New concept in external fixation

A new concept in external skeletal fixation is presented. A 3D unilateral system developed by Mitkovic has widely been investigated biomechanically in AO institute in Davos (Switzerland). Consists of three components only providing extremely simple application and dynamic fixation of bones and different joints. This simple external fixator functions as an accurate reduction device at the same time, minimizing need for fluoroscopy. Clinically this system has been applied to mere then 13 thousand patients in 43 clinics. This paper presents the results of its application for treatment of open fractures, war wounds with fractures and for comminuted and intraarticular closed fractures in the series of 597 patients. Overall average time for union time was 3.2 months. Overall success of fracture healing was 96.8% including open and closed fractures. Our study suggests that the use of this 3D unilateral system is suitable for routine use.

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

QJM ◽

10.1093/qjmed/hcaa059.008 ◽

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.

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External fixator combined with three different fixation methods of fibula for treatment of extra-articular open fractures of distal tibia and fibula: a retrospective study

10.21203/rs.3.rs-29918/v2 ◽

2020 ◽

Author(s):

DongDong Sun ◽

Dan Lv ◽

Kun Zhou ◽

Jian Chen ◽

Li-Lan Gao ◽

...

Keyword(s):

Blood Loss ◽

Fracture Healing ◽

External Fixator ◽

Distal Tibia ◽

Operation Time ◽

Healing Time ◽

Open Fractures ◽

Group A ◽

Group B ◽

Ankle Function

Abstract Background To compare the efficacy of three different fixation methods of fibula combined with external fixation of tibia for the treatment of extra-articular open fractures of distal tibia and fibula. Methods From January 2017 to July 2019, 91 cases of open fractures of distal tibia and fibula were treated with external fixator, and the fibula was fixed with non-fixation (group A, n=35), plate-screw (group B, n=30) and Kirschner wire(group C, n=26).The operation time, intraoperative blood loss, surgical and implants costs, fracture healing time, postoperative complications, and American Orthopaedic Foot and Ankle surgery (AOFAS) scores were compared among the groups. Results Four patients were lost to follow-up, and 87 patients were followed up for 5-35 months (average, 14.2 months). The operation time of group C(114.92±36.09min) was shorter than that of group A (142.27±47.05min) and group B(184.00±48.56min) (P<0.05). There was no difference in intraoperative blood loss among the three groups (P>0.05). The surgical and implants costs in group C (5.24±1.21, thousand dollars) is lower than that in group A (6.48±1.11, thousand dollars) and group B (9.37±2.16, thousand dollars) (P < 0.05).The fracture healing time of group C(5.67±1.42months) was significantly less than that of group A (6.90±1.33months) and group B(6.70±1.12months) (P<0.05). The postoperative complications such as fractures delayed union and nonunion in group C (2 cases, 8.00%) is less than that in group A (13 cases, 39.39%) and group B (11cases, 37.93%) (P<0.05). The wound infection and needle-tract infection did not differ among the three groups (P>0.05). The excellent or good rate of ankle function was 69.70% in group A, 72.41% in group B and 84.00% in group C, with no statistical difference among the three groups (P>0.05). conclusion Compared with simple external fixator fixation and external fixator combined with plate-screw osteosynthesis, external fixator combined with K-wire intramedullary fixation shortens the operative time and fracture healing time, reduced costs and complications of fracture healing, while the blood loss, infection complications and ankle function recovery showed no difference with the other two groups. External fixator combined with plate-screw osteosynthesis had no advantage in treating extra-articular open fractures of distal tibia and fibula when compared with simple external fixation.

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External fixator combined with three different fixation methods of fibula for treatment of extra-articular open fractures of distal tibia and fibula: a retrospective study

10.21203/rs.3.rs-29918/v3 ◽

2020 ◽

Author(s):

DongDong Sun ◽

Dan Lv ◽

Kun Zhou ◽

Jian Chen ◽

Li-Lan Gao ◽

...

Keyword(s):

Blood Loss ◽

Fracture Healing ◽

External Fixator ◽

Distal Tibia ◽

Operation Time ◽

Healing Time ◽

Open Fractures ◽

Group A ◽

Group B ◽

Ankle Function

Abstract Background To compare the efficacy of three different fixation methods of fibula combined with external fixation of tibia for the treatment of extra-articular open fractures of distal tibia and fibula. Methods From January 2017 to July 2019, 91 cases of open fractures of distal tibia and fibula were treated with external fixator, and the fibula was fixed with non-fixation (group A, n=35), plate-screw (group B, n=30) and Kirschner wire(group C, n=26).The operation time, intraoperative blood loss, surgical and implants costs, fracture healing time, postoperative complications, and American Orthopaedic Foot and Ankle surgery (AOFAS) scores were compared among the groups. Results Four patients were lost to follow-up, and 87 patients were followed up for 5-35 months (average, 14.2 months). The operation time of group C(114.92±36.09min) was shorter than that of group A (142.27±47.05min) and group B(184.00±48.56min) (P<0.05). There was no difference in intraoperative blood loss among the three groups (P>0.05). The surgical and implants costs in group C (5.24±1.21, thousand dollars) is lower than that in group A (6.48±1.11, thousand dollars) and group B (9.37±2.16, thousand dollars) (P < 0.05).The fracture healing time of group C(5.67±1.42months) was significantly less than that of group A (6.90±1.33months) and group B(6.70±1.12months) (P<0.05). The postoperative complications such as fractures delayed union and nonunion in group C (2 cases, 8.00%) is less than that in group A (13 cases, 39.39%) and group B (11cases, 37.93%) (P<0.05). The wound infection and needle-tract infection did not differ among the three groups (P>0.05). The excellent or good rate of ankle function was 69.70% in group A, 72.41% in group B and 84.00% in group C, with no statistical difference among the three groups (P>0.05). Conclusion Compared with simple external fixator fixation and external fixator combined with plate-screw osteosynthesis, external fixator combined with K-wire intramedullary fixation shortens the operative time and fracture healing time, reduced costs and complications of fracture healing, while the blood loss, infection complications and ankle function recovery showed no difference with the other two groups. External fixator combined with plate-screw osteosynthesis had no advantage in treating extra-articular open fractures of distal tibia and fibula when compared with simple external fixation.Fund program: National Natural Science Foundation of China (11572222)

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External fixator combined with three different fixation methods of fibula for treatment of extra-articular open fractures of distal tibia and fibula: a retrospective study

10.21203/rs.3.rs-29918/v1 ◽

2020 ◽

Author(s):

DongDong Sun ◽

Dan Lv ◽

Kun Zhou ◽

Jian Chen ◽

Li-Lan Gao ◽

...

Keyword(s):

Blood Loss ◽

Fracture Healing ◽

External Fixator ◽

Distal Tibia ◽

Operation Time ◽

Healing Time ◽

Open Fractures ◽

Group A ◽

Group B ◽

Ankle Function

Abstract PurposeTo compare the efficacy of three different fixation methods of fibula combined with external fixation of tibia for the treatment of extra-articular open fractures of distal tibia and fibula.MethodsFrom January 2017 to July 2019, 91 cases of open fractures of distal tibia and fibula were treated with external fixator, and the fibula was fixed with non-fixation (group A, n = 35), plate-screw (group B, n = 30) and kirschner wire(group C, n = 26).The operation time, intraoperative blood loss, surgical and implants costs, fracture healing time, postoperative complications, and American Orthopaedic Foot and Ankle surgery (AOFAS) scores were compared among the groups.ResultsFour patients were lost to follow-up, and 87 patients were followed up for 5–35 months (average, 14.2 months). The operation time of group C(114.92 ± 36.09 min) was shorter than that of group A (142.27 ± 47.05 min) and group B(184.00 ± 48.56 min) (P < 0.05). There was no difference in intraoperative blood loss among the three groups (P > 0.05). The surgical and implants costs in group C (5.24 ± 1.21, thousand dollars) is lower than that in group A (6.48 ± 1.11, thousand dollars) and group B (9.37 ± 2.16, thousand dollars) (P < 0.05).The fracture healing time of group C(5.67 ± 1.42months) was significantly less than that of group A (6.90 ± 1.33months) and group B(6.70 ± 1.12months) (P < 0.05). The postoperative complications such as fractures delayed union and nonunion in group C (2 cases, 8.00%) is less than that in group A (13 cases, 39.39%) and group B (11cases, 37.93%) (P < 0.05). The wound infection and needle-tract infection did not differ among the three groups (P > 0.05). The excellent or good rate of ankle function was 69.70% in group A, 72.41% in group B and 84.00% in group C, with no statistical difference among the three groups (P > 0.05).conclusionCompared with simple external fixator fixation and external fixator combined with plate-screw osteosynthesis, external fixator combined with K-wire intramedullary fixation shorten the operative time and fracture healing time, reduced costs and complications of fracture healing, while the blood loss, infection complications and ankle function recovery showed no difference with the other two groups. External fixator combined with plate-screw osteosynthesis had no advantage in treating extra-articular open fractures of distal tibia and fibula when compared with simple external fixation.Fund program: National Natural Science Foundation of China (11572222)

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Effects of growth hormone in patients with tibial fracture: a randomised, double-blind, placebo-controlled clinical trial

Acta Endocrinologica ◽

10.1530/eje-06-0598 ◽

2007 ◽

Vol 156 (3) ◽

pp. 341-351 ◽

Cited By ~ 31

Author(s):

Michael Raschke ◽

Michael Højby Rasmussen ◽

Shunmugam Govender ◽

David Segal ◽

Mette Suntum ◽

...

Keyword(s):

Fracture Healing ◽

Tibial Fracture ◽

Open Fractures ◽

Tibial Fractures ◽

Controlled Study ◽

Double Blind ◽

Double Blind Placebo ◽

Post Surgery ◽

Significant Difference ◽

Closed Fractures

Objective: Investigate whether intervention with GH after tibial fracture enhances fracture healing. Design: Randomised, double-blind, placebo-controlled study in 406 patients (93 women, 313 men, age: 18–64 years) with tibial fracture. Methods: Patients were stratified by tibial fracture (open or closed) and allocated to placebo or GH treatment (15, 30 or 60 μg/kg daily, until clinically assessed healing or until 16 weeks post-surgery). Primary outcome was time from surgery until fracture healing and assessment of healing was done centrally and observer blinded. Patients reported for evaluation every 4 weeks until 24 weeks, and at 9 and 12 months. Results: GH did not accelerate time to healing in the combined group of open and closed fractures. When separately analysing the closed and open fractures, a significant difference in time to healing was observed between treatment groups, exclusively in the closed fractures (P<0.05; subgroup analysis revealed that the 60 μg/kg group was significantly different from placebo). The relative risk of fracture healing for 60 μg/kg versus placebo during the 12 month was: all fractures, 1.16; 95% CI: (0.86; 1.57) (ns); closed fractures, 1.44; 95% CI: (1.01; 2.05; P<0.05); open fractures, 0.75; 95% CI: (0.42; 1.31) (ns). The estimated median number of days before fracture healing in closed fractures was 95 with 60 μg/kg versus 129 with placebo (95% CI: (94; 129) and (94; 249)) corresponding to approximately 26% decrease in healing time. Conclusions: In the overall group of open and closed tibial fractures, no significant enhancement of fracture healing was observed with GH, whereas in closed tibial fractures, GH accelerated healing significantly.

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External fixator combined with three different fixation methods of fibula for treatment of extra-articular open fractures of distal tibia and fibula: a retrospective study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03840-y ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Dong-Dong Sun ◽

Dan Lv ◽

Kun Zhou ◽

Jian Chen ◽

Li-Lan Gao ◽

...

Keyword(s):

Blood Loss ◽

Fracture Healing ◽

External Fixator ◽

Distal Tibia ◽

Operation Time ◽

Healing Time ◽

Open Fractures ◽

Group A ◽

Group B ◽

Ankle Function

Abstract Background To compare the efficacy of three different fixation methods of fibula combined with external fixation of tibia for the treatment of extra-articular open fractures of distal tibia and fibula. Methods From January 2017 to July 2019, 91 cases of open fractures of distal tibia and fibula were treated with external fixator, and the fibula was fixed with non-fixation (group A, n = 35), plate-screw (group B, n = 30) and Kirschner wire (group C, n = 26). The operation time, intraoperative blood loss, surgical and implants costs, fracture healing time, postoperative complications, and American Orthopaedic Foot and Ankle surgery (AOFAS) scores were compared among the groups. Results Four patients were lost to follow-up, and 87 patients were followed up for 5–35 months (average, 14.2 months). The operation time of group C (114.92 ± 36.09 min) was shorter than that of group A (142.27 ± 47.05 min) and group B (184.00 ± 48.56 min) (P < 0.05). There was no difference in intraoperative blood loss among the three groups (P > 0.05). The surgical and implants costs in group C (5.24 ± 1.21, thousand dollars) is lower than that in group A (6.48 ± 1.11, thousand dollars) and group B (9.37 ± 2.16, thousand dollars) (P < 0.05). The fracture healing time of group C (5.67 ± 1.42 months) was significantly less than that of group A (6.90 ± 1.33 months) and group B (6.70 ± 1.12 months) (P < 0.05). The postoperative complications such as fractures delayed union and nonunion in group C (2 cases, 8.00%) is less than that in group A (13 cases, 39.39%) and group B (11cases, 37.93%) (P < 0.05). The wound infection and needle-tract infection did not differ among the three groups (P > 0.05). The excellent or good rate of ankle function was 69.70% in group A, 72.41% in group B and 84.00% in group C, with no statistical difference among the three groups (P > 0.05). Conclusion Compared with simple external fixator fixation and external fixator combined with plate-screw osteosynthesis, external fixator combined with K-wire intramedullary fixation shortens the operative time and fracture healing time, reduced costs and complications of fracture healing, while the blood loss, infection complications and ankle function recovery showed no difference with the other two groups. External fixator combined with plate-screw osteosynthesis had no advantage in treating extra-articular open fractures of distal tibia and fibula when compared with simple external fixation.

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Fracture healing of the sheep tibia treated using a unilateral external fixator. Comparison of static and dynamic fixation

Injury ◽

10.1016/s0020-1383(99)00126-6 ◽

1999 ◽

Vol 30 ◽

pp. SA44-SA51 ◽

Cited By ~ 10

Author(s):

R. Hente ◽

J. Cordey ◽

B.A. Rahn ◽

M. Maghsudi ◽

St. von Gumppenberg ◽

...

Keyword(s):

Fracture Healing ◽

External Fixator ◽

Dynamic Fixation

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Lateral entry pins and Slongo’s external fixation: which method is more ideal for older children with supracondylar humeral fractures?

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02541-z ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Man He ◽

Qian Wang ◽

Jingxin Zhao ◽

Yu Jin ◽

Yu Wang

Keyword(s):

Fracture Healing ◽

External Fixation ◽

External Fixator ◽

Elbow Joint ◽

Kirschner Wire ◽

Healing Time ◽

Humeral Fractures ◽

Older Children ◽

Fractures In Children ◽

Supracondylar Humeral Fractures

Abstract Objective The standard surgical treatment for supracondylar humeral fractures in children is closed reduction and percutaneous pinning. Given the need for greater fixation strength and higher risk of joint stiffness for children older than 8 years, external fixation is often performed for treating supracondylar humeral fractures in older children. The aim of this study was to compare the efficacy of lateral entry pins and Slongo’s external fixation for treating supracondylar humeral fractures in older children. Methods Children older than 8 years who underwent surgery for supracondylar humeral fractures at our hospital for surgery from January 2016 to December 2020 are to be retrospectively assessed. One group (n = 36) underwent internal fixation and percutaneous pinning with three lateral Kirschner wires, and the other group (n = 32) underwent Slongo’s external fixator surgery. The demographic data, operation duration, number of fluoroscopies, and fracture healing time were compared between both groups. The elbow joint function was evaluated 6 months after the surgery on the basis of fracture healing time, lifting angle, elbow joint range of motion (ROM), and Flynn score. The incidence of postoperative complications was also recorded. Results There was no significant difference between the two patient groups in terms of the demographic parameters. Compared to external fixation surgery, Kirschner wire surgery required shorter duration and fewer fluoroscopies (P < 0.05). Nevertheless, the fracture healing time was significantly less (P < 0.05), and the elbow ROM and Flynn scores were higher in the external fixator group compared to the Kirschner wire fixation group (P < 0.05). There was one case of secondary fracture displacement in the Kirschner wire group and one of pin tract infection in the external fixator group. No other iatrogenic injuries or complications were observed. Conclusion Maybe Slongo’s external fixator is a suitable alternative treatment option for supracondylar humeral fractures in children older than 8 years since it can achieve better fixation strength and early restoration of elbow joint movement with a lower risk of joint stiffness.

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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

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02814-7 ◽

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.

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A practical, quantitative, fracture healing endpoint assessment criterion for tibial fractures treated with external fixation

Proceedings of the Institution of Mechanical Engineers Part H Journal of Engineering in Medicine ◽

10.1177/0954411919835453 ◽

2019 ◽

Vol 233 (5) ◽

pp. 497-505

Author(s):

Peter J Ogrodnik ◽

Peter BM Thomas

Keyword(s):

Fracture Healing ◽

External Fixation ◽

External Fixator ◽

Assessment Tool ◽

Tibial Fractures ◽

X Rays ◽

Assessment Criterion ◽

Fracture Stiffness ◽

Method Of Assessment ◽

Made In

There is a need for a quick, simple, repeatable, but quantifiable assessment tool to determine the fracture healing endpoint of tibial fractures that does not rely on the use of X-rays or on un-measured manipulation. This article presents an argument to support a ‘maximum of 1° bending’ criterion. The criterion was established from an examination of patient fracture stiffness profiles and following observations of stiffness measurements made in clinics. A proprietary mono-lateral external fixator was used to test the criterion. Sixty subjects had their fracture healing endpoint assessed using this criterion compared with the 15 N m/deg in two planes criterion, and it was deemed to be successful. The method of assessment for both mono-lateral and frame fixation (Ilizarov) is demonstrated.

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