External fixation of complex tibial fractures: the design rationale and biomechanical testing of a new hybrid external fixator

Injury ◽  
1998 ◽  
Vol 29 (2) ◽  
pp. 155
Keyword(s):  
External Fixation ◽  
External Fixator ◽  
Biomechanical Testing ◽  
Tibial Fractures ◽  
Design Rationale ◽  
Hybrid External Fixator

scholarly journals Open segmental fractures of the tibia treated by external fixation

2012 ◽  
Vol 140 (11-12) ◽  
pp. 732-737 ◽  
Author(s):  
Ivan Golubovic ◽  
Zoran Vukasinovic ◽  
Predrag Stojiljkovic ◽  
Zoran Golubovic ◽  
Sonja Stamenic ◽  
...  
Keyword(s):  
External Fixation ◽  
External Fixator ◽  
Tibial Fractures ◽  
Type I ◽  
Severe Injuries ◽  
Results Of Treatment ◽  
Additional Surgery ◽  
Segmental Fracture ◽  
Segmental Fractures ◽  
Angular Deformities

Introduction. Open segmental fractures of the tibia are rare but severe injuries. In these fractures the wide zone of injury (damage of all structures of the lower leg) creates very unsuitable biological conditions for healing of the fracture. Objective. The aim of our work was to present the results of treatment of patients with segmental open fractures of the tibia treated by external fixation. Methods. We analyzed treatment results of 21 patients with open segmental tibial fractures who were treated using the method of external fixation at the Clinical Center Nis from January 1, 1995 to July 31, 2010. The average age of the patients was 53 years; the youngest patient was 27 years and the oldest one 80 years. According to the Gustilo open fracture classification, there were 3 (14.3%) type I, 6 (28.6%) type II, 8 (38.1%) type IIIA, and 4 (19.0%) type IIIB. All the patients were treated by a unilateral type Mitkovic external fixator by Traffix Company. Results. Union was attained in 16 (76.2%) fractures without severe complications (pseudoarthrosis, chronic osteitis and angular deformities of over 10 degrees). Among severe complications associated with open segmental tibial fractures, in two cases we registered septic pseudoarthrosis, in one aseptic pseudoarthrosis and in two large angular deformities of the tibia after union, with a valgus of over 10 degrees and extremity shortening of over 2 cm which required additional surgery. Conclusion. External fixation by the use of Mitkovic external fixator is one of the methods of choice in the treatment of open segmental tibial fractures, which incorporated with antibiotic therapy provides good biomehanical conditions for segmental fracture healing that enables good stability of the segmental tibial fracture and decreases the risk of deep infections.

Comparison between External Locking Plate Fixation and Conventional External Fixation for Extraarticular Proximal Tibial Fractures: A Finite Element Analysis

2021 ◽  
Author(s):  
Dejan Blažević ◽  
Janoš Kodvanj ◽  
Petra Adamović ◽  
Dinko Vidović ◽  
Zlatko Trobonjača ◽  
...  
Keyword(s):  
Finite Element ◽  
External Fixation ◽  
External Fixator ◽  
Tibial Fracture ◽  
Locking Plate ◽  
Plate Fixation ◽  
Tibial Fractures ◽  
Proximal Tibial Fracture ◽  
Locking Plate Fixation ◽  
Maximum Stiffness

Abstract BackgroundGood clinical outcomes for locking plates as an external fixator to treat tibial fractures have been reported. However, external locking plate fixation is still generally rarely performed. This study aimed to compare the stability of external locking plate fixator with that of conventional external fixator for extraarticular proximal tibial fractures, using finite element analysis. MethodsThree models were constructed: (1) external locking plating of proximal tibial fracture with lateral proximal tibial locking plate and 5-mm screws (ELP), (2) conventional external fixation of proximal tibial fracture with an 11-mm rod and 5-mm Schanz screws (EF-11), and (3) conventional external fixation of proximal tibial fracture with a 7-mm rod and 5-mm Schanz screws (EF-7). The stress distribution, displacement at the fracture gap, and stiffness of the three finite element models at 30-, 40-, 50-, and 60-mm plate–rod offset from the lateral surface of the lateral condyle of the tibia were determined. ResultsThe conventional external fixator showed higher stiffness than did the external locking plate fixator. In all models, the stiffness decreased as the distance of the plate–rod from the bone surface increased. The maximum stiffness was 121.06 N/mm in the EF-11 model with 30-mm tibia–rod offset. In the EF-7 model group, the maximum stiffness was 40.00 N/mm in the model with 30-mm tibia–rod offset. In the ELP model group, the maximum stiffness was 35.79 N/mm in the model with 30-mm tibia–plate offsetConclusionsExternal locking plate fixation is more flexible than conventional external fixation, which can influence secondary bone healing. External locking plate fixation requires the placement of the plate as close as possible to the skin, which allow low-profile design, because the increased distance of the plate from bone can be too flexible for bone healing.

Ankle spanning external fixator with limited internal fixation for distal tibial extra-articular fractures

2017 ◽  
Vol 5 (10) ◽  
pp. 4355
Author(s):  
Siddharth Goel ◽  
Abhay Elhence
Keyword(s):  
Soft Tissue ◽  
Internal Fixation ◽  
External Fixation ◽  
External Fixator ◽  
Tibial Fractures ◽  
Fixation Method ◽  
Ankle Pain ◽  
Distal Tibial Fractures ◽  
Tract Infections

Background: Fractures of the distal tibia are among the most difficult fractures to treat. The short distal segment presents difficulty in choosing the appropriate fixation method. The greatest challenge lies in the relatively tight soft tissue around the ankle. As a result, it has been a recent interest in treating these fractures with external fixation and limited internal fixation. The external stable fixation methods used are tubular or ring fixators, with or without immobilising the ankle. This minimally invasive nature of the surgery can avoid catastrophic wound complications like dehiscence, implant exposure and infection.Methods: 18 patients with extra-articular distal tibial fractures (AO Type 43A) were treated with the technique of ankle spanning external fixation. Lag screws or K-wires were supplemented for limited internal fixation when required. Fibula was stabilised in all cases. Intra- articular and Compound fractures were excluded. In addition to union at fracture site, ankle pain and motion was noted in each follow-up.Results: The mean follow-up was 25 months. Of the 18 patients included all but one fractures united with an average healing time of 16 to 18 weeks. Ankle pain and motion was graded according to Mazur modified by Teeny and Wiss clinical scoring system. 15 of them had excellent or good results, 2 had fair results. One patient had poor result. Five pin tract infections occurred. 17 patients had no evidence of osteoarthritis after completing follow up of at least 2 years.Conclusions: Distal tibial fractures are complex injuries, not only regarding the bony component, but also in terms of the management of the soft tissue problem. Ankle Spanning External Fixator with Limited Internal fixation is a relatively simple and cost-effective method for treating these fractures, achieving union and also maintaining ankle function.

The Salford Technique for the Treatment of Complicated Tibial Fractures

1980 ◽  
Vol 9 (2) ◽  
pp. 84-86
Author(s):  
A J Banks ◽  
E Dervin
Keyword(s):  
External Fixation ◽  
External Fixator ◽  
Fracture Site ◽  
Bone Screws ◽  
Tibial Fractures ◽  
Simple Method ◽  
Acrylic Cement ◽  
Auxiliary Mechanism

A simple method of external fixation of tibial fractures is described. Acrylic cement is used to secure the bone screws to the external fixator. The angulation at the fracture site can be easily adjusted by the addition of an auxiliary mechanism which can be removed after completion of any necessary realignment manoeuvre.

scholarly journals A Prospective Observational Study on Efficacy of Ilizarov External Fixation in Infected Non-Union Tibial Fractures

2021 ◽  
Vol 8 (15) ◽  
pp. 932-938
Author(s):  
Avinash Gundavarapu ◽  
Vishal Singh ◽  
Prashant Kumar Mishra ◽  
Santhosh Kumar M
Keyword(s):  
External Fixation ◽  
External Fixator ◽  
Functional Results ◽  
High Energy ◽  
Tibial Fractures ◽  
Bony Union ◽  
Ilizarov External Fixator ◽  
Non Union ◽  
Ring Fixator ◽  
Study Results

BACKGROUND Open fractures and fractures caused by high-energy trauma are likely to get infected and result in non-union. Infected non-union of long bones is a problem in developing countries like India. Ilizarov external fixator was employed to correct all the complications associated with non-union such as bone gap, infection, shortening, and deformities. Stable fixation, corticotomy and bone transport was employed to reduce or eliminate infection at the same time achieving bone union and correction of limb length discrepancy. Our study assesses the efficacy and safety of Ilizarov external fixation in patients with infected non-union tibial fractures. METHODS A series of 30 patients with infected non-union of tibia were treated with Ilizarov external fixation in Yashoda super speciality hospital and regularly followed-up between May 2014 and April 2016 (2 years). Bony and functional results were estimated and correlated with existing studies. RESULTS Out of thirty patients treated, bony results were excellent in 17 patients, good in 8 patients, fair in 4 patients and poor in 1 patient. Functional results were excellent in 17 patients, good in 5 patients, fair in 5 patients, and poor in 3 patients. Average duration of the fixator period was 8.1 months (min - 3 months, max - 14 months). Average length of regenerate was 3.64 cm (min - 2 cm, max - 6 cm). Average lengthening index in the study was 2.09 months / cm. Our study in all 4 categories of Association for the Study and Application of Methods of Ilizarov (ASAMI) criteria had approached Dror Paley’s Bony results and functional results. CONCLUSIONS In our study results have been encouraging in addressing all the complex problems by Ilizarov principle. Ilizarov external fixator system is the best device to treat infected non-union of tibia. Distal third of tibia is more prone for infection and non-union. Corticotomy or bone grafting is required for augmentation of the healing process. Almost all patients had varying degrees of oedema and pin track infections. Infection was controlled in all the cases and bony union was achieved, no patient had persistence of non-union and infection at the end of 2 years. KEYWORDS Ilizarov External Ring Fixator, Infected Non-Union, ASAMI Criteria, Bony Results, Functional Results, Bony Union

scholarly journals Hughes External Fixator in Treatment of Tibial Fractures

1985 ◽  
Vol 78 (10) ◽  
pp. 830-837 ◽  
Author(s):  
C M Court-Brown ◽  
S P F Hughes
Keyword(s):  
External Fixation ◽  
External Fixator ◽  
Prospective Trial ◽  
Tibial Fractures ◽  
External Fixators ◽  
Complication Rates ◽  
Initial Reduction ◽  
Diaphyseal Fractures ◽  
Grade Ii

The results of a prospective trial of the use of the Hughes unilateral external fixator in the management of 48 tibial diaphyseal fractures are presented. Good results were obtained in grade II and III fractures but not in closed and grade I fractures. The results and complication rates were comparable with those of other more complex external fixators. Good results were found to be dependent on the adequacy of the initial reduction and the duration of external fixation, but independent of alterations in pin angle, length and location as well as fixator location.

scholarly journals TIBIAL PLATEAU FRACTURES

2018 ◽  
Vol 25 (06) ◽  
pp. 810-814
Author(s):  
Saeed Ahmad ◽  
Tariq Mahmood ◽  
Muhammad Imran Haider
Keyword(s):  
External Fixator ◽  
Tibial Plateau ◽  
Case Series ◽  
High Energy ◽  
Tibial Plateau Fractures ◽  
Tibial Fractures ◽  
Female Ratio ◽  
Non Union ◽  
Hybrid External Fixator ◽  
Pin Track

Background: Tibial fractures is most common type of long bone fractures. Highspeed lifestyles with vehicles motorcycles as well as growing waves of violence, contributingincrease occurrence of tibial fractures. Tibial plateau fractures continues to be a challenge fororthopedic surgeon. Treatment of these fractures have been plagued by complications. Recentimprovements in the techniques and development of hybrid external fixator have revolutionizedthe treatment of such fractures. Objective: To evaluate the clinical outcomes of hybrid externalfixator in high energy Schatzkar V and VI tibial plateau fractures. Study Design: Descriptive,Case series. Period: 27 June 2013 to 26 June 2016. Setting: Nishtar Hospital, Multan. Materialand methods: A total of 125 patients with open and close tibial plateau fractures, 20 to 50 yearsof age of both genders were included in the study. Patients having history of pervious surgeryor intervention tibial plateau fractures, and h/o malignancy were excluded. All the patients wereoperated by a consultant orthopedic surgeon. Outcome was assessed at 16 weeks by serialradiological x-ray by formation of callus and noting any grade of pin track infection. Results; Ourstudy comprised of 125 patients having Schatzker V and Schatzker VI tibial plateau fractureswho met our inclusion criteria. Mean age of 38.925 ± 7.09 years. Majority of the patients 47(37.60%) were between 41 to 50 years of age. Mean duration since injury in our study was 13.18± 4.79 hours. Out of 125 patients, 102 (81.60%) were males and 23(18.40%) were females withmale to female ratio of 1.2:5.4. Fifty three (42.4%) patients presented with Schatzker V and 72(57.6%) had Schatzker VI type of tibial plateau fractures. In our study, non-union was seen in10cases (8.0%) and pin track infection was noted to be present in 19 (15.20%) patients. So, theacceptable outcome (achievement of union without non-union or pin track infection during 16weeks) was seen in 96(76.8%) patients. Conclusion: This study concluded that there is highrate of acceptable outcome (achievement of union without any non-union or pin track infectionduring 16 weeks) after hybrid external fixator of the open and closed fractures of tibial plateauamong the patients having schatzker-V and VI.

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 Biomechanically validated transosseus fixation in patients with femur pseudarthrosis complicated by chronic osteomyelitis

2018 ◽  
Vol 25 (3-4) ◽  
pp. 71-78
Author(s):  
A. V Tsiskarashvili ◽  
A. V Zhadin ◽  
K. A Kuzmenkov ◽  
K. M Bukhtin ◽  
R. E Melikova
Keyword(s):  
Retrospective Study ◽  
External Fixation ◽  
Clinical Outcomes ◽  
External Fixator ◽  
Chronic Osteomyelitis ◽  
Weight Bearing ◽  
Femur Bone ◽  
Bone Consolidation ◽  
Hybrid External Fixator

The aim of the study is to evaluate results of follow-up in patients with femur pseudarthrosis complicated by chronic osteomyelitis who underwent biomechanically validated transosseus fixation. Materials and methods. A retrospective study of transosseus fixation in 72 patients with femur pseudarthrosis complicated by chronic osteomyelitis was conducted. Described fixation was completed according to the biomechanical fixation conception from 2011 to 2017. Hybrid external fixator was applied to 38 (52,8%) patients, rod-based external fixator - to 34 (47,2%). Results. Full bone consolidation and pyoinflammatory process remission in treated femur bone is achieved in all cases. Results classified as excellent were acquired in 21 patients (29,5%), good - in 41 (57,7%), satisfactory - in 7 (9,8%), unsatisfactory - in 2 (3%). patients results were classified as unsatisfactory because of lacking of weight-bearing ability of the leg because of other reasons not related to consolidation. Conclusion. In patients with infected femur pseudarthroses external fixation using biomechanical conception allows to provide up to 97% positive clinical outcomes of the treatment.

Sign in / Sign up

Export Citation Format

Share Document