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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↗
PubMed1989

Infection after intramedullary nailing of severe open tibial fractures initially treated with external fixation.

Twenty-four patients had a severe open fracture of the tibia that was initially treated by external fixation and subsequently by reamed intramedullary nailing. The external fixation had been maintained for an average of fifty-two days (range, seven to 230 days). The mean interval between removal of the external fixator and intramedullary nailing was sixty-five days (range, three to 360 days). In five of the seven patients who had had an infection at one or more of the pin sites, an infection later developed around the intramedullary nail. In comparison, only one of the seventeen patients who had not had a pin-site infection had an infection later around the nail (p = 0.003). An analysis of other variables, including the duration of external fixation, wound coverage, other injuries, and the type of fracture, showed that none was a predictor of infection either at the pin sites or around the intramedullary nail. We concluded that a pin-site infection that develops during external fixation is a contraindication to the subsequent use of reamed intramedullary nailing in patients who have a fracture of the tibia.

Adolescent↗
PubMed1989

External fixation of Colles' fracture.

Radiographic and functional results of external fixation of 32 Colles' fractures were compared with the results of plaster fixation of 189 Colles' fractures. Despite the fact that the fractures treated with the external device were more unstable and comminuted, the final results were equal in both groups, and the radiographic outcome of external fixation was superior. Pin loosening decreased with predrilling rather than self-tapping. We recommend external fixation for unstable fractures of the distal forearm.

Adolescent↗
PubMed1989

The use of the Manuflex disposable mini external fixator.

The Manuflex mini external fixator is an original device which is suitable for either provisional or definitive fixation of hand or foot fractures. The system is simple, disposable, relatively radiolucent, and inexpensive. It has been tested in an animal laboratory and has been used successfully in 27 human cases.

Animals↗
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↗
PubMed1992

External fixation for diaphyseal femoral fractures: a benefit to the young child?

External fixation for the treatment of diaphyseal femoral fractures in children seems an attractive alternative, which explains why its application gets more and more advocates. Between 1984 and 1989 15 children aged from 4 to 10 years were treated for a diaphyseal femoral fracture with an external fixation using a small Hofmann system. Fracture healing was without complications. Four children were able to walk on crutches non-weight-bearing after a short period. Six cases had complications, such as pin tract infection, inexplicable pain, or secondary displacement. One patient sustained a supracondylar fracture through one of the distal pin tracts. Hospital stay was longer than expected. In conclusion external fixation for femoral fractures in children is simple and elegant, but has considerable complications, while presumed advantages are not always obtained. In selected cases it is an attractive alternative, but the indications must be restricted.

Child↗
PubMed1990

Cast or external fixation for fracture of the distal radius. A prospective study of 126 cases.

In a prospective 4-year study, 126 consecutive patients with a fracture of the distal radius were followed. Functional, anatomic, and radiographic final results of fixation with above-the-elbow cast immobilization were compared with the results obtained with external fixation. The results following external fixation of comminuted intraarticular fractures were better than those of similar fractures treated in a cast. Aged osteoporotic patients tolerated better residual deformities, and the clinical results had a relatively low correlation with the final anatomic alignment. We suggest that extraarticular fractures of the distal radius should be treated with cast immobilization. Comminuted intraarticular fractures of the distal radius should be treated with external fixation, which maintains accurate anatomic position until solid fracture healing is achieved.

Adult↗
PubMed1991

Open tibial fractures. Treatment by uniplanar external fixation and early bone grafting.

Seventy-nine open tibial fractures were treated with unilateral uniplanar tubular external fixators. Excellent stability allowed early weight-bearing. All comminuted fractures, with or without bone loss, and some transverse or short oblique fractures with intermediate fragments were treated by early bone grafting through a posterolateral approach. The external fixator was dynamised as soon as periosteal callus was seen on the radiograph. Bone healing times ranged from 11 to 40 weeks (mean 20). Significant ankle stiffness occurred in 10.9% and leg shortening in 2.8%. Pin track infection was seen in 45.2% but was easily controlled with standard management. The external fixation frame allowed excellent functional freedom for Oriental patients to sit cross-legged and squat. Combined with early bone grafting, external fixation is an excellent method for the management of open tibial fractures.

Adolescent↗
PubMed1992

Biomechanical consequences of callus development in Hoffmann, Wagner, Orthofix and Ilizarov external fixators.

A theoretical analysis by a finite elements model (FEM) of some external fixators (Hoffmann, Wagner, Orthofix and Ilizarov) was carried out. This study considered a logarithmic progress of callus elastic characteristics. A standard configuration of each fixator was defined where design and application characteristics were modified. A comparison among standard configurations and influence of every variation was made with regard to displacement and load transmission at the fracture site. An experimental evaluation of standard configurations was performed with a testing machine. After experimental validation of the theoretical model was achieved, an application of physiological loads which act on a fractured limb during normal gait was analysed. A minimal contribution from an external fixator to the total rigidity of the bone-callus-fixator system was assessed when a callus showing minimum elastic characteristics had just been established. Insufficient rigidity from the fixation devices to assure an adequate immobilization during the early stages of fracture healing was verified. However, regardless of the external fixator, callus development was the overriding element for the rigidity of the fixator-bone system.

Biomechanical Phenomena↗
PubMed1990

[Stabilization of open tibial fracture by an external fixator. Advantages through supplemental screw osteosynthesis].

One hundred thirty-two open tibial shaft fractures were treated by unilateral external fixation. In order to evaluate the usefulness of supplemental lag screw fixation, we compared forty-four reexamined fractures in which only external fixation was utilized with fifty-five reexamined fractures, stabilized with supplemental lag screws and external fixation. We did not find significant differences in time to full-weight bearing (17.1 vs. 15.6 weeks), time to union (18.7 vs 18.0 weeks), incidence of delayed union [as defined by time to union over 32 weeks (10.9% vs. 11.4%)], incidence of osteomyelitis (5.4% vs. 4.5%), or incidence of malunion [axial malalignment greater than 5 degrees (12.7% vs. 11.4%)]. Clinically significant differences were found demonstrating a twofold increase in refracture rate in the group with supplemental lag screws (10.9% vs. 4.5%) and requiring twice as many bone grafting procedures to achieve union (65.5% vs. 29.5) than did the group treated by external fixation alone. Therefore we do not recommend the routine use of supplemental lag screw fixation.

Adolescent↗
PubMed1991

[External fixator as primary and definitive treatment of tibial fracture with severe soft tissue damage].

The initial treatment of choice of fractures with severe soft tissue damage of the leg is the stabilization with an external fixator. After successful healing the question arises whether to continue the initial treatment with the external fixator to bone union or to change the initial concept by an internal fixation. Our experience with 62 fractures of the tibia (follow-up of 59 fractures) from 1985 to 1989 shows that 72% of the fractures were healed by the external fixator alone. Delayed union or pseudoarthrosis occurred in 17% and were mostly treated by late internal fixation. An analysis of the fracture types (new AO classification) did not show certain fracture types, that did not respond to the external fixator treatment alone. We conclude that the reason for a delayed union or pseudoarthrosis is less a morphological than a biological one. We recommend the first and final external fixator as treatment for fractures with severe soft tissue damage of the leg.

External Fixators↗
PubMed1979

External fixation devices in fractures of the leg.

External fixation devices, of which there are many types, represent a new and extremely effective method of fixation in fractures of the leg. These are extremely common, frequently severe and often complicated by a variety of other lesions. The usefulness of this method lies in the fact that they can be applied immediately with minimal additional trauma, and the fracture can be immobilised whilst leaving the damaged area uncovered and thus available to carry out repairs and reconstruction of the soft tissues. Mobilisation of the patient is not impeded, and they can be replaced by other more traditional methods as and when these may become more appropriate. The author presents his own views based on some ten years experience with external fixation devices in traumatology, with special reference to fractures of the tibia.

Bone Nails↗
PubMed1990

Tibia nonunions treated by interlocked nailing: increased risk of infection after previous external fixation.

Eighteen patients, mean age 36 years (range of 22-76 years), with tibia-shaft nonunions were treated with interlocked nailing. There were 12 nonunions originally treated with either cast, lag screws, plate, or Ender nails (nine closed, two open grade I and one grade II injury). The remaining six nonunions, all open fractures (five grade II and one grade III injury) initially received external fixation. After removal of the fixator, 72 days postinjury (range of 58-111 days), there was a delay of 218 days (range of 112-449 days) before the nailing procedure in those patients primarily treated with external fixation. All 12 nonunions not primarily treated with external fixation healed without complications after nailing within 17 weeks (range of 12-24 weeks). All six nonunions primarily treated with external fixation had temporary pin-tract infections, which healed after pin extraction. Two of the nonunions healed without any complication, whereas four developed intramedullary infection with the same bacteria as from the pin-tract site. Although the number of patients is small in this report, there is an apparently high incidence of intramedullary infection in the group originally treated with external fixation. The sequential procedure of external fixation followed by intramedullary nailing is, therefore, not recommended in the treatment of open tibia fractures.

Adult↗