Management of tibial fractures with the orthofix dynamic external fixator

We report our experience with the use of the Orthofix external fixator for the management of closed and open tibial fractures. One hundred fractures were treated in 96 patients between May 1985 and December 1989. There were 47 closed and 53 open fractures. Of the open fractures, 11 were grade I, 16 were grade II and 26 were grade III. Forty-five closed fractures and 49 open fractures went on to solid bony union in an average of 15.2 and 20.5 weeks, respectively. Non-union requiring operative intervention occurred in two closed and four open fractures (6%). The other main complications were pin track infection (30% of cases) and malunion which occurred in 14% of closed fractures and 32% of open fractures. We concluded that dynamic axial fixation is a useful method of treatment for open and difficult closed tibial fractures. Our experience indicates that malunion and pin track infection remain common problems and have still to be overcome.     

滑动加压股骨粗隆间骨折外固定器的设计和临床应用

目的报告股骨粗隆间骨折滑动加压外固定器的设计和初步临床应用结果。方法在单侧成角外固定器和动力髋螺钉（DHS）的基础上，设计制作滑动加压外固定器。自2003年5月～2005年12月，用此新型外固定器治疗老年股骨粗隆间骨折22例。结果获随访20例，时间2～30个月，平均12个月。骨折全部愈合，愈合时间10～13周，平均12周。术后针孔感染4例，无深部感染发生，无骨折不愈合及髋内翻，髋关节功能恢复良好。结论滑动加压外固定器使用方便、灵活，兼有加压和滑动双重功能，能根据临床需求进行动静力固定转换，使固定更合理，能防止髋内翻及固定针滑脱或穿越股骨头等情况发生，是治疗高龄股骨粗隆间骨折患者较理想方法。     

外固定支架结合内固定治疗桡骨远端骨折合并同侧掌指骨骨折

目的探讨外固定支架结合内固定治疗桡骨远端骨折合并同侧掌、指骨骨折的临床疗效。方法对32例桡骨远端骨折合并掌、指骨骨折行Orthofix公司的超关节微型单侧多功能外固定支架结合内固定治疗。结果随访4～11月,平均5．2个月,骨折愈合时间6～12周,平均8周。腕关节功能按Sarmiento标准进行评定：优22例,良8例,可2例;按TAFS评分标准进行功能评估,优28例,良4例。结论对桡骨远端骨折合并掌、指骨骨折,采用超关节微型单侧多功能外固定支架结合内固定治疗,是一种安全实用、简便有效的治疗方法。     

The A-O external skeletal fixator in the treatment of severe tibia fractures

A series of 33 cases of Grade II and III open tibia fractures were treated with local wound care followed by application of the A-O external fixator. Two transfixing Steinmann pins were usually used above and two below the fracture site. In six cases one Steinmann pin and one anteroposterior Schanz half pin above and below the fracture were combined with a triangulated frame. Additionally, minimal internal fixation with lag screws was used in five cases. Union was achieved in 83% of tibiae in an average time of 9.9 months. Union occurred faster when the fixator was removed in less than 3.5 months but then the incidence of malunion tended to rise. Three patients required early amputation. Eleven tibiae developed deep wound infections. Knee function was well preserved but ankle function was often impaired. The A-O fixator performed as a useful, simple, stable, light weight and versatile system in the care of these Grade II and III fractures. However, many problems intrinsic to the open tibia fracture remain.     

儿童闭合性胫腓骨骨折的外固定架治疗

目的探讨儿童闭合性胫腓骨骨折Orthofix单臂外固定架治疗的疗效,分析外固定架治疗的优缺点。方法 2001年8月～2008年11月,应用单臂外固定架(Orthofix SRL公司)治疗169例儿童胫腓骨骨折,其中单侧闭合骨折97例纳入本组。采用在C形臂或G形臂透视下进行闭合复位,Orthofix外固定架固定。结果手术时间35～160min,平均54min;出血量都在10ml以下。17例固定过程中出现Ⅰ～Ⅱ级针道感染,通过换药等手段控制,无一例因针道感染导致外固定架失效。固定过程中膝关节及踝关节活动均不受影响。骨性愈合时间12～24周,平均14.2周。23例过度生长不超过1cm。97例术后随访15～39个月,平均31个月,骨折全部骨性愈合。结论应用外固定架治疗儿童闭合性胫腓骨骨折,不破坏骨折端血运,且可提供牢固固定,允许早期关节活动及负重练习,减轻了护理负担。     

Role of Ilizarov external fixator in the management of proximal/distal metadiaphyseal pediatric femur fractures

Given the constraints of a short metaphyseal fragment and adjacent growth plates, there are limited options for operative fixation of metadiaphyseal fractures of the femur in children. This article outlines the surgical technique and reports early results of metadiaphyseal pediatric femur fractures treated with an Ilizarov external fixator by a single surgeon. Ten skeletally immature males with 5 proximal and 5 distal metadiaphyseal femur fractures underwent closed reduction and application of an Ilizarov external fixator. Time in the fixator averaged 138 (range, 104-180) days. At a mean follow-up of 26 months, there were no cases of loss of reduction, refracture, malalignment, leg length inequality, or loss of knee and hip mobility. Although superficial pin tract infections were common, no patient developed deep infection or required premature pin removal. One patient developed a transient foot drop after external fixation for a distal metadiaphyseal fracture, which recovered after revision of the pin construct. A low profile Ilizarov fixator can be effective in the management of certain metadiaphyseal pediatric femur fractures that may be difficult to manage by traditional methods.     

The dynamic axial fixator in fractures of the tibia and femur. A retrospective study in 98 patients

In a retrospective study involving 98 patients the results achieved with the dynamic axial fixator (Orthofix) in closed or open fractures of the tibia or femur treated in two district hospitals in the southwest of England during the period 1986-1988 were evaluated. Fifteen patients were vacationers and, as a result, were lost to followup. The operation and subsequent management was performed by more than 15 different members of the staff, of different levels of seniority and experience. The present survey in this group of surgeons has demonstrated that the dynamic axial fixator is a reliable means of treating open fractures of the tibia following an initial good reduction. It does, however, highlight the importance of the strict adherence to simple guidelines for application, pin care and dynamization if best results are to be obtained.     

外固定支架治疗锁骨中段骨折的初步报告

目的 探讨应用外固定支架治疗锁骨中段骨折的疗效.方法 2002年6月至2009年5月应用外固定支架治疗7例锁骨中段骨折患者,男4例,女3例;年龄25 ～ 42岁,平均33.7岁.根据Edinburgh分型:均为Edinburgh 2B1型.5例合并多发伤的患者于伤后当天即接受锁骨骨折Orthofix单平面多轨道支架固定治疗,1例开放性锁骨骨折和1例锁骨感染性骨不连患者择期行HoffmanⅡ多平面框架式支架固定治疗.结果 所有患者术后获11～18个月(平均14.1个月)随访.外固定支架保留时间为53 ～90 d,平均64.4 d.患者末次随访时肩关节功能优良,Constant-Murley评分平均为94 3分.骨折均获骨性愈合.所有患者对其肩关节外观和治疗结果均表示满意.随访发现3例患者发生并发症:1例钉道瘢痕增生;1例术后复位丢失,骨折畸形愈合;1例钉道感染.结论 对于开放性骨折、感染性骨不连及部分合并有严重并发症,且无法耐受标准切开复位内固定术而又移位明显的锁骨中段骨折患者,应用外固定支架治疗能取得良好的疗效.     

Secondary fractures associated with external fixation in pediatric femur fractures.

Sixty-six femur fractures sustained by children ages 4-14 years and treated with external fixation were reviewed retrospectively to assess factors influencing the incidence of refracture. The total rate of secondary fracture was 12% (eight patients) including five recurrent fractures at the original fracture site and three fractures through the pin sites. After removal of the external fixator, five patients refractured at the original fracture site and one patient fractured through a pin tract. Two patients fractured at pin sites while the fixator was still in place. Multivariate linear-regression analysis showed no correlation between the incidence of refracture and fracture pattern, percentage of bone fragment contact after fixator application, type of external fixator, or dynamization. A statistically significant association (p < 0.05) was found between the number of cortices demonstrating bridging callus [on both anteroposterior (AP) and lateral views] at the time of fixator removal and the rate of refracture. Fractures showing fewer than three cortices of bridging callus had a three (33%) in nine rate of refracture, whereas fractures with three or four cortices of bridging callus had a two (4%) of 57 rate of refracture.     

外固定支架结合有限内固定治疗儿童股骨远端骨折

目的 :探讨外固定支架结合有限内固定治疗儿童股骨远端骨折的临床疗效。方法 :自2008年1月至2014年6月,采用外固定支架结合有限内固定法治疗儿童股骨远端骨折17例,其中男12例,女5例;年龄6~13岁,平均10.2岁;病程1 h~2 d。所有患儿经X线片确诊,股骨髁上骨折11例,髁间粉碎性骨折6例。按AO/ASIF分型:A1型9例,A2型5例,C1型3例。观察并记录患者术中及术后并发症、术后放射学检查、下肢长度及膝关节活动度,并采用KSS膝关节功能评分对膝关节功能进行评分。结果:17例患者均获随访,时间6~38个月,平均24.4个月。术后均无神经血管损伤表现,出现外固定针松动1例,针道感染2例,双侧肢体不等长3例。膝关节活动度及长度测量(与健侧对比):平均屈曲受限10°(0°~20°),平均伸直受限4°(0°~10°),平均内/外翻3°(0°~5°)。末次随访时膝关节功能KSS临床评分为96.4±5.0;优16例,良1例。X线片显示所有骨折愈合,未发现骨骺早闭现象。结论:采用外固定支架结合有限内固定方法治疗儿童股骨远端骨折,具有手术操作简单、固定牢固、早期功能锻炼等优点。     

Role of external fixators for treatment of humeral fractures: report of 23 cases using Orthofix fixators

From 1991 to 1998, 23 humeral fractures has been treated using the Orthofix external fixator. Average age of the patient was 42 y and average follow-up 55.5 m. Initial trauma was: 13 traffic accidents, four falls at home, two devastating farming accidents, two sports accidents, one aggression and one gun accident. AO classification was used and location of the fracture was classified using Hackethal classification modified by de la Caffinière. Majority of fractures were located at the one-third distal humerus and the majority was also comminuted. At follow-up, elbow range of motion was 130 degrees, shoulder range of motion 161 degrees, external rotation 69.5 degrees and internal rotation 92.5 degrees. Using the classification of Stewart and Hundley, eight excellent, seven good, three fair and two bad results were obtained. There were no postoperative radial nerve palsy. Two external fixators had to be removed because of pin mobility. Failures were: non union and pin mobility in one patient which has to be reoperated on; two non unions have been grafted on and plated. There were no malunion in the postoperative X-rays. This device is our favourite for this type of injury because of its rigidity and the possibility of secondary dynamization. The external fixator was removed after union: this explains the long delay of union in our series.     

有限内固定结合微型外固定架治疗手部骨折

目的 总结应用有限内固定结合微型外固定架治疗手部关节内或关节周围骨折的方法及疗效。方法 2002年5月-2005年2月，对15例手部关节内或关节周围骨折的患者，应用有限内固定结合Orthofix微型外固定装置进行治疗。结果 术后骨折全部愈合，愈合时间为6～12周，平均8周。按TAM标准评定手指活动度其优良率达93．3％。术后无钢针断裂、松动及针道感染等并发症。结论 有限内固定结合微型外固定架治疗手部关节内或关节周围骨折具有微创、固定可靠、疗效肯定等优点，为手部关节内或关节周围骨折的治疗提供了一种新的思路。     

Treatment of femur fractures in children with cerebral palsy

Purpose  Children with cerebral palsy may have low bone density stemming from various etiologies and are, thereby, at risk for fractures. The treatment of femur fractures in children with cerebral palsy may need to be tailored to address the management of spastic muscle tone and multiple medical co-morbidities. Methods  Our study is a retrospective review that evaluates the treatment of 47 femur fractures in children with cerebral palsy in both ambulatory and non-ambulatory patients. Results  Thirty-two fractures in non-ambulators were treated non-operatively, 11 of which resulted in malunions and five developed pressure sores. Six fractures in non-ambulators were treated operatively, one of which resulted in a malunion. In ambulators, five fractures were treated non-operatively; one of these fractures lost reduction after 2 weeks and required surgical intervention. One of four fractures in ambulators treated operatively developed a malunion. Conclusion  Our study results suggest that femur fractures in children with cerebral palsy can be treated non-operatively; however, because of the high risk of malunion in this patient population, fracture alignment needs to be followed closely during healing. Careful attention during casting is necessary to prevent pressure sores. Strong consideration should be given to initial operative treatment in ambulatory patients in order to preserve function.     

Management of trochanteric fractures of the femur with external fixation in high-risk patients

The aim of this prospective study was to assess the outcome of trochanteric fractures of the femur after external fixation in a group of elderly patients with high surgical risk. The study population consisted of 50 patients with trochanteric fractures of the femur and a mean age of 87 years who were classified by an anaesthetist as ASA 3 or 4 and considered not suitable for conventional fractures fixation. The fracture was fixed with an external fixator under spinal anaesthesia. The final follow-up was at 12 months. All fractures healed within 12 weeks. Superficial pin tract infection occurred in 30 patients, and fracture united with a shortening of 14 mm (5-20) in 12 patients. No implant failures or limitation of knee movements were recorded. Five patients died within 1 year. External fixation is a valuable treatment alternative for trochanteric fracture of the femur in elderly patients.     

Mechanical analysis of the factors affecting dynamization of the Orthofix Dynamic Axial Fixator

Loading trials were conducted to identify mechanical factors affecting dynamization of a commercially available external fixator (Orthofix) that is designed to undergo free telescopic motion when axially loaded. Angular variations between the proximal and distal screw clamps and the telescoping fixator body failed to produce fixator binding (failure to dynamize) in any of the loading trials. However, binding was produced by applying external torques in magnitudes that occasionally occur during routine ambulation. The specific torque necessary to induce binding (typically 3-4 Nm) was only a weak function of axial load magnitude, axial loading frequency, or simulated fracture stiffness. Among several geometrical variables of fixator application, only the pre-extension of the telescoping body and circumferential misalignment between proximal and distal pin clusters had an appreciable influence on the threshold binding torque. Axial fixator motions were also monitored in a small adjunct clinical series of 22 dynamized tibial fractures. The fixator dynamized appropriately in 15 cases (68%). Three patients (14%) showed evidence of fixator binding, and another four (18%) had less than predicted slider excursions. The role of several design factors implicated in torque-induced fixator binding is discussed in light of the benchtop and clinical observations.     

Varus collapse of comminuted distal femur fractures after open reduction and internal fixation with a lateral condylar buttress plate

Twenty-six comminuted distal femur fractures treated with a lateral condylar buttress plate were followed up until fracture union or implant revision (mean follow-up, 26 months). Mean postoperative angle (medial distal femoral angle immediately after surgery) was 96 degrees, and mean final angle (angle at fracture healing or implant revision) was 91 degrees (P = .06). Distal femoral angle decreased 5 degrees or less in 15 patients, 6 degrees to 10 degrees in 8 patients, and more than 10 degrees in 3 patients. Final distal femoral angle was 90 degrees or less in 13 of the 26 fractures: 38% of these 13 fractures required reconstruction for nonunion, malunion, or knee arthrosis. The lateral condylar buttress plate, which is not a fixed-angle device, allowed more than 5 degrees of varus collapse to occur in 42% of the comminuted distal femur fractures.     

Treatment of open femur fractures in children: comparison between external fixator and intramedullary nailing

BACKGROUND: Open femur fractures in children are uncommon and usually associated with other injuries. In adults, there is a current trend to treat open fractures with intramedullary (IM) devices. The goal of this study was to compare external fixator (EF) to IM devices in the treatment of open femur fractures in children. METHODS: Diaphyseal femur fractures without growth plate involvement were included. Thirty-five patients (12 IM; 23 EF) were identified. Age, hospital stay, polytrauma, mechanism of injury, and Gustilo-Anderson grade were recorded. Follow-up was at least until the fracture was clinically and radiographically healed. RESULTS: Patients with EFs were 5.2 times more likely (95% confidence interval, 1.05-25.5) to have any complication. Excluding pin track infections, patients with EFs were 2.7 times as likely (95% confidence interval, 0.567-13.2) to have a complication. Refractures occurred only in the EF group (6/23, 26%) and not in the IM nailing group (P = 0.062, Fischer exact test). These were associated with varus malunions-all 3 of the EF group with more than 15 degrees of varus at fracture union suffered a refracture. CONCLUSIONS: Treatment of open femur fractures in children is a challenging problem. Treatment with IM devices had fewer complications than the EF. We think that whenever possible, the use of IM devices for the treatment of open femur fracture in children should be considered, especially grade 1 open injuries. If EFs are used, avoiding varus malunion may decrease the refracture rate, and secondary change to an IM device should be considered. LEVEL OF EVIDENCE: Comparative cohort study. Grade 3 level of evidence.     

Stabilisation of periprosthetic fractures with angular stable internal fixation: a report of 13 cases

Introduction: Periprosthetic fractures of the femur present a challenging surgical problem. The aim of this study was to retrospectively evaluate the outcome of periprosthetic fractures stabilised with an angular stable, less invasive stabilisation system (LISS). Patients and methods: Thirteen patients (ten total hip-, two total knee-, one total hip- and knee-arthroplasty) with periprosthetic fractures were treated with the LISS internal fixator (in ten cases minimal invasive). Six patients had previous operations due to periprosthetic fractures. The average follow-up period was 20 months, follow-up rate 85%. Results: All fractures showed radiographic fracture healing without implant loosening. Except one patient, all patients had returned to their pre-operative activity level. No early post-operative complications were seen. There was one implant failure after 4 months and two cases of malunion. Conclusion: The cases showed the internal fixator to be effective for the stabilisation of periprosthetic fractures, even in cases of poor bone quality with good functional outcomes. The internal fixator, with the option of minimal invasive application, is the preferred method of osteosynthesis in periprosthetic fractures.     

VSD结合外固定支架在西藏高原地区胫腓骨开放性骨折分期治疗中应用

目的：探讨负压吸引敷料结合外固定支架技术在西藏高原地区胫腓骨开放性骨折分期治疗中的应用及临床疗效。方法2014年8月-2015年8月收治16胫腓骨开放性骨折患者,其中男性12例,女性4例,年龄19~66岁,平均年龄39.4岁(19~66岁);胫腓骨中上段骨折4例,下段骨折12例。待患者病情稳定后患者生命体征稳定后,无继发性损伤,予行清创、外固定支架固定骨折端,并采用负压吸引敷料覆盖创面或创腔。7 d后更换VSD或予行二期缝合或软组织覆盖。 X线检查明确骨折愈合时间并记录相关并发症。结果本组16例创面均二期愈合,未见感染、皮肤或皮瓣坏死等软组织并发症。本组共随访患者12例(电话通知来院复诊),4例失访,平均随访18个月(12~24个月)。影像学检查明确平均骨折愈合时间为5.5个月(3~7个月),其中骨折一期临床愈合9例(75%),延迟愈合3例(25%)。随访期间除2例出现钉道感染,经保守治疗后治愈,余患者未见深部感染、植皮或皮瓣坏死、畸形愈合、骨不连或骨髓炎发生。结论负压吸引敷料结合外固定支架治疗西藏高原地区胫腓骨开放性骨折,在迅速有效地稳定骨折的同时,能安全有效地封闭创面,缩短二期创面修复时间,促进骨折愈合,减少并发症。