External Fixation and Internal Fixation

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A Comparative Analysis of Surgical Management using External Fixation and Internal Fixation in Unstable Comminuted Fracture of Distal Radius.

A Comparative Analysis of Surgical Management using External Fixation and Internal Fixation in Unstable Comminuted Fracture of Distal Radius.

In the surgical procedure, External fixation 2.94% patients had Excellent results, 70.59% had good results, 23.53% had fair results and 2.94% had poor results. In the Internal fixation group 5.88% patients had excellent results, 82.35% had good results, 11.76% had fair results and no one had poor results. Our study showed that method of fixation is statistically not significant (P = 0.3955) in determining the functional outcome of the patient, though the study has certain limitations such as non-randomized, non-blinding techniques used and less number of patients were employed. Similarly Margaliotet al 23 did a Meta – analysis of distal radius fractures treated with External fixation and Internal fixation. 46 articles were included in the study after careful serenity of Internal fixation and external fixation 917 patients were included in external fixation group and 603 were included in Internal fixation group. Outcomes were assessed using pooled grip strength, Range of motion, Radiographic assessment and physician related outcomes. The authors conclude that current literature does not recommend the superiority of one method over the other.
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Management of extra-articular distal tibial fractures with combined external fixation and limited internal fixation: A prospective study

Management of extra-articular distal tibial fractures with combined external fixation and limited internal fixation: A prospective study

The results of open reduction and internal fixation of fractures of the distal tibial have not been excellent or good at many trauma centers. The thin, traumatized soft-tissue envelope about the ankle and the complex pathoanatomy of this fracture can lead to numerous complications. In various clinical series, the rates of wound breakdown and deep infection have been reported to be as high as 100 per cent after open reduction and internal fixation of severely comminuted fractures of the tibial plafond. In a recent retrospective study of the operative treatment of these fractures, major complications developed in twenty-one of fifty-two patients who had had open reduction (35) . Excellent results with few complications after treatment with external fixation have recently been reported (36) .
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Original Article Comparative study of the efficacy of open reduction and internal fixation versus closed reduction and external fixation in treating distal radius fracture

Original Article Comparative study of the efficacy of open reduction and internal fixation versus closed reduction and external fixation in treating distal radius fracture

Abstract: Objective: To compare the efficacy of open reduction and internal fixation versus closed reduction and external fixation in treating distal radius fracture. Methods: A total of 77 patients with distal radius fracture were ret- rospectively analyzed. There were 40 patients in the open reduction and internal fixation group (observation group) and 37 patients in the closed reduction and external fixation group (control group). The fracture symptoms, healing time of fracture, postoperative evaluation of wrist function, disabilities of the arm, shoulder and hand (DASH) score and life quality for 3 months after operation were compared. Results: In terms of fracture symptoms, the patients in the observation group had better improvements in pain, swelling and ecchymosis over the patients in the control group. The differences were statistically significant (P<0.05). Healing time of the patients’ fracture in the observa- tion group was less than that of the patients in the control group (P<0.05). As for the recovery of wrist function, the observation group showed better recovery of the palmar tilt angle, ulnar deviation angle and radius height than the control group (P<0.05). What’s more, the excellent and good scores of DASH scale was higher in the observation group than in the control group (P<0.05). Lastly, with regard to postoperative life quality, physical function, physical role functioning, social functioning, emotional role functioning and bodily pain of the patients in the observation group were all significantly better than those of the patients in the control group (P<0.05). Conclusion: Open reduc- tion and internal fixation is better than closed reduction and external fixation in treating distal radius fracture. When treated by open reduction and internal fixation, patients with distal radius fracture have shorter healing time and good postoperative life quality. Therefore, it is worthwhile to popularize and apply open reduction and internal fixa- tion in clinical practice.
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Treatment of open tibial diaphyseal fractures by external fixation combined with limited internal fixation versus simple external fixation: a retrospective cohort study

Treatment of open tibial diaphyseal fractures by external fixation combined with limited internal fixation versus simple external fixation: a retrospective cohort study

The fixation methods for open tibial diaphyseal frac- tures have evolved over the years but remain controver- sial [4–6]. Damage control orthopaedics (DCO) with external fixation followed by definitive internal fixation with nailing or plating is a popular strategy for signifi- cantly decreased complications [7]. However, the sec- ondary fixation procedure causes economic, physical, and psychological burdens, making the strategy less than ideal [7–9]. Thus, external fixation is an alternative as the definitive fixation in some cases such as improper conditions of soft tissues or patients’ non-compliance for the staged surgeries. Nevertheless, based on relevant studies, external fixation as a definitive treatment should warrant more attention for possible issues related to pin-track infection, unsatisfactory alignment, and poor union, leading to unplanned secondary fixation proce- dures and consequent additional burdens to patients in physiology and economy [5, 10–14].
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Bladder incarceration following anterior external fixation of a traumatic pubic symphysis diastasis treated with immediate open reduction and internal fixation

Bladder incarceration following anterior external fixation of a traumatic pubic symphysis diastasis treated with immediate open reduction and internal fixation

Only two of these five reports actually describe incarcera- tion of the bladder after anterior external fixation and reduction of a pubic diastasis. Bartlett and colleagues [10] reported the case of a man initially treated with anterior pelvic external fixation for an open-book pelvic injury. The entrapped bladder was recognized with a postopera- tive CT cystogram and re-manipulation of the pelvis and fixator failed to reduce the incarcerated bladder. The patient underwent open reduction and fixation of the pubic symphyseal diastasis 10 days post-injury. Persistent bladder incarceration was noted and reduced. Gerraci and Morey reported a similar case where closed reduction and external fixation of the pelvic fracture were performed in an unstable multi-injured patient11. Twenty-four hours later, postoperative CT revealed bladder entrapment in the reduced pubic diastasis. Definitive internal fixation was performed without complication.
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Biomechanical stability of a supra-acetabular pedicle screw Internal Fixation device (INFIX) vs External Fixation and plates for vertically unstable pelvic fractures

Biomechanical stability of a supra-acetabular pedicle screw Internal Fixation device (INFIX) vs External Fixation and plates for vertically unstable pelvic fractures

The data show that both the INFIX and the external fixator are significantly weaker than internal fixation at the pubic symphysis. The INFIX was stiffer than external fixation for both overall axial stiffness, and stiffness at the pubic symphysis, the area of most clinical import- ance for this type of fixation. Combined with the presumed benefit of minimizing the complications asso- ciated with external fixation, the INFIX may be a more preferable option for temporary anterior pelvic fixation in situations where external fixation may have otherwise been used. Future improvements to the design may help to increase the stability of the construct.
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External Fixation Versus Internal Fixation for Closed Unstable Intra Articular Fracture of the Distal Radius  Early Results from a Prospective Study

External Fixation Versus Internal Fixation for Closed Unstable Intra Articular Fracture of the Distal Radius Early Results from a Prospective Study

External fixation was used to treat 12 patients, 8 patients were augmented with a bone graft from the iliac crest. In the internal fixation group 10 out of 14 cases needed bone graft. The decision to perform bone graft depended on the intra-operatively findings where significantly large defect of the metaphyseal region were grafted. Bone grafting of the metaphyseal defect not only provides mechanical buttress of the joint fragments but also accelerates fracture healing 8 .

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Biomechanical characteristics of fixation methods for floating pubic symphysis

Biomechanical characteristics of fixation methods for floating pubic symphysis

Depending on the energy level of the trauma, the mortality rate is between 18 and 25% in patients with hemodynamic instability [6]. Therefore, pathophysio- logical and hemodynamic stabilization should be consid- ered carefully before surgical intervention is undertaken. For patients with hemodynamic instability, maneuvers should be performed to decrease pelvic volume and re- duce motion of the bony fragments. The aim of these early damage control techniques is to achieve relative stability in a minimally invasive manner [7–10]. For pa- tients who are hemodynamically stable, early definitive fixation can be undertaken with the goals being good functional recovery and a return to normal life. The purpose of definitive fixation is accurate reduction, rigid fixation, and minimal soft tissue disruption. There are several fixation methods used to treat FPS, including external fixation [11], anterior subcutaneous fixation [10, 12], internal fixation [13], and percutaneous can- nulated screw fixation [14]. To choose the optimal fixation method, it is necessary to study the biomech- anical performance of the different methods.
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Sport and physical activity after ankle arthrodesis with Ilizarov fixation and internal fixation

Sport and physical activity after ankle arthrodesis with Ilizarov fixation and internal fixation

Patients with Ilizarov fixation had better FAAM SPORT scale scores, UCLA activity scale scores and VAS ACTIV- ITY scale scores after treatment than those after internal fixation. Ilzarov fixation exerts lesser impact on musculo- skeletal biomechanics than in the case of internal fixation. Also, the possibility of fully loading the treated limb soon after fixation with the Ilizarov apparatus seems to be more beneficial than completely sparing the extremity after in- ternal stabilization. The better sports and physical activity results of arthrodesis with external fixation can be related to better frontal and sagittal plane alignment of the ankle joint and higher ankle fusion rate. However, irrespective of the study group, the sports and physical activity level scores of our patients were close to those reported by other researchers. 2,5 According to some authors, the sports and
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Transarticular external fixation versus deltoid ligament repair in treating SER IV ankle fractures: a comparative study

Transarticular external fixation versus deltoid ligament repair in treating SER IV ankle fractures: a comparative study

In recent years, suture-anchor was widely used for pa- tients treated with deltoid ligament repair (DLR) [9 – 11], and plaster casts were most often used in treatment without DLR. Previous studies had shown that transarti- cular external fixators might raplace the plaster casts well by offering the opportunity for self-healing of del- toid ligament and allowing early weight bearing [12 – 14]. Our previous study had also shown that open reduction and internal fixation (ORIF) with transarticular external fixation (TEF) but no DLR could achieve satisfactory outcomes in treating SER IV ankle fractures [15].
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Clinical results of resection arthrodesis by triangular external fixation for posttraumatic arthrosis of the ankle joint in 89 cases

Clinical results of resection arthrodesis by triangular external fixation for posttraumatic arthrosis of the ankle joint in 89 cases

tion by screws with or without resection of the joint surfaces [23, 25, 33, 37, 42]. Some authors report arthroscopic methods in specific cases [39, 41]. The preference for internal fixation is often based on the gained comfort and compliance of the patients. On the other hand some authors quote a higher rate of non-union for the use of external fixators [4, 8, 14, 16, 24, 35]. Often the results of internal fixation are com- pared with historical studies or techniques using the Charnley-type external fixation with, compared to modern fixators [5], unstable frame fixator construc- tions [24, 40]. Studies directly comparing the tech- nique were unable to find a significant difference in non union rates [6, 9, 13].
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A comparative study of analysis of functional outcome of intra articular distal radius fractures treated with dynamic external fixator and locking compression plate.

A comparative study of analysis of functional outcome of intra articular distal radius fractures treated with dynamic external fixator and locking compression plate.

Marco Rizzo et al 63 . in his retrospective study compared the outcomes of open reduction and internal fixation with locked volar plating with closed reduction and bridging external fixation and percutaneous K wire fixation of unstable distal fractures. The demographic characters were almost similar to our study but in his study, for Ex fix group he started wrist mobilization after fixator removal on an average of 6 weeks post op, but in our study we used the double ball and socket joint type external fixator for allowing the wrist a 50 degrees arc of motion after 3 weeks. But the range of movement and strengthening exercises were started after 6 weeks in both the studies. Unfortunately, most of the studies are comparing the bridging external fixator where the dynamisation started after 6 weeks with the volar locking compression plate for unstable distal radius fractures.
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LCP external fixation - External application of an internal fixator: two cases and a review of the literature

LCP external fixation - External application of an internal fixator: two cases and a review of the literature

A 54-year old male motorcyclist was involved in a motor-vehicle accident with a car. He sustained closed Schatzker V [10] right tibial plateau and fibula shaft fractures. On presentation, there was marked swelling of the right leg, with blistering of the overlying skin and severe pain on passive dorsiflexion of the ankle. He was diagnosed with compartment syndrome of the right leg and underwent emergency two-incision fasciotomy and external fixation within nine hours of presentation. Intravenous antibiotics were continued in the periopera- tive period. In the first postoperative week, he under- went two further surgical debridements and dressing changes owing to dressing staining with malodorous, greenish discharge from both fasciotomy wounds. The presence of continuous wound discharge made internal fixation hazardous at this point. Ten days after the Table 1 Comparison of Reports of Plate External Fixation
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Triple Arthrodesis with Internal and External Fixation: Technique Paper

Triple Arthrodesis with Internal and External Fixation: Technique Paper

Traditional arthrodesis techniques involved joint resection with or without internal fixation. Kirienko et al. developed an operative technique where external fixation followed joint resection for the triple arthrodesis. Joint compression and subsequent fusion was achieved by introducing wires into the foot and arching the wires onto the external fixator. This arch-wire technique allowed for compression of the joints as the wires of the talus, calcaneus, cuboid and navicular were tensioned and fixated upon the external fixator [3].

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Steimann Pin Repair of Zygomatic Complex Fractures

Steimann Pin Repair of Zygomatic Complex Fractures

Patient Selection: Only patients with type B fractures were included in this study. Patients with other midface fractures were also excluded. Patients who revealed ocu- lar symptoms and/or major depression of the orbital floor necessitating manipulation of the orbital floor were also excluded because a lower lid approach and open reduc- tion with or without free bone transplantation is usually required in such cases, and the influences of intervention should be discussed separately. Based on this criteria eleven patients were excluded. Therefore, twelve patients with type B fractures treated with internal or external fixation had appropriate data for analysis. Patients were separated into two groups: those treated with open reduc- tion and internal fixation (ORIF), and those treated with closed reduction and transzygomatic external fixation (Steinmann Pin). All patients were taken to surgery 3 - 14 days post-trauma.
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Prolonged Unilateral Disuse Osteopenia 14 Years Post External Fixator Removal: A Case History and Critical Review

Prolonged Unilateral Disuse Osteopenia 14 Years Post External Fixator Removal: A Case History and Critical Review

There are few studies investigating disuse osteopenia in single limbs. Tandon et al. [12] reported reduced disuse osteopenia following external fixation of the tibia compared to those placed in plaster of Paris, even though those who underwent internal fixation had more severe fractures. Marchetti et al. [13] reported disuse osteopenia following shoulder surgery, which was partially reversed six weeks fol- lowing remobilisation, whilst R¨uegsegger et al. [14] reported bone loss bilaterally post total hip replacement. One of the most frequently studied groups su ff ering disuse osteoporosis are astronauts following time spent in microgravity during space missions. Lang [15] reported that up to 15% of bone strength can be lost at the proximal femur over a flight of 6 months. Rapid and severe bone loss has been reported in patients su ff ering stroke [16] and in volunteers on bed-rest studies [17].
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Fixed Time and Fixed Angle External Fixation in the Treatment of Gartland Type III Supracondylar Humerous Fractures in Children

Fixed Time and Fixed Angle External Fixation in the Treatment of Gartland Type III Supracondylar Humerous Fractures in Children

humerous and crossed K-needle internal fixation, which not only avoids injury to the triceps but also maintains integrity of the elbow extension device. Furthermore, this method allows direct view of the reduction and complete post- surgery drainage, with reduced risk of atopic ossification. Fixation is achieved by insertion of the K-needles from both sides of the proximal end towards the cortical bone of the opposite end The crossing technique can provide good stability to the fractured ends and reduce surgical injury to a minimum.
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Functional outcome of intra-articular fractures of distal radius using external fixator: A long term study

Functional outcome of intra-articular fractures of distal radius using external fixator: A long term study

The use of an external fixator alone or in conjunction with percutaneous or limited internal fixation, for unstable fractures of the distal end of the radius has produced good or excellent results. We attribute to these good or excellent results to the early removal of the fixator that allows early range-of-motion exercises and to avoid complications commonly associated with the prolonged use of external fixators 18 . We believe that intra-articular (AO type-B/C) fractures of the distal part of the radius can be treated by closed reduction and external fixation. Our series demonstrates that this technique, supplemented by k-wires as needed, is a satisfactory treatment that can lead to a high rate of return to work and sports, a high level of patient satisfaction, and a low rate of complications.
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Clinical evaluation of ankle arthrodesis with Ilizarov fixation and internal fixation

Clinical evaluation of ankle arthrodesis with Ilizarov fixation and internal fixation

There was no statistically significant difference in FAAM scores for patients in Ilizarov group and group 2. In the group evaluated by Dalat et al., mean postopera- tive FAAM scores of patients with ankle joint endo- prosthesis and ankle arthrodesis were 77.6 and 63.4 points, respectively [7]. Mean FAAM score for a group of 164 patients with various pathologies of the feet and ankle examined by Martin et al. was 74.9 points [18]. In Houdek’s study, mean FAAM score of 31 patients sub- jected to bilateral ankle fusion with internal fixation was 70 points [13]. Strasser and Turner documented the average FAAM score of 81.5 points for a group of 30 in- dividuals after ankle arthrodesis with external fixation [14]. According to Hendrickx et al., mean FAAM score of 66 subjects subjected to ankle fusion with internal fix- ation was 69 points [15]. Katsenis et al. followed-up 21 patients after ankle arthrodesis with Ilizarov fixation; ex- cellent functional outcomes were documented in 15 pa- tients, good in three, fair in two and poor in only one [9]. In our research, patients with Ilizarov stabilization presented similar functional FAAM scores, compared to internal fixation group. FAAM scores of our individuals were slightly higher than those reported by other re- searchers. This shows that our treatment results in terms of FAAM scores are similar or slightly better than the results presented in the quoted articles. In the available literature, the results on the FAAM scale after ankle arthrodesis are similar regardless of the stabilization methods and are comparable to FAAM scores after ankle joint endoprosthesis. According to some re- searchers, functional outcomes of ankle joint arthrodesis are not good [5, 19]. In the study performed by Chahal et al., patients after ankle arthrodesis with internal fix- ation had functional scores below the values of average American population [5]. The same study demonstrated that patients with non-union presented with worse func- tional outcomes [5]. Also in another study, patients with non-union after ankle arthrodesis experienced dysfunc- tion more often than those with normal healing [19 From the literature review and our results it can be con- cluded, that patients after ankle arthrodesis can have worse functional outcomes than the general population. This may be due to the fact that patients after ankle arthrodesis have higher pain sensations and greater dis- ability compared to the general population.
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Treatment of the surgical neck fracture of the humerus with a novel external fixator in the elderly with osteoporosis: biomechanical analysis

Treatment of the surgical neck fracture of the humerus with a novel external fixator in the elderly with osteoporosis: biomechanical analysis

Fixation mechanisms of internal plate are different from those of external fixator. In terms of parallel pin- ning fixation, traditional T parallel pinning has a longer arm than the plate, and its fixation strength is lower than that of plate. In the present study, intersection pinning was applied in the external fixator, with the pins fixed in bone cortex through the humeral shaft and head, which is similar to the intramedullary fixation system. In the resistance to load stress test, the exter- nal fixator showed greater load bearing and more steady values during humerus rotation than control group (P < 0.05). And torsional resistance was signifi- cantly uniform in the fixator group compared with the clover plate group (P < 0.01). Therefore, intersec- tion pinning in the external fixator group is likely to yield more stable fixation. Besides, the external fixator can contribute to promote fracture healing due to re- duced stress shielding effect of the plate [22].
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