scholarly journals SECONDARY INTERNAL OSTEOSYNTHESIS WITH LOCKING PLATES FOR RECENT OR OLD OPEN FRACTURE OF THE TIBIA, OVERLAPPING PROVISIONAL EXTERNAL FIXATOR PIN SITES: IS THE INFECTION RISK INCREASED?

2020 ◽  
pp. 1-3
Author(s):  
Garg Uttam Kumar ◽  
Shukla S. K ◽  
Pathak S. K ◽  
Usmani I. A
Keyword(s):  
External Fixation ◽  
External Fixator ◽  
Open Fracture ◽  
Locking Plate ◽  
Deep Infection ◽  
Site Infection ◽  
Superficial Infection ◽  
Pin Site ◽  
The Mean ◽  
Type Of Fracture

Twenty-two patients had a severe open fracture of the tibia that was initially treated by external fixation and subsequently by locking plate. The external fixation had been maintained for an average of fifty-nine days (range, 15 to 240 days). The mean interval between removal of the external fixator and plating was twenty-six days (range, 10 to 44 days). five out of twelve patients who had an infection at one or more of the pin sites, developed one superficial and four deep infection. In comparison, only one of the ten patients who had not had a pin-site infection had a superficial infection. An analysis of other variables, including the duration of external fixation, wound coverage, other injuries, and the type of fracture, showed that none was a predictor of infection either at the pin sites or around the plate. We concluded that a pin-site infection that develops during external fixation is a contraindication to the subsequent plating in patients who have a fracture of the tibia.

scholarly journals Static monolateral external fixation for the Rolando fracture: a simple solution for a complex fracture

2012 ◽  
Vol 94 (2) ◽  
pp. 112-115 ◽  
Author(s):  
D Marsland ◽  
AP Sanghrajka ◽  
B Goldie
Keyword(s):  
External Fixation ◽  
External Fixator ◽  
Case Series ◽  
X Rays ◽  
Site Infection ◽  
Study Support ◽  
Pin Site ◽  
The Mean ◽  
Joint Incongruity ◽  
Mean Time

INTRODUCTION Rolando fractures are often difficult to manage because of their inherent instability. We describe a simple technique for the treatment of this fracture using the principle of ligamentotaxis, with a static, two-pin external fixator spanning the trapeziometacarpal joint, and present the results of a single-surgeon case series. METHODS Eight consecutive patients (mean age: 32.8 years) with Rolando fractures were treated using a Hoffmann II® Micro small bone external fixator using blunt ended 2.0mm half pins, inserted into the trapezium and diaphysis of the first metacarpal. Functional outcome was assessed with the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score at a mean time of 2.7 years following the fracture (range: 4 months – 6.0 years). The mean time to frame removal was 28 days. RESULTS There were three cases of superficial pin site infection. Follow-up x-rays at four months did not demonstrate significant joint incongruity or malunion in any case. The mean QuickDASH score was 7.95 and all patients returned to their previous levels of activity. CONCLUSIONS Although external fixation risks pin site infection, the results of this study support the use of spanning trapeziometacarpal external fixation for Rolando fractures as it reliably gives excellent functional outcomes.

scholarly journals Treatment of segmental tibial defects by bone transport with circular external fixation and a locking plate

2020 ◽  
Vol 48 (4) ◽  
pp. 030006052092040
Author(s):  
Yao Lu ◽  
Teng Ma ◽  
Cheng Ren ◽  
Zhong Li ◽  
Liang Sun ◽  
...  
Keyword(s):  
External Fixation ◽  
Locking Plate ◽  
Short Form ◽  
Clinical Results ◽  
Bone Transport ◽  
Fixation Index ◽  
Fixation Time ◽  
Sf 36 ◽  
Health Related ◽  
The Mean

Objective To evaluate the effectiveness of bone transport involving circular external fixation and locking plate application for the treatment of segmental tibial defects. Methods A retrospective review of 12 patients with segmental tibial defects who underwent bone transport with circular external fixation and locking plate application. We evaluated external fixation time, external fixation index, time to achieve union, and complications. Clinical results were assessed using the Association for the Study and Application of the Methods of Ilizarov (ASAMI) score. Generic health-related outcome was assessed using the 36-Item Short-Form Health Survey questionnaire (SF-36). Results The mean follow-up was 25.8 months, and the mean defect size was 6.7 cm. All of the patients achieved union at the distraction callus and docking site. The average external fixation time was 299.5 days. The mean external fixation index was 16.5 days/cm, and the mean healing index was 44.9 days/cm. The functional outcomes were excellent in eight cases and good in four. The average SF-36 score was 92. Conclusion Bone transport with external fixation and locking plate application may be a promising method for the treatment of segmental tibial defects.

Comparison between External Locking Plate Fixation and Conventional External Fixation for Extraarticular Proximal Tibial Fractures: A Finite Element Analysis

2021 ◽  
Author(s):  
Dejan Blažević ◽  
Janoš Kodvanj ◽  
Petra Adamović ◽  
Dinko Vidović ◽  
Zlatko Trobonjača ◽  
...  
Keyword(s):  
Finite Element ◽  
External Fixation ◽  
External Fixator ◽  
Tibial Fracture ◽  
Locking Plate ◽  
Plate Fixation ◽  
Tibial Fractures ◽  
Proximal Tibial Fracture ◽  
Locking Plate Fixation ◽  
Maximum Stiffness

Abstract BackgroundGood clinical outcomes for locking plates as an external fixator to treat tibial fractures have been reported. However, external locking plate fixation is still generally rarely performed. This study aimed to compare the stability of external locking plate fixator with that of conventional external fixator for extraarticular proximal tibial fractures, using finite element analysis. MethodsThree models were constructed: (1) external locking plating of proximal tibial fracture with lateral proximal tibial locking plate and 5-mm screws (ELP), (2) conventional external fixation of proximal tibial fracture with an 11-mm rod and 5-mm Schanz screws (EF-11), and (3) conventional external fixation of proximal tibial fracture with a 7-mm rod and 5-mm Schanz screws (EF-7). The stress distribution, displacement at the fracture gap, and stiffness of the three finite element models at 30-, 40-, 50-, and 60-mm plate–rod offset from the lateral surface of the lateral condyle of the tibia were determined. ResultsThe conventional external fixator showed higher stiffness than did the external locking plate fixator. In all models, the stiffness decreased as the distance of the plate–rod from the bone surface increased. The maximum stiffness was 121.06 N/mm in the EF-11 model with 30-mm tibia–rod offset. In the EF-7 model group, the maximum stiffness was 40.00 N/mm in the model with 30-mm tibia–rod offset. In the ELP model group, the maximum stiffness was 35.79 N/mm in the model with 30-mm tibia–plate offsetConclusionsExternal locking plate fixation is more flexible than conventional external fixation, which can influence secondary bone healing. External locking plate fixation requires the placement of the plate as close as possible to the skin, which allow low-profile design, because the increased distance of the plate from bone can be too flexible for bone healing.

scholarly journals A comparative study between proximal femur locking compression plate and dynamic hip screw fixation in management of intertrochantric femur fractures

2016 ◽  
Vol 2 (4) ◽  
pp. 327
Author(s):  
Mithlesh Kumar Meena ◽  
Vinay Joshi
Keyword(s):  
Locking Plate ◽  
Locking Compression Plate ◽  
Dynamic Hip Screw ◽  
Intertrochanteric Fractures ◽  
Trochanteric Fractures ◽  
Superficial Infection ◽  
Femur Fractures ◽  
Compression Plate ◽  
Hip Screw ◽  
The Mean

<p class="abstract"><strong>Background:</strong> Proximal femur fractures are one of the commonest fracture encountered in orthopaedic trauma practice. Dynamic hip screw (DHS) is the gold standard procedure for treatment for stable intertrochanteric  fractures, however problem arises with unstable fractures in maintenance of neck shaft angle and proper reduction. Here we are giving results of trochanteric fractures treated with proximal femoral locking compression plate (PFLCP) as compared with dynamic hip screw (DHS).</p><p class="abstract"><strong>Methods:</strong> This study was a prospective study. Two groups of trochanteric fractures of 25 patients operated with DHS and LCP were taken. Each patient was followed-up from July 2011 to October 2012 for minimum of 12 month or till the bony union.<strong> </strong>Every fracture was classified according to AO classification. Functional results will be assessed as per modified Harris hip evaluation score.<strong></strong></p><p class="abstract"><strong>Results:</strong> Among 25 patient treated with PFLCP, length discrepancy was .857 cm while that for DHS was 1.2 cm. The mean time of unaided walking with LCP Was 14.20 weeks while for DHS it was 16.20 weeks. The mean varus angulation for LCP 8 degree while for DHS 10.2 degree. In LCP in 1 case screw cut out from head and neck of femur while in DHS, same is seen in 2 cases and in addition loss of position of lag screw seen in 5 cases.one case was found with superficial infection in LCP while in case of DHS 3 cases with deep infection for that implant was removed and 6 cases were found with superficial infection.</p><p><strong>Conclusions:</strong> Proximal femoral locking plate (PFLCP) is simple, stable for fixation with fewer complications, and is an effective method for unstable intertrochanteric fractures.  Comparing with DHS group, the locking plate has shorter operative time, fewer blood loss and drainage.</p>

Novel Use of Active Leptospermum Honey for Ringed Fixator Pin Site Care in Diabetic Charcot Deformity Patients

2017 ◽  
Vol 11 (2) ◽  
pp. 117-122 ◽  
Author(s):  
Alexander L. Lazarides ◽  
Kamran S. Hamid ◽  
Michael S. Kerzner
Keyword(s):  
External Fixation ◽  
Case Series ◽  
Deformity Correction ◽  
Controlled Study ◽  
Control Group ◽  
Diabetic Patients ◽  
Superficial Infection ◽  
Safety And Efficacy ◽  
Fine Wire ◽  
Pin Site

Introduction. Open reduction with external fixation (OREF) utilizing fine wire ringed fixators for correction of Charcot deformity has gained popularity over the past decade. Pin site infections are a well-documented complication of external fixation as well as a driver of escalating health care costs. We aimed to demonstrate the safety and efficacy of a novel method of pin site care utilizing active Leptospermum honey–impregnated dressings (MediHoney) in diabetic patients undergoing deformity correction with OREF. Methods. Twenty-one diabetic patients with Charcot deformities of the lower extremity were prospectively enrolled and followed for pin site complications following OREF for deformity correction. Active Leptospermum honey dressings were applied at metal-cutaneous interfaces at the end of the OREF procedure and replaced weekly for a total of 8 weeks. Patients were monitored for pin site infections from the time of surgery until external fixator removal. Sixteen consecutive patients receiving standard OREF for Charcot deformities were evaluated retrospectively to serve as a control group. Results. Of the 21 enrolled patients, 19 underwent OREF and followed up throughout the study period. Treated patients had a mean age of 58.5 years and mean body mass index measuring 33.3 kg/m2 as documented prior to surgery. The 15 patients with hemoglobin A1c labs drawn in the 3 months preceding surgery averaged 7.5. Fixators were removed at an average of 12.1 weeks after adequate bony healing. Of the 244 pin sites in 19 patients, 3 pin sites (1.2% of pins) in 2 patients (10.5% of patients) showed evidence of superficial infection. All infections resolved with oral antibiotics. Infection rates were significantly reduced when compared to the standard care control group. Conclusions. Pilot data in a prospectively collected case series demonstrate safety and efficacy of active Leptospermum honey–impregnated dressings when used for fine wire ringed fixator pin site care in diabetic Charcot deformity patients. Further investigation in the form of a prospective randomized controlled study is warranted to demonstrate the potential value of this novel intervention. Levels of Evidence: Level IV

scholarly journals A COMPARATIVE STUDY OF VOLAR LOCKING PLATE VERSUS EXTERNAL FIXATION FOR DISPLACED INTRAARTICULAR DISTAL END RADIUS FRACTURES AT ORTHOPAEDICS DEPARTMENT OF DMCH, LAHERIASARAI, BIHAR

2021 ◽  
pp. 1-3
Author(s):  
Kunal Shankar ◽  
Vikash M. Harinandan ◽  
Laljee Chaudhary ◽  
Debarshi Jana
Keyword(s):  
External Fixation ◽  
Distal Radius Fracture ◽  
Distal Radius ◽  
External Fixator ◽  
Locking Plate ◽  
Plate Versus ◽  
Radius Fracture ◽  
Volar Locking Plate ◽  
Radius Fractures

Background: Distal radius fracture is more common accounting for 1/6th of the all fractures. With this background, this study was carried out to compare the functional outcome of volar locking plate and external fixator to the displaced intra-articular distal end radius fractures using Modified Mayo Wrist Score (MMWS). Materials and methods: This study included those patients with distal radius fracture attending the Orthopaedic Department of DMCH, Laheriasarai, Bihar, during January 2019 to December 2019. Patients were randomised based on - even and odd day of the week. This included two set of group with twenty patients in each group- one with volar locking plating and other with external fixation. Patients were followed up at 6 months and 1 year. At each follow up, the pain and range of movements were assessed by MMWS score which was entered in Microsoft excel and analysed in SPSS 20. Results: At the end of one year after surgery, we observed that external fixation technique was superior for treating displaced intra-articular comminuted distal end radius fractures than volar locking plate. Conclusion: External fixator showed more advantageous than volar locking plates after 1year of follow up.

TREATMENT OF ROLANDO FRACTURE BY CAPSULOLIGAMENTOTAXIS USING MINI EXTERNAL FIXATOR: A REPORT OF 16 CASES

Hand Surgery ◽  
2013 ◽  
Vol 18 (01) ◽  
pp. 73-78 ◽  
Author(s):  
Shirzad Houshian ◽  
Shan Shan Jing
Keyword(s):  
External Fixation ◽  
External Fixator ◽  
Kirschner Wire ◽  
Case Series ◽  
Pinch Strength ◽  
Fracture Union ◽  
Minimal Loss ◽  
The Mean ◽  
Fixation System

Treatment of Rolando fractures remains a challenge for hand surgeons. We present a case series of 16 comminuted Rolando type fractures treated by controlled capsuloligamentous distraction (and over distraction by 2 mm) using the Pennig mini-external fixation system. Additional Kirschner wire(s) were used to maintain fracture reduction and stability. Average time of injury to surgery time was five days. Mean age of patients was 26 years. The mean follow-up was 20 months. Excellent fracture union was achieved in all cases. All except two patients were pain free at the final consultation. The mean grip and pinch strength of the affected thumb was 96% and 93%, respectively, of the unaffected thumb with a minimal loss of movements. This technique is simple and effective. It enables immediate mobilisation of the unaffected joints and prevents stiffness. We recommend this distraction technique for the treatment of significantly comminuted Rolando type fractures.

scholarly journals Lower limb lengthening over an intramedullary nail: a long-term follow-up study of 28 cases

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Pasquale Farsetti ◽  
Fernando De Maio ◽  
Vito Potenza ◽  
Kristian Efremov ◽  
Martina Marsiolo ◽  
...  
Keyword(s):  
External Fixation ◽  
External Fixator ◽  
Intramedullary Nail ◽  
Lower Limb ◽  
Average Length ◽  
Limb Lengthening ◽  
Limb Length ◽  
Tibial Lengthening ◽  
The Mean

Abstract Background Limb lengthening using an external fixator requires a long period of external fixation and may be associated with several complications such as axial deformity, fracture of the regenerated bone, and joint stiffness. With the goal of reducing the time of external fixation as well as some of these complications, we performed femoral or tibial lengthening over an intramedullary nail, according to Paley’s technique, in 28 patients, followed up after a mean period of 8 years. Materials and methods Twenty-eight patients treated for lower limb discrepancy by limb lengthening over an intramedullary nail were reviewed from 5 to 11 years after healing of regenerated bone. There were 20 femurs and 8 tibiae, with average age at surgery of 14.2 years and average length inequality of 6.1 cm for femurs and 5.3 cm for tibiae. Results The mean lengthening was 5.8 cm for femurs and 4.8 cm for tibiae. The mean period of radiographic consolidation of the regenerated bone was 6 months for femoral lengthening and 4.5 months for tibial lengthening. At follow-up, we observed 8 excellent results, 15 good results, 4 fair results, and 1 poor result, based on Paley’s evaluation criteria. The main complications were one deep infection, one nonunion of the distracted segment, one breakage of the distal fiche of the external fixator, and one breakage of both distal locking screws of the intramedullary nail. Discussion We believe that limb lengthening over an intramedullary nail still represents a good method to treat limb length discrepancy because it reduces the time of external fixation, prevents axial deformities and fractures of regenerated bone, and allows early rehabilitation. The new intramedullary lengthening nails, which theoretically are the ideal device for treating limb length inequality, are still very expensive and need longer follow-up for definitive evaluation. Level of evidence 4.

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