ISSN:0885-9698    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

SummaryThe general principles of external fixation of the tibia from the viewpoint of its role in private practice are discussed. The volume and pattern of injuries, as well as the patient mix, changes from the trauma center setting to private practice and the role of external fixation changes as well. Key indications for external fixation in this setting include temporary and definitive stabilization of periarticular fractures with soft-tissue compromise and severe open shaft fractures of the tibia. The emphasis, in these complex cases, is on temporary external fixation for initial soft-tissue management with staged early conversion to internal fixation. Technique and patient management principles, complications, and their prevention are discussed.

ISSN:0885-9698    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

SummaryTibia pilon fractures, fracture-dislocation of the tibiotalar joint, or severely unstable ankle fractures can be readily reduced and stabilized with the urgent application of a simple unilateral external fixator with a two medial bar frame and a foot connection. This frame design can be maintained as a temporary, first stage procedure, a sort of portable form of calcaneal traction in the management of challenging injuries such as pilon fractures. It can also be converted to a full circular frame, implementing thin wires and the half-pins already installed; or it can remain as a “neutralizing implant” in cases of delayed open reduction and internal fixation (ORIF). In other situations, it can act as a temporary method and portable form of calcaneal traction, until the soft tissue injuries have improved.

ISSN:0885-9698    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

SummaryHigh-energy periarticular fractures of the tibia can be limb threatening and functionally compromising injuries. Significant osseous injury can result with concomitant severe soft tissue injury. External fixation can play a pivotal role in staged treatment of these injuries. We present several techniques of distractive, joint spanning, limb realigning external fixation for periarticular fractures of the proximal and distal tibia.

ISSN:0885-9698    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

SummaryTreatment of complex fractures of the distal tibia has improved dramatically over the past 10 to 12 years.4–7,9,10Better understanding of the soft tissue injury, indirect reduction methods, low profile, and custom implants have increased the surgeon’s ability to achieve better results.5,7,9,10To accomplish this goal, the surgeon must strive for anatomic reconstruction and stable fixation without compromising the soft tissue envelope. This allows for early rehabilitation during the healing process. The use of external fixation has become an essential component of treatment of these injuries.4,5,7,9The external fixator can be part of staged treatment, an intraoperative reduction tool, or adjuvant to definitive fixation. The “hybrid” type of external fixator described uses wires in the talus and calcaneus combined with half pins in the tibia. Ideally, external fixation allows for improved indirect reduction capabilities and excellent stability with a low risk of pin infection and loosening. This configuration gives the surgeon an increased ability to achieve stable, anatomic reduction of these difficult injuries.

ISSN:0885-9698    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

SummaryModern advances in plastic surgery have significantly improved the outcome of severe open tibial fractures. An improved understanding of cutaneous blood supply combined with advances in microsurgical techniques has led to reliable coverage of large soft tissue defects by either local or free tissue transfer, and a significant reduction in the incidence of deep infection. The method of skeletal stabilization of open tibial fractures remains controversial. Although intramedullary nailing (IMN) is increasingly used for the stabilization of both closed and open tibial diaphyseal fractures, we advise caution in the use of IMN in severe open fractures because of the high risk of deep sepsis. We believe that external fixation continues to have a key role in the stabilization of the more severe open tibial fractures, particularly heavily contaminated injuries, fractures associated with significant bone loss, and cases associated with a high risk of infection. However, the use of external fixation in open fractures demands a close cooperation between orthopaedic and plastic surgeons to maximize wound access without compromising skeletal stability. We advocate unilateral external fixation with individual pin clamps and multiple longitudinal bars for stable open fractures with minimal bone loss. Improved materials, modern surgical techniques, and close postfixation monitoring of fracture healing have reduced the incidence of problems such as pin-site infection and loosening, delayed union, and malunion. The advent of the Ilizarov method and small wire circular external fixation has rationalized the management of the open tibial fracture associated with significant bone loss and reduced the need for autogenous bone grafting. We prefer local or free tissue transfer by plastic surgeons rather than the transport of poor quality soft-tissues that accompanies the Ilizarov method. The ability to reliably reconstruct large soft-tissue and bone defects allows an aggressive debridement, similar to a radical tumor resection, which is essential to prevent deep infection.

ISSN:0885-9698    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

SummaryThe Taylor Spatial Frame is a modern multiplanar external fixator that combines ease of application plus computer accuracy in the reduction of acute long-bone fractures. Indirect reduction of fractures is achieved by realigning one fracture end to the other through a spatial point of rotation. One to six axes of deformity between bone ends can be corrected sequentially or simultaneously by adjusting six connecting struts between two circular rings that are fixed externally to the bone fragments. The spatial frame is applied easily during the acute fracture period. The accuracy of fracture reduction is dependent on analyzing anteroposterior and lateral radiographs of the fracture afterward. Inputting 13 parameters into a computer software program provides the proper adjustments needed to reduce the fracture. Adjustments during the postoperative period are possible without modifying the fixator because the fracture site can be manipulated by changing the strut length. Fifty-four acute fractures have been treated with the Taylor Spatial Frame. A 93% union rate with only 1 refracture (2%) and 2 nonunions (4%) occurred; 1 patient died. The three failures were treated successfully with a second procedure. Anatomic alignment was achieved in 96% of patients. The Taylor Spatial Frame is a valuable tool in the arsenal of a fracture surgeon. It is an effective definitive method of fracture care using external fixation.

ISSN:0885-9698    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0885-9698    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

SummaryTreatment of complex tibia fractures with associated longitudinal bone loss remains a difficult treatment challenge. Treatment modalities that are used to assist limb salvage efforts include external fixation, internal fixation, limb lengthening, bone transport, and a variety of techniques to help remedy the soft tissue deficits. External fixation has the advantage of easy technical application, but is poorly tolerated over time, and conversion to internal fixation is often advantageous to the patient. In this article, we present several difficult cases in which these combined procedures were successfully performed.

ISSN:0885-9698    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

SummaryFracture healing by external callus formation or by modeling and remodeling is dependent on the rigidity of fracture fixation and is influenced by the application of mechanical loads through the fractured limb. A unilateral external fixator, used to provide micromotion by known displacements at a fracture site, must have a sliding mechanism capable of withstanding lateral bending moments under offset loading conditions when a patient is walking. The Rigidyne fixator (Corin, Cirencester, UK) was originally designed for research purposes as an instrument that could provide axial reciprocal micromotion (dynamization) reliably, in a controlled manner, to promote fracture healing. The fixator body was later modified to provide specific military requirements for rigid fixation of long bone and pelvic fractures. Additional features allow hybrid external fixation, combined ipsilateral limb fracture fixation, compression arthrodesis, leg lengthening, bone transport and dynamization, as well as rigid fixation of fractures. The recent addition of an upper limb fixator completed the inventory of a comprehensive external fixation system. The Rigidyne external fixator is suitable for clinical use and provides the means for further investigation of the modification of fracture healing by applying known displacements and loads to a healing fracture.

ISSN:0885-9698    

出版商:OVID    

年代:2002

数据来源: OVID