External fixation combined with limited internal fixation in the treatment of pilon tibia fractures

Background/Aim. Intraarticular fractures of the tibial plafond (pilon fractures) belong to the group of most severe fractures. They are usually caused by high-energy trauma and frequently associated with a marked soft-tissue damage. Surgical treatment has replaced the traditional nonoperative treatment. The aim of this study was to present the results of the treatment of distal tibial intraarticular fracture by the use of internal fixation, as well as the combination of minimal internal fixation and external fixation. Methods. The study included 47 patients with pilon tibia fractures who went through at the Clinic for Orthopedics and Traumatology, School of Medicine, Niš (1995-2004). Within the analyzed group there were 33 (70.2%) males and 14 (29.8%) females. The patients mean age was 45.8 years. In the first group, which consisted of 22 patients, open reduction and internal fixation of both the tibia and the fibula was performed in the two separate incisions. The second group consisted of 25 patients managed with external fixation by external fixator "Mitković" with limited internal fixation. Besides external fixation, a minimal internal fixation was performed by the use of Kirschner wires and screws. The patients were followed-up inside a 24-months-period. Results. The obtained was a substantially high number of complications after open reduction and internal fixation in the group of patients. There was no difference in a long-term clinical outcome. Postoperative osteitis, as the most severe complication in the management of closed pilon tibia fractures, was not registered in the second group. Conclusion. Considering the results obtained in this study, it can be concluded that external fixation by the "Mitković" external fixator with the minimal internal fixation is a satisfactory method for the treatment of fractures of the tibial plafond causing less complications than internal fixation.

Mechanical testing of a device for subcutaneous internal anterior pelvic ring fixation versus external pelvic ring fixation

BACKGROUND: Although useful in the emergency treatment of pelvic ring injuries, external fixation is associated with pin tract infections, the patient’s limited mobility and a restricted surgical accessibility to the lower abdomen. In this study, the mechanical stability of a subcutaneous internal anterior fixation (SIAF) system is investigated. METHODS: A standard external fixation and a SIAF system were tested on pairs of Polyoxymethylene testing cylinders using a universal testing machine. Each specimen was subjected to a total of 2000 consecutive cyclic loadings at 1 Hz with sinusoidal lateral compression/distraction (+/−50 N) and torque (+/− 0.5 Nm) loading alternating every 200 cycles. Translational and rotational stiffness were determined at 100, 300, 500, 700 and 900 cycles. RESULTS: There was no significant difference in translational stiffness between the SIAF and the standard external fixation when compared at 500 (p = .089), 700 (p = .081), and 900 (p = .266) cycles. Rotational stiffness observed for the SIAF was about 50 percent higher than the standard external fixation at 300 (p = .005), 500 (p = .020), and 900 (p = .005) cycles. No loosening or failure of the rod-pin/rod-screw interfaces was seen. CONCLUSIONS: In comparison with the standard external fixation system, the tested device for subcutaneous internal anterior fixation (SIAF) in vitro has similar translational and superior rotational stiffness

External fixation in tumour pathology

An appraisal of the clinical records of patients with malignant bone tumours enabled us to identify 61 whom we have treated by external fixation. There were 38 males and 23 females with ages ranging from 4 to 58 years, the mean being 14 years. The average period of follow-up was 6 years (1-12 years). For the purpose of our analysis the patients were divided into three groups according to whether the fixator was fitted before, during or after tumour resection

Biomechanical stability of a supra-acetabular pedicle screw Internal Fixation device (INFIX) vs External Fixation and plates for vertically unstable pelvic fractures

Abstract Background We have recently developed a subcutaneous anterior pelvic fixation technique (INFIX). This internal fixator permits patients to sit, roll over in bed and lie on their sides without the cumbersome external appliances or their complications. The purpose of this study was to evaluate the biomechanical stability of this novel supraacetabular pedicle screw internal fixation construct (INFIX) and compare it to standard internal fixation and external fixation techniques in a single stance pelvic fracture model. Methods Nine synthetic pelves with a simulated anterior posterior compression type III injury were placed into three groups (External Fixator, INFIX and Internal Fixation). Displacement, total axial stiffness, and the stiffness at the pubic symphysis and SI joint were calculated. Displacement and stiffness were compared by ANOVA with a Bonferroni adjustment for multiple comparisons Results The mean displacement at the pubic symphysis was 20, 9 and 0.8 mm for external fixation, INFIX and internal fixation, respectively. Plate fixation was significantly stiffer than the INFIX and external Fixator (P = 0.01) at the symphysis pubis. The INFIX device was significantly stiffer than external fixation (P = 0.017) at the symphysis pubis. There was no significant difference in SI joint displacement between any of the groups. Conclusions Anterior plate fixation is stiffer than both the INFIX and external fixation in single stance pelvic fracture model. The INFIX was stiffer than external fixation for both overall axial stiffness, and stiffness at the pubic symphysis. Combined with the presumed benefit of minimizing the complications associated with external fixation, the INFIX may be a more preferable option for temporary anterior pelvic fixation in situations where external fixation may have otherwise been used

Distal tibial pilon fractures (AO/OTA type B, and C) treated with the external skeletal and minimal internal fixation method

Background/Aim. Distal tibial pilon fractures include extra-articular fractures of the tibial metaphysis and the more severe intra-articular tibial pilon fractures. There is no universal method for treating distal tibial pilon fractures. These fractures are treated by means of open reduction, internal fixation (ORIF) and external skeletal fixation. The high rate of soft-tissue complications associated with primary ORIF of pilon fractures led to the use of external skeletal fixation, with limited internal fixation as an alternative technique for definitive management. The aim of this study was to estimate efficacy of distal tibial pilon fratures treatment using the external skeletal and minimal internal fixation method. Methods. We presented a series of 31 operated patients with tibial pilon fractures. The patients were operated on using the method of external skeletal fixation with a minimal internal fixation. According to the AO/OTA classification, 17 patients had type B fracture and 14 patients type C fractures. The rigid external skeletal fixation was transformed into a dynamic external skeletal fixation 6 weeks post-surgery. Results. This retrospective study involved 31 patients with tibial pilon fractures, average age 41.81 (from 21 to 60) years. The average follow-up was 21.86 (from 12 to 48) months. The percentage of union was 90.32%, nonunion 3.22% and malunion 6.45%. The mean to fracture union was 14 (range 12-20) weeks. There were 4 (12.19%) infections around the pins of the external skeletal fixator and one (3.22%) deep infections. The ankle joint arthrosis as a late complication appeared in 4 (12.90%) patients. All arthroses appeared in patients who had type C fractures. The final functional results based on the AOFAS score were excellent in 51.61%, good in 32.25%, average in 12.90% and bad in 3.22% of the patients. Conclusion. External skeletal fixation and minimal internal fixation of distal tibial pilon fractures is a good method for treating all types of inta-articular pilon fractures. In fractures types B and C dynamic external skeletal fixation allows early mobility in the ankle joint. [Projekat Ministarstva nauke Republike Srbije, br. III41017

Costs and Complications of Single Stage Fixation Versus Two-Stage Treatment of Select Bicondylar Tibial Plateau Fractures

Objectives: To determine the differences in costs and complications in patients with bicondylar tibial plateau (BTP) fractures treated with one stage definitive fixation compared to two stage fixation following initial spanning external fixation. Design: Retrospective cohort study Setting: Level one trauma center Patients/Participants: Patients with OTA 41-C (Schatzker 6) treated with open reduction internal fixation (ORIF). Intervention: Definitive treatment with ORIF either acutely (one stage) or delayed following initial spanning external fixation (two stage). Main Outcome Measures: Wound healing complications, implant costs, hospital charges, PROMIS outcome measures. Results: 105 patients were identified over a three-year period, of which 52 met inclusion criteria. There were 28 patients in the One-Stage group and 24 patients in the Two-Stage group. Mean follow-up was 21.8 months, and 87% of patients had at least 12 months follow-up. The mean number of days to definitive fixation was 1.2 in the One-Stage group and 7.8 in the Two-Stage group. There were no differences between groups with respect to wound healing or any other surgery-related complications. Functional outcomes (PROMIS) were similar between groups. Mean implant cost in the Two-Stage group was $10,821 greater than the One-Stage group, mostly due to the costs of external fixation. Median hospital inpatient charges in the Two-Stage group exceeded the One-Stage group by over$68,000 for all BTP fractures and by $61,000 for isolated BTP fractures. Conclusions: Early single stage treatment of BTP fractures is cost effective, and is not associated with a higher complication rate than two stage treatment in appropriately selected patients. Level of Evidence: Level III- Retrospective cohort stud

Visuo-tactile links in covert exogenous spatial attention remap across changes in unseen hand posture

We investigated the effect of unseen hand posture on cross-modal, visuo-tactile links in covert spatial attention. In Experiment 1, a spatially nonpredictive visual cue was presented to the left or right hemifleld shortly before a tactile target on either hand. To examine the spatial coordinates of any cross-modal cuing, the unseen hands were either uncrossed or crossed so that the left hand lay to the right and vice versa. Tactile up/down (i.e., index finger/thumb) judgments were better on the same side of external space as the visual cue, for both crossed and uncrossed postures. Thus, which hand was advantaged by a visual cue in a particular hemifield reversed across the different unseen postures. In Experiment 2, nonpredictive tactile cues now preceded visual targets. Up/down judgments for the latter were better on the same. side of external space as the tactile cue, again for both postures. These results demonstrate cross-modal links between vision and touch in exogenous covert spatial attention that remap across changes in unseen hand posture, suggesting a modulatory role for proprioception

Eye movement patterns during the recognition of three-dimensional objects: Preferential fixation of concave surface curvature minima

This study used eye movement patterns to examine how high-level shape information is used during 3D object recognition. Eye movements were recorded while observers either actively memorized or passively viewed sets of novel objects, and then during a subsequent recognition memory task. Fixation data were contrasted against different algorithmically generated models of shape analysis based on: (1) regions of internal concave or (2) convex surface curvature discontinuity or (3) external bounding contour. The results showed a preference for fixation at regions of internal local features during both active memorization and passive viewing but also for regions of concave surface curvature during the recognition task. These findings provide new evidence supporting the special functional status of local concave discontinuities in recognition and show how studies of eye movement patterns can elucidate shape information processing in human vision

The Minimally Invasive Plate Osteosynthesis (MIPO) Technique with a Locking Compression Plate for Femoral Lengthening

A minimally invasive plate osteosynthesis technique using a locking compression plate (LCP) has been used widely in trauma cases. Its advantages are that the MIPO technique does not interfere with the fracture site and thus provides improved biological healing, and that the LCP has excellent angular stability. Its use in bone lengthening, however, has not been established. In such cases, it is desirable to shorten the external skeletal fixation period as much as possible. Here, the MIPO technique using an LCP was applied to femoral distraction osteogenesis in an attempt to shorten the external skeletal fixation period. For femoral lengthening, the MIPO technique was performed in 2 stages. Orthofix external fixators (Orthofix, England) were used to insert screws from the anterolateral side rather than from the lateral side of the femur for bone lengthening. When sufficient callus formation was detected postoperatively at the site of bone lengthening, and the absence of infection was ensured, limb draping was performed, including a whole external fixator, and then the MIPO technique was applied with an LCP. In 3 cases (5 limbs), the average duration of external skeletal fixation was 134days, the average external-fixation index was 24days/cm, and the average consolidation index was 22days/cm. The MIPO technique using an LCP made it possible to shorten the external skeletal fixation-wearing period in femoral lengthening.</p