A Ring Fixator (Taylor Spatial Frame (TSF); Smith &
Nephew, Memphis, TN), was used in the treatment of 5 patients (ages 11 to 16 years) with proximal tibial growth arrest following trauma. The mean corrections were 14.20 (max 280, min 00) in the saggital plane and 140 (max 380, min 20) in the coronal plane. Leg length discrepancy was also corrected (max 1 cm). The average time in frame was 17.8 weeks, with an average correction time of 29.8 days. Knee Society Clinical Rating System (KSCRS) scores post operatively ranged from 95 to 100. All patients returned to full activity, and would accept the same treatment if offered again. The
Introduction. The various problems that are managed with circular external fixation (e.g. deformity, complex fractures) also typically require serial plain x-ray imaging. One of the challenges here is that the relatively radio-opaque components of the
Introduction: Treatment of defected pseudoarthrosis tibia remains controversial due to bone loss with/without infection arises from previous interventions. In the present study we evaluated the results of acute shortening and distraction osteogenesis in the treatment of tibia pseudoarthrosis with bone loss. Material and Methods: Eleven patients were treated with acute shortening and distraction osteogenesis. Mean age and bone loss was 27.5 years (range 10–44) and 8.9 cm (range 3.5–12) respectively. 7 of eleven patients is infected pseudoarthrosis. Enfected patients were type 4A according to Chierny-Mader classification. The 4 of infected patients were treated with two staged procedure. In the first stage antibiotic (teicoplanin) impregnated polymethylmetacrilate beads were placed to the space occurred as a result of excision of sclerotic bone segment and fixation was performed by external fixator or braces. Second stage composed of acute compression (shortening) and distraction osteogenesis. Other 3 infected and noninfected patients were treated with resection, acute shortening and distraction osteogenesis in one stage. In six cases docking site were grafted with autografts. Defects greater than 4 cm were gradually shortened 2mm/day in addition to acute shortening. Limb length inequality was solved with lengthening from proximal tibial corticotomy and achieving union of both sites about the same time. Results: Mean follow up, external fixator time and external fixator index was 48.3 months (21–80), 8.9 months (6–13) and 1,3 month/cm respectively. results were evaluated according to Paley’s bone and functional evaluation scoring. Eleven patient revealed excellent results with regard to bone evaluation and 10 patient revealed excellent and 1 patient revealed good results in terms of functional evaluation. In one patient fracture at the pseudoartrosis site occurred due to new trauma after removal of the fixator which was treated with
Purpose of study. Pin tract infection is a common complication with the use of
We treated 24 patients with high-energy fractures of the tibial plateau by the Ilizarov fixator and transfixion wires. Eleven fractures were open, and 20 patients had complex injuries. Twelve were treated by ligamentotaxis and percutaneous fixation, seven by limited open reduction and five by extensive open reduction. All were followed for at least 24 months. All the fractures united, with an average time to healing of 14.4 weeks. Thirteen patients achieved full extension and 13 more than 110° of flexion. Twenty-two knees were stable. Fifteen patients walked normally and the rest with only a slight limp. All but two knees had an articular step-off of less than 4 mm and all had normal axial alignment except two. There were no cases of postoperative skin infection, osteomyelitis or septic arthritis. Ilizarov circular fixation is an ideal method of treatment for these fractures when extensive dissection and internal fixation are contraindicated due to trauma to the soft tissue, deficiency of bone stock, and bony comminution.
To determine the effectiveness of Ilizarov external fixator in the treatment of complex fractures of the tibial plateau. From July 2006 to April 2009, we treated 10 patients with the Ilizarov fixator. Six men and four women ranging in age from 31 to 70 (mean age 56.3 years) were evaluated. All patients were preoperatively evaluated with Computed Tomography scans for better preoperative planning. Eight cases had fractures type VI according to Schatzker Classification and 2 cases type V. In all patients fixation included pushing olive wires or simple wires and 2 to 4 frames. In 4 patients minimal invasive open reduction was performed with use of bone allograft. In 2 fractures, we combined the treatment with minimal internal fixation There was no major complication trans- or postoperatively. The mean follow-up was 16 months (4–30). The mean hospitalization was 8 days and there were no cases of blood transfusion. Mobilization with no weight-bearing was immediately allowed, with partial weight bearing after 2 months and full weight bearing after 3 months. Three patients had minor pin tract complications. The average duration of external fixation was 120 days. All the fractures united and patients achieved full extension with more than 110 degrees of flexion. Ilizarov circular fixation is an alternative method of treatment for these fractures when internal fixation is contraindicated due to trauma to the soft tissue, deficiency of bone stock, and bony comminution
We would like to present this case series of 10 adolescent patients with displaced, closed diaphyseal tibial fractures managed using the Taylor Spatial Frame. Management options for these injuries include non-operative treatment, antegrade nailing, flexible nailing systems, plating and external circular fixation. External circular fixation allows anatomical reduction avoiding potential complications such as growth arrest associated with antegrade nailing and retained metal work with plating. Flexible nailing system and cast immobilisation are unreliable for precise anatomical reduction. With limited evidence as to the extent of post-traumatic deformity that is acceptable, combined with the limited remodeling potential that this patient group possess, the precision of percutaneous fixation with the Taylor Spatial Frame system has clear advantages. This is a retrospective analysis of 10 adolescent patients with a mean age of 14.5 years (range 13 to 16 years). Data collected includes fracture configuration, deformity both pre and post operatively compared to post frame removal, length of time in frame and complications. The data was gathered using the patient case notes and the Picture Archiving and Communications System. The mean time in frame was 15.5 weeks (range 11 to 22 weeks). One non-union in a cigarette smoker was successfully managed with a second Taylor Spatial Frame episode. Our conclusion was that with careful patient selection the Taylor Spatial Frame allows successful treatment of closed tibial fractures in adolescents, avoiding complications such as growth arrest and post-traumatic deformity as well as avoiding retained metalwork.
The aim of this retrospective study is to compare the different anaesthetic techniques in children undergoing circular frame application for lengthening and deformity correction. Data was collected from 68 cases on severe pain episodes, postoperative duration of analgesia, requirement for top-up analgesia, complications and side-effects and number of osteotomies. The three analgesic methods used were morphine infusion (M), epidural analgesia (E) and continuous peripheral nerve blocks (CPNB). There was a significant difference between the number of episodes of severe pain experienced by the patients receiving a morphine infusion when compared to the epidural and CPNB groups (M vs. E p<0.0001, M vs. CPNB p=0.018). CPNB were associated with the lowest incidence of severe pain episodes and top-up analgesia requirements. The difference in the incidence of nausea and vomiting between the methods was approaching significance (p=0.06). A significant difference was found when comparing epidural and morphine infusions (p=0.05). Epidural analgesia was associated with significantly more nausea and vomiting (p=0.023), and motor blockade (p<0.01) than CPNB. The results show the most effective method of post-operative analgesia for our paediatric patients, in light of pain episodes and associated side-effects, is sciatic nerve catheterisation with continuous infusion.
Purpose: Use of six-axis analysis and computer assisted deformity correction via a
Between 2005 and 2010 ten consecutive children
with high-energy open diaphyseal tibial fractures were treated by early
reduction and application of a programmable
External fixation (EF) devices are commonly used in the management of complex skeletal trauma, as well as in elective limb reconstruction surgery for the management of congenital and acquired pathology. The subsequent removal of an EF is commonly performed under a general anaesthetic in an operating theatre. This practice is resource intensive and limits the amount of operating theatre time available for other surgical cases. We aimed to assess the use of regional anaesthesia as an alternative method of analgesia to facilitate EF removal in an outpatient setting. This prospective case series evaluated the first 20 consecutive cases of EF removal in the outpatient clinic between 10/06/22 to 16/09/22. Regional anaesthesia using ultrasound-guided blockade of peripheral nerves was administered using 1% lidocaine due to its rapid onset and short half-life. Patients were assessed for additional analgesia requirement, asked to evaluate their experience and perceived pain using the Visual Analogue Scale (VAS).Introduction
Materials & Methods
Introduction. Temporary spanning fixation aims to provide bony stability whilst allowing access and resuscitation of traumatised soft-tissues. Conventional monolateral fixators are prone to half-pin morbidity in feet, variation in construct stability and limited weight-bearing potential. This study compares traditional delta-frame fixators to a circular trauma frame; a virtual tibial ring block spanned onto a fine-wire foot ring fixation. Materials and Methods. The two cohorts were compared for demographics and fracture patterns. The quality of initial reduction and the maintenance of reduction until definitive surgery was assessed by two authors and categorised into four domains. Secondary measures included fixator costs, time to definitive surgery and complications. Results. Fifty-six delta-frames and 48
Introduction. The vast majority of orthopaedic surgeons use C-arm fluoroscopy in the operating theatre when building a
Introduction. Knee arthrodesis is a useful limb salvage technique to maintain function in patients with complex and infected total knee arthroplasties (TKA). There are a number of commonly used external fixators, but no consensus on which of these are optimal. The aim of this study was to synthesise the current literature to guide clinical decision making and improve patient outcomes. We systematically review the literature to compare outcomes of external fixators in arthrodesis following infected TKA. Materials & Methods. A systematic review of the literature of primary research articles investigating the use of external fixators for knee arthrodesis after an infected TKA was conducted. Relevant articles were identified with a search strategy on online databases (EMBASE and Medline) and reviewed by two independent reviewers. Clinical outcome measures were independently extracted by two reviewers which included union rate, infection eradication rate, complication rate, time to fusion, and time in frame. Results. Circular frames were more likely to result in union compared to biplanar (OR 1.40 p=0.456) and monoplanar frames (OR 2.28 p=0.018). Infection recurrence was least likely in those treated by circular frames when compared to monoplanar (OR 0.12 p=0.005) and biplanar external fixators (0.41 P=0.331). Complication rates were highest in the
Our previous rat study demonstrated an ex vivo-created “Biomimetic Hematoma” (BH) that mimics the intrinsic structural properties of normal fracture hematoma, consistently and efficiently enhanced the healing of large bone defects at extremely low doses of rhBMP-2 (0.33 μg). The aim of this study was to determine if an extremely low dose of rhBMP-2 delivered within BH can efficiently heal large bone defects in goats. Goat 2.5 cm tibial defects were stabilized with
Introduction. Treatment of non-union in open tibial fractures Gustilo-Anderson(GA)-3A/3B fractures remains a challenging problem. Most of these can be dealt using treatment methods that requires excision of the non-union followed by bone grafting, masquelet technique, or acute shortening.
Survivors of infantile meningococcal septicaemia often develop progressive skeletal deformity as a result of physeal damage at many sites, particularly in the lower limb. Distal tibial physeal arrest typically occurs with sparing of the distal fibular physis leading to a rapidly progressive varus deformity. There have been reports of isolated cases of this deformity, but to our knowledge there have been no papers which specifically describe the development of the deformity and the options for treatment. Surgery to correct this deformity is complex because of the patient’s age, previous scarring and the multiplanar nature of the deformity. The surgical goal is to restore leg-length equality and the mechanical axis at the end of growth. Surgery should be planned and staged throughout growth in order to achieve the best functional results. We report our experience in six patients (seven ankles) with this deformity, who were managed by corrective osteotomy using a programmable
Introduction: Medial laxity is an important problem in knees with mono-compartmental gonarthrosis. Medial laxity can cause the progression of the gonarthrosis if it is left uncorrected. Therefore, managing of medial laxity during high tibial osteotomy is very important. In this study, the effect of openning focal-dome type osteotomy on the medial laxity was investigated. Materials-Methods: Four knees of two cadavers (74-year-old male and 52-year-old female) were used in this study. For the creating pseudo-medial laxity in the knee, while total medial menisectomy was performed in two knees of male cadaver, 5 mm osteochondral resection of both joint surfaces of the medial femoral condyle and medial tibial plateau was performed in two knees of female cadaver. Results: After creation of the pseudo-medial laxity, opening focal-dome type osteotomy extending to proximal to the insertion of superficial medial collateral ligament was applied with
Background: Ilizarov and Taylor Spatial Fixators are commonly used in the management of complex fractures and in the management of fracture non-union at our institute. We aim to review 15 years of circular frame use by a single surgeon to assess the incidence of successful treatment of fractures and fracture non-unions. Methods: We retrospectively reviewed the case notes, theatre lists, and radiology records of all patients who had been treated with a
To investigate the use of the Ilizarov