Distal tibial fractures treated with hybrid external fixation

Babis, George C.; Kontovazenitis, P.; Evangelopoulos, Dimitrios-Stergios; Tsailas, Panagiotis G.; Nikolopoulos, K.; Soucacos, P.N.

doi:10.1016/j.injury.2009.09.014

Cited by 28 publications

(24 citation statements)

References 32 publications

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“…• the articular surface of the tibia needs anatomical restoration • the length of the peroneum must be properly, so as to achieve a normal talo-crural angle (75-87 degrees, and symmetrical to the uninjured side) • the joint must be stable and congruent, the width of the joint space must be the same on the internal, external and superior aspects and symmetrical to that from the uninjured site • the vertical axis of the talus must be in line with the vertical axis of the distal tibial fragment and with the axis of the tibial diaphysis, both on AP and lateral views • the middle point of the tibial articular surface and that of the talar articular surface must be on the in line with the vertical axis of the tibia [6,[8][9][10][11]. The most difficult to treat are type C fractures and especially type C3, when comminution makes difficult the primary restoration.…”

Section: Discussionmentioning

confidence: 99%

Using External Fixation in distal tibial fractures- good principle, debatable application- Case presentation

Lupescu

Nagea

Grosu

et al. 2018

Romanian Journal of Orthopaedic Surgery and Traumatology

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Distal tibial fractures usually result from high-energy trauma, affecting young, active people, producing long-term disability and numerous complications. Their treatment is difficult, especially in type C fractures, which affect both the articular surface and the metaphysis, are quite frequent comminuted fractures, and are accompanied by soft tissue injuries. In these situations, External Fixation (EF) is used as a temporary bridging method, either for treating concomitant soft tissue injuries (in open fractures) or for achieving and maintaining reduction in order to prevent blisters or compartment syndrome, possibly resulting from severe displacement, bleeding or oedema. It must be however underlined that EF is rarely a definitive method for these fractures, especially when the ankle is splinted, and it must be followed by definitive Internal Fixation (IF) - the so-called “sequential method”, otherwise restoration of a normal ankle anatomy and function is improbable, resulting in ankle stiffness or even osteoarthritis. This paper presents a case in which this principle was only partially applied, thus requiring corrective surgery followed by a long-term recovery period.

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Section: Discussionmentioning

confidence: 99%

Using External Fixation in distal tibial fractures- good principle, debatable application- Case presentation

Lupescu

Nagea

Grosu

et al. 2018

Romanian Journal of Orthopaedic Surgery and Traumatology

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“…In the literature, the results of hybrid fi xation are good, with a substantial reduction in the reported incidence of soft-tissue complications compared with the results of acute open reduction and internal fi xation using large incisions. [8][9][10] However, the patient is still required to wear a large, bulky external fi xator on the leg for variable lengths of time.…”

Section: Hybrid External Fixationmentioning

confidence: 99%

External Fixation of Tibial Fractures

Tejwani

Polonet

Wolinsky

2015

Journal of the American Academy of Orthopaedic Surgeons

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External fixation for definitive or initial management of tibial fractures has a long history, with pin-to-bar external fixation being the standard of care for definitive management of tibial fractures. However, the use of this method lessened because of the increased popularity of intramedullary nailing and drawbacks associated with external fixation. This method is still commonly in use in the military environment and can be used for temporary stabilization of tibial fractures, especially in the setting of periarticular injuries. These fixators also may be useful for salvage of open and/or infected fractures that are unsuitable for internal fixation.

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“…However, this modification was the least effective means of increasing stiffness of the construct. The second strategy considered to improve the stiffness of hybrid fixators focuses on the addition of linear components between the circular and the linear portions of the frames (11,12,15,(26)(27)(28)(29)(30). These additions may consist of struts or 'box' hybrid configurations (two connecting bars on each side of the bone).…”

Section: Addition Of Linear Componentsmentioning

confidence: 99%

Biomechanical comparison of strategies to adjust axial stiffness of a hybrid fixator

Socie¹,

Rovesti²,

Griffon³

et al. 2012

Vet Comp Orthop Traumatol

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SummaryObjectives: To evaluate strategies for increasing the axial stiffness of a hybrid external bone fixator.Materials and methods: Type Ia hybrid fixators, consisting of a uniplanar linear component connected to a circular ring, were tested in displacement controlled loading in axial compression. The basic hybrid construct was modified to explore strategies considered to increase fixator stiffness including: decreasing ring diameter, increasing ring thickness, adding pins to the ring fixation, and adding struts between the ring and vertical post components of the device. Stiffness in the initial phase of loading was compared between the groups.Results: The addition of a single diagonal bar between the ring and linear connecting rail did not significantly improve the stiffness of constructs. However, the addition of two half-pins to the ring, the addition of two struts between the ring and linear connecting rail, or decreasing the internal ring diameter from 115 to 85 mm progressively increased the stiffness of the frame. The most effective strategy consisted of increasing the thickness of the ring from 6 to 12 mm, thereby increasing the stiffness of the control frame by 335%.Clinical significance: Modulating the ring thickness, adding two struts between the ring and linear connecting rail, and reducing the ring diameter appear to be the most effective, simple, and clinically versatile ways to increase axial stiffness, most likely due to their impact on reducing ring bending.

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Distal tibial fractures treated with hybrid external fixation

Cited by 28 publications

References 32 publications

Using External Fixation in distal tibial fractures- good principle, debatable application- Case presentation

Using External Fixation in distal tibial fractures- good principle, debatable application- Case presentation

External Fixation of Tibial Fractures

Biomechanical comparison of strategies to adjust axial stiffness of a hybrid fixator

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