Top PDF Hybrid External Fixation for Open Severe Comminuted Fractures of the Distal Femur

Hybrid External Fixation for Open Severe Comminuted Fractures of the Distal Femur

Hybrid External Fixation for Open Severe Comminuted Fractures of the Distal Femur

The limitation of knee motion was the most disabling complication in our study, as also reported in other stud- ies [9,11,27,28]. There are several factors that cause limitation of knee motion including: type of the fracture (type C3 of OTA classification), severity of the associ- ated soft-tissue injury (type IIIB and type IIIC of Gustilo classification) and incorrect application of external fixa- tor (the knee in extension). We carried out the applica- tion of distal wires in a position of moderate knee flexion, in accordance with Ilizarov’s original technique, thus stretching the extensor mechanism of the knee [16].
Show more

8 Read more

Loss of correction in unstable comminuted distal radius fractures with external fixation and bone grafting -a long term followup study

Loss of correction in unstable comminuted distal radius fractures with external fixation and bone grafting -a long term followup study

Restriction of movements at the wrist has been attrib- uted to the extended period of application of external fixation and improper physiotherapy and also due to associated injuries in the ipsilateral limb which inter- fered with the physiotherapy. Use of open pin insertion technique with a predrilled system has reduced the injury to both tendon and nerves. Radial sensor nerve is generally not at risk when pins are placed 10 cm proxi- mal to the radial styloid process by this technique. Open pin placement and pin insertion with sharp drill bits and improved fixation with better thread design and inser- tion of pins at an angle of 60 degrees to each other increased the purchase of pins in the bone and decreased complications like pin bending, loosening and breakage. Papadonikolakis et. al in their study concluded that more than 5 mm of wrist istraction increases the load required for the flexor digitorum superficialis to generate MCP joint flexion for the middle, ring, and small fingers. For the index finger, however, as much as 2 mm of wrist distraction significantly increases the load required for flexion at the MCP joint[15].
Show more

10 Read more

Stiffness of the locking compression plate as an external fixator for treating distal tibial fractures: a biomechanics study

Stiffness of the locking compression plate as an external fixator for treating distal tibial fractures: a biomechanics study

kind of treatments often companies with tibial shorten- ing and angular malunion [1]. IM is associated with a high rate of union and a reduction of disturbance to the soft-tissue envelope as well as blood supplies at the frac- ture site; nevertheless, good reduction is very difficult to be acquired and maintained with IM strategy [2]. EF is a preferred strategy in the first stage treatment of the two- stage protocol for severe high-energy tibial fractures, but is usually with complications like ankle stiffness, pin site infection, and pin loosening [3]. Particularly, the rates of infection are kept relatively high in the open reduction and internal fixation [4]. MIPPO was developed to re- duce irritation and damage to soft tissue, and was re- ported to do well in alignment, union, as well as holding low infection rates in some basic and clinical studies [5]; however, sample sizes in these studies were quite small,
Show more

6 Read more

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

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

Treatment of intra-articular fractures of the distal tibia is challenging due to the difficulties they present in achiev- ing anatomical reduction of the articular surface of the ankle joint and the instability that may occur due to liga- mentous and soft tissue injury. Numerous methods of treatment for these fractures have been reported, includ- ing conservative treatment with cast, open reduction and internal fixation and the combination of different types of external fixators with or without internal fixation [1]. Intra-articular fractures of the distal tibia are divided into two major groups. Those being caused by axial compres- sion and those being as a result of torsional forces [2]. (Figure 1) The first group includes Pilon fractures, which are high energy fractures and are often complicated with severe soft tissue damage and postoperative articular sur- face defects due to the difficulties in anatomical restora- tion. The second group includes maleollar fractures, which are usually low energy fractures, are accompanied by smaller soft tissue injury and have as a major compli- cation ankle instability due to ligament's tears.
Show more

7 Read more

Analysis of functional outcome of Muller's Type A and C fractures distal femur using locking compression condylar plate: A Prospective study

Analysis of functional outcome of Muller's Type A and C fractures distal femur using locking compression condylar plate: A Prospective study

Fractures of the distal femur are complex injuries. They can produce significant long term disability. They account for 7% of all femoral fractures. If hip Fractures are excluded, 31% of femoral fractures involve distal portion. Although open reduction and internal fixation with plate and screws has Become a standard method of treatment for many types of fractures, the Management of comminuted, intra articular distal femoral fractures still remains Complex and challenging to the orthopaedic surgeon. Many of these fractures are the result of high energy trauma which generates severe soft tissue damage and articular and metaphyseal communition.
Show more

106 Read more

Functional analysis of Distal tibial fractures treated by Hybrid external fixator

Functional analysis of Distal tibial fractures treated by Hybrid external fixator

Of the 84 fractures, 60 were secondary to low energy skiing injuries. 90% of the patients returned to their pre-injury occupations.17 A series of 26 patients were divided into 2 groups based on fracture pattern. Type A fractures with twisting injuries with little comminution, whereas Type B fractures were more severe injuries, with a crush component. On treatment with open reduction and internal fixation, 65% cases had good to excellent results. Better results were obtained in Type A fractures (84%) than B (53%). Crucial factors besides fracture type were the length of immobilization and quality of reduction. Prolonged immobilization resulted in poor outcome, showing the need for stable fixation to permit early mobilisation 1 .
Show more

156 Read more

Open reduction and internal fixation with bone grafts for comminuted mason type II radial head fractures

Open reduction and internal fixation with bone grafts for comminuted mason type II radial head fractures

in the literature [7, 29–31]. Ring et al. [7] applied ORIF with an autogenous bone graft to 1 of 30 patients with Mason type II fractures. Oztürk et al. [29] reported that 15 patients with radial head fractures underwent ORIF, and bone grafts from the distal part of the radius were used in 5 patients. Patel et al. [30] treated a severe comminuted fracture of the radial neck by ORIF with a tricortical iliac crest bone graft. Luenam et al. [30] reported that union was achieved in 9 of 10 patients who underwent an operation using an iliac crest bone graft for partial radial head reconstruction in the treat- ment of complex dislocation of the elbow. We prefer autografting from the lateral epicondyle of the humerus. The reasons for this choice are as follows: (1) taking bone chips from the same incision is convenient and induces less iatrogenic damage; (2) preparation of another sterile
Show more

7 Read more

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

Several investigators have returned to the principles of Scheck, who advocated reconstruction of the joint surface with limited open reduction and emphasized that little soft-tissue stripping is needed for this technique. In two reports by Bone et al.( 38 ), the result was good or excellent for eleven of sixteen patients who had been managed with external fixation combined with limited internal fixation; there were no infections or clinically important complications related to the wound. Recently, Bonar and Marsh (39) reported on twenty-one patients in whom a severe fracture of the tibial plafond had been treated with unilateral external fixation. There were no soft-tissue complications and osteomyelitis did not develop in any patient. The early functional results were promising. Those authors also demonstrated good functional results with few complications after use of an articulated fixator (40) .
Show more

62 Read more

Hybrid external fixation for neglected fractures of the distal radius: results after one year

Hybrid external fixation for neglected fractures of the distal radius: results after one year

The goal and methods of the study were approved by the ethical board of Poznan University of Medical Sciences in Poland and are in accordance with the Declaration of Hel- sinki. We report on the late outcomes of 14 cases of DRF treated with HEF. All sustained comminuted extrarticular fractures with significant displacement of the distal frag- ment, and gave informed consent to be enrolled to the current study. There were nine females aged 34–70 and five males aged 39–56 (Table 1). The use of HEF was always a sec- ondary choice, after failed attempts at conservative treatment. Fractures were classified according to the AO classification system [34]. All were considered unstable because of marked dorsal or volar comminution, angular deformity exceeding 20°, osteoporosis or redisplacement after previous satisfactory reduction. The operation was performed under general anesthesia or brachial plexus block (optional upon patient–anesthesiologist agreement) after 2– 5 weeks from injury (mean: 3).
Show more

6 Read more

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

Patients were placed in a supine position under general anesthesia or a brachial plexus block. After the entire arm was disinfected and covered with a surgical drape, closed reduction of the fracture was firstly performed[1, 2]. If this procedure failed, a lateral approach was used. Briefly, a 2- 4cm incision was created lateral to the distal humerous, and the tissues between the biceps and triceps were incised and separated until the fractured ends of the bone were exposed. After limited peeling of the periosteum and removal of the soft tissues and blood clots at the ends of the fracture, the bones were realigned and fixed by inserting two 1.5mm- or 2.0mm-diameter Kirschner needles (K-needles) through the lateral and medial epicondyles until 2.0mm of the needle has pierced through the cortical bone of the proximal humerous. The patient’s elbow was moved to confirm joint movement, and if satisfactory, the distal ends of the K-needles were bent, cut then embedded subcutaneously [3-5]. After the surgical site had been rinsed with hydrogen peroxide and normal saline, a silica gel drainage strip was inserted and the tissues closed layer by layer. The surgery was completed by wrapping the elbow with sterile gauze.
Show more

6 Read more

A Case Control study to Compare Distal Femur Tunnel Widening between Suspensory Fixation and Suspensory Fixation Augmented with Bioabsorbable Screw for Anterior Cruciate Ligament Reconstruction with Hamstring Graft

A Case Control study to Compare Distal Femur Tunnel Widening between Suspensory Fixation and Suspensory Fixation Augmented with Bioabsorbable Screw for Anterior Cruciate Ligament Reconstruction with Hamstring Graft

The patients who undergo ACL fixation with endobutton develop widening of the femoral and tibial tunnel. The widening is more in the femoral tunnel(72%- twice as that of the tibial side) than the tibial tunnel(38%)(2). The widening in the tunnel was found to be due to movement of the graft inside the tunnel, as the tunnel is slightly larger than the graft, a phenomenon called windshield wiper effect(2,3). The tunnel widening happens more when the fixation points are far apart than when the fixation points are close to each other, because when the fixation points are far it causes more mobility of the intervening graft(4). The tunnel widening happens maximum within 6weeks(3)of the surgery and is almost complete by 3 months(5)and remains the same till 12 months after the surgery, hence a 6 month to 2 year follow up was taken.
Show more

101 Read more

Functional Outcome of Locking Compression Plating for Closed Schatzker Type V and Type VI Tibial Plateau Fractures: A Prospective study

Functional Outcome of Locking Compression Plating for Closed Schatzker Type V and Type VI Tibial Plateau Fractures: A Prospective study

Locking screws were applied to the tibial condyles, a maximum of 2 to 3 screws were applied, in the lateral view the presence of posteromedial fragmention of the medial tibial condyle was looked for, if present the fragments were held using the screws from the lateral locking plate. In two of our cases it was still found displaced, hence a separate medial plate was used through a separate incision at posteromedial aspect of the knee joint 40 . Distally locking screws or cortical screws were used based on the fracture pattern and the need for any compression or not. The distal screws were applied only after ensuring perfect anatomical reduction as the locking compression plate does not provide dynamic compression. Principles of bridge plating were used and the fracture fragments were not disturbed during any stage of the surgery. In cases which had the fracture fragments displaced in an antero posterior manner a lag screw in the antero posterior direction was used to hold the fragments. Wounds were closed by mattress skin sutures. Sterile dressings applied.
Show more

108 Read more

Comparative analysis of functional outcome of distal femur fractures treated with Locking Compression Plate fixation and Dynamic Condylar Screw fixation

Comparative analysis of functional outcome of distal femur fractures treated with Locking Compression Plate fixation and Dynamic Condylar Screw fixation

Fractures affecting the distal femur are very complex injuries that pose a challenge to every orthopaedic surgeon. It involves about 7% of all femur fractures. It commonly occurs during high velocity trauma in younger group of patients and frequently are associated with other skeletal injuries and concomitant other system injuries. In contrast to this, elderly patients with severe osteopenia might sustain isolated distal femur fractures from trivial trauma such as a simple slip and fall. Treating the elderly individuals with relatively weak bone quality is night mare to surgeons. Though well advanced Technologies and modern diagnostic imaging modalities versatile implants available in market, makes this fractures more amenable to treat satisfactorily. Despite all these modalities ,treatment of distal femur fractures are not
Show more

132 Read more

Short Term Functional Outcome Analysis of Internal Fixation of Distal Ulna Fractures with Concomitant Distal Radius Fractures

Short Term Functional Outcome Analysis of Internal Fixation of Distal Ulna Fractures with Concomitant Distal Radius Fractures

Fixation of the ulnar column was stressed for better function of the wrist and to avoid late distal radio ulnar instability 31,32 . Many studies revealed negative outcomes of distal radius fixation with untreated distal ulna fractures. Hence the classification of the distal ulna fractures came to vogue. Even separate classification for ulnar styloid fractures were proposed by Fernandez et al. The level of fracture has implications for management. The ulnar styloid fracture at the tip can be treated conservatively as only few ulnotriquetralfibres would be disrupted. The base of the styloid fractures with greater displacement along the line of the distal radius are to primarily fixed to achieve osteosynthesis to prevent later complications.
Show more

96 Read more

High energy tibial plateau fractures treated with hybrid external fixation

High energy tibial plateau fractures treated with hybrid external fixation

After receiving approval from our Institutional Review Board, we retrospectively examined a consecutive series of 33 patients (33 bicondylar tibial plateau fractures (Schatzker type V, VI) admitted at our level I trauma centre between 2002 and 2006. Fractures were identified through our trauma database and were cross-matched with operating room records. Median ISS was 14.3, ran- ging from 9 to 33. Inclusion criteria were the presence of a bicondylar tibial plateau fracture Schatzker type V- VI, patients’ age over 18 years and the ability to walk without assistance before injury. Polytrauma patients with tibial plateau fractures requiring prolonged ICU care (AIS>3 for head and chest) and patients with bilat- eral plateau fractures, were excluded from the study. All patients were followed according to a protocol. All frac- tures were treated with either closed reduction and hybrid external fixation (14 fxs/36.6%) or with minimal open reduction and a hybrid system (19 fxs/63.4%). The study group was consisted of 20 males (60.6%) and 13 females (39.4%) with an average age for males of 40.3 years (range 30 - 62 years) and for females 49 years (range 17 - 86 years). In 27 patients (81.8%) the mechanism of injury was high energy trauma (motor vehicle accident or fall from height greater than 3 m). All patients had anteroposterior and lateral radiographs as well as a CT-scan for proper preoperative evaluation of their fracture.
Show more

7 Read more

Comparison of outcomes and analysis of risk factors for non-union in locked plating of closed periprosthetic and non-periprosthetic distal femoral fractures in a retrospective cohort study

Comparison of outcomes and analysis of risk factors for non-union in locked plating of closed periprosthetic and non-periprosthetic distal femoral fractures in a retrospective cohort study

A positive trend toward union was observed in associ- ation with use of longer plates. This trend was not ob- served in conjunction with longer plate working lengths, where union rates are predicted to be improved as a re- sult of reduced fixation rigidity, allowing for fracture site micromotion [28]. It is generally recommended that three to four holes should be left empty at the site of the fracture [29]. Although the average plate working length in both groups in this study was 4.4 holes, a positive re- lationship with union from this was not found. This is in keeping with a number of studies showing no or min- imal correlation between longer working length and union [25, 30, 31]. Some studies have shown better heal- ing with titanium versus stainless plates, proposed to be associated with reduced material stiffness [32, 33]. This relationship was not examined in this study as stainless steel plates were exclusively used.
Show more

10 Read more

Volar locking plate versus external fixation with optional additional K-wire for treatment of AO type C2/C3 fractures: a retrospective comparative study

Volar locking plate versus external fixation with optional additional K-wire for treatment of AO type C2/C3 fractures: a retrospective comparative study

Under local or general anesthesia and control of tourni- quet in supine position, modified Henry approach was used to make a 10–12-cm longitudinal incision along the course of the flexor carpi radialis (FCR). FCR tendon, the flexor pollicis longus tendon, and radial nerve were retracted ulnarly, and brachioradialis and radial blood vessels were retracted radially. Then, pronator quadratus muscle was elevated from its radial origin and retracted ulnarly to expose the fracture fragments. Every fragment was reduced and re-confirmed under the fluoroscopic guidance. As for impacted fragments into the articular surface or metaphysis, periosteum elevator is introduced to elevate the fragments. Autogenous bone graft or allograft was applied to fill the bone detect, if necessary. Temporary fixation with K-wires was used to stabilize the reduced fragments. 2.4 mm or 3.5 mm T-shape
Show more

8 Read more

Open reduction and internal fixation versus casting for highly comminuted and intra articular fractures of the distal radius (ORCHID): protocol for a randomized clinical multi center trial

Open reduction and internal fixation versus casting for highly comminuted and intra articular fractures of the distal radius (ORCHID): protocol for a randomized clinical multi center trial

The ORCHID (Open Reduction and internal fixation versus Cast immobilization for Highly comminuted, Intra-articular fractures of the Distal radius) trial is a pragmatic, multi-center RCT that aims at evaluating dif- ferences in patient-centered outcomes between two major options (i.e., volar locked plating versus closed reduction and cast stabilization) for treating wrist frac- tures in an elderly population. 600 patients will be recruited at 15 hospitals of various levels of care and associated private practices throughout Germany. It is expected that 150 patients are recruited during the first year after the initiation of all centers, followed by recruitment of 300 and 150 patients in the subsequent years.
Show more

12 Read more

What happens to the elbow joint after fractured radial head excision? Clinical and radiographic study at a mean 15-yearfollow-up

What happens to the elbow joint after fractured radial head excision? Clinical and radiographic study at a mean 15-yearfollow-up

Resection of the radial head has been considered by many authors as the treatment of choice for Mason type III fractures, because of their complexity [22–26]. Resection of the radial head is a simple technique, avoids revision sur- gery, and prevents pain at the elbow joint. Proximal migra- tion of the radius represents the most significant complica- tion of this technique and the main reason for which many surgeons do not practice it. However, there is complete lack of correlation between the quality of the functional result and the extent of migration of the radius [26, 27].

5 Read more

Functional Outcome of the Distal Femur Locking Compression Plates in the Treatment of Fractures of Distal Femur

Functional Outcome of the Distal Femur Locking Compression Plates in the Treatment of Fractures of Distal Femur

Limb length discrepancy in the form of shortening less than 2.5 cm was seen in two patients . In this study by the analysis of the results using the Neer’s rating criteria taking into account pain, knee range of motion, angulation and functional ability, there were two cases with excellent results, 7 cases with good results and one cases with failure results. Failure case which we had associated open fracture both bone leg and may that may be result of failure result as the patient had post op infection and was not allowed to weight bear.
Show more

147 Read more

Show all 10000 documents...

Related subjects