scholarly journals Study on the relationship between the timing of conversion from external fixation to internal fixation and infection in the treatment of open fractures of extremities

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Zelin Ye ◽  
Shanwen Zhao ◽  
Canjun Zeng ◽  
Ziheng Luo ◽  
Song Yuan ◽  
...  
Keyword(s):  
Internal Fixation ◽  
External Fixation ◽  
External Fixator ◽  
Soft Tissues ◽  
Open Fractures ◽  
External Fixators ◽  
Type I ◽  
Infection Rates ◽  
Local Conditions ◽  
The Relationship

Abstract Objective To investigate the relationship between the infection rate and the timing of replacement of temporary external fixators with internal fixation, and the timing of immediate or delayed internal fixation after removal of temporary external fixation in the staging treatment modality of open fractures of extremities. Methods A retrospective analysis was performed on 122 cases of open fractures of extremities. External fixators were applied at the early stage and replaced with internal fixation when the condition of soft tissues improved and inflammatory indexes dropped to the normal range or showed a steady downward trend. Depending on the carrying time of external fixators after wound closure or healing, the patients were divided into three groups; the carrying time of groups A, B, and C was ≤ 14 days, 15–28 days, and > 28 days, respectively. Depending on the immediate or delayed internal fixation after removal of external fixator, patients were divided into group a (immediate internal fixation after removal of external fixator) and group b (delayed internal fixation after removal of external fixator, 5–7 days later). Results The infection rates of groups A, B, and C were 6.5%, 5.9%, and 23.3%, respectively. The differences among the three groups were statistically significant (P < 0.05). The infection rates of different Gustilo–Anderson fractures were as follows: no cases of infection out of 10 cases with type I fracture (0%); two cases of infection out of 35 cases with type II fracture (5.7%); three cases of infection out of 36 cases with IIIa fracture (8.3%); five cases of infection out of 28 cases with IIIB fracture (17.9%); and five cases of infection out of 13 cases with IIIC fracture (38.5%). The differences among the five groups were statistically significant. Conclusions The occurrence of infection of open fractures of extremities is associated with the fracture severity (Gustilo classification). For open fractures of Gustilo types I and II, the final internal fixation should be placed as soon as possible when the recovery of general and local conditions is good and the infection is controlled.

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.

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.

Methyl methacrylate in external fixation of supracondylar humerus fractures: An experimental study

2018 ◽  
Vol 232 (10) ◽  
pp. 1025-1029
Author(s):  
Ali Güleç ◽  
Mehmet Ali Acar ◽  
Bahattin Kerem Aydin ◽  
Teyfik Demir ◽  
Mustafa Özkaya
Keyword(s):  
Methyl Methacrylate ◽  
External Fixation ◽  
External Fixator ◽  
External Fixators ◽  
Three Point Bending ◽  
Fixation Methods ◽  
Supracondylar Humerus Fractures ◽  
Methacrylate Group ◽  
Humerus Fractures ◽  
K Wires

Supracondylar humerus fractures are common fractures around the elbow. Open fractures, comminuted metaphyseal fractures and also fractures with bone loss may need to be treated with external fixators. The aim of this study is to compare two different external fixators, tubular external fixators and polymethyl methacrylate with K wires external fixators, with regard to stiffness and stability for metaphyseal-diaphyseal osteotomies of distal humerus close to the joint. Six matched pairs (24 specimens) of second-generation sawbone humerus were prepared in a standard fashion to create a metaphyseal fracture, 5 cm proximal to the distal joint line of humerus and were randomly divided into two groups of 12 specimens each. Each sawbone humerus was osteotomized transversely at the mid-olecranon fossa with a 2-mm oscillating saw to simulate a Gartland type III fracture. The osteotomy was then reduced and stabilized using two different external fixation methods: carbon tubular external fixator with Schanz screws and methyl methacrylate with multiple K wires. Three-point bending and torsion tests were performed on the specimens. Bending and torsional stiffness of specimens were obtained for the fixation methods. According to the results of the study, the methyl methacrylate group has provided higher stiffness than classical tubular fixator with Schanz screws in three-point bending test (7.79 ± 2.33 N/mm vs 3.78 ± 1.18 N/mm, p = 0.006). The methyl methacrylate group also showed better stiffness in torsion test (0.12 ± 0.042 N m/° vs 0.067 ± 0.013 N m/°, p = 0.02). We determined for the first time in literature that external fixation with methyl methacrylate was significantly superior to the classical tubular external fixator with Schanz screws with regard to stiffness and stability under three-point bending and torsional loads. Moreover, methyl methacrylate is inexpensive and easily applied.

scholarly journals Can a linear external fixator stand as a surgical alternative to open reduction in treating a high-grade supracondylar humerus fracture?

2018 ◽  
Vol 47 (1) ◽  
pp. 133-141
Author(s):  
Barak Rinat ◽  
Eytan Dujovny ◽  
Noam Bor ◽  
Nimrod Rozen ◽  
Guy Rubin
Keyword(s):  
Internal Fixation ◽  
External Fixation ◽  
External Fixator ◽  
Closed Reduction ◽  
Open Reduction ◽  
High Grade ◽  
Supracondylar Humerus Fractures ◽  
Long Term Follow Up ◽  
Humerus Fractures ◽  
Carrying Angle

Objective High-grade pediatric supracondylar humerus fractures are commonly treated with closed reduction and internal fixation with percutaneous pinning. When this fails, open reduction followed by internal fixation is the widely accepted procedure of choice. Use of a lateral external fixator was recently described as an optional procedure, but evidence is scarce. Methods We investigated the outcomes of upper limbs treated by either open reduction with internal fixation or closed reduction and external fixation. Results Twenty-one patients completed the long-term follow-up; 11 underwent open reduction, and 10 underwent external fixation. Most patients in both groups reported excellent satisfaction. In both groups, the modified Disabilities of the Arm, Shoulder, and Hand score was extremely low and the average elbow range of motion was almost identical. Radiographic analysis consisting of Baumann’s angle and the carrying angle revealed no statistical difference between the two groups. Discussion Optional treatment using a linear external fixator for complex nonreducible supracondylar humerus fractures yielded acceptable clinical and radiographic results, as with open reduction. Our sample size was small, but the promising results may assist in the implementation of an alternative surgical procedure, especially in more complicated cases involving flexion-type fractures or severe soft tissue damage and swelling.

scholarly journals Low cost 3D printed clamps for external fixator for developing countries: a biomechanical study

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Felix J. Landaeta ◽  
Jose Nauaki Shiozawa ◽  
Arthur Erdman ◽  
Cara Piazza
Keyword(s):  
Developing Countries ◽  
External Fixation ◽  
Axial Compression ◽  
External Fixator ◽  
Low Cost ◽  
Biomechanical Properties ◽  
External Fixators ◽  
The Novel ◽  
Astm Standard ◽  
3D Printed

Abstract Background External fixation is a mainstream limb reconstruction technique, most often used after a traumatic injury. Due to the high rates of trauma in developing countries, external fixation devices are often utilized for immediate fracture stabilization and soft tissue repair. Proper external fixation treatment too often still fails to be adopted in these regions due to the high cost and trauma complexity. A novel, inexpensive, unilateral fixator was constructed using 3D printed clamps and other readily available supporting components. ASTM standard F1541 tests were used to assess the biomechanical properties of this novel external fixator. Methods Applicable sections of ASTM standard F1541 were used to determine the biomechanical properties of the novel external fixator. 3D printed clamps modeled using SolidWorks and printed with chopped carbon fibers using a fuse deposition modeling (FDM) based 3D printer by Markforged (Boston, MA) were used. This study included 3 different testing configurations: axial compression, anterior-posterior (AP) bending, and medial-lateral (ML) bending. Using the novel unilateral fixator with 3D printed clamps previously sterilized by autoclave, an input load was applied at a rate of 20 N/s, starting at 0 N via a hydraulic MTS tester Model 359. Force and deformation data were collected at a sampling rate of 30 Hz. There was a load limit of 750 N, or until there was a maximum vertical deformation of 6 mm. Also, 4 key dimensions of the 3D printed clamps were measured pre and post autoclave: diameter, width, height and length. Results The novel external fixator had axial compression, AP and ML bending rigidities of 246.12 N/mm (σ = 8.87 N/mm), 35.98 N/mm (σ = 2.11 N/mm) and 39.60 N/mm (σ =2.60 N/mm), respectively. The 3D printed clamps shrunk unproportionally due to the autoclaving process, with the diameter, width, height and length dimensions shrinking by 2.6%, 0.2%, 1.7% and 0.3%, respectively. Conclusion Overall, the biomechanical properties of the novel fixator with 3D printed clamps assessed in this study were comparable to external fixators that are currently being used in clinical settings. While the biomechanics were comparable, the low cost and readily available components of this design meets the need for low cost external fixators in developing countries that current clinical options could not satisfy. However, further verification and validation routines to determine efficacy and safety must be conducted before this novel fixator can be clinically deployed. Also, the material composition allowed for the clamps to maintain the appropriate shape with minimal dimensional shrinkage that can be accounted for in clamp design.

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.

scholarly journals Optimization of a Patient-Specific External Fixation Device for Lower Limb Injuries

Polymers ◽  
2021 ◽  
Vol 13 (16) ◽  
pp. 2661
Author(s):  
Mohammed S. Alqahtani ◽  
Abdulsalam Abdulaziz Al-Tamimi ◽  
Mohamed H. Hassan ◽  
Fengyuan Liu ◽  
Paulo Bartolo
Keyword(s):  
Topology Optimization ◽  
External Fixation ◽  
Polylactic Acid ◽  
External Fixator ◽  
Bone Fractures ◽  
Healing Process ◽  
Patient Specific ◽  
External Fixators ◽  
Fixation Devices ◽  
Limb Injuries

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.

scholarly journals Surgical treatment of tibial nonunion after wounding by high velocity missile and external fixators: A case report

2012 ◽  
Vol 140 (7-8) ◽  
pp. 515-520
Author(s):  
Ivan Golubovic ◽  
Zoran Vukasinovic ◽  
Predrag Stojiljkovic ◽  
Zoran Golubovic ◽  
Danilo Stojiljkovic ◽  
...  
Keyword(s):  
External Fixation ◽  
External Fixator ◽  
High Velocity ◽  
Primary Treatment ◽  
External Fixators ◽  
Risk Of Infection ◽  
Tissue Destruction ◽  
Reconstructive Operations ◽  
Delayed Healing ◽  
Tibial Nonunion

Introduction. The missiles of modern firearms can cause severe fractures of the extremity. High velocity missile fractures of the tibia are characterized by massive tissue destruction and primary contamination with polymorphic bacteria. Treatment of these fractures is often complicated by delayed healing, poor position healing, nonhealing and bone tissue infection. Case Outline. We present the management of tibial nonunion after wounding by high velocity missile and primary treatment by external fixation in a 25-year-old patient. The patient was primarily treated with external fixation and reconstructive operations of the soft tissue without union of the fracture. Seven months after injury we placed a compression-distraction external fixator type Mitkovic and started with compression and distraction in the fracture focus after osteotomy of the fibula and autospongioplasty. We recorded satisfactory fracture healing and good functional outcome. Conclusion. Contamination and devitalization of the softtissue envelope increase the risk of infection and nonunion in fractures after wounding by high velocity missile. The use of the compression-distraction external fixator type Mitkovic may be an effective method in nonunions of the tibia after this kind of injury.

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