scholarly journals The Axial Load-Share Ratio in Vivo as a Supplemental Assessment for the External Fixator Safe Removal

2021 ◽  
Author(s):  
Yanshi Liu ◽  
Qiyu Jia ◽  
Feiyu Cai ◽  
Kai Liu ◽  
Tao Zhang ◽  
...  
Keyword(s):  
External Fixation ◽  
Clinical Experience ◽  
External Fixator ◽  
Axial Load ◽  
Mechanical Test ◽  
Statistical Significance ◽  
Demographic Data ◽  
Ratio Test ◽  
Ilizarov External Fixator

Abstract Background: Timing the fixator removal is vital for a successful external fixation treatment. The purpose of this study was to determine the effectiveness of axial load-share ratio in vivo as a supplemental decision support tool for the safe removal of an Ilizarov external fixator.Methods: This prospective observational study consists of 83 patients undergoing tibial or femoral lengthening with Ilizarov circular external fixation in our institution, from January 2011 to October 2019. In group Ⅰ (38 patients), the external fixator was removed based on the surgeon’s clinical experience and radiographs from January 2011 to June 2015. In group Ⅱ (45 patients), from July 2015 to October 2019, the supplemental axial load-share (LS) ratio test was accomplished without the knowledge of the clinical results by another medical team. The test was performed by electronically measuring forces in the fixator rods and in a ground force plate. When the LS ratio < 10% was consistent with the conclusion (dense bone formation was achieved in the distraction zone) drawn from the corresponding routine radiographs by the treating surgeon, the external fixator was removed.Results: There was no statistical significance in demographic data between the two groups (P>0.05). In group Ⅰ, 4 of the 38 patients suffered refracture (the refracture rate was 10.5%) after fixator removal, and bone union was finally achieved with further intervention by intramedullary nail. In group Ⅱ, 36 patients terminated the external fixation after the first mechanical test, and another 9 patients terminated the external fixation at the subsequent test. None of the 45 patients in group Ⅱ suffered refracture (the refracture rate was 0%). There was statistical significance in the refracture rate between the two groups (P<0.05).Conclusions: Adequate assessment of bone regenerate is crucial before removing an external fixator to prevent deformation or refracture. The axial load-share ratio in vivo is a practically quantitative method to supplement radiography and clinical experience for the assessment of regenerate healing, and the axial load-share ratio dropped below 10% is a safe limit for the Ilizarov external fixator removal.

scholarly journals The axial load-share ratio in vivo as a supplemental assessment for the external fixator safe removal

2021 ◽  
Author(s):  
Yanshi Liu ◽  
Qiyu Jia ◽  
Feiyu Cai ◽  
Kai Liu ◽  
Xingpeng Zhang ◽  
...  
Keyword(s):  
External Fixation ◽  
Clinical Experience ◽  
External Fixator ◽  
Axial Load ◽  
Mechanical Test ◽  
Statistical Significance ◽  
Demographic Data ◽  
Ratio Test ◽  
Ilizarov External Fixator

Abstract Background: Timing the fixator removal is vital for a successful external fixation treatment. The purpose of this study was to determine the effectiveness of axial load-share ratio in vivo as a supplemental decision support tool for the safe removal of an Ilizarov external fixator.Methods: This prospective observational study consists of 83 patients undergoing tibial or femoral lengthening with Ilizarov circular external fixation in our institution, from January 2011 to October 2019. In group Ⅰ (38 patients), the external fixator was removed based on the surgeon’s clinical experience and radiographs from January 2011 to June 2015. In group Ⅱ (45 patients), from July 2015 to October 2019, the supplemental axial load-share (LS) ratio test was accomplished without the knowledge of the clinical results by another medical team. When the LS ratio < 10% was consistent with the conclusion (dense bone formation was achieved in the distraction zone) drawn from the corresponding routine radiographs by the treating surgeon, the external fixator was removed.Results: There was no statistical significance in demographic data between the two groups (P>0.05). In group Ⅰ, 4 of the 38 patients suffered refracture (the refracture rate was 10.5%) after fixator removal, and bone union was finally achieved with further intervention by intramedullary nail. In group Ⅱ, 36 patients terminated the external fixation after the first mechanical test, and another 9 patients terminated the external fixation at the subsequent test. None of the 45 patients in group Ⅱ suffered refracture (the refracture rate was 0%). There was statistical significance in the refracture rate between the two groups (P<0.05).Conclusions: Adequate assessment of bone regenerate is crucial before removing an external fixator to prevent deformation or refracture. The axial load-share ratio in vivo is a practically quantitative method to supplement radiography and clinical experience for the assessment of regenerate healing, and the axial load-share ratio dropped below 10% is a safe limit for the Ilizarov external fixator removal.

scholarly journals Bony callus stiffness indirectly evaluated by the axial load-share ratio in vivo as a guide to removing a monolateral external fixator safely

2021 ◽  
Author(s):  
Yanshi Liu ◽  
Feiyu Cai ◽  
Kai Liu ◽  
Xingpeng Zhang ◽  
Hong Li ◽  
...  
Keyword(s):  
External Fixator ◽  
Axial Load ◽  
Mechanical Test ◽  
Statistical Significance ◽  
Radiological Assessment ◽  
Group I ◽  
Bony Callus ◽  
Group Ii ◽  
Monolateral External Fixator

Abstract Purpose As the monolateral external fixator is increasingly used in trauma-control and definitive management for high-energy long bone fractures, timing the fixator removal remains a challenge for surgeons. The purpose of this study was to determine the feasibility and effectiveness of the bony callus stiffness indirectly evaluated by the axial load-share ratio in vivo as a guide to removing a monolateral external fixator safely. Methods A total of 131 patients with tibial shaft fractures treated by the monolateral external fixator in our institution were collected from January 2013 to July 2019. In group I, the fixators were removed based on the clinical and radiological assessment only by the treating surgeon. As for group II, the axial load-share (LS) ratio test was accomplished by another medical team without the knowledge of the clinical results. The external fixator was removed when the mechanical test outcome (LS ratio < 10%) was consistent with the conclusion drawn from the clinical and radiological assessment (bone union achieved) by the treating surgeon. Results There was no statistical significance in demographic data between the two groups (P > 0.05). In group I, four patients suffered refracture (the refracture rate was 7.7%) after fixator removal and were successfully treated by an intramedullary nail. In group II, 71 patients underwent fixator removal after the first mechanical test, and another eight patients terminated the external fixation after the second test. None of the 79 patients in group II suffered refracture (the refracture rate was 0%). There was statistical significance in the refracture rate between the two groups (P < 0.05). Conclusion The bony callus stiffness indirectly evaluated by the axial load-share ratio in vivo using the additional circular frame components is an effectively quantitative indicator to complement the clinical assessment of fracture healing in a monolateral external fixation treatment. Removal of the monolateral external fixator is safe when the axial load-share ratio dropped below 10%.

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

2021 ◽  
Vol 16 (1) ◽  
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 ◽  
Group I ◽  
Outcomes Evaluation

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.

scholarly journals Treatment of Open Tibial Fracture by Ilizarov External Fixator versus Unreamed Interlocking Nail

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M M H Fayed ◽  
M A Alkersh ◽  
A E Eldesouky
Keyword(s):  
Clinical Outcome ◽  
External Fixation ◽  
External Fixator ◽  
Tibial Fracture ◽  
Open Fractures ◽  
Open Tibial Fracture ◽  
Tibial Shaft ◽  
Ilizarov External Fixator ◽  
Interlocking Nail ◽  
Tibial Shaft Fractures

Abstract The objective of this study is to compare the radiographic results and clinical outcome of unreamed tibial nailing (UTN) and Ilizarov external fixation (IEF) for the treatment of open fractures of the tibia. Patients with open tibial shaft fractures were treated with an IEF or UTN. Both groups were compared for union time, nonunion, infections, mechanical failure of the implant, and malunion. We searched numerous sources and eventually included studies, totaling participants.

A Biomechanical Comparison of Micromotion after Ankle Fusion Using 2 Fixation Techniques: Intramedullary Arthrodesis Nail or Ilizarov External Fixator

2008 ◽  
Vol 29 (3) ◽  
pp. 334-341 ◽  
Author(s):  
Austin T. Fragomen ◽  
Kathleen N. Meyers ◽  
Nicole Davis ◽  
Hengsheng Shu ◽  
Timmothy Wright ◽  
...  
Keyword(s):  
External Fixation ◽  
Bone Mineral ◽  
External Fixator ◽  
Mineral Density ◽  
Ilizarov External Fixator ◽  
Ankle Fusion ◽  
Wide Range ◽  
Significant Difference ◽  
Fusion Site ◽  
New Generation

Background: In difficult ankle arthrodesis situations, intramedullary (IM) arthrodesis nails and external fixation are often considered in lieu of standard fusion techniques. The purpose of this study was to compare the amount of micromotion measured across an ankle fusion site stabilized with either an IM nail or with the Ilizarov external fixator. Materials and Methods: The relative bone mineral density of 8 pairs of human cadaveric lower legs was measured by DEXA scanning. One specimen from each pair was randomly assigned to be stabilized with a new generation IM nail and the other with an Ilizarov external fixator. Specimens were tested in compression, rotation, and dorsiflexion. Optical motion capture was used to measure the direct motion occurring at the fusion site. Results: No significant difference was found between the axial displacements ( p = 0.94), torsional displacement ( p = 0.07), or the dorsiflexion angular displacement ( p = 0.28) for the IM rod group and the external fixation group. A weak correlation was found between BMD and displacement. Conclusion: Both the new generation IM nail and the Ilizarov external fixator imparted excellent stability to the fusion site despite a wide range of bone mineral densities. Medialization of the talus, the ability to compress the nail, and the addition of a posterior-to-anterior locking screw were thought to improve the performance of the nail. Clinical Relevance: Both IM nail and Ilizarov external fixation provided excellent fusion site stability. The decision of which implant to use for complex arthrodesis should be dictated by the clinical needs.

scholarly journals Tibiocalcaneal arthrodesis using the Ilizarov fixator in compromised hosts: an analysis of 19 patients

2021 ◽  
Author(s):  
Charlotte Reinke ◽  
Sebastian Lotzien ◽  
Emre Yilmaz ◽  
Yannik Hanusrichter ◽  
Christopher Ull ◽  
...  
Keyword(s):  
External Fixator ◽  
Demographic Data ◽  
Joint Destruction ◽  
Salvage Procedure ◽  
Aofas Score ◽  
Ilizarov External Fixator ◽  
Tibiocalcaneal Arthrodesis ◽  
Ilizarov Fixator ◽  
Lost To Follow Up

Abstract Introduction Salvage of joint destruction of the tibiotalar and subtalar joint with necrosis or infection of the talus in compromised hosts is a challenging problem. In these cases, tibiocalcaneal arthrodesis using the Ilizarov external fixator represents a possible alternative to amputation. This retrospective study presents the results and complications of this salvage procedure. Materials and methods Between 2005 and 2015, 19 patients were treated with tibiocalcaneal arthrodesis using the Ilizarov external fixator. Ten patients received tibiocalcaneal arthrodesis due to an acute or chronic infection with joint destruction. The other nine patients presented posttraumatic necrosis of the talus or Charcot arthropathy. In addition to demographic data, the time spent in the fixator, the major and minor complications and the endpoint of the consolidation were evaluated retrospectively. Furthermore, clinical outcomes were measured using the modified American Orthopedic Foot and Ankle Society (AOFAS) score. Results The average time spent in the fixator was 22 (range 14–34) weeks. The average follow-up in 17 patients was 116 (range 4–542) weeks. Two patients were lost to follow-up. Complete osseous consolidation was achieved in 14 out of 19 patients. One patient presented partial consolidation, and in four patients, pseudarthrosis could be detected. The mean modified AOFAS score at the final follow-up was 53 out of 86 possible points. Conclusion Tibiocalcaneal arthrodesis using the Ilizarov fixator is a possible salvage procedure even in compromised hosts. However, the healing rates are below the rates reported in the literature for tibiotalar arthrodesis in comparable clinical situations.

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

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.

scholarly journals A Prospective Observational Study on Efficacy of Ilizarov External Fixation in Infected Non-Union Tibial Fractures

2021 ◽  
Vol 8 (15) ◽  
pp. 932-938
Author(s):  
Avinash Gundavarapu ◽  
Vishal Singh ◽  
Prashant Kumar Mishra ◽  
Santhosh Kumar M
Keyword(s):  
External Fixation ◽  
External Fixator ◽  
Functional Results ◽  
High Energy ◽  
Tibial Fractures ◽  
Bony Union ◽  
Ilizarov External Fixator ◽  
Non Union ◽  
Ring Fixator ◽  
Study Results

BACKGROUND Open fractures and fractures caused by high-energy trauma are likely to get infected and result in non-union. Infected non-union of long bones is a problem in developing countries like India. Ilizarov external fixator was employed to correct all the complications associated with non-union such as bone gap, infection, shortening, and deformities. Stable fixation, corticotomy and bone transport was employed to reduce or eliminate infection at the same time achieving bone union and correction of limb length discrepancy. Our study assesses the efficacy and safety of Ilizarov external fixation in patients with infected non-union tibial fractures. METHODS A series of 30 patients with infected non-union of tibia were treated with Ilizarov external fixation in Yashoda super speciality hospital and regularly followed-up between May 2014 and April 2016 (2 years). Bony and functional results were estimated and correlated with existing studies. RESULTS Out of thirty patients treated, bony results were excellent in 17 patients, good in 8 patients, fair in 4 patients and poor in 1 patient. Functional results were excellent in 17 patients, good in 5 patients, fair in 5 patients, and poor in 3 patients. Average duration of the fixator period was 8.1 months (min - 3 months, max - 14 months). Average length of regenerate was 3.64 cm (min - 2 cm, max - 6 cm). Average lengthening index in the study was 2.09 months / cm. Our study in all 4 categories of Association for the Study and Application of Methods of Ilizarov (ASAMI) criteria had approached Dror Paley’s Bony results and functional results. CONCLUSIONS In our study results have been encouraging in addressing all the complex problems by Ilizarov principle. Ilizarov external fixator system is the best device to treat infected non-union of tibia. Distal third of tibia is more prone for infection and non-union. Corticotomy or bone grafting is required for augmentation of the healing process. Almost all patients had varying degrees of oedema and pin track infections. Infection was controlled in all the cases and bony union was achieved, no patient had persistence of non-union and infection at the end of 2 years. KEYWORDS Ilizarov External Ring Fixator, Infected Non-Union, ASAMI Criteria, Bony Results, Functional Results, Bony Union

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

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.

scholarly journals Simultaneous septic arthrodesis of the tibiotalar and subtalar joints with the Ilizarov external fixator—an analysis of 13 patients

2021 ◽  
Author(s):  
Charlotte Cibura ◽  
Sebastian Lotzien ◽  
Emre Yilmaz ◽  
Hinnerk Baecker ◽  
Thomas Armin Schildhauer ◽  
...  
Keyword(s):  
Soft Tissue ◽  
External Fixator ◽  
Demographic Data ◽  
Joint Destruction ◽  
Case Series ◽  
Fistula Formation ◽  
Chronic Infections ◽  
Ilizarov External Fixator ◽  
Tibiocalcaneal Arthrodesis ◽  
The Mean

Abstract Purpose Treatment of joint destruction of the tibiotalar and subtalar joints caused by acute or chronic infections in compromised hosts is a challenging problem. In these cases, simultaneous septic arthrodesis with the use of the Ilizarov external fixator represents a possible alternative to amputation. This case series presents the results and complications of patients with acute or chronic infection of the tibiotalar and subtalar joints. Methods Between 2005 and 2015, 13 patients with acute or chronic infections were treated by simultaneous single-stage debridement/arthrodesis of the tibiotalar and subtalar joints. In seven patients, there was a florid infection with fistula formation and soft tissue defects, and in six patients, there was chronic osteomyelitis with closed soft tissue. In addition to the demographic data, the time spent in the fixator, the major and minor complications and the endpoint of consolidation were reviewed. Results The mean time spent in the fixator was 18 (min 15, max 26) weeks. The mean follow-up time for nine patients was 100 (min 3, max 341) weeks. Complete osseous consolidation of both the tibiotalar and subtalar joints was achieved in 10 patients (77%). In three (23%) patients, there was complete consolidation of one of the joints and partial consolidation of the other joint. Conclusion The Ilizarov external fixator allows for simultaneous arthrodesis of the tibiotalar and subtalar joints in septic joint destruction. However, the healing rates are below the rates reported in the literature for isolated tibiotalar or tibiocalcaneal arthrodesis in comparable clinical situations.

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