Search

INTRODUCTION: Staged treatment of high-energy periarticular tibia fractures involves temporization with closed reduction and external fixation, aiming to provide early reduction and stabilization while mitigating soft-tissue complications. Various external fixator configurations exist, including those that use a multipin clamp capable of holding multiple pins but limiting pin placement to a single plane. The purpose of this study was to compare clinical and radiographic outcomes and associated costs of standard and multipin outrigger clamp constructs in tibial plateau and pilon fractures treated with temporary external fixation. We hypothesized that use of the multipin clamp may be associated with poorly aligned reductions and increased complication rates. METHODS: A retrospective review of 100 patients with periarticular tibial plateau (AO/OTA: 41B/C) or pilon (43B/C) fracture at a Level 1 trauma center from 2014 to 2023 was conducted. Patient, injury, and complication characteristics were collected. Patients were categorized based on the external fixator clamp used: multipin (MP) or standard (S). Clinical outcomes and complication rates were assessed. Radiographic alignment was evaluated by the change in anterior and lateral distal tibial angles, and sagittal plane translation for pilon fractures, and medial and posterior proximal tibial angles for plateau fractures. RESULTS: 70 patients underwent standard (25 pilon, 45 plateau) and 30 multipin (10 pilon, 20 plateau) external fixation. MP and S groups showed no notable differences in demographics or injury characteristics. Both groups demonstrated comparable complication rates and radiological alignment outcomes, with no notable differences observed. MP constructs were more costly than standard systems. CONCLUSION: In this retrospective study of 100 patients, there was no difference in radiographic or clinical outcomes between the standard frame and multipin frame groups. Typical costs for the multipin frame constructs were $635 to $1249 more than the standard frame constructs.

BackgroundProvisional stabilization of high-energy tibia fractures using temporary plate fixation (TPF) or external fixation (ex-fix) prior to definitive medullary nailing (MN) is a strategy common in damage control orthopaedics. There is a lack of comprehensive data evaluating outcomes between these methods. This study compares outcomes of patients stabilized with either TPF or ex-fix, and with early definitive MN only, assessing complications including nonunion and deep infection.MethodsA retrospective review was performed on adult patients with tibia fractures treated with MN followed until fracture union (≥3 months) at a single level-1 trauma center from 2014 to 2022. Medical records were evaluated for nonunion and deep infection. Demographics, injury characteristics, and fixation methods were recorded. Significance between patients who underwent TPF and ex-fix was compared with a matched cohort of early MN using Pearsons exact tests, independent t-tests, and one-way ANOVA, depending on the appropriate variable.Results81 patients were included; 27 were temporized with TPF (n = 12) or ex-fix (n = 15). 54 early MN cases defined the matched cohort. All groups had similar patient and fracture characteristics. The difference in rates of nonunion between groups was significant, with TPF, ex-fix, and early MN groups at 17, 40, and 11% respectively (p = 0.027). Early MN had lower rates of nonunion (11% vs. 40%, p = 0.017) and deep infection (13% vs. 40%, p = 0.028) compared to ex-fix.ConclusionTemporary ex-fix followed by staged MN was associated with higher rates of nonunion and deep infection. There was no difference in complication rates between TPF and early definitive MN. These data suggest that ex-fix followed by MN of tibia fractures should be avoided in favor of early definitive MN when possible. If temporization is needed, TPF may be a better option than ex-fix. Level of Evidence: IV.

Purpose Methods Results Conclusion Level of Evidence Despite the clinical utility of the pivot shift exam, the requisite applied forces and torques to elicit a pivot shift remain unclear. The purposes of this study are (1) to identify the greatest forces and torques applied to the knee during the pivot shift exam and (2) to evaluate if the applied loads differ among experienced surgeons.Three cadaveric hemipelvis‐to‐toe specimens (ages 53, 36 and 31 years; two males and one female) with no history of knee or hip injury were utilized. The experimental setup consisted of securing the hemipelvis to a mounting frame via an external fixator to simulate patient positioning during the clinical exam. The hemipelvis, femur, and tibia were spatially tracked by motion capture and the applied loads were measured using a 6‐axis force‐torque sensor. After sectioning the anterior cruciate ligament (ACL), three board‐certified sports medicine surgeons then performed the pivot shift exam on each specimen utilizing their preferred technique. Forces (compression‐distraction, anterior‐posterior, and medial‐lateral) and torques (varus‐valgus, internal‐external rotation, and flexion‐extension) applied to the knee joint immediately preceding the reduction of the proximal lateral tibia during each pivot shift exam were calculated.Compression was the largest applied force averaging 95 N ± 15 N for all surgeons and knees, which was at least 4.5 times greater, on average, than the applied anterior and applied medial tibial forces (p < 0.0001). Valgus was the largest of the three applied torques, averaging 8.5 ± 2.1 Nm. Internal rotation torque was 3.7 times less, on average, than the applied valgus torque (p < 0.0001). Each surgeon applied compressive force. However, anterior force was more variable among surgeons, with one of the three surgeons applying minimal anterior force (p ≤ 0.024). The magnitude of applied torques was similar among examiners (n.s).Compressive force and valgus torque were the predominant applied loads during the pivot shift exam. A lower magnitude of internal rotation torque was also applied. The anterior force was not consistently applied among examiners. These data can better inform clinical, cadaveric, and computational studies utilizing the pivot shift exam to assess knee biomechanics and can be used to educate trainees in conducting this complex manoeuvre.An in vitro biomechanic study. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate the fracture patterns and complexity of distal humerus fractures with high-resolution computed tomography (CT) as a function of Dual-Energy X-ray absorptiometry (DXA)-derived bone marrow density (BMD) measurements in an elderly patient cohort. Methods: A retrospective chart review was conducted on patient data collected at a Level I trauma center between January 2007 and January 2022. Inclusion criteria comprised patients aged ≥40 years with a confirmed distal humerus fracture as demonstrated by CT. Additionally, patients were included if they underwent DXA. Patient demographics and detailed information regarding the surgical treatment and trauma mechanism were retrieved from the institutional databank. Fractures were classified as either 'low-plane' distal humeral fractures or 'non-low-plane' distal humerus fractures. Furthermore, the fracture patterns were classified according to established classification systems. Intra- and postoperative complication and revision rates were analyzed. Results: A total of 41 patients (30 women; mean age 74 ± 13 years) were enrolled. Low-energy trauma was sustained by 68% of the patients. The remaining 32% of the fractures involved medium-energy trauma. A total of 62% of the patients underwent primary osteosynthesis, while 30% of patients were initially treated with an external fixator. ORIF was performed in 89% of cases and, in the majority, double-plate osteosynthesis was used (76%). An olecranon osteotomy was performed in 30% of cases. A total of 5% of cases received total elbow arthroplasty, and 10% of cases were treated conservatively. A total of 61% of patients had osteoporosis, 24% of patients had osteopenia, and 15% of patients had a normal BMD with an overall mean T-score of −2.4. Most of the fractures were complex (including 61% Type C fractures). A total of 66% of cases were considered as 'low-plane' fractures. Postoperative complications occurred in 11% of patients (64% of cases among 'low-plane' fractures). Revision surgery was required in 20% of cases. Conclusions: The consecutive series of patients showed a high incidence of 'low-plane' fractures. However, no statistical significance was found between the BMD and fracture complexity. The very distal 'low-plane' fractures showed a high complication rate, which was aggravated by osteoporotic bone conditions. These findings highlight the need for future research with larger patient samples to better understand the relationship between the BMD, fracture complexity, and outcomes in patients with 'low-plane' fractures in order to reduce complications and improve clinical outcomes. [ABSTRACT FROM AUTHOR]

Background: Although the specific relationship between the stress changes in the external fixator during tibial fracture treatment and the bone healing process remains unclear, it is believed that stress variations in the external fixator scaffold can, to a certain extent, reflect the progress of tibial healing. Objective: This study aims to propose a non‐invasive method for assessing the degree of fracture healing by monitoring the changes in stress transmission, the locations of stress‐sensitive points, and displacement in the external fixator‐tibia system during the healing process of tibial fractures. Methods: In this study, finite element models of tibial fractures at various healing stages were developed. Physiological conditions, including axial, torsional, and bending loads on the tibia, were simulated to evaluate stress and strain within the external scaffold‐tibia system under normal physiological loading conditions. Results: The results indicate variations in the stress distribution between the external fixator and the tibia during different stages of healing. In the early phase of fracture healing, the external fixator plays a crucial role as the primary load‐bearing unit under all three loading conditions. As the fracture healing progresses, the stress on the tibia gradually increases, concentrating on the medial part of the tibia under axial and torsional loading, and at the upper and lower ends, as well as the central part of the anterior and posterior tibia during bending loading. The stress at the callus gradually increases, while micro‐movements decrease. The stress within the external bracket gradually decreases, with a tendency for the connecting rod to transfer stress towards the screws. Throughout the fracture healing process, the location of maximum stress in the external fixator remains unchanged. Under axial and torsional loading, the maximum stress is located at the intersection of the lowest screw and the bone cortex, while under bending loading, it is at the intersection of the second screw and the connecting rod. Conclusion: During the bone healing process, stress is transferred between the external fixation frame and the bone. As bone healing advances, the stress on the connecting rods and screws of the external fixation frame decreases, and the amplitude of stress changes diminishes. When complete and robust fusion is achieved, stress variations stabilize, and the location of maximum stress on the external fixation frame remains unchanged. The intersections of the lowest screw and the bone cortex, as well as the second screw and the connecting rod, can serve as sensitive points for monitoring the degree of bone healing. [ABSTRACT FROM AUTHOR]

Objective: Tibia plateau fractures account for 1-2% of all fractures and might adversely affect the knee joint. The current research aimed to evaluate the effect of surgical procedures, age, and gender on proximal tibia fracture functional outcomes. Methods: The present data for the retrospective analysis was obtained from an observational longitudinal cohort trauma registry study, initiated at a tertiary care hospital in June 2015. A total of 51 isolated tibia plateau fracture patients were routinely treated with open reduction internal fixation or external fixator and assessed for functional outcomes till twelve months by the Rasmussen scoring scale. Patients were divided into five age groups. The functional outcome association to gender, age groups, and surgical procedures was assessed by the Fisher Exact test and logistic regression analysis. Results: The mean age of the total 51 patients was 40±11 years. Patients operated with Open Reduction and Internal Fixation (74.5%) or with an external fixator (25.5%). Road traffic accidents were the common mechanism of injury. There were non-significantly different functional outcomes observed among age groups or between surgical procedures at all follow-ups but significantly different between genders at three-month follow-ups. Males recovered better than females (p=0.02). Conclusion: Tibia Plateau fracture patients respond almost equally to both external fixation and Open Reduction Internal Fixation procedures. Age does not influence the outcome. However, males had better functional outcomes at three months post-surgery indicating that gender could affect the outcomes. Further exploration might assist in planning gender-based proximal tibia fracture treatment strategies for optimum outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To observe the effect of the forearm rotation function reconstruction with an external fixator in treating congenital radioulnar synostosis. Methods: From July 2017 to July 2023, 6 patients (9 sides) with congenital radioulnar synostosis who underwent reconstruction of the forearm rotation with the external fixator were retrospectively analyzed. The extent of flexion and rotation, the Modified An and Morrey functional rating index, and the grade according to the classification system proposed by Failla et al. were compared before and after the operation. Results: All patients were followed up for an average of 12.00 (8.00, 38.50) months. The average range of rotation, the Modified An and Morrey functional rating index increased from 0°, 64.56 ± 1.33 points to 85.00° ± 25.86°, 83.71 ± 5.50 points, respectively. The differences were statistically significant (t = 9.86, P < 0.01, t = 11.20, P < 0.01). There was no significant difference in forearm flexion before and after the operation (Z = 1.34, P = 0.18). According to the Failla classification system, 2 forearms were classified as poor preoperatively, 6 as fair and 1 as good. 2 forearms were assessed as excellent, 6 as good and 1 as fair during the last follow-up. Conclusion: Reconstruction of the forearm rotation function with an external fixator is safe and effective for treating congenital radioulnar synostosis. This technique can restore the partial rotational function of the forearm. [ABSTRACT FROM AUTHOR]

Incomplete sacroiliac joint injuries are often associated with external rotation and extension deformities on the injured hemipelvis. To appropriately correct this deformity, an oblique reduction force from caudal to cranial and lateral to medial is helpful. These injuries are often associated with traumatic disruption of the pubic symphysis. However, in injuries without traumatic disruption to the pubic symphysis, a two-pin oblique anterior external fixator can be used to obtain and maintain reduction of the sacroiliac joint, while percutaneous fixation is subsequently placed. Through a small case series and three specific patient examples, we demonstrate that the oblique anterior external fixator frame is a simple and effective strategy with the reduction and stabilization process of these multiplanar hemipelvis deformities. [ABSTRACT FROM AUTHOR]

Background: Compound fractures of the distal tibia (with or without the middle third) represent a challenge for orthopedic and plastic surgeons because of the scarcity of available soft tissue reconstruction and the important comminution of the fractures that usually appear. Methods: The design of this study is based on the PRISMA guidelines. Databases were searched for articles published and available until the first half of 2023. Articles that presented the evolution of patients treated by combining circular external fixators with reconstructive methods were selected. Results: After searching the literature using keywords, we obtained 3355 articles, out of which 14 articles met all the inclusion criteria, with a total number of participants of 283. The bone loss varied between 0.7 and 18.2 cm, while the soft tissue defect was between 3/3 cm and 16/21 cm. The average period of fixation ranged from 4 to 22.74 months. The most used reconstruction methods were 80 free flaps and 73 pedicled flaps out of 249 interventions. Complete flap loss appeared only in 3/283 patients. Regarding the bone union, the percentage of non-union was low, and in all cases, it was achieved after reintervention. A low rate of major complications was observed. Conclusions: The orthoplastic team is the key to successfully treating the high-energy traumatism of the distal tibia (with or without a middle third). The Ilizarov external fixator can be used as a definitive limb-salvage treatment (secondary to the standard primary methods of fixation) in combination with a flap to cover the defects because it does not damage the pedicle, and it helps stabilize the soft tissues and bones around the flap to lower the complications. [ABSTRACT FROM AUTHOR]

Objective: To describe the clinical and surgical characteristics of external fixation technique to manage complex open proximal humerus fractures caused by high-energy firearm injuries at the Hospital Militar Central, Colombia. Methods: A retrospective case series of patients with open complex proximal humerus fractures (Gustilo & Anderson III A-B or Neer III and IV) caused by long range or fragmentation weapons treated with external fixation. The variables are demographic data, range of motion, consolidation measurements, and functional outcomes according to the Quick Disabilities of the Arm, Shoulder and Hand (Quick DASH) functional scale. Results: Seven male patients, with high-energy injuries causing open complex proximal humerus fractures (Gustilo & Anderson III A-B or Neer III or IV) underwent surgical treatment with external fixation and arthrodiastasis. Median age was 21.0 (19–24) years, mean treatment duration was 5.6 (4–7) months, and all patients completed 15 months of follow-up. Mean postoperative active movement measurements were flexion: 80° (40°–120°), abduction 85.7° (40°–130°), external rotation: 24.7° (10°–45°), and internal rotation: 23.6° (10°–45°). Mean postoperative pain according to visual analog scale was 2.7 (1–4) and mean Quick DASH was 36.2 (15.9–58). Two patients presented postoperative complications, one case each of infection and osteitis. Conclusion: Complex open proximal humeral fractures caused by high-energy trauma treated with transarticular external fixation via arthrodiastasis show promising short-term and mid-term results with low complication rates, low levels of postoperative pain, and moderate functional results. This external fixation technique seems to be a valid option for the treatment of polytraumatic patients with humeral injuries. Longer follow ups and larger sample sizes studies must be presented to better characterize the clinical and satisfaction outcomes. [ABSTRACT FROM AUTHOR]

AbstractDistraction osteogenesis (DO) is a bone regenerative maneuver, which is conventionally done with external fixators and, more recently, with telescopic intramedullary nails. Despite the proven effectiveness, external approaches are intrusive to the patient’s life while intramedullary nailing damages the growth plates, making them unsuitable for pediatric patients. An internal DO plate fixator (IDOPF) was developed for pediatric patients to address these limitations. The objective of this study was to test the hypothesis that the IDOPF can withstand a partial weight bearing scenario and create a favorable mechanical microenvironment at the osteotomy gap for bone regeneration as the device elongates. A finite element model of a surrogated long bone diaphysis osteotomy fixation by means of the IDOPF was created and subjected to axial compression, bending and torsion. As the osteotomy gap increased from 2 mm to 20 mm, under compression, The average axial interfragmentary strains decreased from 2.33% to 0.35%. Stress increased from 179 MPa to 281 MPa at the contact interfaces of the telescopic compartments, which exceeded the endurance limit of stainless steel (270 MPa) but was below its yield limit (415 MPa). These results demonstrate, that the IDOPF can withstand a partial load bearing scenario and provide a stable biomechanical environment conductive to bone healing. However, high contact stresses at the telescopic interfaces of the device are likely to cause wear, as is frequently reported in telescopic fixators. This study is a step towards refining the IDOPF design for clinical use. [ABSTRACT FROM AUTHOR]

Purpose: The task faced by surgeons becomes significantly more challenging when they encounter lower extremity bone defects due to a variety of causes requiring lengthening. The most discussed and successful approach is the Illizarov technique, or lengthening over a nail (LON):distraction osteogenesis is also widely performed with monoliteral external fixators and intramedullarylengthening nails have increasingly been used in the last decade. Methods: The data were collected from PubMed, Cochrane Library, Embase, and the Web of Science for all available studies comparing the outcomes of Ilizarov technique alone and LON technique (from January 1, 1997, to November 30, 2023). The outcomes of interest encompassed the external fixation index (EFI) (month/cm), mean duration of follow-up (MFT) (month), length gained (LG) (cm), consolidation index (CIx) (month/cm), and bone healing index (BHI) (month/cm).Complications include pin tract infection rate (PTI), axial deviation rate (AD), occurrence of intramedullary infection (II), delayed consolidation rate (DC), as well as data categorized into three levels of problems, obstacles, and sequelae based on the severity of complications.Two reviewers independently assessed each study for quality and extracted data. The case–control or respective cohort studies were evaluated using the Newcastle–Ottawa scale (NOS) to determine their techniqueological rigor.The Cochrane Collaboration's risk assessment tool was employed to perform quality evaluations for randomized controlled trials. Results: This review included thirteen studies comprising a total of 629 patients.The external fixation index (month/cm) was significantly smaller in the LON technique compared to the Ilizarov technique alone [Mean Difference(MD) = -29.59, 95% CI -39.68–-19.49, P < 0.00001].In terms of the mean follow-up time(month) (MD = -0.92, 95% CI -3.49–1.65, P = 0.57), length gained (cm) (MD = -0.87, 95%CI -2.80–1.07, P = 0.38), consolidation index (month/cm) (MD = 0.66, 95% CI -3.44–4.77, P = 0.75), and bone healing index (month/cm) (MD = -3.33, 95% CI -13.07–6.41, P = 0.5), there were no significant differences observed. The LON technique exhibited a lower incidence of axial deviation [Odds Ratio(OR) = 0.06, 95%CI 0.03–0.16, P < 0.00001] and pin tract infection (OR = 0.30, 95%CI 0.18–0.50, P < 0.00001) compared to the Ilizarov technique alone.The remaining complications, such as intramedullary infection rate (OR = 0.93, 95%CI 0.42–2.06, P = 0.85) and delayed consolidation rate(OR = 0.61, 95%CI 0.20–1.86, P = 0.38), did not exhibit statistically significant differences.Our findings demonstrated that the LON technique results in lower incidences of problems (38.5%vs.58.6%) and sequelae (16.6% vs.30.9%) when compared to the Ilizarov technique alone. However, the rates of obstacles (32.4% vs.32.3%) were comparable between the two methods. Conclusions: Our findings indicate that patients treated with the LON technique experienced significantly shorter external fixation durations and a lower incidence of complications (e.g., pin tract infections and axial deviation) compared to those treated with the Ilizarov technique alone. Other outcome metrics showed no significant differences between the two techniques. However, the LON technique offers substantial benefits, including reduced external fixation times and increased comfort, which enhance patient compliance. In conclusion, the LON technique is a safe, reliable, and effective method for treating tibial and femoral defects. [ABSTRACT FROM AUTHOR]

Objective: Bone transport has become the gold standard for treating large segmental tibial bone defects. The technique for application the Ilizarov circular fixator (ICF) has a long learning curve and is associated with many complications. There are few clinical studies on bone transport via the Taylor spatial frame (TSF). The main purpose of this study was to compare the radiological and clinical and outcomes of bone transport by using the TSF and the ICF. Methods: There were 62 patients included in this retrospective study from June 2011 to June 2021 and distributed to two groups according to the fixation method: a TSF group consisting of 30 patients and an ICF group consisting of 32 patients. Demographic information, surgical duration, external fixation times, external fixation index, final radiographic results, complications, and clinical outcomes were recorded and examined. The clinical outcomes were assessed using the ASAMI criteria during the most recent clinical visit. Then, statistical analysis such as independent‐samples t tests or chi‐Square test was performed. Results: The mean surgical duration in the TSF group was 93.8 ± 7.3 min, which was shorter than that in the ICF group (109.8 ± 1.4 min) (p < 0.05). Compared to the ICF group (10.2 ± 2.0 months), the TSF group (9.7 ± 1.8 months) had a shorter average external fixation time (p > 0.05). The external fixation index was 1.4 ± 0.2 m/cm and 1.5 ± 0.1 m/cm in the two groups. Moreover, there was no significant difference between the two groups. At the last follow‐up visit, the medial proximal tibial angle (MPTA) and posterior proximal tibial angle (PPTA) in the TSF group were 88.1 ± 12.1° and 80.9 ± 1.3°, respectively. The MPTA and PPTA in the ICF group were 84.4 ± 2.4° and 76.2 ± 1.9°, respectively. There were statistically significant differences between the two groups (all p < 0.05). The complication rate was 50% in the TSF group and 75% in the ICF group. Moreover, the ASAMI score between the two groups was no statistically significant difference (p > 0.05). Conclusion: No statistically significant difference was found in clinical outcomes between the use of Taylor spatial frame and Ilizarov circular fixator for treating large segmental tibial bone defects. However, TSF is a shorter and simpler procedure that causes fewer complications and improves limb alignment. [ABSTRACT FROM AUTHOR]

Biomechanical and orthopaedic studies frequently encounter complex datasets that encompass both circular and linear variables. In most cases (i) the circular and linear variables are considered in isolation with dependency between variables neglected and (ii) the cyclicity of the circular variables is disregarded resulting in erroneous decision making. Given the inherent characteristics of circular variables, it is imperative to adopt methods that integrate directional statistics to achieve precise modelling. This paper is motivated by the modelling of biomechanical data, that is, the fracture displacements, that is used as a measure in external fixator comparisons. We focus on a dataset, based on an Ilizarov ring fixator, comprising of six variables. A modelling framework applicable to the six-dimensional joint distribution of circular-linear data based on vine copulas is proposed. The pair-copula decomposition concept of vine copulas represents the dependence structure as a combination of circular-linear, circular-circular and linear-linear pairs modelled by their respective copulas. This framework allows us to assess the dependencies in the joint distribution as well as account for the cyclicity of the circular variables. Thus, a new approach for accurate modelling of mechanical behaviour for Ilizarov ring fixators and other data of this nature is imparted. [ABSTRACT FROM AUTHOR]

In the clinical application of the parallel external fixator, medical practitioners are required to quantify deformity parameters to develop corrective strategies. However, manual measurement of deformity angles is a complex and time‐consuming process that is susceptible to subjective factors, resulting in nonreproducible results. Accordingly, this study proposes an automatic measurement method based on deep learning, comprising three stages: tibial segment localization, tibial contour point detection, and deformity angle calculation. First, the Faster R‐CNN object detection model, combined with ResNet50 and FPN as the backbone, was employed to achieve accurate localization of tibial segments under both occluded and nonoccluded conditions. Subsequently, a relative position constraint loss function was added, and ResNet101 was used as the backbone, resulting in an improved RTMPose keypoint detection model that achieved precise detection of tibial contour points. Ultimately, the bone axes of each tibial segment were determined based on the coordinates of the contour points, and the deformity angles were calculated. The enhanced keypoint detection model, Con_RTMPose, elevated the Percentage of Correct Keypoints (PCK) from 63.94% of the initial model to 87.17%, markedly augmenting keypoint localization precision. Compared to manual measurements conducted by medical professionals, the proposed methodology demonstrates an average error of 0.52°, a maximum error of 1.15°, and a standard deviation of 0.07, thereby satisfying the requisite accuracy standards for orthopedic assessments. The measurement time is approximately 12 s, whereas manual measurement requires about 15 min, greatly reducing the time required. Additionally, the stability of the models was verified through K‐fold cross‐validation experiments. The proposed method meets the accuracy requirements for orthopedic applications, provides objective and reproducible results, significantly reduces the workload of medical professionals, and greatly improves efficiency. [ABSTRACT FROM AUTHOR]

Background: Orthopedic fixators depend on mechanical characteristics like stiffness and firmness. The Ilizarov Apparatus (IA) is a common surgical management approach to restructure the bone fractures. IA includes two wires, specifically K-wire and olive wire, to treat the fractures. Methods: The functions of IA using K-wire and olive wire have been explored with experimental and finite element approach. To describe the stability of fixation and stiffness of olive wire and K-wire, the mechanical performance of the wires was evaluated experimentally as well as numerically by ANSYS software. Results: The results obtained from the olive wire experimental setup with applied loads of 50 to 100 N, showed stiffnesses ranging from 13.85 to 14.58 N/mm and displacements ranging from 3.61 to 6.86 mm. Also, in analytical evaluation, the obtained stiffness ranges from 14.36 to 14.34 N/mm for loads of 50–100 N with a displacement of 3.48–6.97 mm. Conclusions: A two-ring olive wire was found to be stiffer than a two-ring K-wire fixator under the same loading conditions. The goal of this study is to help orthopedic specialists assess the stiffness and stability of IA setups with olive and K-wires. [ABSTRACT FROM AUTHOR]

Purpose: Treatment of osteomyelitis (OM) is challenging. Ilizarov bone transport is a commonly used technique for management of OM. The recently introduced limb reconstruction system (LRS) has been effectively used for management of OM. It was suggested to be easier in use and less invasive. The present retrospective study aimed to compare LRS and Ilizarov bone transport in management of femoral OM using a propensity score matched analysis. Methods: The present retrospective study included 80 consecutive patients with femoral OM. The studied patients were managed either using Ilizarov external fixator (n = 40) or Orthofix LRS (n = 40). The clinical outcome measurements included union time, limb length discrepancy, additional operative procedures, refracture and infection. Results: Patients in the LRS group were exposed to significantly higher frequency of bone transport (30.0 versus 15.0%) and lower frequency of acute compression and lengthening (10.0 versus 32.5%). Patients in Ilizarov group had significantly higher frequency of tobramycin pellets as compared to their counterparts. The studied groups were comparable regarding the operative complications including pin-tract infection, non-union at docking site and refracture. Patients in the Ilizarov had significantly shorter time to union (8.2 ± 3.2 versus 11.0 ± 5.6 months, p = 0.012). No statistically significant differences were found between the studied groups regarding the quality-of-life domains. Conclusions: Use of Ilizarov external fixator and Orthofix LRS devices proved to be effective and reliable. Their influences on patients' quality appear to be comparable. [ABSTRACT FROM AUTHOR]

• The error model of a 5-DOF PEF is established based on the POE formula to satisfy completeness, continuity, and minimality. • An MPC-based parameter identification approach is proposed to address the challenge in the measurement of pose information. • A novel calibration method containing the POE-based error model and the MPC-based identification approach is formed. • The method makes advances in model accuracy and measurement difficulty, and can cost-effectively finish calibration tasks. Limb deformity is a common complaint in orthopedic surgery. Currently, gradual treatment using parallel external fixator (PEF) has become the preferred option for deformity correction. As the key medical apparatus with the special application properties of temporary assembly and direct utilization, the geometric errors generated during the manufacturing and assembly process of the PEF contribute to the post-correction residual and iatrogenic deformities. However, considering the complexity of clinical scenarios, there is a lack of an applicable solution to reduce the effect of the above error source of PEF. To overcome these problems, taking a 4-U P S/S P R PEF as the research object, this paper proposes a novel kinematic calibration method. First, the error model with the features of completeness, continuity, and minimality is first established based on the product of exponentials (POE) formula. Then, the identifiability analysis is conducted to eliminate the redundant error parameters and ensure the stability and accuracy of the iterative calculation in the process of parameter identification. Furthermore, a multiple plane constraint (MPC)-based parameter identification approach is introduced to the calibration task of the PEF to effectively reduce the difficulty of the pose information measurement in the current cost-effective constraint calibration method. Finally, the simulation and prototype experiments validate that the proposed calibration method (i.e., the combination of the POE-based error model and the MPC-based parameter identification approach) can accomplish the calibration tasks in clinical applications and meet the cost-effectiveness and efficiency requirements. [ABSTRACT FROM AUTHOR]

A 15-day-old colt was presented with grade 5 lameness (American Association of Equine Practitioners - lameness scale), oedema of the right pelvic limb and stifle joint instability. A radiographic examination revealed a complete comminuted fracture of the proximal right tibia. To treat this, a surgical reduction was performed using a hybrid external fixator. The hybrid external fixator consisted of two rings placed above the proximal and distal epiphyseal plates, respectively, which were then linked with threaded rods. Within 24 hours of the surgery, the foal started weight-bearing again. After 6 days, the hybrid external fixator rings were distracted by 1 mm per day for 17 days, which helped to increase the bone length. Once the hybrid external fixator was removed, a small shortening of the tibia (1 cm) was observed compared to the contralateral limb, but the epiphyseal cartilage was maintained. [ABSTRACT FROM AUTHOR]

Isolated, closed, femoral shaft fractures are dangerous injuries that commonly occur in the setting of high energy trauma or among older patients with significant comorbidities. Despite their prevalence, relatively little data exists connecting patient independent risk factors to the time to 30-day mortality, unplanned reoperations and unplanned readmissions in these fractures. Using National Surgical Quality Improvement Program (NSQIP) database, isolated close femoral shaft fractures were identified using ICD-10 codes. Patient demographics, perioperative course and adverse events were identified. Categorical and binary variables were analyzed among procedure cohorts using Chi2 analysis. Univariate and multivariate analysis were conducted to identify independent risk factors associated with primary outcomes. Between 2010 and 2019, 1346 closed isolated femoral shaft fracture patients with a mean age of 66.7 were identified, of whom 30.6% and 69.4% were male and female, respectively. Surgical procedures included: 915 (68.0%) intramedullary nail (IMN); 428 (31.8%) open reduction internal fixation (ORIF); and 3 (0.2%) external fixator (Ex-fix). Patients who underwent ORIF reported 3.19 (OR: 3.19; CI: 1.45–7.03; p = 0.004) and 2.12 (OR: 2.12; CI: 1.10–4.09; p = 0.024) increased odds of mortality and unplanned related readmission compared to patients who received IMN. Transfusion, DVT, and PE rates were 34.2%, 1.4%, and 1.1%, respectively. Furthermore, 50% of mortality cases occurred within 6 days of surgery. Patients requiring reintubation reported 61.8 (OR: 61.8; CI: 15.7–242.40; p < 0.001) increased odds of mortality compared to patients not requiring reintubation. Patients with femoral shaft fractures who require reintubation have increased odds of mortality than those successfully extubated. In addition to precautions prior to extubation, patients with femoral shaft fractures should also be carefully monitored for the development of DVT or PE, and they should be definitively fixed with IMN whenever possible. [ABSTRACT FROM AUTHOR]

Objective: Distraction osteogenesis (DO) has been widely used to treat bone defects as its effectiveness in bone regeneration. Currently, distraction devices for establishing DO models are mainly developed for rats or large animals. However, a mouse DO model is in great need for in-depth mechanistic investigations using various transgenic mice. The current study reports the development of a reproducible murine DO model. Methods: A mini-titanium lengthener was designed and fabricated. The mini-lengthener was applied on the murine femur with four threaded pins using a designed clamp as the drilling and insertion guide. After transverse osteotomy using a Gigli saw, and after 5 days of latency, DO procedures started at 0.3 mm/day for 10 days, and the consolidation period was left for 28 days. The bone formation was monitored by radiography and histology. Potential effects on animal locomotion during DO were also measured by behavior tests. Results: Separated bone segments maintained good alignment during the entire DO phases. New bone formation was found as early as the end of the distraction phase. Active bone remodeling was found between the separated bone segments at late distraction and early consolidation phases. At the mature consolidation phase, bone remodeling was mainly observed in the contact cortical bone. Mice underwent DO procedure did not have significant impairment in their locomotion. Conclusion: We have successfully developed a murine femoral DO model, which may be used to study the biological processes of DO. We also developed the mini-lengthener and the guide clamp to ensure the standardization and reproducibility of the mouse DO model.The translational potential of this article: Current study reports the development of a murine femoral DO model. A well-established murine DO model will facilitate further investigations of the biological mechanisms of DO in various transgenic and normal mice.

Objective Bone transport has become the gold standard for treating large segmental tibial bone defects. The technique for application the Ilizarov circular fixator (ICF) has a long learning curve and is associated with many complications. There are few clinical studies on bone transport via the Taylor spatial frame (TSF). The main purpose of this study was to compare the radiological and clinical and outcomes of bone transport by using the TSF and the ICF. Methods There were 62 patients included in this retrospective study from June 2011 to June 2021 and distributed to two groups according to the fixation method: a TSF group consisting of 30 patients and an ICF group consisting of 32 patients. Demographic information, surgical duration, external fixation times, external fixation index, final radiographic results, complications, and clinical outcomes were recorded and examined. The clinical outcomes were assessed using the ASAMI criteria during the most recent clinical visit. Then, statistical analysis such as independent‐samples t tests or chi‐Square test was performed. Results The mean surgical duration in the TSF group was 93.8 ± 7.3 min, which was shorter than that in the ICF group (109.8 ± 1.4 min) (p 0.05). The external fixation index was 1.4 ± 0.2 m/cm and 1.5 ± 0.1 m/cm in the two groups. Moreover, there was no significant difference between the two groups. At the last follow‐up visit, the medial proximal tibial angle (MPTA) and posterior proximal tibial angle (PPTA) in the TSF group were 88.1 ± 12.1° and 80.9 ± 1.3°, respectively. The MPTA and PPTA in the ICF group were 84.4 ± 2.4° and 76.2 ± 1.9°, respectively. There were statistically significant differences between the two groups (all p 0.05). Conclusion No statistically significant difference was found in clinical outcomes between the use of Taylor spatial frame and Ilizarov circular fixator for treating large segmental tibial bone defects. However, TSF is a shorter and simpler procedure that causes fewer complications and improves limb alignment.

Introduction: Open extruded fractures of the talus occur in 2% of talar fractures. These fractures are challenging for surgeons due to complications such as infection, nonunion, and arthritis. The most common treatment method is talus reimplantation and osteosynthesis. Case report: A 19-year-old presented with an open extruded fracture of the talus, classified as Hawkins II, following a fall from a height. Emergency surgery involved wound debridement, talus reimplantation, osteosynthesis with modified external fixation for dynamic ankle joint fixation (Mitkovic-type), and two Kirschner wires. Fragments were repositioned under C-Arm fluoroscopy. The patient received a 14-day antibiotic regimen (Cephalosporins, Aminoglycoside, Metronidazole) and thromboembolic prophylaxis for 35 days. After 6 weeks we allowed movements in the ankle joint with physical therapy. Gradual weight-bearing was allowed after 8 weeks. The osteosynthetic material was removed after 18 weeks, with full weight-bearing achieved after 6 months. Radiographic follow-up was conducted up to 24 months postoperatively, showing excellent healing with minimal dorsiflexion restriction. Conclusions: Treating this injury is a significant challenge. External fixation can be a viable method for managing open luxation fractures of the talus.

Study Design A 2-year follow-up study. Purpose To evaluate the effectiveness of modified halo-pelvic Ilizarov distraction assembly in the management of patients with severe kyphoscoliosis. Overview of Literature Severe and rigid scoliosis curves are always a challenge for operating surgeons. Preoperative correction through halo-pelvic devices successfully minimizes the severity of the curve; however, cumbersome complications are also reported with its use. Modified assembly could be safe for these cases. Methods Patients with severe kyphoscoliosis having coronal Cobb angle >90° were applied with modified halo-pelvic Ilizarov distraction assembly preoperatively. The modified assembly consisted of a pelvic component and halo ring, and distraction was given at the rate of 2–3 mm/day for 6–12 weeks. Complete clinical assessments along with pulmonary function tests were performed, and scoliosis series X-ray images were assessed for coronal and sagittal Cobb angle and other spinopelvic parameters before applying the assembly and during 2 years of follow-up. Results Thirty-four patients (age, 9–27 years; male/female ratio of 18:16) were included. The coronal and sagittal Cobb angles were 116°±16.2° and 84°±28.3°, respectively. Correction rates obtained through modified halo-pelvic assembly were nearly 52% (p

Purpose: This systematic review aims to investigate the management and outcomes of pelvic ring fractures (PRFs) during pregnancy, emphasizing maternal and fetal mortality rates, mechanisms of injury, and treatment modalities. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a comprehensive search of databases from 2000 to 2023, identifying 33 relevant studies. Data extraction included demographics, fracture types, treatment methods, and outcomes. Risk of bias was assessed using the JBI criteria. Results: Maternal mortality stood at 9.1%, with fetal mortality at 42.4%. Maternal factors impacting mortality included head trauma and hemodynamic instability. Fetal mortality correlated with mechanisms like motor vehicle accidents and maternal vital signs. Surgical and conservative treatments were applied, with a majority of pelvic surgeries performed before delivery. External fixators proved effective in fracture stabilization. Conclusion: Pelvic ring fractures during pregnancy present significant risks to maternal and fetal health. Early stabilization and vigilant monitoring of maternal vital signs are crucial. Vaginal bleeding/discharge serves as a critical fetal risk indicator. The choice between surgical and conservative treatment minimally influenced outcomes. Multidisciplinary collaboration and tailored interventions are essential in managing these complex cases.

Background: Total talus dislocation without ankle (malleoli) fracture is a very rare injury with prevalence of only 0.06% of all dislocations and only 2% of talar injuries, and are usually associated with common complications such as infection, avascular necrosis, and posttraumatic arthritis. The treatment usually involves debridement, reduction, stabilization of the ankle joint, and primary or secondary closure of the wound. Case presentation: We present the case of a 40-year-old South Asian woman who was involved in an accident. She was rushed to our hospital, whereby subsequent examination revealed an open total talus dislocation with the talus being exposed in its entirety from a contaminated wound in the medial side. Furthermore, radiograph confirmed total talus dislocation without concomitant malleoli fracture. She was immediately taken to the operating theater whereby debridement and immediate reduction was performed under anesthesia, and the ankle was stabilized with external fixator for about 6 weeks. She is now able to bear weight on the affected ankle with minimal tolerable pain and has normal range of motion of the ankle. Conclusions: Open total talus dislocation without concomitant malleoli fracture is a rare injury. Reduction of the talus in combination with complete wound debridement potentially successfully avoids infection, provides early revascularization preventing avascular necrosis, and preserves the normal ankle anatomy. [ABSTRACT FROM AUTHOR]

Background: Fractures of the talus are relatively infrequently reported in small animals. Furthermore, talar neck fracture in cats seems to be very rare. This case report aims to consider the diagnosis, treatment, and a 7-month follow-up of a cat with a Hawkins type 3 talar fracture treated with a type 1b external skeletal fixator (ESF). Emphasizing on the complexity of the injury, considering treatment options and complications, and comparing them to previous reports on cats and humans. Case Description: A 4.5-year-old mixed-breed cat was diagnosed with a Hawkins type 3 talar fracture. Additionally, there were considerations related to the collateral support of the hock joint. The fracture fragment, i.e., the talar body and parts of the neck, was reduced with pointed reduction forceps through a small medial insition. The fracture was then stabilized with a trans articular type 1b ESF. Based on radiographic fracture assessment, de-staging of the frame was done 8 weeks postoperatively. While complete frame removal was at 12 weeks postoperatively. Seven months after the fracture, the cat was minimally lame when walking, and there was a reduced range of motion in the hock joint compared to the contralateral joint. Conclusion: Based on this case and the four previous cases with talar neck fractures, we cannot conclude, but ESF seems to be a good solution, especially when considering the possibility of disruption to the collateral support of the hock joint in this case. [ABSTRACT FROM AUTHOR]

Extramedullary devices are used extensively to stabilize fractures in long bones. The type of pin–bone anchorage is a determining factor in fixation properties, which differ between mono-cortical and bi-cortical stabilizations. This computational study compares the effects of mono-cortical and bi-cortical pins of a unilateral uniplanar external fixator on the construct stiffness, the early phase of bone healing, and pin loosening. Eight finite element models were established for a simple transverse tibia fracture, treated with a unilateral uniplanar external fixator with surgical variations in the pin-bone anchorage. Each model was subjected to a partial body weight, and axial stiffness was calculated. A deviatoric strain-based mechano-regulation algorithm was applied, and tissue differentiation in the callus was predicted. Finally, a strain-based failure criterion was employed to assess the risk of pin loosening. The axial stiffnesses of bi-cortical structures were slightly larger than the results of the mono-cortical sets. Regardless of the number of pins, bi-cortical systems produce a more uniform distribution of differentiated tissue than the corresponding mono-cortical constructs. Finally, both mono-cortical and bi-cortical groups held the critical strains of the pin–bone interface within the acceptable ranges and provided a protected construct against the risk of pin loosening. Based on the findings of this study, mono-cortical pins could be considered potential alternatives to bi-cortical fixations at the early stage of healing. Nevertheless, successful management of diaphyseal fracture through mono-cortical fixation needs to be assessed in further studies over the full period of healing. [ABSTRACT FROM AUTHOR]

Background/Aim. The number of pelvic traumas is increasing globally, mostly due to car accidents but also due to an increasing number of sports and recreational traumas. Tile C-type unstable pelvic trauma (TCUPT) is a kind of high-energy trauma that occurs during traffic accidents or accidents when falling from big heights. The aim of our study was to explore the application of the internal fixation (INFIX) system for the anterior pelvic ring (APR) with simultaneous application of sacroiliac screw (SS) INFIX of the posterior pelvic ring (PPR) in TCUPT. Methods. The subjects (89 of them in total) were recruited among patients with TCUPT from December 2020 to December 2023. A retrospective analysis of the subjects' data was performed, after which the subjects were divided into two groups based on different therapeutic regimens applied: group A (INFIX system for the APR + SS INFIX of the PPR, n = 46) and group B (external fixator for the APR + SS INFIX of the PPR, n = 43). Results. In comparison with group B, group A had a shorter period before the commencement of the first activity after surgery, shorter fracture healing time and joint function recovery time, as well as length of hospital stay (t = 6.623, 4.796, 7.992, and 5.227, respectively, p < 0.05). The surgery duration and bleeding volume showed no significant differences between the two groups (t = 1.433, 1.123, respectively, p > 0.05). The fracture reduction outcomes were better in group A than in group B (Z = 2.058, p < 0.05). The incidence rate of complications was lower in group A than in group B (2.17% vs. 18.60%) (2 = 4.917, p < 0.05). Conclusion. For patients with TCUPT, the INFIX system for the APR with simultaneous application of SS INFIX of the PPR achieves good fracture reduction outcomes. [ABSTRACT FROM AUTHOR]

Study Design: A 2-year follow-up study. Purpose: To evaluate the effectiveness of modified halo-pelvic Ilizarov distraction assembly in the management of patients with severe kyphoscoliosis. Overview of Literature: Severe and rigid scoliosis curves are always a challenge for operating surgeons. Preoperative correction through halo-pelvic devices successfully minimizes the severity of the curve; however, cumbersome complications are also reported with its use. Modified assembly could be safe for these cases. Methods: Patients with severe kyphoscoliosis having coronal Cobb angle >90° were applied with modified halo-pelvic Ilizarov distraction assembly preoperatively. The modified assembly consisted of a pelvic component and halo ring, and distraction was given at the rate of 2–3 mm/day for 6–12 weeks. Complete clinical assessments along with pulmonary function tests were performed, and scoliosis series X-ray images were assessed for coronal and sagittal Cobb angle and other spinopelvic parameters before applying the assembly and during 2 years of follow-up. Results: Thirty-four patients (age, 9–27 years; male/female ratio of 18:16) were included. The coronal and sagittal Cobb angles were 116°±16.2° and 84°±28.3°, respectively. Correction rates obtained through modified halo-pelvic assembly were nearly 52% (p<0.001) in coronal and 40% (p<0.001) in sagittal Cobb angles, with improvement in height (p<0.001). Apical vertebral translation and coronal balance were also improved significantly (p<0.001). Further improvements in all the parameters were obtained after definitive surgery, with improvements in the forced expiratory volume in 1 second (p=0.002) and forced vital capacity (p=0.001). Conclusions: Our modified halo-pelvic Ilizarov distraction assembly can achieve good correction in severe spinal deformities without significant risk to neurology, has fewer complications, and promotes good patient compliance. [ABSTRACT FROM AUTHOR]

Limb lengthening relies on the process of distraction osteogenesis. The active periosteal bone formation has been detected in clinical practice with a lengthening and then nail (LATN) technique but has not been confirmed by experimental studies to date. The aim of this study is to compare the tissue regeneration of the distraction regenerate during tibial lengthening in rabbits using a LATN technique. This study was performed on 54 mature rabbits of the Soviet Chinchilla breed, which were divided into three groups of 18 animals. In group 1 (control), the tibia was lengthened in an external fixator. In group 2, the LATN technique was modeled and in group 3, lengthening over nail (LON) was modeled. The total duration of the experiment was 45 days. On the 10th, 15th, 20th, 30th, and 45th day X‐ray, computed tomography and morphological studies were performed. In the experimental groups (2 and 3), a more pronounced periosteal bone formation in the area of regenerate was noted when compared to group 1. In group 2 (LATN), wide cortical plates were formed from the intermediate and periosteal areas. In this group, the maximum densitometric density values were noted. Endosteal bone formation was preserved in all groups. The LON and LATN techniques, when compared with the classical Ilizarov lengthening, do not demonstrate any deficiency in the tissue regeneration of the bone tissue at the regenerate sites. The most powerful bone structures are formed with the sequential use of the external fixation and nailing (LATN). [ABSTRACT FROM AUTHOR]

Objective: Distances and angles measured from long-leg radiographs (LLR) are important for surgical decision-making. However, projectional radiography suffers from distortion, potentially generating differences between measurement and true anatomical dimension. These phenomena are not uniform between conventional radiography (CR) digital radiography (DR) and fan-beam technology (EOS). We aimed to identify differences between these modalities in an experimental setup. Materials and methods: A hemiskeleton was stabilized using an external fixator in neutral, valgus and varus knee alignment. Ten images were acquired for each alignment and each modality: one CR setup, two different DR systems, and an EOS. A total of 1680 measurements were acquired and analyzed. Results: We observed great differences for dimensions and angles between the 4 modalities. Femoral head diameter measurements varied in the range of > 5 mm depending on the modality, with EOS being the closest to the true anatomical dimension. With functional leg length, a difference of 8.7% was observed between CR and EOS and with the EOS system being precise in the vertical dimension on physical-technical grounds, this demonstrates significant projectional magnification with CR-LLR. The horizontal distance between the medial malleoli varied by 20 mm between CR and DR, equating to 21% of the mean. Conclusions: Projectional distortion resulting in variations approaching 21% of the mean indicate, that our confidence on measurements from standing LLR may not be justified. It appears likely that among the tested equipment, EOS-generated images are closest to the true anatomical situation most of the time. [ABSTRACT FROM AUTHOR]

The elbow joint consists of the ulnohumeral joint, radiocapitellar joint and the proximal radio-ulnar joint. The osseous anatomy, static ligamentous restraints and dynamic stabilizers all contribute to maintain elbow stability. Elbow instability is a commonly encountered condition in clinical practice. There are several ways to classify elbow instability. Instability can be classified as simple or complex based on presence of an associated fracture, it could be classified based on mechanism of injury or it could be classified in a temporal fashion as acute or chronic. It is critical to understand injury patterns that can be treated non-operatively with physiotherapy and mobilization and the ones that need surgery. Surgical management of elbow instability could involve a combination of interventions addressing various ligaments like the lateral ulnar collateral ligament and medial collateral ligament; osseous structures including the radial head, coronoid and proximal ulna based on the mechanism and extent of injury. Adjunctive and salvage procedures may be necessary in delayed presentations or severe injuries. These include application of an internal joint stabilizer, external fixator, internal bracing of the ligament and bone grafting of the coronoid. The goal of treatment of instability is to provide an elbow that is stable and amenable to early active mobilization. [ABSTRACT FROM AUTHOR]

Background: Early soft tissue management is crucial in lower extremity defects, particularly those involving vital tissue exposure, bone integrity impairment or underlying instrumentation material. In the recent literature, free flaps and perforator flaps are considered as suitable options for this region. However early microsurgery planning may not be possible in every center due to the surgical experience, equipment or hospital and patient related factors. In such cases, transposition fasciocutaneous flaps emerge as a more accessible and efficient choice. Methods: All patients who underwent reconstruction with a random pattern transposition flap due to tissue defect in the lower extremity between 2019 and 2023 were retrospectively analyzed. Demographic characteristics, comorbidities, and defect mechanisms were recorded. Additionally, information regarding bone injuries, interventions performed, duration between injury and reconstruction, pre- and post-reconstruction cultures, and antibiotic treatments were documented. Post-reconstruction complications, ambulation period, and discharge time were also assessed. The limitations of microsurgery and reasons for flap planning were noted. Results: Twelve patients were included in this study. The mean age of the patients was 44 (20–67). The mechanism of defects were gunshot (6), fall (3), traffic accident (1), pressure ulcer (1), and tumor excision (1). In three patients (25%) who have previously undergone an operation for soft tissue defect, but there was exposed titanium implant or bone due to skin necrosis, a transposition flap was performed as a salvage procedure. In addition, 8 patients (73%) had multiple or comminuted bone fractures and 1 patient (8.3%) had a single bone fracture. While fixation was performed with titanium implants in 41.7% (5 patients) of the patients in the defect area, the fracture was stabilized with an external fixator in 2 patients and with a Kishner wire in 1 patient. Wound healing was observed good in 10 patients without other complex surgical intervention. Partial necrosis was observed in one patient due to infection. Partial dehiscence was observed in another patient with a pressure ulcer in the calcaneal region which was left to heal secondarily. Conclusions: Transposition fasciocutaneous flaps offers rapid planning process, easy disection and functionally and aesthetically benefits with proper planning. They should be considered as a simple option as salvage of complex soft tissue reconstruction. Level of evidence: Level IV, Therapeutic [ABSTRACT FROM AUTHOR]

Purpose: We aimed to evaluate the safety and effectiveness of three-dimensional (3D)-printed guide plates for assisting in the positioning of the rotation axis of an elbow-hinged external fixator. Methods: Terrible triad (TT) patients, who were screened using the predefined inclusion and exclusion criteria, underwent installation of a hinged external fixator on the basis of internal fixation; 3D-printed guide plates, generated from the patient's imaging data, assisted in positioning the rotation axis. All patients received the same peri-operative management and were followed up at six, 12, 24, and 48 weeks postoperatively. The duration of positioning pin placement, the number of fluoroscopies, pin placement success rate, types and incidence of post-operative complications, and the Mayo elbow performance score (MEPS) of the diseased elbow and range of motion (ROM) of both elbows were assessed. Results: In 25 patients who completed the follow-up, the average time required for positioning pin placement was 329.32 ± 42.38 s (263–443 s), the average number of fluoroscopies was 2.32 ± 0.48 times (2–3 times), and the pin placement success rate was 100%. At the last follow-up, the mean MEPS of the diseased elbow was 97.50 ± 6.92 (75–100), with an excellent and good rate of 100%, and all patients demonstrated stable concentric reduction. The average range of flexion and extension was 135.08° ± 17.10° (77–146°), while the average range of rotation was 169.21° ± 18.14° (108–180°). No significant difference was observed in the average ROM between the both elbows (P > 0.05). Eight (32%) patients developed post-operative complications, including elbow stiffness due to heterotopic ossification in three (12%) patients, all of whom did not require secondary intervention. Conclusion: Utilizing 3D-printed guide plates for positioning the rotation axis of an elbow-hinged external fixator significantly reduced intra-operative positioning pin placement time and the number of fluoroscopies with excellent positioning results. Satisfactory results were also obtained in terms of post-operative complications, elbow ROM, and functional scores. [ABSTRACT FROM AUTHOR]

Purpose: Ankle fracture-dislocations (AFD) often necessitate staged management involving temporary external fixation (EF) due to mechanical instability or blistering. However, limited literature exists on the optimal temporary immobilization method for low-energy closed AFD. This study compared baseline patient and fracture characteristics, along with clinical and radiological outcomes between AFD initially immobilized with EF versus splinting. Methods: A retrospective cohort study was conducted involving patients with AFD temporarily immobilized using EF or splinting, followed by definitive open reduction and internal fixation. Quality of reduction (QOR) was assessed for each patient post-initial immobilization and after the definitive surgery. Results: The study encompassed 194 patients: 138 treated with a splint (71.1%) and 56 (28.9%) with EF. Secondary loss of reduction had occurred in three patients who were splinted (2.2%). The mean ages in the EF and splint groups were 63.2 and 56.1 years, respectively (p = 0.01). Posterior malleolus fracture (PMF) and blisters were more prevalent in EF patients (69.6% vs. 43.5% for PMF and 76.8% vs. 20.3% for blisters, respectively; p = 0.05 and p < 0.01). Postoperative complication rates were 8.9% for EF versus 10.9% for splinting (p = 0.69). Satisfactory final QOR was attained in 79.8% of patients treated with a splint versus 64.3% with EF (p = 0.02). Conclusion: Patients immobilized by EF presented with poorer baseline characteristics and had more unstable injuries. Nevertheless, postoperative complication rates were comparable. Thus, EF appears to be a valuable tool for standardizing outcomes in AFD patients with a less favorable prognosis. [ABSTRACT FROM AUTHOR]

Background: Grade III open tibial diaphyseal fractures are challenging to treat and controversy exists on whether to treat them with an intramedullary nail (IMN) or a circular frame (CF). This study aims to compare outcomes for intramedullary nail and circular frame in the treatment of open tibial diaphyseal fractures. Methodology: Retrospective study at a major trauma center of all patients admitted with a grade III open tibial diaphyseal fracture between January 2016 and January 2022. The primary outcome measures were major complications: non-union, malunion, refracture, DBI and amputation. Secondary outcome measures were time to union and reoperation rates. Results: Fifty-five patients were included in the study, 32 patients in CF group and 23 patients in IMN group. There were no significant differences in the baseline demographics of patients in both groups. Major complications were recorded in 13 limbs (54%) in IMN group and in 18 limbs (56%) in CF group which were not statistically significant (p = 0.797). Deep bone infection rates were noted in 4 (12.5%) in the CF group, compared to 1 (4%) in IMN group; however, the result was not statistically significant (p = 0.240). Amputation rates as a result of infected non-unions were seen in 1 limb (4%) in IMN group and 2 limbs (6%) in CF group (p = 0.99). Median time to union was significantly shorter in IMN group at 30 weeks compared to 30 weeks for CF group (p = 0.04). Conclusion: IMN should be the treatment of choice in the treatment of grade III open tibial diaphyseal fracture, but CF should be considered for delayed treatment and in patients with bone loss. [ABSTRACT FROM AUTHOR]

The article discusses the use of cross leg flaps as a solution for wound coverage in cases of severe leg trauma. While the frequency of cross leg flap procedures has decreased with the advancement of microsurgical techniques, it is still important to have this technique available as a last resort or in areas without microsurgical expertise. The article provides technical tips and an algorithmic approach for deciding on the type of fixation technique for maintaining the position of the two limbs during the procedure. The authors propose the use of external fixators and describe the process of creating a fixator frame specifically for cross leg flaps. The article also emphasizes the importance of patient comfort and preventing pressure sores during the postoperative period. [Extracted from the article]

Background and Purpose: Two basic methods for genu valgum correction are osteotomy and internal fixation or external fixator assited correction. External fixators have the advantage of stabilizing fragments before osteotomy allowing better control of fragments and preventing secondary displacements. The purpose of this study was to evaluate the efficacy and complications of fixator assisted correction for genu valgum and internal fixation, using the AO distal femur pediatric osteotomy plate. Materials and Methods: Thirty-six limbs in 26 patients (age 10–16 years) underwent osteotomy in the distal femur at CORA. Open lateral wedge osteotomy was done; the desired position obtained was temporarily stabilized by connecting the pins with the AO external fixator and stabilized with 90 degrees AO distal femur pediatric locking plate and gap grafted with hydroxyapatite bone granules. Results: Translation of distal fragment was required in 17 osteotomies (53.12%). Osteotomies united within 12 weeks; no non-union was observed. The range of motion was full in all patients. The mean tibiofemoral angle was corrected by 12 degrees and the mean mechanical LDFA was corrected to 87 degrees. There was no secondary deformity, either in the rotational or sagittal plane. Conclusion: This method combines the modularity of external fixator and the advantages of internal fixation. [ABSTRACT FROM AUTHOR]

Purpose: Healing after bone fracture is assessed by clinical examination and frequent radiographs, which expose patients to radiation and lack standardisation. This study aimed to explore electrical impedance patterns during bone healing using electrical impedance spectroscopy in 18 rabbits subjected to tibial fracture stabilised with an external fixator. Methods: Impedance was measured daily across the fracture site at a frequency range of 5 Hz to 1 MHz. Biweekly radiographs were analysed using modified anterior‐posterior (AP) radiographic union score of the tibia (RUST). The animals were divided into three groups with different follow‐up times: 1, 3 and 6 weeks for micro‐computer tomography and mechanical testing. Results: A decreasing trend in impedance was observed over time for all rabbits at lower frequencies. Impedance closest to 5 Hz showed a statistically significant decrease over time, with greatest decrease occurring during the first 7 postoperative days. At 5 Hz, a statistically significant correlation was found between impedance and the modified AP RUST score and between impedance and bone volume fraction. Conclusions: This study showed that the electrical impedance can be measured in vivo at a distance from the fracture site with a consistent change in impedance over time and revealed significant correlation between increasing radiographic union score and decreasing impedance. Level of Evidence: Not applicable. [ABSTRACT FROM AUTHOR]

Background: Evidence concerning the complex foot trauma, especially its definitive management, is scarce. Soft tissue envelope sequalae are the primary parameters that delay or make internal fixation implausible. Stability conferred by external fixators makes them a reasonable initial treatment choice. Although AO or circular fixators can be applied around the foot, this can involve a learning curve and substantial costs, especially for the circular fixator. There is little evidence as to how well external fixators work as a definite method of fixation in patients where progression to internal fixation cannot be made. Methods: We prospectively evaluated 10 adult patients with severe and complex foot trauma who were consecutively treated at our clinic. Initial reduction and stabilization were performed with an external fixator that was initially conceived for distal radius fractures, applied during the initial procedure and mantained throughout the treatment. Results: Fracture healing was obtained in all 10 cases, and both internal and external column length was restored. One of the patients developed chronic osteomyelitis. At the 1-year follow-up visit, these patients averaged 45.6 points in the physical and 44.8 points on the mental status sections of the 12-Item Short Form Health Survey (SF-12). The Foot Function Index findings for pain, disability, and daily activities limitations were 33.3, 39, and 41.5, respectively, which suggest moderate residual impairment. Conclusion: In this relatively small case series of complex foot trauma, we found that the use of simple external fixation as definitive treatment worked reasonably well. Level of Evidence: Level III, prospective cohort study. [ABSTRACT FROM AUTHOR]

Deep soft tissue defects next to the joints can rapidly lead to irreversible damages and have to be covered urgently and effectively. In severely burned patients the usual approach is to use a flap even though it has its limitations in regards to the extent of the burn and the general condition of the patient. A 27-year-old male was admitted at the Burn Treatment Center for a thermic burn of 72% of his BSA. At first he has benefited from several skin grafts and later on a major open right elbow had to be treated urgently to rescue the joint. After the burn, a revascularization of the donor site was noticed, sufficient to use the radial forearm pedicled flap as a cover for the elbow. This case reports an innovative approach based on the use of an irrigation and drainage system placed underneath the flap. The elbow was rigidly immobilized with an external fixator in order to facilitate an optimal healing of the flap. In this case, the choice of this flap, combined with the irrigation and drainage system and the immobilization by external fixation, provided an original and efficient treatment. Postoperatively the healing of the flap and of the donor site was complete. The functional results exceeded the expectations with a complete recovery of the joint amplitude. Thus, in case of no other therapeutic options, it is probably possible to use a variety of flaps recently healed. [ABSTRACT FROM AUTHOR]

Floating elbow represents an injury that is a combination of ipsilateral humeral shaft and forearm fractures. Shotgun injury of the elbow is a very severe and complex type of injury, often with complications such as infection, nerve palsy, and range of motion limitation. We present a case report of a 46-year-old man with a gunshot wound to the right elbow. He sustained an injury of the distal humerus and proximal ulna which resulted in a floating elbow injury. As the initial clinical exam indicated normal neurovascular status, after adequate preoperative preparation, primary surgical treatment of the wound was performed under general endotracheal anesthesia as well as stabilisation of the right elbow with the Mitković external fixator with two pins placed in the humeral shaft and two pins placed in ulna shaft. Two weeks later we performed internal fixation of the mentioned injury. Surgical treatment of such severe gunshot wounds requires primary treatment with an external fixator with subsequent conversion to internal fixation when the local status of the wound is normal. Floating elbow injuries should be brought into the correct anatomical reposition as soon as possible with internal fixation because it allows us to have good function of the elbow with the best possible range of motion. [ABSTRACT FROM AUTHOR]

Purpose: To present the technique of correction of multiplanar deformities around the knee in children and adolescents using the monolateral external fixator. Also, to evaluate the results of the technique regarding radiological correction, time to union, and possible complications. Methods: A total of 29 patients (47 limbs) were prospectively included in the study (14 males and 15 females). Their median age was 13 years (range, 7–17). All patients had at least a 2-plane deformity around the knee which was corrected using a monolateral external fixator. The primary outcome measure was deformity correction (correction of mechanical axis deviation (MAD) in both the coronal and sagittal planes with correction of rotational deformities). The secondary outcome measures included bony union, radiographic, and functional results (assessed by using the Association for the Study and Application of the Method of Ilizarov (ASAMI) score). Results: The median pre-operative MAD improved from 6.3 to 0.4 cm post-operatively. According to the ASAMI scoring system, the radiographic scoring was excellent in all cases (100%), and the functional scoring was excellent in 22 cases (89.7%) and good in three cases (10.3%). Conclusion: The simple monolateral fixator can be an effective tool for multiplanar correction of complex deformities around the knee without limb length discrepancy. [ABSTRACT FROM AUTHOR]

The Ilizarov fixator is a type of external fixator that is used to treat patients who have suffered injuries from accidents, bone shortening, or nonunion of the bone. The principle behind the Ilizarov fixator is that thin wires (called Kirschner wires) are used to support the bones and connect them to framed rings. Before being fastened to the rings, the wires are tensioned and drilled through the bones. This study suggests using a new parallel wires configuration at the same level on the same ring and two revised versions, which are divergent and convergent models, and compare them with standard wires, 60 angle wires model. All models were designed using SolidWorks, a computer-aided design (CAD) software, and then analyzed in four conditions (axial compression, medial bending, posterior bending, and torsion) with Finite Element Analysis (FEA) using Ansys Workbench 2020 R2. Mechanical testing was conducted to validate the FEA results, A simple model consisting of a single ring, two K-wires, and polylactic acid (PLA) cylinders was utilized in a tensile test. It has been concluded from the results that the parallel model and its improvement have higher stiffness to axial compression, medial bending, and torsion, but a lower posterior bending stiffness, except the divergent model with 8-hole separation which has a relatively acceptable stiffness for posterior bendin [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: This study aimed to evaluate the surgical treatment of diaphyseal femur fractures in polytraumatized children, considering consolidation rate, complications, and function as outcomes of interest. Methods: This is a quantitative, cross-sectional, and retrospective study of medical records of patients treated from 2012 to 2021. The 39 patients (41 femurs) were divided into four groups according to the method of osteosynthesis. We used the IBM SPSS Statistics software, version 20 (SPSS Inc, Chicago, IL), and performed Chi-square, Fisher, Kruskal-Wallis, and Shapiro-Wilk tests with a significance level of 5%. Results: We observed six complications among patients. Functional outcomes were satisfactory in 40 cases (97.6%) and unsatisfactory in one case (2.40%) according to the adopted criteria. We found one case (2.40%) of non-union and one case (2.40%) of malunion, whereas 39 cases (95.20%) achieved full consolidation. Conclusions: Flexible intramedullary nails and external fixators are the preferred options for patients aged 5 to 10 years. Intramedullary nails, plates, or external fixators are prioritized for patients over 11 years old. The type and pattern of fractures were considered relevant for treatment selection. Level of evidence III, Therapeutic study - Investigation of outcomes and treatment. Comparative retrospective study.

ABSTRACT Flexible intramedullary nailing and external fixation have become the main methods to surgically treat femur fractures in children. This study aimed to search the current literature and evaluate the clinical and radiographic results of surgical treatment by comparing these methods and investigating their associated complications. This systematic review was carried out following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) recommendations. Searches were carried out on the PubMed, Embase, and Web of Science databases. The search for journals in these databases was carried out from January 2023 to August 2023, retrieving 695 studies. This systematic review included 11 articles, which encompassed 718 patients who underwent surgical external fixation and flexible nailing. The most frequently observed complications referred to late or malunion, superficial and deep infections, skin irritation, angular deformity, and length discrepancy between lower limbs. Both methods of stabilization of pediatric femoral fractures can provide good clinical and radiographic results. However, the choice of treatment with flexible nails is certainly more valid and has greater acceptance than external fixation. Level of Evidence III, Systematic Review .

Objective: to evaluate three methods of nasogastric tube fixation in terms of adhesion, displacement and skin integrity. Method: ex vivo study, with a sample of 30 experimental noses (10 for each type of fixation), developed with porcine skin, based on the average measurements of the human nose, in which 14-gauge polyvinyl chloride probes were inserted and 2 methods of fixation with adhesive tape (Fixation A and B) and one with an industrial device (Fixation C) were used. Each group was exposed to traction of 50, 100 and 500g sequentially over 12 and 24 hours, testing: adhesion capacity, probe displacement and skin integrity. The Chi-square test of independence was calculated for nominal variables and Student’s t-tests and analysis of variance (p< 0.05) for rational variables. Results: fixation B showed lower adhesion capacity (p

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)