Functional outcome of hybrid external fixator in proximal tibial fractures Schatzker type V and VI with Gustillo grade-II

<h2>Background: Management of high energy tibial plateau fractures along with extensive soft tissue damage is still challenging to many orthopaedic surgeons. This study evaluates the purpose of hybrid external fixator intreating high energy tibial plateau fractures with minimal invasion and accurate reduction.</h2><h2>Methods: Twenty patients with high energy Schatzker type V and VI tibial plateau fractures with severe soft tissue injury were enrolled into the study in RNT medical college, Udaipur.</h2><h2>Results: The results- bony union, range of movements and associated complications were assessed. All fractures united in an average time period of 20 weeks. Ten patients developed knee stiffness, five patients developed delayed union andthreenon-union.15 patients required split skin graft. Final outcome showed excellent score in 53 patients.</h2><h2>Conclusions: Hybrid external fixation is a safe option for managing complex high energy tibial plateau fractures by simultaneously providing adequate fracture stabilization and necessary protection to soft tissue healing to achieve bony union.</h2>

A COMPARATIVE STUDY OF FUNCTIONAL AND RADIOLOGICAL OUTCOME OF HIGH ENERGY PROXIMAL TIBIA FRACTURE USING ILLIZAROV EXTERNAL FIXATOR VS HYBRID EXTERNAL FIXATOR

Background: In High energy proximal tibia fracture aim is to achieve adequate reduction and stability without signicantly compromising the soft tissue integrity and vascularity . External xator minimizes soft tissue dissection and minimize other complications. Method: 60 patients' high energy proximal tibia fracture with cases were considered in the study. 30 patients were treated with Ilizarov external xator and 30 patients were treated with hybrid external xator. Results were analyzed both clinically and radiologically using Johner and Wruh's criteria. Results: Mean time of union was 22 week in ilizarov xator group and 34 week in hybrid xator group. Pin tract infection occured in 6 patient (20%) in ilizarov xator group and 4 patient in hybrid xator group. Joint stiffness occured in 3 Patient (10 %) in ilizarov group and 10 patient in hybrid xator group.Shortning occured in 2 patient (6.6 %) in ilizarov xator group and 2 patient in hybrid xator group. Overal results in ilizarov group were excellent in 23 patient (76.7%), good in 5 patient (16.67%) , fair in 2 patient (6.67%) while in hybrid group excellent in 16 patient( 53.33%),good in 10 patient(33.33%),fair in 4(13.33%)patient. Conclusion: External xators are excellent modalities in treatment of high energy proximal tibia fracture with ilizarov method has advantage of early mobilization and early union but require long operative time and bulky framework on other hand hybrid xator has simpler construct ,lesser operative time but has lesser stability , longer union time and longer immobilization time.

Functional results of compound extra articular tibial pilon fractures managed with hybrid external fixator

<p><strong>Background: </strong>Distal tibia fractures are difficult to treat. It is often difficult to assess the potential risk of surgical complications because of the variations in the clinical findings. Less subcutaneous tissue, limited blood supply and no muscle insertions are the factors that tend to make the healing of the soft tissue more complex. Compounding presents a great challenge for the treating surgeon regarding the treatment options.</p><p><strong>Methods:</strong><strong> </strong>A total of 23 patients were included in the study based on the inclusion and exclusion criteria and were managed by hybrid external fixator as definitive treatment. They were kept in follow up for at least 6 months and were assessed using Ovadia and Beal’s objective and subjective scoring.</p><p><strong>Results: </strong>All patients achieved fracture union with 82% patients reporting excellent to good functional outcome. Pin site infections and ankle stiffness were most common complications.</p><p><strong>Conclusions:</strong> A very good outcome is achieved in compound extra articular tibial pilon fractures with the hybrid fixator technique. Adequate stability is provided and hence early motion and ambulation can be started.</p>

The AO triangular external fixator: a backup option in the treatment of ankle fractures in geriatric patients?

Purpose To analyze the indications, radiological short-term outcomes, and complications of ankle fractures in geriatric patients treated with a triangular external fixator (AEF) until fracture healing. Furthermore, the effect of an additional osteosynthesis to AEF on the radiological outcome was investigated. Methods Retrospective analysis of ankle fractures treated in a Level I Trauma Center between 2005 and 2015 with an AEF in patients aged ≥ 65 years until fracture has healed. The combination of AEF and at least one additional osteosynthesis of a malleolus was defined as hybrid external fixator (HEF). At the time of AEF removal, a preserved ankle joint congruity was defined as good radiological outcome. Incongruity more than 2 mm was defined as poor radiologic results. Results 16 patients (13 women, 3 men) with a mean age of 74 years (SD 6.2) were treated with AEF until fracture healing, 9 with a single AEF and 7 with a HEF. Stabilization with HEF (n = 7 [100%]) showed higher rates of good radiological outcome than AEF alone (n = 4 [44%] of 9; p = 0.034). The duration of therapy did not differ between HEF and AEF (70 day vs 77 days). 4 patients (22%) required surgical revision. Conclusion It could be shown that osteosynthesis in addition to AEF leads to a better radiological short-term results than using AEF alone. Therefore, in the situation where an AEF is considered as the definitive treatment option for an ankle fracture in geriatric patients with expected or existing soft tissue problems, it should be done or completed as a HEF. Level of evidence Therapeutic level IV.

Management of tibial plateau fractures with compromised soft tissue using hybrid external fixator

<p class="abstract">Tibial plateau fractures with high energy trauma are complex injury due to its precarious soft tissue envelope. High energy trauma has high incidence of open fractures, articular depression, fracture comminution and displacement, soft tissue injury, and neurovascular compression. It is often difficult to achieve and maintain reduction and commonly predisposes to secondary arthritis. Hybrid external fixator minimizes the iatrogenic soft tissue damage, provides adequate fixation of the fracture, permits early range of motion, easy wound care and leave no large implant in subcutaneous position. This study was performed to evaluate the functional and radiological outcome with this procedure. In this case series, prospective study of 15 cases of tibial plateau fractures were treated with hybrid external fixator at tertiary care teaching hospital in southern Rajasthan from July 2018 to June 2019. The functional and radiological outcome was assessed by Rasmussen functional and radiological score. The mean interval between surgery and union was 16 weeks (range 13 to 18 weeks). Rasmussen functional results were acceptable in 13 cases (86.66%) comprising excellent in 9 (60%), good in 4 (26.66%), and fair in 2 (13.33%). Rasmussen radiological results were acceptable in 13 cases (86.66%) comprising excellent in 9 (60%), good in 4 (26.66%), and fair in 2 (13.33%). Minimal internal and hybrid external fixation for management of tibial plateau fracture with compromised soft tissue is more biological, require less surgical time, less hospital stay, very effective in compromised soft tissue, highly cost effective and has minimal complications with good functional outcome.</p>

Biomechanically validated transosseus fixation in patients with femur pseudarthrosis complicated by chronic osteomyelitis

The aim of the study is to evaluate results of follow-up in patients with femur pseudarthrosis complicated by chronic osteomyelitis who underwent biomechanically validated transosseus fixation. Materials and methods. A retrospective study of transosseus fixation in 72 patients with femur pseudarthrosis complicated by chronic osteomyelitis was conducted. Described fixation was completed according to the biomechanical fixation conception from 2011 to 2017. Hybrid external fixator was applied to 38 (52,8%) patients, rod-based external fixator - to 34 (47,2%). Results. Full bone consolidation and pyoinflammatory process remission in treated femur bone is achieved in all cases. Results classified as excellent were acquired in 21 patients (29,5%), good - in 41 (57,7%), satisfactory - in 7 (9,8%), unsatisfactory - in 2 (3%). patients results were classified as unsatisfactory because of lacking of weight-bearing ability of the leg because of other reasons not related to consolidation. Conclusion. In patients with infected femur pseudarthroses external fixation using biomechanical conception allows to provide up to 97% positive clinical outcomes of the treatment.

An Unusual Complication after Infected Total Knee Arthroplasty

One-stage or two-stage revision total knee arthroplasty (TKA) in periprosthetic joint infections has been at the center of scientific debate for many years. As regards two-stage revision TKA, cement spacers have a good infection control rate with successful results reportable up to 96%, though some studies describe related spacer complications such as stiffness and loss of bone stock. We report a case of a fracture close to the antibiotic-loaded cement spacer in a 74-year-old female patient. Due to the blood tests and high risk of infection, we performed a hybrid external fixator. Six months after the surgery, X-rays did not show signs of fracture consolidation and nonunion was considered as an impending complication; therefore, the decision was made to perform tumor-like total knee arthroplasty. The postoperative evolution was satisfactory and return to daily activity without pain. At the 5-year follow-up, the patient showed a good score of 36-Item Short Form Health Survey and a range of motion from 0 to 90° without pain. The X-rays did not show signs of mobilization, dislocation, recurrence of infection, or other complications.