Dynamic external fixation for comminuted intra-articular fractures of the distal end of the radius

An external fixation device that allows motion of the wrist was developed for the treatment of severely comminuted intra-articular fractures of the distal end of the radius, and in specimens from cadavera that motion was demonstrated with the device in place. Thirty patients who had thirty-two comminuted intra-articular radial fractures were then treated with fixation using this device during a six-month interval. Thirty-one of the wrists were examined at follow-up one and two years later. The first fifteen wrists that were allowed full flexion and extension immediately postoperatively had lost some volar tilt postoperatively. The other patients, for whom only flexion was allowed immediately postoperatively, while extension was allowed four weeks later, did not lose volar tilt. The device maintained the reduction of the fracture fragments and allowed the early return of a functional range of motion of the wrist.     

External fixation versus ORIF for distal intra-articular tibia fractures

Tibia plafond fractures have historically demonstrated high complication rates. The purpose of this study was to assess the outcomes of tibia plafond fractures following treatment with definitive external fixation vs delayed open reduction and internal fixation (ORIF). Sixty patients were enrolled in a prospective cohort trial at 1 Level I trauma center. No differences were noted between the 2 treatment groups in terms of age, smoking history, presence of comorbidities, mechanism of injury, incidence of open fractures, or Orthopaedic Trauma Association fracture classification. Complete 12-month follow-up was available for 18 patients in the definitive external fixation group and 27 patients in the ORIF group. No difference was noted in articular reduction between the groups at 6 and 12 months postoperatively. Delayed union or non-union occurred in 4 (22.2%) of 18 patients in the external fixation group and 1 (3.7%) of 27 patients in the ORIF group (P=.05). Deep infection was equally likely in either group (P=.33). The ORIF group had improved Iowa Ankle Scores at 6 (23.6 ± 12.1 vs 11.1 ± 7.7; P<.05) and 12 months (5.5 ± 2.2 vs 3.1 ± 1.7; P<.05) postopertively and improved Short Form-36 Physical Function scores at 6 months (49.7 ± 30.1 vs 25.5 ± 8.0; P<.05) postoperatively compared with the external fixation group.External fixation and ORIF can attain bony union with adequate articular reduction and similar infection rates. Patients treated with ORIF appeared to have improved union rates and early outcomes with ankle function and Short Form-36 Physical Function scores.     

Nonbridging external fixation of intra-articular distal radius fractures

New solutions to difficult problems are always welcome, but nonbridging external fixation of intra-articular fractures is still in its infancy.Multicenter clinical trials are necessary to deter-mine whether the superior results obtained with nonbridging fixation of extra-articular fractures can be duplicated. With further study and new fixator designs, it is anticipated that nonbridging external fixation of intra-articular distal radius fractures will become another viable treatment option.     

Advantages of the Ilizarov external fixation in the management of intra-articular fractures of the distal tibia

Background  

Treatment of distal tibial intra-articular fractures is challenging due to the difficulties in achieving anatomical reduction of the articular surface and the instability which may occur due to ligamentous and soft tissue injury. The purpose of this study is to present an algorithm in the application of external fixation in the management of intra-articular fractures of the distal tibia either from axial compression or from torsional forces.     

有限内固定和超关节外固定支架治疗胫骨远端粉碎性骨折

自2001年7月至2005年10月,应用有限内固定和超关节外固定架治疗胫骨远端骨折31例,取得满意疗效。     

Dynamic external fixation for pilon fractures of the interphalangeal joints

Eight consecutive pilon fractures of the finger proximal interphalangeal joint and one of the interphalangeal joint of the thumb were treated by closed reduction and application of a new dynamic external fixator. The average range of movement achieved was 12 degrees -88 degrees and there were no serious complications. The technique described offers an effective and simple solution for treatment of pilon fractures of the interphalangeal joint.     

Anatomy of pilon fractures of the distal tibia

In a series of 126 consecutive pilon fractures, we have described anatomically explicable fragments. Fracture lines describing these fragments have revealed ten types of pilon fracture which belong to two families, sagittal and coronal. The type of fracture is dictated by the energy of injury, the direction of the force of injury and the age of the patient.     

Osteonecrosis of the distal tibia after pilon fractures

BackgroundPilon fractures are devastating injuries with high complication rates. Osteonecrosis has been previously described after Weber C fracture-dislocations but has not been reported following fixation of pilon fractures.MethodsAll AO/OTA 43-C pilon fractures from 2007 to 2018 were reviewed. Injury factors and demographics were recorded. Computed tomography (CT) scans of the fracture pattern were analyzed to determine risk factors for ON.Results71 pilon fractures in 69 patients were included. Mean follow-up was 21.6 months. 18 patients demonstrated ON at a mean 7.3 months’ post-injury. Regression analysis demonstrated no differences between cohorts with respect to smoking status, open injury, or diabetic status. ON was associated with small anterolateral fragment less than 2.0 cm² (OR = 19.47, p = 0.012), higher comminution (OR = 3.00, p = 0.005), use of calcium phosphate bone substitute (OR = 20.72, p = 0.013).ConclusionsON of the distal tibia was not associated with patient factors but was associated with fracture characteristics.     

超腕关节外固定支架治疗桡骨远端关节内粉碎性骨折

目的:评价超腕关节外固定支架治疗成年人桡骨远端关节内粉碎性骨折的疗效.方法:自2001年1月～2003年1月应用超腕关节外固定支架治疗成年人桡骨远端关节内粉碎性骨折16例,术后随访6个月～2年,观察患者的主、客观及X线片表现,依据Jakim评分标准进行评分.结果:优9例,良5例,占82%(14/17)患者获得满意的疗效,无严重并发症.结论:超腕关节外固定支架可以选择性地用于治疗成年人复杂的桡骨远端关节内骨折.     

Management of distal tibial intra-articular fractures with circular external fixation

The treatment of tibial plafond fractures requires careful management of the soft tissue envelope, reconstruction of the articular surface and stable fixation with minimal additional damage. Thirty cases of AO type 43 C tibial fractures were treated by transosseous osteosynthesis (Ilizarov technique). The external fixator constructs used were Ilizarov (Transosseous osteosynthesis: theoretical and clinical aspects of the regeneration and growth of tissue, Springer, Berlin, 1992) and Sheffield (Classification AO des fractures, Springer, Berlin, 1987) circular fixator systems. All tibial plafond fractures healed. Using radiological criteria for assessment of reduction of the articular fragments and the clinical scoring system described by Teeny and Wiss, there were excellent and good restoration of articular structure in 27 cases and good clinical results in 14. This treatment method compares well with previous published series and is to be recommended for this group of difficult fractures.     

桡骨远端粉碎性骨折及关节内骨折的手术治疗

目的探讨桡骨远端粉碎性骨折及关节内骨折的手术治疗方法及临床效果评价。方法对1999年1月～2001年1月通过手术治疗的桡骨远端粉碎性骨折及关节内骨折的42例病例进行分析。按AO原则分类,根据不同的类型分别采用钛板螺钉内固定、简单内固定加外固定架固定及单纯外固定架固定。结果42例患者全部获随访,功能满意35例(83.3%),可6例(14.3%),不满意1例(2.4%)。结论桡骨远端粉碎性骨折及关节内骨折通过手术的方法,能最大限度地恢复桡骨与尺骨的相对长度、关节面的平整、掌倾角及尺偏角,术后配合合理的康复锻炼,能使腕关节功能达到最大的恢复。     

外固定架加掌侧钢板治疗桡骨远端关节内粉碎性骨折

[目的]探讨外固定支架结合掌侧钢板内固定治疗桡骨远端关节内粉碎性骨折的疗效。[方法]自2004年2月~2008年2月采用外固定支架结合掌侧钢板内固定治疗桡骨远端关节内粉碎性骨折35例。男23例,女12例:平均年龄41.6岁。按AO/ASIF分型均为C3型。其中闭合性骨折30例,开放性骨折5例。[结果]术后随访24~118个月,平均37个月,35例骨折均获得愈合。术后1年随访,32例关节面台阶2mm,3例关节面台阶2mm;平均桡骨高11.11mm(8~15mm);平均掌倾角8.37°(-5~20°);平均尺偏角21.83°(13~25°)。与健侧相比,尺偏角、桡骨高的差异无统计学意义(P0.05),掌倾角较健侧相比平均丢失了2.69°,差异有显著性意义(P0.05)。根据Gartland-Werley腕关节评分标准,优良率为91%。[结论]外固定支架结合切开复位掌侧钢板内固定治疗桡骨远端关节内粉碎性骨折效果满意,病人腕关节、前臂及手的功能恢复好,术后创伤性骨关节炎的发生率低,并发症少,病人主观满意率高,是目前比较安全有效的方法。     

Complications of definitive open reduction and internal fixation of pilon fractures of the distal tibia

A series of 49 pilon fractures in a tertiary referral centre treated definitively by open reduction and internal fixation have been assessed and the complications of such injuries examined. A retrospective analysis of case notes, radiographs and computerised tomographs over a seven-year period from 1999–2006 was performed. Infection was the most common postoperative problem. There were seven cases of superficial infection. There was a single case of deep infection requiring intravenous antibiotics and removal of metalwork. Other notable complications were those of secondary osteoarthritis (three cases) and malunion (one case). The key finding of this paper is the 2% incidence of deep infection following the direct operative approach to these fractures. The traditional operative approach to such injuries (initially advocated by Rüedi and Allgöwer in Injury 2:92–99, 1969) consisted of extensive soft tissue dissection to gain access to the distal tibia. Our preferred method is to access the tibia via the “direct approach” which involves direct access to the fracture site with minimal disturbance of the soft tissue envelope. We therefore believe that open reduction and internal fixation of pilon fractures via the direct approach to be a safe technique in the treatment of such devastating injuries.     

有限内固定加外固定支架治疗桡骨远端粉碎性骨折

目的探讨有限内固定加外固定支架治疗桡骨远端粉碎性骨折的临床疗效。方法采用有限内固定加外固定支架治疗桡骨远端粉碎性骨折45例。结果 42例患者获得随访,时间3～36个月。按Lidstrom评分系统行影像学评价:优30例,良7例,中5例,优良率为88.09%;依据Dienst标准评价腕关节功能:优30例,良8例,中4例,优良率为90.47%。无严重并发症发生。结论有限内固定结合外固定支架治疗桡骨远端粉碎性骨折,复位满意,操作简单,固定牢固,疗效满意。     

Hybrid external fixation of tibial pilon fractures

Although external fixation reduces drastically the number of iatrogenic complications compared with acute open reduction and plate fixation, the prognosis for functional recovery after a pilon fracture remains guarded. Many authors have applied validated patient outcome measures to patients who have had pilon fractures. These studies confirmed that there are significant decreases in general health perceptions, physical and emotional role function, pain, and energy levels in patients who have suffered pilon fractures, regardless of the treatment modality. The high-energy tibial pilon fracture with soft tissue compromise remains a treatment dilemma. Hybrid external fixation with limited open reduction has proved to be a safe, reproducible, and effective treatment modality for this complex fracture.