External Fixator Frames as Interim Damage Control for Limb Injuries: Experience in the 2010 Haiti Earthquake

The use of external fixation devices is considered a valuable approach for the treatment of bone fractures, providing proper alignment to fractured fragments and maintaining fracture stability during the healing process. The need for external fixation devices has increased due to an aging population and increased trauma incidents. The design and fabrication of external fixations are major challenges since the shape and size of the defect vary, as well as the geometry of the human limb. This requires fully personalized external fixators to improve its fit and functionality. This paper presents a methodology to design personalized lightweight external fixator devices for additive manufacturing. This methodology comprises data acquisition, Computer tomography (CT) imaging analysis and processing, Computer Aided Design (CAD) modelling and two methods (imposed predefined patterns and topology optimization) to reduce the weight of the device. Finite element analysis with full factorial design of experiments were used to determine the optimal combination of designs (topology optimization and predefined patterns), materials (polylactic acid, acrylonitrile butadiene styrene, and polyamide) and thickness (3, 4, 5 and 6 mm) to maximize the strength and stiffness of the fixator, while minimizing its weight. The optimal parameters were found to correspond to an external fixator device optimized by topology optimization, made in polylactic acid with 4 mm thickness.

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The damage control in tibial pilon open fractures with a new external fixator delta frame

Journal of Acute Disease ◽

10.4103/2221-6189.219618 ◽

2017 ◽

Vol 6 (5) ◽

pp. 222

Author(s):

Giuseppe Rollo ◽

Andrea Pasquino ◽

Paolo Pichierri ◽

Michele Bisaccia ◽

Alessandro Stasi ◽

...

Keyword(s):

External Fixator ◽

Damage Control ◽

Open Fractures ◽

Tibial Pilon

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Evaluation of the Structural Behaviour of a Unilateral External Fixator for Osteosynthesis

The Open Biomedical Engineering Journal ◽

10.2174/1874120702115010029 ◽

2021 ◽

Vol 15 (1) ◽

pp. 29-36

Author(s):

Mara Terzini ◽

Simona Sicuranza ◽

Flavia Alberghina ◽

Laura Ravera ◽

Domenico Costantino Aloj ◽

...

Keyword(s):

External Fixator ◽

Damage Control ◽

Trauma Surgery ◽

Vertical Displacement ◽

Infection Rates ◽

Structural Behaviour ◽

Static Tests ◽

Damage Control Orthopedics ◽

Tibia Fractures ◽

Tract Infections

Background: External fixation is an osteosynthesis technique particularly useful in trauma surgery and Damage Control Orthopedics (DCO). However, complications, such as pin loosening and pin tract infections, are fairly common. For reducing thermal damage and infection rates, monocortical pins have been proposed as an alternative to the most used bicortical pins. However, there is a lack of studies regarding their mechanical properties. Objective: The aim of the study is to assess the static and dynamic stability of a unilateral external fixator experimentally when applied through monocortical pins for the reduction of femur and tibia fractures. Methods: A modular unilateral external fixator was used and a total number of 6 pins were used per test. The static tests were performed in displacement control by applying a vertical displacement to the upper fixture at 1 mm/min until a tension load of 380 N was reached. The dynamic tests were performed by applying a sinusoidal displacement. During each test, forces and crosshead displacements were acquired. Two different stiffness indexes were assessed. Results: By comparing the two anatomic regions, it was found that the fixator behaves stiffer when mounted on the femur, regardless of the pins used, while stiffnesses comparable to the femur ones are reached by the tibia when 4 mm diameter pins are used. Static analysis revealed excellent fixator stability when implanted with 4 mm diameter monocortical pins on both anatomic regions. On the contrary, two tibia and one femur samples showed failures at the bone-pin interface when 3 mm diameter pins were used. Conclusion: Dynamic analysis showed no substantial difference between the tested configurations and confirmed the fixator's ability to sustain cyclic loading without further damage to the sample.

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Comminuted Fractures of the Distal Femur Treated with Ilizarov External Fixator. Case Series Study

Ortopedia Traumatologia Rehabilitacja ◽

10.5604/01.3001.0010.8071 ◽

2017 ◽

Vol 19 (6) ◽

pp. 553-562 ◽

Cited By ~ 1

Author(s):

Łukasz Szelerski ◽

Radosław Górski ◽

Sławomir Żarek ◽

Karol Mochocki ◽

Paweł Małdyk

Keyword(s):

External Fixator ◽

Femoral Fractures ◽

Bone Union ◽

Ilizarov Method ◽

Ilizarov External Fixator ◽

Distal Femoral Fractures ◽

Articular Fractures ◽

Case Series Study ◽

Limb Injuries ◽

Ilizarov Apparatus

Background. Distal femoral fractures constitute a type of lower limb injuries that is rare and difficult to treat. Despite advances in surgical technique and development of implants used for internal fixation of fracture fragments, the treatment continues to result in numerous complications. The Ilizarov External Fixator reduces the risk of complications and allows for bone union. Material and methods. Six men with distal femoral fractures resulting from multisite and multiorgan injuries were treated at the Department of Orthopaedics and Musculoskeletal Traumatology of the Medical University of Warsaw between 2008 and 2016. Mean age of the patients was 42.6 years. Four of them were managed with the Ilizarov method as a primary treatment and two wore the apparatus as a second-line treatment following unsuccessful plate osteosynthesis. Results. Mean treatment duration with the Ilizarov apparatus was 29 weeks. Bone union was achieved in all patients. After the treatment, the patients ambulated unassisted, without orthopaedic aids. All patients returned to work. Conclusions. 1. The Ilizarov method allows for efficient fixation of comminuted distal femoral fractures, including C2 and C3 intra-articular fractures (AO/ASIF classification). 2. The use of the Ilizarov apparatus reduces soft tissue laceration, preserves blood supply to the bone fragments, and allows for easier skin care, which is particularly important in the case of open fractures. 3. Early rehabilitation with the patient fully loading the operated limb reduces muscle atrophy and stimulates bone union.

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External skeletal fixation of femoral shaft fractures in polytrauma patients

Medicinski pregled ◽

10.2298/mpns0810497s ◽

2008 ◽

Vol 61 (9-10) ◽

pp. 497-502 ◽

Cited By ~ 7

Author(s):

Predrag Stojiljkovic ◽

Zoran Golubovic ◽

Desimir Mladenovic ◽

Ivan Micic ◽

Sasa Karalejic ◽

...

Keyword(s):

Internal Fixation ◽

External Fixation ◽

External Fixator ◽

Damage Control ◽

Healing Time ◽

Safe Procedure ◽

Femur Fractures ◽

Definitive Method ◽

Polytrauma Patients ◽

Rigid Stabilisation

Introduction. Polytrauma remains a major social, economic and medicine affliction. A successful surgical treatment of polytrauma patients requires an approach predicated on prioritizing injuries. An isolated femur fractures rarely poses any threat but in association with multiple injuries, this fracture assumes greater significance. The proper management of femur fractures in polytrauma can greatly reduce the mortality and morbidity. Material and methods. We present our results in the treatment of 24 femur shaft fracture in 22 polytrauma patients treated by Mitkovic external fixator in 5 year period (2000-2004) on Orthopeadic and Traumatology Clinic - Clinical Center Nis. The average of patients age was 32.8 years (ranging from 17 to 62). There were 11 (46%) closed and 13 (54%) open fractures. Results. Eighteen fractures were treated by external fixation until union. The remaining six fractures were treated by conversion of the external fixation to internal fixation. Sixteen fractures (88.88%), in which the external fixation was the definitive method of treatment, healed completely. The average healing time was 6.29 (4-9) months. There were three pin-track infections (16.66%), one nonunion (5.55%) and only one deep infection (5.55%). Conclusion. The external fixation by the use of Mitkovic external fixator in the treatment of femur fractures is a safe procedure to achieve temporary rigid stabilisation in polytrauma patients before the subsequent internal fixation (damage control orthopaedics). The external fixation using Mitkovic external fixator can be definitive method of choice in treatment of open and comminutiwe femur fractures in polytrauma patients until union.

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Application of an external fixator vascular compressor (EFVC) in the critically injured trauma patient: a novel damage control technique

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-019-02439-x ◽

2019 ◽

Vol 29 (6) ◽

pp. 1337-1345

Author(s):

Bradley Saitta ◽

Jonathan Edgington ◽

Theodore Hart ◽

Kenneth Wilson ◽

Gary An ◽

...

Keyword(s):

Trauma Patient ◽

External Fixator ◽

Damage Control ◽

Control Technique

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Features of medical care in patientswith elbow joint gunshot wounds

ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS ◽

10.15674/0030-5987202115-8 ◽

2021 ◽

pp. 5-8

Author(s):

Aleksandr Loskutov ◽

Andriy Domanskyi ◽

Ivan Zherdev ◽

Svyatoslav Lushnya

Keyword(s):

Medical Care ◽

Elbow Joint ◽

Damage Control ◽

Soft Tissue Injuries ◽

Gunshot Wounds ◽

Shoulder Injuries ◽

Combat Injuries ◽

Limb Injuries ◽

Two Stages ◽

Favorable Conditions

Gunshot wounds of the elbow joint are the third most common after knee and shoulder injuries. Features of the anatomical and functional structure of the elbow joint, the close location of the vascular and nervous formations, favorable conditions for the development of infection determine the severity of gunshot wounds and cause the complexity of its treatment. Objective. To evaluate the frequency and nature of the elbow joint gunshot wounds in the structure of the general combat injuries, as well as to determine the volume of medical care and direction of treatment of such injuries in the conditions of the regional hospital as a stage of care. Methods. A retrospective study included 1 809 patients (96.0 % of men, mean age (33.7 ± 0.2) years). Firearms limb injuries were detected in 1 013 (56.0 %) of all victims, of which the elbow joint — 25 (2.47 %). Mines and explosives injuries were in 22 (88 %) of the patients, bullet — in 3 (12 %). Results. Tactics of treatment of elbow joint gunshot wounds depended on the severity of the condition of the victims and the nature of concomitant traumatic injuries. In the structure of combat injury of the elbow joint the majority was combined (52 %) and multiple (40 %) injuries and was accompanied by gunshot fractures in 60 %. In patients who were in severe state, applied the tactics of Damage control in two stages. At the first stage the fractures were fixed with plaster splints or external fixation devices (EF), the wounds were not subjected to full surgical debridment (SD), but only washed with antiseptics and the visible foreign bodies were removed. In patients with soft tissue injuries wounds the primary SD was performed according to general principles, injured nerves were not restored. In the second stage, after patient is stabilized, the repeated SD of the wound was performed. After their uncomplicated healing the EF was removed and the method of fixation was changed to internal osteosyntesis. Conclusions. It is recommended to perform stabilization of intra-articular gunshot fractures of the elbow joint with EF and after uncomplicated wound healing go to the internal osteosynthesis. Key words. Elbow joint, gunshot wounds, treatment.

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