Time Of Fixator Removal Research Articles

Achilles Tendon Rupture Treated with Flexor Digitorum Lateralis Tendon Transposition and Transarticular External Skeletal Fixator in Ouessant Sheep

Abstract Objective To describe the appositional augmentation of a complete Achilles tendon rupture in Ouessant sheep, using the intact flexor digitorum lateralis tendon, and immobilization with a type II transarticular external skeletal fixator. Clinical Report A 1-year-old neutered male Ouessant sheep was presented for Achilles tendon rupture and multiple bite wounds, secondary to a dog attack. The Achilles tendon was torn entirely, and a significant 3-cm gaping defect was present. The remnants of the Achilles tendon were debrided and attached using locking-loop and epitendinous sutures. The intact flexor digitorum lateralis tendon was then transposed and secured over the tendinous repair to increase the tendon strength. The bite wounds were closed with a primary repair. Finally, a type II transarticular external skeletal fixator was used to immobilize the tarsocrural joint for 6 weeks. Results A mild lameness, associated with a decreased range of motion of the tarsocrural joint, was present at the time of external skeletal fixator removal. Four months postoperatively, the lameness had completely resolved. A slight decrease in the range of motion of the tarsocrural joint was conserved. Clinical Significance In a small ruminant, transposition of the flexor digitorum lateralis was successful for the repair of an Achilles tendon rupture with a large musculotendinous gap and infected open wounds. To the authors' knowledge, this is the first such case described in sheep.

First web space plasty using Ilizarov mini fixator in patients with complex hand injuries

Effective treatment and rehabilitation of complex hand injuries are often challenging. Various corrective techniques and approaches have been proposed for the first web space contractures based on a classification system, however, consensus regarding optimal management does not exist. In this study, we evaluated twelve consecutive patients with the mean age of 46.72 years who underwent first web space dilatation using Ilizarov mini fixator from 2009 to 2020. The tip length during radial/palmar abduction and radial/palmar abduction angles were measured preoperatively, after instrumentation, and in the last follow-up. The average thumb-index finger distance during Passive Radial Abduction (PRA) increased from 4.3 to 9 cm, and the distance during Passive Palmar Abduction (PPA) decreased from 10.2 to 9.22 cm, the average passive radial abduction angle (PRAA) of the first web space increased from 21.6 to 58.3°, Active Radial Abduction Angle (ARAA) from 20.0 to 49.7°. The average Passive Palmar Abduction Angle (PPAA) increased from 32.5 to 59.1°, and Active Palmar Abduction Angle (APAA) from 30.9 to 47.7° after using Ilizarov mini fixator. Ilizarov mini fixator provides promising outcomes with the optimal range of motion in severe first web space contractures. • Patients with severe first web space contractures were treated and followed. • The duration of this study was from 2009 to 2020. • We used unidirectional and bidirectional Ilizarov mini fixators for our patients. • Radiographic parameters were evaluated preoperative, at the time of fixator removal and in latest follow up. • Radial and Palmar Abduction parameters were significantly improved at the time of final follow up.

TREATMENT INTERTROCHANTERIC FRACTURE OF FEMUR IN ELDERLY BY EXTERNAL FIXATION: PROSPECTIVE CASE-SERIES STUDY; IBN-SINA TRAINING HOSPITAL, BAGHDAD

Background: Internal fixation is gold standard in treatment of intertrochanteric fractures, but in patients with anesthesia or surgical hazards the external fixation should be explored as a safe approach to reduce operative time and complications risk. Objective: To assess the outcome of external fixation of an intertrochanteric fracture is in elderly patients with co-morbidities. Methods: Twenty-eight elderly patients with non-pathological fractures, closed, who were 65 years old or older, unsuited for surgery for a long period, and had chronic uncontrolled medical problems such as hypertension, diabetes mellitus, or heart disease were included in the study. Criteria for exclusion include reverse obliquity fractures, dementia, pathological fractures and prior hip fractures. Those patients treated with percutaneous external fixation under image intensifier from 2015 to 2020 in Ibn Sina Training Hospital in Baghdad. Results: At 1-year follow-up, 80% returned to pre-fracture ambulatory status. Average time to fixator removal was 12 weeks. There were no cases of pin loosening, breakage, or penetration of femoral head. All patients were evaluated clinically and radiologically for 24 months except 3 patients, 2 died 6 months’ post-operative due to causes unrelated to the surgery, and 1 lost follow up 3 months after surgery. Excellent and good results were found in 8 patients. The time of radiological union and fixator removal about 12 weeks. Pin tract infection occurred in most of the patients. Varus malalignment occurred in 20% of patients. Shortening ranged from 0 to 3 cm. Conclusion: External fixation of intertrochanteric fractures in elderly high-risk patients is a dependable, successful, and safe therapeutic option. Keywords: Intertrochanteric fracture, external fixator, elderly patient Citation: Alsudany FKI, Alhamashi AHS, Al-Abbody HHT, Ismael HA. Treatment intertrochanteric fracture of femur in elderly by external fixation: prospective case-series study; Ibn-Sina Training Hospital, Baghdad. Iraqi JMS. 2022; 20(1): 113-120. doi: 10.22578/IJMS.20.1.15

Clinical and Radiological Outcome of Complex Proximal Tibia Fractures Managed with Hybrid/Ilizarov Fixator with or without Minimal Internal Fixation.

Complex high grade proximal tibia fractures with associated extensive soft tissue injury pose a management challenge. The timing of surgery and fracture fixation options depend upon the extent of soft tissue damage. Post-operative complications such as wound breakdown, infection and infected non-union are common in such cases managed early with open reduction and internal fixation. Such fractures can be treated with primary closed reduction and Ilizarov/hybrid fixator application. It is a retrospective cross sectional study conducted at two tertiary care multispecialty hospitals to report the mid-term clinical and radiological outcomes of complex high grade proximal tibia fractures. These injuries were managed by closed reduction and external fixation with/without minimal internal fixation as a definitive procedure and outcome measures were checked with serial radiographs and functional scores at a regular interval of follow up. 17 patients with Schatzker's type 5 or 6 proximal tibia fractures with soft tissue compromise were operated on at two tertiary care referral centres from 2017 to 2019. These cases were operated on by two experienced trauma surgeons. Periodic follow-up was done and radiological and functional progression noted from case records. Average time to union was noted to be 12.59 weeks and mean time of fixator removal was 21.4 weeks. At the end of 1 year of follow-up, average range of motion was 121.76 degrees, average WOMAC score was 74.81(63-82) and KOOS score was 78.24(63-85). 1. Hybrid/Ilizarov fixator method is a safe way of fixing high energy proximal tibia fractures. It is associated with a good functional outcome, less soft tissue complications and allows early weight bearing. 2. We recommend this method of treatment for complex high grade proximal tibia fractures.

Acute correction of proximal tibial coronal plane deformity in small children using a small monolateral external fixator with or without cross-pinning.

PurposeSurgical correction of proximal tibia deformity in small children can be challenging. We present the surgical technique and outcome of proximal tibia osteotomy fixed with small monolateral external fixator in this patient group.MethodsA total of 17 cases in eight patients younger than nine years of age were study subjects. A proximal tibia osteotomy was fixed with a small monolateral external fixator with or without cross-pinning. Outcome was evaluated by changes of radiographic parameters such as medial proximal tibia angle (MPTA), metaphyseal diaphyseal angle (MDA) and clinical findings of complications, time interval until weight bearing and fixator removal time.ResultsMPTA improved from a preoperative mean of 73° (sd 4°; 66° to 78°) to an immediate postoperative mean of 90° (sd 3°; 85° to 96°) in varus tibiae, and from 104° (sd 1°; 103° to 105°) to 89° (sd 1°; 88° to 89°) in valgus tibiae. In all, 15 of the 17 cases (88.3 %) achieved postoperative MPTA within the normal range (85° to 90°). MDA improved from a preoperative mean of 19° (sd 5°; 11° to 24°) to an immediate postoperative mean of 0° (sd 4°; -6° to 7°) in varus tibiae, and from -25° (sd 2°; -22° to -24°) to 2° (SD 1°; 1° to 3°) in valgus tibiae. Full weight bearing was possible at mean 1.7 months (0.5 to 3.0). Mean follow-up period was 6.5 years (sd 5.4; 1.0 to 16.0). No complications developed during the follow-up.ConclusionProximal tibia osteotomy fixed with small monolateral external fixator provides accurate, safe and efficient correction in the management of coronal plane angular deformity in small children.Level of EvidenceLevel IV

Clinical study of calcium phosphate cement loaded with recombinant human bone morphogenetic protein 2 combined with calcium phosphate cement loaded with antibiotic for chronic osteomyelitis with bone defect

To compare the effectiveness of calcium phosphate cement (CPC) loaded with recombinant human bone morphogenetic protein 2 (rhBMP-2) combined with CPC loaded with antibiotic versus CPC loaded with antibiotic alone in one stage for chronic osteomyelitis with bone defect. A single-blind prospective randomized controlled clinical trial was conducted. Between April 2018 and April 2019, 80 patients of chronic osteomyelitis with bone defect in accordance with the random number table were randomly divided into two groups, 40 in the trial group (CPC loaded with rhBMP-2 combined with CPC loaded with antibiotic) and 40 in the control group (CPC loaded with antibiotic). There was no significant difference in gender, age, disease duration, lesion, and preoperative white blood cells (WBC) count, platelet count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) between the two groups ( P>0.05). All patients were implanted the corresponding CPC and external fixator after lesion clearance in the two groups. The postoperative WBC count, platelet count, ESR, CRP, hospital stay, cure rate of osteomyelitis, repaired bone defect volume, the time of external fixator removal, and the time of full weight-bearing of the affected limb were compared between the two groups. All patients were followed up 12-24 months, with an average of 18.4 months. There was no significant difference in WBC count, platelet count, ESR, and CRP between the two groups at 4 weeks after operation ( P>0.05). There were significant differences in WBC count, platelet count, and CRP in the two groups between 1 week before operation and 4 weeks after operation ( P<0.05). And the ESR showed no significant difference between pre- and post-operation in the two groups ( P>0.05). In the trial group, the anaphylactic exudate occurred in 1 patient with tibial osteomyelitis and the incision healed after oral administration of loratadine. The incisions of other patients healed by first intention in the two groups. One case of distal tibial osteomyelitis recurred in each group, and 1 case of humeral osteomyelitis recurred in the control group. The cure rates of osteomyelitis were 97.5% (39/40) in the trial group and 95% (38/40) in the control group, showing no significant difference between the two groups ( χ 2 =0.000, P=1.000). There was no significant difference in the repaired bone defect volume and hospital stay between the two groups ( P>0.05). X-ray film and CT showed that the bone defects were repaired in the two groups. The time of external fixator removal and the time of full weight-bearing of the affected limb were significantly shorter in the trial group than in the control group ( P<0.05). Application of CPC loaded with rhBMP-2 and antibiotic in one stage is effective for the chronic osteomyelitis with bone defect, which can accelerate the bone regeneration in situ to repair bone defect, reduce the trauma, shorten the course of treatment, and obtain good function of the affected limb.

The Clinical and Economic Impact of High Value External Fixation Utilization at a Level II Trauma Center

Introduction: In the current climate of cost containment and fiscal responsibility, high value implant alternatives represent a substantial opportunity for the treatment of orthopedic trauma patients. As patents have expired on many commonly used trauma implants, high value alternatives have become available. The purpose of this study was to examine the clinical and economic impact of a cost containment program using high quality, low cost external fixation components for temporary spanning constructs in the treatment of tibial plateau and pilon fractures. Methods: 62 patients with tibial plateau and pilon fractures treated with temporary high value external fixation devices were compared to 62 patients treated with conventional brand external fixation devices over the same time period. The groups were analyzed for differences in intraoperative and post-operative outcomes in order to analyze the clinical efficacy of high value devices. Operative records were analyzed to identify intraoperative complications, operative time and estimated blood loss. Cases of infection, malunion, nonunion or need for repeat surgery were recorded. Hospital financial records were appraised to determine implant costs. Results: There were no significant differences in age, sex, presence of diabetes, smoking or fracture type between the high value and conventional groups. No difference in operative time was noted. No intraoperative or postoperative complications occurred in either group from the time of external fixation to the time of external fixator removal and conversion to definitive fixation. Overall the hospital realized a 58% reduction in implant costs, an average of $2,200 savings per case and a total savings of $136,400 during the study period. Conclusions: Use of high value external fixation implant constructs has been a very successful endeavor at our institution providing equivalent clinical outcomes while significantly reducing implant expenditures. Based on this data the use of high value implants has the potential to markedly reduce operative costs as long as quality products are utilized.

Complex foot deformities associated with lower limb deformities: a new therapeutic strategy for simultaneous correction using Ilizarov procedure together with osteotomy and soft tissue release

AimThe aim of the current study is to introduce a new therapeutic strategy for simultaneous correction of complex foot deformities (CFD) and the associated lower limb deformities (LLD) by using Ilizarov technique with osteotomy and soft tissue procedure and to report its early clinical results.MethodsA retrospective review of CFD associated with LLD simultaneous correction utilizing the Ilizarov procedure together with osteotomy and soft tissue balance from 2015 to 2019 was conducted.ResultsThirty-two patients were followed for an average of 42.8 months. The mean external fixation time (EFT) was 6.5 months. The mean healing index (HI) was 1.7 months/cm. At the time of fixator removal, plantigrade feet were achieved in all patient and lower limb deformities were corrected. No recurrence of the deformities occurred. The mean LLRS AIM score was improved from 7.5 to 0.3. At the final follow-up, the ASAMI-Paley score was graded as excellent in all limbs in the aspect of bone results, and functional results were defined as excellent in 29 (90.6%) limbs and good in 3 (9.4%) limbs. The mean modified Dimeglio score was significantly improved from 7.2 to 1.3. No deep infection of the osteotomy site or nonunion was noted in the current study.ConclusionThe therapeutic strategy by using the Ilizarov procedure together with osteotomy and soft tissue balance is a safe and effective way to simultaneously correct CFD and LLD.Level of evidenceLevel IV, retrospective case series

Changes in lower limb alignment and their effect on the functional outcome after treatment of varus degenerative OA knee by hemicallotasis using modular dynamic HTO fixator

ObjectiveHigh tibial osteotomy (HTO) is an established procedure to treat medial compartmental osteoarthritis (OA) knee associated with varus deformity. It is well documented that precise correction of deformity and maintenance of correction achieved is important to ensure long term good results. This study was undertaken to record changes in radiological parameters and its effect on the functional outcomes in first two years following HTO done for varus degenerative OA kneeby hemicallotasis technique using HTO fixator. Methods31 patients meeting our inclusion-exclusion criteria who underwent HTO by hemicallotasis method using self-adjusting unilateral HTO fixator were included in the study. Their femoro tibial angle (FTA), mechanical axis %, Insall- Salvati ratio, proximal tibial antero-posterior slope and knee injury and osteoarthritis outcome Score (KOOS) were recorded preoperatively, postoperatively at the time of removal of fixator, at 1 year and at 2 years. ResultsThe FTA and mechanical axis significantly improved from a mean of 183.12⁰ and −3.26% respectively preoperatively to 173.38⁰ and 61.81% at the time of removal of fixator but subsequently showed significant deterioration to 176.06⁰ and 57.96% at 1 year and further insignificant deterioration to 176.16⁰ and 57.74 at 2 years. The KOOS improved from mean 56.61 preoperatively to 70.48 at the time of fixator removal and further improved significantly to 85.68 at 1 year but significantly deteriorated to 84.54 at 2 years. The Insall-Salvati ratio, tibial slope showed no significant change throughout the study. Conclusion: Though desired alignment can be achieved by using the fixator, we found a significant deterioration in achieved radiological parameters after removal of fixator adversely affecting the functional outcome which is a matter of concern.

Analysis of influence factor for the failure of anterior cruciate ligament reconstruction

To investigate the influence of gender, age, activity level, and diameter of graft on the anterior cruciate ligament (ACL) reconstruction. Between February 2012 and June 2017, 179 cases (111 males and 68 females) with an average age of 30.0 years (range, 11-63 years) were included in study. The patients underwent internal fixator removal at 2 years or more after single bundle ACL reconstruction with hamstring tendon autografts. All patients were sports injuries. The time from injury to operation ranged from 3 days to 26 years (median, 120 days). Lachman test and pivot shift test were positive. Univariate analysis was conducted on gender, age, post-operative activity level (Tegner score at the time of internal fixator removal), diameter of graft, and number of graft strands, and logistic regression was used to conduct multivariate analysis to screen the independent risk factors. All patients were followed up 24-90 months (mean, 29.1 months). At last follow-up, Lachman test was positive in 25 cases and pivot shift test was positive in 28 cases. The KT-2000 side-to-side difference was -1-7 mm (mean, 1.89 mm). Eleven patients (6.15%) failed after ACL reconstruction. Univariate and multivariate analyses showed that the age, gender, post-operative activity level, diameter of graft, and number of graft strands were not risk factors for the failure of ACL reconstruction (P>0.05). There was no significant difference in the risk for ACL reconstruction failure among age, gender, and activity level. ACL reconstruction failure rate cannot be reduced by increasing the number of graft strands to increase the diameter of grafts.

Bone transport using the Ilizarov method for osteosarcoma patients with tumor resection and neoadjuvant chemotherapy

BackgroundStudies on the applications of bone transport using the Ilizarov method for osteosarcoma (OS) patients with surgical resection and neoadjuvant chemotherapy are rare. MethodsA retrospective analysis was conducted in 10 patients with limb OS receiving limb-salvage treatment by Ilizarov method from 2007 to 2012 in our hospital. The general information, treatment outcomes and follow-up data of the patients were collected. ResultsThe mean length of the transported fragment and the mean transport distance of the affected limb were both 14 cm. The mean time in the external fixator was 34.2 ± 11.2 months (16–47 months) and the mean external fixation index (EFI) was 75 days/cm. The mean follow-up time was 68.6 ± 26.6 months (37–103 months). Seven patients underwent additional operations to treat the postoperative complications, and the mean number of operation was 1.7 times. Only one patient underwent amputation due to tumor relapse and all patients survived without tumor. The limb-salvage rate was 90%. At the time of external fixator removal, the ASAMI-bone score was good in 66.7% of patients and the ASAMI-function score was fair in 66.7% of cases. The mean MSTS score was 18.6 ± 3.2 (n = 9). At 10 months after fixator removal, both the ASAMI-bone score and ASAMI-function score were both excellent in 80% and good in 20% cases, and the mean MSTS score was further improved to 27.2 ± 1.11 (n = 5). ConclusionBone transport using the Ilizarov method can achieve good therapeutic effectiveness in the limb-salvage treatment for OS patients with neoadjuvant chemotherapy as long as the complications can be timely recognized and well managed.

Treatment of intertrochanteric fracture femur by Ilizarov fixator in elderly patients

Objective To assess the effectiveness of fixation of intertrochanteric fracture femur in elderly high-risk patients using Ilizarov fixator. Background Internal fixation of intertrochanteric fractures is a routine procedure, but in patients with anesthetic risks, external fixation can be considered a semiconservative method to reduce operative time and complications. In this study, the functional and radiological results of management of intertrochanteric fracture femur in elderly patients using Ilizarov fixator is evaluated. Patients and methods A total of 20 elderly high-risk patients with intertrochanteric fracture were treated by Ilizarov fixator. All patients had uncontrolled concomitant medical disorders such as hypertension, diabetes mellitus, and chronic hepatic or renal failure. The age range was 50–85 years. Results The patients were followed up for a mean of 7.5 months with a range from 6 to 9 months. Excellent and good (satisfactory) results were found in 16 patients and fair and poor (unsatisfactory) results were found in four patients. The time of radiological union and fixator removal ranged from 10 to 16 weeks. Pin-tract infection occurred in all patients. Varus malalignment occurred in 20% of patients. Shortening ranged from 0 to 3°. There were two cases of penetration of the femoral head. Conclusion It was found that external fixation of intertrochanteric fractures in elderly high-risk patients is a reliable, effective, and safe treatment option. It offers minimal operative risk, no blood loss, early mobilization, short hospital stay, and low morbidity and mortality.

Factors associated with refracture after surgery for femoral shaft fracture in children

Objective To analyze the factors influencing the incidence of refracture after surgery for femoral shaft fracture in children and put forward their countermeasures. Methods A retrospective study was conducted in the children who had been treated at Department I of Pediatric Orthopaedics, Zhengzhou Orthopaedic Hospital from September 2013 to May 2017 for primary femoral shaft fracture or refracture after surgery for femoral shaft fracture. Their clinic data were collected concerning age, gender, height, weight, primary fracture, treatment protocol, time for removal of fixation, time and site of refracture, and violence for refracture. The likely factors associated with refracture were identified by comparing the gender ratios, age distributions and primary fractures between the children with primary fracture and those with refracture, and by comparing the proportions of overweight and obese ones between the children with refracture and their normal counterparts. Results A total of 278 children, with a male to female ratio of 2.43∶1, were treated for primary femoral shaft fracture while 22 children, with a male to female ratio of 0.83∶1, for refracture contemporarily. In the children with primary fracture and those with refracture, respectively, there were 172 (61.9%) cases and 2 cases (9%) aged from 0 to 4 years, 85 cases (30.6%) and 10 cases (45.5%) aged from 5 to 9 years, 21 cases (7.5%) and 10 cases (45.5%) aged from 10 to 14 years. There were significant differences between the 2 groups in gender ratio and proportions of age (P 0.05). Conclusions Refracture after surgery for femoral shaft fracture in children may be closely associated with their gender, age and overweight. Care should be taken to avoid refracture in children with high risks. Key words: Femoral fractures; Risk factors; Child; Sex factors; Body weight

The assessment of the application of Taylor spatial frame in treatment of intermediate or distal tibiofibula fractures

To determine the effectiveness and the safety of the Taylor spatial frame in treatment of intermediate or distal tibiofibula fractures. The clinical data of 74 patients with intermediate or distal tibiofibular fractures treated between January 2015 and January 2017 were retrospectively analyzed. According to fixation methods, they were divided into internal fixation group (26 cases) and external fixation group (48 cases). There was no significant difference in the age, gender, cause of injury, type of fracture, time from injury to operation between 2 groups ( P>0.05). The intraoperative blood loss, fracture healing time, fixator removal time, and complications were recorded and compared. The final function evaluation criteria of Johner-Wruhs humeral shaft fracture were used to evaluate the function of the affected limb. The lower limb force line recovery after operation was evaluated according to the standard evaluation of LUO Congfeng et al. Both groups were followed up 6-22 months (median, 14 months). All patients obtained the fracture healing. The intraoperative blood loss, fracture healing time, and fixator removal time were significantly higher in the internal fixation group than those in the external fixation group ( P<0.05). There were 1 case of plate exposure, 1 case of delayed fracture healing, and 1 case of plate fracture in the internal fixation group; and there were 2 cases of delayed fracture healing and 4 cases of soft tissue defect in the external fixation group; no significant difference was found in the incidence of complications between 2 groups ( χ2=0.015, P=0.904). The function of the affected limb was evaluated by Johner-Wruhs standard at 10 months after operation, the results was excellent in 19 cases, good in 5 cases, and fair in 2 cases in the internal fixation group, with an excellent and good rate of 92.3%; the results was excellent in 42 cases, good in 3 cases, and fair in 2 cases in the external fixation group, with an excellent and good rate of 95.7%; showing no significant difference between 2 groups ( χ2=0.392, P=0.531). The lower limb force line recovery after operation was evaluated according to the standard evaluation of LUO Congfeng et al.at 4 months after operation, the results was excellent in 24 cases, fair in 1 case, poor in 1 case in the internal fixation group, with an excellent and good rate of 92.3%; the results was excellent in 46 cases, fair in 1 case, poor in 1 case in the external fixation group, with an excellent and good rate of 95.8%; showing no significant difference between 2 groups ( χ2=0.520, P=0.471). The use of Taylor spatial frame in the treatment of the intermediate or distal tibiofibular fractures can obviously reduce the healing time and complications than the internal fixation of the plate. It can reduce the fracture treatment cycle and is beneficial to the fracture healing and limb function recovery, which is relatively safe and reliable.

Precise orthormorphia of tibial angulation deformity and shortening deformity by using digital technology combined with circular external fixator

To evaluate the effectiveness of precise orthormorphia of tibial angulation deformity and shortening deformity by using digital technology combined with external fixator. Twenty-six cases of tibial angulation deformity combined with shortening deformity were treated between June 2012 and August 2016, including 12 males and 14 females aged from 1 to 19 years with an average age of 16.5 years. There were 6 cases of congenital patella pseudoarthrosis, 1 case of fibrous dysplasia of femur and tibia, 3 cases of limb shortening deformity caused by infantile paralysis, 16 cases of fracture malunion. Limb shortening was 1.5-9.5 cm (mean, 6.2 cm) before operation. The deformity from three-dimensional perspective was analysed by digital technology, the surgical procedures of lengthening and osteotomy was simulated, the navigation templates were completed with computer aided design (CAD) and three-dimensional printing, and the external fixator was used to assist the lengthening of the tibia. X-ray films were regularly reviewed after operation to observe the new bone remolding, limb lengthening, load bearing line of lower limb, and recurrences of angulation. All the patients were followed up 14-48 months (mean, 18.8 months). There was only 1 case of superficial pin site infection which was cured with oral antibiotics and pin site care with mild disinfectants, and no complication such as bone nonunion, equines deformity, or vascular nerve injury occurred. The deformity of tibia and load bearing line of lower limb had been completely recovered according to postoperative X-ray films at 1 week. All the cases achieved perfect limb length as with preoperative design. The bone mineralization time was 12-20 weeks (mean, 11.6 weeks), the external fixator removal time was 18-26 weeks (mean, 14.9 weeks), and the healing index was 21-78 d/cm (mean, 63.4 d/cm). The postoperative flexion range of the injured limb was 15° less than the unaffected extremity in 1 case, and the situation was improved significantly after some physical manipulation and exercise, who completed the limb lengthening and achieved the expected effectiveness finally. Precise orthormorphia of tibial deformity by using digital technology, and limb lengthening with the aid of external fixator can achieve good effectiveness with good reliability, invasiveness, and precision.

Management of Complete Talocrural Luxations by Selective Talocrural Arthrodesis using Hybrid Transarticular External Skeletal Fixation in Dogs.

This article presents a novel surgical technique in the management of open complete talocrural luxations and evaluates the results, and clinical benefits with its routine clinical utilization. Retrospective study. Seventeen medium- or large-breed client-owned dogs of different breed, age and sex with complete talocrural luxations and radiographic follow-up of at least 24 weeks duration. Selective talocrural arthrodesis was performed by using a hybrid transarticular external skeletal fixator frame. Clinical and radiographical evaluation was performed regarding the lesion, concomitant injury, duration of the surgery, time to first use of the limb, fixator removal time, complications and clinical outcomes. Dogs started to use the injured limb between postoperative days 1 to 11. Pin or wire tract related complications were observed in all dogs. Time to fixator removal ranged from 57 to 90 days with a median of 73 days. All of the operated joints with an exception of one dog resulted in talocrural fusion. Mid-term clinical outcomes score was regarded as excellent in 13/17 dogs, good in 3/17 dogs and poor in 1/17 dogs subject to authors' evaluation. A transarticular hybrid external fixator may allow early use of postoperative limb with an excellent patient compliance and is well tolerated as well. The technique showed a promising opportunity of providing favourable limb use.

Management of metacarpal and phalangeal fractures with JESS fixator: A prospective study

The human hand architected to show an exceptional movements and is often a most vulnerable to various degree of injuries caused often by road traffic accidents and industrial accidents. Treatment of hand injuries involves in joint range improvement and redevelopment of coordinative movements. Joshi’s external stabilizing system (JESS) provides a stable skeletal environment with early tissue healing and immediate active and passive mobilization of the uninjured adjacent joints. This study designed to assess the efficacy of JESS in management of Hand injuries. Study includes 50 patients of both sexes and all age groups with open or close type of hand injuries. All the patients were allowed to complete clinical and radiological assessment before and after surgical procedure along with subsequent follow up. Various types of distractors (30%) were applied because majority fractures were intra-articular and in 18% cases basic and extended hand frames were used. Fixators was removed within 6 weeks and in 68% wounds were healed at that time of fixator removal. Swelling was commonly associated complications in 32% cases. The incidence of non-union and delayed union of fractures was 8%, 10% respectively. At the time of final follow up 62.8% metacarpophalangeal joints, 64% of interphalangeal joints, 63% of proximal metacarpophalangeal joints, 63.5% of distal metacarpophalangeal joints and 62% of wrist joints regained their normal movements. In 74% cases grip strength was remains normal. JESS is simple, modular and low expensive. It assists the surgeon in obtaining tissue stabilization, spontaneous revascularization and tissue expansion by gradual and controlled distraction.

Complications Associated With Pelvic External Fixation.

An external fixator is an essential tool for treating unstable pelvic ring injuries but its use carries risks, including pin-site infections and injury to the lateral femoral cutaneous nerve (LFCN). Surgeons currently lack data regarding these risks for patient counseling. This study aimed to identify the incidence of and risk factors for superficial and deep pin-site infection and LFCN damage. Fifty-two patients who underwent pelvic external fixation with anterior pin placement as part of definitive treatment for unstable pelvic ring disruption were retrospectively evaluated to identify factors associated with the development of infection. Ten (19%) patients developed superficial pin-site infections, with none developing a deep infection. Five were treated with oral antibiotics alone, 5 with additional intravenous antibiotics, and 1 underwent superficial surgical debridement at the time of external fixator removal. Three (6%) patients had temporary symptoms consistent with irritation to their LFCN that all resolved by 3 months. One (2%) patient had residual mild and intermittent LFCN dysesthesias at the 6-month follow-up. Adjusted logistic regression models identified no specific factors that were associated with increased risk of infection. The incidence of superficial infections related to pelvic external fixation was 19%, which can usually be treated with antibiotics with low risk of deep infection. In addition, there remains a low risk of long-term LFCN damage. Patients should be counseled on these risks during the perioperative period. [Orthopedics. 2017; 40(6):e959-e963.].

Effect of axial stress stimulation on tibial and fibular open fractures healing after Taylor space stent fixation

To investigate the effect of axial stress stimulation on tibial and fibular open fractures healing after Taylor space stent fixation. The data of 45 cases with tibial and fibular open fractures treated by Taylor space stent fixation who meet the selection criteria between January 2015 and June 2016 were retrospectively analysed. The patients were divided into trial group (23 cases) and control group (22 cases) according to whether the axial stress stimulation was performed after operation. There was no significant difference in gender, age, affected side, cause of injury, type of fracture, and interval time from injury to operation between 2 groups ( P>0.05). The axial stress stimulation was performed in trial group after operation. The axial load sharing ratio was tested, and when the value was less than 10%, the external fixator was removed. The fracture healing time, full weight-bearing time, and external fixator removal time were recorded and compared. After 6 months of external fixator removal, the function of the limb was assessed by Johner-Wruhs criteria for evaluation of final effectiveness of treatment of tibial shaft fractures. There were 2 and 3 cases of needle foreign body reaction in trial group and control group, respectively, and healed after symptomatic anti allergic treatment. All the patients were followed up 8-12 months with an average of 10 months. All the fractures reached clinical healing, no complication such as delayed union, nonunion, or osteomyelitis occurred. The fracture healing time, full weight-bearing time, and external fixator removal time in trial group were significantly shorter than those in control group ( P<0.05). After 6 months of external fixator removal, the function of the limb was excellent in 13 cases, good in 6 cases, fair in 3 cases, and poor in 1 case in trial group, with an excellent and good rate of 82.6%; and was excellent in 5 cases, good in 10 cases, fair in 4 cases, and poor in 3 cases in control group, with an excellent and good rate of 68.2%, showing significant difference between 2 groups ( Z=-2.146, P=0.032). The axial stress stimulation of Taylor space stent fixation can promote the healing of tibial and fibular open fractures and promote local bone formation at fracture site.

Management of traumatic tarsal luxations with transarticular external fixation in cats.

To report our experience with the use of contoured mini circular transarticular external skeletal fixators for the management of traumatic tarsal luxations in 15 cats. Fifteen cats with traumatic tarsal joint luxation treated by using mini circular transarticular external fixators with available clinical records and complete clinical and radiographic follow-up of at least 30 weeks duration were included in the study. Data collected were the signalment, history, type of injury, concomitant injury, frame configuration, stabilization technique, duration of the surgery, time to first use of the operated limb, fixator removal time, complications, final outcome and follow-up. The surgical procedure chosen was based on the type of luxation; partial tarsal arthrodesis was performed in 10 cases, tarso-crural stabilization in four cases, and pantarsal arthrodesis in three cases. Five cats started to use the operated limb immediately after recovering from anaesthesia. In the other 10 cats, time to first use ranged from one to four days (mean 2 days). In one case, early pin loosening due to half pin fixation bolt failure was observed as a postoperative complication. Fixator removal time ranged from 24 to 60 days (mean 45 days). Functional outcome was excellent in 15 cats and good in two. This is a preliminary report about the treatment of tarsal luxations with a mini circular transarticular external fixation system in which early postoperative and long-term results seem to be favourable.