Non-bridging External Fixation Research Articles

Surgical Treatment of Extra-Articular or Simple Intra-Articular Distal Tibial Fractures: External Fixation versus Intramedullary Nailing

To compare intramedullary nailing (IMN) with external fixation (EF) in the treatment of tibial shaft fractures located within 5 cm of the ankle. University teaching hospital. Retrospective comparative study. Sixty-seven patients with a mean age of 48 years (range, 16-78 years; 24 women, 43 men). Thirty-three fractures were treated with EF from 1998 to 2004 and 34 fractures were treated with reamed IMN from 2004 to 2007. Olerud-Molander ankle score, RAND-36 Item Health Survey, and the number of secondary interventions. The healing time was 21 weeks in the IMN group and 23 weeks in the EF group (P = 0.53). One fracture in the IMN group and three in the EF group malunited (P = 0.62). Olerud-Molander ankle score was 75 in the IMN group and 74 in the EF group (P = 0.51). There was no difference in any of the RAND-36 subscores measuring physical functioning. More patients in the EF group had secondary intervention resulting from delayed healing (8 versus 1, P = 0.03). The patients in the EF group also needed more secondary interventions as a result of any complication (15 versus 2, P < 0.001). There was one deep infection in the IMN group. Distal extra-articular or simple intra-articular fractures can be treated with modern IMNs or nonbridging EF. Although functional results are similar, EF carries a significant greater risk of secondary interventions; based on these data, IMN is recommended.

Randomised study of non-bridging external fixation compared with intramedullary fixation of unstable distal radial fractures

This is a randomised study to compare two types of osteosynthesis to mobilise wrists after distal fractures of the radius. Inclusion criteria were Older type 2 and 3 fractures. External fixation was managed with Hoffmann II compact non-bridging. Internal fixation was managed with Micronail. Patients were followed up for 12 weeks. The primary outcome was the results of the disabilities of arm, shoulder and hand (DASH) questionnaire. The secondary outcomes were answers to the patient-rated wrist evaluation (PRWE), grip strength, satisfaction, radial length, and volar tilt. Thirty patients were randomised to have external fixation and 31 to have internal fixation.There were no significant differences in DASH score. Internal fixation gave significantly better grip strength at five (p = 0.00) and 12 weeks (p = 0.03). The operating time was significantly shorter (p = 0.00) when non-bridging external fixation was used, and there were minor radiological differences. An activity-based costing analysis showed that external fixation cost three times more overall.

In-Depth Oral Presentations and Oral Communications

Introduction Distal radial fractures represent 17% of fractures in the Italian E.R. At the University Hospital ‘‘Policlinico Umberto I’’ of Rome E.R. we have started treating these fractures with a new fixation system designed by us: the CASLAU. This system provides a nonbridging external fixation. The synthesis is guaranteed by two or more K-wires which can be intramedullary or x-crossing the cortex and/or inter-fragmentary. These K-wires are connected with two radial pins by an external bar. This radial to radial system gives stability to the fracture and allows the patient to move the wrist immediately. We remove this fixation system after 40 days. Materials and methods From July 2008 to July 2010 we treated 127 distal radial fractures. Evaluation outcomes are presented only for the 101 patients that, at the present time, have a follow-up longer than 8 months. Clinical assessment was performed every 7 days until removal of external fixation system, then at 2, 3, 6 and 12 months. Radiographic assessment was performed at 30 and 40 days, consequently at 2, 3, 6 and 12 months. Outcome was measured on the basis of range of motion, grip and pinch strength, DASH and PRWE scores. A questionnaire was used to determine patient satisfaction, and a detailed analysis of complications was carried out. Results All patients had excellent or good results and were satisfied with the clinical outcome. At 60 days after surgery 94% of patients showed complete clinical and functional recovery. After 3 months 100% of patients showed complete clinical and functional recovery. After 6 and 12 months no modification of the obtained result was detected. Discussion Considering the immediate movement recovery and the minimal invasive system CASLAU non bridging external fixator is on our opinion a useful tool for DRF’s treatment. Conclusions On our series, at an average 14-month follow-up, the CASLAU system showed good to excellent results.

A novel non-bridging external fixator construct versus volar angular stable plating for the fixation of intra-articular fractures of the distal radius—A biomechanical study

Non-bridging external fixation has recently been introduced as an alternative to volar angular stable plating for the fixation of unstable intra-articular distal radial fractures. The purpose of this study was to biomechanically compare a new non-bridging external fixator construct to volar angular stable plate fixation in a dorsally comminuted intra-articular fracture model of the distal radius. Five pairs of fresh frozen human cadaveric radii were randomly supplied with either a non-bridging external fixator or a stainless steel volar locking plate. A three-fragmental AO 23-C2.1 fracture was created by removing a 15 degrees dorsal wedge with remaining volar cortical contact and by an intra-articular osteotomy lateral to the lister-tubercle. Physiological load transfer via the wrist was simulated by means of a custom-made seesaw. For biomechanical testing, the bones were loaded in cyclic axial compression. Starting at 100N, the load was monotonically increased at 0.025 degrees N per cycle until failure of the construct. Motion of the lunate and scaphoid fragments with respect to the radial diaphysis was acquired by optical three-dimensional (3D) motion tracking. Plastic wedge deformation was determined after 2000, 4000 and 6000 cycles. The amplitude of wedge motion at the beginning of the test as a measure for construct stiffness was significantly lower for the fixator group (P=0.003, power=0.99). Plastic wedge deformation after 2000, 4000 and 6000 cycles was found significantly lower for the external fixator (repeated measures analysis of variance (ANOVA), P=0.009, power=0.86). Displacement of the intra-articular gap was found below 0.6mm (mean) for both groups (P>0.05). The study revealed superior biomechanical properties of the proposed non-bridging external fixation compared to volar locked plating in an unstable intra-articular fracture model with volar cortical support. However, both fixation techniques seem to apply sufficient stabilisation to restore and retain anatomy after fracture of the most distal part of the radius and should be individually chosen according to distinct criteria.

Colles' Fracture Treated with Non-Bridging External Fixation: A 1-Year Follow-Up

The results in 75 of 105 patients with Older type II/III (AO type A2.2, A3.1, A3.2) Colles' fractures, treated with non-bridging external fixation are presented. The mean age was 67.8 years, and all patients were followed prospectively for 12 months with radiological and functional assessment. No statistically significant loss of radial length, angulation or inclination was seen between the postoperative reduction and the 1-year follow-up examination. The clinical results after 1 year were 66 (88%) excellent/good, nine (12%) fair and 0 (0%) poor according to the modified Gartland and Werley score. Mean visual analogue scale pain score after 1 year was 0.8. In three patients (4%), re-displacement of the fracture occurred and was treated with plating. Non-bridging external fixation offers a reliable method of maintaining radiological reduction of Older type II/III fractures of the distal radius and gives a good functional outcome after 1 year.

Treatment of Distal Radius Fractures With a Nonbridging Cross-Pin Fixator (The CPX System)

Many treatment methods exist for patients presenting with a fracture of the distal radius. With the evolution of innovative procedures and devices, treatment of these particular fractures is shifting to more contemporary approaches. The minimally invasive technique with the cross-pin fixator (CPX) system offers a new biomechanical concept for relatively rigid fixation of distal radius fractures (DRF). The CPX system uses percutaneous cross Kirschner wire fixation in combination with a nonbridging external fixator. The stability of the model is derived from the external unilateral frame and the positioning of multiple 1.6 mm Kirschner wires at various angles and planes to each other. This allows for maintenance of DRF reduction, early wrist mobilization, and a prompt return to the usual activities. Between September 2004 and September 2008, there were 54 patients with 56 DRF who were treated with the CPX system. Excluded from the report are 2 patients who had a bone graft and 1 patient who was not willing to adhere to the postoperative protocol. Of the 51 patients with 53 DRF, no major complications were reported. This article describes the CPX surgical technique, the indications, the complications, and the postoperative management.

Colles’ Fracture Treated with Non-Bridging External Fixation: A 1-Year Follow-Up

The results in 75 of 105 patients with Older type II/III (AO type A2.2, A3.1, A3.2) Colles' fractures, treated with non-bridging external fixation are presented. The mean age was 67.8 years, and all patients were followed prospectively for 12 months with radiological and functional assessment. No statistically significant loss of radial length, angulation or inclination was seen between the postoperative reduction and the 1-year follow-up examination. The clinical results after 1 year were 66 (88%) excellent/good, nine (12%) fair and 0 (0%) poor according to the modified Gartland and Werley score. Mean visual analogue scale pain score after 1 year was 0.8. In three patients (4%), re-displacement of the fracture occurred and was treated with plating. Non-bridging external fixation offers a reliable method of maintaining radiological reduction of Older type II/III fractures of the distal radius and gives a good functional outcome after 1 year.

Fractures of the Distal Radius Treated With Cross-Pin Fixation and a Nonbridging External Fixator, the CPX System: A Preliminary Report

To present the preliminary findings of distal radius fractures (DRF) treated with percutaneous cross-pin fixation and a nonbridging external fixator, the Cross-Pin Fixation (CPX) system. Thirty-five consecutive patients with 37 DRFs were selected from a series of 51 DRFs for closed reduction, percutaneous pinning, and external fixation with the CPX system. Outcome was determined by studying (1) radiological measurements of radial height, palmar tilt, radial inclination and ulnar variance (UV); (2) grip and pinch strength; (3) wrist active range of motion; and (4) patient outcome instruments-the Patient-Rated Wrist Hand Evaluation and the Disabilities of the Arm, Shoulder, and Hand. We are reporting on 21 patients, 13 females and 8 males, mean age 54 years (range, 27 to 87 y) with AO type fractures A2, B2, B3, C1, C2, and C3. Follow-up was a minimum of 1 year (range, 12 to 36 months). Wrist rehabilitation began at a mean of 10 days (range, 4 to 16 d) after surgery. There was no loss of reduction. Final mean grip and lateral pinch strength recovered 86% and 94%, respectively, and active range of motion increased to a minimum of 89% of the noninjured side. Disabilities of the Arm, Shoulder, and Hand showed change in functional status (minimal detectable change at 95% confidence level) at 4 and 12 weeks. The Patient-Rated Wrist Hand Evaluation results reported resumption of usual activities in the early postoperative period. One patient developed type I complex regional pain syndrome, which resolved, and one patient had residual transient mild superficial radial nerve sensitivity. There were no pin track infections, nonunions, or tendon injuries. All patients returned to their prior employment and activities. The CPX system is a minimally invasive technique of closed reduction and internal fixation for displaced, reducible extra-articular and nondisplaced and displaced reducible intra-articular fractures of the distal radius, allowing rehabilitation of the wrist and resumption of usual activities while maintaining fracture reduction. Therapeutic IV.

Bridging and non-bridging external fixation in the treatment of unstable fractures of the distal radius: A retrospective study of 588 patients

Bridging and non-bridging external fixation in the treatment of unstable fractures of the distal radius: A retrospective study of 588 patients

Bridging and non-bridging external fixation in the treatment of unstable fractures of the distal radius: A retrospective study of 588 patients

Bridging and non-bridging external fixation in the treatment of unstable fractures of the distal radius: A retrospective study of 588 patients

A comparison of RhBMP-7 (OP-1) and autogenous graft for metaphyseal defects after osteotomy of the distal radius

SUMMARY AIM: The aim of the study was to demonstrate whether RhBMP-7 is an effective alternative to autogenous bone graft in the healing of metaphyseal defects in the distal radius following corrective osteotomies for symptomatic malunion after distal radial fractures. Thirty patients were entered into the study and were randomised to receive either RhBMP-7 or autogenous bone graft harvested from the ipsilateral iliac crest. Stabilisation of the osteotomy was either carried out with non- bridging external fixation or the pi-plate. Clinical, radiographic and functional review were carried out at regular intervals up to 1 year. The first 10 patients were treated using non-bridging external fixation of the osteotomy. Two of the 4 patients treated with RhBMP-7 developed excessive osteolysis around the osteotomy site resulting in loss of the corrected position and non-union of the osteotomy. The other 2 patients healed at 13 weeks. The 6 patients treated with autogenous bone graft all healed at an average of 7 weeks, without any complications. It was postulated that the osteolysis was related to instability of the osteotomy site, and the use of external fixation was abandoned and replaced with internal fixation with a dorsal pi-plate. In the pi-plate group of patients, 10 were treated with autogenous bone graft and 10 with RhBMP-7. The bone graft patients healed at 7 weeks compared to 18 weeks for the RhBMP-7 patients, which was statistically significant (p = 0.019). The patients who received bone graft had complete filling of the metaphyseal defect radiologically. Five patients treated with RhBMP-7 healed at the volar cortex with a dorsal defect remaining at 1 year. Two patients developed non-union radiologically. Ten patients (3 in the RhBMP-7 and 7 in the bone graft groups) required plate removal for soft tissue complications. RhBMP-7 does not confer the same stability as bone graft, allowing shear forces across the osteotomy site when used in conjunction with non-bridging external fixation, reducing the capacity for healing and resulting in osteolysis. Using the RhBMP-7 with a pi-plate resulted in healing of the osteotomy, but at a slower rate than autogenous bone graft.

Biomechanical Characteristics of Nonbridging External Fixators for Distal Radius Fractures

Nonbridging external fixation is becoming popular for distal radius fractures, although its biomechanical characteristics have not been documented. This study evaluated the biomechanical characteristics of nonbridging external fixators for distal radius fractures. We tested 3 currently available nonbridging fixators (F-Wrist fixator, Hoffman II Compact, and Pennig Dynamic Wrist Fixator) and determined their relative stiffness under axial compression, torsion, and bending moments (dorsal, volar, radial, and ulnar aspects) using a uniform unstable distal radius fracture model. The contact pressure and its total load on the fracture plane were also measured to evaluate the mechanical stimuli at the stable fracture site using a pressure-sensitive conductive rubber sensor. Differences were observed in the stiffness: the Pennig fixator was the stiffest, whereas the F-Wrist fixator was the least rigid. The total load transmitted from the wrist joint to the fracture plane depended on the fixator stiffness in axial compression. By determining the biomechanical characteristics of nonbridging external fixators, these data may help the clinician when deciding on a particular device for nonbridging external fixation.

Treatment of distal radial fracture with non-bridging external fixation

Treatment of distal radial fracture with non-bridging external fixation

Gradual Reduction of Distal Radial Malunion Using Distraction Osteogenesis

To evaluate gradual distraction lengthening or distraction osteogenesis as a technique for treating malunions of the distal radius. Twenty patients with clinical and radiographic evidence of distal radius malunion were treated with osteotomy of the distal radius using distraction osteogenesis. At the follow-up evaluation each patient was evaluated for healing rates, complications, resolution of pain, and radiographic alignment. Surgical treatment consisted of an application of a nonbridging external fixator that could be distracted to correct the deformity. A loosely set screw that connected the distal pins to the fixator served as a hinge and allowed the distal radius to rotate into a corrected position. Gradual distraction via distraction osteogenesis was initiated 1 week after surgery. Seventeen osteotomies healed uneventfully in an average of 9 weeks. Complications included 9 pin track infections. Two nonunions required bone grafting. One patient inadvertently compressed rather than distracted the fixator, leading to premature healing of the osteotomy. One patient ruptured the extensor pollicis longus. All complications resolved with additional intervention. Overall the patients showed radiographic and symptomatic improvement. An external fixator and distraction lengthening through distraction osteogenesis is a viable alternative to plate fixation and bone grafting. In 18 of 20 of our patients, the technique eliminated the need for bone grafting and the need for a second surgical procedure to remove a dorsal plate.

Distal radial fractures

Evidence from four quasi-randomized or randomized controlled trials suggests that treatment of acute distal radial fractures with wrist-bridging external fixation compared with nonbridging external fixation leads to comparable results with respect to VAS pain score, grip strength, and extension. There was conflicting evidence in regard to which method may provide the best final degree of flexion. The total number of reported complications was greater for nonbridging fixation in three of the four trials. The percentage of patients with pin-track infection was consistently higher in the nonbridging fixation groups, however, the difference did not reach statistical significance. Additional methodologically rigorous comparative studies with larger populations are necessary to establish the long-term safety and efficacy of these two operative treatments, and to establish the superiority of one treatment over another.

Wrist-bridging versus non-bridging external fixation for displaced distal radius fractures: A randomized assessor-blind clinical trial of 38 patients followed for 1 year

Wrist-bridging versus non-bridging external fixation for displaced distal radius fractures: A randomized assessor-blind clinical trial of 38 patients followed for 1 year

Wrist-bridging versus non-bridging external fixation for displaced distal radius fractures: A randomized assessor-blind clinical trial of 38 patients followed for 1 year

Background Non-bridging external fixation has been introduced to achieve better fracture fixation and functional outcomes in distal radius fractures, but has not been specifically evaluated in a randomized study in the elderly. The purpose of this trial was to compare wrist-bridging and non-bridging external fixation for displaced distal radius fractures.Method The inclusion criteria were women ≥ 50 or men ≥ 60 years, acute extraarticular or intraarticular fracture, and dorsal angulation of ≥20° or ulnar variance ≥ 5 mm. The patients completed the disabilities of the arm, shoulder and hand (DASH) questionnaire before and at 10, 26 and 52 weeks after surgery. Pain (visual analog scale), range of motion and grip strength were measured by a blinded assessor.Results 38 patients (mean age 71 years, 31 women) were randomized at surgery (19 to each group). Mean operating time was shorter for wrist-bridging fixation by 10 (95% CI 3–17) min. There was no significant difference in DASH scores between the groups. No statistically significant differences in pain score, range of motion, grip strength, or patient satisfaction were found. The non-bridging group had a significantly better radial length at 52 weeks; mean difference in change in ulnar variance from baseline was 1.4 (95% CI 0.1–2.7) mm (p = 0.04). Volar tilt and radial inclination were similar in both groups.Interpretation For moderately or severely displaced distal radius fractures in the elderly, non-bridging external fixation had no clinically relevant advantage over wrist-bridging fixation but was more effective in maintaining radial length.

Fractures of the Distal Radius Treated With a Nonbridging External Fixation Technique Using Multiplanar K-Wires

Joint-bridging external fixation is a minimally invasive treatment option for distal radius fractures. Although radial length can be restored easily the anatomic reduction of articular fragments and restoration of the normal volar tilt proves to be more difficult. A method of nonbridging hybrid fixation of distal radius fractures facilitates fracture reduction and allows for free wrist movement. Twenty-five consecutive patients with fractures of the distal radius were treated with nonbridging external fixation for 6 weeks. The stepwise surgical technique comprised a preliminary joint-bridging construction for reduction purposes, the subsequent insertion of 3 to 4 K-wires in the distal fragment, the assembling of wires to a bar nearly parallel to the fracture line, and lastly the removal of the joint-bridging part. Clinical and radiologic evaluation was performed on the first and seventh days and at 6 weeks and 2 years after surgery. All fractures united. Palmar tilt (> or =0 degrees ) and articular surface (articular step-off < 2 mm) were restored in all patients whereas loss of radial length occurred in 4 patients having the distal fracture fragment secured with 3 K-wires. No radial shortening was seen in fractures with 4 K-wires inserted in the distal fragment. Functional results at 2 years after surgery showed an average extension of 55 degrees and flexion of 64 degrees without significant differences between extra-articular and intra-articular fractures. There was no extensor tendinitis or pin loosening in the distal fragment; however, 3 pin track infections of proximal pins occurred. This surgical technique of nonbridging external fixation is a good treatment option for distal radius fractures: it permits wrist movement. We recommend the insertion of 4 K-wires in the distal fracture fragment.

Treatment of Distal Radius Fracture With the Use of Calcium Phosphate Bone Cement as a Filler

A new procedure for unstable fractures of the distal radius is presented. It uses a nonbridging external fixator in conjunction with calcium phosphate bone cement through a limited exposure. The best indication for the new procedure is intra-articular fracture with some large displaced fragments in young adults. In the C2 or C3 type fractures according to AO classification, it is very difficult to obtain satisfactory fixation with a plate and screws due to comminution of the articular surface and metaphysical bone defects in many instances. After reduction of the articular surface, this new technique allows fixation of the comminuted fragments using half pins of a nonbridging external fixator. Furthermore, injection of calcium phosphate bone to the bone defect helps to make both the articular surface and the cortical bone stable. The nonbridging external fixator allows early exercises. However, it cannot be applied to all types of the fracture because of its structural limitations. The combination of nonbridging external fixation and calcium phosphate bone applications assures early exercise of the wrist.

Intra-articular fractures of the distal radius: a prospective randomised controlled trial comparing static bridging and dynamic non-bridging external fixation

This prospective randomized trial compared a non-bridging external fixator with a bridging external fixator system for the treatment of severe comminuted intra-articular fractures of the distal radius. The results did not demonstrate a statistically significant difference in the radiological and clinical outcomes achieved with these two treatments.