scholarly journals Effects and Anti-rotation Stabilization of the Non-bridging External Fixation for Pronation-Abduction Stage III Ankle Fracture: A Cadaveric Study

2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
Yili Chen ◽  
Xiaoyu Huang ◽  
Yongzhong Cheng ◽  
Jingjing Xu ◽  
Yang Chen ◽  
...  
Keyword(s):  
Internal Fixation ◽  
External Fixation ◽  
Ankle Fracture ◽  
Reduction Rate ◽  
Stage Iii ◽  
Fixation Method ◽  
Fixation Technique ◽  
Fixation Group ◽  
Pin Fixation ◽  
20 Nm

Objective. This study is aimed at providing a nonbridging external fixation technique with pinning fixation for the pronation-abduction stage III ankle fracture. The secondary purpose was to evaluate its effect on anatomic reduction and fracture fragment stability against cadaveric models’ rotation. Method. A paired design study was conducted using 14 pairs of the cadaveric model which had been modeled for pronation-abduction stage III ankle fracture. One fracture model from each pair was randomly allocated to receive an open reduction and internal fixation, while the other was reduced and stabilized with the external fixation technique. After the surgery, the antirotational stability tests were performed with external rotation torques of 10 nm, 15 nm, and 20 nm applied, respectively. The postoperation reduction rate and ankle parameters were recorded in anteroposterior and lateral radiographs before and after the antirotational stability experiment. Result. The outcomes were assessed according to Burwell-Charnley’s radiographic criteria of reduction. It showed no statistically significant differences in reduction between the two groups ( P < 0.05 ). The displacement of lateral fragment following a reduction in the external fixation group was significantly larger than that of the internal fixation group ( 3.14 ± 0.56 vs. 1.49 ± 0.39 , P < 0.05 ). After applying rotational torques of 10 nm, 15 nm, and 20 nm, the results of other parameters showed no significant differences between the two groups. Conclusion. This nonbridging external fixation method with pin fixation of fracture fragments might have the same effect as that of internal fixation on the reduction rate of pronation-abduction stage III ankle fracture.

scholarly journals Outcomes of Hindfoot and Ankle Arthrodesis in Neuropathic Patients

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0028
Author(s):  
David Macknet ◽  
Andrew Wohler ◽  
Carroll P. Jones ◽  
J. Kent Ellington ◽  
Bruce E. Cohen ◽  
...  
Keyword(s):  
Internal Fixation ◽  
External Fixation ◽  
Limb Salvage ◽  
Median Number ◽  
Ankle Arthrodesis ◽  
High Rate ◽  
Hardware Failure ◽  
Radiographic Outcomes ◽  
Fixation Group

Category: Ankle Arthritis, Diabetes, Hindfoot Introduction/Purpose: Charcot neuropathy of the ankle and hindfoot is a progressive and destructive process that can lead to instability and ulceration resulting in significant morbidity which can end with amputation. The foot and ankle surgeon’s aim is to reconstruct the high risk foot with the creation of a stable plantigrade foot, while reducing the risk of ulceration and allowing the patient to mobilize in commercially available footwear. There are numerous techniques for the reconstruction of the neuropathic hindfoot, but the most utilized of these include multiplanar external fixation or internal fixation with a plate or intramedullary nail. It is our goal to further elucidate outcomes of Charcot patients undergoing corrective ankle and hindfoot fusion comparing internal versus external fixation. Methods: We retrospectively collected 377 patients undergoing hindfoot and ankle arthrodesis at our institution from 2006- 2017. 77 patients were identified that underwent arthrodesis for Charcot arthropathy, 56 of which met our inclusion and exclusion criteria. This included 47 who had internal fixation as their primary procedure and 9 patients who underwent external fixation with a multi-planar external fixator. Our median follow up time was 3.4 years (IQR .5 to 12.9). Preoperatively we collected basic demographic variables, reasons for neuropathy, and ulcer status. Postoperatively we collected complications including infection, hardware failure, ulceration, recurrent deformity, and radiographic outcomes including union and hardware backout. Reoperation numbers and indications were also collected. Our primary outcome was limb salvage at final follow up. Secondarily, we collected final ambulatory and footwear status. Results: The limb salvage rate was 82% with 10 patients undergoing amputation, which did not vary between groups (p=.99). The primary reasons for amputation were persistent infection (4 of 10) and nonunion (4 of 10). Thirteen (24%) patients developed an infection. The median number of reoperations per patient was 1 (IQR 0-2) with the patients who underwent amputation undergoing a median of 2 (IQR 2-4) reoperations. The rate of union was 54%, occurring at a median of 26.5 (IQR 12-47) months. 44% (4/9) of patients in the external fixation group had a preoperative ulceration versus 19% (9/47) of the patients in the internal fixation group (p=.19). Preoperative ulceration was not a risk factor for amputation. Forty-two (75%) patients were ambulatory at final follow up. Conclusion: We report on the single largest series of Charcot patients undergoing hindfoot and ankle arthrodesis. The surgical management of this population has a high rate of complications with infection and reoperation being common. Despite a high nonunion rate most patients are able to ambulate in a brace or orthotic. Limb salvage can be expected with either internal or external fixation techniques.

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.

External Fixation for Comminuted Phalangeal Fractures

1996 ◽  
Vol 21 (6) ◽  
pp. 760-764 ◽  
Author(s):  
F. FITOUSSI ◽  
W. Y. IP ◽  
S. P. CHOW
Keyword(s):  
Mechanical Properties ◽  
Internal Fixation ◽  
External Fixation ◽  
Cadaver Study ◽  
Kirschner Wires ◽  
Fixation Technique ◽  
Lateral Plate ◽  
Lateral Plating ◽  
Phalangeal Fractures ◽  
Phalangeal Fracture

The mechanical rigidity obtained by external fixation in a comminuted phalangeal fracture model was assessed and the results compared with two other types of internal fixation commonly used (lateral plate and crossed Kirschner wires) in a biomechanical cadaver study. Each fixation technique was tested in apex palmar bending, compression and torsion. The results showed that lateral plating provided the best rigidity in apex palmar bending and compression and that external fixation and Kirschner wires showed the same mechanical properties. For the torque test, external fixation provided the best rigidity.

A New Fixation Technique for the Lapidus Bunionectomy

2005 ◽  
Vol 95 (4) ◽  
pp. 405-409 ◽  
Author(s):  
James C. Wang ◽  
Brendan M. Riley
Keyword(s):  
Internal Fixation ◽  
External Fixation ◽  
External Fixator ◽  
Preliminary Report ◽  
Delayed Union ◽  
Oral Antibiotics ◽  
Fixation Technique ◽  
Short Course ◽  
Time To Initiation ◽  
Fixation Techniques

Presented here is a preliminary report of 102 patients who underwent first metatarsocuneiform joint arthrodeses performed with external fixation for the correction of hallux valgus. The advantages of using external fixation are the ability to initiate early weightbearing, predictable fusion, and removal of all of the hardware postoperatively. In the 102 patients reported here, the average time to initiation of unassisted full weightbearing was 13.1 days. The average time to fusion was 5.3 weeks, with removal of the external fixator at an average of 5.5 weeks postoperatively. There was no incidence of delayed union or nonunion. There was one case of pin-tract irritation, which resolved with appropriate pin care and a short course of oral antibiotics. External fixation is an effective alternative to traditional internal fixation techniques in metatarsocuneiform joint arthrodesis. (J Am Podiatr Med Assoc 95(4): 405–409, 2005)

Fat Repositioning With a Combination of Internal Fixation and External Fixation in Transconjunctival Lower Blepharoplasty

2021 ◽  
Author(s):  
Jianwu Chen ◽  
Tao Zhang ◽  
Xuanru Zhu ◽  
Wenhua Huang
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Internal Fixation ◽  
External Fixation ◽  
Fixation Method ◽  
Resonance Imaging ◽  
Facial Soft Tissue ◽  
Level Of Evidence ◽  
Tear Trough ◽  
Fat Repositioning

Abstract Background Various methods on transconjunctival fat repositioning have been promoted to treat tear trough deformities in patients with eye bags. Objectives The authors present a modified approach based on the facial soft-tissue spaces with the combined fixation method. Methods A total 226 patients underwent this procedure. Through a preseptal approach, the premaxillary and prezygomatic spaces were sequentially separated. Orbital fat was repositioned into the spaces together with the septum. The proximal part of the septum-fat flap was sutured to orbital rim with internal fixation, and their distal stumps were fixed to the end of the soft spaces with externalized percutaneous sutures. Surgical outcome was assessed by surgeons based on Hirmand’s grading system. Patients’ satisfaction and quality of life were measured using FACE-Q scales. Magnetic resonance imaging was employed to assess the long-term fate of the transposed fat. Results Tear trough deformities were eliminated in 86.7% of cases. Scores of lower eyelid FACE-Q decreased significantly (P &lt; 0.05). Patients demonstrated enhanced social confidence (P &lt; 0.05) and high satisfaction (74.3 ± 17.2) and were satisfied with their decision to undergo blepharoplasty (78.2 ± 18.7). Undercorrection occurred in 1 patient. Additional complications included transient granulomas, dye eye, unexplained swelling, and numbness, which resolved in all patients. Magnetic resonance imaging confirmed viability of the transposed fat within 6 to 8 months follow-up. Conclusions Transconjunctival fat repositioning, utilizing a combination of internal fixation and external fixation, is an effective approach to treat eye bags and tear trough deformities with good patient and surgeon satisfaction. Level of Evidence: 4

Treatment for Complex Elbow Fractures Involving Both a Hinged External Fixator and Internal Fixation

2021 ◽  
Author(s):  
Xiao He ◽  
Quan Fen ◽  
Jiarui Yang ◽  
Yutian Lei ◽  
Lisong Heng ◽  
...  
Keyword(s):  
Internal Fixation ◽  
External Fixation ◽  
External Fixator ◽  
Elbow Joint ◽  
Fracture Dislocation ◽  
Monteggia Fracture ◽  
Fixation Group ◽  
Elbow Fractures ◽  
Flexion Extension ◽  
Hinged External Fixator

Abstract PurposeTo explore the clinical outcomes of a hinged external fixator combined with internal fixation in treating complex elbow fractures.MethodsThis was a retrospective analysis of 42 cases of complex elbow fractures treated in our hospital from January 2015 to December 2019. Twenty-four cases were treated with a hinged external fixator combined with internal fixation (external fixation group), including 14 cases of the terrible triad of the elbow, 5 cases of posterior Monteggia fracture, and 5 cases of transolecranon fracture-dislocation. Eighteen cases were treated with adjustable brace fixation combined with internal fixation (brace group), including 11 cases of the terrible triad of the elbow, 3 cases of posterior Monteggia fracture and 4 cases of transolecranon fracture-dislocation. All patients were treated with open reduction and internal fixation, and the patients with postoperative elbow instability underwent fixation with a hinged external fixator or adjustable brace. Preoperative and surgical data were collected. At the last follow-up, elbow motion (extension-flexion, rotation) was recorded in the two groups of patients, and the Mayo Elbow Function Score (MEPS) was used to assess elbow joint function.ResultsAll patients were followed up for 12 to 55 months (mean 28.2 months). The bones healed in all patients with fractures; the healing time was 12.9±1.9 weeks for the external fixation group and 12.2±1.8 weeks for the brace group, and the difference was not statistically significant (P＞0.05). The average flexion-extension range of the elbow joint in the external fixation group was 128.8°±15.7°, the average rotation range of the forearm was 142.7° ± 21.5°, and the average MEPS score was 89.8±11.3 points (range 60-100 points); 14 cases were excellent, 7 cases were good, 2 cases were fair, and 1 case was poor. The excellent and good rate was 87.5%. In the brace group, the average flexion-extension range of the elbow joint was 110.3°±37.0°, the average rotation range of the forearm was 125.6°±30.5°, and the average MEPS score was 81.1±15.5 points (50-100 points); 8 cases were excellent, 5 cases were good, 2 cases were fair, and 3 cases were poor. The excellent and good rate was 72.2%. The difference between the two groups was statistically significant (P <0.05).ConclusionsThe combination of an external fixator and internal fixation in the treatment of unstable complex elbow fractures can better restore the stability and function of elbow joints than can adjustable brace fixation.

scholarly journals Open distal tibial pilon fractures treated with "one-stage" external fixation method

2015 ◽  
Vol 62 (1) ◽  
pp. 13-18
Author(s):  
Sasa Milenkovic ◽  
Milan Mitkovic ◽  
Milorad Mitkovic ◽  
Ivan Micic ◽  
Sonja Stamenic ◽  
...  
Keyword(s):  
Internal Fixation ◽  
External Fixation ◽  
Major Complication ◽  
Functional Results ◽  
High Energy ◽  
Fixation Method ◽  
Wound Irrigation ◽  
One Stage ◽  
Tibial Pilon ◽  
Pilon Fractures

Introdiction: Open distal tibial pilon fractures are considered as hard injuries, caused by high-energy axial load. Different treatment methods of these injuries are described in the literature. Authors of this paper are presenting own experience and results in the method of ?one-stage? external fixation with or without limited internal fixation of the fracture. Material and methods: All the patients had emergent surgical treatment in 4 to 8 hours after the hospitalisation. Surgical protocol included wound irrigation, debridement, fracture reduction and external fixation in type A fractures. Type B and type C fractures were treated by ?bridging? external fixation with limited internal fixation. In the cases where wound had not been possible to close primarily additional surgical procedures (soft tissue defects coverage) were performed. Results: Final functional outcome was excelent in 5(31,25%) patients, good in 6 (37,5%) patients, moderate in 3(18,75%) patients and bad in 2 (12,5%) patients (according Karlsson Score). Final anatomical and functional results were in correlation with the type of primary injury. One case of septic pseudoarthrosis and three cases of late ankle arthrosis were found as a major complication. Conclusion High-energy open distal tibial pilon fractures are still considered as a challange and significant surgical problem. The method of external fixation with or without limited internal fixation, as ?one-stage? method, was approved in clinical practice to give excelent and good final functional and anatomical results. Though final functional results were in correlation with degree of the injury, described method gives good outcome results and further clinical application will surely approve its clinical significance.

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.

Splinting vs temporary external fixation in the initial treatment of ankle fracture-dislocations

2021 ◽  
Author(s):  
Mehmet Ozbey Buyukkuscu ◽  
Seckin Basilgan ◽  
Ali Mollaomeroglu ◽  
Abdulhamit Misir ◽  
Hakan Basar
Keyword(s):  
External Fixation ◽  
Initial Treatment ◽  
Ankle Fracture ◽  
Fracture Dislocations
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