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PubMed · 7867978

[External fixation in reconstructive hand surgery].

I Matev
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Abstract

Over the last two decades, a new type of treatment has been established in reconstructive surgery of the hand. By means of an external fixator used as a distraction device, thumb and fingers are reconstructed. Used as a compression device, the external fixator accelerates the treatment of pseudarthroses, posttraumatic deformities, chronic osteomyelitis and healing following arthrodesis in the hand. There is no universal external device for the hand. Each part of the hand needs a specific fixator. Two basic questions require further studies: Improvement of the external fixators. Acceleration of the callus formation in the distraction method.

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External FixatorsFracture HealingHand Deformities, AcquiredHand InjuriesHumansMotor SkillsOsteomyelitisPostoperative ComplicationsPseudarthrosisRadiographyRange of Motion, ArticularThumbJournal Article

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I Matev. 1994. [External fixation in reconstructive hand surgery].. https://pubmed.ncbi.nlm.nih.gov/7867978/

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Even though external fixation is considered to be a rather "new" trend in orthopedics and traumatology, in fact it has been something used by physicians and surgeons for thousands of years. In the mid 1800's, external fixation would see some substantial growth and evolution, pioneered by physicians and surgeons whose principles are still in use today. Through the 1900's, the indications and usage would continue to expand, not to mention the modernization of the external fixation apparatus. Many surgeons in this era are notable for their work with external fixation, especially Gavriel Ilizarov, considered to be the father of external fixation. Further research and development with external fixation needs to be performed and, with time, will more than likely become fully integrated into modern clinical practice.

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New composite hybrid fixators for fracture stabilization using single or multiple rings with monolateral bars and half-pin fixation may provide clinical advantages such as reduced bulk and easier skin access. However, the mechanical properties of these fixators are difficult to estimate from numerous design parameters. Addressing this problem the following research questions were asked: (1) Do composite hybrid fixators have similar stiffness properties to clinically proven triple-ring fixators; (2) How does the fixation mechanism affect the stiffness properties of external fixators, and, (3) Are there interferences between ring number and fixation method? An experimental study was done on simulated metaphyseal tibial fractures and stiffness of 12 fixators was measured for different loading conditions. The results showed that triple-ring fixators provide approximately 20% stiffer properties than double-ring and single-ring fixators. No influence of ring number on the AP bending properties was found and different fixation methods were associated with large differences in fixator stiffness, whereas significant interferences were found between ring number and fixation method. Although the mechanical properties investigated in the current study cannot predict directly the clinical performance of these fixators, the stiffness data provide useful information for making decisions regarding the treatment of fractures using external fixation.

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