Olive Wires Research Articles

Analysis of K-Wire and Olive Wire in Ilizarov Apparatus: A Comparative Study.

Orthopedic fixators depend on mechanical characteristics like stiffness and firmness. The Ilizarov Apparatus (IA) is a common surgical management approach to restructure the bone fractures. IA includes two wires, specifically K-wire and olive wire, to treat the fractures. The functions of IA using K-wire and olive wire have been explored with experimental and finite element approach. To describe the stability of fixation and stiffness of olive wire and K-wire, the mechanical performance of the wires was evaluated experimentally as well as numerically by ANSYS software. The results obtained from the olive wire experimental setup with applied loads of 50 to 100 N, showed stiffnesses ranging from 13.85 to 14.58 N/mm and displacements ranging from 3.61 to 6.86 mm. Also, in analytical evaluation, the obtained stiffness ranges from 14.36 to 14.34 N/mm for loads of 50-100 N with a displacement of 3.48-6.97mm. A two-ring olive wire was found to be stiffer than a two-ring K-wire fixator under the same loading conditions. The goal of this study is to help orthopedic specialists assess the stiffness and stability of IA setups with olive and K-wires.

Clinical outcomes of an olive wire and external fixator versus a metallic screw in the treatment of inferior tibiofibular syndesmosis injuries in ankle fractures

BackgroundMetal screws are the most widely used in treating syndesmotic injuries, but failure and the rigidity of the screws can threaten the success of the treatment and increase the cost of care. We have provided an alternative with an olive wire and external fixator(OWEF) used for syndesmotic fixation. MethodsA retrospective longitudinal follow-up study was conducted. From February 2011 to January 2018, 58 of 72 patients with ankle fractures and associated syndesmotic disruption were treated with either screw or OWEF fixation. The costs, complications, and clinical outcomes using Olerud-Molander score and Visual Analog score in screw and OWEF fixation group were compared. ResultsWe found the severity of the injury, BMI of the patients and the different fixation methods were determinants of the complications and clinical outcomes. But if no malreduction of the syndesmosis was present, no difference in clinical result was detected. ConclusionThe OWEF method appeared to be at least equally functional and effective to screw fixation while maintaining possible lower complication rate. Levels of clinical evidenceLevel 3

Management of Scaphoid Nonunion (SNU) With Ilizarov Ring Fixator Using Two Olive Wire Compression Without Bone Grafting: A Case Series.

The scaphoid is the most commonly fractured bone among the carpal bones seen in orthopedic practice. The majority have good favorable prognosis, but some develop nonunion of fracture despite optimal treatment, which can lead to further complications if left untreated. It is recommended that displaced scaphoid nonunions (SNUs) should be reduced and fixed to prevent degenerative changes from occurring, even if they are asymptomatic. Many treatments have been described, from a percutaneous fixation with a k-wire or screw to open reduction and internal fixation with or without bone grafting, but none of them is the gold standard. To evaluate the outcome of an SNU treated with an Ilizarov fixator using two olive wires without bone graft. Eleven cases of non-union scaphoid fractureswere considered in the study which was presented to the Department of Orthopedics of Kalinga Institute of Medical Sciences during the period of March 2015 to March 2018. This study has been approved by the scientific and ethical committees.The anatomical location of the fracture was graded according to the MAYO classification. An Ilizarov frame was applied with two cross olive wires forachieving compression at the fracture area and maintained for six weeks. A final outcome was assessed using the scaphoid outcome score. One out of 11 patients operated on during the study period was lost in follow-up, so 10 patients were considered for analysis of the results. There were nine male patients and one female patient. The majority were right-sided and dominant-handed, with varied occupations. The average duration of nonunion, when presented, was 10.7 months (a range of 6-20 months). The average follow-up was 43.6 months (range 27-60 months). Union was achieved in an average of 12.9 weeks (range 10-18 weeks). All the patients returned to their pre-injury activity level in a mean of 17.1 weeks (range 13-23 weeks). Grip strength improved from a mean of 29.5 kg preoperatively to 39.4 kg postoperatively. At the final follow-up, the mean scaphoid outcome score was 9.1. An excellent outcome was obtained in five cases (50%), a good outcome in three cases (30%), a fair outcome in one case (10%), and in one case (10%), a poor outcome. With our technique of Ilizarov fixation and compression with two cross olive wires, SNU can be treated safely even without opening the non-union site and even without bone grafting. Since we excluded SNU patients with humpback deformity, carpal instability, carpal collapse, or avascular necrosis (AVN), our results might not be directly comparable to those of other SNU series in the literature. These would have predisposed to a poor outcome. Since we did not assign the patients at random, it is challenging to compare the Ilizarov technique to other widely used SNU treatments and determine whether it is more effective. However, the study's results are encouraging and show that the Ilizarov method using two olive wires for compression.

Case Series of Tibial Plateau Fracture Treated Using Illizarov External Fixator – Functional and Radiological Outcome

Introduction: Tibia plateau fracture consist of 1% of the total fractures caused by road vehicle accident. It is commonly associated with high energy trauma and usually presented either as open fracture or closed fractures with poor soft tissue condition. External fixation is commonly used in higher grade open fracture due to high risk of infection but conventional external fixator is not suitable as it is unable to address intra articular fractures. Illizarov external fixator uses olive wires to achieve compression of the intra-articular fragments and hence a better option. Case series: 8 cases of tibia plateau fracture treated in our institution from January 2019 to December 2020. 7 cases completed treatment but one patient deceased before the treatment was completed due to medical reason. The objective of the studies is to assess the functional and radiological outcome of tibia plateau fracture using IEF. It was performed clinically using knee injury and osteoarthritis score (KOOS) and radiologically using Rasmussen score during the 1st month follow up after the removal of the IEF. The mean KOOS score is 82% and the mean Rasmussen radiological score is 14. Conclusion: Illizarov external fixator is a good choice for treatment of tibia plateau fracture due to its various advantages.

Functional and radiological assessment of complex tibial plateau fractures managed with Ilizarov fixator: a study of 60 cases

<p class="abstract"><strong>Background:</strong> Tibial plateau fractures represent 1% of fractures in adults. The soft tissue envelope is in jeopardy in these fractures and can be complicated by wound dehiscence and osteomyelitis. In an Ilizarov fixator, the juxta-articular wires are placed percutaneously with minimal disruption of periosteal and endosteal blood supplies, olive wires can compress the fracture lines. The aim was to analyse the results of application of Ilizarov fixator in patients with Schatzker V and VI of tibial plateau.</p><p class="abstract"><strong>Methods:</strong> The study was conducted with 60 patients who sustained Schatzker V and VI type of tibial plateau fractures, of either sex, of an age of more than 18 years as a prospective observational study. 50 patients were treated with closed reduction and ligamentotaxis and 10 with mini open reduction prior to ring fixator application. They were followed up for a mean period of 15.4 months. The results were assessed in according to the criteria of Honkonen and Jarvinen (1992).<strong></strong></p><p class="abstract"><strong>Results:</strong> All the fractures united at a mean of 13.2 weeks. 48 patients felt their knee to be fully stable and 4 patients had severe pain. All patients were able to fully extend their knee, 36 patients had a flexion of >130 degrees and in 24 ranged between 110-129 degrees. There were 40 excellent results, 12 good, 4 fair and 4 poor. 14 patients had pin tract infections which were treated by antibiotics, 4 patients required changing the pin.</p><p class="abstract"><strong>Conclusions:</strong> Application of Ilizarov fixator is a useful method for early, definitive management of complex tibial plateau fractures with excellent results.</p>

Treatment of distal femur fractures with metaphyseal comminution by minimal internal fixation combined with Ilizarov external fixator

Objectives To evaluate the minimal internal fixation combined with Ilizarov external fixator in treatment of distal fractures of the femur, its effectiveness, complications, and ability to return to work. Patients and methods Fifteen patients (11 males and four females) with comminuted distal femur fractures (12 patients closed and three open) were treated at our hospital. All patients were admitted to the same treatment procedure, which is open reduction, minimal internal fixation by two cannulated screws, and preplanned Ilizarov frame fixation. Olive wires fixation of the reduced condyles to the distal Ilizarov ring was done, which is just above the knee joint. There is no ring distal to the knee joint. Results According to ASAMI protocol, we have nine cases of good results, five excellent, and one case of fair result. Operative time for the procedure averaged 70 min (range, 50–140 min). The mean time in fixation was 26.4 weeks (24–32 weeks). The mean follow-up period after removal of Ilizarov frame was 48.6 weeks (36–67 weeks). Conclusion With short-term follow-up, the Ilizarov external fixator associated with minimal internal fixation is effective in treatment of comminuted distal femur fractures.

A study on outcome of tibial plateau fractures (TPF) at a tertiary care hospital

The head of the tibia is sometimes obliquely broken; and if it be fractured into the knee joint the treatment which it requires is similar to that which is necessary in the oblique fracture of the condyle of the Os femoris; i.e., Firstly, the straight position of the limb, because the femur preserves the proper adaptation of the fractured tibia by forming a splint to its upper portion, and keeping the articular surfaces in apposition. Secondly, a roller, to press one part of the broken surface against the other. Thirdly, a splint of pasteboard, to assist in the preservation of that pressure and fourthly, early passive motion to prevent ankylosis. All surgeries were performed under either spiral or lumbar plexus block with Sciatic nerve block. Tourniquet was not used in any of the patients. Patient was positioned supine on the fracture table. Traction was given along the axis of the limb, fracture reduced by closed manipulation with the help of C arm. Condyles were fixed with 6 mm cannulated lag screws and olive wires. Most of the patients were followed up for a period of 23 months. The longest follow up was 24 months and the shortest was 3 months. Average duration of follow up was 16.3 months. The maximum flexion achieved was 150 deg [2 patients] and minimum was 90 deg [4 patients] and 7 patients had a flexion of 135 deg. The average flexion achieved was 118.25 deg.

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.

An Alternative Strategy for Treatment of Distal Tibiofibular Syndesmotic Disruption: A Technical Note

Metal screws are the most widely used in treating syndesmotic injuries; however, failure and the rigidity of the screws can threaten the success of the treatment and increase the cost of care. We performed open reduction and internal fixation of a fibula fracture followed by fixation of the tibiofibular joint with an olive wire and one half of an external fixator. We present a review of 1 patient treated with this material. We believe this method to be a physiologic fixation system with the advantage of being safe, inexpensive, adjustable, and effective; however, further clinical investigation and comparison to other methods is needed in order to better understand it clinical utility.

Massive segmental bone loss due to pantibial osteomyelitis in children reconstructed by medial fibular transport with Ilizarov frame

ObjectivesVascularized or non-vascularized fibula transport is a novel procedure for limb salvage but has been associated with high failure rates and complications. Ipsilateral medial fibular transport (IMFT) using Ilizarov apparatus is a modification of the procedure to prevent complications and increase success rate. This article presents the largest series of limb salvage for massive tibial bone loss in children due to pan-osteomyelitis by IMFT with Ilizarov apparatus.MethodsA case series of 12 patients with a mean age of 12 (6–18) years is described. At the first stage of surgery, the excision of all dead bone was performed, and Ilizarov without traction apparatus was applied. In second stage, ipsilateral fibula is gradually transferred to tibial defect with the help of ilizarov olive wires. In the third stage, the freshening of docking sites of fibula to tibia was performed. The minimum follow up was of two years.ResultsHypertrophy of the transported fibula accompanied by full weight bearing and satisfactory joint motion occurred in all patients. Removal of sequestrated bone resulted in control of infection in 27.17 ± 7.76 days. Fibular transport took 16.58 ± 4.14 days. The length of tibial bone loss replaced by fibula was 9.50 ± 2.23 cm. The mean days required for union after freshening of the docking site was 76.58 ± 6.20 days.ConclusionsIlizarov frame for pan tibial osteomyelitis with bone excision and medial fibular transport works well for limb salvage in children.

Treatment of high-energy pilon fractures using the ILIZAROV treatment.

The management of high-energy pilon fractures is still controversial. Open reduction and internal fixation are often associated with serious complications. Various methods have been used to treat these injuries, with variable results. The aim of this retrospective study was to analyze the clinical and radiographic outcome of the ILIZAROV technique in patients with high-energy pilon fractures. Thirty cases of distal tibia epiphysis fractures (pilon fractures) were managed from 1999 to 2012. The study group included 5 cases of open fractures. The mean age was 47 years. According to Rüedi and Algower classification; 11 fractures were type II, and 19 type III. All fractures were a consequence of high-energy trauma. Fractures of the lower fibula were present in 28 of the patients. An external Fixator was applied for open fractures. Closed injuries were operated on 3 to 13 days after injury, with an average of 8 days. The mean follow-up was 48 months. All fractures united. The external fixator was removed after a mean of 22 weeks (10 - 28 weeks). Two patients with a type III fracture had a delayed union and were treated with corticotomy and dynamisation of the ILIZAROV fixator. Only one secondary displacement of a type III fracture was noted after two months and was treated by adjuction of 2 olive wires. There were no cases of osteomyelitis or deep infections. Pin-tract infections occurred in ten patients. We had not any case of nervous injury due to introduction of the pins. Using radiological criteria for assessement of reduction of the articular fragments, there was excellent and good restoration of articular structure in 24 cases. The average American Orthopeadic Foot and Ankle Society ankle-hind foot score was excellent in 16, good in 6, fair in 6 and poor in 2. Soft tissue healing occurred without need for plastic surgery in all cases. The movements of the ankle ranged from 0 to 20° of dorsiflexion and 5° to 40° of plantar flexion. Twenty patients had gone back to their preinjury profession. The ILIZAROV technique is a safe and a very effective treatment for severe pilon fractures with minimum complications and good healing results.

ILIZAROV TECHNIQUES

Objectives: 1. To assess the results of infected nonunion of tibia by Ilizarovtechniques. 2. To ascertain the incidence of complications and advise methods to prevent them.3. To determine various risk factors which contribute to these complications. Study Design: Thisdescriptive case series. Setting: Department of Orthopaedic Surgery, Dow University of HealthSciences/ Civil Hospital Karachi. Period: 1st March 2010 to 28th Feb. 2013. Methods: A total of 30patients with infected nonunion of tibia with or without shortening and bone loss was includedin the study. Patients lying in supine position, after spinal anesthesia, radical debridement weredone and all previous infected implants and necrotic bone removed, pre-assembled ilizarovframe was applied with the help of four or five rings, each ring was fixed with k-wires andschanz pins. Olive wires were used where interfragmentary compression, correction of axialdeviation of fragment, in osteoporotic bones, transport of fibular fragment or more stability wasrequired. Results: Results were divided into bony and functional parts by ASAMI. We achieveexcellent to good bony result in 86.66% (26/30) of cases and excellent to good functional resultin 76.66% (23/30) of cases. Conclusion: It is concluded that bony and functional outcome ofinfected nonunion of tibia treated with ilizarov ring fixator is satisfactory. Although its applicationis lengthy but once applied patients get benefits, they can start walking with full weight bearing,limb length equality and soft tissue coverage achieved, so we recommend its applications insuch type of cases.

English

Objectives: 1. To assess the results of infected nonunion of tibia by Ilizarov techniques. 2. To ascertain the incidence of complications and advise methods to prevent them. 3. To determine various risk factors which contribute to these complications. Study Design: This descriptive case series. Setting: Department of Orthopaedic Surgery, Dow University of Health Sciences/ Civil Hospital Karachi. Period: 1 st March 2010 to 28 th Feb. 2013. Methods: A total of 30 patients with infected nonunion of tibia with or without shortening and bone loss was included in the study. Patients lying in supine position, after spinal anesthesia, radical debridement were done and all previous infected implants and necrotic bone removed, pre-assembled ilizarov frame was applied with the help of four or five rings, each ring was fixed with k-wires and schanz pins. Olive wires were used where interfragmentary compression, correction of axial deviation of fragment, in osteoporotic bones, transport of fibular fragment or more stability was required. Results: Results were divided into bony and functional parts by ASAMI. We achieve excellent to good bony result in 86.66% (26/30) of cases and excellent to good functional result in 76.66% (23/30) of cases. Conclusion: It is concluded that bony and functional outcome of infected nonunion of tibia treated with ilizarov ring fixator is satisfactory. Although its application is lengthy but once applied patients get benefits, they can start walking with full weight bearing, limb length equality and soft tissue coverage achieved, so we recommend its applications in such type of cases.

Complex proximal tibia fracture dislocations managed by Ilizaorov fixator-A case series with review of literature

Background: Bicondylartibial fractures are serious injuries and are difficult to manage even for the most experienced trauma surgeons. The soft tissue around proximal tibia demonstrates poor healing response following dissection or manipulation. Hence surgical fixation of these injuries by osteosynthesis has shown mixed results over the years. Case Series: We conducted a prospective study of five consecutive patients of compound proximal tibia bicondylar fractures from January 2013 to June 2016. All of them were compound type 3A or 3B injuries classified according to Gustilo-Anderson grading system of open injuries. ILIZAROV fixator was used for treatment in all the cases. The fixator was kept for an average of twelve to twenty weeks. The patients range of motion and knee society score was recorded at the end of 32 weeks. Results: The average range of movements achieved in the knee joint was105 degrees at the end of eight months. Complications included knee stiffness and pin site infections. Knee stiffness was managed by subjecting the patient to aggressive physiotherapy by continuous passive movements. In one patient manipulation under general anesthesia had to be done. Two patients had pin site infections which were superficial and subsided by antibiotics and daily pin site dressings. The knee society score was excellent in four patients and good in one patient. Conclusion: This case series emphasizes the clinical success and low morbidity to the patient when treated with ILIZAROV fixator. The technique is suited well to manage complex proximal tibia injuries as it provides a stable construct in all the planes. Anatomical reduction of fragments can be achieved by closed reduction using olive wires during ILIZAROV application. This would avoid excessive dissection of soft tissue required during plating. Keywords: Proximal tibia fracture; Knee dislocation; ILIZAROV fixator; Knee joint

Removal of a broken distal cannulated intramedullary femoral nail with solid reamer with closed methods and without using C-arm: A case report

Intramedullary nailing of long bone fractures is an accepted technique with the advantages of not disturbing the fracture hematoma and the biomechanical superiority over plating.1 However, problems with the nail are not infrequent, with broken nails and locking screws particularly posing a difficult problem for the orthopedic surgeon, especially when nail get broken due to cyclical stress of retrauma at site of distal screw placement as this the one of the weak part of intramedullary nail. Many techniques are described for extraction of the distal broken intramedullary nail that require special equipment like olive wires or laparoscopic grabbers.1–3 There are many difficulties at times This equipment may not be always readily available which can make the process quite difficult. In remote parts of developing nation availability of C-arm is also an issue. We describe a simple reproducible method of extraction of the distal broken cannulated femoral nail fragment by antegrade approach without using C-arm and opening fracture site by using solid K-nail reamer. We have successfully used this technique to extract nail which is broken at D1 SCREW site, by using sequential K-nail reamer of size smaller than nail diameter in a young adult male patient.

Use of Tensioned Olive Wires through a Neutralization Plate for Syndesmotic Reduction

Ankle fractures are a common osteologic outcome from trauma. These fracture patterns include a variety of concomitant soft tissue disruptions, including diastasis. Surgical treatment of a syndesmotic injury can be performed in conjunction with open reduction with internal fixation. The present technique guide demonstrates the use of pre-existing hardware, after open reduction with internal fixation from a previous ankle fracture, with an Ilizarov fixation construct to percutaneously reduce a bimalleolar equivalent fracture and diastasis to the syndesmosis.

A Biomechanical Evaluation of Three Drop Wire Configurations

Evaluate effect of adding drop wires to single-ring constructs. Biomechanical study Single ring circular external skeletal fixator constructs stabilizing a Delrin segment bone model. Eight replicates of 5 constructs made with 66 mm complete rings, 1.6 mm olive wires, and a 15.9-mm diameter Delrin rod were loaded in axial compression, craniocaudal and mediolateral bending, and torsion. Constructs tested were: (1) base single-ring construct; (2) single-ring construct with a drop wire mounted on fixation bolts; (3) single-ring construct with a drop wire mounted on 1-hole posts; (4) single-ring construct with a drop wire mounted on 2-hole posts; and (5) 2-ring construct. Construct stiffness for each mode of loading was compared using repeated measures ANOVAs (P ≤ .05). Axial compression and torsion: the 2-ring construct was stiffer than all others. Drop wire constructs were stiffer than the single-ring construct, but not significantly different from each other. Craniocaudal bending: the 2-ring construct was stiffest with the 2-hole post construct being stiffer than all except the 2-ring construct. Mediolateral bending: the 2-hole post construct was stiffer than the 2-ring construct, which was stiffer than the 1-hole post construct, which was stiffer than the fixation-bolt construct, which was stiffer than the single-ring construct. Drop wires improved stiffness of single-ring constructs in all loading modalities. Positioning the drop wire farther from the ring surface significantly improved craniocaudal and mediolateral bending stiffness, but did not affect axial compression and torsional stiffness.

Strength Evaluation of Lateral Calcaneal Wall with Circular External Fixation Application in Cadaveric Specimens

Circular external fixation is a useful treatment option for the correction of complex trauma, extremity deformity, osteomyelitis, and reconstruction of the foot and ankle. The goal of the present study was to determine the degrees of bolt rotation required to create enough wire tension to cause structural failure of the lateral calcaneal wall when stressed with both olive and smooth wires in a cadaveric model. Ten fresh, thawed, below-the-knee specimens were tested at the San Diego Cadaveric Academic Research Symposium. The mean bolt rotation required to pull an olive wire through the lateral wall of the calcaneus was 79.8° ± 32.81°, and the mean bolt rotation required to “walk” a skinny wire (narrow diameter) and create 1 mm of cortical bone failure was 50.5° ± 30.91°. The results of the present investigation further define and elucidate the appropriate “Russian tensioning” technique applicable for external fixation of the calcaneus using olive or skinny wires in the case of fracture repair or compression arthrodesis.

A Biomechanical Comparison of Three Hybrid Linear‐Circular External Fixator Constructs

To evaluate the stiffness, displacement, ring deformation and bone model motion of 3 configuations of linear-circular hybrid fixator constructs loaded in axial compression, craniocaudal and mediolateral bending, and torsion. Biomechanical evaluation. Three hybrid construct configurations with 8 replicates/configuration. Construct Ia used a single, 84 mm, incomplete ring and 2 tensioned olive wires to stabilize 1 bone segment and a primary hybrid rod with 3 fixation pins to stabilize the other bone segment. Constructs Ia(d) and Ib were similar to Ia with the addition of a secondary diagonal hybrid rod. Construct Ib had a fixation pin inserted orthogonally from the diagonal rod. Constructs were loaded for 10 cycles in each mode of loading using a materials testing machine. Ring deformation was assessed by obtaining serial ring measurements. Bone model motion at the fracture gap as a result of loading was also calculated. Axial compression: constructs Ia(d) and Ib were significantly stiffer than construct Ia. Craniocaudal bending: Construct Ib was significantly stiffer than construct Ia. Mediolateral bending: there were no significant differences between constructs. Torsion: Construct Ib was significantly stiffer than constructs Ia and Ia(d) . Permanent ring deformation did not occur. Bone model translational motion decreased in constructs Ia(d) and Ib compared to construct Ia. Addition of a secondary hybrid rod as well as biplanar fixation pin placement improved construct stiffness in several loading modes.

Management of thromboangiitis obliterans using distraction osteogenesis: A retrospective study

Background:Thromboangiitis obliterans (TAO), also known as Buerger disease, is characterized by thrombosis in medium-sized arteries and veins along with a marked inflammatory response. TAO can be managed by using the principle of distraction osteogenesis to induce neoangiogenesis. We report thirty patients of TAO in the age-group of 20–50 years were treated with the Ilizarov method.Materials and Methods:Patients with severe rest pain (n=30), absent distal pulsation (n=30) and ulcer (n=6) and/or gangrene of the toes (n=4), who had failed the conservative pharmacological modalities of treatment were included. A lateral tibial corticotomy was performed and distraction applied by use of olive wire. A two-ring frame was used for all cases.Results:Of the 30 cases, 25 patients became pain free while 1 had partial relief of pain. The four patients worsened on treatment and developed frank infection were amputed. The average distraction was 1.8±0.3 mm (range: 1.5–2.2 cm). The mean consolidation period was 98±11 days, after which the fixator was removed. The total duration of treatment was 122±23 days. There were two cases of osteomyelitis in our series; both healed after debridement and both patients had good result, with relief of pain. The ulcers started healing by 4–6 weeks.Conclusion:The principle of the distraction osteogenesis including neoangiogenesis can be used for treatment of TAO and has an acceptable complication rate.