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Results for “External Fixators”

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PubMed1992

Treatment of hand injuries by external fixation.

Thirty-five consecutive applications of external fixation to the hand, including 27 acute cases and 8 reconstructive procedures, were studied. In both settings, external fixation was used not only for skeletal stabilization but also for management of the soft tissues. Twenty of the 22 acute fractures healed, and six arthrodeses with interposition bone grafts resulted in fusion. Three septic nonunions resolved, and two united successfully. There were no complications. We recommend external fixation systems in the hand, and several case reports are included in the study to illustrate the various applications.

Adolescent↗

PubMed1990

Design and testing of external fixator bone screws.

In external fixation, bone screw loosening still presents a major clinical problem. For this study, the design factors influencing the mechanics of the bone-screw interface were analysed and various experimental screws designed with the intention of maximizing the strength and stiffness of the inserted screw. Push-in, pull-out and bending tests were then carried out on the three experimental screws, and on two commercially available screws in both a synthetic material and in cadaveric bone; photoelastic tests on different screw threadforms were also performed. The results of the push-in and pull-out tests indicate that both the screw threadform and cutting head have a significant effect on the holding strength of the screw. The photoelastic tests show that most of the applied load is distributed over the first few threads closest to the load, and that the area between the thread crests is subjected to high shear stresses.

Biomechanical Phenomena↗

PubMed1992

[Stabilizing the pelvic ring with the external fixator. Biomechanical studies and clinical experiences].

Experimental studies were performed on anatomic pelvis specimens. In different series of experiments the positioning of the screws and the assembly of the external fixator were changed. We tried fixing the external fixator to the screws at varying distances from the body surface. For stabilisation of the fractured pelvic girdle a self-constructed "bow fixator", fixed to supra-acetabular screws with proximal compression and distal traction showed the best results. Homogeneous distribution of the pressure could be achieved on the unstable dorsal pelvic ring structures. In clinical routine we used the triangular external fixator, which in the experimental situation yielded results close to those of the bow fixator. External fixation of the pelvic girdle has been performed 128 times since 1977, in January 1991 a prospective study was started. For Tile type B injuries the external fixator itself represents an effective, minimally invasive system, but type C fractures often require an additional internal fixation of the dorsal lesion.

Acetabulum↗

PubMed1992

A report of the first 20 cases using a simple external fixator.

The results of treatment using a locally-designed external fixator in 20 patients are presented. Open fractures were the main indications for external fixation. Pin tract infection occurred in 8 patients. Only 2 patients had unstable fixation which required removal of the device. One third of patients developed malunion exceeding 15 degrees and two thirds had joint stiffness after conversion to plaster cast. This external fixator is adequate in the treatment of most open fractures of the tibia. However, improved techniques of pin insertion and cast application upon removal of the external fixator may help to reduce the incidence of pin tract infections and malunion.

Adolescent↗

PubMed1989

The effect of rigidity on fracture healing in external fixation.

Knowledge of the basic biomechanics of external fixation is necessary to obtain the full benefits of the technique for bone fracture treatment. The rigidity of external fixation, including pin-bone interface stresses, is discussed and bone healing and remodeling under different fixation stiffnesses and fracture gap conditions are described. The rigidity of fixation ultimately depends on the biomechanical characteristics of the fracture, the accuracy of reduction, and the amount of physiologic loading. Comparative experiments using a canine tibial fracture model have suggested that fixation rigidity is important in early bone healing and in the prevention of pin loosening. Bone union can be achieved under external fixation through different pathways, ranging from callus-free gap healing under a rigid neutralization configuration to direct-contact healing with periosteal new bone formation under axially dynamized stable fixation. Cortical reconstruction by secondary osteons seems to be important for the ultimate strength of the bone union.

Animals↗

PubMed1991

External fixation of distal radial fractures: results and complications.

External fixation of unstable fractures of the distal radius yields satisfactory results but has a high complication rate. We studied thirty-five fractures in thirty-four patients to determine whether the results obtained with external fixation warranted it use. At a mean follow-up period of 31 months, the results of treatment were assessed by interviews and clinical and radiographic examination of both wrists. Twelve fractures had an excellent result, twelve had a good result, ten had a fair result, and one had a poor result. Radiographic results were graded excellent in ten fractures, good in thirteen, fair in five, and poor in seven. No correlation was found between the anatomical results and the clinical results or the patients' subjective ratings. Complications that were related directly to the fixation pins occurred in fourteen of the fractures. There were forty-five additional complications. The frequency of complications and the limitations of external fixation demand caution on the part of the surgeon to prevent iatrogenic morbidity, which would limit the benefits of the technique.

Adult↗

PubMed1989

[Use of external fixators in infected fractures].

The purpose of this study was to present our own experience with external fixation in the treatment of infected fractures. External fixation was first used in the Trauma Center of Sarajevo in 1972 for the treatment of infected concquassant fracture of the lower leg. Since then it has been used in 111 patients. In most of the cases we have used AO fixation, the Hoffmann external fixation, and, more recently, the Ilizarov device. External fixation was applied in 49 cases with the infected fractures out of the total number of 111. Forty six of the patients were males and the fractures involved 31 lower legs, 13 upper legs, 3 forearms, and 2 upper arms. The work presents our own experience concerning etiology, a type of injuries, method of choice, length of the treatment, complications and results.

Adult↗

PubMed1978

External fixation. Classification and indications.

The conclusion from the above clinical and experimental presentation is that stabilization by using external fixation in problematic cases is the method of choice because the risk of infection is better than by using the standard methods of plating and nailing. Using external fixation based on the tubular system of ASIF we can achieve rigid stability. Correct application allows early mobilization ensuring alignment even in bone defects. This method of treatment also facilitates the care of wounds. Our experimental and clinical information provides us with the opportunity to offer a systematic classification of each individual type of external fixation and its merits, as described above in types I, II, and III and its application in different situations. Our clinical experience also shows that external fixation has greatly reduced the risk of amputation in these problematic cases, but it has not solved all the problems associated with the primary injury. The advantage of the three-dimensional external fixation type III can also be seen in the case of arthrodesis of the knee joint. Here there is a better neutralization of the bending moment, than by using type II. Finally we would like to emphasize that the external fixation is not the panacea for every problematic case and each surgeon should be well aware of its methodical and correct application, as abuse of external fixation may lead to secondary complications.

Biomechanical Phenomena↗

PubMed1992

Remanipulation or external fixation after slipped Colles' fractures? An anatomical study.

A series of 50 consecutive patients with Colles' fractures which redisplaced after reduction underwent either remanipulation and a plaster cast or remanipulation and external fixation. The external fixator group achieved a significantly better anatomical result than simple remanipulation and replastering. Where plaster immobilization has failed, external fixation gives a better anatomical result than remanipulation and replastering.

Adult↗

PubMed1992

[External fixation of the tibial with primary full weightbearing].

The external fixation of open fractures of the tibia has many advantages. Nevertheless by many surgeons it is used only as a temporary emergency fixation. There are two main problems to be solved: delayed fracture healing and pin-track infections. It is widely known that physiological weight-bearing leads to a better fracture healing. Weight-bearing needs stability. For transverse and even short oblique fractures of the tibia correct reduction and a good external fixation gives enough stability to stand on the leg completely. 27 patients with such fractures have been externally fixated during the last 5 years. With immediate weight-bearing the healing time was only 12 weeks on an average.

External Fixators↗

PubMed1991

Treatment of open femoral and tibial shaft fractures preliminary report on external fixation and secondary intramedullary nailing.

From January 1987 to May 1989, a total of 38 adult cases were treated with 15 femoral and 25 tibial shaft shifting procedures from external fixation to reamed intramedullary nailing and followed up for at least 1 year (average, 23 months) at the authors' institution. The indications for the shifting procedures included routine sequential femoral external fixation and failed tibial external fixation treatment such as loss of reduction, atrophic healing process and inability of patients to tolerate casting. The delay period for the shifting procedure was 5 days in the femur and 48 days in the tibia. The union rate for the femur was 93% (14/15), and the tibia, 96% (24/25). The union period after the shifting procedure was 4.8 +/- 1.7 months in the femur, and 5.2 +/- 1.8 months in the tibia. Range of motion of the knee and ankle were satisfactory. Deep infection was the most serious complication, and the tibia was involved more often than the femur (20% to 13%) (p greater than 0.05). The most favorable management of deep infection was local drainage till bony union. We conclude that a shifting operation can be considered as one of the alternative procedures for several femoral or tibial shaft open fractures after fixation with external fixation. Wound and pin tract care, a shorter period of external fixation, a longer delay period before nailing, and perioperative antibiotic use may significantly lessen the infection rate.

Adolescent↗

PubMed1990

[External fixation of unstable wrist fractures].

The results of external fixation of 66 unstable distal radial fractures were evaluated. In the majority, the radiological results were excellent or good. There was a clear correlation between an excellent or good clinical score and the subsequent radiological result. Upper limb dystrophy which caused a considerable morbidity was found in every third patient. Unstable distal radial fractures with severe initial displacement predispose to reflex dystrophy. External fixation obviously cannot prevent this severe complication, it is even possible that tension on soft tissues, capsules and ligaments caused by ligamentotaxis might induce reflex dystrophy. Therefore, the indication for using external fixation of unstable distal radial fractures has to be defined with due caution.

Adult↗

PubMed1989

[Change in external fixator and when in multiple trauma patients].

External fixation of fractures in polytraumatized patients normally should be regarded as temporary. After the patient's general condition is stabilized, in most cases it is necessary to change the procedure in order to provide sufficient mobility of joints, timely bony healing and early mobilisation. The earlier the transition toward internal osteosynthesis, the lower the complication rate. The follow up of 37 polytraumatized patients who were subjected to 50 changes of method after primary external fixation is described.

Adult↗

PubMed1990

External fixation of the femur.

External fixation of the femur remains a viable option in the acute treatment of fractures or in reconstructive procedures. As in any method of fixation, the surgeon must be familiar with the device used, the mechanical properties of the device, the application technique of such devices, and, most importantly, the postoperative management of the patient.

Bone Nails↗

PubMed1990

A cheap external fixator device.

A cheap external fixator made from readily available materials is described. This device should prove useful in the management of difficult compound fractures of the leg. Multiple staged procedures such as serial debridement, and bone and skin grafts can be carried out while maintaining the fracture fragments in position by means of this fixator.

Adult↗

PubMed1989

[External fixation in open fractures].

Author analyses 644 cases of compound fractures managed at the University Department of traumatology, Ljubljana from 1981. do 1987. He examines the incidence of compound fractures and fractures of other types. He analyses the fractures according to the Matter-Rittmann-Algöver classification. Various fixation techniques are described, especially reduction by external fixators used in nearly all grade III compound fractures. The most frequently applied tube-shaped fixator (Synthes) is presented. In 51% of cases external fixation was changed in first three months of treatment. The average length of external fixator application was 4 months, the full weight bearing in average after 7 months. Postoperative bone infection occurred in 4% of cases.

Fracture Fixation↗

PubMed1991

The surgical treatment of severe comminuted intraarticular fractures of the distal radius with the small AO external fixation device. A prospective three-and-one-half-year follow-up study.

Although fractures of the distal radius are very common, an optimal treatment has not been clearly delineated. This is a prospective study of 40 patients, mainly young and active adults, with comminuted and unstable intraarticular fractures of the distal radius. The end results of closed reduction and rigid fixation with the small AO external fixator includes 36 patients (90%) with excellent and good results. Roentgenograms of 33 of these patients showed accurate alignment of the healed fractures. Four patients (10%) had a fair functional result, with a partial restriction of the range of movement, although roentgenograms demonstrated good alignment of the healed fractures. The small AO external fixator is both a useful and convenient method for the reconstruction and treatment of comminuted intraarticular fractures of the distal radius.

Adult↗

PubMed1991

Risk of deep infection with intramedullary nailing following the use of external fixators.

A retrospective review was carried out to assess the incidence of deep infection occurring when intramedullary nailing was performed following the use of an external fixator. Three groups of patients were identified: group 1 in which the external fixator was used in initial fracture management (ten cases, nine patients), group 2 in which the external fixator was used in the management of established non-union (seven cases, seven patients), and group 3 in which the external fixator was used in limb lengthening procedures (eight cases, eight patients). All the 25 cases reviewed had clinical evidence of pin track infection before removal of the external fixator. After removal of the fixator it is our normal policy to wait for the pin sites to become dry before performing intramedullary nailing. In only one case, where there was a history of preceding recrudescent osteomyelitis, was there evidence of deep infection being reactivated following intramedullary nailing. We therefore conclude that pin track infection does not seem to be a contraindication to the subsequent use of an intramedullary nail, providing that underlying active osteomyelitis is not present. A delay of 7 to 14 days after removal of the fixator is recommended. Some problems experienced during nailing are highlighted, and solutions proposed.

Adolescent↗