Hybrid External Fixator Research Articles

Le fratture complesse del piatto tibiale: tecniche di fissazione esterna

Complex fractures of the tibial plateau are caused by high-energy trauma and are often associated with severe soft tissue damage. Different external fixation techniques are now available to the surgeon to lead to healing of these fractures. A milestone in their surgical management is soft-tissue management which, if added to the possible external fixation techniques, configures the best solution to damage control orthopaedic trauma surgery for polytrauma patients. We believe that hybrid external fixators are the most appropriate kind of external fixation for type V and VI Schatzker fractures, because they allow for good manoeuvrability during fracture reduction, any subsequent changes of the fixator configuration, early loading and faster functional recovery.

Comparative biomechanical analysis of three implants used in bicondylar tibial fractures.

Currently, the most difficult-to-treat tibial plateau fractures are complex, comminuted fractures, which result from high-energy trauma. The anatomical reconstruction of the articular surface and the preservation of the soft tissue envelope are required for agood functional result. The aim of this study is to perform abiomechanical evaluation of three constructs used in the treatment of bicondylar fractures: the L‑shaped plate, the LCP locking plate, and the hybrid external fixator. We used 30experimental models divided into three study groups. There were ten models for each type of implant. The best biomechanical behavior was found with the LCP locking plate, which showed minimal deformation upon cyclic loading, followed by the hybrid external fixator. The LCP plate is the optimal implant for the stabilization of Schatzker type V tibial plateau fractures, with low rates of degradation for the implant and the bone-implant assembly.

Role of hybrid external fixator in proximal tibial fractures: A prospective analysis

Introduction: The proximal tibial fractures are associated with high energy trauma and present with difficulty in treatment due to poor skin condition. In our study, we have operated 32 patients with hybrid external fixator for definitive treatment of these fractures. This technique gives good reduction, adequate stability, early mobilization and less complications. Aim: To assess the functional and radiological outcome after application of hybrid external fixator in proximal tibial fractures. Material and Methods: Prospective analysis of 32 patients was done with proximal tibial fractures classified according to Schatzker classification in our institute who were treated by application of hybrid external fixator. Results: In our study, Road traffic accident was the most common mechanism of injury (n=23). There was a male preponderance (n=23) in our study. The mean age was 39.2±11.0 years. Functional and radiological outcome was assessed using Rasmussen functional and radiological criteria at final followup. 16 patients had an excellent functional outcome and 13 patients had excellent radiological outcome. Superficial pin tract infection was seen in 4 patients which healed uneventfully. Varus malalignment was seen in 2 patients. Conclusion: Hybrid external fixator is a simple way to treat proximal tibial fractures with a low complication rate and good clinical outcomes.

Management of a complete stifle luxation with a hinged transarticular hybrid external fixator in a dog

A 2 years old, 15 kg, male, mix breed dog that was presented with a right open tibial fracture and left complete stifle luxation. Cranial and caudal cruciate ligaments with medial and lateral collateral ligaments were completely torn. Stabilization of the stifle was established with a hinged transarticular external fixator. After fixator removal, radiographic findings were normal besides some periarticular osteophyte formations. Physical therapy was initiated postoperatively. Now the dog can perform all daily activities with mild lameness

Treatment of open tibial plateau fractures with Hybrid external fixation

Objective To evaluate the clinical results of minimally invasive surgery for open tibial plateau fractures using minimally open reduction and Hybrid external fixation. Methods From January 2011 through January 2015, 9 complicated open tibial plateau fractures were treated with Hybrid external fixation. They were 6 males and 3 females, with an average age of 33.8 years (range, from 18 to 53 years). According to the Schatzker classification, there were 5 cases of type Ⅴ and 4 ones of type Ⅵ. According to the Gustilo classification, there were 5 cases of type Ⅱ, 3 ones of type ⅢA and one of type ⅢB. All the patients were treated with Hybrid external fixation with or without minimally open reduction. Results The average operation time was 185.6 minutes (from 140 to 240 minutes). The average time for hospital stay was 18.4 days (from 10 to 45 days). The patients were followed up for an average of 15.6 months (from 6 to 36 months). All the 9 fractures got united after an average time of 4.3 months (from 3 to 7 months). The external fixation was removed after confirmation of fracture union. According to Merchant scores, the clinical results were evaluated as excellent in 4 cases, as good in 3, as fair in one and as poor in one. The knee joint was stable in each case. Pin tract infection was observed in one and wire loosening in one. Conclusion Hybrid external fixation with or without minimally open reduction is a safe and feasible surgical method which avoids massive soft tissue dissection for complicated open tibial plateau fractures. Key words: Tibia; Fracture, open; External fixators; Hybrid

Hybrid external fixation in the treatment of tibial pilon fractures: A retrospective analysis of 162 fractures

ObjectivesTo determine the efficacy of hybrid external fixation in the treatment of tibial pilon fractures. DesignRetrospective, multicentre study. Patients/ParticipantsAdult patients with tibial pilon fractures treated with hybrid external fixation. InterventionFracture reduction with ligamentotaxis and fixation with XCaliber hybrid external fixator. Main outcome measurementsFracture union, complications, functional outcome (Mazur Ankle Score). ResultsUnion was obtained in 159 fractures at an average of 125days; there were three delayed unions and three non-unions. The most frequent complication was superficial pin‐track infections (48), all of which responded to local wound care and antibiotics. There were no deep infections and no DVT. Only one fracture had loss of reduction that required frame revision. The overall functional scores were 91 (excellent) for AO/OTA type A fractures, 89 (good) for type B fractures, and 75 (satisfactory) for type C fractures. ConclusionsHybrid external fixation is an effective method of stabilising tibial pilon fractures, particularly those with marked comminution. The minimally‐invasive technique and stable fixation enable early mobilisation, with good functional results and minimal complications. Level of evidenceLevel IV Case series.

Comparison of outcome of tibial plafond fractures managed by hybrid external fixation versus two-stage management with final plate fixation.

Background:Tibial platfond fractures are usually associated with massive swelling of the foot and ankle, as well as with open wounds. This swelling may cause significant decrease of the blood flow, so the state of the soft tissue is determinant for the surgical indication and the type of implant. This retrospective study compares the union times in cases of tibial plafond fractures managed with a hybrid external fixation as a definitive procedure versus those managed with a two stage strategy with final plate fixation.Materials and Methods:A retrospective study in a polytrauma referral hospital was performed between 2005 and 2011. Patients with a tibial plafond fracture, managed with a hybrid external fixation as a definitive procedure or managed with a two stage strategy with the final plate fixation were included in the study. Postoperative radiographs were evaluated by two senior surgeons. Fracture healing was defined as callus bridging of one cortex, seen on both lateral and anteroposterior X-ray. The clinical outcome was evaluated by means of 11 points Numerical Rating Scale for pain and The American Orthopedic Foot and Ankle Society ankle score, assessed at the last followup visit. Thirteen patients had been managed with a hybrid external fixation and 18 with a two-stage strategy with the final plate fixation. There were 14 males and 17 females with a mean age of 48 years (range 19–82 years). The mean followup was 24 months (range 24–70 months).Results:The mean time from surgery to weight bearing was 7 ± 6.36 days for the hybrid fixation group and 57.43 ± 15.46 days for the plate fixation group (P < 0.0001); and the mean time from fracture to radiological union was 133.82 ± 37.83) and 152.8 ± 72.33 days respectively (P = 0.560).Conclusion:Besides the differences between groups regarding the baseline characteristics of patients, the results of this study suggest that in cases of tibial plafond fractures, the management with a hybrid external fixation as a definitive procedure might involve a faster union than a two-stage management with final plate fixation.

Outcome Assessment of Hybrid External Fixation in the Treatment of Comminuted Distal Femur and Proximal Tibial Fractures

Background: Treatment of comminuted fractures of the distal femur and proximal tibia is difficult, and a challenge in the field of

Evaluation of Hybrid External Fixator for Tibial Plateau Fractures: A Prospective Study

Background: Tibial plateau fracture is one of the common injuries encountered in our daily clinical practice. The goals of management of these peri-articular fractures are restoration of joint congruity by anatomic reduction of the articular fragments, stable fixation of fragments, early joint movements, care of injured soft tissues and prevention of fracture related, surrounding soft tissue and wound related complications. Though open reduction and internal fixation is preferred in the current day practice for such fractures, they are associated with a variety of complications leading to poor outcome. Ligamentotaxis and percutaneous fixation has been advocated by many authors to improve the results and to minimize the risk of serious complications. The aim of the present study is to evaluate and assess the results of closed reduction and hybrid external fixator application in the management of tibial plateau fractures. Materials and methods: Study included 28 patients with Schatzker type II and above closed tibial plateau fractures treated by Hybrid external fixator by the same team of surgeons on a tertiary care center following relevant investigations and assessment. Patients were followed up at regular intervals and finally evaluated clinically and radiologically at the end of one year. Conclusion: Our study highlighted the success of indirect reduction and hybrid external fixation application as the definitive method for the management of tibial plateau fractures. It minimizes the risk of soft tissue damage and reduces the incidence of serious complications with good fracture union and functional outcome in patients. Keywords: Hybrid external fixator, Tibial plateau fracture, Schatzker

Operative management of tibial plateau fractures

Background and Objectives: Advance in mechanization and acceleration of travel have been accompanied by increase in number and severity of fractures and those of tibial plateau are no exception. Treatment modality in these fractures has been a controversial question. The objectives of the study were assessment of the functional outcome of fixation of proximal tibial fractures using cannulated cancellous screws or ORIF with BP/LCP or External fixator, comparing the results of different treatment modalities and at the same time, identifying the complications associated with them.Materials and Methods: 22 cases of tibial plateau fractures in K.V.G. Medical College, Sulia were treated in from October 2013 to October 2015 with the objectives of precise reconstruction of articular surface, stable fragment fixation and early range of motions Totally 23 patients were treated, among which 6 patients were treated by cancellous screws fixation, 13 patients by ORIF with BP, 3 patients by ORIF with LCP and 1 patient with Hybrid external fixator. The functional evaluation of knee joint was done using modified Hohl and Luck Criteria.Results: The result revealed most patients were aged between 31–50 years (56.5%) with male preponderance, commonest mode of injury being RTA (86.2%).Schatzker type I fracture was commonest (26.7%).The functional result for ORIF with Buttress plate was excellent in 25.2% of cases and good in 50.1% of cases.66.7% of cases treated with LCP had good functional result. cancellous screws fixation was associated with equal number of good and fair results (33.3%). Commonest complication with operative treatment were wound related (37.5%) followed by knee stiffness (36.36%).Interpretation and Conclusion: Operative management of tibial plateau fractures will give excellent anatomical reduction to restore articular congruity and rigid fixation to fascilitate early motion thereby reducing post-traumatic OA and achieving optimal knee function.

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.

Hybrid external fixation via a minimally invasive method for tibial pilon fractures ​- Technical note.

IntroductionWe aimed to present the clinical and radiological outcomes of patients with tibial pilon fractures who were treated with hybrid external fixators. Shanz screws were applied synchronously and used as joysticks for fracture reduction. Radiological evaluations were conducted on roentgenograms at the second week, sixth week, third month and first year.Material and methodsThe study group included 42 patients with tibial pilon fractures that were classified as 43C according to the AO/OTA classification system. We used 2-hydroxyapatite-coated Schanz screws for the tibial pilon reduction. Schanz screws fixated to two separate motors were synchronously passed through the fracture fragments. An external fixator was applied after the fracture was stabilized with Schanz screws.Results and discussionThe mean operation duration was 45 min Fracture healing was observed in all patients, and the mean fracture healing time was 17 (range, 12–32 weeks) weeks. The mean lateral distal tibial angle was 89°. Joint surface irregularity was not observed in any patient. All of the patients had 0–15° of ankle dorsiflexion. None of the patients had restricted ankle plantar flexion. No wound complications were observed. According to the AOFAS scoring system, the clinical evaluation was excellent in 26 patients, good in 14 patients and fair in 2 patients. Malunion and nonunion may necessitate additional surgical procedures, delay the return to activities of daily living, and increase treatment costs. Good alignment was achieved, with a mean lateral distal tibial angle of 89 (range, 84–92) degrees.ConclusionPermanent hybrid external fixator applied using Schanz screws via a mini open technique is a fast, easily applied alternative with low morbidity and satisfying results.

Emergent hybrid external fixation for tibial pilon fractures in adults

ObjectiveTo investigate that if the hybrid external fixation is the definitive treatment and management of tibial extra articular and intra-articular pilon fractures of the adult in emergency. MethodsWe treated 237 cases of pilon fractures using hybrid external fixation with or without minimal osteosynthesis from February 1999 to December 2014. All fractures were classified according to the Association for the Study of Internal Fixation. The three groups were represented by 108 patients (45.5%) for the Type A; 75 patients (31.8%) for Type B and 54 patients (22.7%) for Type C. Road accidents [118 patients (50.0%)] were the most common cause of tibial pilon fractures. ResultsAccording to a mean follow-up of 7.3 years we had bone healing after 4.8 months from surgery in the 61.18% of the patients. The results were subjectively excellent, while the 54.00% were objectively excellent according to Ovadia and Beals score, and the results showed 29 complications. ConlusionsFrom our data hybrid external fixation with or without minimal fixation is a good surgical method to treat pilon fractures.

Retrospective review of tibial plateau fractures treated by two methods without staging

IntroductionManagement of complex tibial plateau fractures can be challenging for orthopaedic surgeons. Wide disagreement still remains about the best surgical technique to use in these fractures. The purpose of this study was to compare the results of complex tibial plateau fractures treated by an open reduction and internal fixation (ORIF) versus hybrid external fixation (EF) in term of clinical and functional outcomes. Materials and methodsWe retrospectively examined a series of 79 patients affected by tibial plateau fractures admitted at our Department between January 2006 and November 2011. Forty-one patients were treated using a hybrid EF; in 38 cases, ORIF technique was used. Clinical evaluation was performed using the method of Rasmussen; functional assessment was made using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire. Residual pain was detected using a Numeric Rating Scale (NRS). ResultsThe average time to union in the plate group was 17.2 weeks (9.1–45 weeks), while in the EF one 15.9 (7.5–32). The mean overall hospital stay was 14.2 days for the ORIF group and 7.8 for the EF group. At the last follow-up, the mean Rasmussen score was 24.9 (good) in the patients treated with ORIF and 25 (good) in those who received EF. The WOMAC index disclosed a relatively higher score in the EF group (80.5 ORIF–84.2 EF). Pain evaluation revealed no differences between the groups.In terms of complications, deep infection occurred in four (10.5%) patients belonging to the ORIF group and 2 (4.9%) to EF one. Signs of osteoarthritis (OA) were observed in 4 (10.5%) knees that had open reduction and in 11 (26.9%) that had a hybrid external fixator. ConclusionsEither ORIF or hybrid EF represents a valid treatment option in complex tibial plateau fractures. However, hybrid external fixation has shown relative better functional outcome results, relative lower rate of infection and decreased hospital stays. These aspects make of EF our best choice in case of high-energy complex tibial fractures.

Hybrid External Fixation for Arbeitsgemeinschaft für Osteosynthesefragen (AO) 43-C Tibial Plafond Fractures

Arbeitsgemeinschaft für Osteosynthesefragen (AO) type 43-C tibial plafond/pilon fractures represent a challenge for the treating orthopedic surgeon. We assessed the outcomes of using hybrid external fixation for this fracture type. The present prospective cohort study was started in August 2009 and ended by July 2012. Thirty consecutive patients (mean age 37.4 ± 10.7 years) with a type C tibial plafond fracture who had presented to our tertiary care orthopedic hospital were included. Motor vehicle accidents and fall from height were the cause of the fracture in 14 (46.7%) and 13 (43.3%) patients, respectively. A type C3 fracture was present in 25 patients (83.3%), and type C1 and C2 fractures were present in 2 (6.7%) and 3 (10.0%) patients, respectively. Nine fractures (30.0%) were open. Hybrid external fixation was used for all fractures. All fractures were united; clinical healing was achieved by a mean of 18.1 ± 2.2 weeks postoperatively and radiologic healing at a mean of 18.9 ± 1.9 weeks. The fixator was removed at a mean of 20.4 ± 2.0 weeks postoperatively. At a mean follow-up point of 13.4 ± 2.6 months, the mean modified Mazur ankle score was 84.6 ± 10.4. It was not associated with wound classification (p = .256). The most commonly seen complication was ankle osteoarthritis (17 patients; 56.7%); however, it was mild in >50.0% of the affected patients. In conclusion, using hybrid external fixation for type C tibial plafond fractures resulted in good outcomes. However, this should be investigated further in studies with a higher level of evidence.

Сomparative study of computer-assistance ortho-suv external fixation and conventional hybrid external fixation in adolescent with genu recurvatum

The aim of the study: to compare the results with the use of computer-assisted Ortho-SUV ExFix and conventional hybrid external fixator.Materials and methods.A retrospective analysis of examination and treatment of 13 patients aged 13 to 17 years with genu recurvatum of different etiology in combination with crus shortening. Ortho-SUV Frame was used in 5 patient, conventional hybrid external fixation was used in 5 patients.Results.Average time correction of deformity using Ortho-SUV ExFix (group A) was 23 ± 3,8 days, and using hybrid external fixator - 31 ± 4,5 days (group B). Fixation index (FI) for group A was 49,8 days/cm and 72,7 days/cm for group B. Posterior proximal tibia angle (aPPTA) reference value is 81° (77-84°). aPPTA after the final correction was 81,8 ± 1,6° for group A and 85,2 ± 4,1° for group B.Conclusions.Ortho-SUV frame allow for correction time reduction of 8 days and FI decrease of 22,9 days/cm. Genu recurvatum correction accuracy by Ortho-SUV frame is superior to the correction accuracy when using a hybrid wire-rod device.

Tibiotalar or tibiocalcaneal arthrodesis using the ilizarov technique in the presence of infected nonunions of ankle joints

To evaluate the results of managing the infected nonunions of distal tibial fractures combined with talar fracture and calcaneal fracture with tibial bone transport, tibiotalar or tibiocalcaneal arthrodesis using the hybrid external fixator. A retrospective review of 26 patients who underwent either tibiotalar arthodesis or tibiocalcaneal arthodesis using an hybrid external fixator for infected nonunions of distal tibial fractures, talar and calcaneal fractures after tibial bone distraction was made. Each patient had a debridement of all infected and nonviable bones, the wound area were 2 cm×4 cm-4 cm×8 cm. The bony surfaces of distal tibia and talus were prepared for the fusion followed by application of an Orthofix's hybrid external fixator. The remaining 18 patients undertook debridement at the docking sites, and 14 of them had autogenous bone grafting. There was a mean follow-up of 32 months (22-38 months). All the patients had successful fusions. There were no recurrent deep infections or amputations. Two patients had 6° of varus deformity at the docking site. Tibiotalar or tibiocalcaneal arthrodesis using the Ilizarov technique is viable alternative to amputation in patients with infected nonunions,especially if there is a large bone loss of the tibias, talus and calcaneus.

New Hybrid External Fixator for Complex Tibial Platau Fractures

Intra-articular fractures of the proximal tibia are serious, complex, and difficult to treat injuries. These injuries are produced by an initial axial load, which fractures the tibial articular surface resulting in impaction. Over the years, many different treatment modalities have been proposed for these complex factures. We report the use of a new modified hybrid external fixator in a minimally invasive technique which gives fair reduction results without compromising already endangered soft tissues for types V and VI fractures.

Combined Use of Percutaneous Canulated Screws and External or Internal Fixation for Less Invasive Treatment of Tibial Plateaux Fractures

The classic way of treatment of tibial plateau fractures with an extensive approach, opening of the knee and compressive internal fixation can lead to major complications such as infection, skin necrosis and knee stiffness. Here we present a less invasive and thus safer surgical technique, and its indications and results. Twenty patients with various types of fractures according to Schatzker’s classification (mainly V and VI) were treated during a time period of seven years. Surgical treatment usually consisted of a combination of percutaneous canulated screws with a hybrid external fixator. In three cases canulated screws were combined with a laterally applied anatomic locking plate. Patients were followed up for six months to three years postoperatively. Indications as well as intra and postoperative parameters such as surgical time, stability of fixation, blood loss, wound healing, infection, fracture healing and final result were studied. No major complications were recorded either early or later. The use of external οr less invasive internal fixation in combination with percutaneous canulated screws appears to be an adequate method for the treatment of most types of these fractures.

Hybrid Fixator-Fixation modality in compound comminuted Fractures of Tibia

Background: Tibial plateau fractures, Tibial plafond fractures, proximal 1/3 fractures of tibia are serious type of injuries which are found to be difficult to treat. The injury is caused by high velocity RTA which apart from causing fractures, cause extensive damage to soft tissue envelop. Aim: To study functional and radiological outcome of compound comminuted fractures of proximal and distal third tibia. Method: This is a descriptive longitudinal study carried out in 15 patients operated for hybrid external fixation for compound comminuted fractures of proximal and distal third tibia. Every patient was assessed for common fracture site, healing time and functional outcome. Results: Out of 15 patients 13 has good result 1 had varus deformity and average fracture healing time with full weight bearing walking was 20 to 24 weeks. Conclusion:-The comminuted fractures of the proximal third or the distal third fractures pose serious problems due the injury/ degloving of the soft tissue envelop. The risk of infection secondary to internal fixation is very high. Also it has been noted to have high incidence of post injury residual deformity, & knee joint stiffness. Hence less invasive method of hybrid fixator was tried which would minimize these problems and allow the biological healing of the fracture. This technique is simple, user friendly, & can allow adjustment even after frame application.