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Internal fixator vs External fixator in the management of unstable pelvic ring injuries:A prospective comparative cohort study

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World Journal of Orthopedics 2023年第7期14卷 562-571页

作者： Mohamed Abo-Elsoud Mostafa I Awad Mahmoud Abdel Karim Sherif Khaled Mohamed Abdelmoneim Department of Orthopedics and Traumatology Cairo University HospitalsCairo 11562Egypt Department of Trauma and Orthopedics Mataria Teaching HospitalCairo 4540046Egypt

BACKGROUND Reconstruction of the pelvic ring anatomy in unstable anterior pelvic ring injuries is a significant step to reduce the mortality rate associated with these injuries efficiently.There is a debate on using either an anterior subcutaneous pelvis internal fixator(INFIX)or an anterior supra-acetabular External fixator(EXFIX)to manage an unstable anterior pelvic ring fracture.AIM To compare the functional and radiological outcomes and complications of INFIX vs EXFIX in managing unstable pelvic ring injuries.METHODS A prospective cohort study included 54 patients with unstable pelvic ring fractures.The patients were divided into two groups;the INFIX group,in which 30 cases were fixed by INFIX,and the EXFIX group,in which 24 patients were treated by EXFIX.The average age in the EXFIX group was 31.17 years(16-57 years),while in the INFIX group,it was 34.5 years(17-53 years).The study included 20(66.7%)males and 10(33.3%)females in the INFIX group and 10(41.7%)males and 14(58.3%)females in the EXFIX group.The radiological outcomes were evaluated using Matta and Tornetta's score,and the functional outcomes using the Majeed score.RESULTS The results revealed a statistically significant difference between both groups(P=0.013)regarding radiological outcomes,according to Matta and Tornetta's score in favor of the INFIX group.Sitting,standing,and walking abilities were measured at a 3-mo follow-up visit using Majeed score modules.It was significantly better among the INFIX group than the EXFIX group in all three modules.At the final follow-up,both groups had no statistically significant difference according to the Majeed score;92.35 in the INFIX group and 90.99 in the EXFIX group(P=0.513).A lower surgical site infection rate was noticed in the INFIX group(P=0.007).CONCLUSION Anterior subcutaneous pelvis INFIX is associated with better radiological outcomes and a lower infection rate than anterior supra-acetabular EXFIX in managing patients with unstable anterior pelvic ring fractures.

关键词： Internal fixator External fixator Unstable Anterior Pelvic Injuries

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A comparative study of variable angle volar plate and bridging External fixator with K-wire augmentation in comminuted distal radius fractures

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Chinese Journal of Traumatology 2021年第5期24卷 301-305页

作者： Ratish Kumar Mishra Bhagwati Prasad Sharma Amit Kumar Rohit Sherawat Orthopedic Department Sir Gangaram HospitalNew Delhi 11006India Central Institute of Orthopedics Vardhman Mahavir Medical College and Safdarjung HospitalNew Delhi 110029India Orthopedic Department All India Institute of Medical SciencesRae Bareli 229405India Central Institute of Orthopaedics Vardhman Mahavir Medical College and Safdarjung HospitalNew Delhi 110029India

Purpose:Comminuted intraarticular distal radial fractures are difficult to treat conservatively and require operative treatment.This study compared the functional outcomes between variable angle volar plating and External fixator with K-wire augmentation in open reduction and internal fixation.Methods:A total of 62 adult patients with comminuted intraarticular distal radius fracture were randomized into 2 groups:volar plate group and External fixator group.These patients aged between 18 and 60 years had unilateral fractures,and agreed to be included in the study.Patients with a history of fracture,bilateral fracture,associated other injuries,delayed injury for more than 2 weeks,open fracture,pre-existing arthrosis or disability,psychiatric illness and pathological fracture were excluded.Patients were followed up at 6 weeks,3 months,6 months and 1 year.The assessment of pain,functional activity,range of motion and grip strength was done at each stage of follow-up.The pain and functional activities were assessed by patient rated wrist evaluation(PRWE)score and disabilities of the arm,shoulder and hand(DASH)score.Results:Patients in volar plate group had superior PRWE score and DASH score at each stage of followup.At 1 year follow-up,the mean PRWE score were 7.48 for volar plate group and 7.35 for External fixator group;while the mean DASH score was 4.65 for volar plate group and 5.61 for External fixator group.They had better flexion and extension range of movement.They also had better pronation and supination range of motion at initial follow-up,however the difference get attenuated by 1 year.Volar plate group had significantly better grip strength than External fixator group.Complication rates were higher in external fixation group.Conclusion:Fixation with variable angle volar plate results in early wrist mobilization,better range of movement,less pain and disability and early return of function.

关键词： Comminuted Distal radius fracture Intraarticular Volar plate External fixator

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Management of intra-articular fracture of the fingers via mini External fixator combined with limited internal fixation

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Chinese Medical Journal 2009年第21期122卷 2616-2619页

作者： LI Wen-jun TIAN Wen TIAN Guang-lei CHEN Shan-lin ZHANG Chang-qing XUE Yun-hao LI Zhong-zhe ZHU Yin Department of Hand Surgery Beijing Jishuitan Hospital Beijing 100035 China

Background Intra-articular fractures of the fingers are common problems to emergency physicians and hand surgeons Inappropriate management of these injuries may result in chronic pain, stiffness, deformity, or post traumatic arthritis. Ideal treatment necessitates the restoration of a stable and congruent joint that will allow early mobilization. The purpose of this study was to investigate the results of intra-articular fracture of the fingers by mini External fixator combined with limited internal fixation. Methods From May 2005 to May 2007, a total of 26 patients with intra-articular fracture of the fingers were treated by mini External fixator combined with limited internal fixation. Of the 26 cases, 11 involved in metacarpophalangeal joint, and 15 interphalangeal joint in proximal interphalangeal. Kirschner wire, mini wire and absorbable suture were used for limited internal fixation. All patients were followed up and patients were accomplished with total active motion （TAM） of fingers. Results All patients were reviewed by an independent observer. The mean follow up was 13 months （range 9 to 24 months）. Subjective, objective and radiographic results were evaluated. X-ray films revealed fracture union and the average radiographic union time was 7 weeks with a range of 5-12 weeks and the phalange shortening or rotation in 2 cases, joint incongruity （less than 1 mm） and joint space narrowing in 3 cases respectively. Phalangeal shortening or rotation was observed in 2 cases and joint incongruity or joint space narrowing was observed in 3 cases. An artificial implant was performed on one case for traumatic arthritis 1.5 years after surgery. Based on TAM the overall good-excellent rate of joint motion function was 80.8%. Conclusion Mini External fixator combined with limited internal fixation is a reliable and effective method for treatment of intra-articular fracture of the fingers.

关键词： External fixator intra-articular fracture internal fixation finger

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Treatment of type C3 distal radius fracture resulted from high-energy injuries by volar plate in combination with External fixator

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Chinese Medical Journal 2009年第13期122卷 1517-1520页

作者： ZHANG Qiu-lin ZHU Xiao-dong LI Guo-dong TANG Hao LI Ming WU Da-jiang Department of Orthopedics Changhal Hospital Second Military Medical University Shanghai 200433 China

Background With a type C3 distal radius fracture it is extremely difficult to maintain the reduction and to restore congruity of the articular surface because the support for the volar and dorsal bone cortex has been lost. An External fixator crossing wrist in combination with Kirschner wire （K-wire） fixation was popularly used by most studies in recent years. But loss of reduction often occurred especially in the volar sides. Methods A total of 30 cases of type C3 distal radius fracture were treated by a volar buttress plate combined with a transarticular External fixator and other techniques such as K-wire fixation and bone grafting if necessary. The postoperative volar tilt angles, ulnar inclinations, radial heights, range of motion, grip strength and complications were recorded to assess the therapeutic effects. Results Of the 30 patients, 27 patients were followed up for 12-29 （mean 18） months and all fractures healed in 8-13 weeks after surgery （mean 10 weeks）. The wrist function was excellent in 8 cases, good in 16 cases and fair in 3 cases according to the Sarmiento scoring system （modified by Stewart）. Conclusions For type C3 comminuted fracture with severe volar and dorsal instability, fixation by volar buttress plate combined with transarticular External fixator should be adopted. Dorsal instability could be further stabilized by other techniques such as Kirschner wire fixation, and bone grafting.

关键词： distal radius fracture internal fixation External fixator

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Dynamic condylar screw or hip joint （spanning） External fixator for treatment of pathological fractures of femoral neck and trochanter secondary to benign lesions

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Chinese Medical Journal 2008年第2期121卷 178-180页

作者： ZHANG Chun-lin ZENG Bing-fang DONG Yang Daria brooks Terrell Martin M. Malawer Department of Orthopaedics The Sixth People's Hospital Affiliated to Shanghai Jiao Tong University Shanghai 200233 China Department of Orthopaedic Oncology Washington Cancer Institute Washington Hospital Center DC 20010 USA

The treatment of pathological fractures of the femoral neck and trochanteric region secondary to benignlesions can be a challenge for orthopaedic surgeons because of the size and nature of the lesions, the resulting bony defect, the risk of recurrence, the possible associated deformities, and the risk of osteonecrosis. Numerous treatment modalities have been reported for the management of pathological fractures of the proximal femur secondary to benign lesions. An unsatisfactory outcome in 25% of patients and a complication rate of 45% have been observed.

关键词： pathological fractures benign lesions dynamic condylar screw External fixator

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Proximal tibial osteotomy for genu varum:Radiological evaluation of deformity correction with a plate vs External fixator

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World Journal of Orthopedics 2021年第3期12卷 140-151页

作者： S Ali Ghasemi David T Zhang Austin Fragomen S Robert Rozbruch Department of Orthopedic Surgery Hospital for Special SurgeryWeill Medical College of Cornell UniversityNew YorkNY 10021United States

BACKGROUND High tibial osteotomy(HTO)is a well-known procedure for the correction of knee varus.The purpose of this study was to compare the radiological results and accuracy of deformity correction performed using two different techniques:acute opening wedge correction using a plate and gradual correction with a monolateral External fixator.AIM To compare of the radiological results of two different techniques:acute opening wedge correction(a plate and screw)and gradual correction(External fixator).METHODS A total of 43 patients with plates and 36 patients with External fixators were included.All patients had moderate uniplanar varus deformities.We measured radiographic parameters,including the mechanical axis deviation(MAD),medial proximal tibial angle(MPTA),Caton-Deschamps Index(CDI),posterior proximal tibial angle,and joint line obliquity angle(JLOA).The accuracy of MAD correction was calculated based on a correction goal of neutral or overcorrection for medial compartment arthritis.RESULTS Demographics including age,body mass index,sex,and preoperative deformities were similar between the groups.The MAD significantly improved from 23.6 mm medial to the midline(SD=8.2 mm)to 6.9 mm lateral to the midline(SD=5.4 mm)(PExternal fixator group(P=0.18).The MPTA significantly improved from 83.9°(SD=2.9°)to 90.9°(SD=3.3°)(PExternal fixator groups,respectively(PExternal fixator groups,respectively(P=0.04).CONCLUSION Reliable correction of moderate varus alignment was achieved with both the acute opening wedge technique with a plate and the gradual monolateral External fixator technique.The patellar height decreased

关键词： High tibial osteotomy External fixator Gradual correction Plate and screw Genu varum Radiological

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HYBRID External fixator FOR THE TREATMENT OF UNICAMERAL BONE CYSTS WITH PATHOLOGICAL FRACTURE IN THE PROXIMAL HUMERUS

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Chinese Journal of Cancer Research 2004年第1期16卷 62-66页

作者：郭征王臻赵黎 Department of Orthopaedic Surgery Xijing Hospital Fourth Military Medical University

Objective: Unicameral bone cyst is a nonneoplasticbone lesion characterized by its tenacity and risk ofrecurrence. Pathological fracture is common and is often the presenting symptom. The objective of the present study was to evaluate the results of hybrid External fixator for thetreatment of a unicameral bone cyst with a pathologicalfracture. Methods: Hybrid External fixator for thetreatment of a unicameral bone cyst was performed intwelve patients. These patients presented with a pathological fracture and were managed immediately with hybridExternal fixator, of whom four had been managedconservatively at other clinics before they were referred toour department. The cyst was located in the proximalhumerus in all patients. The mean age of the patients at the time of surgery was 8.7 years, and the mean duration offollow-up was 32.6 months. Radiographic evaluation wasperformed according to the criteria of Capanna et al., andthe cyst was classified as completely healed, healed withresidual radiolucency (osteolysis), recurred, or having noresponse. Results: The healing period ranged from three to eight months. Eight cysts healed completely, and threehealed with residual radiolucent areas visible onradiographs. There was recurrence of one cyst that hadhealed with residual radiolucency. All of the cysts in thepresent study responded to treatment. A modulation ofhybrid External fixator was necessary in three patients, asthe bars had become too short after bone growth or the pins had been loose. No major complications were observed.Conclusion: Hybrid External fixator provides earlystability, which allows early mobilization and thus obviates the need for a plaster cast. This method of treatment alsoallows for an early return to normal activity.

关键词： Unicameral bone cyst External fixator Pathological fracture Bone graft

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Dynamic External fixator Combined with Volar Locking Plate Fixation for the Treatment of AO Type C3 Distal Radius Fractures

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Open Journal of Orthopedics 2022年第4期12卷 131-141页

作者： Kinya Nishida Yong Ho Che Hideto Irifune Kazuhiro Uesugi Akane Maeda Koji Miyata Department of Orthopaedic Surgery Teine Keijinkai Hospital Sapporo Japan

Background: AO type C3 distal radius fracture (DRF) is the most difficult-to-treat fracture type because of a tendency to shorten and collapse. The purpose of this study is to investigate the clinical and radiographic outcomes of comminuted intra-articular DRFs treated with a dynamic External fixator combined with a volar locking plate (VLP). Methods: Eleven patients (mean age, 61 years) with comminuted intra-articular DRFs were treated with a dynamic type of External fixator combined with a VLP. Following reduction and fixation with a VLP, the dynamic External fixator was applied and the distal ball joint of the fixator was aligned with the lunate-capitate line. The ball joint was unlocked approximately 2 weeks after surgery to allow wrist mobilization. The fixator was removed 3 - 6 weeks (mean, 5 weeks) after surgery. Consequently, clinical and radiographic assessments were carried out at the final follow-up. Results: At the final follow-up, the mean range values of wrist extension and flexion were 76°and 64°, respectively. Compared with the contralateral side, the mean grip strength was 84%. The mean Modified Mayo Wrist Score and the Disabilities of the Arm, Shoulder and Hand score were 88 and 9, respectively. No significant differences in the radiographic parameters exist between after surgery and final follow-up. Conclusions: This study indicated that the dynamic wrist fixator combined with a VLP is effective for the treatment of AO type C3 DRFs.

关键词： Distal Radius Fracture Intra-Articular Fracture External fixator Dynamic External fixator Volar Locking Plate

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Biomechanical　Study　on　Osteotomized　Tibias　Fixed　with　Unilateral　Adjustable　external　fixator

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Journal of Huazhong University of Science and Technology(Medical Sciences) 1995年第4期15卷 242-245,248页

作者：刘国平杜靖远王洪陈汝轻徐兆雄 Orthopaedic Department Xiehe Hospital Tongji Medical University Wuhan

Five fresh tibias removed from 30-40 years old dead males were osteotomized at one-third supra-medium segment and then fixed by an unilateral adjustable External fixator (UAEF) to be used as a model of external fixation of tibial fracture. For each loading test under different configurations of UAEF, the ratio of the force-displacement was used to determine its stiffness value. The weakest mode of the UAEF device is in AP bending. Under each mode of compression,distraction , anteroposterial and lateral bending and torsion loading , increasing the pin number or pin diameter or pin separation, and/or reduction of pin group separation can significantly increase the stiffness values of UAEF (Pexternal fixation of tibial fracture.

关键词： tibia External fixator biomechanics

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Role of coatings and materials of external fixation pins on the rates of pin tract infection:A systematic review and meta-analysis

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World Journal of Orthopedics 2021年第11期12卷 920-930页

作者： Cristhopher Stoffel Bruno Eltz Mauro Jose Salles Department of Orthopedic Surgery Instituto de Ortopedia e Traumatologia do Rio Grande do SulPasso Fundo 99010110Rio Grande do SulBrazil Department of Orthopedic Surgery Hospital São FranciscoConcordia 89700-000Santa CatarinaBrazil Musculoskeletal Infection Group Internal Medicine DepartmentSanta Casa de Sao Paulo School of Medical SciencesSao Paulo 01221-020Brazil Musculoskeletal Infection Group Division of Infectious DiseasesEscola Paulista de MedicinaUniversidade Federal de Sao PauloSao Paulo 01221-020Brazil

BACKGROUND Infection at the pin tract is a frequent and feared complication of External fixators(EF).The type of pin material and coatings have been regarded as possibly influencing infection rates.Over the last 20 years,few prospective clinical studies and systematic reviews addressed the role of coated pins on the rate of pin site infection in human clinical studies.AIM To assess the EF literature over the past 20 years on the clinical benefits of pins manufactured from varied materials and coating systems and their possible role in pin tract infection rates.METHODS We performed a systematic review according to the PRISMA and PICOS guidelines using four scientific platforms:PubMed,LiLacs,SciELO,and Cochrane.We searched the literature for related publications over the past 20 years.RESULTS A literature search yielded 29 articles,among which seven met the inclusion criteria.These studies compared stainless-steel pins and pins coated with hydroxyapatite(HA),titanium and silver.The pin tract infection definitions were arbitrary and not standardized among studies.Most studies included a low number of patients in the analysis and used a short follow-up time.Three metaanalyses were carried out,comparing stainless steel vs silver pins,stainless steel vs HA-coated pins,and titanium vs HA-coated pins.None of this analysis resulted in statistically significant differences in pin tract infection rates.CONCLUSION Currently,no clinical evidence supports the advantage of EF pins manufactured with materials other than stainless steel or coated over uncoated pins in reducing the rates of pin tract infections.A standardized definition of pin tract infection in external fixation is still lacking.

关键词： External fixator Pin tract infection Stainless steel pin Coated pin Coating systems Pin site infection

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