المؤلفون: Ma, Pengcheng¹ (AUTHOR), Zheng, Jiachun¹ (AUTHOR), Chen, Huizhi¹ (AUTHOR), Yang, Weijie¹ (AUTHOR), Gao, Hongwei¹ (AUTHOR) gaohongwei202210@163.com

المصدر: International Orthopaedics. Jul2024, Vol. 48 Issue 7, p1799-1808. 10p.

مصطلحات موضوعية: *FLUOROSCOPY, *ELBOW, *SURGICAL complications, *ROTATIONAL motion, *HETEROTOPIC ossification, EXTERNAL fixators

مستخلص: 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]

المؤلفون: Elbarbary, Hassan¹ (AUTHOR), Abdelmohsen, Ahmed¹ (AUTHOR), Zein, Abo-Bakr¹ (AUTHOR), Arafa, Amr¹ (AUTHOR), Hegazy, Mohamed¹ (AUTHOR), Yaseen, Ahmed¹ (AUTHOR), Afifi, Ahmed¹ (AUTHOR) ahmedafifi@kasralainy.edu.eg

المصدر: International Orthopaedics. Jun2024, Vol. 48 Issue 6, p1427-1438. 12p.

مصطلحات موضوعية: *HUMAN abnormalities, *KNEE, *TEENAGERS, *ANATOMICAL planes, EXTERNAL fixators

مستخلص: 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]

المؤلفون: Wen, Yuwei¹ (AUTHOR), Wang, Qiang¹ (AUTHOR) wangqiangmd@aliyun.com, Song, Baojian¹ (AUTHOR), Feng, Wei¹ (AUTHOR), Zhu, Danjiang¹ (AUTHOR)

المصدر: BMC Musculoskeletal Disorders. 5/18/2024, Vol. 25 Issue 1, p1-9. 9p.

مصطلحات موضوعية: *INTRAMEDULLARY rods, *FEMORAL fractures, *FEMUR, *FRACTURE healing, *HIP fractures, EXTERNAL fixators

مستخلص: Background: Several methods have been used for the treatment of pediatric distal femoral fractures, such as elastic stable intramedullary nail (ESIN), external fixator (EF) and plate osteosynthesis, but there has been no consensus about the optimal method. The purpose of this study was to compare the clinical outcome between EF and ESIN techniques used in metaphyseal-diaphyseal junction (MDJ) fractures of the pediatric distal femur. Methods: We retrospectively analyzed operatively treated MDJ fractures of pediatric distal femur between January 2015 and January 2022. Patient charts were reviewed for demographics, injury and data of radiography. All of the patients were divided into EF and ESIN groups according to the operation techniques. Malalignment was defined as more than 5 degrees of angular deformity in either plane. Clinical outcomes were measured by Flynn scoring system. Results: Thirty-eight patients were included in this study, among which, 23 were treated with EF, and 15 with ESIN. The mean follow-up time was 18 months (12-24 months). At the final follow-up, all of the fractures were healed. Although there were no statistical differences between the two groups in demographic data, length of stay, estimated blood loss (EBL), rate of open reduction, time to fracture healing and Flynn score, the EF was superior to ESIN in operative time, fluoroscopic exposure and time to partial weight-bearing. The EF group had a significantly higher rate of skin irritation, while the ESIN had a significantly higher rate of malalignment. Conclusion: EF and ESIN are both effective methods in the treatment of MDJ fractures of the pediatric distal femur. ESIN is associated with lower rates of skin irritation. However, EF technique has the advantages of shorter operative time, reduced fluoroscopic exposure, and shorter time to partial weight-bearing, as well as lower incidence of malalignment. Level of evidence: Level III. [ABSTRACT FROM AUTHOR]

المؤلفون: Liu, Sida^1,2,3 (AUTHOR), Lu, Lin^1,2,3 (AUTHOR), Chen, Tao^1,2,3 (AUTHOR), Liu, Yanshi⁴ (AUTHOR), Wei, Dong⁵ (AUTHOR), Miao, Jun⁶ (AUTHOR) mj6688@tju.edu.cn, Yu, Defu³ (AUTHOR) anhuiyudefu@sina.com, Fu, Xuefei³ (AUTHOR) fxf18355105781@outlook.com

المصدر: BMC Musculoskeletal Disorders. 5/9/2024, Vol. 25 Issue 1, p1-14. 14p.

مصطلحات موضوعية: *FRACTURE healing, *ORTHOPEDISTS, *TIBIAL fractures, *TREATMENT of fractures, EXTERNAL fixators

مستخلص: Background: External fixation is widely used in the treatment of traumatic fractures; however, orthopedic surgeons encounter challenges in deciding the optimal time for fixator removal. The axial load-share ratio (LS) of the fixator is a quantitative index to evaluate the stiffness of callus healing. This paper introduces an innovative method for measuring the LS and assesses the method's feasibility and efficacy. Based on a novel hexapod LS-measurement system, the proposed method is to improve the convenience and precision of measuring LS in vivo, hence facilitating the safe removal of external fixators. Methods: A novel hexapod system is introduced, including its composition, theoretical model, and method for LS measurement. We conducted a retrospective study on 82 patients with tibial fractures treated by the Taylor Spatial Frame in our hospital from September 2018 to June 2020, of which 35 took LS measurements with our novel method (Group I), and 47 were with the traditional method (Group II). The external fixator was removed when the measurement outcome (LS < 10%) was consistent with the surgeon's diagnosis based on the clinical and radiological assessment (bone union achieved). Results: No significant difference was found in the fracture healing time (mean 25.3 weeks vs. 24.9 weeks, P > 0.05), frame-wearing duration (mean 25.5 weeks vs. 25.8 weeks, P > 0.05), or LS measurement frequency (mean 1.1 times vs. 1.2 times, P > 0.05). The measurement system installation time in Group I was significantly shorter compared to Group II (mean 14.8 min vs. 81.3 min, P < 0.001). The LS value of the first measurement in Group I was lower than that of Group II (mean 5.1% vs. 6.9%, P = 0.011). In Group I, the refracture rate was 0, but in Group II it was 4.3% (2/47, P > 0.05). Conclusion: The novel hexapod LS-measurement system and involved method demonstrated enhanced convenience and precision in measuring the LS of the external fixator in vivo. The LS measurement indicates the callus stiffness of fracture healing, and is applicable to evaluate the safety of removing the fixator. Consequently, it is highly recommended for widespread adoption in clinical practice. [ABSTRACT FROM AUTHOR]

المؤلفون: Wang, Yu¹ (AUTHOR), Dong, Mingjie¹ (AUTHOR), Zuo, Guoyu² (AUTHOR), Li, Jianfeng¹ (AUTHOR), Ju, Jie¹ (AUTHOR), Ma, Qianhui¹ (AUTHOR), Zuo, Shiping² (AUTHOR) zuoshiping@bjut.edu.cn

المصدر: Applied Mathematical Modelling. Sep2024, Vol. 133, p394-413. 20p.

مصطلحات موضوعية: *PARAMETER identification, *MEDICAL equipment, *CALIBRATION, *ORTHOPEDIC surgery, *IDENTIFICATION, *POSE estimation (Computer vision), EXTERNAL fixators

مستخلص: • 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]

المؤلفون: Zhao, Yong^1,2 (AUTHOR) nihaoedde@126.com, Ma, Yupeng^1,2 (AUTHOR), Wu, Hao^1,2 (AUTHOR), Lian, Wei^2,3 (AUTHOR), Li, Wenliang^1,2 (AUTHOR), Jiang, Wenkang^1,2 (AUTHOR)

المصدر: Scientific Reports. 4/25/2024, Vol. 14 Issue 1, p1-9. 9p.

مصطلحات موضوعية: *SACRAL fractures, *PELVIC fractures, *COMPRESSION loads, *FINITE element method, *VAGINAL contraceptives, *PELVIS, *SACRUM, *ECCENTRIC loads, EXTERNAL fixators

مستخلص: To compare the biomechanical properties of several anterior pelvic ring external fixators with two new configurations in the treatment of Tile C pelvic fractures, in order to evaluate the effectiveness of the new configurations and provide a reference for their clinical application. A finite element model of a Tile C pelvic ring injury (unilateral longitudinal sacral fracture and ipsilateral pubic fracture) was constructed. The pelvis was fixed with iliac crest external fixator (IC), anterior inferior iliac spine external fixator (AIIS), combination of IC and AIIS, combination of anterior superior iliac spine external fixator (ASIS) and AIIS, and S1 sacroiliac screw in 5 types of models. The stability indices of the anterior and posterior pelvic rings under vertical longitudinal load, left–right compression load and anterior–posterior shear load were quantified and compared. In the simulated bipedal standing position, the results of the vertical displacement of the midpoint on the upper surface of the sacrum are consistent with the displacement of the posterior rotation angle, and the order from largest to smallest is IC, AIIS, ASIS + AIIS, IC + AIIS and S1 screw. The longitudinal displacement of IC is greater than that of the other models. The displacements of ASIS + AIIS and IC + AIIS are similar and the latter is smaller. In the simulated semi-recumbent position, the vertical displacement and posterior rotation angle displacement of the midpoint on the upper surface of the sacrum are also consistent, ranking from large to small: IC, AIIS, ASIS + AIIS, IC + AIIS and S1 screw. Under the simulated left–right compression load state, the lateral displacements of the highest point of the lateral sacral fracture end are consistent with the highest point of the lateral pubic fracture end, and the order from large to small is S1 screw, IC, AIIS, ASIS + AIIS and IC + AIIS, among which the displacements of S1 screw and IC are larger, and the displacements of ASIS + AIIS and IC + AIIS are similar and smaller than those of other models. The displacements of IC + AIIS are smaller than those of ASIS + AIIS. Under the simulated anterior–posterior shear load condition, the posterior displacements of the highest point of the lateral sacral fracture end and the highest point of the lateral pubic fracture end are also consistent, ranking from large to small: IC, AIIS, ASIS + AIIS, IC + AIIS and S1 screw. Among them, the displacements of IC and AIIS are larger. The displacements of ASIS + AIIS and IC + AIIS are similar and the latter are smaller. For the unstable pelvic injury represented by Tile C pelvic fracture, the biomechanical various stabilities of the combination of IC and AIIS are superior to those of the external fixators of conventional configurations. The biomechanical stabilities of the combination of ASIS and AIIS are also better than those of the external fixators of conventional configurations, and slightly worse than those of the combination of IC and AIIS. Compared with sacroiliac screw and conventional external fixators, the lateral stabilities of IC + AIIS and ASIS + AIIS are particularly prominent. [ABSTRACT FROM AUTHOR]

المؤلفون: Maimaiti, Xiayimaierdan¹ (AUTHOR), Liu, Kai¹ (AUTHOR), Yusufu, Aihemaitijiang¹ (AUTHOR) ahmatjang@163.com, Xie, Zengru¹ (AUTHOR) xiezenru@126.com

المصدر: BMC Musculoskeletal Disorders. 4/12/2024, Vol. 25 Issue 1, p1-7. 7p.

مصطلحات موضوعية: *INTRAMEDULLARY rods, *SURGICAL blood loss, *SURGICAL complications, *AGE differences, *TREATMENT effectiveness, EXTERNAL fixators

مستخلص: Background: The purpose of the study was to assess and compare the clinical efficacy of bone transport with either circular or unilateral external fixators over an intramedullary nail in the treatment of tibial bone defects caused by infection. Methods: Between May 2010 and January 2019, clinical and radiographic data were collected and analyzed for patients with bone defects caused by infection. Thirteen patients underwent bone transport using a unilateral external fixator over an intramedullary nail (Group A), while 12 patients were treated with a circular external fixator over an intramedullary nail (Group B). The bone and functional outcomes of both groups were assessed and compared using the Association for the Study and Application of the Method of the Ilizarov criteria, and postoperative complications were evaluated according to the Paley classification. Results: A total of 25 patients were successfully treated with bone transport using external fixators over an intramedullary nail, with a mean follow-up time of 31.63 ± 5.88 months. There were no significant statistical differences in age, gender, previous surgery per patient, duration of infection, defect size, and follow-up time between Group A and Group B (P > 0.05). However, statistically significant differences were observed in operation time (187.13 ± 21.88 min vs. 255.76 ± 36.42 min, P = 0.002), intraoperative blood loss (39.26 ± 7.33 mL vs. 53.74 ± 10.69 mL, P < 0.001), external fixation time (2.02 ± 0.31 month vs. 2.57 ± 0.38 month, P = 0.045), external fixation index (0.27 ± 0.08 month/cm vs. 0.44 ± 0.09 month/cm, P = 0.042), and bone union time (8.37 ± 2.30 month vs. 9.07 ± 3.12, P = 0.032) between Group A and Group B. The excellent and good rate of bone and functional results were higher in Group A compared to Group B (76.9% vs. 75% and 84.6% vs. 58.3%). Statistically significant differences were observed in functional results (excellent/good/fair/poor, 5/6/2/0 vs. 2/5/4/1, P = 0.013) and complication per patient (0.38 vs. 1.16, P = 0.012) between Group A and Group B. Conclusions: Bone transport using a combined technique of external fixators over an intramedullary nail proved to be an effective method in treating tibial bone defects caused by infection. In comparison to circular external fixators, bone transport utilizing a unilateral external fixator over an intramedullary nail resulted in less external fixation time, fewer complications, and better functional outcomes. [ABSTRACT FROM AUTHOR]

المؤلفون: Jiang, Feijuan¹, Guo, Hao¹, Zeng, Qing¹, Long, Peibo¹, Zeng, Canjun¹ zengcanjun@163.com, Yan, Han¹ 286160668@qq.com

المصدر: Foot & Ankle Surgery. Apr2024, Vol. 30 Issue 3, p239-244. 6p.

مصطلحات موضوعية: *ANKLE fractures, *PREOPERATIVE period, *PATIENT satisfaction, *HOSPITAL care, EXTERNAL fixators

مستخلص: The authors developed a simple extensible external fixator, which has the advantages of easy application and inexpensiveness. The present study aimed to make a comparison between this external fixator and calcaneal traction in preoperative temporary fixation for malaligned ankle fractures and pilon fractures. From May 2020 to February 2022, patients with malaligned ankle fractures or Rüedi-Allgöwer type 2 or 3 pilon fractures with obvious soft tissue swelling were retrospectively reviewed and divided into the calcaneal traction group and the external fixation group. The two groups of patients were matched 1:1 before making comparisons. A total of 38 patients were included. Higher General Comfort Questionnaire score and lower visual analog scale score were noticed in the external fixation group during hospitalization (p < 0.05), while the operation latency time, total cost, patient satisfaction, and functional outcomes one year after surgery were not significantly different between the two groups. No wound complications were observed. Preoperative temporary fixation for fractures around the ankle using this simple extensible external fixator significantly improves patient comfort when compared to calcaneal traction. III, retrospective comparative study. [ABSTRACT FROM AUTHOR]

المؤلفون: YEŞİLOVALI, Gökay¹ gokay.yesilovali@neu.edu.tr, ÇETİNKAYA, Mehmet Alper^1,2

المصدر: Veterinary Journal of Ankara University / Ankara Universitesi Veteriner Fakultesi Dergisi. 2024, Vol. 71 Issue 2, p215-224. 10p.

مصطلحات موضوعية: *FRACTURE healing, *RANGE of motion of joints, *DOGS, EXTERNAL fixators

مستخلص: This study aims to describe a novel design of an acrylic external skeletal fixator (ESF) system for stabilizing epiphyseal/metaphyseal fractures with or without articular involvement and evaluate its efficiency in 13 cases. Client-owned five cats and eight dogs with epiphyseal/metaphyseal fractures were included in this study. Cross pins with or without a transcortical pin were included in "J" shaped acrylic ESF, and this novel technique was called the Tie-cross ESF. The functional use of the extremity was evaluated, and the joint range of motion was assessed and compared with the contralateral side. Radiographs were evaluated for bone healing and potential complications. The first use of the extremities changed from the day of surgery to the 3rd day. Fracture healing occurred in 35-69 days, and ESFs were removed. No persistent lameness was observed, and total functional recovery was provided in all cases. Fixation of epiphyseal and metaphyseal fractures can be challenging, especially when it involves the articular surface. Including cross-pins in an acrylic ESF (Tie-cross ESF) is useful and can be considered an alternative technique for stabilizing these fractures. This technique encourages the patient to use the extremity during the fracture healing and enables joint functions; therefore, additional physical therapy will not be necessary. [ABSTRACT FROM AUTHOR]

المؤلفون: Marcel, Aaron J.¹ (AUTHOR) Aaron.marcel@quinnipiac.edu, Green, Joshua S.¹ (AUTHOR), Porrino, Jack² (AUTHOR), Katz, Lee D.² (AUTHOR), Medvecky, Michael J.³ (AUTHOR)

المصدر: Skeletal Radiology. Apr2024, Vol. 53 Issue 4, p629-636. 8p.

مصطلحات موضوعية: *KNEE injuries, *MAGNETIC resonance imaging, *LITERATURE reviews, *KNEE dislocation, *MAGNETIC flux density, *RADIO frequency therapy, *MEDICAL artifacts, EXTERNAL fixators

مستخلص: After emergent assessment of potentially limb-threatening injuries in knee dislocation or multi-ligament knee injury patients, magnetic resonance imaging is necessary to visualize ligamentous structures and plan for soft tissue repair. However, the application of a knee-spanning external fixator may introduce artifact and reduce overall image quality, which can limit the evaluation of soft tissue injury. As a result, the utility of MRI in the context of a knee-spanning external fixator has been called into question. Signal-to-noise ratio, contrast-to-noise ratio, and qualitative scales have been used to assess image quality of MRI in the context of a knee-spanning external fixator. Despite the potential for artifact, studies have demonstrated that useful diagnostic information may be obtained from MRI in the presence of an external fixator. This review examines the general principles of anatomical assessment, magnetic field strength, device composition and design, radiofrequency coil use, and MRI sequences and artifact reduction as they pertain to MRI in the presence of a knee-spanning external fixator. [ABSTRACT FROM AUTHOR]