Stability with unilateral external fixation in the tibia.
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ABSTRACT:
SUBMITTER: Giotakis N
PROVIDER: S-EPMC2321723 | biostudies-other | 2007 Apr
REPOSITORIES: biostudies-other
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Project description:It is a prerequisite for surgeons using external fixation systems to be familiar with safe corridors for half pin or wire insertion. Several atlases of cross-sectional anatomy are available, mostly in print, to provide guidance [1-3]. This series of articles provides high-quality cross-sectional anatomical images together with guidance in locating safe corridors; the added benefit here is that the information can be downloaded and stored on the surgeon's or in the operating room computer for ease of reference. This review covers the lower leg from knee joint to foot.
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Project description:The treatment of fractures of the distal third of the tibia has evolved with the development of improved imaging and surgical techniques. The outcome of treatment using conventional fixation is poor. We report a study on indirect reduction in 26 patients. All cases achieved radiological union and full weight bearing. The good to excellent results suggest that this method should be considered in metaphyseal fractures where intra-medullary nails are not suitable.
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Project description:The purpose of our study was to compare the curative effect of two surgical methods for Schatzker type I to III tibia plateau fractures, arthroscopy assisted reduction percutaneous internal fixation (ARIF) and open reduction internal fixation (ORIF), with the intent of evaluating the quality of evidence to assist treatment selection. Searches of PubMed, Cochrane and China National Knowledge Infrastructure (CNKI) databases were performed to identify randomized controlled trials (RCTs) and quasi-RCTs comparing ARIF and ORIF regarding the following outcomes: functional outcomes, perioperative complications and post-traumatic osteoarthritis. Odds ratios (OR) and weighted mean differences (MDs) were pooled using either a fixed-effects model or random-effects model, depending on the heterogeneity of the trials included in the analysis. 19 RCTs and one quasi-RCT provided the data from 1272 patients. ARIF was associated with better functional outcomes, a lower risk of perioperative complications, and lower risk of post-traumatic osteoarthritis. After consideration of the quality of evidence of the included studies, the advantages provided by ARIF are not substantive over ORIF for the treatment of Schatzker type I to III tibia plateau fractures, except reducing the risk of perioperative complications.
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Project description:External fixation has evolved from being used primarily as a last resort fixation method to becoming a main stream technique used to treat a myriad of bone and soft tissue pathologies. Techniques in limb reconstruction continue to advance largely as a result of the use of these external devices. A thorough understanding of the biomechanical principles of external fixation is useful for all orthopedic surgeons as most will have to occasionally mount a fixator throughout their career. In this review, various types of external fixators and their common clinical applications are described with a focus on unilateral and circular frames. The biomechanical principles that govern bony and fixator stability are reviewed as well as the recommended techniques for applying external fixators to maximize stability. Additionally, we have illustrated methods for managing patients while they are in the external frames to facilitate function and shorten treatment duration.
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Project description:Posterolateral impression fractures of the tibial plateau are common, and open reduction and fixation can be demanding, including exposure of the peroneal nerve. Based on a patient example, the surgical technique of an arthroscopic controlled closed reduction and percutaneous screw fixation of a posterolateral tibia plateau impressed fracture is described. A patient sustained a posterolateral impression currently described as an "apple bite" fracture of the tibial plateau. The surgical technique includes standard arthroscopic portals and posteromedial and (transseptal) posterolateral portals. The posterolateral tibial plateau is visualized by incision of popliteomeniscal fibers, retraction of the popliteus tendon, and exposure of the posterolateral plateau. The impression area is marked with a K-wire using an anterior cruciate ligament target device. A cannulated ram is placed over the K-wire. The fracture is lifted under arthroscopic guidance and can be supported with allograft bone chips. To stabilize the reduction, 3 K-wires are positioned from anterior to posterior, and 3 cannulated screws are inserted directly under the joint surface to support the fractured area. In comparison with open surgical techniques, this procedure is exclusively performed under arthroscopic control and enables an anatomic reduction and fixation of the posterolateral tibial plateau.
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Project description:This study describes an arthroscopic pullout fixation technique for small and comminuted avulsion fractures of the posterior cruciate ligament from the tibia. Intra-articular surgery required 3 arthroscopic portals, the anterolateral, anteromedial, and posteromedial portals. To simplify surgery, the posterolateral portal was omitted. A 2.4-mm K-wire was inserted through the anterior incision to the center of the bone fragment. This central guidewire was subsequently overdrilled with a 4.0-mm cannulated drill. The fixation material consisted of Pass Telos artificial ligaments inserted through the fiber loop of a fixed suspensory device such as RIGIDLOOP. The leading end of the thread of the RIGIDLOOP was pulled out through the anteromedial portal. The button of RIGIDLOOP was gradually advanced through the bone tunnel. The button was pulled out and flipped over the bony fragment. The artificial ligament was pulled distally to reduce the bony fragment, and fixed onto the tibia using a ligament button while applying anterior drawer force to the proximal tibia with the knee flexed at 90°. This minimally invasive procedure was successful in treating small and comminuted avulsion fracture of the tibial attachment of the posterior cruciate ligament.
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Project description:A poor soft tissue envelope often accompanies periprosthetic tibia fracture around a well-fixed total knee arthroplasty and the tibial stem leaves little room for screw fixation. This article describes the practicability and effectiveness of a novel surgical technique using circular hexapod external fixation, in patients with this clinical scenario. It was applied for fixation of periprosthetic tibia fracture in 2 patients. Contact between the external fixation pins and the prosthesis was avoided. Using a web-based software program, a gradual reduction in all planes was achieved. Adequate fixation, stability, reduction, and quick healing were obtained in the 2 cases, with minimal complications. The patients returned to their activity level a few months after external fixation removal.
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Project description:Background The purpose of this study was to review clinical and radiographic outcomes of perilunate dislocations (PLDs) and fracture-dislocations (PLFDs) treated with external fixation and Kirschner wires (K-wires). Materials and Methods Twenty patients (18 males and 2 females) with a mean age of 38 years (range 18-59) with an acute PLD or PLFD were treated with external fixator and K-wires. There were 12 PLDs and seven transscaphoid and one transstyloid PLFDs. The median time from trauma to operation was 8 hours (range 2-12 hours). Indirect reduction via ligamentotaxis was achieved in 17 patients with a mean age of 38years (range 18-59). There were 12 PLDs and 5 trans-scaphoid PLFDs; however, in three cases (two transscaphoid and one transstyloid PLFDs), indirect reduction failed and an open reduction was required. The intercarpal ligaments were not repaired even after open reduction. Results The mean follow-up was 39 months (range 18-68 months). The flexion-extension range of motion (ROM) and grip strength of the injured wrist averaged 80% and 88%, respectively, of the corresponding values for the contralateral wrists. According to Cooney's scoring system, overall functional outcomes of the 17 patients were rated as excellent in 4 patients, good in 8, fair in 4, and poor in 1. Fifteen patients returned to their former occupations. Two patients with a trans-scaphoid perilunate injury developed nonunion of the scaphoid, and two developed posttraumatic arthritis. Conclusion External fixation plus percutaneous K-wires for the treatment of acute PLDs has satisfactory midterm functional and radiographic outcomes. When successful, this minimally invasive technique is simple and provides restoration of the carpal alignment. It may especially be useful in the polytrauma patient, thanks to its decreased operative time and diminished blood loss, when other emergent surgical procedures may be necessary. An open reduction with possible fixation may be necessary for PLDs and PLFDs, especially in the presence of polytrauma and scaphoid comminution.IV.
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Project description:A group of 30 patients of unstable tibial diaphyseal fractures were managed using unilateral tubular external fixator. The fixator assembly comprised a double stainless steel hollow rod with universal joints and schanz screws as principal implant. Reduction and controlled distraction or compression were achieved by means of distracter/compressor device. Early dynamization was resorted to. The union rate was 100% with average healing time between 20 weeks for closed unstable fractures and 27 weeks for open Gustilo grade-II fractures. Minor pin tract infections accounted for majority of the complications. The unilateral fixator assembly permits early ambulation in unstable tibial diaphyseal fractures without sacrificing a sound anatomical result.
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Project description:Twenty patients with intertrochanteric fractures of the femur were treated by external fixation. They were selected because of their surgical risk and evaluated clinically and radiographically after 6,12 and 18 weeks. Fourteen out of twenty patients had excellent results. Caxa vara deformity, shortening and delayed union was observed in two patients. Results indicate that external fixation is a useful method for treatment of these type of patients.
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