scholarly journals External skeletal fixation of femoral shaft fractures in polytrauma patients

2008 ◽  
Vol 61 (9-10) ◽  
pp. 497-502 ◽  
Author(s):  
Predrag Stojiljkovic ◽  
Zoran Golubovic ◽  
Desimir Mladenovic ◽  
Ivan Micic ◽  
Sasa Karalejic ◽  
...  
Keyword(s):  
Internal Fixation ◽  
External Fixation ◽  
External Fixator ◽  
Damage Control ◽  
Healing Time ◽  
Safe Procedure ◽  
Femur Fractures ◽  
Definitive Method ◽  
Polytrauma Patients ◽  
Rigid Stabilisation

Introduction. Polytrauma remains a major social, economic and medicine affliction. A successful surgical treatment of polytrauma patients requires an approach predicated on prioritizing injuries. An isolated femur fractures rarely poses any threat but in association with multiple injuries, this fracture assumes greater significance. The proper management of femur fractures in polytrauma can greatly reduce the mortality and morbidity. Material and methods. We present our results in the treatment of 24 femur shaft fracture in 22 polytrauma patients treated by Mitkovic external fixator in 5 year period (2000-2004) on Orthopeadic and Traumatology Clinic - Clinical Center Nis. The average of patients age was 32.8 years (ranging from 17 to 62). There were 11 (46%) closed and 13 (54%) open fractures. Results. Eighteen fractures were treated by external fixation until union. The remaining six fractures were treated by conversion of the external fixation to internal fixation. Sixteen fractures (88.88%), in which the external fixation was the definitive method of treatment, healed completely. The average healing time was 6.29 (4-9) months. There were three pin-track infections (16.66%), one nonunion (5.55%) and only one deep infection (5.55%). Conclusion. The external fixation by the use of Mitkovic external fixator in the treatment of femur fractures is a safe procedure to achieve temporary rigid stabilisation in polytrauma patients before the subsequent internal fixation (damage control orthopaedics). The external fixation using Mitkovic external fixator can be definitive method of choice in treatment of open and comminutiwe femur fractures in polytrauma patients until union.

Clinical Value of Computer-Assisted Taylor Three-dimensional External Fixation in the Treatment of Tibiofibular Fracture (Preprint)

2020 ◽  
Author(s):  
Hongfeng Sheng ◽  
Weixing Xu ◽  
Bin Xu ◽  
Hongpu Song ◽  
Di Lu ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Internal Fixation ◽  
External Fixation ◽  
External Fixator ◽  
Theoretical Basis ◽  
New Technology ◽  
Three Dimensional ◽  
Computer Assisted ◽  
Clinical Value

UNSTRUCTURED The retrospective study of Taylor's three-dimensional external fixator for the treatment of tibiofibular fractures provides a theoretical basis for the application of this technology. The paper collected 28 patients with tibiofibular fractures from the Department of Orthopaedics in our hospital from March 2015 to June 2018. After the treatment, the follow-up evaluation of Taylor's three-dimensional external fixator for the treatment of tibiofibular fractures and concurrency the incidence of the disease, as well as the efficacy and occurrence of the internal fixation of the treatment of tibial fractures in our hospital. The results showed that Taylor's three-dimensional external fixator was superior to orthopaedics in the treatment of tibiofibular fractures in terms of efficacy and complications. To this end, the thesis research can be concluded as follows: Taylor three-dimensional external fixation in the treatment of tibiofibular fractures is more effective, and the incidence of occurrence is low, is a new technology for the treatment of tibiofibular fractures, it is worthy of clinical promotion.

scholarly journals Can a linear external fixator stand as a surgical alternative to open reduction in treating a high-grade supracondylar humerus fracture?

2018 ◽  
Vol 47 (1) ◽  
pp. 133-141
Author(s):  
Barak Rinat ◽  
Eytan Dujovny ◽  
Noam Bor ◽  
Nimrod Rozen ◽  
Guy Rubin
Keyword(s):  
Internal Fixation ◽  
External Fixation ◽  
External Fixator ◽  
Closed Reduction ◽  
Open Reduction ◽  
High Grade ◽  
Supracondylar Humerus Fractures ◽  
Long Term Follow Up ◽  
Humerus Fractures ◽  
Carrying Angle

Objective High-grade pediatric supracondylar humerus fractures are commonly treated with closed reduction and internal fixation with percutaneous pinning. When this fails, open reduction followed by internal fixation is the widely accepted procedure of choice. Use of a lateral external fixator was recently described as an optional procedure, but evidence is scarce. Methods We investigated the outcomes of upper limbs treated by either open reduction with internal fixation or closed reduction and external fixation. Results Twenty-one patients completed the long-term follow-up; 11 underwent open reduction, and 10 underwent external fixation. Most patients in both groups reported excellent satisfaction. In both groups, the modified Disabilities of the Arm, Shoulder, and Hand score was extremely low and the average elbow range of motion was almost identical. Radiographic analysis consisting of Baumann’s angle and the carrying angle revealed no statistical difference between the two groups. Discussion Optional treatment using a linear external fixator for complex nonreducible supracondylar humerus fractures yielded acceptable clinical and radiographic results, as with open reduction. Our sample size was small, but the promising results may assist in the implementation of an alternative surgical procedure, especially in more complicated cases involving flexion-type fractures or severe soft tissue damage and swelling.

Ankle spanning external fixator with limited internal fixation for distal tibial extra-articular fractures

2017 ◽  
Vol 5 (10) ◽  
pp. 4355
Author(s):  
Siddharth Goel ◽  
Abhay Elhence
Keyword(s):  
Soft Tissue ◽  
Internal Fixation ◽  
External Fixation ◽  
External Fixator ◽  
Tibial Fractures ◽  
Fixation Method ◽  
Ankle Pain ◽  
Distal Tibial Fractures ◽  
Tract Infections

Background: Fractures of the distal tibia are among the most difficult fractures to treat. The short distal segment presents difficulty in choosing the appropriate fixation method. The greatest challenge lies in the relatively tight soft tissue around the ankle. As a result, it has been a recent interest in treating these fractures with external fixation and limited internal fixation. The external stable fixation methods used are tubular or ring fixators, with or without immobilising the ankle. This minimally invasive nature of the surgery can avoid catastrophic wound complications like dehiscence, implant exposure and infection.Methods: 18 patients with extra-articular distal tibial fractures (AO Type 43A) were treated with the technique of ankle spanning external fixation. Lag screws or K-wires were supplemented for limited internal fixation when required. Fibula was stabilised in all cases. Intra- articular and Compound fractures were excluded. In addition to union at fracture site, ankle pain and motion was noted in each follow-up.Results: The mean follow-up was 25 months. Of the 18 patients included all but one fractures united with an average healing time of 16 to 18 weeks. Ankle pain and motion was graded according to Mazur modified by Teeny and Wiss clinical scoring system. 15 of them had excellent or good results, 2 had fair results. One patient had poor result. Five pin tract infections occurred. 17 patients had no evidence of osteoarthritis after completing follow up of at least 2 years.Conclusions: Distal tibial fractures are complex injuries, not only regarding the bony component, but also in terms of the management of the soft tissue problem. Ankle Spanning External Fixator with Limited Internal fixation is a relatively simple and cost-effective method for treating these fractures, achieving union and also maintaining ankle function.

Skeletal Stabilisation

2020 ◽  
pp. 41-56
Keyword(s):  
Soft Tissue ◽  
Internal Fixation ◽  
External Fixation ◽  
Surgical Procedures ◽  
External Fixator ◽  
Definitive Treatment ◽  
Mutual Understanding ◽  
Published Evidence ◽  
The Difference ◽  
Skeletal Stability

In this chapter we draw upon published evidence and the experience of the authors to provide guidance in stabilisation for open tibial fractures. Most orthopaedic surgeons have, through their training, reached higher levels of proficiency and expertise in methods of internal fixation than with external fixation. The difference reflects the greater number of fractures treated with internal fixation methods. Spanning external fixation should provide skeletal stability without impeding access for plastic surgical procedures. This combination of prerequisites has to be met through a mutual understanding of bony and soft tissue requirements at first debridement and at definitive treatment of the open fracture. Many fixator configurations used currently and even advocated for in external fixator manuals simply fail to meet these requirements. Consequently, we provide a clear rationale for the recommendations made and encourage adoption of the principles described.

scholarly journals Minimally invasive treatment of bilateral femoral shaft fractures in polytrauma patient using selfdinamisibile internal fixator: A case report

2013 ◽  
Vol 60 (2) ◽  
pp. 59-64
Author(s):  
Predrag Stojiljkovic ◽  
Ivan Micic ◽  
Sasa Milenkovic ◽  
Milan Mitkovic ◽  
Ivan Golubovic ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Femoral Fractures ◽  
Internal Fixator ◽  
Invasive Technique ◽  
Invasive Treatment ◽  
Operative Trauma ◽  
Femur Fractures ◽  
Definitive Method ◽  
Polytrauma Patients ◽  
Polytrauma Patient

Proper timing and surgical method in management of femur fractures in polytrauma patients can greatly reduce the mortality, morbidity and disability. The aim of this paper is to present the treatment of bilateral femoral fractures in polytrauma patient with dominant chest trauma by selfdynamisable internal fixator Mitkovic (SIF) as a definitive method of fractures treatment. A 23 years old female was injured in a traffic accident. After resuscitation and treatment of the dominant chest injuries, surgical treatment of bilateral femur fractures performed on the fourth day after the injury. Length of surgery was 65 minutes. There was not blood substitution during the intervention and blood loss through the operative wounds drainage. There was no worsening of the pulmonary function after orthopaedic surgery. The patient discharged from hospital postoperative day ten. Postoperative follow-up was 9 months. The fractures healed with an excellent functional result. Application of selfdynamisable internal fixator (SIF) with minimally invasive technique for the treatment of bilateral femoral fractures in polytrauma patients is a good operative method because poses minimally additional operative trauma and provides excellent biomechanical conditions for fracture healing.

A New Fixation Technique for the Lapidus Bunionectomy

2005 ◽  
Vol 95 (4) ◽  
pp. 405-409 ◽  
Author(s):  
James C. Wang ◽  
Brendan M. Riley
Keyword(s):  
Internal Fixation ◽  
External Fixation ◽  
External Fixator ◽  
Preliminary Report ◽  
Delayed Union ◽  
Oral Antibiotics ◽  
Fixation Technique ◽  
Short Course ◽  
Time To Initiation ◽  
Fixation Techniques

Presented here is a preliminary report of 102 patients who underwent first metatarsocuneiform joint arthrodeses performed with external fixation for the correction of hallux valgus. The advantages of using external fixation are the ability to initiate early weightbearing, predictable fusion, and removal of all of the hardware postoperatively. In the 102 patients reported here, the average time to initiation of unassisted full weightbearing was 13.1 days. The average time to fusion was 5.3 weeks, with removal of the external fixator at an average of 5.5 weeks postoperatively. There was no incidence of delayed union or nonunion. There was one case of pin-tract irritation, which resolved with appropriate pin care and a short course of oral antibiotics. External fixation is an effective alternative to traditional internal fixation techniques in metatarsocuneiform joint arthrodesis. (J Am Podiatr Med Assoc 95(4): 405–409, 2005)

scholarly journals Unilateral external fixation of the tibial shaft malunion

2020 ◽  
Vol 148 (1-2) ◽  
pp. 37-40
Author(s):  
Sasa Milenkovic ◽  
Milan Mitkovic ◽  
Milorad Mitkovic
Keyword(s):  
External Fixation ◽  
External Fixator ◽  
Varus Deformity ◽  
Functional Results ◽  
Clinical Results ◽  
Valgus Deformity ◽  
Healing Time ◽  
Fixation Method ◽  
Tibial Shaft ◽  
Complications Rate

Introduction/Objective. Fracture malunion is still a major problem in orthopaedic practice. The external fixation of tibial fracture malunion has become popular in recent years. The objective of this work was to evaluate clinical results in tibial shaft malunion treatment based on unilateral external fixation method. Methods. The patients with tibial shaft malunion have surgically been treated by unilateral Mitkovic external fixation system. Malunion deformities were corrected by ?one stage? technique, using Mitkovic-CD type external fixator, or gradually, using Mitkovic-V type external fixator. This retrospective study included 15 patients with tibial shaft angular malunion. The main type of malunion was valgus deformity, in 10 patients, and varus deformity, in five patients. Results. The mean healing time was 89.66 days (range 50?125). There were no complications in the present study. The follow-up time after surgery was three years. Final functional results were excellent in 13 cases and good in two cases. Conclusion. This unilateral external fixator system was successfully used in the treatment of tibial shaft malunion, with good results and low complications rate.

scholarly journals An Alternative Site for Pin Placement in External Fixation of Pelvic Fractures: Lateral Posterior Pelvic External Fixator Surgical Technique

2021 ◽  
Vol 7 ◽  
Author(s):  
Matthias K. Russ ◽  
Pierre Navarre ◽  
Jarrad P. Stevens
Keyword(s):  
Surgical Technique ◽  
Internal Fixation ◽  
External Fixation ◽  
External Fixator ◽  
Pelvic Fractures ◽  
Interquartile Range ◽  
Definitive Treatment ◽  
Easy Access ◽  
Lateral Posterior ◽  
Insertion Sites

Introduction: The application of an external fixator for unstable pelvic fractures is an important component of many resuscitation protocols. Moreover, certain pelvic fractures may be treated with an external fixator without requiring further internal fixation. We report our initial clinical results with an alternate pelvic external fixator site, the lateral posterior external fixator (LPEF), and describe the surgical technique.Methods and Materials: From 2010 to 2013, we identified 27 consecutive patients (mean age 44.6 years, range 18–80 years) treated by the same surgeon (MKR) with an LPEF in a level 1 trauma center. Retrospective data collection included mechanism of injury, surgical interventions, and complications.Results: The LPEF was used in 16 patients as acute pelvic stabilization and converted at a median of 2 days (interquartile range 1–3.5) to internal fixation, whereas in 10 patients, it was used as definitive treatment and removed at a median of 48 days (interquartile range 37–64). One patient died on day 14, secondary to his severe closed head injury. The only surgical complications were two wound infections (20%, 2/10 in the group of definitive LPEFs), which resolved without sequelae after the removal of the LPEF (at 36 and 50 days) and antibiotics, one case of loss of fixation leading to the removal of the LPEF at 71 days, and one patient who had hypergranulating external fixator sites and eventually healed without any cutaneous sequelae. All fractures consolidated in a good position.Discussion: The described techniques of pelvic external fixation include the anterosuperior (iliac wing), supra-acetabular (anteroinferior), and subcristal (anterior superior iliac spine) insertion sites. The reported infection rates in definitive pelvic fracture treatment range from 20 to 40%. Due to the localization of the insertion sites, the lateral femoral cutaneous nerve is potentially at risk with the last two techniques. On the other hand, the LPEF insertion site is quite safe, as it is anatomically far from any nerves and the inguinal region, and allows easy access for laparotomy. The results in this series suggest that the lateral posterior pelvic external fixator technique is an alternative to previous techniques with a low risk of complications.

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