ObjectiveTo explore the mechanical stability of the three-dimensional (3-D) external fixator for osteoporotic fracture so as to provide the biomechanical basis for clinical application. MethodsForty-five fresh frozen adult tibial specimens were selected to rapidly prepare the extracorporal tibia osteoporotic fracture models, and were randomly divided into 3 groups (n=15). Fractures were fixed with 3-D external fixators (3-D external fixators group), intramedullary nails (intramedullary nail group), and plate (plate group) respectively. Five specimens randomly from each group were used to do axial compression test, three-point bending test, and torsion test with microcomputer control electronic universal testing machine, then the mechanical parameters were calculated. ResultsIn the axial compression test, the displacement of 3-D external fixator group and intramedullary nail group were shorter than plate group, showing significant differences (P<0.05); but no significant difference was found between 3-D external fixator group and intramedullary nail group (P>0.05). In the three-point bending test and torsion test, the deflection and the torsional angle of 3-D external fixator group and intramedullary nail group were smaller than plate group, showing significant differences (P<0.05); but no significant difference was found between 3-D external fixator group and intramedullary nail group (P>0.05). ConclusionThe 3-D external fixator can fix fracture three-dimensionally from multiple plane and it can offer strong fixing. It is biomechanically demonstrated to be suitable for osteoporotic fracture.
Objective To investigate the effectiveness of hinged external fixator with mini-plate to treat terrible triad of the elbow. Methods Between August 2008 and June 2011, 11 patients with terrible triad of the elbow were treated with hinged external fixator combined with mini-plate. There were 9 males and 2 females, aged 22-56 years (mean, 34 years). The injuries were caused by falling from height in 8 cases and traffic accident in 3 cases. All patients were closed injury. The time from injury to operation varied from 8 hours to 7 days (mean, 3.7 days). According to Mason classification standard, all radial head fractures were type IV and complicated by posterior dislocation of the elbow; according to Regan-Morrey classification standard, ulna coronary process fractures were type I in 3 cases, type II in 3 cases, and type III in 5 cases. Results All the patients achieved primary healing of incision after operation and no nerve injury occurred. The patients were followed up 12-20 months (mean, 15 months). Two cases had screw channel infection after 12 weeks of operation, and 1 case had mild heterotopic ossification of the elbow after 4 months of operation. X-ray films showed that all fractures healed from 8 to 20 weeks (mean, 16 weeks). No recurrent dislocation or instability of the elbow occurred. At 12 months after operation, the elbow range of motion (ROM) were 120-145° (mean, 135°) in flexion, 0-25° (mean, 10°) in extension, 50-90° (mean, 70°) in pronation, and 50-80° (mean, 60°) in supination. According to Mayo elbow function evaluation standard, the results were excellent in 5 cases, good in 4 cases, and fair in 2 cases, with an excellent and good rate of 81.8%. Conclusion Hinged external fixator with mini-plate can enhance postoperative stability of the elbow. This therapy is beneficial to early functional exercise and obviously decrease the disability rate caused by complex damage on the elbow.
To provide the scientific theoretical basis for cl inical practice by comparing biomechanicalcharacteristics of single compressed plate with intramedullary pin, locking intramedullary nail and simple arm externalfixator with simple internal fixation devices. Methods Eighteen wet humeral bone specimens of adult cadaver were madecompl icated fracture models of humeral shaft and divided into 3 groups according to fixation methods. Fracture was fixed by single compressed plate with intramedullary pin in plate group, by locking intramedullary nail in intramedullary nail group and by external fixator with simple internal fixation devices in external fixator group. The intensity and rigidity of compl icated fracture models of humeral shaft was measured in compress test and torsion test. Results In compress test, the maximum load in plate group (6 162.09 ± 521.06) N and in intramedullary nail group (6 738.32 ± 525.89) N was significantly larger than that in external fixator group (2 753.57 ± 185.59) N (P lt; 0.05); but there was no significant difference between plate group and intramedullary nail group (P gt; 0.05). Under 600 N physiological compress load, the rigidity was (171.69 ± 6.49) N/mm in plate group, (333.04 ± 36.85) N/mm in intramedullary nail group and (132.59 ± 2.93) N/mm in external fixator group; showing no significant difference between plate group and external fixator group (P gt; 0.05), and showing significant difference between intramedullary nail group and plate, external fixator groups (P lt; 0.05). In torsion test, the maximum torque in plate group (38.24 ± 7.08) Nm was significantly larger than those in intramedullary nail group (17.12 ± 5.73) Nm and external fixator group (20.26 ± 6.42) Nm (P lt; 0.05), but there was no significant difference between intramedullary nail group and external fixator group (P gt; 0.05). Under 0.80 Nm physiological torque, the rigidity was (16.36 ± 2.07) Ncm/° in plate group and (18.79 ± 2.62) Ncm/° in external fixator group, which was significantly larger than that in intramedullary nail group (11.45 ± 0.22) Ncm/° (P lt; 0.05); but there was no significant difference between plate group and external fixator group (P gt; 0.05). Conclusion Those fracture models fixed by single compressed plate with intramedullary pin have better compress and torsion intensity, they also have better torsion rigidity but less compress rigidity. Those fracture models fixed by locking intramedullary nail have better compress intensity but less torsion intensity, they also have better compress rigidity but less torsion rigidity. Those fracture models fixed by external fixator with simple internal fixation device have less compress and torsion intensity, they also have less compress rigidity but better torsion rigidity.
A series of 28 cases of fractures of the small tubular bones of the hand, including Bennetts fracture, were treated with the minor unilateral multifunctional external fixator. After manipulation, a hole was drilled on the proximal and distal parts of the fractured bone. Hand in functional position, the external fixator was set in place. Functional exercises were begun after the fixation. The patients were follwed up for two to six months. The average healing time was thirtyfive days. The average healing time for Bennett’s fractures was twentyeight days, and for the fractures of metacarpal bone was forty-two days. There were no deformity and complication of infection following external fixation.The functional recovery of the hands was satisfactory. The fixator had the following advantages: It was simple and had tight fixation; fractures with infection, was still indicated and could be adjusted according to the clinical purpose.
ObjectiveTo analyze the clinical efficacy of Ilizarov bone transport and bone lengthening in the treatment of long bone infection and limb shortening, and fracture nonunion caused by infection. MethodsWe retrospectively analyzed the clinical data of 13 patients with long bone infection, chronic osteomyelitis of the femur and tibia, and infectious bone nonunion, treated with infection focus removal, Ilizarov outer fixation, bone transport and bone lengthening between June 2011 and October 2013. Among the patients, 8 of them had chronic osteomyelitis of the femur and tibia, 4 had infectious bone nonunion, and one had chronic fibula osteomyelitis. ResultsAll the 13 patients had a first-stage healing of the sinus tract and junctions. Among the patients who did the bone transport by themselves after being discharged from hospital, two had nail infections (one was cured after debridement, and the other underwent amputation after re-infection after debridement). One had a re-fracture after the healing of the previous fracture, and was cured by intramedullary nailing. The length of bone transport in these 13 cases ranged from 5 to 13 cm, averaging 7.5 cm. After bone transport, 11 patients had equal length of the lower limbs, and the affected lower limb of the other two patients became shorter than before. No neural function damage occurred in all the patients. ConclusionIlizarov bone transport and lengthening technique is an effective way to treat infections and bone defect of long bone, and it can improve patients' quality of life greatly.
Objective To evaluate the safety of conversion from external fixation to internal fixation for open tibia fractures. Methods Between January 2010 and December 2014, 94 patients (98 limbs) with open tibia fractures were initially treated with external fixators at the first stage, and the clinical data were retrospectively analyzed. In 29 cases (31 limbs), the external fixators were changed to internal fixation for discomfort, pin tract response, Schantz pin loosening, delayed union or non-union after complete wound healing and normal or close to normal levels of erythrocyte sedimentation rate (ESR), C reactive protein (CRP), and the leucocyte count as well as the neutrophil ratio (trial group); in 65 cases (67 limbs), the external fixators were used as the ultimate treatment in the control group. There was no significant difference in gender, age, side of the limbs, interval from injury to the first debridement, initial pathogenic bacteria, the limbs that skin grafting or flap transferring for skin and soft tissue defect between the two groups ( P>0.05). The incidence of Gustilo type III fractures in the control group was significantly higher than that in the trial group (P=0.000). The overall incidence of infection was calculated respectively in the two groups. The incidence of infection according to different fracture types and whether skin grafting or flap transferring was compared between the two groups. The information of the pathogenic bacteria was recorded in the infected patients, and it was compared with the results of the initial culture. The incidence of infection in the patients of the trial group using different internal fixation instruments was recorded. Results The overall incidences of infection for the trial and control groups were 9.7% (3/31) and 9.0% (6/67) respectively, showing no significant difference (χ2=0.013, P=0.909). No infection occurred in Gustilo type I and type II patients. The incidence of infection for Gustilo type IIIA patients in the trial group and the control group were 14.3% (1/7) and 6.3% (2/32) respectively, showing no significant difference (χ2=0.509, P=0.476); the incidence of infection for type IIIB patients in the two groups were 50.0% (2/4) and 14.3% (2/14) respectively, showing no significant difference (χ2=2.168, P=0.141); and the incidence of infection for type IIIC patients in the two groups were 0 and 16.7% (2/12) respectively, showing no significant difference (χ2=0.361, P=0.548). Of all the infected limbs, only 1 limb in the trial group had the same Staphylococcus Aureus as the result of the initial culture. In the patients who underwent skin grafting or flap transferring, the incidence of infection in the trial and control groups were 33.3% (2/6) and 13.3% (2/15) respectively, showing no significant difference (χ2=1.059, P=0.303). After conversion to internal fixation, no infection occurred in the cases that fixed with nails (11 limbs), and infection occurred in 4 of 20 limbs that fixed with plates, with an incidence of infection of 20%. Conclusion Conversion from external fixation to internal fixation for open tibia fractures is safe in most cases. However, for open tibia fractures with extensive and severe soft tissue injury, especially Gustilo type III patients who achieved wound heal after flap transfer or skin grafting, the choice of secondary conversion to internal fixation should carried out cautiously. Careful pre-operative evaluation of soft tissue status, cautious choice of fixation instrument and meticulous intra-operative soft tissue protection are essential for its safety.
Objective To compare the effectiveness of suspension fixation plus hinged external fixator with double plate internal fixation in the treatment of type C humeral intercondylar fractures. Methods Between January 2014 and April 2016, 30 patients with type C (Association for the Study of Internal Fixation, AO/ASIF) humeral intercondylar fractures were treated. Kirschner wire suspension fixation plus hinged external fixator was used in 14 cases (group A), and double plate internal fixation in 16 cases (group B). There was no significant difference in gender, age, injury cause, disease duration, injury side, and type of fracture between 2 groups (P>0.05). Results There was no significant difference in operation time and hospitalization stay between 2 groups (P>0.05). But the intraoperative blood loss in group A was significantly less than that in group B (P<0.05); the visual analogue scale (VAS) score at 1 day and 3 days after operation in group A were significantly less than those in group B (P<0.05). Primary healing of incision was obtained in all patients of 2 groups, and no surgery-related complications occurred. The patients were followed up 6-24 months (mean, 12.3 months) in group A and 6-24 months (mean, 12.8 months) in group B. The self-evaluation satisfaction rate was 85.7% (12/14) in group A and was 81.2% (13/16) in group B at 3 months after operation, showing no significant difference (χ2=0.055, P=0.990). Based on the improved Gassebaum elbow performance score at 6 months after operation, excellent and good rate of the elbow function was 78.6% (excellent in 5 cases, good in 6 cases, fair in 2 cases, and poor in 1 case) in group A and was 81.2% (excellent in 6 cases, good in 7 cases, fair in 2 cases, and poor in 1 case) in group B, showing no significant difference between 2 groups (χ2=0.056, P=0.990). Heterotopic ossification occurred at 3 months after operation in 1 case of each group respectively. The X-ray films showed bony union in all cases; no loosening or breakage of screw was observed. The bone union time showed no significant difference between 2 groups (t=–0.028, P=0.978). The time of internal fixation removal, the intraoperative blood loss, and VAS score at 1 day and 3 days after operation in group A were significant better than those in group B (P<0.05). Conclusion The suspension fixation plus hinged external fixator and double plate internal fixation for the treatment of type C humeral intercondylar fractures have ideal outcome in elbow function. But the suspension fixation plus hinged external fixator is better than double plate internal fixation in intraoperative blood loss, postoperative VAS score, and time of internal fixation removal.
Objective To investigate the surgical characteristics and preliminary effectiveness of Orthofix unilateral external fixator in the treatment of musculoskeletal tumors. Methods Twenty-two patients received Orthofix unilateral external fixator treatment for bone defect after tumor excision or complications after limb salvage surgery between June 2011 and March 2016. There were 11 males and 11 females with a median age of 23.5 years (range, 4-57 years). The bone defect or limb length discrepancy after tumor resection was at proximal femur in 6 cases, distal femur in 8 cases, diaphysis of femur in 3 cases, proximal tibia in 2 cases, and diaphysis of tibia in 3 cases. The external fixation was used for temporary fixation after reconstruction of bone defect in 10 cases [the length of bone defect was 6-19 cm (mean, 12.3 cm); using vascularized fibular graft in 2 cases, allograft bone and free fibular graft in 2 cases, allograft bone and autogenous bone graft in 5 cases, allograft bone reconstruction in 1 case]; bone distraction lengthening for limb length discrepancy in 5 cases [the length of shortening was 6.5-8.5 cm (mean, 7.5 cm)]; temporary fixation after open biopsy in 3 cases; bone transportation over locking plate in 1 case (the length of bone defect was 7.5 cm); fixation for preoperatively pathology fracture in 1 case; and joint distraction for dislocation after tumor ablation in 2 cases. Results All the patients were followed up 12-72 months (mean, 36 months). In 10 patients with bone defect reconstruction, the wearing external fixator time was 3-8 months (mean, 4.8 months); all got bone union with the healing time of 3-16 months (mean, 6.4 months); the Musculoskeletal Tumor Society 93 (MSTS 93) score was 73.3-93.3 (mean, 87.2); and no complication occurred during wearing external fixator. In 5 patients with bone distraction lengthening for limb length discrepancy, the wearing external fixator time was 7-15 months; 2 patients had axial deviation during distraction and2 had greenstick fracture after apparatus removal; pin site infection was observed in 2 cases with grade 1 and 1 case with grade 2 according to Checketts-Otterburn classification system; the MSTS 93 score was 80.0-96.7 (mean, 89.2). The remaining patients had no complications, the knee and ankle joint movement was normal. Conclusion Orthofix unilateral external fixator can be used in fixation for complex bone defect after tumor resection and to correct limb length discrepancy after limb salvage surgery.
Objective To investigate the effectiveness of arthroscopy-assisted combined fixation of Kirschner wire and external fixator for treating extreme distal radial fractures. Methods Between January 2014 and May 2016, 21 patients who suffered from extreme distal radial fractures were treated by arthroscopy-assisted combined fixation of Kirschner wire and external fixator. There were 14 males and 7 females with an age of 32-57 years (mean, 42.3 years). The causes of injury included falling in 13 cases and traffic accident in 8 cases. The fracture type included 8 cases of type 23C1, 9 cases of type 23C2, and 4 cases of type 23C3 according to AO/OTA classification. The time from injury to operation was 3-7 days (mean, 4.4 days). The Mayo score and disability of arm, shoulder, and hand (DASH) score were used to assess the pain and function of the wrist joint. Results There was no needle red swelling, tendon irritation, or orther early complications. All the patients were followed up 10-35 months (mean, 18.3 months). The fracture healing time was 9-13 weeks (mean, 10.6 weeks). At last follow-up, the Mayo score was 87-94 (mean, 90.9); and 17 cases were excellent and 4 were good. The DASH score was 7-13 (mean, 10.6). Conclusion Arthroscopy-assisted combined fixation of Kirschner wire and external fixator for treating extreme distal radial fractures has the advantages of firm fixation, early functional exercise, less postoperative complications, and good functional recovery of wrist joint.
Objective To evaluate the effectiveness of precise orthormorphia of tibial angulation deformity and shortening deformity by using digital technology combined with external fixator. Methods Twenty-six cases of tibial angulation deformity combined with shortening deformity were treated between June 2012 and August 2016, including 12 males and 14 females aged from 1 to 19 years with an average age of 16.5 years. There were 6 cases of congenital patella pseudoarthrosis, 1 case of fibrous dysplasia of femur and tibia, 3 cases of limb shortening deformity caused by infantile paralysis, 16 cases of fracture malunion. Limb shortening was 1.5-9.5 cm (mean, 6.2 cm) before operation. The deformity from three-dimensional perspective was analysed by digital technology, the surgical procedures of lengthening and osteotomy was simulated, the navigation templates were completed with computer aided design (CAD) and three-dimensional printing, and the external fixator was used to assist the lengthening of the tibia. X-ray films were regularly reviewed after operation to observe the new bone remolding, limb lengthening, load bearing line of lower limb, and recurrences of angulation. Results All the patients were followed up 14-48 months (mean, 18.8 months). There was only 1 case of superficial pin site infection which was cured with oral antibiotics and pin site care with mild disinfectants, and no complication such as bone nonunion, equines deformity, or vascular nerve injury occurred. The deformity of tibia and load bearing line of lower limb had been completely recovered according to postoperative X-ray films at 1 week. All the cases achieved perfect limb length as with preoperative design. The bone mineralization time was 12-20 weeks (mean, 11.6 weeks), the external fixator removal time was 18-26 weeks (mean, 14.9 weeks), and the healing index was 21-78 d/cm (mean, 63.4 d/cm). The postoperative flexion range of the injured limb was 15° less than the unaffected extremity in 1 case, and the situation was improved significantly after some physical manipulation and exercise, who completed the limb lengthening and achieved the expected effectiveness finally. Conclusion Precise orthormorphia of tibial deformity by using digital technology, and limb lengthening with the aid of external fixator can achieve good effectiveness with good reliability, invasiveness, and precision.