scholarly journals Management of post-traumatic femoral defects with a monorail external fixator over an intramedullary nail

2021 ◽  
Author(s):  
Victor Lu ◽  
James Zhang ◽  
Andrew Zhou ◽  
Matija Krkovic
Keyword(s):  
External Fixation ◽  
External Fixator ◽  
Intramedullary Nail ◽  
Weight Bearing ◽  
Bone Union ◽  
Unique Challenge ◽  
Patient Reported ◽  
Post Traumatic ◽  
Partial Weight ◽  
Consolidation Time

Abstract Purpose The management of limb-length discrepancy secondary to traumatic femoral bone loss poses a unique challenge for surgeons. The Ilizarov technique is popular, but is associated with long external fixator time and many complications. This retrospective study assessed outcomes of post-traumatic femoral defects managed by monorail external fixation over an intramedullary nail. Methods Eight patients were included from October 2015 to May 2019 with post-traumatic femoral defects that underwent treatment with monorail fixator-assisted intramedullary nailing. Primary outcome was time to bone union and bone results according to ASAMI classification. Secondary outcomes were lengthening index, consolidation time and index, external fixator index (EFI), time to partial weight bearing(PWB) and full weight bearing (FWB), and complications. Patient reported outcome measures including EQ-5D-5L, SF-36, Oxford knee scores (OKS), and Oxford hip scores (OHS) were recorded after recovery. Results Mean follow-up time was 227 weeks. Average bone defect size was 9.69 cm. Average consolidation time and index were 11.35 months and 1.24 months/cm, respectively. Mean lengthening and external fixator index were 20.2 days/cm and 23.88 days/cm, respectively. On average, patients achieved FWB and bone union 56.25 weeks and 68.83 weeks after bone transport initiation, respectively. Two patients had docking site non-union, five patients had pin site infections, and two patients had osteomyelitis. EQ-5D-5L and EQ-VAS scores were compared to UK population norms (p = 0.104, p = 0.238, respectively). Average OKS was 32.17 and OHS was 34.00. Conclusion Monorail external fixation over an intramedullary nail is an effective option for post-traumatic femoral defects, reducing external fixator time and returning patients’ quality of life to a level comparable with the normal population.

scholarly journals External skeletal fixation of the tibial shaft fractures

2005 ◽  
Vol 62 (1) ◽  
pp. 11-15 ◽  
Author(s):  
Sasa Milenkovic ◽  
Milorad Mitkovic ◽  
Mile Radenkovic
Keyword(s):  
External Fixation ◽  
External Fixator ◽  
Weight Bearing ◽  
Early Mobilization ◽  
Tibial Shaft ◽  
Closed Fracture ◽  
Early Weight Bearing ◽  
Shaft Fractures ◽  
Pin Tract Infection ◽  
Tibial Shaft Fractures

Aim. To present the possibility of a successful use of external skeletal fixation in treating the open and closed tibial shaft fractures with Mitkovic?s external fixator. Methods. 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 Mitkovic?s external fixator type M 20. Results. 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. Conclusion. 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.

scholarly journals Lower Leg Fractures in Children and Adolescents—Comparison of Conservative vs. ECMES Treatment

2021 ◽  
Vol 9 ◽  
Author(s):  
Birte Weber ◽  
Miriam Kalbitz ◽  
Meike Baur ◽  
Christian Karl Braun ◽  
Jörn Zwingmann ◽  
...  
Keyword(s):  
External Fixator ◽  
Conservative Therapy ◽  
Bone Fractures ◽  
Plate Osteosynthesis ◽  
Weight Bearing ◽  
Lower Leg ◽  
Full Weight Bearing ◽  
Oblique Fracture ◽  
Fractures In Children ◽  
Consolidation Time

Background: Lower leg fractures are one of the most common fractures in pediatric age. In general, treatment of lower leg fractures is predominantly non-operative, requiring clinical and radiological controls. Nevertheless, it can be observed that in recent years tibial shaft fractures have increasingly been treated surgically. The aim of the present study is to investigate treatment strategies in the context of different fracture types of the lower leg.Methods: In this retrospective chart review, we analyzed 168 children with a diaphyseal fracture of the lower leg admitted to a trauma center between 2005 and 2017. The fractures were classified according to the AO Pediatric Comprehensive Classification of Long Bone Fractures (AO-PCCF).Results: The frequency of fractures based on the AO-PCCF classification was as follows: Simple oblique fracture of the tibia (43.5%, n = 73), hereof 32 toddler's fractures, multifragmentary oblique fracture of the tibia in 14.3% (n = 24) and simple oblique fracture of both, tibia and fibula in 18 patients (10.7%). Most pediatric fractures were treated conservatively by cast (n = 125). Thirty-seven patients received an ECMES, whereas 3 patients were treated with an external fixator and also 3 fractures were stabilized by plate osteosynthesis. Conservatively treated patients were significantly younger (mean age 6.0) compared to patients treated with ECMES (mean age 10.2) or plate osteosynthesis (PO)/external fixator (EF) (mean age 11.3), even if toddler's fractures (mean age 2.0) are excluded (mean age 7.4). There was no difference in time to full weight-bearing, hospitalization of patients treated with ECMES compared to conservative therapy although ECMES-treated fractures show more instability. The consolidation time was significantly higher in ECMES treated patients compared to conservative therapy.Conclusion: Pediatric patients (≤4 years) with lower leg fractures most often showed simple oblique fractures of the tibia, half of them toddler's fractures, which were treated predominantly by conservative therapy. All in all, the consolidation time was longer in intramedullary nailing (ECMES) than in conservative therapy. Nevertheless, time to full weight bearing and duration of cast was the same in both groups, even though ECMES treated fractures show more instability.

scholarly journals Learning Curve and Clinical Outcomes of Performing Surgery with the InterTan Intramedullary Nail in Treating Femoral Intertrochanteric Fractures

2017 ◽  
Vol 2017 ◽  
pp. 1-6
Author(s):  
A-Bing Li ◽  
Wei-Jiang Zhang ◽  
Ji-Qi Wang ◽  
You-Ming Zhao ◽  
Wei-Jun Guo
Keyword(s):  
Learning Curve ◽  
Intramedullary Nail ◽  
Operative Time ◽  
Weight Bearing ◽  
Operation Time ◽  
Harris Hip Score ◽  
Intertrochanteric Fractures ◽  
Partial Weight Bearing ◽  
Negative Exponential ◽  
Partial Weight

Purpose. The purpose of this study is to evaluate the learning curve of performing surgery with the InterTan intramedullary nail in treating femoral intertrochanteric fractures, to provide valuable information and experience for surgeons who decide to learn a new procedure. Methods. We retrospectively analyzed data from 53 patients who underwent surgery using an InterTan intramedullary nail at our hospital between July 2012 and September 2015. The negative exponential curve-fit regression analysis was used to evaluate the learning curve. According to 90% learning milestone, patients were divided into two group, and the outcomes were compared. Results. The mean operative time was 69.28 (95% CI 64.57 to 74.00) minutes; with the accumulation of surgical experience, the operation time was gradually decreased. 90% of the potential improvement was expected after 18 cases. In terms of operative time, intraoperative blood loss, hospital stay, and Harris hip score significant differences were found between two groups (p=0.009, p=0.000, p=0.030, and p=0.002, resp.). Partial weight bearing time, fracture union time, tip apex distance, and the number of blood transfusions and complications were similar between two groups (p>0.5). Conclusion. This study demonstrated that the learning curve of performing surgery with the InterTan intramedullary nail is acceptable and 90% of the expert’s proficiency level is achieved at around 18 cases.

scholarly journals Treatment of 5th Metatarsal Shaft Fracture using MIPO (Minimally Invasive Plate Osteosynthesis) Technique

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Yoo Jung Park ◽  
Yeokgu Hwang ◽  
Dong-Woo Shim ◽  
Jin Woo Lee ◽  
Seung Hwan Han
Keyword(s):  
Weight Bearing ◽  
Shaft Fracture ◽  
Bone Union ◽  
Minimally Invasive Plate Osteosynthesis ◽  
Aofas Score ◽  
Early Weight Bearing ◽  
Anatomic Reduction ◽  
Significant Difference ◽  
Partial Weight

Category: Lesser Toes, Trauma Introduction/Purpose: The standard treatment of 5th metatarsal shaft fracture is still not determined yet. Conservative treatment using cast immobilization can be applied for shaft fractures without displacement, but there are reports that open reduction is indicated for displacement more than 3 mm, rotational displacement, and angular displacement more than 30 degrees. In this study, we report the result of 5th metatarsal shaft fracture using MIPO technique, which can shorten recovery period by reducing soft tissue damage with minimal incision. Methods: This study consists of 25 patients who had undergone surgery for displaced 5th metatarsal shaft fracture from March 2013 to December 2015; 8 males and 17 females. Mean age at the time of surgery was 47.4(29~69) and mean follow period was 15.0(8~25) months. 11 cases were simple oblique fracture and 14 cases were comminuted fracture with fracture fragments. Mean fracture gap was 4.4(3.1~7.6)mm. MIPO technique with LCP Compact Hand Locking Condylar Plate 2.0(Depuy-Synthes, Zuchwil, Switzerland) was used for all cases. Partial weight bearing was allowed until 4th week post-op, then full weight bearing was allowed until 6th week post-op. Clinical and radiological follow-up was made at post-op week 2, 6, 12, 24. Clinical results were obtained using Visual Analogue Scale(VAS) and American Orthopedic Foot and Ankle Society(AOFAS) score. Results: VAS of 24 weeks post-op was decreased from 5.6 ± 0.8 (4~7) preoperatively to 1.2 ± 1.3 (0~4), and AOFAS score of 24 weeks post-op was increased from 42.0 ± 12.8 (24~54) preoperatively to 86.4 ± 7.7 (74~95), both showed significant difference. Anatomic reduction and complete bone union was noted in all cases. Mean union period obtained from follow-up radiograph was 6.0 week post-op. For 15 cases, plate removal was performed at 9.5(7~25) months post-op. Conclusion: Plate fixation can be the preferred option for 5th metatarsal shaft fracture, because 5th metatarsal shaft is surgically easily accessible and more stable fixation can be applied. Since it results complete bone union without any complications and enables early weight bearing, MIPO techinque for displaced 5th metatarsal shaft fracture can be considered as useful surgery technique.

scholarly journals EXTERNAL FIXATOR;

2013 ◽  
Vol 20 (04) ◽  
pp. 600-605
Author(s):  
ROOHULLAH JAN ◽  
ZAHID ASKAR ◽  
JAVED IQBAL
Keyword(s):  
Body Weight ◽  
External Fixation ◽  
External Fixator ◽  
Weight Bearing ◽  
Functional Results ◽  
Type Ii ◽  
Tibial Shaft ◽  
Shaft Fractures ◽  
Tibial Shaft Fractures ◽  
Full Body

Introduction: Open Tibial shaft fractures are one of the most common fractures of long bones. External fixation is methodof choice for the treatment of open tibial shaft fractures. The subcutaneous location of tibia makes it suitable for the application of externalfixator. Patients and Methods: This study was done on 50 patients at Orthopaedics and Trauma unit “B” at Khyber Teaching Hospital,Peshawar, from Jan 2008 to Feb. 2009 to determine functional outcome of A.O. external fixator in open tibial fractures in terms of knee andankle mobility, pain and gait on full body weight bearing. The data of all patients was entered in standardized proforma and analyzed onSPSS 10. Results: There were 43 (86%) males and 7 (14%) females. There were 17 (34%) type-II and 20 (40%) type IIIA and 13 (26%)type III B fractures. Knee mobility was full (100%) in 49 (98%) cases, 75% in 1(2%). 43 (86%) cases retained 100% ankle joint mobilitywhile it was 75% in 4 (8%), 50 % in 2 (4%) cases and 25 % in 1(2%) cases. On full body weight bearing, 42(84%) patients were pain free,and moderate pain was in 4(8%) cases. In 42(84%) cases the gait was completely normal on full body weight bearing while 3(6%) casesshowed significant limping. Conclusion: The excellent functional results in our series show that external fixation of tibia is safe andeffective in terms of restoring functions of tibia.

scholarly journals Conservative treatment of refractures after modified tension band wiring of fifth metatarsal base stress fractures in athletes

2020 ◽  
Vol 28 (2) ◽  
pp. 230949902092628
Author(s):  
Kyung Tai Lee ◽  
Ki Chun Kim ◽  
Ki Won Young ◽  
Hyuk Jegal ◽  
Young Uk Park ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Weight Bearing ◽  
Stress Fractures ◽  
Activity Level ◽  
Tension Band ◽  
Tension Band Wiring ◽  
Bone Union ◽  
Lateral Side ◽  
Sports Activity ◽  
Partial Weight

Objective: Recurrent fifth metatarsal base stress fractures (MT5-BSF) in athletes present a challenging problem. The aim of this study was to evaluate the result of conservative treatment for the refracture of MT5-BSF after modified tension band wiring (MTBW). Materials and Methods: The outcomes of 15 elite athletes undergoing conservative treatment for refracture of MT5-BSF after MTBW were retrospectively reviewed. They were instructed to avoid weight-bearing with short leg cast for 6 weeks. After that, they started partial weight with a postop shoe. Stepwise exercise followed bone union by radiographs. Results: Thirteen cases (86.6%) had a complete bone union after a mean of 18.9 ± 8.6 weeks. Twelve cases (80%) returned to their previous activity level and maintained for at least two consecutive seasons. Conclusion: Eighty percent of all athletic patients with the conservative treatment for refractures with healed MT5-BSF after MTBW on the plantar-lateral side could maintain and return to their previous sports activity for at least 2 years.

scholarly journals Lower limb lengthening over an intramedullary nail: a long-term follow-up study of 28 cases

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Pasquale Farsetti ◽  
Fernando De Maio ◽  
Vito Potenza ◽  
Kristian Efremov ◽  
Martina Marsiolo ◽  
...  
Keyword(s):  
External Fixation ◽  
External Fixator ◽  
Intramedullary Nail ◽  
Lower Limb ◽  
Average Length ◽  
Limb Lengthening ◽  
Limb Length ◽  
Tibial Lengthening ◽  
The Mean

Abstract Background Limb lengthening using an external fixator requires a long period of external fixation and may be associated with several complications such as axial deformity, fracture of the regenerated bone, and joint stiffness. With the goal of reducing the time of external fixation as well as some of these complications, we performed femoral or tibial lengthening over an intramedullary nail, according to Paley’s technique, in 28 patients, followed up after a mean period of 8 years. Materials and methods Twenty-eight patients treated for lower limb discrepancy by limb lengthening over an intramedullary nail were reviewed from 5 to 11 years after healing of regenerated bone. There were 20 femurs and 8 tibiae, with average age at surgery of 14.2 years and average length inequality of 6.1 cm for femurs and 5.3 cm for tibiae. Results The mean lengthening was 5.8 cm for femurs and 4.8 cm for tibiae. The mean period of radiographic consolidation of the regenerated bone was 6 months for femoral lengthening and 4.5 months for tibial lengthening. At follow-up, we observed 8 excellent results, 15 good results, 4 fair results, and 1 poor result, based on Paley’s evaluation criteria. The main complications were one deep infection, one nonunion of the distracted segment, one breakage of the distal fiche of the external fixator, and one breakage of both distal locking screws of the intramedullary nail. Discussion We believe that limb lengthening over an intramedullary nail still represents a good method to treat limb length discrepancy because it reduces the time of external fixation, prevents axial deformities and fractures of regenerated bone, and allows early rehabilitation. The new intramedullary lengthening nails, which theoretically are the ideal device for treating limb length inequality, are still very expensive and need longer follow-up for definitive evaluation. Level of evidence 4.

Minimally-Invasive Repair of Bilateral Calcaneal Fractures with Unilateral External Fixation: A Case Report

2016 ◽  
Vol 106 (sp1) ◽  
pp. 10-10
Author(s):  
Louis V. DeFazio ◽  
Guido A. LaPorta
Keyword(s):  
Soft Tissue ◽  
External Fixation ◽  
Operating Room ◽  
External Fixator ◽  
Weight Bearing ◽  
Calcaneal Fracture ◽  
Calcaneal Fractures ◽  
Percutaneous Approach ◽  
Soft Tissue Envelope ◽  
Percutaneous Repair

INTRODUCTION AND OBJECTIVES: Calcaneal fractures are a serious injury with significant associated morbidity. Bilateral calcaneal fractures complicate issues even further, due to the physical disability that the patient is left with. One of the major issues with any calcaneal fracture is the risk of soft tissue compromise caused by the traumatic nature of the injury. A percutaneous approach allows the soft tissue envelope to remain viable, while still fixating the fractures. The purpose of this presentation is to highlight the use of percutaneous repair, the role of external fixation in calcaneal fractures, and lastly discuss the outcome for this particular patient. METHODS: A 26 year-old male presented to the office with bilateral calcaneal fractures, approximately 1 week after sustaining a fall from a height of 12 feet. The patient was brought to the operating room after spending approximately 2 weeks in bilateral posterior splints with Jones compressive dressings. The right calcaneal fracture was fixated percutaneously with 4 screws. The left calcaneal fracture was fixated percutaneously with 3 screws, as well as an Ilizarov external fixator. Approximately 8 weeks later, the patient returned to the operating room for removal of the external fixator and a cast application to the left lower extremity. RESULTS: The patient continued to progress and was subsequently transitioned into bilateral CAM walkers. In the following weeks, the patient was again upgraded to full weight-bearing with physical therapy. The fracture sites were completely consolidated with minimal to no pain in his bilateral heels and full ambulation. CONCLUSIONS: Percutaneous repair, along with external fixation, offers a viable alternative to ORIF for calcaneal fractures. A percutaneous approach also does not disrupt the potentially fragile soft tissue envelope in a calcaneal fracture. Although this outcome is positive, larger controlled studies are needed to confirm percutaneous approaches and external fixation in the realm of a calcaneal fracture.

scholarly journals External Fixation of Extra-Articular Open Tibial Fractures

2018 ◽  
Vol 35 (4) ◽  
pp. 330-336 ◽  
Author(s):  
Saša Milenković ◽  
Milan Mitković
Keyword(s):  
External Fixation ◽  
External Fixator ◽  
Weight Bearing ◽  
Early Mobilization ◽  
Proximal Part ◽  
Tibial Fractures ◽  
Type I ◽  
Union Rate ◽  
Early Weight Bearing ◽  
Open Tibial Fractures

Abstract External fixation is one of the most commonly used methods for the treatment of open tibial fractures. In everyday practice, for fixation of open tibial fractures we use the external fixator by Mitković. External fixator is unilateral and easy to use. This retrospective study included 59 patients with 59 open tibial fractures, of which 37 (62.71%) men and 22 (37.28 %) women, with mean age 43.92 (16-84) years. The fractures were localized in the proximal part of the tibia (11), tibial shaft (29) and distal part of the tibia (19). According to Gustilo classification, 12 (20.33 %) patients had Type I open tibial fractures, 15 (25.42%) patients had Type II open tibial fractures, and 32 (54.23%) (13 IIIA, 17 IIIB, 2 IIIC) patients had Type III open tibial fractures. The union rate without complications was 77.96 % (46). Nonunion and delayed union rate was 15.25 % (9). Malunion rate was 6.77% (4). Pin tract infection rate was 13.55 % (8). Compartment syndrome was observed in 5.08 % (3) of patients. The patients had fasciotomy done and the external fixator applied. The average time of fracture healing was 26 weeks (6.06 months). External fixation of open tibial fractures is a simple and effective method that enables the safe healing of fractures, early mobilization of patients, early weight-bearing as well as early rehabilitation.

scholarly journals Open Tibial Fracture in a Non-Compliant Patient: A Case Report

2018 ◽  
Vol 3 (3) ◽  
pp. 44
Author(s):  
Samuele Pizzolo ◽  
Gianluca Testa ◽  
Giacomo Papotto ◽  
Giuseppe Mobilia ◽  
Giovanni Di Stefano ◽  
...  
Keyword(s):  
External Fixation ◽  
Intramedullary Nailing ◽  
External Fixator ◽  
Intramedullary Nail ◽  
Soft Tissues ◽  
Present Report ◽  
Treatment Method ◽  
Tissue Healing ◽  
Compliant Patient ◽  
Diaphyseal Fractures

Open tibial fractures represent the most frequent fractures of long bones, comprising approximately 1.9% of all fractures. Although locked intramedullary nailing is the gold standard for treating closed and unstable tibia diaphyseal fractures, for most exposed fractures, an external fixator can first be used, followed by conversion through an intramedullary nail. The present report describes the case of a 17-year-old male who presented with a complex multi-segmented displaced tibia fracture, type 42-C3, with exposure of IIIB type according to the Gustilo–Anderson classification, and with an attached disrupted fracture of peroneal malleolus, type 44-B2. External fixation was the preferred treatment method. Before the definitive surgical treatment, the patient had a second accident that caused refracture and damage to the soft tissues and external fixation system. This prolonged the time estimated for the conversion from the external fixator to the intramedullary nail. The reported case shows the use of various treatment steps with different timelines and an intervention with vacuum-assisted closure therapy for soft tissue healing as well as subsequent intramedullary nailing in order to reach the definitive healing of a non-compliant patient. These combined methods achieved an acceptable reduction and good stability of such a complex fracture.

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