Twenty-three cases of severeopen commiunted fractures of thetibia and fibula were treated byexternal skelatal fixation and skinflaps.The skin defects were repairedby the facio-cutaneous flaps, themusculo-cutanecus flap of the gast-rocnemius muscle or the vascularizedosteo-cutaneous flap of the ilium.Seventeen cases were followed-upfor an average of 13 months.Clinicalbony union was obtained in anaverage of 110 days. The authorsrecommended that it was a satisfact-ory method of traetment if a thoroughdebridment, reduction and fixation of the fracture by external skeletal fixation and repaire of wound and the skin defects by tissues flaps were carried out.
Objective To summarize the effect and complication of treatment for Pilon fracture using limited internal fixation combined with external fixation. Methods From April 1996 to June 2003, 20 patients with Pilon fracture were treated with limited internal fixation combined with external fixation as the treatment group and 22 patients with Pilon fracture with other methods as the control group. The X-ray films, clinical effect and complication were analyzed and compared between 2 groups. Results All cases were followed up for 8 to 26 months(15.2 months on average). According to Helfet’s criterion forclinical effect, the excellent and good rates were 75% in the treatment group and 72.7%in the control group, being no significant difference (Pgt;0.05). According to Burwell-charnley criterion for reduction, the X-ray film resultsshowed the excellent and good rates were 90% in the treatment group and 86.4% in the control group, being no significant difference (Pgt;0.05). But there was significant difference in complications between 2 groups (Plt;0.05). Conclusion Limited internal fixation combined with external fixation is better in resuming ankle joint function and remarkably reducing complication, especially in reducing soft tissue complication and collapse of bone joint; it is useful in the treatment of Pilon fracture.
Bone lengthening technique is one of the core surgical technique for skeletal lengthening and reconstruction. It is widely used in the treatment of nonunion, segmental bone defect, bone infection, congenital or post-traumatic limb length differences, and hand-foot deformity correction. Until today, the surgical techniques and devices of bone lengthening are improving over time, and it is to improve the quality of treatment and reduce complications. However, the bone lengthening technique is different from the treatment for other orthopedic diseases, and it has the following feature, including requiring multiple steps, longer treatment course, and application of external fixator. This article will summarize the hot research in the field of bone lengthening treatment in recent years and provide reference for future clinical treatment.
【Abstract】 Objective To assess the results of treatment of unstable distal radius fractures with leverage reductionand bone graft assisted by external fixators. Methods From September 2005 to May 2007, 27 cases of unstable distal radius fractures were treated by leverage reduction and bone graft, meanwhile assisted by external fixators. The cases included 16 males and 11 females, aged from 18 to 69 years with an average of 49. 3 years. Fractures were caused by fall ing in 19 cases, crash from high place in 1 case, traffic accident in 6 cases, and obtuse strike directly in 1 case, which were all closed fresh bone fractures. According to the standard of AO, all cases were classified as type C1 in 13 cases, type C2 in 11 cases, and type C3 in 3 cases. The palmar incl inination was from － 38° to 10°(mean － 12.2°); the ulnar deviation angle was from 6° to 30° (mean 19. 1°) before operations. The operations were performed from 1 to 3 days after injuries. The function of the carpal joints and the boneheal ing conditions were evaluated after operations. Results All cases were followed up for 4-24 months(mean 13. 1 months). No compl ications such as pin loosening, dislocation of fixators, injury of blood vessels and radial nerves, pin track infections occurred. According to Mcbride scoring, the results were excellent in 10 cases, good in 13 cases, fair in 3 cases and poor in 1 case, the excellent and good rate being 85. 2%. One case had traumatic arthritis and 1 case had wrist joint stiffness. All achieved fractures uniton 8-10 weeks (mean 9.3 weeks) after operations. The palmar incl inination angle was from 0° to 20° (mean 13. 4°); the ulnar deviation angle was from 10° to 33° (mean 22. 1°) after operations. Conclusion Treatment of unstable fractures of the distal radius by use of leverage reduction and bone graft with external fixator offers many advantages, such as simple operation, satisfactory reduction, rigid fixation, excellent function and lower incidence rate of traumatic arthritis.
Objective To explore the effectiveness of Ilizarov external fixation without bone graft in the treatment of atrophic femoral shaft nonunion. Methods The clinical data of 12 patients with atrophic femoral shaft nonunion admitted between October 2010 and January 2017 were retrospectively analyzed. There were 8 males and 4 females, aged from 24 to 61 years, with an average age of 41.7 years. The nonunion sites located in the middle and upper femur in 7 cases and in the distal femur or supracondylar in 5 cases. The disease duration ranged from 1 to 9 years, with an average of 3.7 years. Previous operations ranged from 1 to 9 times, with an average of 2.8 times. The original fixator was removed, the fracture end of nonunion was debrided, and Ilizarov external fixator was installed. In patients with the length of bone defect less than 4 cm, direct compression fixation was performed during operation; in patients with limb shortening more than 2.5 cm, proximal femoral osteotomy and bone lengthening components were required to prepare limb lengthening after operation; all patients did not receive bone graft. The wearing time of external fixator, clinical bone healing time of nonunion fracture end, and complications were recorded. The effectiveness was evaluated by Paley’s nonunion evaluation criteria. Results All patients were followed up 24-50 months, with an average of 30 months. Bony union was achieved in all 12 cases with a healing time of 6.0-23.5 months (mean, 11.5 months). The wearing time of external fixator ranged from 7 to 25 months, with an average of 13.5 months. At last follow-up, according to Paley’s nonunion evaluation criteria, the results were excellent in 6 cases, good in 4 cases, and fair in 2 cases, with an excellent and good rate of 83.3%. Sagittal angulation deformity of femur more than 7° occurred in 4 cases, with no significant effect on knee extension function, and no special treatment such as osteotomy was performed. Two patients had shorter limbs (>2.5 cm) after operation and were replaced by high shoes; 4 patients with trans-knee fixation lost knee joint mobility of 10-30° after operation; 10 cases of needle tract infection occurred, of which 4 cases with infection and loosening of fixed needle were replaced and re-fixed after needle extraction, the remaining 6 cases of infection without loosening of fixed needle were controlled by local dressing change, needle nursing, and oral cephalosporin anti-inflammatory drugs. No complications such as deep infection and vascular nerve injury occurred. Conclusion Ilizarov external fixation has a high healing rate for atrophic femoral shaft nonunion, which is relatively minimally invasive and can avoid bone grafting. Its preliminary effectiveness is exact, and it is also effective for patients who have experienced multiple failed operations. It is necessary to pay attention to the nursing and rehabilitation training after external fixation.
Objective To evaluate the effectiveness and safety of external fixation (EF) and open reduction and internal fixation (ORIF) for unstable distal radius fractures in adults. Methods We searched MEDLINE (1966 to September 2008), Cochrane Central register of controlled Trials (The Cochrane Library, Issue 3, 2008), EMbase (1974 to September 2008), CBM, CNKI, and collected randomized controlled trials (RCTs) of EF and ORIF for unstable distal radius fractures in adults. The quality of the included studies was critically assessed and data analyses were performed with the Cochrane Collaboration’s RevMan 5.0 software. Results Seven RCTs involving 634 patients were included, of which 269 were in EF group, and 293 were in ORIF group. Only 1 study had relative high quality, all the others had some limitation in randomization, blinding, and allocation concealment. The results of meta-analyses showed that, 1) about the effectiveness: according to the Gartland and Werley grade standard, the ORIF group was better than the EF group with statistic difference (RR=1.50, 95%CI 1.11 to 2.03, P=0.008); because of the original studies did not offer the detailed data including pad strength, grip strength, flexion-extension, radial deviation, and ulnar deviation, we only processed a descriptive analysis; and 2) about complications: the infection rate of the pin track was higher in the EF group than that in the ORIF group with statistic difference (RR=0.24, 95%CI 0.08 to 0.76, P=0.02); but there were no differences between the two groups in reflex sympathetic dystrophy (RSD) (RR=0.88, 95%CI 0.30 to 2.56, P=0.82), extensor tendon rupture (RR=3.93, 95%CI 0.45 to 34.62, P=0.22), and compartment syndrome (RR=3.13, 95%CI 0.51 to 19.09, P=0.22). Conclusions Compared with EF, ORIF is much better based on Gartland and Werley grade standard, and causes much less infection. Because of the limited quality and quantity of the included studies, more proofs are required from more RCTs with large sample.