Introduction. The purpose of this research is to compare the quality of life in children during gradual deformity correction using external fixators with intramedullary lengthening nails. Materials and Methods. Prospective analysis of children during lower limb lengthening. Group A included children who had
Introduction. A subset of patients in cast awaiting fixation of ankle fractures require conversion to delayed
Introduction. The vast majority of orthopaedic surgeons use C-arm fluoroscopy in the operating theatre when building a circular external fixator. In the absence of previous research in this area, we hypothesised that the surgeon who builds a circular external fixator is exposed to a greater amount of radiation purely as a result of the presence of the metallic fixator in the x-ray beam. The aim of our study therefore was to investigate how the presence of a circular external fixator affects the radiation dose to the surgeon and the surgical assistant. Materials & Methods. A simulated environment was created using a radiolucent operating table, an acrylic lower limb phantom (below knee segment), various configurations of metalic circular
Introduction. Circular external fixators are fundamental to lower limb reconstruction, primarily in situations with a high risk of infection such as open fractures. During the Covid-19 pandemic, use of circular frames in our unit decreased, following departmental approval, due to resource management and in keeping with BOA guidelines as we opted to “consider alternative techniques for patients who require soft tissue reconstruction to avoid multiple operations”. These alternatives included the use of internal fixation (plate osteosynthesis and intramedullary nailing) as a measure to reduce the number of hospital attendances for patients and to conserve resources. This change in practice has continued in part following the pandemic with the increased use of internal fixation in cases previously deemed unsuitable for such techniques. We present our experience of this treatment strategy in the management of complex lower limb injuries, focusing on outcomes and consider the lessons learnt. Materials & Methods. Data of patients with complex lower limb injuries treated before, during and after the pandemic were collected from our in-house trauma database, theatre records and follow up clinics. The rationale for choosing other techniques over a circular frame, the type of alternative technique used, the cost of such alternatives, the need for soft tissue reconstruction, time to recovery, complications and amputation rates were compared among groups. Results. These data suggest comparable outcomes between circular frames and alternative techniques can be achieved. A notable reduction in the number of circular frames applied during the review period was observed. Furthermore, frame fixation was associated with more frequent outpatient review and the associated implications for resource management. Conclusions. Conclusion: The Covid-19 pandemic has posed great challenges to the Trauma and Orthopaedic community, forcing us to be flexible by adopting alternative treatment methods to traditional circular
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 circular fixator group, followed by the monoplanar fixator group and biplanar fixator group at 34%, 31% and 11% respectively. Conclusions. Analysis of the available literature suggests higher union and infection eradication rates with circular frames over the other two fixation methods despite a higher complication rate. There is a paucity in the literature and therefore, no firm conclusions can be drawn. Further research investigating the variations and biomechanical properties between different
A single centre, prospective study of 196 closed tibial diaphyseal fractures treated by monolateral
Purpose of the study:. To determine the outcomes of cases converted from an external fixator to an internal fixation device in the management of limb reconstructions and deformity corrections. Method:. A retrospective review of 18 patients, that underwent a conversion procedure to internal fixation following long term
The purpose of this study was to evaluate and to compare the mechanical stability of
To present the results achieved with the use of
Management of open tibial fractures remains controversial. We hypothesised that unreamed intramedullary nail offers inherent advantages of nail as well as
Introduction. Indications for the use of
Purpose of Study. Bicondylar tibial plateau fractures are serious injuries to a major weight bearing joint. These injuries are often associated with severe soft tissue injuries that complicate the surgical management. This retrospective study evaluates the management of these high-energy injuries with the use of limited open reduction and fine wire circular
Introduction. To report our early experience and suitability over unicortical fixation system to reduce and hold the bone fragments in position during a CHAOS procedure of the femur or tibia during lower limb reconstruction surgery. Materials and Methods. We report a case series of the first consecutive 10 patients (11 bones) for which this CHAOS technique was used between May 2017 and October 2019 by the same surgeon. The novel aspect of the procedure was the use of a unicortical device, Galaxy UNYCO (Orthofix, Verona, Italy), which eliminate the need for any change of fixation during the procedure. It also means the intramedullary canal was left free for the intramedullary nailing. Results. We treated 4 femurs and 7 tibias with this technique without any loss or failure of the construct. We treated uniplanar and multiplanar deformities with the angulations between 8 degrees of valgus to 15 degrees of varus and from 0 to 8 mm translation in the AP view, from 20 degrees procurvatum to 15 degrees recurvatum and 0 to 2 mm translation on the lateral view and from 20 degrees internal rotation to 5 degrees external rotation and 0 to 10 mm translation on axial view. Conclusions. The construct was able to deal with the total tension in the system both in the correction phase and the additional stress applied during insertion of a nail such as reaming and impacting the nail to the canal. The potential advantage also included the possibility of intramedullary nailing without interference with the
Purpose of the study:. Is circular
Purpose. To elucidate whether there is an advantage in
Despite all modern advances the indications and possibilities of treatment in Legg-Calvé-Perthes Disease (LCPD) are still controversial. In the past 15 years we started using arthrodiastasis of the hip creating negative pressure over the avascular femoral head in some selected cases of LCPD in the active phasis of the disease. Now we present our experience with distraction in LCPD using the original Ilizarov circular frame for the hip. From 2015 to 2021, eight patients with LCPD were submoitted to hip distraction; all male ranging from six to 12 years (avg 8.2 years). All patients with bad prognosis, in Catterall Groups III and IV. All patients in the active phasis of the disease. Our follow-up is ranging from two to six years, with an average of 3.4 years.Introduction
Materials and Methods
Introduction:. Distal humerus fractures as well as elbow fracture dislocation are often accompanied by soft tissue damage that warrants early fixation with an external fixator. The distal humerus is a hazardous area for placement of an external fixator due to the close proximity of the radial nerve to the humerus in this area. No known safe zone has been identified on the lateral border of the humerus to avoid radial nerve damage. The aim of this study was to record the incidence of radial nerve damage by placing two 4 mm pins into the humerus and to note the relation of the nerve to the pins. Methods:. Two 4 mm pins used to fix an external fixator were drilled into the lateral border of the humerus at points 100 mm and 70 mm proximal to the lateral epicondyle of both arms of 39 cadavers. The 30 mm interval between the pins is the interval between the pins in a pinblock of a commonly-used external fixator. The arms were dissected by medical students and the incidence of radial nerve damage was recorded. Statistical analysis was done using a Fischer's exact test to identify the incidence of nerve damage relative to pin insertion. The number of damaged nerves was compared to the number of non-damaged nerves. A design based Chi Square test was carried out to test left and right arms. The proportions of interest were estimated along a 95% confidence interval. Results:. The radial nerve was hit (damaged) by 56.4% of the proximal and 20.5% of the distal pins. The radial nerve ran posterior to the proximal pin in 2.57% of arms and 0% to the distal pin. Conclusion:. Although no clear safe zone could be established, pins should be placed closer than 100 mm from the lateral epicondyle and as posterior on the humerus as possible to minimize the risk for radial nerve damage. Keywords: Radial nerve,
Purpose:. This study attempts to establish whether biomechanical manipulation through distraction can result in fracture union. Method:. A retrospective clinical audit of 15 patients with delayed or hypertrophic non-unions treated successfully with closed distraction in circular
Ilizarov fixators are reliant on tensioned fine wires for stability. The tension in the wires is generated using specific tensioning devices. Loss of wire tension over time may lead of loss a stability and complications. A series of in vitro experiments were undertaken to explore wire tensioner accuracy, the impact of fixation bolt torque and initial tension on loss of tension in ilizarov constructs under static and dynamic loads. Medical grade materials were applied to a synthetic bone analogue using surgical instruments in all experiments. Bolt torque was fixed at 6, 10 or 14 Nm using a torque limiting wrench. Wire tension was assessed using a strain measurement bridge. Wires were tensioned to 90, 110 and 130kg as measured by a commercial dynamometric tensioner. Static and dynamic testing was undertaken using an instron testing machine. Cyclical loads from 50–750N were applied for 5000 cycles.Introduction
Materials & Methods
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. 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.Introduction
Materials and Methods