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Svyatoslav Teterin
Svyatoslav Teterin

External Fixation In Orthopedic Traumatology |BEST|

External fixation in Orthopedic traumatology is the only textbook on the market that addresses the specific issue of external fixation in the acute setting as a whole. Other textbooks have explored the issue but either focusing on lengthening techniques (Ilizarov), focusing on one body part (pelvis), or focusing on one external fixation brand (Orthofix)

External Fixation in Orthopedic Traumatology

The editors have a life long expertise in the field of external fixation, one of them (DS) having contributed to their designs. The editors and authors have a rich variety of backgrounds with experience in the military, application of these techniques in economically disadvantaged areas and training in different part of the world including the USA, Europe and the Asian continent giving a flavour of universality to this textbook

The textbook contains drawings, illustrations and clinical photographs detailing surgical techniques and various types of external fixation constructs enabling the reader to rapidly visualise and understand the concepts described

Background: Bone defects represent the main challenging problem for the orthopedic surgeon and, consequently, they increase the duration of hospitalization, risk of complications and health expenditures. The aim of our observational, descriptive and retrospective study is to evaluate the outcomes of patients treated with a mo-nolateral external fixator for bone defects greater than 3 cm.

Conclusion: 1. A review of the literature related to our experience shows that bone transport is an effective tech-nique to repair loss of bone in the lower limbs. The use of a system of external fixation enables corrective actions throughout the treatment that can be in-dividualized on a case-by-case basis. In our experience, the LRS fixator (Orthofix) is a sta-ble, easy-to-use and very handy device. 2. In situations where soft tissue reconstruction procedures are needed, the size and shape of the splint should be such as not to constitute an obstacle. Fur-thermore, the use of pins rather than transfixation wires eliminates the risk of neuro / vascu-lar injury such as may occur during the application of a circular fixator. 3. The analysis of the cases presented here indicates that where possible the technique of bone transport produces good results and can often salvage the limb. Amputation should be reserved only for cases where the general and / or local preoperative status indicate that the surgeon can expect a poor result or when the compliance of the patient is determined to be inadequate.

Even though external fixation is considered to be a rather "new" trend in orthopedics and traumatology, in fact it has been something used by physicians and surgeons for thousands of years. In the mid 1800's, external fixation would see some substantial growth and evolution, pioneered by physicians and surgeons whose principles are still in use today. Through the 1900's, the indications and usage would continue to expand, not to mention the modernization of the external fixation apparatus. Many surgeons in this era are notable for their work with external fixation, especially Gavriel Ilizarov, considered to be the father of external fixation. Further research and development with external fixation needs to be performed and, with time, will more than likely become fully integrated into modern clinical practice.

External fixation is the primary treatment option in children for femoral shaft fractures, such as open femoral or multiple fractures. One complication is refracture, which is the biggest limitation of fixation devices. This study aims to investigate the risk factors associated with refracture after the removal of external fixation devices and decrease the frequency of refracture.

Retrospectively reviewed clinical data of 165 patients treated at our hospital for fresh femoral shaft fractures with external fixation between May 2009 and February 2018 were included in this study. Patients with pathological fractures, fractures of the femoral neck, fractures that were fixed using plates or elastic stable intramedullary nailing, and old fractures, as well as those who underwent postoperative femoral surgery were excluded. Potential risk factors included: patient age, gender, and weight, fracture sides, open or closed fracture, fracture sites, reduction methods, operation time, perioperative bleeding, number and diameter of the screws, and immobilization time. These factors were identified by univariate and logistic regression analyses.

Femoral shaft refracture is relatively common in children treated with external fixation. Because of the limited number of cases in this study, we cautiously concluded that the PCCF classification type 32-D/4.2 and L2/L3 ratio were independent risk factors for femoral shaft refracture in these patients.

Radiograph showing the right femoral shaft fracture in a 6-year-old male patient. a Initial fracture; b Fracture treated with external fixation (EF); c Removal of EF after 8 months; d At the fourth week after the fixation removal, refracture, unfortunately, happened due to a fall; e Refracture treated with an elastic intramedullary nail; f Removal of the fixator after 11 months. No refracture occurred within 1 year

The mechanical features of and biologic response to using distraction osteogenesis with the circular external fixator are the unique aspects of Ilizarov's contribution that allows deformity correction and reconstruction of bone defects. We present a retrospective study of 20 patients who suffered from a variety of benign tumours for which external fixators (EF) were used to treat deformity, bone loss, and limb-length discrepancy. A total of 26 bony segments in twenty patients (10 males, 10 females; mean age 17 years; range 7-58 years) were treated with EF for residual problems from the tumour itself (primary treatment) in 8 patients and for complications related to the primary surgery (secondary treatment) in 12 patients. Histological diagnoses were Ollier's disease (n = 4), Fibrous Dysplasia (n = 5), Congenital multiple exostosis (n = 5), giant cell tumour (n = 2) and one case for chondromyxoid fibroma, desmoid fibroma, chondroma and unicameral bone cyst. Various types of external fixators used to treat these problems. These were Ilizarov, unilateral fixator, multiaxial correction frame (Biomet, Parsippany, NJ), Taylor spatial frame (Memphis, TN) and smart correction multiaxial frame. The mean follow-up time was 69.5 months (range 35-108 months). The mean external fixation time was 159.5 days (range 27-300 days). The mean external fixation index was 67.4 days/cm (12-610) in 26 limbs who underwent distraction osteogenesis. The mean length of distraction was 4.9 cm (range 0.2-14 cm). At final follow-up, all patients had returned to normal activities. Complications were in the form of knee arthrodesis in one patient, pin tract infection in six and residual shortening in eight patients. The use of EF and the principles of distraction osteogenesis, in the management of problems associated with benign bone tumours and related surgery yields successful results especially in young patients. With this approach, the risk for recurrence of shortening and deformity may be minimized with overcorrection or over-lengthening as dictated by preoperative planning.

In order to explore the clinical effect of external fixation in patients with traumatic orthopedics, 84 patients with various types of fractures in our hospital were selected as the research object. They were randomly divided into control group and experimental group, 42 cases in each group. The control group received routine orthopedic treatment, and the experimental group received external fixation. The therapeutic effects of the two groups were observed and compared statistically. Compared with the control group, the excellent and good rate of the experimental group was higher. The operation time, wound healing time and hospital stay were shorter, and the difference between the two groups was statistically significant (P

(SBQ18TR.27) A 45-year-old male construction worker presents with right ankle pain after falling from a two-story building and landing on his right leg. He noticed immediate pain and inability to bear weight on the affected limb. Physical examination reveals diffuse soft tissue swelling around the ankle joint without any open injuries. The patient reveals he never completed a high school degree, smokes 1/2 a pack of cigarettes per day, and occasionally uses marijuana recreationally. Injury radiographs are shown in figures A and B. The patient undergoes an ankle-spanning external fixator placement for soft tissue stabilization and then undergoes definitive fixation shown in figures C and D. Which factor suggests a poor clinical outcome and failure to return to work?

(SBQ18TR.26) A 37-year-old construction worker falls off a rock and lands on his right leg. He reports severe pain and inability to bear weight on the right leg. Current imaging is shown in figures A-C. On examination, the injury is closed, but there is substantial soft tissue swelling. An ankle spanning external fixator is placed on the right leg to allow for soft tissue stabilization. The treating surgeon decides to perform an open reduction internal fixation (ORIF) through combined anterolateral and medial approaches. What is true regarding the anterolateral approach for this injury?

(OBQ13.135) A 34-old-male was involved in a high speed MVC. He sustained an injury to his right leg as seen in Figures A and B. He was treated initially with external fixation for 11 days before his soft-tissues would permit definitive open internal fixation. After removing the external fixator and plating the fibula, what would be next step in the operative plan for reduction and fixation of this injury? 041b061a72


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