Ring Fixator Research Articles

Outcomes of Infected Non-unions of Distal Femur Managed with the Masquelet Method and Ilizarov Ring Fixator

Outcomes of Infected Non-unions of Distal Femur Managed with the Masquelet Method and Ilizarov Ring Fixator

CT-Based Evaluation of Volumetric Posterior Pelvic Bone Density with Implications for the Percutaneous Screw Fixation of the Sacroiliac Joint.

Background: Operative treatment of fragility fractures of the pelvis has become a gold standard. Preoperative planning, including the assessment of the pathway for iliosacral screws, is crucial. The anchorage of the screw depends on the bone quality. Some recent studies have concentrated on assessing bone mineral density (BMD) with the use of Hounsfield unit (HU) values obtained from CT scans. The aim of the present study is to determine the best sacral levels of S1-S3 on the pathway of iliosacral screws for sacroiliac joint fixation. Methods: Patients admitted to the Independent Public Healthcare Center in Rypin between 1 of September and 1 of December in 2023, who had CT scans of the pelvis performed on them for different reasons, were included in this study. In total, 103 patients-56 men and 47 women-were enrolled in the study and consecutively separated into two groups of different ages: 18-60 years old (group A) and above 60 years old (group B). The volumetric bone density expressed in HU values was measured with sacral levels of S1, S2 and S3. Apart from the bodies of sacral vertebrae S1-S3, our measurements involved the ala of the ilium in the vicinity of the sacroiliac joint and the wing of the sacrum. All the measurements were performed on the pathway of presumptive iliosacral screws to stabilize the sacroiliac joint. Results: In group A (58 patients) the highest bone density in sacral bodies was found in S1 that gradually decreased to S3, while the opposite tendency was demonstrated in the ala of ilium. The HU values in the wing of the sacrum did not display statistical significance. In group B (45 patients), the highest bone density was also found in the sacral body S1 that decreased toward S3 but in the ala of ilium, the highest bone density was found with level S1 and lowest with level S2. In both groups, the highest bone density referred to the wing of the sacrum. Conclusion: While the perfect construct for posterior pelvic ring fixation remains unclear, our findings may imply that sacroiliac joint screws inserted into the wing of the sacrum of greater bone density could provide much more successful fixation in comparison to those anchored in the body of sacral vertebra of lesser bone density.

Biomechanical evaluation of an experimental internal ring fixator (RingFix) for stabilization of pelvic ring injuries on an osteoporotic bone model

During the last decades, effective pain reduction and early mobilization were identified as the central priorities in therapy of insufficiency fractures of the pelvis. For operative treatment minimally-invasive stabilization techniques are favored. While there is consensus on the significance of sufficient dorsal stabilization the role of additional fixation of the anterior fracture component stays under discussion. Within the present study we developed an internal ring fixator system (RingFix) with the question whether an in-itself-closed construct can improve stability of the entire ring structure. RingFix was evaluated on an osteoporotic bone model with a standardized FFP IIIc fracture within an established biomechanical setup regarding its primary stabilization potential. Further, it was compared to transiliac–transsacral screw fixation with and without stabilization of the anterior fracture component. The transiliac–transsacral fixation with separate screw fixation of the anterior fracture showed significantly higher stability than the RingFix and the transiliac–transsacral screw fixation without anterior stabilization. Our results show that stabilization of the anterior fracture component relevantly improves the stability of the entire ring construct. As a bridging stabilizer, RingFix shows biomechanical advantages over an isolated dorsal fracture fixation, but inferior results than direct stabilization of the single fracture components.

The mode of delivery after operative fixation of pelvic ring fractures-a retrospective observational study.

The purpose of this study is to investigate whether retained hardware after surgical treatment for a pelvic fracture prior to pregnancy affects the choice of delivery method. The study aims to provide insights into the rates of vaginal delivery and caesarean sections, understanding whether the mode of delivery was influenced by patient preference or the recommendations of obstetricians or surgeons, and examining the rate of complications during delivery and postpartum. All women of childbearing age who underwent surgical fixation for a pelvic ring fracture between 1994 and 2021 were identified. A questionnaire was sent about their possible pregnancies and deliveries. Of the included patients, surgical data were collected and the fracture patterns were retrospectively classified. Follow-up was a minimum of 36months. A total of 168 women with a pelvic fracture were identified, of whom 13 had a pregnancy after surgical stabilization. Eleven women had combined anterior and posterior fracture patterns and two had isolated sacral fractures. Four women underwent combined anterior and posterior fixation, the others either anterior or posterior fixation. Seven women had a total of 11 vaginal deliveries, and 6 women had 6 caesarean sections. The decision for vaginal delivery was often the wish of the mother (n = 4, 57%) while the decision to opt for caesarean section was made by the surgeon or obstetrician (n = 5, 83%). One woman in the vaginal delivery group suffered a postpartum complication possibly related to her retained pelvic hardware. Women with retained hardware after pelvic ring fixation can have successful vaginal deliveries. Complications during labor or postpartum are rare. The rate of primary caesarean sections is high (46%) and is probably influenced by physician bias. Future research should focus on tools that can predict labor outcomes in this specific population, and larger multicenter studies are needed. Level III.

Comparison of clinical and radiographic outcomes of bilateral versus unilateral ramus fixation in straddle fractures with posterior pelvic ring injury.

Superior and inferior ramus fractures, termed straddle fractures, are high-energy fractures often accompanied by unstable pelvic ring injuries. However, consensus is lacking regarding indications for surgical treatment or fixation methods. We aimed to compare clinical and radiological outcomes of unilateral ramus fixation (URF) and bilateral ramus fixation (BRF) for straddle fractures with unilateral posterior pelvic ring injuries. We enrolled 118 patients (73 males, 45 females; mean age, 47 years) diagnosed with straddle fractures between March 2015 and December 2021 with > 1 year of follow-up. Patients were divided into URF (n = 60) and BRF (n = 58) groups based on the anterior pelvic ring fixation method. Preoperative factors including body mass index, diabetes, smoking, injury mechanism, injury severity score, American Society of Anesthesiologists classification system, Tile classification, and Young and Burgess classification were compared. Intraoperative blood loss, operation time, postoperative bone union rate, complications, and the need for additional surgeries were analyzed. There were no statistically significant preoperative differences between the two groups. However, the URF group showed a significantly lower mean operative time and blood transfusion requirement (63min and 2 units, respectively) than the BRF group (104min and 3 units, respectively) (both p < 0.001). Postoperatively, bone union was achieved in 57 (95.0%) and 56 (96.6%) patients in the URF and BRF groups, respectively. Complications occurred in 17 (28.3%) and 14 (24.1%) patients in the URF and BRF groups, respectively, with additional surgeries needed in 3 (5.0%) patients in the URF group and 2 (3.4%) patients in the BRF group. Unilateral anterior fixation can provide sufficient stability and clinical effectiveness in the surgical treatment of straddle fractures in areas with posterior pelvic ring injuries. Compared with bilateral anterior fixation, unilateral fixation significantly reduces operation time and blood loss, making it a viable fixation method for straddle fractures.

A dependent circular-linear model for multivariate biomechanical data: Ilizarov ring fixator study.

Biomechanical and orthopaedic studies frequently encounter complex datasets that encompass both circular and linear variables. In most cases (i) the circular and linear variables are considered in isolation with dependency between variables neglected and (ii) the cyclicity of the circular variables is disregarded resulting in erroneous decision making. Given the inherent characteristics of circular variables, it is imperative to adopt methods that integrate directional statistics to achieve precise modelling. This paper is motivated by the modelling of biomechanical data, that is, the fracture displacements, that is used as a measure in external fixator comparisons. We focus on a dataset, based on an Ilizarov ring fixator, comprising of six variables. A modelling framework applicable to the six-dimensional joint distribution of circular-linear data based on vine copulas is proposed. The pair-copula decomposition concept of vine copulas represents the dependence structure as a combination of circular-linear, circular-circular and linear-linear pairs modelled by their respective copulas. This framework allows us to assess the dependencies in the joint distribution as well as account for the cyclicity of the circular variables. Thus, a new approach for accurate modelling of mechanical behaviour for Ilizarov ring fixators and other data of this nature is imparted.

Mid to Long-Term Outcomes of Grade III-B Open Tibial Fractures Definitively Managed With a Circular Frame: A 13-Year Prospective Database Study at a Major Trauma Center.

The aim of this study was to report experience of a major trauma center utilizing circular frames as definitive fixation in patients sustaining Gustilo-Anderson 3B open tibial fractures. A prospectively maintained database was retrospectively interrogated. Single major trauma center in the United Kingdom. All patients over the age of 16 sustaining an open tibial fracture with initial debridement performed at the study center. All patients also received orthoplastic care for a soft tissue defect (via skeletal deformation or a soft tissue cover procedure) and subsequent definitive management using an Ilizarov ring fixator. Patients who received primary debridement at another center, had preexisting infection, sustained a periarticular fracture, or those who did not afford a minimum of 12-month follow-up were excluded. Case notes and radiographs were reviewed to collate patient demographics and injury factors. The primary outcome of interest was deep infection rate with secondary outcomes including time to union and secondary interventions. Two hundred twenty-five patients met inclusion criteria. Mean age was 43.2 year old, with 72% males, 34% smokers, and 3% diabetics. Total duration of frame management averaged 6.4 months (SD 7.7). Eight (3.5%) patients developed a deep infection and 41 (20%) exhibited signs of a pin site infection. Seventy-nine (35.1%) patients had a secondary intervention, of which 8 comprised debridement of deep infection, 29 bony procedures, 8 soft tissue operations, 30 frame adjustments, and 4 patients requiring a combination of soft tissue and bony procedures. Bony union was achieved in 221 cases (98.2%), 195 (86.7%) achieved union in a single frame without the need for secondary intervention, 26 required frame adjustments to achieve union. Autologous bone grafts were used in 10 cases. Orthoplastic care including circular frame fixation for Gustilo-Anderson-3B fractures of the tibia resulted in a low rate of deep infection (3.5%) and achieved excellent union rates (98.2%). Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Stability before and after percutaneous anterior medullary fixation of lateral compression 1 and 2 pelvic ring disruptions: Should surgeons prioritize the anterior ring?

Surgical intervention for lateral compression (LC) 1 and 2 pelvic ring fractures is controversial. Posterior ring stabilization remains the most common mode of initial fixation. However, greater mechanical instability is observed in the anterior component of LC pelvic fractures. This study tested whether reduction and percutaneous superior ramus fixation will decrease the instability of LC pelvic fractures on intraoperative fluoroscopic imaging. All adult patients (≥ 18 years) presenting with either a Young-Burgess LC1 or LC2 pelvic ring disruption treated operatively with percutaneous anterior followed by posterior fixation by a single surgeon from July 2021 to June 2023 were retrospectively reviewed. Displacement of the anterior ring to intraoperative manual internal rotation stress examination under fluoroscopy was compared before and after anterior pelvic ring reduction and fixation and prior to posterior pelvic ring fixation. Pre- and post-operative visual analog scores (VAS) for pain were also compared. Twenty-one patients with a mean age of 48.7 years were included. Fifteen patients (71.4%) presented with an LC1, and six (28.6%) with an LC2 injury patterns. Anterior pelvic fixation alone provided 7.5mm reduction in mean displacement of the anterior pelvic ring (pre-operative = 9.2 mm vs. post-operative = 1.6 mm, p < 0.001). VAS significantly decreased from 7.2 one-day pre-operatively to 2.2 twenty-four h post-operatively (p < 0.001). Reduction and fixation of the anterior pelvic ring prior to posterior fixation for LC1 and LC2 pelvic ring disruptions substantially improves mechanical stability on intraoperative stress examination. Combination of percutaneous anterior and posterior fixation significantly decreased VAS above the MCID 24 h after stabilization.

Severe Pilon Fractures: The Role of Quality of Reduction in Clinical and Functional Outcomes.

Introduction The purpose of the current study is to present the outcome of closed reduction and stabilization using an Illizarov ring fixator in severe pilon fractures and to investigate the correlation between reduction quality and clinical and functional outcomes. Materials and methods Thirty-three type III tibial plafond fractures, which had been treated with this method, were retrospectively analysed. Quality of reduction was classified according to the Teeny & Wiss (TW) criteria. Clinical and functional assessment was carried out using the Ovadia & Beals (OB) and Olerud & Molander (OM) scores. Results All fractures were successfully united. The mean time in the fixator was 6.3 months, and the mean follow-up was 50 months after frame removal. There were no major infections. There was no significant relationship between TW and OM (r=-0.34, p=0.13), TW and OB (r=0.35, p=0.23), neither Delay (from injury until surgery) and OM (r=-0.03, p=0.28), and Delay and OB (r=0.30, p=0.31). Conclusions The present study demonstrates that the major problems of open reduction and internal fixation of pilon type III fractures can beavoided by a non-invasive approach to the treatment of these fractures. The articular surface can be reconstituted with olive-tip wires and small fragment washers, early ligamentotaxis and fracture stabilization with the Ilizarov ring fixator. These simple steps couldlead safely to union and a good clinical and functional outcome.

Pediatric-Specific Lesions in Unstable Pelvic Ring Fractures of Skeletally Immature Children: Impact on Diagnosis and Management Decisions.

Surgical fixation of pediatric pelvic ring injuries is gaining popularity to avoid the poor long-term outcomes of pelvic asymmetry. The surgical techniques and fixation choices depend on the individual injuries affecting the anterior and posterior pelvic ring areas. The immature bony pelvis of young children has anatomic differences including soft bones, elastic ligaments, and the presence of growth centers. Understanding the unique pediatric lesions with unstable pelvic fractures is essential for treatment decisions. Anterior lesions include pubic symphysis disruption through the pubic apophysis, single ramus fractures, pubic rami fractures through the triradiate cartilage, and/or the ischiopubic synchondrosis; ischiopubic ramus infolding injury; or the unstable superior and inferior quadrant lesions. Posterior pelvic lesions include iliac wing infolding and sacroiliac joint dislocation or transiliac (crescent) fracture/dislocations through the iliac apophysis growth plate. Pubic symphysis and sacroiliac disruptions are physeal injuries in children, and they have excellent healing potential. External fixation is an ideal choice for anterior ring fixation including bony and pubic symphysis injuries. Posterior lesions are mostly sacroiliac joint disruptions with iliac apophysis separation that can serve as a landmark for vertical displacement correction. Posterior lesions can be treated by percutaneous iliosacral screw fixation or open reduction techniques.

Posterior-only fixation in pelvic fractures: Is it sufficient in lateral compression injuries?

PurposeLateral compression (LC) injuries account for more than two-thirds of all pelvic fractures. The goal of surgical treatment is to provide adequate stability and early mobilization. The consensus on posterior fixation of such injuries is strong in the literature; however, the necessity of anterior ring fixation is not clear. Therefore, this study was formulated to determine the practicability of posterior-only fixation in LC injuries. MethodsBetween March 2015 and May 2020, all patients with LC type pelvic ring fractures who were admitted and operated upon in a single level 1 trauma center were included in this cross-sectional observational study. Demographic data, co-morbidities, treatment, types of surgical fixation, concomitant injuries and surgeries, surgical complications, length of hospital stay, injury to weight bearing duration, and follow-up period were documented. Functional outcome and quality of life were assessed using Majeed score and SF-36 questionnaire. Non-normally distributed data were presented as median (Q1, Q3) and normally distributed data were presented as mean ± SD. Spearman's rank correlation coefficient was used for correlation analysis. ResultsA total of 25 patients were included, with a mean age of 29.8 years. All patients were managed operatively with posterior-only fixation. The median Majeed score was 90 (76, 95). The median physical component summary score was 69.37 (38.75, 85.62). The median mental component summary score was 63.95 (39.25, 87.87). There was no significant difference compared to population norms of both physical component summary and mental component summary. Injury to weight bearing time correlated significantly (p = 0.002) with Majeed score as well as SF-36 score (p = 0.044). No other variable had a significant association with outcomes. ConclusionPosterior-only fixation is sufficient for fixing LC injuries with up to 80% of cases having good to excellent functional outcomes. However, comparative studies with larger sample sizes are needed for further validation.

Effects of Obesity on Systemic Complications After Operative Pelvic Ring Fractures.

To determine the effect of obesity on systemic complications after operative pelvic ring injuries. Retrospective cohort study. Single level 1 trauma center. All patients at a level 1 trauma center who underwent operative fixation of a pelvic ring injury from 2015 to 2022 were included. Patients were grouped based on body mass index (BMI) into 4 categories (normal = BMI <25, overweight = BMI 25-30, obese = BMI 30-40, and morbidly obese BMI >40). Systemic complications including acute respiratory distress syndrome, pneumonia, sepsis, deep venous thrombosis (DVT), pulmonary embolism, ileus, acute kidney injury (AKI), myocardial infarction, and mortality were recorded. Patients who developed a complication were compared with those who did not regarding demographic and clinical parameters to determine risk factors for each complication. A total of 1056 patients underwent pelvic ring fixation including 388 normal BMI, 267 overweight, 289 obese, and 112 morbidly obese patients. The average age of all patients was 36.9 years, with a range from 16 to 85 years. Overall, 631 patients (59.8%) were male. The overall complication and mortality rates were 23.2% and 1.4%, respectively. BMI was a significant independent risk factor for all-cause complication with an odds ratio of 1.67 for overweight, 2.30 for obese, and 2.45 for morbidly obese patients. The risk of DVT and AKI was also significantly increased with every weight class above normal with ORs of 5.06 and 3.02, respectively, for morbidly obese patients (BMI >40). This study demonstrated that among patients undergoing pelvic ring fixation, higher BMI was associated with increased risks of overall complication, specifically DVT and AKI. As the prevalence of obesity continues to increase in the population, surgeons should be cognizant that these patients may be at higher risk of certain postoperative complications during the initial trauma admission. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Progress of anterior subcutaneous internal fixation in the treatment of anterior pelvic ring injury

Anterior subcutaneous internal fixation (INFIX) is one of the current representatives of minimally invasive fixation of injuries to the anterior pelvic ring. The nail insertion point of this technique is located at the anterior inferior iliac spinous screw, with an angle of 30° outward and 20° backward. Screw in at an angle, and note that the screw head should be above the deep fascia and maintain a safe distance of 20 to 25 mm from the bone surface. Its improved versions include 3 or 4 nails INFIX with added pubic tubercle screws, unilateral INFIX, short-rod INFIX, and double INFIX. These improvements further enhance stability. The lateral femoral cutaneous nerve (LFCN) is relatively easy to be damaged during anatomy, so special attention should be paid during the operation. Biomechanical stability has advantages over external fixation, and its application is flexible. It is not limited to pubic ramus fracture, symphyseal separation, etc. It also plays an important role in combined anterior and posterior ring fixation. It can be combined with posterior sacroiliac screws, iliac lumbar screws, etc. Fixed etc. Good clinical results have also been reported in children, pregnant women, and people with contraindications for subcutaneous connecting rods. In addition, the current application of robots, reduction frames and other technologies has greatly reduced the difficulty of reduction and improved the quality of closed reduction, making it possible to fix complex pelvic fracture. This technique has high reduction quality and is as effective as traditional steel plates. A common complication is LFCN injury. Careful exposure and adjustment of the position and depth of internal fixation during surgery can effectively avoid this complication.

Complications of Ilizarov method treatment for infected nonunion femoral shaft fracture

Background: Infected non-union of the femur is complicated by the involvement of soft tissue and bone, long-term resistant multi-bacterial infection, limb length discrepancy, deformities, joint stiffness, and multiple draining sinuses, and poses a challenge for orthopedic surgeons. This study aimed to analyze the complications of Ilizarov method treatment for infected non-union femoral shaft fracture. Methods: This prospective observational study was conducted at the national institute of traumatology and orthopedic rehabilitation (NITOR), Dhaka, Bangladesh, from May 2018 to August 2020. A total of 20 patients were selected as study subjects by purposive sampling technique. All data were collected using a pre-formed questionnaire. Data were processed and analyzed using computer software program SPSS version 22.0. Result: The mean bone gap created during the operation was 2.7±1.7 cm of them, in 12 (60%) patients, it was 0 to 2 cm, and in 8 (40%) patients it was more than 2 cm. The mean time needed for radiological union was 7.85±2.1 months ranging from 5 months to 11 months. In 10 (50%) patients, union was achieved within 4 to 7 months, and in 10 (50%) patients it was 8 to 11 months. Regarding limb length discrepancy, in 5 (25%) cases there was no limb length discrepancy (LLD). Twelve patients had 1 cm to 2.4 cm LLD and 3 (15%) patients had ≥2.5 cm LLD. The mean LLD was 1.2±0.9 cm. Regarding complications, in 10 (50%) cases, there was no complication and 10 (50%) patients had complications. The complications were pin tract infection in 7 (35%) patients and wire loosening in 3 (15%) patients. Conclusions: The study concludes that while the Ilizarov ring fixator proves to be a dependable and successful method for stabilizing, correcting length discrepancies, and eliminating infections, it is not without its share of complications. The findings of this research indicate a 50% complication rate among the patients undergoing this treatment.

Hybrid external fixator for treatment of a tibial proximal comminuted diaphyseal fracture in a foal

AbstractA 15‐day‐old colt was presented with grade 5 lameness (American Association of Equine Practitioners ‐ lameness scale), oedema of the right pelvic limb and stifle joint instability. A radiographic examination revealed a complete comminuted fracture of the proximal right tibia. To treat this, a surgical reduction was performed using a hybrid external fixator. The hybrid external fixator consisted of two rings placed above the proximal and distal epiphyseal plates, respectively, which were then linked with threaded rods. Within 24 hours of the surgery, the foal started weight‐bearing again. After 6 days, the hybrid external fixator rings were distracted by 1 mm per day for 17 days, which helped to increase the bone length. Once the hybrid external fixator was removed, a small shortening of the tibia (1 cm) was observed compared to the contralateral limb, but the epiphyseal cartilage was maintained.

OUTCOMES OF ACUTE ANKLE DISTRACTION FOR INTRA-ARTICULAR DISTAL TIBIAL AND PILON FRACTURES

IntroductionIntra articular distal tibia fractures can lead to post-traumatic osteoarthritis. Joint distraction has shown promise in elective cases. However, its application in acute fractures remains unexplored. This pilot study aims to fill this knowledge gap by investigating the benefits of joint distraction in acute fractures.Materials &amp; MethodsWe undertook a restrospective cohort study comprising patients with intra-articular distal tibia and pilon fractures treated with a circular ring fixator (CRF) at a single center. Prospective data collection included radiological assessments, Patient-Reported Outcome Measures (PROM), necessity for additional procedures, and Kellgren and Lawrence grade (KL) for osteoarthritis (OA).137 patients were included in the study, 30 in the distraction group and 107 in the non-distraction group. There was no significant difference between the groups.ResultsMean follow-up was 3.73 years. There was no significant difference between the groups in overall complications or need for further procedures. There was no significant difference in progression of KL between the groups (1.81 vs 2.0, p=0.38) mean follow up 1.90 years.PROM data was available for 44 patients (6 distraction, 38 non-distraction) with a mean follow-up of 1.71 years. There was no significant difference in EQ5D (p=0.32) and C Olerud-H Molander scores (p=0.17).ConclusionsThis pilot study suggests that joint distraction is safe in the acute setting. However, the study's impact is constrained by a relatively small patient cohort and a short-term follow-up period. Future investigations should prioritise longer-term follow-ups and involve a larger patient population to more comprehensively evaluate the potential benefits of joint distraction in acute fractures.

Evaluation of Radiological and Functional Outcomes of Closed Complex Mid-shaft Tibia Fractures Treated with Primary Definitive All Wire Ilizarov Ring Fixator: A Prospective Study at Tertiary Care Centre of Nepal.

Introduction: Closed complex tibial shaft fractures are frequently encountered fractures in lower limb injuries. Various surgical methods for these fractures include primary or delayed fixation with intramedullary nails, minimal invasive plates, and primary definitive external stabilization using ring fixators. We conducted this study to evaluate the radiological and functional outcomes of primary definitive fixation of these fractures using an all-wire Ilizarov circular fixator. Objectives: The objectives of this study were to evaluate the radiological and functional outcomes of primary definitive fixation of closed complex tibial mid-shaft fractures in patients with compromised soft tissue status. Methodology: We defined Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association (AO/OTA) 42-B1 to AO/OTA 43-C3 fractures as complex tibial shaft fractures for this prospective observational study, and evaluated all 26 patients for the functional and radiographical progression according to ASAMI classification. Results: Twenty-six patients were stabilized with an all-wire circular ring fixator. The union time on average was 27.61 weeks. Among all patients, 7 (37.5%) cases had minor pin tract infections, and one (2.7%) patient landed a non-union, which required bone graft. Conclusion: With the use of an all-wire Ilizarov circular frame, there is a good mean time to union, fewer chances of re-operations, and good functional outcomes without any major complications.

Distraction Osteogenesis by Ring Fixator in Post Traumatic Tibial Bone Loss

Background: Reconstructing segmental bone loss defects presents a significant challenge within the field of orthopedics. The purpose of this study is to assess the clinical and radiological results of using the Ilizarov technique for tibia reconstruction following traumatic bone loss. Methods: This study was a prospective study involving 30 patients who experienced tibial bone loss in the diaphysis or metaphysis following trauma. These patients were treated with a ring fixator (Ilizarov) from March 2021 to February 2023. Unfortunately, five patients were lost to follow-up, leaving a cohort of 25 patients who were observed for a duration ranging from 9 to 12 months. Results: The current study involved 25 patients with post-traumatic tibial bone loss. The age range was 14 to 48 years, with a mean age of 28.4±8.8 years. Among the cases, 18 had a moderate defect (72%), which was significantly higher than those with a minor defect (20%) (P ≤ 0.05). Deformity was less than 7° in most cases (96%), while only one case had deformity greater than 7° (4%) (P ≤ 0.05(. Leg length discrepancy was less than 2.5 cm in the majority (96%), with only one case having a 3 cm length discrepancy (4%) (P ≤ 0.05). By the end of the follow-up period, all patients showed perfect union, enabling them to engage in daily activities post-operatively. Conclusion: The success of corticotomy and solid docking relies on well-vascularized bone and soft tissue. Soft tissue compromise at the corticotomy site can hinder healthy tissue regeneration.

Optimized Kalinnikov-Dinh technology for effective pre-Descemet's endothelial keratoplasty (PDEK) graft preparation and preservation.

We report an optimized Kalinnikov-Dinh technology for pre-Descemet's endothelial keratoplasty (PDEK) that involves the use of a ring fixator, base, 30G needle connected to a 5-ml syringe with a spring-loaded plunger, and storage media. Our method allows to minimize graft preparation failure and preserves the PDEK graft efficiently, by reducing complications associated with the formation of type 1 big bubbles, including bubble rupture, perforation of Descemet's membrane and endothelium, and formation of type 2 or mixed type of big bubbles, and may contribute to increasing the number of surgeons performing PDEK around the globe.

Clinical Application and Evaluation of Specialised Ring Fixators for the Management of Upper and Lower Limb Bone Fractures in Dogs

Present study was conducted on nine-clinical cases of humerus (n=4), femur (n=3) and radius-ulna (n=2) fractures in dogs of either sex, weighing 5.5 to 18 kg. Both closed (n=6) and open (n=3) fractures were treated in this study. The fracture was reduced and stabilized by transfixation using modified ring fixators. Semicircular (n=4) and hybrid fixators (n=5) were used for upper limb and lower limb bones respectively. The main component of fixator i.e. aluminium rings were designed locally at Bikaner using 4-mm aluminium sheets and fabricated accordingly. Full rings were used for distal radial (n=2) and distal femoral (n=1) fractures whereas semicircular rings were made through cutting the full ring during surgery for specific humeral (n=4) and femoral (n=2) fractures. Specialised wire fixation bolt (iron based; weighing 5.5g) was also designed locally at Bikaner for transcortical pin and ring articulation. Humeral and distal femoral fractures are challenging while bone plating of distal radial fracture demands further surgeries therefore external fixators were modified and applied in present study. Operated limbs were evaluated clinically with serial postoperative radiographs at regular intervals. Fixator-assembly evaluation and functional recovery of operated limbs were considered as objectives of this study.