Piroxicam-induced reduction in osteopenia after external fixation of rabbit tibia

Twelve rabbits were treated with a unilateral external fixator in one tibia for 12 weeks, while the other tibia served as an intact control. Half of the animals were also treated with 10 mg/kg/day of piroxicam, given in two daily oral doses. Changes in bone mineral content were determined using single photon absorptiometry. After 12 weeks, we found a 3 percent decrease in the bone mineral content in the tibia of the animals treated with piroxicam versus 9 percent in the nonpiroxicam group (P = 0.04). In the femurs, there was an insignificant decrease in bone mineral, 2 percent (piroxicam) and 1 percent (nonpiroxicam) respectively. The results indicate that piroxicam may reduce the osteopenia caused by external fixation.     

Piroxicam-induced reduction in osteopenia after external fixation of rabbit tibia

Twelve rabbits were treated with a unilateral external fixator in one tibia for 12 weeks, while the other tibia served as an intact control. Half of the animals were also treated with 10 mg/kg/day of piroxicam, given in two daily oral doses. Changes in bone mineral content were determined using single photon absorptiometry. After 12 weeks, we found a 3 percent decrease in the bone mineral content in the tibia of the animals treated with piroxicam versus 9 percent in the nonpiroxicam group (P = 0.04). In the femurs, there was an insignificant decrease in bone mineral, 2 percent (piroxicam) and 1 percent (nonpiroxicam) respectively. The results indicate that piroxicam may reduce the osteopenia caused by external fixation.     

Bone healing after metal plate fixation and external fixation of the osteotomized rabbit tibia

Controversy still exists as to the best method of treatment of long bone fractures. The purpose of the present study was to compare the effects on the healing bone of external fixation and metal plate fixation. In an experimental model on the rabbit tibia the stiffness of the fixation corresponded intentionally to that of the same methods in human fracture treatment.

A transverse, midshaft osteotomy was made on one tibia, and fixed with a steel plate (45 × 5 × 1 mm) or external mini-fixation. The animals were killed after 4, 6 or 12 weeks. The bone healing was evaluated by radiography, histology and biomechanical testing in three-point bending. There were no significant differences between plate fixation and external fixation in the pattern of bone healing, as it occurred by periosteal, in-tramedullary and intercortical callus after both methods. The stiffness increased more rapidly than the strength, and reached normal values after about 6 weeks. No significant differences in stiffness between the two methods were found. The strength was significantly greater after plate fixation than after external fixation at 6 weeks, while no significant differences were found at either 4 or 12 weeks.

It is concluded that the speed of bone healing was more rapid after plate fixation. However, in the later stages of healing the plated bones were secondarily weakened because of the stress-protecting effect of the plate.     

Stress protection by external fixation of the rabbit tibia

Osteopenia of the tibia and femur caused by an external fixator in the tibia was studied in 14 rabbits. Eight rabbits were treated with a complete unilateral external fixator in one tibia, whereas the other tibia served as control. The other 6 animals had one leg operated on with inserting of all the pins but without the frame. This technique was chosen to compare osteopenia caused by stress protection and the effect of the pins. After 6 weeks, we found a 7 percent reduction in the bone mineral content in the tibial diaphyseal segment between the pins of the external fixator and no bone loss in the tibia that were operated on with only pins. In the femurs, there was a smaller decrease in the bone mineral content: respectively 3.2 percent (complete frame) and 2.9 percent (only pins). On all the operated on tibiae, there was an increase in the bone mineral content around the pins both proximally and distally.     

Stress protection by external fixation of the rabbit tibia

Osteopenia of the tibia and femur caused by an external fixator in the tibia was studied in 14 rabbits. Eight rabbits were treated with a complete unilateral external fixator in one tibia, whereas the other tibia served as a control. The other 6 animals had one leg operated on with inserting of all the pins but without the frame. This technique was chosen to compare osteopenia caused by stress protection and the effect of the pins. After 6 weeks, we found a 7 percent reduction in the bone mineral content in the tibial diaphyseal segment between the pins of the external fixator and no bone loss in the tibia that were operated on with only pins. In the femurs, there was a smaller decrease in the bone mineral content: respectively 3.2 percent (complete frame) and 2.9 percent (only pins). On all the operated on tibiae, there was an increase in the bone mineral content around the pins both proximally and distally.     

Delayed intramedullary nailing after failed external fixation of the tibia

Thirteen patients (11 males, two females) with 16 tibia fractures (three segmental) were initially treated with external fixation and secondarily had delayed intramedullary nailing after fixator removal. There were six closed injuries and two Grade I, five Grade II, one Grade IIIA, and two Grade IIIB open soft-tissue injuries. The average patient age was 40 years (range, 19-84 years). The external fixator was removed at an average of 12 weeks (range, three to 25 weeks) for malreductions in six case, atrophic segmental fractures in two, and atrophic/unstable fracture patterns in five. Intramedullary nailing was performed at an average of 13 days (range, five to 30 days) after fixator removal. There were 12 reamed nails and one self-broaching nail. Preoperative antibiotics averaged eight days, and postoperative averaged 11 days. All patients healed with bridging callus; full weight bearing occurred at an average of 2.7 months. Follow-up evaluation averaged 22.5 months. Weight bearing began within the first three weeks in 12 of 13 patients. Results were rated as excellent in eight and good in five. There were no complications related to infection or non-union. Delayed intramedullary nailing, after excluding potential high-risk patients, is an option for the treatment of tibia fractures that have failed treatment with external fixation. However, it is not recommended as a routine procedure.     

Nonunion after primary treatment of tibia fractures with external fixation

The authors retrospectively reviewed 207 fractures of tibial diaphysis, treated primarily with external fixation without bone grafting. Forty-two fractures (20.3%) resulted in nonunion and required reoperation. Parameters analyzed for their significance for nonunion included, soft tissue damage, energy of injury, method of fracture reduction, type of external fixation frame, supplemental interfragmentary screw fixation, dynamization at the fracture site, and postoperative infection. Nonunion rate was found to be significantly higher in type II and III open fractures, high-energy fractures, fractures treated by external fixation using a bilateral frame, and fractures treated with supplemental interfragmentary screw fixation. Multivariate analysis showed that type II and III open fracture, high-energy injury, and supplemental interfragmentary screw fixation were the main risk factors for nonunion.     

Stability with unilateral external fixation in the tibia

Abstract Unilateral external fixation can be used in the provisional or definitive treatment of tibial fractures. A properly applied fixator allows bony and soft tissue stability, whereas an improperly applied fixator achieves neither and can be a hindrance. The principles for the successful application of monolateral external fixation, including the rationale for choosing this type of device, the assembly of its components and deciding on planes of application, are discussed in this article.     

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.     

Complications of external fixation of open fractures of the tibia

Forty-two cases of open fractures of the tibia treated by external fixation are presented. Forty-three per cent of patients developed sepsis around one or more pins. Pin track sepsis occurred in 78 per cent of cases involving transfixion pins through muscle and bone but in only 17 per cent of cases using transcutaneous half-pins. Malalignment of more than 5 degrees in any plane was seen in 38 per cent of cases, almost half of which increased in plaster after removal of the fixator.     

外固定架治疗开放性胫腓骨骨折

目的 观察外固定架治疗开放性胫腓骨骨折的疗效。方法 自1994年7月到1999年12月,收治开放性胫腓骨骨折43例,男27例,女16例;年龄18-62岁。全部采用单侧多功能外固定架治疗。结果 43例全部随访,平均18个月,骨折均愈合,平均愈合时间86天,患肢恢复良好,无骨髓炎、骨不连等合并症。结论 该方法操作简单、创伤小、固定可靠、愈合率高,并发症少。为开放性胫腓骨骨折首选治疗方法。     

A strain-gauge study of the effect of external fixation on the canine tibia

Summary Electrical resistance rosette strain gauges bonded directly to the surface of the midshaft of the normal canine tibia were utilized to study the effect of the AO external skeletal fixator on the magnitude and orientation of the peak strain values recorded during locomotion. The application of the fixator in a single lateral bar configuration resulted in a significant decrease in surface bone strain magnitude but in only minor changes in the orientation of those strains. However, in only one of three dogs tested did the addition of a second external connecting bar result in significant further decreases in bone strain.     

Tension wire position for hybrid external fixation of the proximal tibia

OBJECTIVE: To compare a new configuration of proximal wires for hybrid external fixation with the standard configuration. DESIGN: Biomechanical testing of five matched pairs of fresh cadaveric tibia. INTERVENTION: The authors compared the standard tension wire configuration of the three proximal wires with a more sagittal orientation of the oblique wires. A second study compared the new configuration with two wires and an offset half-pin. A two-centimeter segmental defect was created just distal to the tibial tubercle and the tibias fixed in a Montecelli Spinelli (Howmedica, NJ, U.S.A.) hybrid frame. The constructs were biomechanically tested using an Instron servohydraulic biaxial testing machine. RESULTS: There was a significant 67 percent decrease in displacement during anterior posterior bending and a significant 40 percent decrease in displacement in posterior bending with the new configuration compared with the standard configuration (p < 0.05). The differences in stability in all other testing modes were not significant. There was no significant difference between the new configuration and the two wire and off-set half-pin configuration. CONCLUSION: We recommend anterior placement of the oblique tension wires in the proximal tibia to more effectively resist bending in the sagittal plane, which is the most common deforming force on proximal metaphyseal fractures.     

Ilizarov external fixation salvage of failed intramedullary fixation of tibia with nail retention

Failure of intramedullary fixation of the tibia presents a unique problem, as improving fracture alignment is often difficult after nail placement. The purpose of this study was to demonstrate the effectiveness of the Ilizarov technique in obtaining anatomic union after failed intramedullary fixation of the tibia. We reviewed medical records and plain radiographs of 4 men who, at a tertiary-care facility, presented with failed intramedullary fixation of the tibia. Mean age was 28 years (range, 23-36 years). All 4 patients underwent reduction and external fixation by the llizarov technique with retention of the intramedullary nail. Anatomic union was attained in each case. Thin-wire circular-frame external fixation by the Ilizarov technique was a viable salvage option for failed intramedullary fixation of the tibia.     

Fractures of the shaft of the tibia treated with Hoffmann external fixation

Summary Ninety-six compound or unstable fractures of the tibial shaft were treated with external fixation of different mountings. The median healing time was 10 months without a statistically significant difference between the healing time after treatment with unilateral frames and quadrilateral frames. The rate of pin-track infection was 36%, which is comparable to those of other published series. Seven cases of chronic osteitis and four pseudarthroses required further surgical management. We had no primary or secondary amputations in this series.

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Zusammenfassung 96 offene oder instabile Tibiaschaftfrakturen wurden mit verschiedenen Typen von externen Fixateuren nach Hoffmann behandelt. Die mittlere Heilungsdauer war 10 Monate, wobei kein statistisch signifikanter Unterschied zwischen unilateralen und quadrilateralen Fixateuren nachgewiesen werden konnte. Bohrloch-Infektionen traten in 36% der Fälle auf, was mit anderen veröffentlichten Serien vergleichbar ist. Vier Pseudarthrosen und 7 Fälle von chronischer Osteomyelitis erforderten weitere chirurgische Eingriffe, primary oder sekundäre Amputationen waren nicht erforderlich.

     

石膏楔形填塞外固定治疗稳定性胫腓骨骨折成角畸形

<正>临床上,稳定性胫腓骨双骨折或胫骨骨折很常见,不少医院行手法复位石膏外固定,如无明显错位的骨折,即行单纯石膏外固定即可,由于各种原因如患者过早下地活动,或由于小腿肌肉拉力不平衡,石膏松动或患者自行拆除石膏等,很多患者出现胫腓骨成角畸形,自2006年3月至2009年3月有选择性地收治此类胫腓骨骨折成角畸形38例,全部使用石膏楔形填塞外固定治疗,获得满意的疗效。1临床资料     

混合式外固定与内固定治疗胫骨近端复杂骨折的比较

目的 探讨混合式骨外固定治疗胫骨近端复杂骨折的有效性并与切开复位内固定进行比较.方法 回顾性分析自2000年1月至2005年1月收治的胫骨近端复杂骨折69例.除术中和术后48 h各1例因软组织损伤严重而截肢外,共分析67例.其中关节内复杂骨折40例,根据Schatzker分型标准：Ⅳ型17例,Ⅴ型14例,Ⅵ型9例;关节外复杂骨折27例,根据AO分型标准,均为A3型.19例Ⅱ度以上开放性骨折和21例闭合性骨折采用混合式骨外固定器治疗,其中5例骨折近折段结合有限内固定治疗;2例Ⅰ度开放性骨折和25例闭合性骨折采用切开复位内固定治疗.结果 67例患者均获得随访,随访6个月～5年（平均25个月）.骨外固定组,平均手术时间2.66 h,平均失血量170.50ml,平均骨折愈合时间16.40周,骨外固定器拆除时间24.67周,术后均无深部感染、皮肤坏死发生,针道感染6例;根据膝关节HSS评分,优31例,良5例,可3例,差1例.切开复位内固定组,平均手术时间3.33 h,平均失血量285.19 ml,平均骨折愈合时间12.37周,深部感染1例,局部皮肤坏死2例,骨折畸形愈合6例;根据膝关节HSS评分,优5例,良12例,可7例,差3例.两组疗效差异有统计学意义（秩和检验,u=219,P＜0.001）.结论 混合式骨外固定治疗胫骨近端复杂骨折简便、易行,适应证更广泛,术后膝关节功能恢复较好.     

Fractures of the shaft of the tibia treated with Hoffmann external fixation

Ninety-six compound or unstable fractures of the tibial shaft were treated with external fixation of different mountings. The median healing time was 10 months without a statistically significant difference between the healing time after treatment with unilateral frames and quadrilateral frames. The rate of pin-track infection was 36%, which is comparable to those of other published series. Seven cases of chronic osteitis and four pseudarthroses required further surgical management. We had no primary or secondary amputations in this series.     

Inverted arcuate osteotomy and external fixation for adolescent tibia vara

The purpose of our review is to describe and report results of a surgical technique for the treatment of adolescent Blount's disease. We retrospectively reviewed the results of 15 inverted arcuate osteotomies combined with external fixation. The inverted arc provides a proximal and stable osteotomy that can correct deformity in three planes. External fixation provides stable fixation, access to surgical wounds, and postoperative adjustment. According to the criteria of Schoenecker, we had 80% good results. Two patients with poor results were the most overcorrected, suggesting that overcorrection may not be so desirable as once suggested. We conclude that the inverted arcuate osteotomy with external fixation is an effective, reliable, and simple technique for treating adolescent tibia vara.