External fixation for primary and definitive management of open long bone fractures: the Syrian war experience

Yushan

et al. 2020

Injury

Background: The Taylor spatial frame offered the ability of simultaneous correction of the multidirectional deformities without the need to change the frame, and it was widely used for limb lengthening, deformity correction, and fracture reduction in recent years. There are still some inherent limitations that can affect the accuracy of correction, especially for the measurement of the mounting and rotational parameters. The purpose of our study was to propose some more precise postoperative measurement of Taylor spatial frame (TSF) parameters by application of elliptic registration and three-dimensional reconstruction. Methods: This retrospectively study included 28 trauma patients who suffered tibial fracture treated by the TSF at our institution from January 2016 to January 2018, including 25 males and 3 females with a mean age of 43 years (range 14-70 years). We conducted standard full-length anteroposterior and lateral X-rays of the injured extremity and the computed tomographic scans of the bilateral extremities after the operation. Elliptic registration and 3D reconstruction were used to calculate the parameters by two types of software Mimics and CorelDRAW. Correction of the deformity was conducted by adjusting the struts of the TSF according to the electronic prescription. The standard anteroposterior and lateral X-rays after correction were taken to evaluate the effectiveness. Results: All patients acquired functional reduction, which was evaluated by digital radiography. The mean coronal plane translation(1.9 ±2.2 mm), coronal plane angulation(1.2 ±1.0 °), sagittal plane translation(2.7 ±2.1 mm), and sagittal plane angulation(1.2 ±1.0 °) after correction were all less than those(5.5 ±4.6 mm, 4.9 ±3.9 °, 4.7 ±4.0 mm, 2.7 ±2.3 °) before correction. Conclusions: The TSF system can correct the 6-axis deformities simultaneously with the accurate parameters. Elliptic registration and three-dimensional reconstruction are alternative methods to precisely measure the parameters needed by the TSF system, especially for the mounting and rotational parameters of unusually complex cases.

Section: Discussionmentioning

confidence: 99%

Application of elliptic registration and three-dimensional reconstruction in the postoperative measurement of Taylor spatial frame parameters

Yushan

et al. 2020

Injury

“…[ 15 - 19 ] External fixation allows a simple and rapid intervention to stabilize and prepare the patient for the next step of the treatment. [ 20 ] A study by Alhammoud et al[ 21 ] included more patients with Gustilo-Anderson types 1 and 2 rather than type 3. On the contrary, all the patients were classified as Gustilo-Anderson type 3 in our study.…”

Section: Discussionmentioning

confidence: 99%

Orthopedic treatment, complications, and cost analysis of 67 soldiers injured in a three-month period

et al. 2020

Wars are still ongoing across the world even after the Second World War. Countries are obliged to address the significant costs incurred as a result of injuries caused to soldiers and civilians in wars. Extremity injuries are frequently encountered in trauma patients with access to war surgeons. This was the case in many countries, such as Iran, Afghanistan, and Syria. [1-4] Wounds caused by high-energy army weapons are complex and contaminated. [5] Objectives: This study aims to analyze the musculoskeletal injury types, injury mechanisms, treatment modalities, complications, and costs of 67 consecutive soldiers wounded in the battlefield in Syria civil war over a period of three months. Patients and methods: This retrospective study was conducted between January 2018 and March 2018 at Kilis State Hospital. The study included 67 male patients (median age 28.5 years; range, 15 to 46 years). Patients' ages, injury mechanisms, fracture types, fracture locations, injury severity scores, mangled extremity severity scores, complications, and treatment costs were evaluated. Results: Twenty-three patients were injured due to handmade explosives, 21 patients due to gunshots, 16 patients due to landmines, five patients due to rockets, and two patients due to grenades. A total of 35.8% of the patients (n=24) had concomitant trauma. The mean hospitalization period was 10.2 days (range, 1-45 days). A total of 88 treatments were performed on these patients. Thirty-six of these treatments were external fixators, 21 were amputations, 12 were open reduction internal fixations, seven were closed reduction internal fixations, five were intramedullary nailings, three were cannulated screws, three were fasciotomies, and one was an arthrodesis. The treatment costs ranged from 1,577 to 296,286 Turkish Liras. Complications were observed in 17 patients and 11 of them developed infections, three of them had compartment syndrome, and three died during the hospitalization period. Conclusion: The increase in warfare technology is correlated with the severity of military injuries in the battlefields. These injuries still lead to high traumatic amputation rates, high-risk complications, and high costs.

“…infections, deformity correction, or to reconstruct missing or short bones, especially those with extensive soft tissue damage [1][2][3][4] . Prior to external xation, closed reduction must be done to realign the fracture fragments.…”

Section: Background External Xation Played An Important Role Over Thementioning

confidence: 99%

Long Bone Fracture Reduction and Deformity Correction Using the Hexapod External Fixator With a New Method: a Feasible Study and Preliminary Results

et al. 2020

Preprint

Background: The hexapod external fixator (HEF), such as the Taylor spatial frame (TSF), offering the ability of simultaneous correction of the multidirectional deformities without frame modification, whereas there are so many parameters for surgeons to measure and subjective errors will occur inevitably. The purpose of this study was to evaluate the effectiveness of a new method based on computer-assisted three-dimensional (3D) reconstruction and hexapod external fixator for long bone fracture reduction and deformity correction without calculating the parameters needed by the computer program.Methods: This retrospective study consists of 25 patients with high-energy tibial diaphyseal fractures treated by the HEF at our institution from January 2016 to June 2018, including 22 males and 3 females with a mean age of 42 years (range 14-63 years). Hexapod external fixator treatments were performed due to primary and definitive management of multiplanar posttraumatic deformity and/or severe soft-tissue damage that were not suitable for internal fixation in the tibia. Computer-assisted 3D reconstruction and trajectory planning of the reduction by Mimics were applied to perform virtual fracture reduction and deformity correction. The electronic prescription derived from the length changes of the six struts were calculated by SolidWorks. Fracture reduction was conducted by adjusting the lengths of the six struts according to the electronic prescription. The standard anteroposterior (AP) and lateral X-rays after reduction were taken to evaluate the effectiveness.Results: All patients acquired excellent functional reduction (most cases achieved anatomical reduction) in our study. The mean coronal plane translation (1.0±1.1 mm), coronal plane angulation (0.8±1.2°), sagittal plane translation (0.8±1.0 mm) and sagittal plane angulation (0.3±0.8°) after correction were all less than those (6.1±4.9 mm, 5.2±3.2°, 4.2±3.5 mm, 4.0±2.5°) before correction (P<0.05).Conclusion: The computer-assisted three-dimensional reconstruction and hexapod external fixator-based method allows surgeons to conduct long bone fracture reduction and deformity correction without calculating the parameters needed by the computer program. Considering the radiologic exposure, this method is suggested to apply in those unusually complex cases with extensive soft tissue damage and internal fixation is impossible or inadvisable.