Analysis of usage and associated cost of external fixators at an urban level 1 trauma centre

Chaus, George W.; Dukes, Chase; Hak, David J.; Mauffrey, Cyril; Hammerberg, E. Mark

doi:10.1016/j.injury.2014.04.031

Cited by 24 publications

(23 citation statements)

References 15 publications

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“…If this novel external fixator is applied in a clinical setting after appropriate verification and validation techniques dictated by global or local regulatory health agencies, it would be readily accessible to the average patient. In a retrospective study, the cost associated with current definitive fixation for femoral shaft in a clinical setting was on average $15, 374 [19]. Fixation devices used in other applications had a cost which ranged from $3556 to $20,486.…”

Section: Discussionmentioning

confidence: 99%

Low cost 3D printed clamps for external fixator for developing countries: a biomechanical study

et al. 2020

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Background External fixation is a mainstream limb reconstruction technique, most often used after a traumatic injury. Due to the high rates of trauma in developing countries, external fixation devices are often utilized for immediate fracture stabilization and soft tissue repair. Proper external fixation treatment too often still fails to be adopted in these regions due to the high cost and trauma complexity. A novel, inexpensive, unilateral fixator was constructed using 3D printed clamps and other readily available supporting components. ASTM standard F1541 tests were used to assess the biomechanical properties of this novel external fixator. Methods Applicable sections of ASTM standard F1541 were used to determine the biomechanical properties of the novel external fixator. 3D printed clamps modeled using SolidWorks and printed with chopped carbon fibers using a fuse deposition modeling (FDM) based 3D printer by Markforged (Boston, MA) were used. This study included 3 different testing configurations: axial compression, anterior-posterior (AP) bending, and medial-lateral (ML) bending. Using the novel unilateral fixator with 3D printed clamps previously sterilized by autoclave, an input load was applied at a rate of 20 N/s, starting at 0 N via a hydraulic MTS tester Model 359. Force and deformation data were collected at a sampling rate of 30 Hz. There was a load limit of 750 N, or until there was a maximum vertical deformation of 6 mm. Also, 4 key dimensions of the 3D printed clamps were measured pre and post autoclave: diameter, width, height and length. Results The novel external fixator had axial compression, AP and ML bending rigidities of 246.12 N/mm (σ = 8.87 N/mm), 35.98 N/mm (σ = 2.11 N/mm) and 39.60 N/mm (σ =2.60 N/mm), respectively. The 3D printed clamps shrunk unproportionally due to the autoclaving process, with the diameter, width, height and length dimensions shrinking by 2.6%, 0.2%, 1.7% and 0.3%, respectively. Conclusion Overall, the biomechanical properties of the novel fixator with 3D printed clamps assessed in this study were comparable to external fixators that are currently being used in clinical settings. While the biomechanics were comparable, the low cost and readily available components of this design meets the need for low cost external fixators in developing countries that current clinical options could not satisfy. However, further verification and validation routines to determine efficacy and safety must be conducted before this novel fixator can be clinically deployed. Also, the material composition allowed for the clamps to maintain the appropriate shape with minimal dimensional shrinkage that can be accounted for in clamp design.

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Section: Discussionmentioning

confidence: 99%

Low cost 3D printed clamps for external fixator for developing countries: a biomechanical study

et al. 2020

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“…A recent estimate of direct costs of temporary external fixators used for damage control application in pelvic injuries and lower extremity fractures at the authors' institution revealed an average cost of $5900 per fixator frame construct and implant costs of $670,805 annually. 41 In contrast, a nonthreaded stainless steel Kwire costs approximately $8. Thus, a conservative estimate of $20 per dual-wire ankle pinning extrapolates to a 300fold decrease in implant costs compared with an average spanning external fixator construct.…”

Section: N Trauma Updatementioning

confidence: 99%

“…Thus, a conservative estimate of $20 per dual-wire ankle pinning extrapolates to a 300fold decrease in implant costs compared with an average spanning external fixator construct. 41 From a biomechanical perspective, another evident benefit of ankle pinning is the achievement of rigid stability and retention of tibiotalar joint reduction by transarticular K-wires, compared with the relative stability by spanning external fixators allowing residual micromotion at the ankle joint. Figure 4 shows an example of damage control pin transfixation for a Limitations of this study include the design of a retrospective analysis of a prospective database, the shortcomings of a CPT-based data query, and the small study cohort of 13 patients.…”

Section: N Trauma Updatementioning

confidence: 99%

Temporary Transarticular K-wire Fixation of Critical Ankle Injuries at Risk: A Neglected “Damage Control” Strategy?

Friedman¹,

Ly²,

Mauffrey³

et al. 2015

Orthopedics

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High-energy ankle fracture-dislocations are at significant risk for postoperative complications. Closed reduction and temporary percutaneous transarticular K-wire fixation was first described more than 50 years ago. This simple and effective "damage control" strategy is widely practiced in Europe, yet appears largely forgotten and abandoned in the United States. Anecdotal opposing arguments include the notion that drilling K-wires through articular cartilage may damage the joint and contribute to postinjury arthritis. This article describes the experience in a US academic level I trauma center with transarticular pinning of selected critical ankle fracture-dislocations followed by delayed definitive fracture fixation once the soft tissues are healed. Median patient follow-up of 2 years showed that the transarticular pinning technique was performed safely, not associated with increased postoperative complication rates, and characterized by good subjective outcomes using the American Academy of Orthopaedic Surgeons Foot and Ankle Outcome Score questionnaire.

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“…Economic considerations and non-availability of orthopaedic implants for large animals at the field level makes compound fractures non-treatable. In human medicine, the majority of external fixators are intended as "single-use" temporary frames, in place for a limited period of time prior to definitive fixation of skeletal injuries (Chaus et al, 2014).…”

Section: Discussionmentioning

confidence: 99%

External Skeletal Fixation for Surgical Repair of a Bilateral Mandible Fracture in a Mediterranean Buffalo

Valle¹

2018

PVJ

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The surgical treatment and follow-up of a bilateral fracture of the molar part of the horizontal mandibular ramus, of a dairy Mediterranean Buffalo in "the field" were described. The mandibular region was swollen, painful and unstable on palpation. The radiographic examination confirmed the diagnoses. The association between sedation and nerve block of the mandibulo-alveolar nerve assured restraint and analgesia. The fractures were stabilized by linear skeletal external fixation, recycled from human medicine allowing a good mouth occlusion. Fifty-five days after surgery the fractures were completely healed and the heifer regularly calved 3 months after without any consequence for calf health.

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Analysis of usage and associated cost of external fixators at an urban level 1 trauma centre

Cited by 24 publications

References 15 publications

Low cost 3D printed clamps for external fixator for developing countries: a biomechanical study

Low cost 3D printed clamps for external fixator for developing countries: a biomechanical study

Temporary Transarticular K-wire Fixation of Critical Ankle Injuries at Risk: A Neglected “Damage Control” Strategy?

External Skeletal Fixation for Surgical Repair of a Bilateral Mandible Fracture in a Mediterranean Buffalo

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