Internal fixator vs external fixator in the management of unstable pelvic ring injuries:A prospective comparative cohort study

BACKGROUND Reconstruction of the pelvic ring anatomy in unstable anterior pelvic ring injuries is a significant step to reduce the mortality rate associated with these injuries efficiently.There is a debate on using either an anterior subcutaneous pelvis internal fixator(INFIX)or an anterior supra-acetabular external fixator(EXFIX)to manage an unstable anterior pelvic ring fracture.AIM To compare the functional and radiological outcomes and complications of INFIX vs EXFIX in managing unstable pelvic ring injuries.METHODS A prospective cohort study included 54 patients with unstable pelvic ring fractures.The patients were divided into two groups;the INFIX group,in which 30 cases were fixed by INFIX,and the EXFIX group,in which 24 patients were treated by EXFIX.The average age in the EXFIX group was 31.17 years(16-57 years),while in the INFIX group,it was 34.5 years(17-53 years).The study included 20(66.7%)males and 10(33.3%)females in the INFIX group and 10(41.7%)males and 14(58.3%)females in the EXFIX group.The radiological outcomes were evaluated using Matta and Tornetta's score,and the functional outcomes using the Majeed score.RESULTS The results revealed a statistically significant difference between both groups(P=0.013)regarding radiological outcomes,according to Matta and Tornetta's score in favor of the INFIX group.Sitting,standing,and walking abilities were measured at a 3-mo follow-up visit using Majeed score modules.It was significantly better among the INFIX group than the EXFIX group in all three modules.At the final follow-up,both groups had no statistically significant difference according to the Majeed score;92.35 in the INFIX group and 90.99 in the EXFIX group(P=0.513).A lower surgical site infection rate was noticed in the INFIX group(P=0.007).CONCLUSION Anterior subcutaneous pelvis INFIX is associated with better radiological outcomes and a lower infection rate than anterior supra-acetabular EXFIX in managing patients with unstable anterior pelvic ring fractures.

Application of lesser trochanteric reduction fixator in the treatment of unstable intertrochanteric fractures

BACKGROUND Closed reduction and internal fixation with intramedullary nails has been widely accepted for treating intertrochanteric fractures.AIM To focus on how to avoid displacement of the lesser trochanter in unstable intertrochanteric fractures.METHODS We developed a lesser trochanteric reduction fixator for treating intertrochanteric fractures through fixing the lesser trochanter by combining the loop plate through the fixator after reduction by the reducer.Five patients with intertrochanteric fractures treated with the newly developed lesser trochanteric reduction fixator and loop plate combined with intramedullary nails,and 20 patients with intertrochanteric fractures treated with simple intramedullary nails were selected from December 2020 to March 2021.RESULTS The postoperative Harris hip score was significantly higher in patients treated with the lesser trochanteric reduction fixator than in patients treated without the lesser trochanteric reduction fixator,which indicated that this lesser trochanteric reduction fixator had a positive impact on rehabilitation of the hip joint after surgery and could significantly improve the quality of life of patients.CONCLUSION We fully realize the significance of trochanteric reduction and fixation,namely,reconstruction of structures under pressure,in the treatment of intertrochanteric fractures.As long as the general condition of patients is favorable and they are willing to undergo surgery,fixation of the main fracture end should be performed and the lesser trochanter should be reduced and fixed at the same time.

Dynamic External Fixator Combined with Volar Locking Plate Fixation for the Treatment of AO Type C3 Distal Radius Fractures

Background: AO type C3 distal radius fracture (DRF) is the most difficult-to-treat fracture type because of a tendency to shorten and collapse. The purpose of this study is to investigate the clinical and radiographic outcomes of comminuted intra-articular DRFs treated with a dynamic external fixator combined with a volar locking plate (VLP). Methods: Eleven patients (mean age, 61 years) with comminuted intra-articular DRFs were treated with a dynamic type of external fixator combined with a VLP. Following reduction and fixation with a VLP, the dynamic external fixator was applied and the distal ball joint of the fixator was aligned with the lunate-capitate line. The ball joint was unlocked approximately 2 weeks after surgery to allow wrist mobilization. The fixator was removed 3 - 6 weeks (mean, 5 weeks) after surgery. Consequently, clinical and radiographic assessments were carried out at the final follow-up. Results: At the final follow-up, the mean range values of wrist extension and flexion were 76°and 64°, respectively. Compared with the contralateral side, the mean grip strength was 84%. The mean Modified Mayo Wrist Score and the Disabilities of the Arm, Shoulder and Hand score were 88 and 9, respectively. No significant differences in the radiographic parameters exist between after surgery and final follow-up. Conclusions: This study indicated that the dynamic wrist fixator combined with a VLP is effective for the treatment of AO type C3 DRFs.

Kinematics of the Ortho-SUV Frame Using as a Novel External Fixator for Orthopedic Surgery

The Ortho-SUV frame,a novel external fixator,can effectively treat limb deformities and fractures.Its kinematics is used when it is necessary to achieve bone movements with high precision.In this work,the kinematics model of the Ortho-SUV frame is established by six pose parameters,and its forward and inverse solutions are given.There is no need to solve nonlinear high-coupling equations with trigonometric functions in this solution method due to its special structure.By numerical examples and simulated orthopedic experiment of tibial fracture,the correctness and accuracy of the kinematics model and its solutions are verified.Besides,on the basis of kinematics analysis,the position workspace and orientation workspace of the Ortho-SUV frame are simulated in Matlab,which can help surgeons choose suitable device dimensions.The kinematics analysis provides a theoretical basis for the Ortho-SUV frame to be used in orthopedic treatment.

Management of Tibial Metaphyseal Fractures by Hybrid External Fixator

Introduction: The Hybrid External Fixator combines the advantages of the monolateral pin fixators and the circular Ilizarov wire fixators. Principle of early motion has been touted as the functional savior of major intra articular injuries in application of hybrid external fixation. Materials & Methodology: 48 patients were considered for the study with tibial fractures admitted in Mamata General Hospital from May 2011 to May 2013. Results: The union and functional outcome of hybrid external fixator in simple and complex proximal and distal metaphyseal fractures of tibia in adults was evaluated at our centre. The fractures of the proximal tibia united with an average of 13.3 weeks (12 - 16 weeks). The fractures of the distal tibia united with an average of 14.42 weeks (13 - 22 weeks) with minimal complications. Conclusion: Our study shows high satisfaction rate after fixation, provides adequate stability and allows early motion of the joint. It is also effective in extra articular fractures occurring within 5 cm of the joint as the IM nails often do not provide enough stability and plating requires extensive soft tissue dissection.

Proximal tibial osteotomy for genu varum:Radiological evaluation of deformity correction with a plate vs external fixator

BACKGROUND High tibial osteotomy(HTO)is a well-known procedure for the correction of knee varus.The purpose of this study was to compare the radiological results and accuracy of deformity correction performed using two different techniques:acute opening wedge correction using a plate and gradual correction with a monolateral external fixator.AIM To compare of the radiological results of two different techniques:acute opening wedge correction(a plate and screw)and gradual correction(external fixator).METHODS A total of 43 patients with plates and 36 patients with external fixators were included.All patients had moderate uniplanar varus deformities.We measured radiographic parameters,including the mechanical axis deviation(MAD),medial proximal tibial angle(MPTA),Caton-Deschamps Index(CDI),posterior proximal tibial angle,and joint line obliquity angle(JLOA).The accuracy of MAD correction was calculated based on a correction goal of neutral or overcorrection for medial compartment arthritis.RESULTS Demographics including age,body mass index,sex,and preoperative deformities were similar between the groups.The MAD significantly improved from 23.6 mm medial to the midline(SD=8.2 mm)to 6.9 mm lateral to the midline(SD=5.4 mm)(P<0.001).The accuracy of MAD correction did not differ between the groups and was 96.1%(SD=8.1%)in the plate group and 98.2%(SD=5.2%)in the external fixator group(P=0.18).The MPTA significantly improved from 83.9°(SD=2.9°)to 90.9°(SD=3.3°)(P<0.001),and the change was similar between the groups.Differences were noted in patella height,with a CDI change of-19.2%(SD=13.7%)and 3.1%(SD=8.0%)for the plate and external fixator groups,respectively(P<0.001).The change in JLOA was 1.6 degrees(SD=1.1 degrees)and 0.9 degrees(SD=0.9 degrees)for the plate and external fixator groups,respectively(P=0.04).CONCLUSION Reliable correction of moderate varus alignment was achieved with both the acute opening wedge technique with a plate and the gradual monolateral external fixator technique.The patellar height decreased with the open wedge plate technique.Joint line obliquity decreased to a greater degree with the open wedge plate technique,perhaps as a result of medial collateral ligament release.The appropriate technique should be selected based on surgeon and patient preferences;however,external fixation may be a better choice when the preservation of patellar height is deemed important.

Cartilage Repair by Joint Distraction and Motion Using an External Fixator for Massive Cartilage Defect

The objective of the present study was to investigate our novel methods for the repair of massive cartilage defects by joint distraction and motion using an external fixator. In this study, we used a rabbit model of massive articular cartilage defect in order to evaluate the effectiveness of using joint distraction and motion with a ring-type external fixator. This external fixator has a hinged joint with a center of rotation along the femoral transepicondylar axis, which allows the knee joint to freely flex and extend. Mesenchymal cells from bone marrow, induced by spongialization, were differentiated into mature chondrocytes and formed hyaline-like cartilage as a result of joint distraction and movement. The transplantation of autologous cells expanded from bone-marrow-derived mesenchymal cells, concentrated autologous bone marrow aspirate, and concentrated autologous peripheral blood cells were all effective in promoting cartilage repair. The quality of the cartilage after long-term joint distraction for 6 months was inferior to that after 12 weeks. In general, weight bearing on the regenerated cartilage promoted cartilage repair, although this effect differed based on when gradual weight bearing was begun. Specifically, gradual weight bearing beginning at 9 weeks produced superior results to that beginning at 6 weeks. Our methods provide an optimal environment for cartilage regeneration.

HYBRID EXTERNAL FIXATOR FOR THE TREATMENT OF UNICAMERAL BONE CYSTS WITH PATHOLOGICAL FRACTURE IN THE PROXIMAL HUMERUS

Objective: Unicameral bone cyst is a nonneoplasticbone lesion characterized by its tenacity and risk ofrecurrence. Pathological fracture is common and is often the presenting symptom. The objective of the present study was to evaluate the results of hybrid external fixator for thetreatment of a unicameral bone cyst with a pathologicalfracture. Methods: Hybrid external fixator for thetreatment of a unicameral bone cyst was performed intwelve patients. These patients presented with a pathological fracture and were managed immediately with hybridexternal fixator, of whom four had been managedconservatively at other clinics before they were referred toour department. The cyst was located in the proximalhumerus in all patients. The mean age of the patients at the time of surgery was 8.7 years, and the mean duration offollow-up was 32.6 months. Radiographic evaluation wasperformed according to the criteria of Capanna et al., andthe cyst was classified as completely healed, healed withresidual radiolucency (osteolysis), recurred, or having noresponse. Results: The healing period ranged from three to eight months. Eight cysts healed completely, and threehealed with residual radiolucent areas visible onradiographs. There was recurrence of one cyst that hadhealed with residual radiolucency. All of the cysts in thepresent study responded to treatment. A modulation ofhybrid external fixator was necessary in three patients, asthe bars had become too short after bone growth or the pins had been loose. No major complications were observed.Conclusion: Hybrid external fixator provides earlystability, which allows early mobilization and thus obviates the need for a plaster cast. This method of treatment alsoallows for an early return to normal activity.

Biomechanical Study on Osteotomized Tibias Fixed with Unilateral Adjustable External Fixator

Five fresh tibias removed from 30-40 years old dead males were osteotomized at one-third supra-medium segment and then fixed by an unilateral adjustable external fixator (UAEF) to be used as a model of external fixation of tibial fracture. For each loading test under different configurations of UAEF, the ratio of the force-displacement was used to determine its stiffness value. The weakest mode of the UAEF device is in AP bending. Under each mode of compression,distraction , anteroposterial and lateral bending and torsion loading , increasing the pin number or pin diameter or pin separation, and/or reduction of pin group separation can significantly increase the stiffness values of UAEF (P<0.01). These data revealed that UAEF is suitable for the external fixation of tibial fracture.

Treatment of Resistant Clubfoot with Soft Tissue Release and Alkhooly External Fixator

After the first research with this technique done by the first author, ten operations on the foot and ankle were performed on five patients (two boys and three girls) suffering from severe club foot deformity all with bilateral foot affection. Their ages ranged from five to fourteen years. All of them were treated by soft tissue release, skin flap (rotational flap), supplemented with Alkhooly external fixator. The follow up period ranged from two to seven years. The results according to Mittal (1987) [1] were excellent in eight feet (80%) and good in two feet (20%).

浅谈引进型可调垫铁——Fixator固定器

在汽轮发电机组的汽轮机及发电机安装工作中,台板支撑大多数采用的是直接斜垫铁支撑,当斜垫铁灌浆后,就只能使用垫片调整间隙及标高,给设备的标高、水平度再次调整带来许多不便。随着科学技术的发展,旧式的安装工艺已无法满足大型汽轮发电机组设备安装的需要。现本文介绍一种国外引进的新型的可调垫铁装置——Fixator固定器,阐述其安装方法及注意事项,为今后设备安装提供借鉴。

Dynamic external fixator combined with limited internal fixation for Pilon reactures

Objective To evaluate effects of manipulative reduction,dynamic external fixator combined with limited internal fixation for the treatment of Pilon fractures.Methods From January 2007 to June 2009,manipulative reduction,dynamic external

External fixator with lumbopelvic distraction spondylodesis for vertically unstable pelvic fracture

Objective To evaluate the clinical outcomes of external fixator with lumbopelvic distraction spondylodesis in treatment of vertically unstable pelvic fractures.Methods From January 2008 to March 2009,9 patients(4 males and 5 females)

Ilizarov external fixators for maluninon of obsolete calcaneal fracture of Stephen Type Ⅲ

Objective To evaluate the clinical effects of Ilizarov external fixator for maluninon of obsolete calcaneal fracture of Stephen Type Ⅲ.Methods From July 2006 to February 2009,25 patients suffering from maluninon of obsolete calcaneal

The damage control in tibial pilon open fractures with a new external fixator delta frame

Objective: To evaluate the effectiveness of the damage control, in emergency to treat the open tibial pilon fractures with Dolphix? External Fixator Frame(CITIEFFE?, Calderara di Reno, Bologna, Italy). Methods: From January 2017 to August 2017, at the Department of Orthopedics and Traumatology of Vito Fazzi Hospital Lecce, we treated 23 open tibial pilon fractures with Dolphix? External Fixator Frame(CITIEFFE?, Calderara di Reno, Bologna, Italy). The evaluation criteria of the case series were: the time needed to assemble the external fixator;the time taked to treat the ankle associated lesions;the time of skin healing;the ankle alignment;the subjective/objective Ovadia and Beals score;and complications. The Endpoint assessment was set at the days of the definitive surgery. Results: The results in terms of alignment, biomechanical stability of the frame, healing of soft tissue, complications were as good as the objective and subjective results according Ovadia and Beals score. Conclusion:Pilon fractures are complex and often present complications;the damage control treatment, in emergency, with Dolphix? External Fixator Frame(CITIEFFE?, Calderara di Reno, Bologna, Italy) permits a stable osteotaxis with minimal soft tissue damage and permit the repair of muscles, blood vessels and nerves with a stable bone and the soft tissue healing with vaccum therapy.

Finite Element Analysis Study of Prototype of a Novel Intramedullary Injectable Bioresorbable Polymer Fixator versus a Volar Plate for Surgical Treatment of Distal Radius Fractures

Complications and shortcomings of volar plating, which is very widely used for surgical treatment of distal radius fractures, are well known. Thus, there is scope for alternative innovative surgical methods. In the present work, we used the finite element analysis method to compare the biomechanical performance of a model of a construct comprising a simulated distal radius fracture considered fixated using a notional intramedullary injectable bioresorbable polymer-bioresorbable balloon osteosynthesis system (“fixator”) versus using a commercially-available volar locking plate (VP). The biomechanical parameters determined were longitudinal stiffness and factor of safety under each of the applied loads.?For the fixator model, 1) each of the biomechanical parameters was markedly influenced by fracture gap fill ratio (FGFR) (defined as the proportion of the volume of the fracture gap that is considered occupied by the expanded polymer-filled balloon)?but not by modulus of elasticity assigned to the polymer;2) with FGFR = 100%, stiffness was comparable to that of the Ti-6Al-4V alloy VP construct model;and 3) stiffness was within the range of literature values for stiffness of constructs comprising simulated fractures in fresh cadaveric distal radii fixated using metal volar locking plate. These results suggest that the fixator may be an alternative modality to metal volar plating and, as such, deserves further evaluation.

Evaluation of Surgical Treatment of Distal Humeral Fractures in Adults

Introduction: Fractures of the distal end of the humerus are becoming increasingly frequent in young subjects because of the increase in road traffic accidents, and in elderly subjects because of osteoporosis related to aging populations. Materials and Methods: It was a prospective, monocentric study from January 2018 to December 2020 involving 14 patients who received and were treated surgically for distal humeral fractures and followed up. Results: We collected 14 patients, including 11 men (78.57%) and 3 women (21.43%), with a sex ratio of 3.7. The mean age was 36.41 years. The circumstances of onset were dominated by road traffic accidents, with 12 cases (85.71%). The dominant side was right-handed, with 11 cases (78.57%). Standard elbow radiography revealed 8 cases of type A fractures (57.14%), 4 cases of type B and 2 cases of type C fractures of the AO. We performed Lecestre plate osteosynthesis in 12 patients and external fixator in 2 others, using the trans-olecranial and transtricipital approaches. Elbow stiffness was the most frequent complication, with 6 cases (42.86%). After six months’ follow-up, our results were excellent and good in 78.57% of cases (MEPS). Conclusion: Surgical treatment with posterior approaches enabled us to achieve restitution of the articular surfaces, solid restraint and early mobilization of the elbow with satisfactory functional results.

Axial load-share ratio testing to assess the healing of open tibial fractures treated with the Taylor Spatial Frame

Background:The Taylor Spatial Frame(TSF)has gained popularity among orthopedic surgeons for treating open fractures.However,a key challenge is the timely and safe removal of the frame.This study assessed the efficacy and safety of axial load-share ratio(ALSR)testing to evaluate callus healing strength after TSF treatment of open tibial fractures.Methods:A retrospective case-control study was conducted,analyzing 180 adult patients with open tibial fractures treated at Tianjin Hospital’s Orthopedic Limb Correction Unit between August 2019 and August 2022.All patients underwent TSF external fixation surgery,and were divided into two groups based on ALSR testing.Group I(92 patients)underwent ALSR testing,with frame removal if the test value fell below 5%.Traditional methods were used for fixator removal guidance in Group II(88 patients).Clinical outcomes,including fixation duration,complications after fixator removal,and Johner-Wruhs functional scores,were compared between the two groups.Results:The groups showed no statistically significant differences(P>0.05)in sex,age,injury side,body mass index,surgery timing,or fracture type.Group I had a significantly shorter fixation duration(25.85±5.57 weeks)compared to Group II(31.82±6.98 weeks)(P<0.05).Following fixator removal,Group I demonstrated superior Johner-Wruhs scores compared to Group II,indicating better outcomes(P<0.05).Complication rates did not differ significantly between the groups at the last follow-up(P>0.05).Conclusion:Regular postoperative ALSR testing could safely and effectively guide TSF removal following open tibial fracture treatment.This method significantly reduced fixation duration compared to traditional guidance methods while maintaining efficacy and safety.

Treatment of type C3 distal radius fracture resulted from high-energy injuries by volar plate in combination with external fixator

Background With a type C3 distal radius fracture it is extremely difficult to maintain the reduction and to restore congruity of the articular surface because the support for the volar and dorsal bone cortex has been lost. An external fixator crossing wrist in combination with Kirschner wire （K-wire） fixation was popularly used by most studies in recent years. But loss of reduction often occurred especially in the volar sides. Methods A total of 30 cases of type C3 distal radius fracture were treated by a volar buttress plate combined with a transarticular external fixator and other techniques such as K-wire fixation and bone grafting if necessary. The postoperative volar tilt angles, ulnar inclinations, radial heights, range of motion, grip strength and complications were recorded to assess the therapeutic effects. Results Of the 30 patients, 27 patients were followed up for 12-29 （mean 18） months and all fractures healed in 8-13 weeks after surgery （mean 10 weeks）. The wrist function was excellent in 8 cases, good in 16 cases and fair in 3 cases according to the Sarmiento scoring system （modified by Stewart）. Conclusions For type C3 comminuted fracture with severe volar and dorsal instability, fixation by volar buttress plate combined with transarticular external fixator should be adopted. Dorsal instability could be further stabilized by other techniques such as Kirschner wire fixation, and bone grafting.