scholarly journals Conversion of external fixation to internal fixation in a non-acute, reconstructive setting: a case series

2013 ◽  
Vol 8 (1) ◽  
pp. 25-30 ◽  
Author(s):  
T. Monni ◽  
F. F. Birkholtz ◽  
P. de Lange ◽  
C. H. Snyckers
Keyword(s):  
Internal Fixation ◽  
External Fixation ◽  
Case Series

scholarly journals Integrated Reconstruction for Chronic Foot Dislocations

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0012
Author(s):  
Douglas N. Beaman ◽  
Cassandra B. Tomczak ◽  
Paul T. Fortin
Keyword(s):  
Soft Tissue ◽  
Internal Fixation ◽  
External Fixation ◽  
Treatment Protocol ◽  
Case Series ◽  
Clinical Results ◽  
Deep Infection ◽  
Taylor Spatial Frame ◽  
Fixation Methods ◽  
Spatial Frame

Category: Hindfoot; Diabetes; Midfoot/Forefoot Introduction/Purpose: Chronic dislocations of the hindfoot and midfoot are a treatment challenge due to difficulties in achieving re-alignment without bone or soft tissue compromise. Neuropathy and diabetes are often associated with the chronic foot dislocation, and further complicate treatment. Our prior studies with integrated fixation methods (ring external fixation and internal fixation) for severe tibia pilon fractures and deformed, infected neuroarthopathic ankles has shown that internal fixation around the ankle can be safely combined with external fixation in single stage procedures.In this study, a staged approach is utilized to limit bone resection and minimize risks of soft tissue compromise and neurovascualar injury with severe and rigid defomity corrections. The purpose is to assess the results and complications of this surgical treatment approach. Methods: Medical records, clincal evaluation, and radiographs for 9 patients treated with gradual hexapod realignment and staged arthrodesis of chronic foot dislocations were retrospectively reviewed. There were six female and three male patients with a mean age of 59 (range, 43-71) years. Follow-up ranged from 12 months to 12 years. All had neuropathy; seven were diabetic, one CMT, one idiopathic, and one rheumatoid. Dislocation was present for a minimum of 16 weeks (range, 4 to 36 months). Seven patients had preoperative ulcerations. Seven had peritalar dislocations (subtalar and talonavicular), and two had midfoot dislocations (naviculocuneiform-1, talonavicular-1).Treatment protocol included: Surgical stage 1- soft tissue releases and Taylor spatial frame application; gradual correction of dislocation; Surgical stage 2-open arthrodeses with internal fixation and frame modification or removal. Results: All nine patients achieved a stable plantigrade and functional foot position. All fusions healed except for one talonavicular nonunion. All preoperative ulcerations healed. Six patients with peritalar dislocations had frame modification at the time of arthrodesis (mean frame time was 5.9 months). Three patients had frame removal at time of arthrodesis (mean frame time was 3 months). Average time from hexapod realignment to arthrodesis surgery was 8 (range, 3-16) weeks.Outcome with the Reinker/Carpenter scale was 5 excellent, 2 good, and 2 fair. Two peritalar dislocations developed complications; one talonavicular nonunion, and one deep infection. Other complications included further surgery in two midfoot dislocations, two forefoot wire complications, and one ankle deformity during peritalar correction. Conclusion: Staged integrated realignment/arthrodesis for chronic neuropathic foot dislocations resulted in good clinical outcomes with manageable complications. The Taylor spatial frame miter and butt constructs were successful in reducing hindfoot and midfoot dislocations, respectively. There was reliable fusion and ulcer healing with our staged protocol. This case series furthers our successful clinical results with the combined use of ring external fixation and internal fixation methods for complex foot and ankle pathology.

scholarly journals Combined Internal and External Fixation for Charcot Neuroarthropathy: A Learning Curve

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0026
Author(s):  
Muhammed H. Iqbal ◽  
Sultan N. Qasim ◽  
Simon Chambers
Keyword(s):  
Learning Curve ◽  
Internal Fixation ◽  
External Fixation ◽  
Limb Salvage ◽  
Case Series ◽  
Deformity Correction ◽  
Fusion Rate ◽  
Ulcer Recurrence ◽  
Foot And Ankle ◽  
Soft Tissue Envelope

Category: Diabetes; Trauma Introduction/Purpose: Management of complex foot and ankle deformities secondary to charcot neuroathropathy represents a significant challenge. This is a consequence of medical co-morbidities, vascular disease, peripheral neuropathy, and immune compromise with the surgical challenges of progressive bony defomity and bone resorption. To combat these challenges ‘superconstructs’ have been developed to improve fixation. These aim for fusion beyond the zone of injury with adequate deformity correction all whilst maintaining viability of the soft tissue envelope and mechanical function. This can be achieved with internal fixation using indication specific plates and beaming techniques, external fixation with a circular frame or a combination of the two. The aim of this study was to evaluate of a tertiary referral hospital in the operative management of charcot neuroarthopathy. Methods: This is a retrospective two surgeon case series with all cases jointly operated upon. Cases were identified from a locally held diabetic patient registry as those undergoing charcot foot and ankle reconstruction from 2017 to 2019. No exclusion criteria were outlined. Patient demographics and co-morbidities were collected, pre-op radiological markers (meary’s angle) measured and repeated at 6 weeks and one year. Pre-op radiographs were classifed accroding to brodsky classification. Patient outcomes were recorded of amputation, mortality, ulcer recurrence, reported pain, stable heel, ability to ambulate, need for revision surgery, need for prolonged antibiotics, fusion and surgical complications. PROMS were requested and still awaited at time of submission. Results: Eleven Cases were identified from ten patients, all were included for analysis. Three patients had internal fixation, two had external fixation and six had combined internal with external fixation. Eight patients were Brodsky 1, two patients were Brodsky 3 and one patient was Brodsky 2. Limb salvage was 100% with nil amputations, mortality 0%, ulcer recurrence 0%, 100% improved pain score, and 100% with a stable heel. Meary’s angle improved by a mean of 14o from -16o to -2o at 1 year. Fusion rate determined clinically and radiologically with X-ray was 100% with mean of 129 days and range of (360 - 52). Mean follow-up 454 days and range (547-417). Complications of 2 tibial fractures and 1 deep infection with delayed wound healing. Conclusion: The outcomes of using all three methods is positive with 100% limb salvage, 100% fusion rate, 100% ulcer free and maintenace of Meary’s angle at 1 year post op. We believe that combined internal and external fixation, not widely reported in the literature, is a good option in these cases. The complications reported here were in the first three patients undergoing said technique and represent a learning curve.

Clinical Value of Computer-Assisted Taylor Three-dimensional External Fixation in the Treatment of Tibiofibular Fracture (Preprint)

2020 ◽  
Author(s):  
Hongfeng Sheng ◽  
Weixing Xu ◽  
Bin Xu ◽  
Hongpu Song ◽  
Di Lu ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Internal Fixation ◽  
External Fixation ◽  
External Fixator ◽  
Theoretical Basis ◽  
New Technology ◽  
Three Dimensional ◽  
Computer Assisted ◽  
Clinical Value

UNSTRUCTURED The retrospective study of Taylor's three-dimensional external fixator for the treatment of tibiofibular fractures provides a theoretical basis for the application of this technology. The paper collected 28 patients with tibiofibular fractures from the Department of Orthopaedics in our hospital from March 2015 to June 2018. After the treatment, the follow-up evaluation of Taylor's three-dimensional external fixator for the treatment of tibiofibular fractures and concurrency the incidence of the disease, as well as the efficacy and occurrence of the internal fixation of the treatment of tibial fractures in our hospital. The results showed that Taylor's three-dimensional external fixator was superior to orthopaedics in the treatment of tibiofibular fractures in terms of efficacy and complications. To this end, the thesis research can be concluded as follows: Taylor three-dimensional external fixation in the treatment of tibiofibular fractures is more effective, and the incidence of occurrence is low, is a new technology for the treatment of tibiofibular fractures, it is worthy of clinical promotion.

Mini-Invasive Treatment for Brachymetatarsia of the Fourth Ray in Females: Percutaneous Osteotomy With Mini-Burr and External Fixation—A Case Series

2017 ◽  
Vol 56 (2) ◽  
pp. 390-394 ◽  
Author(s):  
Federico Fusini ◽  
Francesco Langella ◽  
Ottorino Catani ◽  
Fabrizio Sergio ◽  
Fabio Zanchini
Keyword(s):  
External Fixation ◽  
Case Series ◽  
Invasive Treatment

scholarly journals Management of Isolated Capitate Nonunion: A Case Series and Literature Review

2018 ◽  
Vol 07 (05) ◽  
pp. 419-423 ◽  
Author(s):  
Rishabh Jethanandani ◽  
Schneider Rancy ◽  
Keith Corpus ◽  
Jeffrey Yao ◽  
Scott Wolfe
Keyword(s):  
Literature Review ◽  
Internal Fixation ◽  
Bone Grafting ◽  
Relevant Literature ◽  
Case Series ◽  
Rare Condition ◽  
Vascular Supply ◽  
Autogenous Bone ◽  
Rare Injury ◽  
Autogenous Bone Grafting

Background Isolated capitate nonunion is rare. No consensus on the appropriate treatment for this condition exists. Case Description We reported two cases of capitate fracture nonunion presenting several months after untreated high-impact wrist trauma. Treatment was delayed as both patients' nonunions were missed on conventional radiographs. Both were ultimately diagnosed with advanced imaging and successfully treated with internal fixation and autogenous bone grafting. The relevant literature pertaining to capitate nonunion was reviewed. Literature Review Immobilization and internal fixation with bone grafting for capitate nonunion have been described in the literature. Loss of vascular supply and progression to avascular necrosis is a concern after capitate nonunion. Clinical Relevance We present two cases and review the literature on the diagnosis and treatment of this rare injury to guide management. Internal fixation with autogenous bone grafting could play a role in management for this rare condition.

scholarly journals Surgical treatment of pertrochanteric fractures by dynamic methods of external and internal fixation

2003 ◽  
Vol 60 (6) ◽  
pp. 663-667 ◽  
Author(s):  
Sasa Milenkovic ◽  
Milorad Mitkovic ◽  
Mile Radenkovic ◽  
Desimir Mladenovic ◽  
Gordana Soldatovic ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Internal Fixation ◽  
External Fixation ◽  
Functional Results ◽  
Surgical Trauma ◽  
Pertrochanteric Fractures ◽  
Skeletal Mass ◽  
Dynamic Methods ◽  
Life Threat ◽  
Methods Of Treatment

Pertrochanteric fractures usually occur in patients over 65 years of age, with greater loss of skeletal mass (osteoporosis). Nonsurgical methods of treatment are accompanied by relatively high lethality rate. Moreover, they do not produce satisfactory anatomical and functional results. Surgical treatment by using dynamic implants represents a method of choice in the fixation of pertrochanteric fractures. This paper presents the treatment results of 110 patients, 61 with pertrochanteric fractures, who were surgically treated by the dynamic method of internal fixation, and 49 patients who were treated by the method of external fixation. Dynamical implants enabled both dynamization and compression of the fracture in the axis of the neck, as well as the diaphysis of the femur, which lowered the risk of mechanical complications, and, at the same time, provided effective healing of the fracture, early activation, and mobilization of the patients on whom the surgery was performed. In patients infected by various diseases, for whom surgical trauma represents a life threat, the external fixation is recommended as a method of choice.

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