Management of high-energy tibial shaft fractures using the hexapod circular external fixator

Abstract Background The hexapod external fixator (HEF) is increasingly used for high-energy tibial shaft fracture care as more general orthopedic surgeons are gaining expertise of this versatile device. The purpose of this study was to evaluate the clinical effectiveness of the HEF for definitive management in patients with high-energy tibial shaft fractures. Methods The study was conducted on 34 patients with tibial shaft fractures who were admitted or referred to our institution and consented to HEF treatment from Jan 2016 to June 2019, including 27 males and 7 females with a mean age of 39 years (range 18 to 65 years). Patients' clinical and radiological data, and the final clinical outcomes at a minimum of 12 months follow-up were collected and retrospectively analyzed. All complications were documented according to Paley’s classification. The clinical outcomes were evaluated using the Association for the Study and Application of the Method of Ilizarov criteria (ASAMI) at the last clinical visit. Results All patients remained in the HEF for a mean of 26 weeks (range 15 to 52 weeks) and acquired complete bone union. The satisfactory alignment was achieved in all patients, and all the patients were able to perform daily activities with no difficulty at the last clinical visit. Complications included pin tract infection (44%), delayed union (6%), nonunion (3%), and joint stiffness (3%). The ASAMI bony result was excellent in 31 patients and good in 3. The ASAMI functional result was excellent in 27 patients, good in 6, and fair in 1. Conclusions Definitive management using the hexapod external fixator is an alternative and effective method for high-energy tibial shaft fractures, including technical advantages of early trauma-control, the versatility of achieving excellent alignment, and the continuity of device until bone union.

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Fracture Reduction and Definitive Management for Acute Tibial Shaft Fractures Using the Taylor Spatial Frame

10.21203/rs.3.rs-155611/v1 ◽

2021 ◽

Author(s):

Yanshi Liu ◽

Jialin Liu ◽

Maimaiaili Yushan ◽

Zhenhui Liu ◽

Tao Zhang ◽

...

Keyword(s):

Clinical Outcomes ◽

Taylor Spatial Frame ◽

Bone Union ◽

Fracture Reduction ◽

Tibial Shaft ◽

Clinical Visit ◽

Spatial Frame ◽

Shaft Fractures ◽

Definitive Management ◽

Tibial Shaft Fractures

Abstract Background: The Taylor spatial frame (TSF) is increasingly used for acute tibial shaft fracture care as more general orthopedic surgeons are gaining expertise of this versatile device. The purpose of this study was to evaluate the clinical effectiveness of the TSF for fracture reduction and definitive management in patients with acute tibial shaft fractures.Methods: The study was conducted on 34 patients with acute tibial shaft fractures who were admitted or referred to our institution and consented to TSF treatment from Jan 2016 to June 2019, including 27males and 7 females with a mean age of 39 years (range 18 to 65 years). Patients' clinical and radiological data, and the final clinical outcomes at a minimum of 12 months follow-up were collected and retrospectively analyzed. All complications were documented according to Paley’s classification. The clinical outcomes were evaluated using the Association for the Study and Application of the Method of Ilizarov criteria (ASAMI) at the last clinical visit.Results: All patients remained in the TSF for a mean of 26 weeks (range 15 to 52 weeks) and acquired complete bone union. The satisfactory alignment was achieved in all patients, and all the patients were able to perform daily activities with no difficulty at the last clinical visit. Complications included pin tract infection (44%), delayed union (6%), nonunion (3%), and joint stiffness (3%). The ASAMI bony result was excellent in 31 patients and good in 3. The ASAMI functional result was excellent in 27 patients, good in 6, and fair in 1. Conclusions: Fracture reduction and definitive management using the Taylor spatial frame is an alternative and effective method for acute tibial shaft fractures, including technical advantages of early trauma-control, ease of soft tissue care, the versatility of achieving excellent alignment, and the continuity of device until bone union.

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Intraoperative acute correction versus postoperative gradual correction for tibial shaft fractures with multiplanar posttraumatic deformities using the hexapod external fixator

10.21203/rs.3.rs-468930/v1 ◽

2021 ◽

Author(s):

Yanshi Liu ◽

Feiyu Cai ◽

Kai Liu ◽

Xingpeng Zhang ◽

Hong Li ◽

...

Keyword(s):

Clinical Outcomes ◽

External Fixator ◽

Demographic Data ◽

Tibial Shaft ◽

Gradual Correction ◽

Shaft Fractures ◽

Significant Difference ◽

Acute Correction ◽

Operation Duration ◽

Tibial Shaft Fractures

Abstract Background: The purpose of this study was to determine the differences in clinical outcomes, if any, between intraoperative acute correction and postoperative gradual correction for tibial shaft fractures with multiplanar posttraumatic deformities using the hexapod external fixator.Methods: We retrospectively analyzed 58 consecutive patients with tibial shaft fractures treated by the hexapod external fixator at our institution from January 2015 to April 2019. Twenty-three patients (Group Ⅰ) underwent intraoperative acute correction, from January 2015 to October 2016. Starting in November 2016, the other 35 patients (Group Ⅱ) all underwent postoperative gradual correction. The demographic data, operation duration, original residual deformities before correction, residual deformities after correction, and external fixation time were collected and analyzed. The clinical outcomes were evaluated by the Johner-Wruhs criteria at the last clinical visit.Results: All patients achieved complete bone union with a mean time of 28.7±4.6 weeks (range 21 to 37 weeks) in Group Ⅰ and 27.9±4.8 weeks (range 19 to 38 weeks) in Group Ⅱ (P>0.05). The operation duration in Group Ⅰ (88.9±7.7 minutes) was longer than that in Group Ⅱ (61.9±8.4 minutes), and there was a statistically significant difference (P<0.05). There were no statistically significant differences between the two groups in original residual deformities before correction and residual deformities after correction (P>0.05). The rate of postoperative complication was similar between the two groups. There was no statistical significance in demographic data and clinical outcomes between the two groups (P>0.05). Conclusions: There is no difference in clinical outcomes between intraoperative acute correction and postoperative gradual correction for tibial shaft fractures with multiplanar posttraumatic deformities using the hexapod external fixator. Postoperative gradual correction may shorten the duration in the operation room and decrease the potential intraoperative risk.

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Treatment of comminuted tibial shaft fractures in four dogs with the use of interlocking nail connected with type I external fixator

Polish Journal of Veterinary Sciences ◽

10.2478/v10181-012-0103-6 ◽

2012 ◽

Vol 15 (4) ◽

pp. 661-666

Author(s):

A. Piórek ◽

Z. Adamiak ◽

M. Jaskólska ◽

Y. Zhalniarovich

Keyword(s):

External Fixator ◽

Healing Process ◽

Clinical Treatment ◽

Bone Union ◽

Type I ◽

Tibial Shaft ◽

Interlocking Nail ◽

Fracture Stabilization ◽

Shaft Fractures ◽

Tibial Shaft Fractures

AbstractThe treatment of comminuted tibial shaft fractures in canine patients is burdened by significant risk which involves bone healing complications, such as delayed bone union. Complications may result from iatrogenic damage to blood vessels during fracture stabilization. To minimize this risk, treatment methods increasingly often rely on the concept of biological osteosynthesis. One of such methods involves the treatment of fractures with the use of new hybrid fixator consisted of an interlocking nail connected with type I external fixator. Connection of the nail with external fixator has been recently developed to maximize treatment efficiency. This manner of stabilization increases bone-fixator construct strength on forces acting in the place of fracture. It also enables fracture fixation with minimal damage of the blood supply of bone fragments. This article describes surgical procedure of stabilization of comminuted tibial bone fractures in four dogs by the use of interlocking nail connected with external fixator type I, discusses and evaluates the results of clinical treatment with the involvement of the said fixator. To control bone consolidation process the radiograms were taken in 6 and 8 week of healing.In all cases, the reviewed methods of clinical treatment were successful in producing bone union after eight week of healing. During the whole period of observations no complication was observed. In all cases the intramedullary nail were left in the medullary canal after the healing process was finished. The fixator supported quick restoration of limb function after treatment.

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Intraoperative acute correction versus postoperative gradual correction for tibial shaft fractures with multiplanar posttraumatic deformities using the hexapod external fixator

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04505-0 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Yanshi Liu ◽

Feiyu Cai ◽

Kai Liu ◽

Xingpeng Zhang ◽

Hong Li ◽

...

Keyword(s):

Clinical Outcomes ◽

External Fixator ◽

Demographic Data ◽

Tibial Shaft ◽

Gradual Correction ◽

Shaft Fractures ◽

Group I ◽

Acute Correction ◽

Group Ii ◽

Tibial Shaft Fractures

Abstract Background The purpose of this study was to determine the differences in clinical outcomes, if any, between intraoperative acute correction and postoperative gradual correction for tibial shaft fractures with multiplanar posttraumatic deformities using the hexapod external fixator. Methods We retrospectively analyzed 58 consecutive patients with tibial shaft fractures treated by the hexapod external fixator at our institution from January 2015 to April 2019. Twenty-three patients (Group I) underwent intraoperative acute correction, from January 2015 to October 2016. Starting in November 2016, the other 35 patients (Group II) all underwent postoperative gradual correction. The demographic data, operation duration, original residual deformities before correction, residual deformities after correction, and external fixation time were collected and analyzed. The clinical outcomes were evaluated by the Johner-Wruhs criteria at the last clinical visit. Results All patients achieved complete bone union with a mean time of 28.7 ± 4.6 weeks (range 21 to 37 weeks) in Group I and 27.9 ± 4.8 weeks (range 19 to 38 weeks) in Group II (P > 0.05). The operation duration in Group I (88.9 ± 7.7 min) was longer than that in Group II (61.9 ± 8.4 min), and there was a statistically significant difference (P < 0.05). There were no statistically significant differences between the two groups in original residual deformities before correction and residual deformities after correction (P > 0.05). The rate of postoperative complication was similar between the two groups. There was no statistical significance in demographic data and clinical outcomes between the two groups (P > 0.05). Conclusions There is no difference in clinical outcomes between intraoperative acute correction and postoperative gradual correction for tibial shaft fractures with multiplanar posttraumatic deformities using the hexapod external fixator. Postoperative gradual correction may shorten the duration in the operation room and decrease the potential intraoperative risk.

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High-Energy Tibial Shaft Fractures

Orthopedic Clinics of North America ◽

10.1016/s0030-5898(03)00081-6 ◽

2002 ◽

Vol 33 (1) ◽

pp. 211-230 ◽

Cited By ~ 23

Author(s):

Bruce French ◽

Paul Tornetta

Keyword(s):

High Energy ◽

Tibial Shaft ◽

Shaft Fractures ◽

Tibial Shaft Fractures

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External skeletal fixation of the tibial shaft fractures

Vojnosanitetski pregled ◽

10.2298/vsp0501011m ◽

2005 ◽

Vol 62 (1) ◽

pp. 11-15 ◽

Cited By ~ 2

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.

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Minimally invasive plate osteosynthesis for the treatment of high-energy tibial shaft fractures

The Egyptian Orthopaedic Journal ◽

10.4103/1110-1148.163124 ◽

2015 ◽

Vol 50 (1) ◽

pp. 36

Author(s):

AhmedSh Rizk

Keyword(s):

Minimally Invasive ◽

Plate Osteosynthesis ◽

High Energy ◽

Minimally Invasive Plate Osteosynthesis ◽

Tibial Shaft ◽

Shaft Fractures ◽

Tibial Shaft Fractures

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Factors affecting the fracture healing in treatment of tibial shaft fractures with circular external fixator

Injury ◽

10.1016/j.injury.2008.12.011 ◽

2009 ◽

Vol 40 (11) ◽

pp. 1151-1156 ◽

Cited By ~ 19

Author(s):

Kadir Bahadır Alemdaroğlu ◽

Uğur Tiftikçi ◽

Serkan İltar ◽

Nevres Hürriyet Aydoğan ◽

Talip Kara ◽

...

Keyword(s):

Fracture Healing ◽

External Fixator ◽

Tibial Shaft ◽

Factors Affecting ◽

Shaft Fractures ◽

Circular External Fixator ◽

Tibial Shaft Fractures

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Operative Choice for Open Tibial Shaft Fracture in Children: A Comparative Study of External Fixator Vs. Elastic Stable Intramedullary Nail

10.21203/rs.3.rs-628593/v1 ◽

2021 ◽

Author(s):

Pan Hong ◽

Saroj Rai ◽

Xin Tang ◽

Ruikang Liu ◽

Jin Li

Keyword(s):

Clinical Outcomes ◽

External Fixator ◽

Intramedullary Nail ◽

Shaft Fracture ◽

Tibial Fractures ◽

Tibial Shaft Fracture ◽

Tibial Shaft ◽

Elastic Stable Intramedullary Nail ◽

Open Tibial Fractures ◽

Significant Difference

Abstract IntroductionExternal fixator (EF) is a preferred choice for open tibial fractures, but pin tract infection (PTI) and refracture are common complications. Elastic stable intramedullary nail (ESIN) has been reported in the treatment for open tibial fractures. This study aims to compare the clinical outcomes of EF vs. ESIN in the treatment for open tibial shaft fracture in children retrospectively.Material and methodsPatients aged 5-11 years old with Gustilo-Anderson II and IIIA tibial shaft fracture treated at our institute from January 2008 to January 2018 were reviewed retrospectively and categorized into EF (n = 55) and ESIN (n = 37) group. Patients with pathological fracture, neuromuscular disorder, metabolic disease, previous tibial fracture or instrumentation, and polytrauma were excluded. Patients with follow up less than 24 months or incomplete medical records were also excluded. ResultsIn all, fifty-five patients (33 males, 22 females) were included in the EF group, whereas 37 patients (21 males, 16 females) were included in the ESIN group. There was no significant difference between the two groups concerning sex, age, body weight, duration from injury to surgery, Gustilo-Anderson (GA) classification, and concomitant injuries. There was no patient of nonunion and malunion in either group. The incidence of implant prominence was higher in the ESIN group (16%) than those in the EF group (0), P < 0.001. The angulation was higher in the EF group than ESIN group in coronal and sagittal plane, P < 0.001. The radiological union was faster in the ESIN group (7.0 ± 0.9, weeks) than those in the EF group (9.0 ± 2.2), P < 0.001. Limb length discrepancy (LLD) was significantly longer in the EF group (12.1 ± 4.4, mm) than those in the ESIN group (7.3 ± 4.3, mm), P < 0.001. ConclusionESIN is a viable option in selected patients of GA grade II and IIIA open tibial fractures with comparable clinical outcomes as external fixator, but with less complications including superficial infection, residual angulation and refracture after hardware removal.

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COMPARISON OF EFFECTS OF DIFFERENT NAIL TIP POSITIONS ON ANTERIOR KNEE PAIN AFTER INTRAMEDULLARY INTERLOCKING NAILING FOR TIBIAL SHAFT FRACTURES

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v6i6.7198 ◽

2021 ◽

Vol 71 (6) ◽

pp. 1950-53

Author(s):

Muhammad Hassan ◽

Adnan Anwar ◽

Hassan Udin Hassan ◽

Muhammad Rehan Saleem ◽

Usman Arif

Keyword(s):

Knee Pain ◽

Anterior Knee Pain ◽

Military Hospital ◽

Tibial Shaft Fracture ◽

Tibial Shaft ◽

Anterior Cortex ◽

Interlocking Nailing ◽

Shaft Fractures ◽

Anterior Knee ◽

Tibial Shaft Fractures

Objective: To determine the frequency of anterior knee pain after intramedullary interlocking nailing in tibial shaft fractures and to compare the intensity of anterior knee pain between positive and negative anterior cortex nail groups.Study Design: Quasi-experimental study. Place and Duration of Study: Department of Orthopaedic Surgery, Combined Military Hospital Rawalpindi, from Oct 2018 to Apr 2019. Methodology: 100 cases of tibial shaft fracture were divided into two groups according to anterior cortex nail distance. Patients 18-40 years of age of both genders, closed fractures, Gustilo Andersen I open tibial diaphyseal fractures and nail tip more than 5mm from tibial tuberosity were included. Patients with osteoarthritis, pathological fractures, renal disease, open fracture GA-II & GA-III and knee instability were excluded from the study. Both groups with positive and negative anterior cortex nail distance were compared for pain using the chi-square test. Results: Frequency of anterior knee pain after intramedullary interlocking nailing in tibial shaft fractures was found in 24% of patients. 8 (16%) out of 50 patients in the group with nail tip deep to anterior cortex had anterior knee pain while 16 (32%) out of 50 patients in the group with nail tip protruding from anterior cortex suffered anterior knee pain (p-value = 0.061). Conclusion: Intramedullary interlocking nailing in tibial shaft fractures with nail tip deep to anterior cortex showed less pain as compared to nail tip protruding from anterior cortex although it was not statistically significant.

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