Percutaneous External Fixation Research Articles

Successful treatment of bilateral open calcaneal fractures with concomitant lower extremity injuries: A case report

Open calcaneal fractures are high morbidity injuries and the risk of complications depends on the concomitant injuries, on the size and the position of the traumatic wound. A 53-year-old male patient with bilateral open calcaneal fractures and associated concomitant lower extremity injuries such as subtalar dislocation, talonavicular dislocation and open distal tibial metaphyseal fracture was immediately operated by percutaneous Kirschner wire fixation combined with external fixators. He was able to walk with full weight bearing without any assistance at the end of the first postoperative year. Early aggressive debridement and irrigation followed by fixation with percutaneous Kirschner wires and external fixator can supply bony alignment in open comminuted calcaneal fractures associated with concomitant lower extremity injuries and should be considered for the healthy and active patients before primary arthrodesis.

Arthroscopic-Assisted Reduction and Percutaneous External Fixation of Lateral Condyle Fractures of the Humerus

Lateral condyle fractures in children are the second most common fracture about the elbow. Anatomic reduction of intra-articular displacement is considered a priority. Most experts agree that the treatment of choice of mildly displaced (>2 mm) lateral condyle fractures is open reduction–internal fixation or intraoperative arthrography followed by closed reduction and percutaneous pinning. In this report we described an alternative approach using closed arthroscopic-assisted reduction. Arthroscopy was performed by use of a 30°, 4.5-mm arthroscope through a proximal anteromedial portal with no pump, and a proximal anterolateral portal was created for instrumentation. The fracture line was easily visualized after blood, fibrin, and loose articular debris were irrigated from the joint. The fracture was manually manipulated and reduced by use of a periosteal elevator placed through the proximal anterolateral portal into the fracture and via rotation until there was no step in the articular cartilage. Two lateral Kirschner wires were placed percutaneously, which result in firm fixation of the fracture. We think that the advantages of arthroscopy are further superior to intraoperative arthrography because arthroscopy not only allows for better anatomic reduction and visualization with minimal surgical trauma and less radiation time but also provides a valid diagnostic and treatment alternative for associated injuries.

Modulation of the soft tissue reactions to percutaneous orthopaedic implants

To evaluate soft tissue reactions and biofilm formation on percutaneous external fixator screws coated with diamond-like carbon (DLC) and hydroxyapatite (HA) coatings on stainless-steel (SS) pins in an ovine loaded osteotomy model, an Orthofix external fixator was used to stabilize a 3-mm tibial midshaft osteotomy with six tapered pins inserted into the right tibia of 32 skeletally mature Friesland ewes. Animals were divided into four groups; SS, fully coated HA, DLC, and HA-coated threads. At 10 weeks, specimens were harvested and the pins were removed en bloc to examine the interfaces between the surface coatings and the tissues. Fully coated HA pins had a significantly higher percentage of dermal contact with the pin surface than HA-coated threads (p=0.028). The presence of a biofilm was evident on all pin surfaces except DLC-coated pins. Significantly greater numbers of bacteria were present on fully coated HA and plain stainless-steel pins compared with DLC. The surface of DLC-coated pins had a significantly lower number of bacterial colonies compared to SS (p=0.028) and fully coated HA pins (p=0.005). Fully coated HA pins have greater dermal attachment to the pin surface than the other pin coatings investigated. DLC-coated pins have the potential to prevent biofilm formation and bacterial colonization that may reduce infection and consequent pin loosening. An external fixator pin that is partially coated with HA to encourage bone and soft tissue integration and with DLC to reduce biofilm formation is advocated.

Infected Charcot spine

Case report of an infected Charcot spine following spinal cord injury. To describe this very rare pathological condition and the results of surgical treatment. A department of orthopaedic surgery in Japan. A 44-year-old man presented with a destructive lesion in the lumbo-sacral spine and a fistula in his back. Anterior bone graft, percutaneous external spinal fixation, and suction/irrigation of the wound were performed. After 4 months, posterior spinal instrumentation surgery was carried out. Primary closure of the fistula and complete bone fusion was achieved after the operation. Infection of a Charcot spine, although a rare clinical entity, should be considered as a diagnostic possibility in the spinal cord-injured patients. External spinal fixation is a useful method for the unstable spinal lesion with infection.

Homoimplante ortotópico conservado, associado à terapia "soft laser" na reparação tenopatelar em cão

Em busca de um método alternativo para reparação de lesões articulares envolvendo o segmento tenopatelar, 24 cães foram submetidos ao implante tenopatelar conservado em solução de glicerina a 98% e distribuídos em dois grupos de igual número (grupos I e II). Os cães do grupo II foram submetidos à terapia laser Arseneto de Gálio nos primeiros 10 dias de pós-operatório. Os animais de cada grupo foram novamente distribuídos em subgrupos de igual número de acordo com a faixa de peso que foi entre 10 e 20kg e 21 e 30kg e períodos pós-operatórios (PO) de 60, 120 e 180 dias. A articulação do joelho foi imobilizada por fixação externa percutânea tipo II e permaneceu por um período de 30 dias de pós-operatório o que proporcionou uma adequada estabilidade articular para cicatrização. Foi notada em todos os animais dos grupos I e II, atrofia da musculatura da coxa sem recuperação da massa muscular até os períodos preestabelecidos de pós-operatório (PO) de 60, 120 e 180 dias. Na avaliação macroscópica, foi notada proliferação de tecido conjuntivo ao redor e sobre a patela implantada. Na análise radiográfica, foram observados diferentes estágios de reabsorção óssea do enxerto patelar e pela microscopia foram vistas em todos os grupos, trabéculas ósseas do enxerto em fase de reabsorções, margeadas por osteoclastos e preenchidas por tecido fibrovascular e neoformação óssea a partir de ossificação endocondral. Conclui-se que a técnica de implantação de segmento tenopatelar homógeno ortotópico conservado em glicerina a 98% é apropriado para substituir segmento tenopatelar em cães pesando até 30kg.

Reconstruction of the Scalp Defect with Advancement of Scalp Flap and Forehead Lifting and Percutaneous External Fixation with Miniscrews-A Case Report

The scalp is a complex structure with multiple layers of tissue, which prvoides the coverage and protection to the skull and brains Therefore, a full-thickness defect of the scalp is a serious condition, which may develop to a life4hreatening situation. There are many methods of reconstruction to the full-thickness defect of scalp, including the rotation flap, transposition flap with skin graft, island pedicle flap with skin graft, and even free flaps Here, we develop a method which combined the wide undermining and advancing of the scalp with the percutaneous external fixation with miniscrews to the outer table of skull and a forehead-lifting, and closes a 6×6 cm scalp defect in one-stage operation, The result is satisfactory and no major complication occurs.

高度不安定性腰椎の化膿性脊椎炎に対し創外固定を用いた１例

External fixation is often used for open fractured or infected long bone. However, That for infected spines has not been reported untilnow. We have used percutaneous external fixation for pyogenic spondylosis with severe instability of the spine and epidural abscess.A 74-year-old man had severe pain of both legs. He was not able to walk. MRI showed bony destruction of the L3 and L4 vertebras and epidural abscess formation at the level of Th8 to L1. Xp showed severe instability of the lumbar spine. External fixation and anterior interbody fusion were performed and good results were achievel Spinal instrumentation for pyogenic spondylosis is now the standerd method. However implants have never been used for infected long bone. And if operations are needed, external fixation is used. Likewise external fixation is a good method for pyogenic spondylosis.

Arthroscopic-Assisted Reduction and Percutaneous External Fixation of a Displaced Intra-articular Glenoid Fracture

Summary: Arthroscopic reduction and percutaneous external fixation is a well-known technique for treating selected fractures. This is the first report of a method of treating intra-articular glenoid rim fracture using shoulder arthroscopy and percutaneous external fixation. The surgical trauma associated with open operative treatment of these fractures can be minimized using minimally invasive techniques under arthroscopic control. This technique not only allows for anatomic reduction with minimal surgical trauma but provides a valid diagnostic and treatment alternative for associated injuries. Arthroscopic reduction and percutaneous external fixation yielded excellent results with no complications. The authors describe the principles of the procedure and discuss its advantages compared with traditional surgery.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 15, No 2 (March), 1999: pp 211–214

Percutaneous Endoscopic Lumbar Spine Fusion

The advantages of the minimally invasive percutaneous approach to the lumbar intervertebral space were learned from percutaneous decompressions. Discoscopy, introduced in 1982, brought the endoscopic dimension to the intervertebral space. Percutaneous external pedicular fixation was adopted in 1988 for segmental stabilization in combination with percutaneous endoscopic preparation of the vertebral plates. The technique of percutaneous endoscopic interbody fusion, standardized since 1988, is presented and discussed with the outcome of a series of 50 patients with a mean follow up of 29 months.

Arthroscopic-assisted reduction of distal radius fractures.

The outcomes of seven patients with severe comminuted intraarticular fractures of the distal radius treated by arthroscopic reduction and percutaneous external fixation (ARPEF) were retrospectively reviewed. All of the fractures were classified as C3 types using the AO classification scheme. Outcomes were evaluated using the Gartland and Werley functional criteria, an objective wrist examination, a radiographic analysis, and a self-assessment outcome form at an average follow-up of 27 months (range, 12 to 45 months). All patients were free of pain and had returned to their prior occupations. No patient had articular incongruency of greater than 1 mm, and there was no evidence of radiocarpal degenerative change. Active range of motion and maximal grip strength averaged 92% and 98%, respectively, of the uninjured wrist. The technique of arthroscope-assisted reduction and percutaneous external fixation yielded excellent results in a small group of patients, with minimal complications.

Treatment of Osteomyelitis of the Spine Using Percutaneous Suction/Irrigation and Percutaneous External Spinal Fixation

External skeletal fixation is a well-known tool in the management of infection of long bones. However, the application of external skeletal fixation in the treatment of spinal infection has not been previously reported. We have used percutaneous external spinal fixation (PESF) for the treatment of osteomyelitis of the spine in 23 patients since 1981. The treatment consists of percutaneous vertebral biopsy for bacteriologic diagnosis, installation of a suction/irrigation system into the intervertebral disk space, and posterior stabilization (and reduction if indicated) with an external fixator placed percutaneously. This treatment was conceived in 15 patients as definitive treatment. One patient died due to pulmonary embolism. In 12 patients, the infection healed without further operative treatment. Preoperative kyphosis averaged 15 degrees (range 0-30 degrees). At follow-up, kyphotic deformity also averaged 15 degrees (range 0-30 degrees). Two patients required anterior debridement and bone grafting because of progression of bony destruction. In eight patients, PESF was performed emergently, followed by planned anterior debridement and interbody grafting. The treatment was successful in all patients. All fusions healed. Preoperative kyphosis averaged 18 degrees (range 0-40 degrees). At follow-up, kyphotic deformity averaged 10 degrees (range 0-22 degrees). Our present indications are listed below and comprise pyogenic and tuberculous osteomyelitis of the spine localized between T3 and S1. The procedure is an alternative to conservative or more invasive operative treatment modalities in the following conditions: (a) painful lesions of the spine with minimal bone loss, not amenable to efficient orthotic stabilization (thoracic spine from T3 to T9, lumbosacral junction, elderly patients, or presence of deleterious general conditions); (b) osteomyelitis of the spine from T3 to S1, when emergency decompression of the spine is mandatory because of neurologic deterioration due to the kyphotic deformity or to a noncapsulated epidural abscess and anterior decompression is not possible emergently; (c) pyogenic osteomyelitis of the spine at L5/S1, when operative treatment is indicated. In addition, percutaneous insertion of external skeletal fixation is indicated in the presence of infected wounds, making internal posterior stabilization unsuitable (e.g., after open decompression of epidural abscess, postoperative infections).