Use Of External Skeletal Fixation Research Articles

External skeletal fixation in large animals: A review

External skeletal fixation (ESF) was first adapted for veterinary medicine in 1934; this fixation method consisted of devices for stabilizing musculoskeletal injuries, such as fractures, dislocations, tendon ruptures, and angular deviation; using transcortical pins or wires connected in sidebars or cast to cover the region of instability. The evolution of orthopedics in veterinary medicine, together with the development of diagnostic imaging and the field of anesthesia, has allowed a substantial increase in success rates in cases of fractures in animals. However, orthopedic cases in large animals, especially, are still challenging due to the unique characteristics of the species, which are associated with bone regeneration and depend on the specific type of lesion and the use of implants that adequately support the stress distribution. External fixation techniques in large animals are plausible strategies for cases of open and/or comminuted fractures of long bones, and the literature shows that these approaches are successful. The objective of this study was to conduct a literature review of the possible configurations of ESF used in large animals and their indications. In addition, we aimed to determine the factors that influence the success rate of these techniques, as well as the advantages and disadvantages, to determine whether the use of ESF in orthopedic patients is a reasonable option for the management of certain diseases.

USO DE FIJADORES ESQUELÉTICOS EXTERNOS EN LA TÉCNICA DE DOBLE OSTEOTOMÍA PÉLVICA EN PERROS

The aim of this study was to evaluate the use of external skeletal fixators as a means of stabilization, using the technique of double pelvic osteotomy in patients with hip dysplasia. Five crossbred dogs (3 males and 2 females), 3-4 months old, weighing 9.4 to 12.5 kg, and clinically healthy were used. The Norberg angle was radiological assessed before and after 6 weeks of the surgery when the external fixators were removed. Weekly X-rays for five weeks after the surgery were taken to monitor the development of the bone callus. The 80% (4/5) of dogs showed radiographic evidence of bone callus formation on week 2 and all dogs showed a well-developed bone callus associated with adequate contribution of mechanical stability on week 5. The Norberg angle increased 9.4 degrees on average (Range: 4 to 14 degress). The results showed that external skeletal fixation provides good stability when using the double pelvic osteotomy.

Distal tibial pilon fractures (AO/OTA type B, and C) treated with the external skeletal and minimal internal fixation method

Distal tibial pilon fractures include extra-articular fractures of the tibial metaphysis and the more severe intra-articular tibial pilon fractures. There is no universal method for treating distal tibial pilon fractures. These fractures are treated by means of open reduction, internal fixation (ORIF) and external skeletal fixation. The high rate of soft-tissue complications associated with primary ORIF of pilon fractures led to the use of external skeletal fixation, with limited internal fixation as an alternative technique for definitive management. The aim of this study was to estimate efficacy of distal tibial pilon fratures treatment using the external skeletal and minimal internal fixation method. We presented a series of 31 operated patients with tibial pilon fractures. The patients were operated on using the method of external skeletal fixation with a minimal internal fixation. According to the AO/OTA classification, 17 patients had type B fracture and 14 patients type C fractures. The rigid external skeletal fixation was transformed into a dynamic external skeletal fixation 6 weeks post-surgery. This retrospective study involved 31 patients with tibial pilon fractures, average age 41.81 (from 21 to 60) years. The average follow-up was 21.86 (from 12 to 48) months. The percentage of union was 90.32%, nonunion 3.22% and malunion 6.45%. The mean to fracture union was 14 (range 12-20) weeks. There were 4 (12.19%) infections around the pins of the external skeletal fixator and one (3.22%) deep infections. The ankle joint arthrosis as a late complication appeared in 4 (12.90%) patients. All arthroses appeared in patients who had type C fractures. The final functional results based on the AOFAS score were excellent in 51.61%, good in 32.25%, average in 12.90% and bad in 3.22% of the patients. External skeletal fixation and minimal internal fixation of distal tibial pilon fractures is a good method for treating all types of inta-articular pilon fractures. In fractures types B and C dynamic external skeletal fixation allows early mobility in the ankle joint.

Complex and open fractures

Cats often present with traumatic injuries of the limbs, including complex and open fractures, frequently as a result of road traffic accidents. On initial assessment, complex and open fractures may appear to require expertise beyond the experience of the general practitioner and, in some cases, referral to a specialist may be indicated or amputation should be considered. Many cases, however, can be managed using straightforward principles. This review describes a logical and practical approach to treating such injuries. It discusses general principles of fracture management, highlights the treatment of open fractures, and describes the use of external skeletal fixation for stabilisation of both open and complex fractures. Most fractures can be stabilised using equipment and expertise available in general practice if the basic principles of fracture fixation are understood and rigorously applied. Many textbooks and journal articles have been published on the management of fractures in companion animals, presenting case studies, case series and original biomechanical research. The simple strategy for managing complex injuries that is provided in this review is based on the published literature and the author's clinical experience.

Unilateral Uniplanar External Skeletal Fixation for Isolated Diaphyseal Tibial Fractures in Skeletally Immature Dogs

To report and evaluate use of external skeletal fixation (ESF) for repair of isolated (fibula intact) diaphyseal tibia fractures in skeletally immature dogs. Case series. Skeletally immature (mean age, 17 weeks; range, 12-23 weeks) dogs (n=5) with isolated diaphyseal tibial fractures. Medical records (2006-2007) of 5 dogs with isolated diaphyseal tibial fractures treated with Type 1a ESF were reviewed and outcome assessed by clinical examination and telephone interviews. Dogs were evaluated approximately 2 and 4 weeks after surgery. Limb function, muscle mass, and comfort level remained very good to excellent throughout healing. Bony union was confirmed radiographically and the ESF removed approximately 4 weeks after surgery (mean, 31.4 days; range, 28-37 days). Owner satisfaction was high when contacted a minimum of 4 weeks after ESF removal. Use of Type Ia ESF with positive profile threaded pins is a practical and biologic method for treatment of isolated tibial fractures in skeletally immature dogs ESF is an effective alternative treatment to external coaptation and internal fixation for isolated diaphyseal tibial fractures in skeletally immature dogs.

Biomechanical comparison of the pullout properties of external skeletal fixation pins in the tibiae of intact and ovariectomised ewes

The pin-bone interface is the least stable component of the external skeletal fixator. Concerns exist regarding the ability to obtain adequate implant purchase in poor quality bone. Consequently, reduced bone quality has been viewed as a contra-indication for the use of external skeletal fixators. The aim of this study was to investigate the holding power of two different fixator pin designs in bone from entire and ovariectomised sheep. Thirty-two aged ewes were divided into two groups. Group 1 were controls, and Group 2 were ovariectomised (OVX). The ewes were sacrificed 12 months post-ovariectomy and five pairs of tibiae were harvested from each group. The holding power of cortical and cancellous fixator pins was assessed at five standardised locations on each tibia. An increase in mean cortical thickness was noted in the OVX group. The holding power of cancellous fixator pins was superior to that of cortical pins, irrespective of whether or not ovariectomy had been performed. Cancellous pins had an increased holding power in post ovariectomy bone compared to control bone. Cortical pin performance was not affected by ovariectomy. There was a lack of correlation between the incidence of insertional fractures of the far cortex and implant holding power. The results raise questions over the effectiveness of ovariectomy in establishing osteopaenic bone suitable for assessing implant performance, hence further investigations are warranted.

The Use of External Skeletal Fixation to Facilitate the Surgical Release of Wrist Flexion and Thumb Web Space Contractures

To evaluate the use of external fixation as a splint to keep the hand in the desired position after simultaneous joint and soft-tissue release in a single stage for treatment of first web space and wrist contractures. Six first web space adduction and 7 wrist flexion contractures were released surgically. All patients had prior unsuccessful surgery. After surgical release of the contracture and capsulotomy, external fixator pins were inserted into the first and second metacarpals to maintain thumb abduction and into the radius and second metacarpal to maintain wrist extension, followed by skin grafting. External fixation was followed by splinting. Results were based on persistence of contracture release, rate of complications, and functional outcome. Before surgery, the thumbs were contracted at an average of 0 degrees of adduction with no range of motion, and wrists were contracted between 85 degrees to 100 degrees of flexion. The duration of contracture and number of prior surgeries did not influence the amount of release obtained during the surgery. After 7 months to 7 years of follow-up of first web space contractures, the thumb was in an average of 55 degrees of palmar abduction. Patients were able to oppose and fully adduct. At long-term follow-up examinations of the wrist contractures, patients had the wrist in the neutral position (0 degrees) in the resting state, with active extension ranging between 5 degrees and 15 degrees and flexion ranging between 35 degrees and 45 degrees . In 1 patient the wrist was at 45 degrees of flexion in the resting state with an arc of motion of 20 degrees . In 1 patient the wrist contracted back to the preoperative position, requiring another surgery. All patients experienced increased activity and improvement in grasping objects at 6-month follow-up evaluations. Complications included 3 pin site infections, 1 severe discomfort after 6 weeks, and 1 median nerve compression. All were treated successfully. External fixation can be used to maintain position in cases of first web space and wrist flexion contractures after surgical release, especially in patients for whom standard methods have failed. It is safe, efficacious, and well tolerated. Therapeutic IV.

Management of tibial fractures with Orthofix axial external skeletal fixator in 15 dogs

In the present study, the applicability of fixator, surgical time, time to weightbearing, the healing time and complications of tibial fractures in dogs after fixation with Orthofix axial external skeletal fixator were evaluated. The study was performed on 15 cases which were presented to the Clinics of Small Animal Surgery. After the determination of the fracture type, fracture location, appropriate screw diameter and the location of the first screw on the fragment according to preoperative radiographs, the dogs were placed under general anaesthesia and the fixator was applied with cranio-medial approach to the tibia. Clinical and radiological examinations were continued until the removal of the external skeletal fixators at three different times (at approx. days 45, 60 and 75) according to the clinical and radiological fracture healing. The treatment results were determined by the Modified Hannover Veterinary Medicine Faculty Small Animal Fracture Evaluation Scale. The results were excellent in eight cases (53.3%), good in four cases (26.7%), fair in one case (6.7%) and poor in two cases (13.3%). Based on this study, the use of external skeletal fixation with Orthofix axial external skeletal fixator can be recommended for dogs with tibial fractures as long as careful pin tract management is performed. Further investigation is needed to determine the use of Orthofix axial external skeletal fixator for the management of other long bone fractures.

Treatment of inherently unstable open or infected fractures by open wound management and external skeletal fixation

To assess the use of external skeletal fixation with open wound management for the treatment of inherently unstable open or infected fractures in dogs. A retrospective review of 10 cases. Fracture stabilisation and wound management required only a single anaesthetic, and despite the challenging nature of these injuries, the final outcome was acceptable or good in every case. However, minor complications associated with the fixator pins were quite common, and two dogs developed complications which required additional surgery. Open management of wounds, even when bone was exposed, proved to be an effective technique, and external skeletal fixators were usually effective at maintaining stability throughout an inevitably extended fracture healing period.

External skeletal fixation of the tibial shaft fractures

To present the possibility of a succesfful use of external skelatal fixation in treating the open and closed tibial shaft fractures with Mitković's external fixator. External fixation was used in 115 patients with 118 fresh tibial shaft fractures, 82 males (71.3%) and 33 females (28.7%), average age 43.92 years (16-84). Open tibial shaft fractures were present in 37 (31.36%). All the fractures were treated with Mitković's external fixator type M 20. The results of external fixation were excellent or good in 94.07% of the cases, and bad in 5.08%. Pin tract infection appeared in 7 (5.93%) patients. In only 3 cases an external fixator was removed and treatment continued with the functional braces. Nonunion occurred in 6 (5.08%) patients, of which 4 were with open fractures (2 Gustilo type IIIB, 1 Gustilo type IIIA, 1 Gustilo type II) and 2 with the segment fractures. Compartment syndrome was observed in 1 (0.85%) patient with closed fracture. Malunion was found in 2 (1.69%) patients. External fixation of tibial shaft fractures is a simple and effective method to enable the safe healing of fractures, early mobilization of the patients, early weight-bearing, as well as early rehabilitation. Fixation of tibial shaft fractures was unilateral with convergent pins orientation, and there was also a possibility of compression and distraction.

Recent advances in external skeletal fixation.

While the use of external skeletal fixation was once associated with substantial postoperative morbidity, clinical and experimental studies have led to technological advances and modifications in application techniques that have greatly improved the results obtained with this treatment modality. The past decade saw numerous advances in external skeletal fixator implants, components and instrumentation, including improvements in fixation pin design, and the development of new linear external skeletal fixation systems and economical circular external skeletal fixation systems specifically engineered for use in dogs and cats. In addition, a greater understanding of fixator biomechanics and the pathobiology of the bone-fixation pin interface have improved fixator application practices. This article reviews many of the more significant recent advances in external skeletal fixation.

Use of external skeletal fixators in the repair of femoral fractures in cats

This paper reports the results of fixation of 35 femoral fractures in cats using an external skeletal fixator alone or in combination with supplementary devices. All the fractures healed. The average time to fixator removal was eight weeks and two days. The external skeletal fixator offers a method of repairing many types of femoral fractures in cats allowing sound orthopaedic principles to be maintained and producing a successful outcome.

External Skeletal Fixation in Ruminants

External skeletal fixation (ESF) techniques are increasingly being adapted for treatment of fractures in large animals. This article includes detailed information regarding decision making for ESF, biomechanics of ESF, interaction of the bone and implants, general surgical techniques for application of ESF (including traditional ESF, use of acrylic sidebars for ESF, and transfixation, pinning, and casting), discussions of application of ESF to specific bones, and complications associated with the use of ESF. Also, techniques for the management of open, infected fractures are presented. Future directions of ESF research and application also are presented.

External Skeletal Fixation: Experience in a Small Rural Hospital in Northern Kenya

The author describes the use of external skeletal fixation in the management of complicated septic limb fractures. Eight fractures in seven patients were treated at Sololo General Hospital using a low cost, simple external device, with good results. The report emphasizes how external fixation can solve difficult fracture cases in small up-country hospitals; a good example of appropriate technology at district level.

(ii) The principles of use of external fixation

Much has been written about the use of external skeletal fixation for the treatment of nearly every type of fracture, and about the mechanical characteristics of different frames. There are still controversial areas concerning the indications for the use of this method, the frame to be selected, and surrounding common problems that present themselves during treatment. In this review, some of these controversies will be discussed.

Bi‐Phase External Skeletal Splint Fixation of Mandibular Fractures in Dogs

The technique for stabilizing the mandible using the bi‐phase external splint is described. Considerations for the use of external skeletal fixation on the mandible are reviewed. Two severe mandibular fracture cases and 1 case of unilateral mandibular body excision for the treatment of oral neoplasia are presented. Excellent results have been obtained by using the bi‐phase splint in dogs of moderate to large size.

The use of external skeletal fixation in the treatment of fractures of the humeral shaft

A method of external fixation is presented which has been applied in 8 patients with a fracture of the humeral shaft. The indications and technique are described.