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.     

Preliminary results of the use of Ilizarov fixation in clavicular non-union

Although clavicular fractures are common, nonunion of clavicle is a rare complication. Clavicular nonunion that occurs due to insufficient stabilization is usually painful and necessitates operative treatment. Seven cases with oligotrophic clavicular nonunion that developed after a conservative process were treated with Ilizarov between January 2000 and December 2002. In all of them, the middle one-third of the clavicle was affected. Details of the cases regarding sex, age information, reason of fracture, previous treatment methods that were applied, nonunion area, nonunion, and duration of frame application were recorded. Two of the cases were female and five of them were male with age mean of 27.1 (19–32 years). Five of these cases had right clavicular injury and two of them had left clavicular injury. Mean nonunion duration was 18 months (range was 6–36 months). All nonunion were fixed and went through acute compression by means of Ilizarov’s external fixators without grafting. The duration between the frame application and union was mean 2.7 months (range was 2.5–3.5 months). Mean follow-up period was 31 months (range was 22–48 months). Cases were evaluated in accordance with the Constant Scoring system. They were able to return to their normal daily activities in 10–15 days. All of them regained full shoulder movement and extension ability. Patients have also been evaluated by using Dash-Score. Union existed for all patients and none of them had any complaints of pain after treatment. Since circular external fixator allows acute compression, early shoulder movements, and requires no such additional procedure as grafting, it is an alternative method which can be used in treating nonunion of clavicle.     

External fixation for surgical off-loading of diabetic soft tissue reconstruction

Early and aggressive treatment of diabetic foot wounds is imperative for the reduction of amputation risk. Whereas sound local wound care is important for successful management; chronic wounds often reach a stagnant point in healing because of diabetic vasculopathy, immunopathy, or neuropathy. The type, size, shape, and location of wound may not always allow primary closure or grafting. In patients with adequate perfusion and in the absence of infection, local advancement flaps are suitable for durable closure. A review and case report demonstrating the use of these flaps with external fixation as an adjunctive therapy for surgical off-loading is presented.     

外固定支架治疗胫骨骨折内固定术后骨髓炎及软组织缺损

目的：使用外固定支架治疗21例骨折内固定术后骨髓炎或软组织坏死缺损的患者，总结用外固定支架治疗这类疾病的临床规律。方法：用单侧多功能外固定支架，治疗21例内固定术后出现感染或软组织坏死缺损的患者，术中拆除内固定材料，清除骨髓炎病灶，用旋转皮瓣、肌瓣转移、植皮、髂骨植骨等方法，术前术后用敏感抗菌素。结果：病人骨髓炎症状消失，2例需再次髂骨植骨，3个月－1年内拆除外固定支架，无1例截肢。优良率71．4％。结论：使用外固定支架治疗内固定术后骨髓炎或软组织坏死缺损的病人，可有效地消除骨髓炎，并同时保持骨折的稳定性，保证骨折顺利愈合。     

外固定支架结合锁定加压钢板在不稳定骨盆骨折治疗中的应用

目的 探讨外固定支架结合锁定加压钢板技术在不稳定骨盆骨折治疗中的应用及效果.方法 对2007年6月至2008年7月获得随访的12例不稳定骨盆骨折患者进行回顾性分析,男9例,女3例;年龄22～51岁,平均36.2岁.均采用髋臼上方外固定架固定前环骨折,锁定加压钢板固定后环骨折的技术.按照Tile分型:B1型5例,B2型3例,B3型2例;C1型2例.合并直肠或膀胱损伤3例,血气胸、颅脑损伤3例,腰骶神经损伤2例,多发骨折8例. 结果 12例患者术后获3～12个月(平均6.3个月)随访.手术时间40～120 min(平均70 min).支架保留时间6～16周(平均11周).骨盆骨折或脱位的愈合时间为12～19周(平均14周).骨折复位按照Tornetta评估标准:优7例,良4例,可1例.术后功能评定按Majeed评分标准:优6例,良4例,可2例.并发症包括2例早期负重行走时后方疼痛,经卧床休息延迟负重后缓解;6例有不同程度钉道感染,2例腰骶神经损伤患者3个月后神经功能部分恢复,无严重医源性并发症和合并症发生. 结论髋臼上方置钉外同定支架技术可有效恢复骨盆前方稳定性,通过股骨牵引还可以达到对骶髂关节的加压.跨骶骨髂骨间锁定加压钢板对骨盆后方的固定有一定优势.两种技术结合应用,创伤较小、手术操作简单,能达到不稳定骨盆骨折微创治疗的目的 .     

Treatment of humeral shaft nonunion by external fixation: a valuable option

We report the treatment of six patients with nonunion of the humerus, using a unilateral fixator and bone grafting. Union was obtained in all patients, with an average time to union of 4.5 months. Superficial pin tract infection was seen in five patients, but resolved uneventfully. One patient had transient radial nerve palsy. The results, according to the Stewart and Hundley criteria, were excellent in one patient, good in three, fair in one, and poor in one. The main cause of the fair and poor results was marked limitation of shoulder and elbow motion. This method, however, seems to be therapeutically effective. Received: August 21, 2000 / Accepted: December 22, 2000     

External fixation of unstable pelvic fractures

Summary The Hoffmann external fixator was used to stabilize unstable pelvic fractures in 56 patients with multiple injuries. It was applied under general anaesthesia and the dislocated pelvis reduced and secured with a single tie bar. In 16 cases residual dislocation of less than 1.5 cm was noted after the reduction and the reduced position was maintained in 48 out of 51 cases, a minor redislocation occurred in the remaining 3 patients. Few complications could be attributed to the method, infection was noted in one patient, the iliac crest was fractured in one case and an exostosis of the iliac crest occurred in one youth.Forty-three patients were symptom free with regard to the pelvis at the time of review whereas 5 patients had residual pain and 3 diffuse symptoms.The technique of application is simple but requires two surgeons at the time of reduction and fixation of the pelvis.

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Résumé Les auteurs ont utilisé le fixateur externe d'Hoffmann pour maintenir une fracture instable du bassin chez 56 blessés présentant des traumatismes multiples. Le fixateur a été mis en place sous anesthésie générale et le bassin fracturé réduit et maintenu par une barre simple. Dans 16 cas, il persistait après réduction une disjonction inférieure à 1,5 cm. La position de réduction s'est maintenue dans 48 des 51 cas, tandis qu'un redéplacement modéré s'est produit dans les 3 autres cas. Il n'y a eu qu'un petit nombre de complications dues à la méthode: une infection, une fracture de la crête iliaque et une exostose de la crête iliaque chez un sujet jeune.Quarante-trois blessés ne présentaient aucune séquelle en ce qui concerne le bassin lors de l'examen de contrôle, tandis que cinq signalaient des douleurs résiduelles et trois des troubles divers.Cette technique est de réalisation facile mais elle nécessite la présence de deux chirurgiens pour effectuer la réduction et la fixation du bassin.

     

骨外固定治疗老年髋部骨折

目的：回顾性分析骨外固定技术在老年髋部骨折中的应用,探讨其可行性。方法：２７例病人接受此手术。年龄６１～８６岁,其中粗隆间骨折１８例,粗隆下骨折６例,股骨颈基底部骨折３例。结果：除２例股骨颈基底部骨折术后２周发现髋内翻外,其余均在术后２～４月摄Ｘ线片示骨愈合,取出外固定架,功能恢复良好。结论：利用骨外固定技术治疗老年髋部骨折,手术风险小,操作简单,固定效果可靠。穿针部位及方法选择合适则可减少术后关节功能活动受限等并发症。各型股骨颈骨折不宜用此法固定。     

外固定或结合有限内固定治疗老年股骨转子下骨折

目的：探讨不同的外固定方法或有限内固定治疗老年股骨转子下骨折的作用。方法：３ 种固定方法即（１）多根直径３～３．５ｍ ｍ 斯氏针骨外穿针外固定支架固定；（２）外固定支架结合有限内固定（中空加压钉）；（３）髓内针内固定加钢丝环扎固定。结果：４５ 例经随访６ 个月～４ 年平均１８ 个月，优２９例、良１１ 例、中３ 例、差２ 例。结论：作者认为这种外固定器结构简单，这种方法具有极小的组织损伤，骨折愈合快，能早期下床，无并发症，手术操作简单固定牢固，针易拔除等优点，因此值得推广应用。     

双边单针外固定架加夹板治疗老年股骨髁上骨折

股骨髁上骨折是老年人的常见骨折类型,因老年人常合并有心脑血管病、糖尿病等内科疾病,给治疗方法的选择带来一定的限制[1-2]。我们在1998年9月-2005年12月应用自制外固定架配合夹板治疗老年股骨髁上骨折46例,取得满意疗效,现总结报告如下。1临床资料本组46例,男21例,女25例;年龄65~91岁,平均为78岁;自己摔伤30例,被车撞伤16例。横断骨折12例,粉碎性骨折34例;其中合并肺功能不全23例,心脏病37例,高血压32例,偏瘫9例,糖尿病16例,老年痴呆7例,合并2种以上疾病38例。2方法2·1外固定架的制作依据大腿上段形状制作2片宽15 cm半圆形铝合金片,内侧…     

The pelvic external fixation: the mid-term results of 41 patients treated with a newly designed fixator

The purpose of this study was to evaluate the clinical and radiological results of unstable pelvic fractures treated with a new external fixation device. Between May 1992 and May 1998, 43 patients with unstable pelvic fractures were treated with a new anterior pelvic external fixator. Two died, and therefore 41 patients' results were evaluated. There were 29 men and 12 women, and their average age was 34 years (range 12-70 years). Traffic accidents accounted for 34 injuries. Three patients fell from a height, 3 were injured in industrial accidents, and 1 was hit by a train. According to the Tile classification, there were 24 type B pelvic injuries and 17 type C. Associated injuries were observed in 21 patients. A considerable reduction of the pelvic pain was noted after application of the fixator in all patients. Excessive blood transfusion was not required in any patient. The average follow-up was 24 months (range 12-50 months). Clinical results at final evaluation were good according to the criteria of Matta and Saucedo in 34 patients and poor in 7. In conclusion, the new pelvic external fixator is effective, safe, and easy to apply in the treatment of unstable pelvic fractures. The fixator can be used alone in patients with type B pelvic injuries such as open book and lateral compression. However, it does not provide sufficient stability for severely displaced type C injuries when applied alone. Nevertheless, it may be helpful for fixing type C injuries like a posterior iliac fracture without dislocation of the sacroiliac joint.     

External fixation of open subtalar dislocation

Subtalar dislocation is a rare and severe injury, caused by high-energy trauma such as fall from a height or traffic accident. Infection and avascular necrosis are not rare sequelae of open subtalar dislocation, and the outcome may be poor. External fixation allows complete wound care, and moderate distraction of the ankle joint should unload the talus, which may reduce the risk of avascular necrosis. We treated 11 open subtalar dislocations by distractional external fixation. The series involved nine males and two females, of average age 30.39 years. In nine cases the injury was caused by falling from a height, and in two by a traffic accident. The follow-up period ranged from 18 to 28 months. The final functional results were good, with no infection and one case of avascular necrosis of the talus. Pain after a longer period of walking or standing was experienced by eight patients, and movement of the subtalar joint was limited in nine patients. Immediate distractional external fixation of open subtalar dislocation may prevent infection and avascular necrosis of the talus.     

External fixation of distal radius fractures

External fixation has been used for the treatment of distal radius fractures for more than 50 years. Although the fixator configurations have undergone considerable modification over time, the type of fixator itself is not as important as the underlying principles that provide the foundation for external fixation. Although volar plate fixation is currently in vogue, the indications for external fixation remain largely unchanged. Newer fixator designs have also expanded the traditional usage to include nonbridging applications that allow early wrist motion. The following discussion focuses on the myriad uses for external fixation as well as the shortcomings and potential pitfalls.     

Functional assessment in patients with osteoporotic wrist fractures treated with external fixation: a review of randomized trials

Introduction  Osteoporosis is a chronic and progressive condition that leads to decreased bone mass and skeletal fragility which may result in fractures, disability, pain, deformity and even death. Fractures of the wrist are the most common symptomatic fracture related to osteoporosis in which up to 80% of the persons with this fracture type have low bone mass. External fixation is minimally-invasive and is used in particular for the treatment of displaced, unstable fractures. Objective  The present systematic review will present functional outcome assessment in randomized controlled trials in the aged with distal radius fractures and treated with external fixation. Materials and methods  Multiple databases including Medline, EMBASE, CINAHL, AMED and OVID Healthstar were searched. MESH headings such as: “Radius fractures” or “wrist injuries” were used in combination with “randomized controlled trials”. Studies were included if the surgical treatment was external fixation, mean patient age was 50 years and over, and were in the English language. Results  The primary focus of wrist outcome assessments in patients treated with external fixation were based on traditional measures such as wrist range of movement and grip strength reflecting the need to shift the focus in future protocols towards measuring a patient’s functional ability, measuring the difficulty of task performance and compensatory mechanisms. Furthermore, it is essential to take into account more evidence of instrument development before clinicians can reliably choose the best measure to assess the aged treated with external fixation.     

外固定架与切开复位内固定治疗不稳定性桡骨远端骨折疗效的Meta分析

目的 应用Meta分析的方法,评价外固定架与切开复位内固定治疗不稳定性桡骨远端骨折的疗效差异,为临床选择治疗不稳定性桡骨远端骨折的治疗方法提供依据. 方法 计算机检索MEDLINE(1975年至2008年1月)、Cochrane图书馆(2007年第2期)、EMBASE(1980年至2007年)和中国生物医学文献数据库(CBM,1978年至2007年)、中国期刊全文数据库(CNKI,1994年至2007年)、中国医学学术会议论文数据库(CMAC,1994年至2007年)、中文科技期刊数据库(1989年至2007年).手检1980年1月至2008年1月国内相关杂志9种,均从创刊检索至2007年11月,搜集不稳定性桡骨远端骨折的内固定或外固定治疗的临床研究.按照文中所述纳入标准收集后进行比较.利用STATA软件进行异质性分析及Meta分析,绘制森林图. 结果 共纳入71篇文献,其中外固定架组23篇文献(856例患者),内固定组48篇文献(1741例患者).结果发现,两组在握力、腕部活动范围、放射学指标以及功能评分上差异无统计学意义(95%置信区间有重叠).外固定架组的感染率、固定失败率和神经炎发生率较高,而内固定组的肌腱并发症的发生率和内固定提前拆除的比例较高(95%置信区间无重叠).结论 采用外固定架与切开复位内固定治疗不稳定性桡骨远端骨折各有利弊,尚缺乏内固定优于外固定治疗的证据,其疗效无明显差异.     

External fixation for unstable intra-articular distal radial fractures in women older than 55 years. Acceptable functional end results in the majority of the patients despite significant secondary displacement

Unstable intra-articular distal radial fractures in women older than 55 years were treated by closed reduction and external fixation to achieve the best functional outcome. Sixteen women had radiographic and functional assessment. Despite initial good alignment secondary displacement occurred in 11 patients, probably due to the comminution of the fracture and possibly influenced by osteoporosis. Malunion of the distal radius was seen in two patients and intra-articular incongruity with an intra-articular step exceeding 1 mm was observed in two other patients. The functional outcome was excellent or good in 10 and fair in two patients. Four patients had a poor functional outcome. Two of these patients had a significant loss of reduction, one resulting in a malunion. The other two had an intra-articular incongruity of more than 1 mm. Three of the four patients with a poor functional outcome had clinical signs of reflex sympathetic dystrophy. CONCLUSION: Closed reduction and external fixation of "bad case" severely comminuted unstable distal radial fractures in the elderly may result in an acceptable functional outcome in the majority of the cases, although significant secondary displacement occurred in eleven of the sixteen patients.     

老年肱骨近端骨折的内固定治疗

目的 总结老年肱骨近端骨折的内固定治疗方法。方法 1999年1月～2003年1月，收治老年肱骨近端骨折患者32例，男13例，年龄60-88岁，平均73．2岁；女19例，年龄60-94岁，平均75．5岁。按Neer分类标准对肱骨近端骨折进行分型：二部分骨折22例，其中肱骨外科颈骨折占二部分骨折的68．1％；三部分骨折6例；四部分骨折4例。二部分骨折中有3例、三部分骨折中有1例患者因内科合并症或不接受手术而行三角巾悬吊或石膏固定，其余28例均行手术治疗。8例行闭合复位、经皮克氏针内固定；8例经肩峰外侧、三角肌切口手术，其中5例大结节骨折复位后，直接拧入螺钉固定，1例因大结节撕脱骨块较薄，用张力带固定，2例外科颈骨折行带锁髓内钉内固定；12例经三角肌、胸大肌切口手术，5例行钢板螺钉内固定，7例行张力带固定。结果 28例手术患者中25例获得随访，随访时间1-3年，平均1．5年。骨折均愈合，5例行张力带治疗的三、四部分骨折患者骨折愈合时间超过3个月，其中2例发生股骨头坏死。三、四部分骨折患者术后均出现不同程度的关节僵硬，6例残留继发性肩关节挛缩。术后根据UCLA评分，二部分骨折优良率为81．2％，三、四部分骨折优良率为33．3％。结论 老年肱骨近端骨折的治疗需根据患者情况选择治疗方法，虽然四部分骨折内固定术后效果欠佳，但对因各种原因不能行关节置换的老年患者，内固定尤其是张力带固定是一种有效的治疗方法。术后继发性肩关节挛缩和肱骨头坏死是三、四部分骨折的常见并发症。肩关节手术后早期和全面的康复训练直接关系到治疗的效果。     

External fixation with bone cement implantation for open calcaneal fractures: A case series

ObjectiveThe purpose of this study was to retrospectively evaluate patients who had open reduction, external fixation and bone cement implantation of open calcaneal fractures.MethodsThe records of 14 patients with open calcaneus fractures from January 2015 to January 2019 were reviewed retrospectively. Clinical evaluations consisting of AOFAS, MFS and EQ-5D VAS scores and radiological evaluations consisting of the height, width and length of the calcaneus as well as Bohler’s and Gissane angle performed at 3 months, 1 year and the last follow-up postoperatively. Time to surgery, wound complications were recorded.ResultsOur study sample consisted of 9 males and 5 females with a mean age of 38.5 ± 9.8 years and a mean follow-up of 31.4 ± 7.7 months. The mean period from injury to surgery was 5.4 ± 1.9 days and the mean duration of hospitalization was 13.2 ± 4.5 days. The AOFAS, MFS and EQ-5D VAS scores were 92.5 ± 10.3, 84.1 ± 9.7 and 86.4 ± 15.1 respectively at the final follow-up. The Bohler’s angle increased from (12.9 ± 3.1)° preoperatively to (28.5 ± 6.3)° at the final follow-up (P < 0.001), with the Gissane’s angle from (104.5 ± 9.7)° to (116.4 ± 8.9)° (P < 0.001). One patients (7.1%) developed pin infections and one patient (7.1%) suffered from dorso-lateral hindfoot hypoaesthesia. There was complete fracture healing without secondary loss of reduction in all cases.ConclusionExternal fixation with bone cement implantation is a valid alternative treatment for the management of displaced open calcaneal fractures with a low rate of complications.Level of evidenceIV, retrospective case series.     

内固定手术治疗老年人股骨粗隆间骨折的临床分析

股骨粗隆间骨折是老年人常见的骨折之一，其临床特点为患者体质较弱，且部分伴有合并症，因此临床治疗也具有相应的特殊性。如保守治疗，可因卧床时间长而出现较多并发症，严重威胁患者的生命。因此，近年来大部分学者主张采用内固定手术治疗股骨粗隆间骨折，可有效降低死亡率和髋内翻畸形。我院2000年7月-2004年12月共收治股骨粗隆间骨折患者112例，其中年龄〉60岁者86例，现总结报道如下。     

长骨骨折内固定术后隐性感染的诊断及处理

[目的]探讨长骨骨折内固定术后隐性感染的诊断及处理方法。[方法]对13例长骨骨折内固定术后隐性感染的患者，采用病灶清除，灌洗引流，其中8例取出内固定物改外固定架固定，5例保留原内固定物。3例Ⅰ期植骨。Ⅱ期内固定加植骨术7例。术后应用抗生素2-3周。[结果]经8-48个月随访，平均23．5个月。骨折愈合11例。部分愈合1例，不愈合1例。1例出现窦道，2例感染复发。[结论]长骨骨折内固定术后隐性感染存在骨缺损、骨折不愈合或骨愈合不良，需要手术治疗。感染轻者病灶清除后可保留内固定物。感染重或内固定物松动者行病灶清除同时取出内固定物改外固定架固定。X线片表现是诊断骨折内固定术后隐性感染的重要依据。