Fracture healing following high energy tibial trauma: Ilizarov versus Taylor Spatial Frame

Introduction

The optimal treatment of high energy tibial fractures remains controversial and a challenging orthopaedic problem. The role of external fixators for all these tibial fractures has been shown to be crucial.

Methods

A five-year consecutive series was reviewed retrospectively, identifying two treatment groups: Ilizarov and Taylor Spatial Frame (TSF; Smith & Nephew, Memphis, TN, US). Fracture healing time was the primary outcome measure.

Results

A total of 112 patients (85 Ilizarov, 37 TSF) were identified for the review with a mean age of 45 years. This was higher in women (57 years) than in men (41 years). There was no significant difference between frame types (p=0.83). The median healing time was 163 days in both groups. There was no significant difference in healing time between smokers and non-smokers (180 vs 165 days respectively, p=0.07), open or closed fractures (p=0.13) or age and healing time (Spearman''s r=0.12, p=0.18). There was no incidence of non-union or re-fracture following frame removal in either group.

Conclusions

Despite the assumption of the rigid construct of the TSF, the median time to union was similar to that of the Ilizarov frame and the TSF therefore can play a significant role in complex tibial fractures.     

Foot and Ankle Function after Tibial Overlengthening

Lengthening the tibia more than 25% of its original length can be indicated for proximal femoral deficiency, poliomyelitis, or femoral infected nonunion. Such lengthening of the tibia can adversely affect the ankle or foot shape and function. The present study aimed to assess the effect of tibial lengthening of more than 25% of its original length on the foot and ankle shape and function compared with the preoperative condition. This was a retrospective study of 13 children with severe proximal focal femoral deficiency, Aitken classification type D, who had undergone limb lengthening from June 2000 to June 2008 using Ilizarov external fixators. The techniques used in tibial lengthening included lengthening without intramedullary rodding and lengthening over a nail. The foot assessment was done preoperatively, at fixator removal, and then annually for 3 years, documenting the range of motion and deformity of the ankle and subtalar joints and big toe and the navicular height, calcaneal pitch angle, and talo-first metatarsal angle. At fixator removal, all cases showed equinocavovarus deformity, with decreased ankle, subtalar, and big toe motion. The mean American Orthopedic Foot and Ankle Society score was significantly reduced. During follow-up, the range of motion, foot deformity, and American Orthopedic Foot and Ankle Society score improved, reaching nearly to the preoperative condition by 2 years of follow-up. The results of our study have shown that tibial overlengthening has an adverse effect on foot and ankle function. This effect was reversible in the patients included in the present study. Lengthening of more than 25% can be safely done after careful discussion with the patients and their families about the probable effects of lengthening on foot and ankle function.     

四肢开放性骨折使用外固定器的治疗与护理

目的探讨四肢开放性骨折使用外固定器治疗术后护理的措施与对康复的效果。方法 2010-01/2012-01商水县人民医院使用单侧外固定器进行四肢开放性骨折治疗的患者100例,术中术后采取一般性护理的心理护理、环境护理、自体护理;患肢血液灌注护理;预防针孔感染;防止交叉感染;营养支持;功能锻炼等综合护理措施。结果 100例患者骨折均愈合良好,随访2年,患者骨折愈合时间平均为（10.3±5.2）月,未发生感染、骨不连接等并发症。结论四肢开放性骨折使用外固定器治疗术,配合系统护理可有效增进患者的康复。     

一种十字型头颈原位固定器的研制

目的：研制一种适合一线灾害现场的便携式、模块化配套组合的十字型头颈原位固定器,能够在避免搬动的情况下迅速将头颈伤伤员固定到固定器上,在转运途中有效地预防脊髓二次损伤,最大限度地挽救患者生命,降低病死率和致残率。方法：采用十字型头颈原位固定器．使伤员头颈安全地进入颈枕顶帽壳。利用纵行夹板上下调节固定下颌角。再用横行夹板端胸鞍脊柱固定带和肩锁固定带分别进行头颈加强固定,使头颈制动。结果：通过重复模拟试验．现场模拟使用收到了预期效果。结论：该固定器结构简单、携带方便、功能兼容性强,可有效地预防脊髓损伤、高位截瘫．特别适用于灾害一线现场的救护。     

应用记忆合金环抱器行多发肋骨骨折内固定术治疗连枷胸合并复合伤（多发伤）29例临床观察

目的：观察应用记忆合金环抱器行多发肋骨骨折内固定术治疗连枷胸的临床效果及其在重症胸外伤救治中的作用。方法研究对象为2010年12月—2014年2月之间的29例连枷胸合并复合伤患者,采用记忆合金环抱器行多发肋骨骨折内固定术治疗,对治疗方案及效果进行总结分析。结果本组病人中28例顺利治愈出院,一例因伤情过重死亡。结论应用记忆合金环抱器内固定治疗连枷胸,能够快速恢复胸廓形状及稳定性,缓解疼痛,有助于骨折愈合,效果显著。     

Outcome of rail fixator system in reconstructing bone gap

Background:

Bone loss following open fracture or infected gap nonunion is a difficult situation to manage. There are many modes of treatment such as bone grafting, vascularized bone grafting and bone transport by illizarov and monolateral fixator. We evaluated the outcome of rail fixator treatment in reconstructing bone and limb function. We felt that due to problems such as heavy apparatus, persistent pain, deformity of joints and discomfort caused by an Ilizarov ring fixator, rail fixator is a good alternative to treat bone gaps.

Materials and Methods:

20 patients (17 males and 3 females with mean age 30.5 years) who suffered bone loss due to open fracture and chronic osteomyelitis leading to infected gap nonunion. Ten patients suffered an open fracture (Gustilo type II and type III) and 10 patients suffered bone gap following excision of necrotic bone after infected nonunion. There were 19 cases of tibia and one case of humerus. All patients were treated with debridement and stabilization of fracture with a rail fixator. Further treatment involved reconstructing bone defect by corticotomy at an appropriate level and distraction by rail fixator.

Result:

We achieved union in all cases. The average bone gap reconstructed was 7.72 cm (range 3.5-15.5 cm) in 9 months (range 6-14 months). Normal range of motion in nearby joint was achieved in 80% cases. We had excellent to good limb function in 85% of cases as per the association for the study and application of the method of ilizarov scoring system[ASAMI] score.

Conclusion:

All patients well tolerated rail fixator with good functional results and gap reconstruction. Easy application of rail fixator and comfortable distraction procedure suggest rail fixator a good alternative for gap reconstruction of limbs.     

克氏针外固定架联合固定治疗Lisfranc损伤

<正>2002年2月~2011年7月,笔者应用克氏针外固定架联合固定治疗32例Lisfranc损伤患者,疗效确切,报道如下。1材料与方法 1.1病例资料本组32例,男22例,女10例,年龄18~65岁。闭合伤28例,开放伤4例。单纯Lisfranc损伤24例,合并Chopart关节损伤8例;按照Myerson分型[1]:单纯内侧柱损伤14例,内侧柱合并中柱损伤12例,三柱损伤6     

骨盆前、后环不稳定的治疗策略

目的探讨骨盆前后环不稳定的治疗策略。方法对22例Tile C型骨盆前、后环不稳定患者均急诊采用股骨髁上骨牵引结合外固定架固定,病情平稳后行前、后路重建钢板联合骶髂螺钉复位内固定术治疗。结果22例均获随访,时间6~31个月。疗效根据Matta评分标准评定:优21例,良1例。根据Majeed功能评分评定:优18例,良2例,差2例。结论先早期外固定架临时固定,二期行手术内固定,手术安全、固定可靠,可早期功能锻炼及负重,是治疗骨盆前后环不稳定的有效方法。     

Bicondylar tibial plateau fractures treated with fine-wire circular external fixation

Bicondylar tibial plateau fractures are serious injuries to a major weight-bearing joint. These injuries are often associated with severe soft tissue injuries that complicate surgical management. We reviewed 54 consecutive patients who sustained bicondylar tibial plateau fractures that were treated with limited open reduction and cannulated screw fixation combined with fine-wire circular external fixation. Forty-six patients met the inclusion criteria of this retrospective review. Eight patients were excluded because they did not complete a minimum of 1-year follow-up. Thirty-six patients had Schatzker type-VI, and ten patients had Schatzker type-V fractures. All fractures were united without loss of reduction; there were no incidences of wound complications, osteomyelitis or septic arthritis. The average Knee Society Clinical Rating Score was 81.6, translating to good clinical results. Minor pin track infection was the most common complication encountered. This review concludes that fine-wire circular external fixation, combined with limited open reduction and cannulated screw fixation, consistently produces good functional results without serious complications.