Traditional External Fixation Research Articles

Advanced Real Time Bone Fracture Monitoring with Pain Control Mechanism

Bones provide structural aid to the frame, and bone fracture recuperation is crucial for regaining functionality and mobility. The boundaries of traditional external fixators in bone fracture remedy, characterized by a loss of actual-time monitoring and capability complications, necessitate a paradigm shift. To clear up this trouble, a clever fixator design imbued with the transformative energy of Aware, Sensing, Smart, and Active (ASSA) technology has been developed. This fixator transcends its passive role, evolving into a wise IoT gateway. It continuously gathers and analyses facts from numerous incorporated sensors, supplying real-time insights into the tricky dance of fracture healing. Its analytical prowess fosters computerized identification of vital activities and milestones within the affected person's recuperation journey, empowering well-timed interventions and knowledgeable scientific selection-making. Furthermore, the fixator vigilantly monitors patient compliance, making sure adherence to prescribed behaviours and nipping non-compliance in the bud. However, its innovation extends beyond mere monitoring. Embedded within its smart framework lies a modern pain manipulation mechanism powered through a thermoelectric generator (TEG).

THE FITBONE INTRAMEDULLARY LENGTHENING NAIL IN THE MANAGEMENT OF ADULT AND PAEDIATRIC LIMB DEFORMITY: A RETROSPECTIVE COHORT STUDY AT A TERTIARY REFERRAL LIMB RECONSTRUCTION SERVICE

IntroductionManagement of deformity involving limb length discrepancy (LLD) using intramedullary devices offers significant benefits to both patients and clinicians over traditional external fixation. Following the withdrawal of the PRECICE nail, the Fitbone became the primary implant available for intramedullary lengthening and deformity correction within our service. This consecutive series illustrates the advantages and complications associated with the use of this device, and describes a novel technique modification for antegrade intramedullary lengthening nails.Materials & MethodsA retrospective cohort review was performed of patient outcomes after treatment with the Fitbone nail at two tertiary referral limb reconstruction services (one adult, one paediatric) between January 2021 to December 2023. Aetiology, indications, initial and final LLD, use of concomitant rail assisted deformity correction (ORDER), removal time and healing index were assessed. Complications of treatment were evaluated and described in detail, alongside technique modifications to reduce the rate of these complications.Results21 nails (18 femoral, 2 tibial, 1 humeral) were inserted in 6 adult and 13 paediatric patients. Post-traumatic and congenital/developmental LLD were the most common indications for surgery in the adult and paediatric cohorts respectively. ORDER was employed in 11 cases (9 femurs and 2 tibias). Treatment goals were achieved in all but one case. Complications included superficial infection, locking bolt migration, periprosthetic fracture and component failure. Seven patients required unplanned returns to theatre.ConclusionsThe Fitbone nail is an established option for intramedullary limb lengthening, however its use in the UK has been relatively limited compared to the PRECICE until 2021. Our data helps to define its place for limb lengthening and complex deformity correction in both adult and paediatric patients, including in humeral lengthening and retrograde femoral insertion across an open physis. We have identified important potential risks and novel techniques to simplify surgery and avoid complications.

Finite element analysis comparison of Type 42A2 fracture fixed with external titanium alloy locking plate and traditional external fixation frame

BackgroundAt present, not all Type AO/OTA 42A2 open fractures can be treated by external fixation brackets, not to mention the inconvenience of this technique in clinical practice. External titanium alloy locking plates, which are lightweight and easy-to-operate, can be used as an alternative treatment option for such patients. However, there are few reports of finite element biomechanical analysis on the titanium alloy locking plates and fixation brackets being placed on the medial side of the tibial fracture. In this study, the biomechanical properties of titanium alloy locking plates and fixation brackets for treating Type AO/OTA 42A2 fractures were compared by applying the finite element method, and the results provided data support for the clinical application of the external titanium alloy locking plate technique.MethodsType AO/OTA 42A2 fracture models were constructed using CT data of a male volunteer for two external fixation techniques, namely the external titanium alloy locking plate technique and the external fixation bracket technique, according to commonly-used clinical protocols. Then, the four-point bending, axial compression, clockwise rotation and counterclockwise rotation tests under the maximum load were simulated in finite element analysis software. The stress distribution, peak stress and overall tibial displacement data for the two different external fixation techniques were obtained and compared.ResultsIn the four different test conditions (i.e., four-point bending, axial compression, clockwise torsion, counterclockwise torsion) under the maximum load, the two external fixation techniques showed obvious von Mises stress concentration at the contacts between the screw and tibia, between the screw and titanium alloy locking plate, between the self-tapping self-drilling needle and tibia, between the self-tapping self-drilling needle and the external fixation device, as well as around the fracture end and around the cortical bone at the upper and lower ends of the tibia. The peak stress was ranged 26.67–558.77 MPa, all below the yield stress strength of titanium alloy. The peak tibial displacement of the external titanium alloy locking plate model was smaller than that of the fixation bracket model. In terms of structural stability, the external titanium alloy locking plate technique was superior to the external fixation bracket technique.ConclusionsWhen fixing Type AO/OTA 42A2 fractures, external titanium alloy locking plates are not only lightweight and easy-to-operate, but also have better performance in terms of axial compression, bending and torsion resistance. According to the finite element biomechanical analysis, external titanium alloy locking plates are superior to traditional external fixation brackets in treating Type AO/OTA 42A2 fractures and can better meet the needs of clinical application.

Supercutaneous Plating Technique: A Case Report of Locking Plate Used as an External Fixator

Introduction: Open fracture is one of the most common and challenging healthcare problem in orthopedic practice1.Despite improvements in implant design, management of open fractures remain a challenge for the orthopedic surgeon. Locked compression plates (LCP) have advantages of angular stability from the locking-head mechanism and less irritation when compared with traditional external fixators due to their low profiles. Here is a case report of the same. Case Report: A 50-year-old lady, a municipal worker by occupation, came to casualty with alleged history of road traffic accident and injury to right thigh and knee. Plain radiograph of of right femur with knee revealed a supracondylar fracture of right femur. As a definitive treatment, patient underwent open reduction and supercutaneous plating. Skin grafting was done for the external wound over distal thigh. The External fixation plate for right distal knee was removed after 6 weeks and knee ROM of 0 to 100 degree flexion was achieved by one year. Conclusion: Open fractures can be treated by external fixation using the LCP plates, which are safe, reliable and have acceptable functional outcomes with minimal complication rates. Its advantages also include ease of performing surgery and ease of removing plate after fracture healing. Keywords: Supercutaneous plating, LCP- locking compression plate, External fixator

Supercutaneous plating: A case report of locking plate used as an external fixator

Introduction: Proximal and distal tibial fractures with a compromised soft tissue envelop still pose a treatment dilemma or challenge for the orthopedic surgeon LCPs have advantages of angular stability from the locking-head mechanism and less irritation when compared with traditional external fixators due to their low profiles. Here is a poster case report of the same.Case Report: A 37-year-old male, flouriest, from Badravathi who came to Orthopedic OPD after he had met with a road traffic accident on 23rd November 2020 and sustained injury to left leg. Plain radiograph revealed fracture of left tibia and fibula at the proximal and middle third junction. Arterial Doppler showed long segment poplitial artery thrombosis.As a definitive treatment patient underwent Open reduction and plate fixation of proximal third tibia with thromboembolectomy and venous grafting done. The limb post-operative went into compartment syndrome and emergency fasciotomy of left leg wasdone. Fasciotomy wound got infected and hence Vacuum assisted closure was applied. The same locking plate was removed and used as an external fixator. The External fixation plate for left tibia was removed and the patient was put on patellar tendon bearing cast and is showing good signs of union.Conclusion: For proximal fractures of the tibia, which are treated by external fixation using the LCP plate is a safe and reliable technique and excellent functional outcomes. There is a high rate of union with minimal complications rate. Its advantages also include ease of performing surgery and ease of removing plate after fracture healing. Though the use of locked plates as external fixators is not a generally acknowledged technique by many surgeons still it has become valuable modality in management.

Research progress of intramedullary lengthening nail technology

To review the research progress of intramedullary lengthening nail technology. The foreign literature on the development history, types, advantages and disadvantages, indications and contraindications, complications, and effectiveness of intramedullary lengthening nail were reviewed and analyzed. The intramedullary lengthening nail system mainly includes mechanical type, electric motor drive type, and magnetic drive type. Compared with traditional external fixation and lengthening technology, the intramedullary lengthening nail technology has certain advantages in incidence of complications, bone healing, postoperative functional rehabilitation, incision aesthetics, convenience, and patient satisfaction. However, there are also shortcomings, such as pain, uncontrollable distraction rate, device failure, etc. In the clinical application of intramedullary lengthening nails for limb lengthening, the indications should be grasped reasonably, and the related complications should be prevented and treated. Intramedullary lengthening nails provide a new option for limb lengthening, and the initial effectiveness is good. It is one of the development direction of limb lengthening technology.

Comparison study of minimally invasive percutaneous bridge internal fixator and traditional external fixator in treatment of unstable pelvic fractures

To evaluate the effectiveness of unstable pelvic fractures treated with minimally invasive percutaneous bridge internal fixator or traditional external fixator. The clinical data of 45 patients with unstable pelvic fractures who met the selection criteria between January 2013 and February 2018 were retrospectively analyzed. According to the different surgical methods, they were divided into two groups. In the observation group (25 cases), minimally invasive percutaneous bridge internal fixators were used, and three-dimensional printing pelvic models were used to simulate the reduction and fixation before operation to develop individual reduction strategies. In the control group (20 cases), external fixators were used. There was no significant difference between the two groups in gender, age, cause of injury, fracture type (according to Tile classification), and time from injury to operation ( P>0.05). The operation time, intraoperative blood loss, fracture healing time, and complications were recorded and compared between the two groups. The reduction quality was evaluated according to the Matta standard, and functional recovery was evaluated according to the Majeed scoring standard. All patients were followed up 12-20 months (mean, 15 months). The operation time of the observation group was significantly longer than that of the control group ( t=2.719, P=0.009); no significant difference in intraoperative blood loss was found between the two groups ( t=0.784, P=0.437). There was no significant difference between the two groups in fracture healing time ( t=0.967, P=0.341). According to the Matta standard, the excellent and good rate of the observation group was 92%, and that of the control group was 70%, showing no significant difference between the two groups ( χ 2 =3.748, P=0.053). At last follow-up, according to the Majeed scoring standard, the excellent and good rate of the observation group was 88%, and that of the control group was 60%, showing significant difference between the two groups ( χ 2 =4.717, P=0.030). The incidences of incision and nailway infection, secondary displacement of fracture, and malunion in the observation group were significantly lower than those in the control group ( P<0.05); the differences in incidences of iatrogenic injury of lateral femoral cutaneous nerve, deep vein thrombosis, and loosening of fixation between the two groups were not significant ( P>0.05). Minimally invasive percutaneous bridge internal fixator is a safe and effective method for the treatment of unstable pelvic fractures. It has the advantages of minimal trauma, stable fixation, less interference to patients' daily life, early functional exercise, and quickly recovery after operation.

Investigating the biomechanical function of the plate-type external fixator in the treatment of tibial fractures: a biomechanical study

BackgroundThe design of an external fixator with the optimal biomechanical function and the lowest profile has been highly pursued, as fracture healing is dependent on the stability and durability of fixation, and a low profile is more desired by patients. The plate-type external fixator, a novel prototype of an external tibial fixation device, is a low profile construct. However, its biomechanical properties remain unclear. The objective of this study was to investigate the stiffness and strength of the plate-type external fixator and the unilateral external fixator. We hypothesized that the plate-type external fixator could provide higher stiffness while retaining sufficient strength.MethodsFifty-four cadaver tibias underwent a standardized midshaft osteotomy to create a fracture gap model to simulate a comminuted diaphyseal fracture. All specimens were randomly divided into three groups of eighteen specimens each and stabilized with either a unilateral external fixator or two configurations of the plate-type external fixator. Six specimens of each configuration were tested to determine fixation stiffness in axial compression, four-point bending, and torsion, respectively. Afterwards, dynamic loading until failure was performed in each loading mode to determine the construct strength and failure mode.ResultsThe plate-type external fixator provided higher stiffness and strength than the traditional unilateral external fixator. The highest biomechanics were observed for the classical plate-type external fixator, closely followed by the extended plate-type external fixator.ConclusionsThe plate-type external fixator is stiffer and stronger than the traditional unilateral external fixator under axial compression, four-point bending and torsion loading conditions.

External fixation of the lower extremities: Biomechanical perspective and recent innovations

The concept of supporting fractured long bones externally with mechanical fixation has been evidentially applied for over 2000 years, and since been expanded on in the mid-19th century by percutaneous bone fixation. Surgical techniques, external fixator systems, and materials have made continued progress since. The benefits of traditional external fixation have been enhanced in recent years with the introduction of hexapod-style fixators, innovative configurations, and pin modifications, among other things. It is generally agreed upon that biomechanical testing of advancements in external fixation must be inclusive of transverse or torsional loading to simulate construct behaviour in realistic scenarios. Biomechanical studies indicate that hexapod-style fixators show comparable axial stiffness to Ilizarov-style systems and improved performance under torsional and transverse forces. The addition of configuration elements to fixators, inclusion of certain carbon fibre chemical compositions, and techniques intended to augment ring thickness have also been investigated, in hopes of increasing construct stiffness under loading. Novel external fixators attempt to broaden their applications by rethinking bone mounting mechanisms and either expanding on or simplifying the implementation of 3D bone segment transport for corrective osteotomy. Older and seemingly unconventional fixation techniques are being rediscovered and evolved further in order to increase patient comfort by improving everyday usability. The development of new pin coatings can potentially enhance the pin-bone interface while lowering infection rates typically expected at thicker soft tissue envelopes. Although complication, malunion, and nonunion rates have decreased over the past 50 years, the clinical results of external fixation today can still be optimized. Unsatisfactory healing in the lower extremities has especially been reported at locations such as the distal tibia; however, advancements such as osteoinductive growth hormone treatment may provide improved results. With the current progression of technology and digitization, it is only a matter of time before ‘smart’, partly-autonomous external fixation systems enter the market. This review article will provide a versatile overview of biomechanically proven fixator configurations and some carefully selected innovative systems and techniques that have emerged or been established in the past two decades.

Restoring Volar Tilt in AO Type C2 Fractures of the Distal Radius With Unilateral External Fixation

To determine whether unilateral external fixation using a staged multiplanar reduction technique restores anatomic volar tilt in a distal radius fracture model. We used radiographic images to obtain baseline measurements in 20 fresh-frozen cadaveric wrists. Through a standard dorsal approach to the radius, we performed osteotomies to simulate displaced AO/ASIF type C2 fractures. After placement of a unilateral external fixator, a stepwise technique of applying longitudinal traction followed by a volar translational maneuver was performed. Radiographic imaging was obtained after each step of the multiplanar reduction technique. Standard longitudinal traction did not restore volar tilt angles to their baseline measurements. The addition of a volar translation maneuver had a significant effect on restoring baseline volar tilt. There was a statistically significant difference in volar tilt measurements between straight longitudinal traction and volar translation. Radial inclination, radial height, and ulnar variance did not differ significantly between longitudinal traction and the addition of volar translation. A criticism of traditional external fixation is the inability of longitudinal ligamentotaxis to attain sagittal plane (volar tilt) reduction of the articular surface. This study demonstrates that a multiplanar reduction technique using unilateral external fixation devices on cadaveric distal radius fractures can achieve an acceptable reduction. External fixation of distal radius fractures may be favorable in situations where soft tissue loss, wound contamination, and comorbid medical factors preclude the use of internal fixation techniques. A multiplanar reduction technique using a unilateral external fixation device may facilitate fracture reduction in acceptable alignment.

External Fixation by Locking Plate as a Definitive Treatment of Tibial Distal Metaphyseal Fractures

Background: Traditional external fixation used for open or soft tissue compromised tibial distal metaphyseal fractures is used both as a temporizing or definitive treatment to minimize more traumas to the soft tissue, but it has its own shortcomings such as joint spanning and bulky construct. Lower profile locked plates used as external fixation may overcome such problems.Methods: A series of 16 open or with soft tissue compromised tibial distal metaphyseal fractures were treated using locking plate as a definitive external fixator. Time to union, nonunion, malunion, device failure, function for the knee and ankle, and deep and pin tract infections were evaluated.Results: All fractures healed without any complications (nonunion, malunion, device failure, or infections including deep and pin tracts). The mean time of fracture healing was 18 weeks (ranged 12 to 26). After walking with full weight-bearing for 1 month, the patients underwent plate removal. The mean hospital for special surgery (HSS) score was 89 (ranged 84 to 100) and 95 (ranged 91 to 100), and the mean American orthopaedic foot and ankle society (AOFAS) score was 93 (ranged 89 to 100) and 95 (ranged 92 to 100) at 4 weeks postoperatively and final follow-up (mean period of 16 months).Conclusions: Application of the locking plate as an external fixator for definitive treatment of distal tibial fractures had the advantages of traditional external fixators and at the same time overcame its shortcomings due to its low-profile frame; therefore, it was more acceptable to patients and Joint-sparing frame gave the opportunity for early range of motion and function exercise. It was a safe and reliable technique with minimal complications and excellent outcomes.

Clinical analysis of modified plaster external fixation in the treatment of the senile comminuted fractures of distal radius in elderly patients

Objective To explore the feasibility and clinical value of the modified plaster external fixation in the treatment of the senile comminuted fractures of distal radius. Methods The 547 patients with the senile comminuted fractures of distal radius were reviewed to clinically evaluate the modified plaster external fixation.The clinical value of 12-lead electrocardiogram after successful reperfusion therapy for acute myocardial infarction was evaluated.All patients were divided into operation group, traditional plaster external fixation group and modified plaster external fixation group.The mean follow up time was 50 weeks.The comfort degree of patients during therapy was appraised by the score of wrist pain, the time of swelling disappearance, complications rates of palmaris pressure sores and acute carpal tunnel syndrome, and the average treatment costs.The efficacy and radiographic changes were assessed by PRWE score and Sanniento score modified by Stewart. Results The grade of wrist pain, the time of swelling disappearance, complication rates and the average treatment cost were less in the modified plaster external fixation group than in traditional plaster external fixation group(t=13.834、12.709、29.443、12.900, P 0.05). Based on radiologic evaluations, the improved Sarmiento score after 10 weeks of treatment was(2.62±2.83)in modified plaster external fixation group, (2.92±2.95)in traditional plaster external fixation group(t=0.544, P>0.05, between the two groups), and(1.29±2.13)in operation group(vs.two plaster external fixation group, t=5.518, P 0.05). Conclusions Modified plaster external fixation for the treatment of the senile comminuted fracture of distal radius has more advantages as compared with traditional plaster external fixation in raising comfort during the treatment and rapid recovery of wrist function.And it can reduce the complications and the economic burden of patients.It is worth popularizing to treat the elderly patients with the senile comminuted fractures of distal radius in primary care settings. Key words: plaster; surgery; radius fracture; comminuted fractures

A Comparative Study of Uniplanar Unilateral External FixationVersus Locking Plate as External Fixation in The Definitive Management of Open Fractures of Tibial Diaphysis in Adults

Background: This study was taken up to analyse the benefits of unilateral uniplanr external fixator versus locking compression plate as external fixator in definitive management of open fractures of tibial diaphysis in adults. Materials and Methods: Prospective randomized double blinded study to divide patients with computer generated randomized table. Results: limb extremity functional scale used to assess and compare recovery. Conclusion: : Supracutaneous plating is a cheap and effective alternative to traditional external fixation in case of open fractures of the tibia in adults and can be used as the definitive management for such fractures.

Anterior Subcutaneous Internal Fixation of the Pelvis: Placement of the INFIX

The treatment of displaced or unstable pelvic fractures involves surgical stabilization. Traditional methods of fixation for the anterior pelvic ring include plate fixation, screw fixation, or external fixation. Recently, a technique for using spinal pedicle screws to create an anterior subcutaneous internal fixator, also termed an “INFIX,” has been reported with some success. Although no technique has proved clinically superior, the subcutaneous technique offers significant advantages over traditional pelvic external fixation. These advantages include obviating the risk of pin tract irritation or infection, decreasing postoperative pain, and increasing the biomechanical stability of the fixation construct. Here, we review the anatomical considerations, imaging, and surgical technique for placing an anterior subcutaneous internal fixator. In addition, the surgical outcomes and complications of this specialized technique are discussed. Surgical management of pelvic ring injuries is complex, and this technique is a valuable tool in the armamentarium of pelvic surgeons.

Internal anterior fixators for pelvic ring injuries: Do monaxial pedicle screws provide more stiffness than polyaxial pedicle screws?

ObjectivesLittle is known about the mechanical properties of internal anterior fixators (known as INFIX), which have been proposed as subcutaneous alternatives to traditional anterior external fixators for pelvic ring disruptions. We hypothesised that INFIX has superior biomechanical performance compared with traditional external fixators because the distance from the bar to the bone is reduced. MethodsUsing a commercially available synthetic bone model, 15 unstable pelvic ring injuries were simulated by excising the pubic bone through the bilateral superior and inferior rami anteriorly and the sacrum through the bilateral sacral foramen posteriorly. Three test groups were established: (1) traditional supra-acetabular external fixation, (2) INFIX with polyaxial screws, (3) INFIX with monaxial screws. Load was applied, simulating lateral compression force. Outcome measure was construct stiffness. ResultsThe traditional external fixator constructs had an average stiffness of 6.21N/mm±0.40standard deviation (SD). INFIX with monaxial screws was 23% stiffer than the traditional external fixator (mean stiffness, 7.66N/mm±0.86SD; p=.01). INFIX with polyaxial screws was 26% less stiff than INFIX with monaxial screws (mean stiffness, 5.69N/mm±1.24SD; p=.05). No significant difference was noted between polyaxial INFIX and external fixators (mean stiffness, 6.21N/mm±0.40SD; p=.65). ConclusionsThe performance of INFIX depends on the type of screw used, with monaxial screws providing significantly more stiffness than polyaxial screws. Despite the mechanical advantage of being closer to the bone, polyaxial INFIX was not stiffer than traditional external fixation.

Preparation of Medical Low-Temperature Wood-Plastic Polycaprolactone Composites and their Properties

Traditional medical external fixation material represented by gypsum is brittle, heavy and prone to adverse reactions, clinical effect is not ideal. The pine wood fiber particles (size for 10 ~ 40 mesh) and polycaprolactone (PCL) are used to prepare a new kind of wood-plastic polycaprolactone composites (WPC) by the blending method. The experimental results show that the increase of PCL mass ratio can enhance the material strength and flexibility, especially the match force between the pine wood fiber particles. Meanwhile, when the mass ratio of PCL reached 65%, this enhancement effect significantly diminished; after the mass ratio of PCL reached 70%, the phenomenon of material mechanics performance decline. In this paper, the prepared WPC, which can soften under temperature 50°Cand repetitively finalize the design, have good mechanical properties, low-temperature thermoplastic and environment protection.

Using a reconstruction locking compression plate as external fixator in infected open clavicle fracture

Open clavicle fracture is an uncommon injury mostly caused by severe direct trauma. It is often associated with multiple organ injuries. Generally, surgical intervention with debridement and fracture repair is always indicated in order to prevent infection, non-union, and malalignment. In situations of bony exposure and significant contamination concomitant with severe soft tissue damage, the external fixation is the treatment of choice because of the possibility it offers of providing stable fixation with minimal local tissue damage resulting in excellent union rates and better soft tissue outcome. Nevertheless, traditional external fixation encountered some potential problems as its bulkiness and sharp edges caused discomfort to the patient. In this study, we present an interesting case of a polytraumatized patient with a gunshot injury with complex open clavicle fracture that was successfully treated with external fixation using reconstruction with a locking compression plate as definitive treatment.

Supracetabular external fixation in treating pelvic fractures associated with injuries of abdominal organs

Objective To evaluate the technique and clinical outcomes of supra-acetabular external fixation in treating pelvic fractures associated with injuries of abdominal organs.Methods There were 17 cases of pelvic fractures associated with injuries of abdominal organs.Nine were males and 8 were females,with the average age of 42 years (range,21-75 years).The injury was caused by traffic accident in 9 cases,fall-down from height in 4,and crush by heavy objects in 6.According to Tile classification of pelvic fractures,7 were type B1,3 were type B2,2 were type B3,4 were type C1 and 1 was type C2.Fifteen cases suffered with hemorrhagic shock,2 with perineal injury and 12 with fractures of the limbs.All patients were treated with supra-acetabular external fixation and the outcomes were evaluated by Cole's clinical scoring,Matta and Tornetta's radiographic standards.Results All 17 cases were followed up with the mean period of 6.5 months (range,2-18 months).The average time of operation was 15 min (range,9-25 min).The mean blood loss was 17 ml (range,5-25 ml).All fractures healed and the mean healing period was 9.2 weeks (range,8-12 weeks).Three had transient palsy of lateral femoral cutaneous nerve.Five had soft tissue infection while the bony structures were not involved.According to Cole's scoring for pelvic fractures,15 cases were excellent,1 case was good and 1 case was fair,with the good-excellent rate of 94.12％.According to Matta and Tornetta's standards of fracture reduction,12 were excellent,3 were good and 2 were fair,with the good-excellent rate of 88.24％.Conclusion Supra-acetabular external fixation is a minimal invasive and convenient method for treating pelvic fractures with abdominal organs injury which is mechanically stronger than traditional external fixation via iliac crest. Key words: Pelvis; Fractures, bone; External fixators

Reconstructing Limb Deformities using the VCAM™ External Fixator: A series of 3 cases

External fixation was used almost exclusively for fracture management. It is also used for arthrodesis, management of lower extremity deformities such as Charcot neuroarthropathy, limb lengthening, osteotomy stabilization, osteomyelitis, nonunion or pseudoarthrosis. It has proven extremely useful in the treatment of a number of conditions because it can provide distraction, compression, stabilization and neutralization as needed. Traditional external fixators involve driving pins through the tibia and fibula. The VCAM TM is a unique below the ankle external fixator. The VCAM TM can avoid possible disruptions and complications that are often seen with traditional Ilizarov fixators. The indications for the VCAM TM external fixator are identical to the Ilizarov fixators, such as off-loading, fracture reduction and reconstructive procedures. In our institution, we have used the VCAM TM device to off-load ulcerations and correct limb deformities. In the cases presented in this paper the VCAM TM was used to off-load wounds secondary to Charcot arthropathy and transmetatarsal amputations, as well as to gradually correct a rearfoot deformity such as seen in a Chopart's amputation. The VCAM TM can be constructed into an Ilizarov type frame or a hybrid frame which can be used to achieve gradual triplanar correction. We have seen good results using the VCAM TM for wound care and limb deformities and recommend this approach when tibia and fibula intervention is not necessary.

LCP external fixation - External application of an internal fixator: two cases and a review of the literature

The locking compression plate (LCP) is an angle-stable fixator intended for intracorporeal application. In selected cases, it can be applied externally in an extracorporeal location to function as a monolateral external fixator. We describe one patient with Schatzker V tibial plateau fracture and one patient with Gustillo IIIB open tibia shaft fracture treated initially with traditional external fixation for whom exchange fixation with externally applied LCPs was performed. The first case went on to bony union while the second case required bone grafting for delayed union. Both patients found that the LCP external fixators facilitated mobilization and were more manageable and aesthetically acceptable than traditional bar-Schanz pin fixators.