Clinical outcome of conversion from external fixation to definitive internal fixation for open fracture of the lower limb

Matsumura, Tomohiro; Takahashi, Tsuneari; Miyamoto, Osamu; Saito, Tomohiro; Kimura, Atsushi; Takeshita, Katsushi

doi:10.1016/j.jos.2019.01.009

Cited by 20 publications

(15 citation statements)

References 21 publications

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“…It is preferred to keep the external fixator for not more than 72 hours and after that to convert to an internal fixation method [19]. Another study has showed that the conversion from external to internal fixation should be done as soon as the general status of the patient improves or the soft tissues quality allow intrafocal osseous manipulation [36], [49]. An exception from external to internal conversion is represented by fractures with important osseous defects that necessitate external fixator reconstruction, for example external circular fixator Ilizarov [1], [39].…”

Section: Secondary Surgical Managementmentioning

confidence: 99%

Management of the High Energy Traumatism of the Limbs

Necula

Șamotă

Tudose

et al. 2020

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The management of high energy traumatism is complex and must be done by a multidisciplinary team. In this review we have tried to discuss and to divide the treatment in three steps, based on the moment of performing it. Soon after the traumatism, the team performs the primary evaluation, plans the future interventions and administer the antibiotic prophylaxis. Secondly, the orthopaedic surgeon, together with the plastic surgeons, and other specialists from the team, perform the first surgical management. Last step is going to be performed especially in Gustilo-Anderson fractures type III and is represented by the secondary surgical management.

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Section: Secondary Surgical Managementmentioning

confidence: 99%

Management of the High Energy Traumatism of the Limbs

Necula

Șamotă

Tudose

et al. 2020

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“…The higher the classification of the fracture, the higher the risk of infection. At present, as for the treatment of open fractures of extremities, the concept of combined treatment of fractures and soft tissue injury has been accepted by many scholars [ 3 ]. Nambi et al [ 8 ] and O’Brien et al [ 9 ] reported that internal fixation immediately after debridement is a safe method for Gustilo I or II fractures and some of IIIa/IIIb fractures.…”

Section: Introductionmentioning

confidence: 99%

“…When the condition of the local soft tissue improves, the external fixator is removed and replaced with the deterministic internal fixation. In the initial treatment of complex fractures, external fixation is simple, convenient, and safe [ 3 , 10 , 11 ]. It has the advantages of rapid fixation of fractures, restoration of limb length, and avoidance of further injury of soft tissue [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Study on the relationship between the timing of conversion from external fixation to internal fixation and infection in the treatment of open fractures of extremities

Zhao

Zeng

et al. 2021

J Orthop Surg Res

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Objective To investigate the relationship between the infection rate and the timing of replacement of temporary external fixators with internal fixation, and the timing of immediate or delayed internal fixation after removal of temporary external fixation in the staging treatment modality of open fractures of extremities. Methods A retrospective analysis was performed on 122 cases of open fractures of extremities. External fixators were applied at the early stage and replaced with internal fixation when the condition of soft tissues improved and inflammatory indexes dropped to the normal range or showed a steady downward trend. Depending on the carrying time of external fixators after wound closure or healing, the patients were divided into three groups; the carrying time of groups A, B, and C was ≤ 14 days, 15–28 days, and > 28 days, respectively. Depending on the immediate or delayed internal fixation after removal of external fixator, patients were divided into group a (immediate internal fixation after removal of external fixator) and group b (delayed internal fixation after removal of external fixator, 5–7 days later). Results The infection rates of groups A, B, and C were 6.5%, 5.9%, and 23.3%, respectively. The differences among the three groups were statistically significant (P < 0.05). The infection rates of different Gustilo–Anderson fractures were as follows: no cases of infection out of 10 cases with type I fracture (0%); two cases of infection out of 35 cases with type II fracture (5.7%); three cases of infection out of 36 cases with IIIa fracture (8.3%); five cases of infection out of 28 cases with IIIB fracture (17.9%); and five cases of infection out of 13 cases with IIIC fracture (38.5%). The differences among the five groups were statistically significant. Conclusions The occurrence of infection of open fractures of extremities is associated with the fracture severity (Gustilo classification). For open fractures of Gustilo types I and II, the final internal fixation should be placed as soon as possible when the recovery of general and local conditions is good and the infection is controlled.

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“…This technique is particularly useful in injuries that might not bene-fit from a conservative approach (simple immobilization or casting). Fractures that cannot be properly stabilized by a cast, such as displaced juxta-articular fractures, multiple injuries, or fractures associated with soft tissue damage, are the main indications for fracture fixation and osteosynthesis [2].…”

Section: Introductionmentioning

confidence: 99%

“…The main requirements of an optimal external fixation system include (1) ease of use and versatility in order to respond to different indications, (2) ability to restore the anatomical morphology of the bone by aligning the fracture fragments using different spatial configurations, (3) elastic deformability of the system in order to induce micromovements and (4) stability against external solicitations.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the Structural Behaviour of a Unilateral External Fixator for Osteosynthesis

Terzini¹,

Sicuranza²,

Alberghina³

et al. 2021

TOBEJ

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Background: External fixation is an osteosynthesis technique particularly useful in trauma surgery and Damage Control Orthopedics (DCO). However, complications, such as pin loosening and pin tract infections, are fairly common. For reducing thermal damage and infection rates, monocortical pins have been proposed as an alternative to the most used bicortical pins. However, there is a lack of studies regarding their mechanical properties. Objective: The aim of the study is to assess the static and dynamic stability of a unilateral external fixator experimentally when applied through monocortical pins for the reduction of femur and tibia fractures. Methods: A modular unilateral external fixator was used and a total number of 6 pins were used per test. The static tests were performed in displacement control by applying a vertical displacement to the upper fixture at 1 mm/min until a tension load of 380 N was reached. The dynamic tests were performed by applying a sinusoidal displacement. During each test, forces and crosshead displacements were acquired. Two different stiffness indexes were assessed. Results: By comparing the two anatomic regions, it was found that the fixator behaves stiffer when mounted on the femur, regardless of the pins used, while stiffnesses comparable to the femur ones are reached by the tibia when 4 mm diameter pins are used. Static analysis revealed excellent fixator stability when implanted with 4 mm diameter monocortical pins on both anatomic regions. On the contrary, two tibia and one femur samples showed failures at the bone-pin interface when 3 mm diameter pins were used. Conclusion: Dynamic analysis showed no substantial difference between the tested configurations and confirmed the fixator's ability to sustain cyclic loading without further damage to the sample.

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Clinical outcome of conversion from external fixation to definitive internal fixation for open fracture of the lower limb

Cited by 20 publications

References 21 publications

Management of the High Energy Traumatism of the Limbs

Management of the High Energy Traumatism of the Limbs

Study on the relationship between the timing of conversion from external fixation to internal fixation and infection in the treatment of open fractures of extremities

Evaluation of the Structural Behaviour of a Unilateral External Fixator for Osteosynthesis

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