The dynamization of external fixation for treatment of open tibia and fibula fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

MA Jihai ¹ , ZHANG Tao ² , HAI Bixia ¹ , CAO Haikun ¹ , YONG Wei ¹ , GE Qihang ¹ , ZHANG Ningning ³ , LIU Zhao ³ ,  WAN Chunyou ²

1. Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, P.R.China;
2. Department of Limb Orthopedics, Tianjin Hospital, Tianjin, 300211, P.R.China;
3. Graduate School, Tianjin Medical University, Tianjin, 300070, P.R.China;

Corresponding author：

WAN Chunyou, Email: wanchunyouxs@163.com

Keywords：

Open tibia and fibula fractures; dynamization; axial mechanical determination; external fixation

DOI：

10.7507/1002-1892.201706015

Video：

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ObjectiveTo evaluate the effects of dynamization of external fixation on open tibia and fibula fracture union.MethodsThe clinical data of 26 cases of open tibia and fibula fractures treated by external fixation were retrospectively analysed. According to different postoperative treatment methods, the patients were divided into elastic dynamic group (group A, n=13) and constant elastic fixation group (group B, n=13). There was no significant difference in gender, age, and fracture type between 2 groups (P>0.05). The removal time of external fixator in group B was evaluated by fracture healing time, X-ray film, and doctor’s experience. In group A, the growth of callus was examined based on X-ray film at 12 weeks after operation; the axial mechanical load ratio was tested, and dynamic loading was carried out when the axial mechanical load ratio was 5%-10%. The using time of external fixator, fracture healing time, and incidence of complications were compared between 2 groups.ResultsAll patients were followed up 4-13 months, with an average of 5.7 months. During the treatment, there was no complication such as loosening or breaking of the external fixator, fracture displacement, or re-fracture in 2 groups. The using time of external fixator in group A was (24.77±1.42) weeks and the fracture healing time was (23.04±1.30) weeks, which were all significantly reduced when compared with those in group B [(34.38±1.71) weeks and (32.46±1.66) weeks] (t=16.10, P=0.00; t=15.58, P=0.00). In group A, there were 2 cases of needle tract infection and 1 case of muscle weakness, the incidence of complication was 23.1%; in group B, there were 3 cases of needle tract infection, 1 case of muscle weakness, and 1 case of delayed union of fracture, the incidence of complication was 38.5%; there was no significant difference in the incidence of complication between 2 groups (P=1.000).ConclusionDynamization of external fixation can promote union of open tibia and fibula fractures with a high security.

Citation： MA Jihai, ZHANG Tao, HAI Bixia, CAO Haikun, YONG Wei, GE Qihang, ZHANG Ningning, LIU Zhao, WAN Chunyou. The dynamization of external fixation for treatment of open tibia and fibula fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(2): 174-177. doi: 10.7507/1002-1892.201706015 Copy

1.	秦泗河, 李刚. Ilizarov 理论与技术的起源、发展与传播史. 中国骨与关节外科, 2010, 3(5): 417-423.
2.	Uzel AP, Lemonne F, Casoli V. Tibial segmental bone defect reconstruction by Ilizarov type bone transport in an induced embrane. Orthop Traumatol Surg Res, 2010, 96(2): 194-198.
3.	卢庆威, 万春友, 张弢, 等. 轴向载荷力学测试在胫腓骨骨折术后外固定器拆除中的临床应用. 中国修复重建外科杂志, 2016, 30(9): 1085-1088.
4.	Frost HM. The biology of fracture healing. An overview for clinicians. Part Ⅱ. Clin Orthop Relat Res, 1989, (248): 294-309.
5.	刘振东, 范清宇. 骨折愈合的基本概念. 中国矫形外科杂志, 1998, 5(5): 459-460.
6.	张弢, 孙振辉, 杜文君, 等. 骨外固定常见并发症的分析与处理. 中华保健医学杂志, 2008, 10(3): 180-182.
7.	郑翔, 章莹, 单永兴, 等. 动力加压钢板固定肱骨中下段螺旋形骨折的有限元分析. 中国矫形外科杂志, 2015, 23(4): 343-348.
8.	葛启航, 万春友, 刘亚北, 等. 胫腓骨开放骨折 Taylor 空间支架外固定术后轴向应力刺激对骨折愈合的影响研究. 中国修复重建外科杂志, 2017, 31(8): 931-935.
9.	Lee JS, Hong JM, Jung JW, et al. 3D printing of composite tissue with complex shape applied to ear regeneration. Biofabrication, 2014, 6(2): 024103.
10.	Lee V, Singh G, Trasatti JP, et al. Design and fabrication of human skin by three-dimensional bioprinting. Tissue Eng Part C Methods, 2014, 20(6): 473-484.
11.	Nishiyama Y, Nakamura M, Henmi C, et al. Development of a three-dimensional bioprinter: construction of cell supporting structures using hydrogel and state-of-the-art inkjet technology. J Biomech Eng, 2009, 131(3): 035001.
12.	喻鑫罡, 张先龙, 曾炳芳. 低频可控性微动影响长骨骨折愈合的实验研究. 中华创伤骨科杂志, 2005, 7(8): 744-748.
13.	徐振东, 刘曦明, 蔡贤华, 等. LCP" 动力化”一折端微动及应力的有限元分析. 中国矫形外科杂志, 2017, 25(8): 747-751.
14.	潘林华, 汪金平, 廖瑛. 交锁髓内钉延迟动力化固定治疗股骨干骨折不愈合.中国修复重建外科杂志, 2014, 28(4): 419-422.
15.	Claes L, Blakytny R, Besse J, et al. Late dynamization by reduced fixation stiffness enhances fracture healing in a rat femoral osteotomy model. J Orthop Trauma, 2011, 25(3): 169.
16.	Mazlina MH, Sarpinah B, Tawie R, et al. Monitoring of bone healing by piezoelectric-EMI method. AIP Publishing LLC, 2016: 521-522.
17.	Aarnes GT, Steen H, Ludvigsen P, et al. In vivo assessment of regenerate axial stiffness in distraction osteogenesis. J Orthop Res, 2005, 23(2): 494-498.
18.	Gelalis ID, Politis AN, Arnaoutoglou CM, et al. Diagnostic and treatment modalities in nonunions of the femoral shaft: a review. Injury, 2012, 43(7): 980-988.

1. 秦泗河, 李刚. Ilizarov 理论与技术的起源、发展与传播史. 中国骨与关节外科, 2010, 3(5): 417-423.
2. Uzel AP, Lemonne F, Casoli V. Tibial segmental bone defect reconstruction by Ilizarov type bone transport in an induced embrane. Orthop Traumatol Surg Res, 2010, 96(2): 194-198.
3. 卢庆威, 万春友, 张弢, 等. 轴向载荷力学测试在胫腓骨骨折术后外固定器拆除中的临床应用. 中国修复重建外科杂志, 2016, 30(9): 1085-1088.
4. Frost HM. The biology of fracture healing. An overview for clinicians. Part Ⅱ. Clin Orthop Relat Res, 1989, (248): 294-309.
5. 刘振东, 范清宇. 骨折愈合的基本概念. 中国矫形外科杂志, 1998, 5(5): 459-460.
6. 张弢, 孙振辉, 杜文君, 等. 骨外固定常见并发症的分析与处理. 中华保健医学杂志, 2008, 10(3): 180-182.
7. 郑翔, 章莹, 单永兴, 等. 动力加压钢板固定肱骨中下段螺旋形骨折的有限元分析. 中国矫形外科杂志, 2015, 23(4): 343-348.
8. 葛启航, 万春友, 刘亚北, 等. 胫腓骨开放骨折 Taylor 空间支架外固定术后轴向应力刺激对骨折愈合的影响研究. 中国修复重建外科杂志, 2017, 31(8): 931-935.
9. Lee JS, Hong JM, Jung JW, et al. 3D printing of composite tissue with complex shape applied to ear regeneration. Biofabrication, 2014, 6(2): 024103.
10. Lee V, Singh G, Trasatti JP, et al. Design and fabrication of human skin by three-dimensional bioprinting. Tissue Eng Part C Methods, 2014, 20(6): 473-484.
11. Nishiyama Y, Nakamura M, Henmi C, et al. Development of a three-dimensional bioprinter: construction of cell supporting structures using hydrogel and state-of-the-art inkjet technology. J Biomech Eng, 2009, 131(3): 035001.
12. 喻鑫罡, 张先龙, 曾炳芳. 低频可控性微动影响长骨骨折愈合的实验研究. 中华创伤骨科杂志, 2005, 7(8): 744-748.
13. 徐振东, 刘曦明, 蔡贤华, 等. LCP" 动力化”一折端微动及应力的有限元分析. 中国矫形外科杂志, 2017, 25(8): 747-751.
14. 潘林华, 汪金平, 廖瑛. 交锁髓内钉延迟动力化固定治疗股骨干骨折不愈合.中国修复重建外科杂志, 2014, 28(4): 419-422.
15. Claes L, Blakytny R, Besse J, et al. Late dynamization by reduced fixation stiffness enhances fracture healing in a rat femoral osteotomy model. J Orthop Trauma, 2011, 25(3): 169.
16. Mazlina MH, Sarpinah B, Tawie R, et al. Monitoring of bone healing by piezoelectric-EMI method. AIP Publishing LLC, 2016: 521-522.
17. Aarnes GT, Steen H, Ludvigsen P, et al. In vivo assessment of regenerate axial stiffness in distraction osteogenesis. J Orthop Res, 2005, 23(2): 494-498.
18. Gelalis ID, Politis AN, Arnaoutoglou CM, et al. Diagnostic and treatment modalities in nonunions of the femoral shaft: a review. Injury, 2012, 43(7): 980-988.

Chinese Journal of Reparative and Reconstructive Surgery

The dynamization of external fixation for treatment of open tibia and fibula fractures

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