Improving postoperative radiographs for the parameter measurement of hexapod external fixator using an additional foot ring

Abstract Background It is challenging to determine the orthogonality of radiographs in daily clinical practice. The purpose of this study was to show the usefulness of an additional foot ring which might determine the orthogonality of postoperative radiographs for the parameter measurement of hexapod external fixator. Methods We retrospectively analyzed 81 consecutive trauma patients with tibial shaft fractures treated by the hexapod external fixator at our institution from September 2014 to July 2019. Starting in March 2016, the postoperative radiographs for parameter measurement were obtained under the control of an additional foot ring. The final data consisted of 47 patients in traditional radiographs (Group I) and 34 patients under the control of foot ring during the radiographic process (Group II). The demographic data, original postoperative deformities, residual deformities after final correction, number of repeated radiographs after the first postoperative radiographs, time to the satisfactory reduction achieved, and external fixation time in all patients were documented and analyzed. The Johner–Wruhs criteria were used for the final clinical outcomes evaluation at the last clinical visit. Results Satisfactory reduction and bone union were achieved in all patients. There were no statistical significances between the two groups in the demographic data, original postoperative deformities, residual deformities after final correction, external fixation time, and the final clinical outcomes (P > 0.05). The mean number of repeated radiographs after the first radiographs (1.4 times) and mean time to the satisfactory reduction achieved (3.3 days) in patients with an additional foot ring used were all less than those without foot ring (2.4 times, 5.3 days) (P < 0.05). Conclusions The additional foot ring is a practical device to ensure the orthogonality of postoperative radiographs for the hexapod external fixator parameter measurement. Radiation exposure, duration of deformity correction, and cost for patients might be reduced due to the less repeated radiographs with the wrong position.

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Improving postoperative radiographs for the parameter measurement of hexapod external fixator using an additional foot ring

10.21203/rs.3.rs-871693/v1 ◽

2021 ◽

Author(s):

Yanshi Liu ◽

Kai Liu ◽

Feiyu Cai ◽

Tao Zhang ◽

Aihemaitijiang Yusufu

Keyword(s):

External Fixation ◽

Clinical Outcomes ◽

External Fixator ◽

Demographic Data ◽

Deformity Correction ◽

Parameter Measurement ◽

Fixation Time ◽

Trauma Patients ◽

Outcomes Evaluation ◽

Mean Time

Abstract Background It is challenging to determine the orthogonality of radiographs in daily clinical practice. The purpose of this study was to show the usefulness of an additional foot ring which might determine the orthogonality of postoperative radiographs for the parameter measurement of hexapod external fixator. Methods We retrospectively analyzed 81 consecutive trauma patients with tibial shaft fractures treated by the hexapod external fixator at our institution from September 2014 to July 2019. Starting in March 2016, the postoperative radiographs for parameter measurement were obtained under the control of an additional foot ring. The final data consisted of 47 patients in traditional radiographs (Group Ⅰ) and 34 patients under the control of foot ring during the radiographic process (Group Ⅱ). The demographic data, original postoperative deformities, residual deformities after final correction, number of repeated radiographs after the first postoperative radiographs, time to the satisfactory reduction achieved, and external fixation time in all patients were documented and analyzed. The Johner-Wruhs criteria were used for the final clinical outcomes evaluation at the last clinical visit. Results Satisfactory reduction and bone union were achieved in all patients. There were no statistical significances between the two groups in the demographic data, original postoperative deformities, residual deformities after final correction, external fixation time, and the final clinical outcomes (P > 0.05). The mean number of repeated radiographs after the first radiographs (1.4 times) and mean time to the satisfactory reduction achieved (3.3 days) in patients with an additional foot ring used were all less than those without foot ring (2.4 times, 5.4 days) (P < 0.05). Conclusions The additional foot ring is a practical device to ensure the orthogonality of postoperative radiographs for the hexapod external fixator parameter measurement. Radiation exposure, duration of deformity correction, and cost for patients might be reduced due to the less repeated radiographs with the wrong position.

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Improving Postoperative Radiographs for the Correction Planning of Hexapod External Fixator Using an Additional Foot Ring

10.21203/rs.3.rs-703882/v1 ◽

2021 ◽

Author(s):

Yanshi Liu ◽

Kai Liu ◽

Feiyu Cai ◽

Xingpeng Zhang ◽

Hong Li ◽

...

Keyword(s):

External Fixation ◽

External Fixator ◽

Demographic Data ◽

Deformity Correction ◽

Radiological Examination ◽

Fixation Time ◽

Trauma Patients ◽

X Rays ◽

Examination Time ◽

Mean Time

Abstract Background: It is challenging to determine the orthogonality of radiographs in daily clinical practice. The purpose of this study was to show the usefulness of an additional foot ring which might determine the orthogonality of postoperative radiographs for the correction planning of hexapod external fixator.Methods: We retrospectively analyzed 81 consecutive trauma patients with tibial shaft fractures treated by the hexapod external fixator at our institution from September 2014 to July 2019. Starting in March 2016, the postoperative radiographs for fracture reduction planning were obtained under the control of an additional foot ring. In this simple way, the radiologist and the patient himself can easily control the rotation position of the limb while taking the radiographs, and the two X-rays are orthogonal to each other. The final data consisted of 47 patients in traditional radiographs (Group Ⅰ) and 34 patients under the control of foot ring during the radiographic process (Group Ⅱ). The demographic data, original postoperative deformities, number of repeated radiographs after the first postoperative radiological examination, time to the satisfactory reduction achieved, and external fixation time in all patients were documented and analyzed.Results: Satisfactory reduction and bone union were achieved in all patients. There were no statistical significances between the two groups in the demographic data, original postoperative deformities, and external fixation time (P>0.05). The mean number of repeated radiographs after the first postoperative radiological examination (1.2 times) and mean time to the satisfactory reduction achieved (3.0 days) in patients with an additional foot ring used were all less than that (2.1 times, 5.3 days) in patients without foot ring (P<0.05).Conclusions: The additional foot ring is a practical device to ensure the orthogonality of postoperative radiographs for the correction planning of hexapod external fixator. Radiation exposure, duration of deformity correction, and cost for patients might be reduced due to the less repeated radiographs with the wrong position.

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Staged correction trajectory with hexapod external fixator for the satisfactory reduction of acute long bone shaft fracture

10.21203/rs.3.rs-864527/v1 ◽

2021 ◽

Author(s):

Yanshi Liu ◽

Fei Wang ◽

Kai Liu ◽

Feiyu Cai ◽

Xingpeng Zhang ◽

...

Keyword(s):

External Fixation ◽

Clinical Outcomes ◽

External Fixator ◽

Demographic Data ◽

Deformity Correction ◽

Shaft Fracture ◽

Long Bone ◽

Fixation Time ◽

Before And After ◽

One Step

Abstract Backgroud: When deformity correction and fracture reduction are conducted in acute long bone shaft fracture using the hexapod external fixator, the collision and interference between the irregular bony end in the reduction process often result in an incomplete reduction and a time-consuming procedure. The purpose of this study was to present and determine the clinical effectiveness of staged correction trajectory with hexapod external fixator for the satisfactory reduction of acute long bone shaft fracture. Methods A total of 57 patients with acute tibial shaft fractures consented to hexapod external fixator treatment in our institution were retrospectively analyzed from June 2016 to February 2020. Thirty-one cases (Group Ⅰ) underwent a conventional one-step reduction trajectory from June 2016 to July 2018. Starting in September 2018, the other twenty-six patients (Group Ⅱ) all underwent staged correction trajectory (three key points reduction trajectory of “extension-rotation-reduction”). The demographic data, residual deformities before and after correction, number of repeated radiographs after the first postoperative radiograph, duration of deformity correction, and external fixation time were documented and analyzed. At the last clinical visit, the Johner-Wruhs criteria were used to evaluate the final clinical outcomes. Results All the 57 patients achieved satisfactory fracture reduction and bone union. There were no statistically significant differences between the two groups in demographic data, residual deformities before and after correction, external fixation time, and final clinical outcomes (P > 0.05). The average number of repeated radiographs after the first postoperative radiograph and mean duration of deformity correction in Group Ⅱ (1.3 times, 2.9 days) were all less than those in Group Ⅰ (2.3 times, 5.1 days) (P < 0.05). Conclusion Compared with the conventional one-step reduction trajectory, there are no statistically significant differences in the final clinical outcomes, but the staged correction trajectory is a superior method with the advantages of less repeated radiographs and reduction duration.

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Clinical Outcomes in the Definitive Treatment of High-energy Tibial Diaphyseal Fractures using Hexapod External Fixator Versus Monolateral External Fixator

10.21203/rs.3.rs-574309/v1 ◽

2021 ◽

Author(s):

Yanshi Liu ◽

Kai Liu ◽

Feiyu Cai ◽

Xingpeng Zhang ◽

Hong Li ◽

...

Keyword(s):

External Fixation ◽

Clinical Outcomes ◽

External Fixator ◽

High Energy ◽

Definitive Treatment ◽

Fixation Time ◽

Significant Difference ◽

Diaphyseal Fractures ◽

Monolateral External Fixator ◽

Surgical Duration

Abstract Background: External fixation, which can preserve the biomechanical microenvironment of fracture healing, playing an important role in managing the high-energy fractures with poor surrounding soft tissues. The purpose of this study was to determine the differences of clinical outcomes, if any, between hexapod external fixator and monolateral external fixator in the definitive treatment of high-energy tibial diaphyseal fractures.Methods: A total of 53 patients with high-energy tibial diaphyseal fractures and definitively treated by the hexapod external fixator (HEF) or monolateral external fixator (MEF) were retrospectively collected and analyzed, from March 2015 to June 2019. There were 31 patients in the HEF treatment, and the other 22 patients were managed by the MEF. The demographic data, surgical duration, external fixation time, final radiological results, complications, and clinical outcomes were documented and analyzed. Difficulties that occur during the treatment were classified according to Paley. The clinical outcomes were evaluated by the Association for the Study and Application of the Method of Ilizarov criteria (ASAMI) at the last clinical visit.Results: The mean surgical duration in the HEF group (62.4±8.3 minutes) was shorter than that in the MEF group (91.4±6.9 minutes) (P<0.05). All patients acquired complete bone union finally. Patients in the HEF group (24.2±3.1 weeks) underwent a shorter average external fixation time than that in the MEF group (26.3±3.8 weeks) (P<0.05). Satisfactory alignment was achieved in all patients without the need for remanipulation. The residual sagittal plane deformities in the HEF group were all less than that in the MEF group (P<0.05). The complication rate was 35.5% in the HEF group, while 45.5% in the MEF group. There was no statistically significant difference between the two groups in ASAMI scores (P>0.05).Conclusion: There is no statistically significant difference in finally clinical outcomes between hexapod external fixator and monolateral external fixator in the definitive treatment of high-energy tibial diaphyseal fractures. The hexapod external fixation treatment is a superior effective method, including advantages of stable fixation, less surgical duration, postoperatively satisfactory fracture reduction, and fewer complications.

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External fixation via the anterior inferior iliac spine for proximal femoral fractures in young patients

Open Medicine ◽

10.1515/med-2021-0295 ◽

2021 ◽

Vol 16 (1) ◽

pp. 1101-1108

Author(s):

Qing Yang ◽

Nong Chen ◽

Wenqin Fu

Keyword(s):

External Fixation ◽

Clinical Outcomes ◽

Acute Treatment ◽

Reduction Rate ◽

Young Patients ◽

Harris Hip Score ◽

Fixation Time ◽

Trauma Patients ◽

Anterior Inferior Iliac Spine ◽

The Mean

Abstract Background and aim Acute treatment of young patients with proximal femoral fracture (PFF) remains a challenge for trauma surgeons due to major fracture displacement and heavy pain in clinical practice. Traditional methods have a variety of intrinsic defaults and cannot successfully manage the requirements of young patients. Benefiting from our anatomic research, we explored a new method of external fixation for this specific trauma and evaluated its feasibility and clinical outcomes. Material and methods Twenty-three young multiple-trauma patients with PFF were included in this study. Surgical treatment was applied using an external fixator via the anterior inferior iliac spine (AIIS). Electronic patient records, surgical characteristics, clinical outcomes, and complications were reviewed for each patient. Results The mean surgical time was 30.3 ± 7.3 min. The mean blood loss was 25.3 ± 10.8 mL. No iatrogenic nerve palsy, pin tract infection, failure of external fixation, or bedsores were observed. The postoperative visual analog scale score was significantly lower than the preoperative score (P < 0.01). The mean fracture reduction rate of the femur was 58.1 ± 17.0%, and the mean degree of reduction was 13.5 ± 6.9°. The mean external fixation time was 7.6 ± 4.0 days and intramedullary nailing was performed. The mean hospital, follow-up, and healing times were 28.7 ± 8.7 days, 23.5 ± 7.9 months, and 22.8 ± 5.7 weeks, respectively. The Harris Hip Score indicated excellent or good results in 20 patients. Conclusion Collectively, the results of this study revealed that external fixation via the AIIS is a safe, rapid, and effective method for acute treatment of PFF in young patients.

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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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Femoral Reconstruction Using External Fixation

Advances in Orthopedics ◽

10.4061/2011/967186 ◽

2011 ◽

Vol 2011 ◽

pp. 1-10 ◽

Cited By ~ 12

Author(s):

Yevgeniy Palatnik ◽

S. Robert Rozbruch

Keyword(s):

External Fixation ◽

External Fixator ◽

Deformity Correction ◽

Orthopedic Procedures ◽

Entire Group ◽

Fixation Time ◽

Limb Alignment ◽

Length Discrepancy ◽

Wide Range ◽

Femoral Reconstruction

Background. The use of an external fixator for the purpose of distraction osteogenesis has been applied to a wide range of orthopedic problems caused by such diverse etiologies as congenital disease, metabolic conditions, infections, traumatic injuries, and congenital short stature. The purpose of this study was to analyze our experience of utilizing this method in patients undergoing a variety of orthopedic procedures of the femur.Methods. We retrospectively reviewed our experience of using external fixation for femoral reconstruction. Three subgroups were defined based on the primary reconstruction goal lengthening, deformity correction, and repair of nonunion/bone defect. Factors such as leg length discrepancy (LLD), limb alignment, and external fixation time and complications were evaluated for the entire group and the 3 subgroups.Results. There was substantial improvement in the overall LLD, femoral length discrepancy, and limb alignment as measured by mechanical axis deviation (MAD) and lateral distal femoral angle (LDFA) for the entire group as well as the subgroups.Conclusions. The Ilizarov external fixator allows for decreased surgical exposure and preservation of blood supply to bone, avoidance of bone grafting and internal fixation, and simultaneous lengthening and deformity correction, making it a very useful technique for femoral reconstruction.

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Reconstruction of Long Segmental Tibial Bone Defects Caused by Infection using the Bifocal or Trifocal Bone Transport Technique with Monolateral Rail External Fixator

10.21203/rs.3.rs-506513/v1 ◽

2021 ◽

Author(s):

Alimujiang Abulaiti ◽

Yanshi Liu ◽

Feiyu Cai ◽

Kai Liu ◽

Abulaiti Abula ◽

...

Keyword(s):

External Fixation ◽

External Fixator ◽

Demographic Data ◽

Bone Defects ◽

Bone Transport ◽

Fixation Index ◽

Fixation Time ◽

Tibial Bone ◽

Operation Duration ◽

Transport Technique

Abstract Background: The purpose of this study was to evaluate the clinical effectiveness and determine the differences, if any, between trifocal and bifocal bone transport technique in the reconstruction of long segmental tibial bone defects caused by infection using a monolateral rail external fixator. Methods: A total of 53 consecutive patients with long segmental tibial bone defects caused by infection and treated by monolateral rail external fixator in our department were retrospectively collected and analyzed from January 2013 to April 2019, including 39 males and 14 females with an average age of 38.8±12.4 years (range 19 to 65 years). 32 patients were treated by bifocal bone transport (BFT) technique, and the other 21 patients were managed by trifocal bone transport (TFT) technique. The demographic data, operation duration, docking time, external fixation time, and external fixation index were documented and analyzed. Difficulties that occur during the treatment were classified according to Paley. The clinical outcomes were evaluated by the Association for the Study and Application of the Method of Ilizarov criteria (ASAMI) at the last clinical visit.Results: All patients achieved an infection-free union finally, and there was no significant difference between the two groups in demographic data and both ASAMI bone and functional scores (P>0.05). The mean defect size and operation duration in TFT (9.4±1.5 cm, 161.9±8.9 minutes) were larger than that in BFT (7.8±1.8 cm, 122.5±11.2 minutes) (P<0.05). The mean docking time, external fixation time, and external fixation index in TFT (65.9±10.8 days, 328.0±57.2 days, 34.8±2.1 days/cm) were all less than those in BFT (96.8±22.6 days, 474.5±103.2 days, 60.8±1.9 days/cm) (P<0.05). Difficulties and complications were more prevalent in the BFT group, while less in the TFT group (P<0.05). Conclusions: Both the trifocal and bifocal bone transport technique in the reconstruction of long segmental tibial bone defects caused by infection using a monolateral rail external fixator achieve satisfactory clinical outcomes. The trifocal bone transport technique can significantly decrease the docking time, external fixation time, external fixation index, difficulties, and complications compared with the bifocal bone transport technique.

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Bone Defects in Tibia Managed by the Bifocal Versus Trifocal Bone Transport Technique

10.21203/rs.3.rs-985713/v1 ◽

2021 ◽

Author(s):

Alimujiang Abulaiti ◽

Yanshi Liu ◽

Feiyu Cai ◽

Kai Liu ◽

Abulaiti Abula ◽

...

Keyword(s):

External Fixation ◽

External Fixator ◽

Demographic Data ◽

Bone Defects ◽

Bone Transport ◽

Fixation Index ◽

Fixation Time ◽

Tibial Bone ◽

Operation Duration ◽

Transport Technique

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Operative Choice for Displaced Proximal Humeral Fractures in Adolescents with Open Visible Physis: A Comparative Study of External Fixator vs. Kirschner Wire

10.21203/rs.3.rs-33678/v1 ◽

2020 ◽

Author(s):

Pan Hong ◽

Saroj Rai ◽

Huabing Qian ◽

Ruikang Liu ◽

Jin Li

Keyword(s):

Clinical Outcomes ◽

External Fixator ◽

Operative Time ◽

Rating Scale ◽

Demographic Data ◽

Kirschner Wire ◽

Humeral Fracture ◽

Good Choice ◽

Proximal Humeral Fractures ◽

Humeral Fractures

Abstract Background: For adolescents of severely displaced proximal humeral fracture (PHF), surgery is a good choice yielding excellent outcomes. Kirchner wire (KW) is a cost-effective choice for fixation, and this study aims to compare the clinical outcomes of external fixator (EF) vs. KW for the treatment of PHF in adolescents. To the best of our knowledge, it is the first report on external fixator for PHF in children and adolescents.Methods: Patients of PHF operated in our institute, from January 2008 to January 2016, were reviewed retrospectively. Demographic data, including sex, age at the time of surgery, operated side, and hardware choice, were collected from the hospital database. Preoperative radiographs were reviewed and classified according to Neer-Horwitz classification. Shoulder function was evaluated during 12th month follow-up using rating scale of the American shoulder and elbow surgeons (ASES). Complications, including infection, malunion, nonunion, stiffness of the shoulder joint, and failure of fixation were also recorded.Results: Thirty-five patients, including 23 males and 12 females, were included in the EF group, whereas 40 patients, including 25 males and 15 females, were included in the KW group (P = 0.867). The average age of patients in the EF group was 13.3 ± 1.7 years, and that of KW was 13.6 ± 1.8 years (P = 0.409). Patients in both groups were followed-up for at least 12 months. The operative time in the EF group (42.4 ± 11.2, min) was significantly shorter than those in the KW group (54 ± 13.6, min), P < 0.001. The frequency of fluoroscopy in the EF group (12 ± 2.4) was significantly less than those in the KW group (17 ± 2.8), P < 0.001. The rate of open reduction was significantly higher in KW (35%) group than those in the EF group (0%), P < 0.001. There was no nonunion, malunion cases in both groups.Conclusion: External fixator is superior to Kirschner wire in the treatment of proximal humeral fractures in adolescents with shorter operative time, lower rate of ORIF and comparable clinical outcomes.

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