Unilateral external fixator in the treatment of lower third humeral shaft fractures

Lowerthirdhumeralshaftfracturesareoftenmanifestedbyoblique,spiralorcomminutedfractureswithahighincidenceofcomplicatingradialnerveinjury.Thispartofhumerusisirregularanatomicallyandneartheelbowjoint.Soitisdifficult toselectproperinternalfixationinstrumentswhile exploringradialnervethroughanterolateralapproach,whichaddsdifficultyinthetreatmentofthiskindof fractures.Inrecent6yearsweusedunilateralexternal fixatorstotreatsuchkindoffracturesinourdepartment andsatisfactoryresultswereachieved.METHOD…     

小儿闭合性股骨干骨折三种治疗方法比较

目的: 比较小儿闭合性股骨干骨折三种方法治疗的效果。方法: 回顾分析骨牵引加石膏外固定、单臂多功能外固定支架及加压钢板内固定治疗小儿闭合性股骨干骨折79例,从临床功能、愈合时间、并发症、X线片检查及经济方面对治疗结果进行综合评定比较。结果: 牵引固定组住院时间长于外固定架组和内固定组(P<0. 001), 外固定架组愈合时间短于牵引组和内固定组(P<0. 05), 费用明显少于牵引组、内固定组(P<0. 01)。结论: 单臂多功能外固定支架治疗小儿闭合性股骨干骨折效果理想, 综合评价优于骨牵引加石膏外固定和加压钢板内固定治疗。     

Operative treatment of tibial fractures in children: are elastic stable intramedullary nails an improvement over external fixation?

BACKGROUND: Operative treatment of tibial fractures in children requires implants that do not violate open physes while maintaining tibial length and alignment. Both elastic stable intramedullary nails and external fixation can be utilized. We retrospectively reviewed our experience with these two techniques to determine if one is superior to the other. METHODS: We retrospectively reviewed the operative records and trauma registries of three institutions within our hospital system and identified thirty-five consecutive patients with open physes who had undergone operative treatment of a tibial fracture between April 1997 and June 2004. Four patients were excluded because they had been managed with locked intramedullary nails or with pins and plaster. Of the thirty-one remaining patients, sixteen had been managed with elastic stable intramedullary nails and fifteen had been managed with unilateral external fixation. The clinical and radiographic outcomes were compared. The functional outcomes were compared with use of the Pediatric Outcomes Data Collection Instrument. Complications related to treatment, such as malunion, delayed union, nonunion, infection, and the need for subsequent surgical treatment also were compared. RESULTS: Thirty-one patients with thirty-one operatively treated tibial fractures were available for evaluation. Fifteen patients had been managed with external fixation. Seven of these patients had a closed fracture, and eight had an open fracture. There were seven healing complications in this group, including two delayed unions, three nonunions, and two malunions. Sixteen patients had been managed with elastic stable intramedullary nailing. Eleven patients had a closed fracture, and five had an open fracture. The mean time to union for the intramedullary nailing group (seven weeks) was significantly shorter than that for the external fixation group (eighteen weeks) (p < 0.01). The functional outcomes for the intramedullary nailing group were significantly better than those for the external fixation group in the categories of pain, happiness, sports, and global function (the mean of the mean scores of the first four categories) (p < 0.01 for these comparisons). CONCLUSIONS: When surgical stabilization of tibial fractures in children is indicated, we believe that the preferred method of fixation is with elastic stable intramedullary nailing.     

The role of supplemental lag-screw fixation for open fractures of the tibial shaft treated with external fixation

Ninety-nine open fractures of the tibial shaft were treated with unilateral external fixation with or without supplemental lag-screw fixation. We compared the results in forty-four fractures in which only external fixation was used (control group) with those in fifty-five fractures that were stabilized with lag-screws and external fixation, and we found no statistically significant differences between the two groups with respect to the time to full weight-bearing, the time to union, or the rates of delayed union, osteomyelitis, malunion, superficial or deep pin-track infection, or loosening of the pins. The limbs in which the fracture was treated with external fixation and supplemental lag-screws had more than twice the rate of refracture of the control limbs (11 compared with 5 per cent), and the percentage of fractures having supplemental lag-screw fixation that needed bone-grafting to achieve union was more than twice that in the group treated with external fixation alone. We concluded that the routine use of supplemental lag-screw fixation is not indicated in patients who have an open fracture of the tibial shaft that has been stabilized with external fixation.     

Evaluation of pediatric lower extremity fractures managed with external fixation: outcomes in a deployed environment

External fixation of pediatric lower extremity fractures is usually reserved for severe, open fractures in polytraumatized patients, but it is often the only available treatment option for deployed military surgeons. We analyzed the outcomes and complications of 17 consecutive pediatric long bone fractures treated with external fixation at a Forward Surgical Team facility in an austere environment during Operation Enduring Freedom in Afghanistan during a 12-month period. Treatment consisted of uniplanar external fixation for 12 femoral shaft fractures (11 closed), 4 tibial shaft fractures (all open), and 1 subtrochanteric fracture (closed) in 14 males and 3 females with an average age of 7.4 years. All 17 fractures went on to union with no incidences of refracture. Complications included 1 broken pin and 3 pin site infections treated with wound care and oral antibiotics. In a deployed environment, external fixation is the treatment method of choice for lower extremity fractures by virtue of patient, environment, equipment, and mission factors. This case series validates the usage of a simple, uniplanar external fixator for a variety of open and closed pediatric long bone fractures as evidenced by the successful union rate and low number of complications.     

Tosic external fixator in the management of proximal tibial fractures in adults.

This retrospective clinical study assessed proximal tibial fractures managed with the Tosic external fixator. Nineteen patients with 21 proximal tibial fractures treated with the Tosic external fixator between July 1997 and October 1998 comprised the study population. Eleven fractures were graded as 41A2, 3 fractures as 41 A3, 4 fractures as 41C1, and 3 fractures as 41 C2. Fourteen fractures were closed, and 7 fractures were open. Average time to healing was 1 7 weeks. No revision of fixation was needed. There were five cases of pin tract infection. Average range of knee motion was 2 degrees-135 degrees. These results indicate the Tosic external fixator is an efficient and simple way to treat proximal tibial metaphyseal fractures.     

单侧双臂外固定支架治疗长骨开放性骨折

目的探讨单侧双臂外固定支架治疗长骨开放性骨折的临床效果。方法采用单侧双臂外固定支架治疗严重长骨开放性骨折30例。所有患者均在急诊手术时行外固定支架固定。二期手术行植皮、转移皮瓣和骨延长治疗。结果开放性骨折均治愈,骨缺损同时纠正。结论单侧双臂外固定支架治疗长骨开放性骨折是一种手术创伤小、操作简单、疗效可靠的方法。     

跨腕关节外固定器治疗不稳定性桡骨远端骨折

目的 回顾分析闭合复位、单侧外固定器跨腕关节固定治疗不稳定性桡骨远端骨折的效果。方法 2000年6月～2005年3月，利用外固定器跨腕关节固定治疗45例50侧不稳定性桡骨远端骨折，年龄15～78岁（平均44．8岁）。骨折按AO分型：A3型5例5侧，B3型4例4侧，C1型3例3侧，C2型9例9侧，C3型24例29侧。手法或外固定器协助复位，外固定器静力性固定，骨折愈合后拆除外固定器。随访8～48个月（平均20个月）。结果 骨折愈合时间6～8周，平均7．6周。4例4侧出现针道表浅感染，经口服抗生素及局部换药后好转。最后一次随访时，影像学评估（Stewan改良的Sarmiento评分）：优39例42侧，良6例8侧。腕关节功能按Garland与Werley功能评分标准：优34例37侧，良8例9侧，可3例4侧，优良率为92％。结论 闭合复位、单侧外固定器跨腕关节静力性固定桡骨远端骨折，通过选择合适的外固定针置入部位，可以避免桡神经损伤及第二掌骨医源性骨折，减少针道感染及松动等并发症的发生，并有利于术后早期行手部功能锻炼；无需辅助性植骨促进骨折愈合，是不稳定性桡骨远端骨折的有效治疗方法。     

手部外固定架的设计及临床应用

目的探讨手部小管状骨骨折,特别是关节附近的掌、指骨骨折,及其粉碎性骨折的更为简便有效的治疗方法,介绍一种新型实用的手部外固定架.方法自1996年10月采用自行设计的手部外固定架治疗掌、指骨骨折30例.其中掌、指骨干骨折18例,掌、指骨头骨折12例;闭合骨折25例,开放骨折5例;单纯骨折24例,粉碎骨折6例.结果平均随访4.5个月,骨折愈合时间4～8周,无骨不连及骨髓炎并发症.手功能恢复按TAM标准优22例,良4例,可4例,优良率86.7%.结论手部外固定架结构简单,方便实用,固定掌、指骨稳固,特别是对掌、指骨头骨折,以及粉碎性骨折有良好的固定作用.     

Pilon fractures. Treatment protocol based on severity of soft tissue injury

One hundred seven pilon fractures in 107 patients were treated according to a staged prospective protocol. All pilon fractures were stabilized immediately by the application of calcaneal traction. Open fractures or fractures in patients with multiple injuries were stabilized with traveling traction that was applied in the operating room. A distraction computed tomography scan was obtained before definitive treatment. Treatment groups were based on the degree of soft tissue compromise. Forty-one patients with Tscherne Grade 0 or Grade I injuries underwent open reduction and internal fixation (open plating) using contemporary techniques and low-profile implants. Sixty-four patients with Tscherne Grade II and Grade III closed injuries and all patients with open fractures underwent definitive treatment with limited open reduction and stabilization using small wire circular external fixators. Clinical and radiographic evaluations were performed at an average 4.9 years after injury. For all fracture types (AO classification), 81% of the patients who were treated with external fixation and 75% of the patients who were treated with open plating had good or excellent results. For severe fracture patterns (Type C), patients in both groups had significantly poorer results than patients with Types A and B fractures. The patients in the open plating group had a significantly higher rate of nonunion, malunion, and severe wound complications compared with the patients who received external fixation for Type C fracture patterns. Because of the increased incidence of bony and soft tissue complications when treating open or closed Type C fractures, use of limited exposures and stabilization with small wire circular external fixators is recommended.     

锁定钢板经皮外固定治疗儿童胫骨骨折

目的：探讨锁定钢板经皮外固定治疗儿童胫骨骨折的效果。方法：回顾2010年7月至2013年2月采用锁定钢板经皮外因定治疗儿童胫骨骨折8例,均为单侧;男6例,女2例;年龄4～10岁,平均7岁。开放性骨折5例按照Gustilo-Anderson分型：Ⅱ型1例,ⅢA型3例,ⅢB型1例;闭合性骨折3例按照AO分型：A3型2例,B2型1例。术后观察骨愈合情况及步态影响,采用Johner-Wruhs评定标准对疗效进行评价。结果：8例患者骨折均愈合,未发生感染。骨折愈合时间3-6个月,平均3．9个月;锁定钢板拆除时间4-7个月,平均4．3个月。7例带架行走后目测走态正常,另l例因胫前肌腱缺失,影响步态。对侧小腿内侧皮肤未见擦伤痕。8例患者获随访,时间6个月～1年,依据Johner-Wmhs疗效评价标准,结果优7例,良1例。结论：锁定钢板经皮外固定操作简便,对于儿童胫骨骨折固定稳定可靠,术后功能恢复好,带钢板行走时步态影响较小,但LCP钢板置钉点固定,要求在安装前完成骨折的复位并确定置钉处有完好的皮肤覆盖。     

Open versus closed pilon fractures: Comparison of management,outcomes, and complications

BackgroundDespite the low incidence of pilon fractures amongst lower limb injuries, their high impact nature presents difficulties in surgical management and recovery. The high complication rate and long recovery times presents a challenge for surgeons and patients. Current literature is varied, with no universal treatment algorithm. We aim to highlight differences in outcomes and complications between open and closed pilon fractures, and between patients treated by open reduction internal fixation (ORIF) or fine wire fixator (FWF) for open and closed fracture subgroups.MethodsThis retrospective study was conducted at a major trauma centre including 135 patients over a 6-year period. Primary outcome was AOFAS score at 3, 6, and 12-months post-injury. Secondary outcomes included time to partial weight-bear (PWB) and full weight-bear (FWB), bone union time, and complications during the follow-up time. AO/OTA classification was used (43A: n = 23, 43B: n = 30, 43C: n = 82). Interobserver agreement was high for bone union time (kappa=0.882) and AO/OTA class (kappa=0.807).ResultsHigher AOFAS scores were seen in ORIF groups of both open and closed fractures, compared to FWF groups. The difference was not statistically significant apart from 12-month AOFAS score of 43C open fractures (p = 0.003) and in 43B closed fractures 3 and 6 months post-injury (p<0.001 and p<0.001, respectively). The majority of ORIF subgroups, open and closed fractures, also had shorter time to PWB, FWB, time to union, and follow-up. Statistically significant differences were seen in the following cases: ORIF-treated 43B closed fracture subgroup had shorter time to PWB and FWB (p<0.001 and p = 0.017, respectively), ORIF-treated 43C closed fractures had shorter time to union (p = 0.005). Common complications for open fractures were non-union (24%), post-traumatic arthritis (16%); for closed fractures they were post-traumatic arthritis (24%), superficial infection (21%). All occurred more frequently in FWF-treated patients.ConclusionMost ORIF-treated subgroups in either open or closed pilon fractures showed better primary and secondary outcomes than FWF-treated subgroups, yet few were statistically significant. Overall, our use of a two-staged approach involving temporary external fixation, followed with ORIF or FWF achieved low complication rates and good functional recovery.     

弹性髓内钉固定与外固定支架治疗儿童股骨干骨折疗效比较

目的：比较弹性髓内针与外固定支架治疗儿童股骨干骨折的疗效。方法：2002年9月至2008年8月治疗儿童股骨干骨折共67例,使用弹性髓内针治疗儿童股骨干骨折36例,男23例,女13例,年龄5～11岁,平均（7.1±1.6）岁;外固定支架治疗31例,男19例,女12例,年龄3～12岁,平均（6.5±2.3）岁。所有病例均为闭合复位,对两种不同内固定术后骨折愈合时间、术后并发症进行比较分析。结果：全部病例均获随访,时间9～24个月,平均（12±3）个月。弹性随内针组治疗小儿股骨骨折在骨折临床愈合时间和骨性愈合时间均短于外固定支架组（P〈0.05）。外固定支架组,继发钉道感染5例,骨折延迟愈合3例,再骨折2例,螺钉断裂1例;弹性髓内针组钉尾激惹3例。结论：弹性髓内针治疗儿童股骨干骨折有很大优势,而对高能量骨折及多发伤的病例外固定支架则不失为一种良好的选择,股骨近端和远端骨折尽量避免使用弹性髓内针固定。     

Simple external fixation of open and complicated fractures

Thirty patients were managed with the use of a simple means of external fixation. Ten of these patients had multiple injuries. In 18 the fractures were open. Five cases had loss of bone length and infected wounds when first seen and were treated with the aid of microvascular surgical procedures. Eight cases required skin grafting. One case required a vein graft to the popliteal artery. The method described is simple to use. It requires little previous experience and is cost effective. We recommend its use in the initial treatment of grade 2 and 3 open fractures. It may also be used on closed unstable fractures, and will maintain limb length in severe injuries with loss of bone substance while further treatment is considered or performed.     

Die Rush-Pin-Osteosynthese der Klavikula als Alternative zur konservativen Behandlung

Fractures of the clavicle in the middle third usually undergo closed treatment by external fixation, because they heal spontaneously in most cases. However, a correct reposition and fixation by external manner is sometimes impossible, and consolidation in malposition with functional and esthetic disturbance occurs. External fixation can be painfull and inconvenient to the patient, and congestion and paresthesia of the upper limbs may occur. Therefore the indication for internal fixation has been extended on fractures in persisting severe malposition despite external fixation and painfull congestion and paresthesia of the arms. A method of internal fixation by a Rush pin has been used. The fracture is exposed by a minimal incision, and both fragments are bored open axially and exactly reposed. The Rusph pin is inserted from the medial side through a second small incision. The corticalis layer on both sides of the bend of the clavicle is also to be penetrated by the pin. Postoperatively no external fixation is necessary, and the patient is told to move the shoulder as soon as possible. The pin is removed after three to six months on outpatient basis under local anesthesia. 43 cases of clavicle fractures and three cases of painfull non-union after closed treatment, operated in this way, have been analyzed. In two cases of the fractures (4.6%) non-union occurred. Both healed after refixation by a plate. 34 of 41 fractures healed without radiologically visible callus. 64% of the registered patients have been handicaped in their daily activities only for two weeks or even less. The advantage of this method is to achieve soon a painless motility of the shoulder and to avoid malposition by a simple and quick procedure.     

桡骨远端C3型骨折不同治疗方法的回顾性研究

目的 探讨C3型桡骨远端骨折有效治疗方法.方法 对2017年6月-2018年7月收治的53例桡骨远端C3型骨折患者,分别采用闭合复位外固定架固定和切开复位锁定加压钢板内固定两种方法进行固定,其中外固定架组34例,内固定组19例,并按照两种治疗方法的复位标准和功能标准对优良率进行比较.结果 53例术后均获得随访,随访时间...     

Le fratture del calcagno: fissazione esterna

The treatment of calcaneal fractures remains controversial. Several techniques have been described since 1900 (traction techniques, less-invasive techniques, open techniques). In intra-articular fractures no treatment has been shown to be superior to others. To date, open reduction with internal fixation through a side access has represented the gold standard in the treatment of this type of injury, owing to the possibility of reducing articular fragments. Minimally invasive techniques are generally used only with exposed fractures. For some time now, minimally invasive techniques have become remarkably popular, especially when the need arises to treat patients with severe soft tissue damage and local or systemic diseases, in whom the classical open technique is contraindicated. We use the Ilizarov technique or a mini external fixator, with 6 chips, which produce a distraction to three points in the longitudinal, angular and cranio-caudal directions. The surgical technique provides closed or minimally invasive reduction, under scopic control. Then Kirschner, chips and external fixator are positioned, with distraction, if necessary. These techniques, such as external fixation, were born to associate the benefits of surgical reduction and stable fixation with those of a minimally invasive technique. In addition to a purely clinical discussion, the use of external fixation proved to be a mechanically sound system able to anticipate and grant the possibility of earlier load after surgery. We think that fixators mechanically express their function by crystallizing the position of fragments and by making the calcaneus a single body, thus maintaining the volume of the calcaneus. This leads to advantages that could be correlated with a positive clinical outcome, because the foot is not subtracted from the load during long periods. These techniques also allow for early mobilization of the neighbouring joint districts, and fixation devices are easy to remove.     

Fractures of the tibia treated by flexible external fixation

Thirty-four patients with fractures of the tibial diaphyseal shaft were treated by flexible anterior half-frame external fixation. The average time to union in the frame was 12 weeks for a simple closed tibial fracture and 26 weeks for a complex open tibial fracture. Complications included malalignment and loss of initial reduction. Most of the complications could have been avoided if special attention had been paid to technical details of reduction of the fracture and insertion of the pins.     

Distal femoral physeal problem fractures

Treatment options in the past for distal femoral physeal fractures have varied from closed reduction to open reduction with internal fixation to balanced skeletal traction. In this study, ten patients with distal femoral physeal fractures treated with closed reduction and casting or skeletal traction are reviewed. Seven fractures lost position in comparison with original reduction films. Nine patients developed subsequent deformity. No consensus exists regarding the use of open versus closed treatment with internal fixation. This review of closed treatment yielded a high rate of unacceptable results. Initial anatomic reduction with rigid fixation of physeal injuries about the ankle has been demonstrated to decrease the incidence of growth deformity. The authors' experience and a review of the literature suggest that a similar approach is applicable to distal femoral physeal fractures.     

套管式骨外固定器的研制和临床应用

作者1992年始研制、应用套管式骨外固定器治疗四肢骨折22例,骨折愈合率100％,平均愈合时间;闭合胫骨2.9个月,开放胫骨3.3个月,胫骨骨不连3.8个月。本器械特点为连接杆为套管式,可滑移,兼有静力和动力加压的功能。连接杆上还特设一弹性垫圈使可以对粉碎性等不稳定骨折早期动力加压而无肢体短缩骨折变位之虑。固针体可远近伸缩固定距连接杆不同距离的钢针,从而使进针无需定位器,自由度极大,可先进针后复位,使用安装方便。