Role Of External Fixation Research Articles

Role of External Fixation in the Management of Distal Tibia Injuries: The “Convertible” Frame

Role of External Fixation in the Management of Distal Tibia Injuries: The “Convertible” Frame

The Role of External Fixation in Pelvic Disruptions

External fixation has a definite role in the management of pelvic fractures. Biomechanically, it is not useful for maintaining reduction of the unstable, vertically migrating pelvis and must be used with some other form of treatment, such as traction, spica cast, or internal fixation. In vertically stable fractures, that is, rotationally unstable fractures, the anteroposterior and lateral compression injuries, the external fixator should probably be the first course of treatment.

External Fixation of Femoral Fractures

The role of external fixation in the management of femoral shaft fractures is reviewed based on a study of 24 femoral fractures managed by either an AO or a Wagner external fixator during 1983-1986. Indications included open fractures with soft-tissue injury (13 patients), comminuted shaft fractures (six patients), and unstable operative candidates (five patients). In 14 patients, external fixation was a temporary method (Group I), while in ten patients it was the definitive method of stabilization (Group II). Twenty-one patients achieved solid union, two developed a delayed union, and one had a nonunion. Three patients developed pin-tract infections, and one developed osteomyelitis after intramedullary fixation in Group I. Two patients in Group II developed shortening (2.1 cm and 3.2 cm). Loss of motion occurred in 11 patients, averaging 56 degrees. It is suggested that external fixation be considered in the following types of femoral fractures: open fractures for aggressive management of soft-tissue injuries; closed fractures in severely traumatized, burn, or head injury patients; fractures about the knee resulting in floating knees; and infected femoral nonunions and pseudarthroses.

The role of external fixation in the treatment of posttraumatic osteomyelitis.

External skeletal fixation played a central role in the reconstruction of 30 limbs involved in posttraumatic osteomyelitis. The tibia was involved in 15, the femur in six, the ankle in five, and the foot and radius in two each. Of the thirty limbs, 27 were ununited. Positive bacteriology and/or histology was found in each case. A total of 36 frames were used with 20 unilateral half-frame constructs and 16 bilateral transfixion frames. The average duration of external fixation was 60 days. Specific procedures for soft tissue coverage were required in 21 cases and autogenous bone grafting in 26. Loosening and local infection occurred in three of 168 external fixation pins. There were no cases of pin-track osteomyelitis, fractures through pintracks, or neurovascular damage from pin insertion. Infection was controlled in 29 of 30 limbs, with one requiring a below-knee amputation. Skeletal union was achieved in all cases. At an average follow-up of 35 months, 20 of 28 lower limbs in 27 patients tolerated full weight bearing without ambulatory aides. Four used a patellar tendon-bearing polypropylene orthosis, two used a cane, and one a walker. In the 23 patients ambulating without upper-extremity aides, the average time from the start of treatment to reach this functional status was 14 months.

Salvage of the destroyed wrist

Two cases of complex limb threatening destruction of the wrist region and their reconstruction are described. The role of external fixation and composite vascular grafts in controlling infection and achieving bony union is outlined.

Salvage of the Destroyed Wrist

Two cases of complex limb threatening destruction of the wrist region and their reconstruction are described. The role of external fixation and composite vascular grafts in controlling infection and achieving bony union is outlined.

The Role of External Fixation and Emergency Fracture Management in Bovine Orthopedics

First aid for limb fractures in cattle is discussed. This includes a discussion of which fractures in cattle are suitable for external fixation and which methods of external fixation are useful to the bovine practitioner.

External Fixation in Maxillofacial Surgery

The role of external fixation in the treatment of facial fractures is well defined. If standard open reduction and internal fixation techniques do not yield a satisfactory result, external fixation techniques may be required. Open reduction has the advantage of effecting precise approximation of fragments. However, this type of fixation may be inadequate, either because no stable point is available or because the angle of traction involved in fixation may result in displacement of the reduced fracture and subsequent malunion. When the facial skeleton is fractured, it tends to collapse inward, and if injury is severe, an external traction point anterior, lateral, or superior to the facial skeleton may be required to obtain a satisfactory result. There are occasions when intermaxillary fixation may be inadvisable, and in these instances external fixation techniques may be an appropriate means of immobilization. Finally external fixation techniques may be required in instances in which massive tissue loss precludes the use of standard open reduction and internal fixation techniques. It must be reemphasized that the methods of external fixation described here are not meant to supplant the standard techniques of open reduction and interosseous wiring, but when judicially employed complement them in achieving the desired result of precise reduction and firm fixation of the fractured facial skeleton.