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Embracing fixator for treating periprosthetic femoral fractures

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Chinese Medical Journal 2001年第12期114卷 97-98页

作者：张先龙章玮眭述平将垚曾炳芳 Shanghai Sixth Peoples Hosp Dept Orthopaed Surg Shanghai 200233 Peoples R China

Femoral fractures in the presence of other intramedullary implants are uncommon. These fractures are difficult to manage and the presence of other intramedullary implants creates a complex problem. The rate of these fractures has increased due to an increase in the number of patients having total hip arthroplasty (THA) and the use of various new techniques for femoral fractures.1-5 Literature on the treatment of femoral fractures with other intramedullary implants is rare.2,3 From 1995 to 1998, we reduced these fractures openly and fixed them with a shape memory alloy sawtooth-arm embracing fixator (EF), and the outcomes were satisfactory.

关键词： femoral fracture · intramedullary implant · embracing fixator

Treatment of Resistant Clubfoot with Soft Tissue Release and Alkhooly External fixator

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Open Journal of Orthopedics 2013年第7期3卷 314-320页

作者： Ali Zein A. A. Al-Khooly Mohamed Ali Ahmed Mohamed Ebrahim El-Hawary Ali Department of Orthopedic and Trauma El-Minia University Hospital El-Minia Egypt.

After the first research with this technique done by the first author, ten operations on the foot and ankle were performed on five patients (two boys and three girls) suffering from severe club foot deformity all with bilateral foot affection. Their ages ranged from five to fourteen years. All of them were treated by soft tissue release, skin flap (rotational flap), supplemented with Alkhooly external fixator. The follow up period ranged from two to seven years. The results according to Mittal (1987) [1] were excellent in eight feet (80%) and good in two feet (20%).

关键词： Clubfoot-External fixator Soft Tissue Release

Cartilage Repair by Joint Distraction and Motion Using an External fixator for Massive Cartilage Defect

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Open Journal of Orthopedics 2013年第1期3卷 35-40页

作者： Tomofumi Nishino Tomoo Ishii Takaji Yanai Fei Chang Naoyuki Ochiai Department of Orthopaedic Surgery China-Japan Union Hospital of Jilin University Jilin China. Department of Orthopaedic Surgery Endowed De- partment of Human Resources Development for Community Medicine Tokyo Medical University Ibaraki Medical Center Inashiki Japan Department of Orthopaedic Surgery University of Tsukuba Tsukuba Japan

The objective of the present study was to investigate our novel methods for the repair of massive cartilage defects by joint distraction and motion using an external fixator. In this study, we used a rabbit model of massive articular cartilage defect in order to evaluate the effectiveness of using joint distraction and motion with a ring-type external fixator. This external fixator has a hinged joint with a center of rotation along the femoral transepicondylar axis, which allows the knee joint to freely flex and extend. Mesenchymal cells from bone marrow, induced by spongialization, were differentiated into mature chondrocytes and formed hyaline-like cartilage as a result of joint distraction and movement. The transplantation of autologous cells expanded from bone-marrow-derived mesenchymal cells, concentrated autologous bone marrow aspirate, and concentrated autologous peripheral blood cells were all effective in promoting cartilage repair. The quality of the cartilage after long-term joint distraction for 6 months was inferior to that after 12 weeks. In general, weight bearing on the regenerated cartilage promoted cartilage repair, although this effect differed based on when gradual weight bearing was begun. Specifically, gradual weight bearing beginning at 9 weeks produced superior results to that beginning at 6 weeks. Our methods provide an optimal environment for cartilage regeneration.

关键词： Cartilage Repair Joint Distraction Joint Motion Spongialization External fixator

Management of Tibial Metaphyseal Fractures by Hybrid External fixator

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Open Journal of Orthopedics 2014年第3期4卷 84-89页

作者： S. K. Venkatesh Gupta Gottipati Sunil Department of Orthopaedics Mamata General Hospital Khammam India

Introduction: The Hybrid External fixator combines the advantages of the monolateral pin fixators and the circular Ilizarov wire fixators. Principle of early motion has been touted as the functional savior of major intra articular injuries in application of hybrid external fixation. Materials & Methodology: 48 patients were considered for the study with tibial fractures admitted in Mamata General Hospital from May 2011 to May 2013. Results: The union and functional outcome of hybrid external fixator in simple and complex proximal and distal metaphyseal fractures of tibia in adults was evaluated at our centre. The fractures of the proximal tibia united with an average of 13.3 weeks (12 - 16 weeks). The fractures of the distal tibia united with an average of 14.42 weeks (13 - 22 weeks) with minimal complications. Conclusion: Our study shows high satisfaction rate after fixation, provides adequate stability and allows early motion of the joint. It is also effective in extra articular fractures occurring within 5 cm of the joint as the IM nails often do not provide enough stability and plating requires extensive soft tissue dissection.

关键词： Hybrid External fixator Tibial Metapyseal Fractures

Advanced concepts in knee arthrodesis

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World Journal of Orthopedics 2015年第2期6卷 202-210页

作者： Jennifer H Wood Janet D Conway Department of Orthopaedics University of Maryland School of Medicine University of Maryland Medical System International Center for Limb Lengthening Rubin Institute for Advanced OrthopedicsSinai Hospital of Baltimore

The aim is to describe advanced strategies that can beused to diagnose and treat complications after knee arthrodesis and to describe temporary knee arthrodesis to treat infected knee arthroplasty. Potential difficult complications include nonunited knee arthrodesis, limb length discrepancy after knee arthrodesis, and united but infected knee arthrodesis. If a nonunited knee arthrodesis shows evidence of implant loosening or failure, then bone grafting the nonunion site as well as exchange intramedullary nailing and/or supplemental plate fixation are recommended. If symptomatic limb length discrepancy cannot be satisfactorily treated with a shoe lift, then the patient should undergo tibial lengthening over nail with a monolateral fixator or exchange nailing with a femoral internal lengthening device. If a united knee arthrodesis is infected, the nail must be removed. Then the surgeon has the option of replacing it with a long, antibiotic cement-coated nail. The authors also describe temporary knee arthrodesis for infected knee arthroplasty in patients who have the potential to undergo insertion of a new implant. The procedure has two goals: eradication of infection and stabilization of the knee. A temporary knee fusion can be accomplished by inserting both an antibiotic cement-coated knee fusion nail and a static antibiotic cement-coated spacer. These advanced techniques can be helpful when treating difficult complications after knee arthrodesis and treating cases of infected knee arthroplasty.

关键词： Arthroplasty Knee Arthrodesis Nonunion Limb salvage Limb length inequality Infection Osteomyelitis Bone lengthening External fixator

Cost of external fixation vs external fixation then nailing in bone infection

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World Journal of Orthopedics 2015年第1期6卷 145-149页

作者： Khaled Mohamed Emara Ramy Ahmed Diab Khaled Abd EL Ghafar Orthopaedic Surgery Ain Shams University

AIM: To study the cost benefit of external fixation vs external fixation then nailing in treatment of bone infection by segment ***: Out of 71 patients with infected nonunion tibia treated between 2003 and 2006, 50 patients fitted the inclusion criteria(26 patients were treated by external fixation only, and 24 patients were treated by external fixation early removal after segment transfer and replacement by internal fixation). Cost of inpatient treatment, total cost of inpatient and outpatient treatment till full healing, and the weeks of absence fromschool or work were calculated and compared between both ***: The cost of hospital stay and surgery in the group of external fixation only was 22.6 ± 3.3 while the cost of hospital stay and surgery in the group of early external fixation removal and replacement by intramedullary nail was 26.0 ± 3.2. The difference was statistically significant regarding the cost of hospital stay and surgery in favor of the group of external fixation only. The total cost of medical care(surgery, hospital stay, treatment outside the hospital including medications, dressing, physical therapy, outpatient laboratory work, etc.) in group of external fixation only was 63.3 ± 15.1, and total absence from work was 38.6 ± 6.6 wk. While the group of early removal of external fixation and replacement by IM nail, total cost of medical care was 38.3 ± 6.4 and total absence from work or school was 22.7 ± 4.1. The difference was statistically significant regarding the total cost and absence from work in favor of the group of early removal and replacement by IM ***: Early removal of external fixation and replacement by intramedullary nail in treatment of infected nonunion showed more cost effectiveness. Orthopaedic society needs to show the cost effectiveness of different procedures to the community, insurance, and health authorities.

关键词： Cost fixator Nailing Infection

Outcome of complex tibial plateau fractures with Ilizarov external fixation with or without minimal internal fixation

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Chinese Journal of Traumatology 2019年第3期22卷 166-171页

作者： Koushik Narayan Subramanyam Madhusudhan Tammanaiah Abhishek Vasant Mundargi Ritesh Nilakanthrao Bhoskar Patllola Siddharth Reddy Department of Orthopaedics Sri Sathya Sai Institute of Higher Medical SciencesPrashanthigramPuttaparthiAndhra Pradesh 515134India

Purpose: To evaluate the clinico-radiological outcome of complex tibial plateau fractures treated with Ilizarov external fixation with or without minimal internal fixation. Methods: This retrospective review was conducted on all the cases of Schatzker types V and VI tibial plateau fractures treated by Ilizarov external fixation between July 2006 and December 2015 with the minimum follow-up duration of one year. There were 30 patients: 24 males and 6 females, mean age 43.33 years, and mean follow-up 3.6 years. Three of them were open fractures;15 cases were Schatzkertype V fractures and the other 15 type VI. According to AO/OTA classification, there were 11 type C1, 12 C2 and 7 type C3 fractures. Outcome assessment was made with American Knee Society Score (AKSS) and Rasmussen's Radiological Score (RRS) at final follow-up. Results: Out of the 30 cases, mini-open reduction was performed in 7, bone graft in 4, minimal internal fixation in 10 and knee temporary immobilisation in 11 patients. Mean duration of external fixation was 11.8 weeks. All fractures united. Pin tract infections in 7 and common peroneal neuropathy in 2 patients were self-limiting. Two patients had axial misalignment of less than 10°. At final follow-up, the mean knee range of motion was 114.7, mean AKSS 81.5 and mean RRS 16.7. On statistical analysis, Schatzker type of fractures, use of minimal internal fixation and knee-spanning did not influence the final outcome. Conclusion: Ilizarov external fixator with or without minimal internal fixation provides acceptable outcome for complex tibial plateau fractures. Care must be taken to look for minor loss of alignment, especially in Type VI Schatzker fractures after removal of the fixator. However small sample size precludes firm conclusions.

关键词： Tibial plateau fractures Schatzker's classification Ilizarov techniques Ring fixator

Ligamentotaxis versus Open Reduction and Internal Fixation for Distal Radius Intra-Articular Fractures

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Open Journal of Orthopedics 2017年第1期7卷 21-31页

作者： Mahmoud Abdel-Ghany Tohamy Goudah Tohamy Wael M. Shaaban Abdel-Hamied A. Atallah Tharwat M. Abdel-Rahman Orthopedic and Trauma Surgery Al-Azhar University Cairo Egypt

Objectives: This study compared the clinical and radiological outcomes of two different methods for the treatment of distal radial intra-articular fractures. Patients and Methods: Forty-six patients with distal radius intra-arti-cular fractures were divided into two groups. Group I included 24 patients with type C fracture treated by external fixator augmented by percutaneous K-wires. Group II included 22 patients with type C fracture treated by volar locked distal radial plate augmented by K-wires. Two patients had complex injuries necessitating double plating (sandwich). All patients were evaluated clinically by Mayo Wrist Score and radiologically by Sarmiento’s radiological score. Results: Both groups reported good personal satisfaction according to Mayo Wrist Score, and the results were not statistically different between the two groups. In Group I, 19 patients (79.2%) had excellent radiological outcome and five patients (20.9%) had good radiological outcome according to Sarmiento’s radiological score. In Group II, 20 patients (90.9%) had excellent outcome, and two (9.1%) had good radiological outcome;there was no or insignificant deformity. Conclusions: Complex distal radial fractures can be treated either by external fixation (ligamentotaxis) or by locked pre-contoured plating. The clinical outcome of plating and external fixator in our study did not show any statistically significant difference. The radiological outcome had no correlation with the clinical outcome.

关键词： Distal Radial Fracture Complex Fracture of Distal Radius External fixator Locked Volar Plate

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

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Surgical Science 2013年第2期4卷 176-183页

作者： Ebrahim Ghayem Hassankhani Ali Birjandinejad Farzad Omidi Kashani Golnaz Ghayem Hassankhani Department of Orthopedics and Spine Surgery Orthopedic Research Center Imam Reza Hospital Mashhad University of Medical Sciences Mashhad Iran Department of Orthopedics Surgery Imam Reza Hospital Mashhad University of Medical Sciences Mashhad Iran Department of Orthopedics Surgery Shahid Kamiab Hospital Mashhad University of Medical Sciences Mashhad Iran Mashhad University of Medical Sciences Mashhad Iran

Background: The treatment of distal femoral open comminuted fractures is a major problem for orthopedic surgeon. The basic and important aim in treatment of these fractures is to assemble the condylar fragments and then fix the condyles to the femoral shaft by minimum handling of the bone and soft tissues. Objectives: To evaluate the treatment of distal femoral open comminuted fractures (type C2 and C3) with hybrid external fixator. Methods: Thirty-four patients with distal femur open comminuted fracture (type C2 and C3) were treated by hybrid external fixator between January 2005 and December 2008. All of the fractures were opened with extension to joint surface. 30 patients were male and 4 were female. Their average age was 30.5 years (17 to 72 years). Average follow up period was 36 months. 12 patients had isolated fracture and 22 patients had multiple fractures. The bony and functional results were evaluated by the association for the study and application of the method of Ilizarov (ASAMI) protocol and knee society score. Results: 29 out of 34 fractures (85%) had union without bone grafts. Average time of union was 6.1 months (4 - 19 ms). The average knee range of motion was 87.5 degrees (30 - 115 degrees). The bony results were excellent in 24 patients (70.5%), good in 6 (17.7%), fair in 2 (5.9%), and poor in 2 (5.9%), and the functional results were excellent in 10 (29.4%) patients, good in 14 (41.2%), fair in 6 (17.6%), and poor in 4 (11.8%), and the functional results were excellent in 10 (29.4%) patients, good in 14 (41.2%), fair in 6 (17.6%), and poor in 4 (11.8%) according to ASAMI protocol. According to the knee society score the functional results were excellent in 9 (26.44%) patients, good in 13 (38.26%), fair in 7 (20.6%), and poor in 5 (14.7%). Conclusion: Hybrid external fixator is an effective method for treatment of distal femoral open comminuted fractures (type C2 and C3) and may be considered as an alternative surgical methods in the management

关键词： Hybrid External fixator Open Fractures Distal Femoral Fracture Type C2 and C3