow-up for the 11 patients was 15.2 months (from 11 to 29 months). The mean duration of the accordion technique treatment was 50.2 d (range, 35-67 d). The accordion technique was used 1 time for 8 patients, and 2 times for 3 patients. The mean duration of bone consolidation was 114.9 d (range, 64-239 d). According to Paley evaluation criteria, osseous results were excellent in 8 cases, good in 3 cases, with a good to excellent rate of 100%(11/11); functional results were excellent in 7 cases, and good in 4 cases, with a good to excellent rate of 100%(11/11). Conclusion The accordion technique is a minimal invasive, safe and reliable treatment program for tibial delayed union or nonunion. Key words: Tibial fractures; Fractures, ununited; External fixators

Biomechanically validated transosseus fixation in patients with femur pseudarthrosis complicated by chronic osteomyelitis

The aim of the study is to evaluate results of follow-up in patients with femur pseudarthrosis complicated by chronic osteomyelitis who underwent biomechanically validated transosseus fixation. Materials and methods. A retrospective study of transosseus fixation in 72 patients with femur pseudarthrosis complicated by chronic osteomyelitis was conducted. Described fixation was completed according to the biomechanical fixation conception from 2011 to 2017. Hybrid external fixator was applied to 38 (52,8%) patients, rod-based external fixator - to 34 (47,2%). Results. Full bone consolidation and pyoinflammatory process remission in treated femur bone is achieved in all cases. Results classified as excellent were acquired in 21 patients (29,5%), good - in 41 (57,7%), satisfactory - in 7 (9,8%), unsatisfactory - in 2 (3%). patients results were classified as unsatisfactory because of lacking of weight-bearing ability of the leg because of other reasons not related to consolidation. Conclusion. In patients with infected femur pseudarthroses external fixation using biomechanical conception allows to provide up to 97% positive clinical outcomes of the treatment.

Prospective study on functional outcome and role of hybrid external fixators in complex tibial plateau fractures

Introduction: Tibial plateau fractures are common due to high energy injuries. The principles of treatment include respect for the soft tissues, restoring the congruity of the articular surface and reduction of the anatomic alignment of the lower limb to enable early movement of the knee joint. There are various surgical fixation methods that can achieve these principles of treatment. Aim: To study the functional outcome and role of hybrid external fixators in complex tibial plateau fractures.Methods: 50 Patients with Schatzker type V fractures and Schatzker type VI closed plateau fractures and Compound tibial fracture Grade I and IIIB were treated with both closed reduction and hybrid external fixation or with minimal open reduction and a hybrid system. Functional outcome were assessed with NEER’s scoring system. Results: Out of 50 cases 20 cases were type 5 and 30 cases were type 6 Schatzker and the average NEER scoring for them were 17.50 and 14.25 respectively. Most common complication is pin site infection, overcame by regular dressing and Knee stiffness. NEER’s Rating score rating system for knee the 52% patients had excellent and 36% patients had good outcome. Conclusion: The hybrid external fixator method we had applied is safe as regards of soft tissue healing and the limited number of complications associated directly to this method of application.

Tibial pilon fractures treated with hybrid external fixator: analysis of 75 cases.

The treatment of tibial pilon fractures is a surgical challenge due to the particular anatomical and vascular characteristics of this area, and the severity of the injury that can compromise soft tissues. Nowadays there is no gold-standard treatment for these fractures. We reviewed 75 patients with tibial pilon fracture type C (AO classification) treated with hybrid external fixation (Stryker TenXor®). The surgical technique was reported. We evaluated clinical (Tornetta's score, VAS score, range of motion) and radiographic outcomes. In 71 cases, the first surgical treatment was definitive. Instead, in four cases, it was necessary a second surgical procedure to achieve fracture healing. We obtained 44% excellent, 40% good, 7% discrete, and 9% bad results. We found a 30% of superficial infections of the pin site, resolved with oral antibiotic treatment (amoxicillin and clavulanic acid). We never had deep infections, no neurovascular injury, and no cases of secondary amputation. Although not statistically significant, we noticed a correlation between longer recovery times and trauma severity, with slower recovery in open or grade III fractures or when associated with other fractures. According to the recent literature, we think that the best treatment for non-articular fracture is the internal osteosynthesis within 6h or after 6days from trauma. In articular fractures, the elective treatment is the two-step management. In complicated articular fractures (Tscherne > 2, open, comminuted type III) is highly indicated the external fixation combined with minimal internal synthesis.

A prospective study of hybrid external fixation for proximal tibial fractures

INTRODUCTION: Intraarticular fractures of the tibial plateau and periarticular fractures of the proximal tibia, caused by high energy trauma pose a therapeutic dilemma. We present the use of hybrid external fixation system which includes Ilizarov ring fixator and AO rod external fixator connected with indigenously manufactured connecting clamps and short shafts augmented with or without minimal internal fixation1. AIM OF THE STUDY: 1. To assess the performance of the Hybrid External Fixator in the treatment of different types of proximal tibial fractures. 2. To evaluate the functional outcome, soft tissue healing and fracture union and radiological outcome. 3. To evaluate the biomechanical and biological advantage of hybrid external fixator. BIOMECHANICS : The mechanical characteristics of hybrid external fixation system can be called as SOLID ELASTIC. It gives solid enough for stabilization and providing micromotion which enhances good callus formation. MATERIALS: From August 2010 to November 2011, 21 caes of periarticular fractures of the proximal tibia were treated by use of 5/8 th Ilizarov ring, AO tubular external fixator and with indigenously manufactured connecting clamps & short shaft in a hybrid mode. All cases were prospectively followed up and studied. Almost all the cases (99%) had sustained Road traffic Accidents (high velocity injuries) except one case which had sustained injury by fall of cement wall over her leg. Minimum follow up – 1.5 months , maximum follow up – 12 months, mean follow up – 6.42 months .All the patients were in the age group of 26 to 65 years, mean age is 43.09. METHOD: SELECTION OF CASES: Inclusion Criteria: 1. Tibial plateau fractures according to Schatzkar classificafion Type 4, Type 5 and Type 6. 2. Proximal 1/4 extra articular tibial fractures (severely comminuted) 3. Open Proxial tibial fractures according to Gustillo Anderson Classification Gr 2, Gr 3A, 3B, 3C 4. Proximal tibial fracture with compartment syndrome after Fasciotomy. 5. High velocity proximal tibial fracture in impending compartment syndrome. Exclusion Criteria : 1. Schatzkar type 1 , type 2 and type 3. 2. More than 2 weeks old fractures. 3. Proximal tibial fractures with neurological disorder. 4. Proximal tibial fractures with paralytic disorder. SURGICAL TECHNIQUE: Reduce the articular surface initially. Determine the wire position. Minimum of 2 0r 3 wires are needed. Position the wires in the safe zone. Wire should be inserted 14 mm distal to the tibial plateau so that the capsule will not be pierced by wires.Each wire should be placed 30 – 50 degrees wide apart as possible. Olive wires are used to reduce and compress the fragments.place the shanz screws and assemble the frame. RESULTS: After analyzing the above characters we have obtained. Excellent results in 7 patients ( 33. 3% ), Good in 9 (42.35% ), Fair in 4 (19.04% ), Failure in 1(4.76% ) patient. CONCLUSION : The hybrid external fixator method we have applied is safe as regards of soft tissue healing and the limited number of complications associated directly to this method of application. We recommend a mini open reduction with percutaneous cannulated cancellous screw (one or two for securing interfragmentary compression) or olive wires with hybrid external fixator. This is the best method for closed (Schatzkar type 4, 5, 6) as well as open proximal tibial fractures.

Management of Complete Talocrural Luxations by Selective Talocrural Arthrodesis using Hybrid Transarticular External Skeletal Fixation in Dogs.

This article presents a novel surgical technique in the management of open complete talocrural luxations and evaluates the results, and clinical benefits with its routine clinical utilization. Retrospective study. Seventeen medium- or large-breed client-owned dogs of different breed, age and sex with complete talocrural luxations and radiographic follow-up of at least 24 weeks duration. Selective talocrural arthrodesis was performed by using a hybrid transarticular external skeletal fixator frame. Clinical and radiographical evaluation was performed regarding the lesion, concomitant injury, duration of the surgery, time to first use of the limb, fixator removal time, complications and clinical outcomes. Dogs started to use the injured limb between postoperative days 1 to 11. Pin or wire tract related complications were observed in all dogs. Time to fixator removal ranged from 57 to 90 days with a median of 73 days. All of the operated joints with an exception of one dog resulted in talocrural fusion. Mid-term clinical outcomes score was regarded as excellent in 13/17 dogs, good in 3/17 dogs and poor in 1/17 dogs subject to authors' evaluation. A transarticular hybrid external fixator may allow early use of postoperative limb with an excellent patient compliance and is well tolerated as well. The technique showed a promising opportunity of providing favourable limb use.

Foot Loading and Gait Analysis Evaluation of Nonarticular Tibial Pilon Fracture: A Comparison of Three Surgical Techniques

The aim of our study was to investigate which technique among hybrid external fixation, plate and screws, and intramedullary nailing produces better outcomes in foot loading when treating type 43.A1, 43.A2, and 43.A3 fractures, according to the AO classification. From November 2011 to December 2014, 34 patients, including 25 (73.5%) males and 9 (26.5%) females with an average age of 32.3 (range 16 to 67) years, with a type A tibia fracture were treated with intramedullary nailing, plate and screws, or hybrid external fixation. The patients were divided into 3 groups: 16 (47%) received hybrid external fixation, 10 (29.4%) received plate and screw fixation, and 8 (23.5%) received intramedullary nailing fixation. The follow-up protocol included clinical and radiologic evaluations performed at 15 days, 1 month, 3 months, 6 months, and 12 months after surgery. The selected outcome parameters for the 3 groups were as follows: visual analog scale for pain of the traumatized tibia, interval from surgery to weightbearing, average time required for fracture recovery, subjective and objective Ovadia–Beals scores, baropodometric examination at 12 months, walking recovery at 12 months, outcomes, and surgical complications. The endpoint assessment was set at 12 months. The results showed that incorrect reduction of a type A tibia fracture can lead to changes in the sagittal balance line for foot loading and pace training. In conclusion, these findings have shown that the experience of the surgeon in the reduction of the fracture and knowledge of the method of synthesis is essential.

TIBIAL PLATEAU FRACTURES

Background: Tibial fractures is most common type of long bone fractures. Highspeed lifestyles with vehicles motorcycles as well as growing waves of violence, contributingincrease occurrence of tibial fractures. Tibial plateau fractures continues to be a challenge fororthopedic surgeon. Treatment of these fractures have been plagued by complications. Recentimprovements in the techniques and development of hybrid external fixator have revolutionizedthe treatment of such fractures. Objective: To evaluate the clinical outcomes of hybrid externalfixator in high energy Schatzkar V and VI tibial plateau fractures. Study Design: Descriptive,Case series. Period: 27 June 2013 to 26 June 2016. Setting: Nishtar Hospital, Multan. Materialand methods: A total of 125 patients with open and close tibial plateau fractures, 20 to 50 yearsof age of both genders were included in the study. Patients having history of pervious surgeryor intervention tibial plateau fractures, and h/o malignancy were excluded. All the patients wereoperated by a consultant orthopedic surgeon. Outcome was assessed at 16 weeks by serialradiological x-ray by formation of callus and noting any grade of pin track infection. Results; Ourstudy comprised of 125 patients having Schatzker V and Schatzker VI tibial plateau fractureswho met our inclusion criteria. Mean age of 38.925 ± 7.09 years. Majority of the patients 47(37.60%) were between 41 to 50 years of age. Mean duration since injury in our study was 13.18± 4.79 hours. Out of 125 patients, 102 (81.60%) were males and 23(18.40%) were females withmale to female ratio of 1.2:5.4. Fifty three (42.4%) patients presented with Schatzker V and 72(57.6%) had Schatzker VI type of tibial plateau fractures. In our study, non-union was seen in10cases (8.0%) and pin track infection was noted to be present in 19 (15.20%) patients. So, theacceptable outcome (achievement of union without non-union or pin track infection during 16weeks) was seen in 96(76.8%) patients. Conclusion: This study concluded that there is highrate of acceptable outcome (achievement of union without any non-union or pin track infectionduring 16 weeks) after hybrid external fixator of the open and closed fractures of tibial plateauamong the patients having schatzker-V and VI.

Bicondylar Tibial Plateau Fractures: A Critical Analysis Review.

* Bicondylar tibial plateau fractures represent a broad category of complex, high-energy injuries associated with a high surgical complication rate.* Computed tomography and magnetic resonance imaging aid in diagnosis, classification, and surgical planning and should be considered during the initial evaluation or after provisional stabilization is performed as part of staged treatment.* No one classification system has superior descriptive traits or reliability. Simply classifying the fracture as unicondylar (partial articular) or bicondylar (complete articular) is the most reliable approach.* Malalignment, especially in the coronal plane, and instability predict poor outcomes and should direct surgical intervention. Articular displacement is less predictive.* Dual plating is the most stable type of fixation biomechanically but is associated with soft-tissue complications.* Single lateral locked plating is an alternative fixation type for bicondylar fractures without a large posteromedial coronal fracture line.* Hybrid external fixators are another means of fixation that avoid large exposures and associated soft-tissue disruption.* No one fixation strategy is superior in all cases. Patient and injury characteristics should be evaluated on a case-by-case basis to optimally direct the treatment of these complex injuries.

Complex Tibial Plateau Fractures Treated by Hybrid External Fixation System

Background:Tibial plateau fractures are common due to high energy injuries. The principles of treatment include respect for the soft tissues, restoring the congruity of the articular surface and reduction of the anatomic alignment of the lower limb to enable early movement of the knee joint. There are various surgical fixation methods that can achieve these principles of treatment. Recognition of the particular fracture pattern is important, as this guides the surgical approach required in order to adequately stabilize the fracture. This study evaluates the results of the combined treatment of external fixator and limited internal fixation along with the advantages using postoperative computed tomography (CT) scan after implant removal. Materials andMethods:55 patients with a mean age of 42 years (range 17–65 years) with tibial plateau fracture, were managed in our institution between October 2010 and September 2013., Twenty fractures were classified as Schatzker VI and 35 as Schatzker V. There were 8 open fractures (2 Gustilo Anderson 3A and 6 Gustilo Anderson 2). All fractures were treated with closed reduction and hybrid external fixation (n = 21/38.2%) or with minimal open reduction internal fixation and a hybrid system (n = 34/61.8%). After the removal of the fixators, CT-scan was programmed for all the cases, for correlation with the results. At final followup, the American Knee Society Score (AKSS) was administered.Results:All patients were evaluated with a minimum of 12 months (range 12–21 months) followup. Average time to union was 15.5 weeks (range 13–19 weeks). The postoperative joint congruity as evaluated in the postoperative CT-scan was <2 mm of articular step-off in 8 patients (14.5%), between 2 and 4 mm in 18 patients (32.7%) and over 4 mm in 29 (52.7%). The injured limb mechanical axis was restored within 5° compared to the contralateral limb in 36 cases (65%) and with an angulation >5° in 19 cases (35%). Patients with residual joint depression <3.5 mm had a 95% chance of having excellent AKSS knee score results and 80% chance of having excellent AKSS function scores. On the other hand, residual joint depression of >4.5 mm displayed a 100% chance of getting poor-fair scores both in AKSS knee and AKSS function score. The association of a postoperative mechanical axis within 5° of the contralateral limb and improved knee scores was statistically significant for the AKSS function and total scores but not for the AKSS knee score. The AKSS was negatively correlated with postoperative joint depression magnitude which was statistically significant. Only the amount of joint collapse was verified as a prognostic factor in a multivariate logistic regression analysis.Conclusions:The postoperative CT-scan shows important information about bone healing, and an exact image of the reduction and the shaft alignment. Postoperative radiographs may have led to an underestimation of the degree of residual displacement. On the contrary, CT-scan demonstrates the exact grade of articular displacement and depending on CT-scan results one can better manage the postoperative rehabilitation.

Application of hybrid external fixation by the "joystick method" in bicondylar tibial plateau fractures: Technical note.

This study aimed to present clinical outcomes in patients with tibial plateau fractures who were treated with hybrid external fixators and describe the details of our technique. Schanz screws were synchronously applied and used as a joystick for fracture reduction. The study population included 72 patients with bicondylar tibial plateau fractures classified as type 41-C2 according to the AO classification. Joint reduction was maintained using Schanz screws transmitted through tibial condyles as a joystick under fluoroscopy. The patients then underwent surgery with these Schanz screws and a hybrid external fixation system. The median age of the patients was 39 (21-67) years, and the median follow-up time was 21 (12-35) months. The mean knee flexion and extension were 105° (80°-125°) and 0° (-5°-7°), respectively. The mean varus laxity and valgus laxity were 4.30° (2°-7°) and 3.10° (2°-5°), respectively. Four patients had leg shortness of 0.4-1.1 cm. The external fixators were removed between 8 and 16 weeks (mean = 11 weeks) postoperatively. The KSS scores at the end of 1 year were "excellent" for 48 patients, "good" for 19 patients, and "inadequate" for 5 patients. With the synchronous application of the two Schanz screws of 6.5-mm thickness and the two-drill technique under fluoroscopic guidance, we obtained stable reductions over a short period. No patient experienced major complications, and this enabled early weight bearing and a return to daily living activities.

Severe tibial plateau fractures (Schatzker V–VI): open reduction and internal fixation versus hybrid external fixation

Tibial plateau fractures (TPF) are highly prone to complications and adverse effects. Their treatment has long been a matter of controversy, as fracture patterns and possible damage to soft tissues can easily aggravate complications. On the one hand, open reduction and internal fixation (ORIF) techniques provide a good approach to joint shape restoration and biomechanics, but they may also provoke a higher rate of soft-tissue complications. On the other, hybrid external fixation (HEF), although allowing little facility for reduction, may, theoretically, produce much less damage to the soft tissues. We present 93 cases of TPF classified as type V or VI that were followed up for at least 24 months. There were no statistical differences among them in relation to consolidation, secondary malalignment or range of motion, according to whether ORIF or HEF was employed. However, when external fixation followed open reduction, both superficial and deep-infection rates were higher.

Domestic external fixator application in the treatment of limb deformities: 7 289 cases application report

Objective: To discuss the clinical application and effects of domestic external fixator in the treatment of patients with malformations of limbs. Methods: A total of 7 289 patients with malformation of limbs who had been operated in Qin Sihe orthopedic surgery team from January 1989 to June 2016 were retrospective analyzed. The patients were treated with domestic external fixator, including 4 033 males and 3 256 females, aging from 2 to 82 years with a mean age of 23.4 years. There were 2 732 patients using Ilizarov external fixator, 4 713 patients using hybrid external fixator, 57 patients using monobrachial external fixator, 232 patients using Ilizarov external fixator and hybrid external fixator. The Ilizarov, hybrid and monobrachial external fixator were used in 67, 65 and 0 patients on the upper limbs and in 2 665, 4 616 and 57 patients on the lower limbs. There were 3 028 patients operated on the left limbs, 3 260 patients operated on the right limbs and 1 001 patients operated on the bilateral limbs. The top three types of diseases were sequelae of poliomyelitis, cerebral palsy and post-traumatic stress disorder peromely. Deformity types inclued talipes equinovarus, knee flexion deformity, cavus foot and so on. Results: All the patients were followed up for a period of 2.5 months to 22.4 years, with an average follow-up time of 5.4 years. All of the external fixators were used for single once, and there was no substitute for external fixator quality problem. All the patients were completed surgery goal until removing external fixation except 1 patient gave up treatment and 1 removed the fixator because of metal allergy. The common complications included wire or pin infection and joint movement limitation and so on. Conclusions: The domestic external fixator developed and produced based on the characteristics of Chinese limb deformity disability. The domestic external fixator can be used to treat kinds of limb deformities with the advantages of practical, economical, adjustable, universal and portable. The domestic external fixator could meet the clinical demand for fixation of the osteotomy end of the limbs, the correction of the deformity, the repair of the defects and the limb lengthening.

Advantages of external hybrid fixators for treating Schatzker V-VI tibial plateau fractures: A retrospective study of 40 cases

IntroductionProximal tibia fractures make up 1% of all fractures in adults. The fractures classified as Schatzker V and VI fractures can compromise knee structure and function. They are challenging to treat and often have complications. While plate fixation is the gold standard, the resulting infection rate has led us to favor external hybrid fixation. The aims of this study were to assess the radiographic and functional outcomes along with the complication rate when using this method and to compare them to historical plate fixation data. Material and methodsThis was a retrospective study of 40 patients. The complications, quality of reduction, IKS, Lysholm and Rasmussen functional scores at the latest follow-up and factors affecting the functional outcome were evaluated. These parameters were compared to published results from plate fixation studies. ResultsThe deep infection rate was 2.5%. The union rate was 80%. Satisfactory reduction was obtained in 70% of cases; however, 52% of patients had malunion. The mean IKS score was 73.74, the mean Rasmussen score was 22.85 and the mean Lysholm score was 75.53. Age, reduction at latest follow-up, mechanical axis and anteroposterior laxity had a significant effect on the functional outcome. DiscussionDespite the malunion rate being higher than other studies, the functional outcomes were nearly identical based on the variables measured. There are several advantages associated with using a hybrid external fixator: shorter operative time, less bleeding, shorter hospital stays and lower infection rate. ConclusionHybrid external fixation is a reliable fracture fixation method that leads to satisfactory functional outcomes, while reducing the infection rate and allowing arthroplasty to be performed in the future if needed.

Emergent and delayed hybrid external fixation management of tibial pilon fractures: A multicentric retrospective analysis of 80 patients

Objective: To report our experience with the hybrid external fixator in emergency. Methods: We assessed 80 cases of pilon fracture treated with the external fixator during the period of January 2009 and December 2016:55 men (69%) and 30 women (33%) with a mean age of 40 years (range between 16 and 70). About 45 occurred as isolated trauma, 35 instead were politrauma. Each patient underwent standard radiographic examination and a CT examination. There were 28 open fractures (35%), (Gustilo type 1, 2 and 3) while closed fractures showed soft tissue involvement of various grade (2-3 Tscherne classification). In all cases, the external fixation, sometimes associated with other reduction and synthesis techniques, was used. The timing of surgery was dictated by the condition of the soft tissues. For clinical evaluation, the Mazur score with mean follow-ups at 12 months was utilized. Results: The final range of ankle motion was 15 dorsal and 10 plantar flexion. In about 80 cases there was an average Mazur score of83. The mean score was 90; in open fractures 85 to 72. Radiographic healing of fractures in 60 patients occurred in 120 days (mean 105 days), at the time when the external fixator was removed. Conclusion: Pilon fractures are complex and often present complications; the definitive treatment, in emergency or delayed, with hybrid external fixator permits a stable synthesis with minimal soft tissue damage. Weight bearing maybe allowed early and functional recovery is generally good.

Fratura cominutiva e articular distal de úmero tratada com fixador esquelético externo transarticular em três gatos

Background: Humeral fractures account for 13% of all fractures in cats and commonly affect the middle diaphysis and supracondylar region with comminution. They are usually the result of high energy traumas such as falls, car accidents and firearm injuries. There are few treatment options for these types of fractures and since they are joint injuries, early surgical repair is mandatory to achieve perfect anatomical reduction, to maintain joint congruence and to allow early weight bearing. Our purpose is to report four subacute and chronic fractures of the distal diaphysis associated with comminuted supra and intercondylar fractures, stabilized with transarticular external skeletal fixator in three domestic felines.Cases: (1)- A 3-year-old male docile Siamese cat with 3.7 kg of body weight was presented for consultation with a 14-day history of high rise syndrome after falling from a 12-meter high. It presented distal comminuted humeral fracture that involved the inter and supracondylar regions. It also had right carpal-ulnar subluxation and comminuted right olecranon fracture involving the articular surface in the left thoracic limb. Fracture and joint stabilization was achieved by use of a transarticular hybrid external skeletal fixator on the right front limb. Fracture healing was observed at 150 days postoperatively. (2)- A 10-year-old female aggressive mixed breed cat with 4.1 kg of body weight was presented for consultation with a 16-day history of high rise syndrome after falling from a 9-meter high. The cat had a comminuted right humeral articular fracture with supra and intercondylar involvement and scapular fracture on the contralateral limb. The humerus fracture was treated with a transarticular linear external skeletal fixator and fracture healing was obtained at 240 postoperative days. (3)- A 1-year-old female unsociable mixed breed cat with 4.5 kg of body weight was presented for consultation with a 15-day history of humeral fractures after falling from a 12-meter high building. The cat had comminuted bilateral humeral articular fracture with supra and intercondylar involvement. Fracture stabilization was achieved by use of a transarticular hybrid external skeletal fixator on both limbs. Fracture healing was achieved after 60 days on the right front limb, and after 120 days on the left front limb.Discussion: Patients with distal humeral diaphyseal fractures should be assessed for peripheral nerve injury. None of the reported cases had neurological damage despite having suffered high energy trauma. Surgical approach to humeral distal fractures may be craniolateral, medial or caudal or even combined. In chronic fractures like those in our study, (fractures with more than 14 days of evolution), perfect anatomic reduction wasn’t considered due to presence of fibrous tissue that would require excessive manipulation, leading to injuries to soft tissues and blood supply, what would increase the risk of infection and bone sequestrum. The gold standard for the treatment of articular fractures is rigid internal fixation by means of compressive screws and compressive plates, and they require open reduction. Whenever anatomical reduction can not be performed, due to either the fracture’s evolution period or by the diminished bone length, closed reduction is indicated and stabilization with transarticular fixators is an alternative. Hybrid constructs are well tolerated by patients since they are lighter than circular apparatus and more versatile than linear fixators. In our study, transarticular fixators were used based on the location of the fractures and fracture period. Despite the ankyloses of the humeral-radio-ulnar joint, all patients adapted to the fixator devices very well and presented satisfactory ambulation weight bearing on the first postoperative day already. A disadvantage of the skeletal fixators is the postoperative care, which includes daily dressings, e-collaring, resting and co-operation on behalf of the owner. Two animals presented aggressive/unsocial behavior and still the prolonged postoperative management and adaptation to the fixator were successful. The results suggest that comminuted humeral distal articular fractures can be treated by the use of transarticular external skeletal fixators in cats.