Results of External Fixation and Metatarsophalangeal Joint Fixation With K-Wire in Brachymetatarsia
Víctor M. Peña‐MartínezDionisio Palacios-BarajasJuan Carlos Blanco-RiveraÁngel Arnaud-FrancoJorge Elizondo-RodríguezCarlos Acosta‐OlivoFélix Vílchez‐CavazosRodolfo Morales-Ávalos
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Abstract:
Background: Brachymetatarsia is a rare foot deformity caused by the premature closure of the metatarsal physis. It may result in functional as well as cosmetic alterations, which may require operative management. Methods: A prospective study examining outcomes of 48 cases of brachymetatarsia with gradual bone lengthening at a rate of 1 mm/d using an external fixator and metatarsophalangeal joint fixation was performed. The difference between the length before treatment and after external fixator removal was measured. The patients were assessed at 2, 4, 6, and 8 weeks postoperatively; at the end of the period of distraction; and 1 year after surgery. The total number of patients was 26, and surgery was performed in 48 metatarsals. The mean age was 17.0 ± 4.1 (range, 11-24) years, and all were female. Results: The fourth metatarsal was the most frequently affected, representing 98% of the cases; the third metatarsal represented the other 2%. The average length gained was 18.6 ± 6.7 mm, and the average length gained as a proportion of the original metatarsal length was 38.2% ± 3.1% (range, 13%-24%). The mean healing time was 71.0 (range, 64-104) days, and the mean healing index (healing time divided by centimeters of length gained [d/cm]) was 38.4 (range, 38.2-50.1) d/cm. Conclusion: Gradual bone lengthening at a rate of 1 mm/d using an external fixator and intramedullary nailing was a safe and efficient method, representing a minimally invasive procedure with a low incidence of complications and satisfactory results for the patient. Level of Evidence: Level IV, retrospective case series.Keywords:
Metatarsal bones
The results of treatment using a locally-designed external fixator in 20 patients are presented. Open fractures were the main indications for external fixation. Pin tract infection occurred in 8 patients. Only 2 patients had unstable fixation which required removal of the device. One third of patients developed malunion exceeding 15 degrees and two thirds had joint stiffness after conversion to plaster cast. This external fixator is adequate in the treatment of most open fractures of the tibia. However, improved techniques of pin insertion and cast application upon removal of the external fixator may help to reduce the incidence of pin tract infections and malunion.
Malunion
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Objective To analyze the data of external fixation instruments (including Ilizarov instruments) used by QIN Sihe orthopaedic surgical team in the treatment of limb deformities in the past 30 years, and to explore the indications for the application of modern external fixation techniques in the correction of limb deformities and individual device configuration selection strategy. Methods According to QIN Sihe orthopaedic surgical team, the use of external fixator between January 1988 and December 2017 was analyzed retrospectively. The total use of external fixation and the proportion of different external fixators were analyzed in gender, different operation time, different age, different parts, and different diseases. Results External fixators were used in 8 113 patients, 69 of them were used simultaneously in both lower extremity surgery, so 8 182 external fixators were used. Among them, there were 4 725 (57.74%) combined external fixators, 3 388 (41.41%) Ilizarov circle fixators, 64 (0.78%) single arm external fixators (including Orthofix), 5 (0.06%) Taylor space external fixators. There were 4 487 males (55.31%) and 3 626 females (44.69%). According to the analysis of different time periods, the number of external fixators increased year by year, and the number of applications increased after 2000. The main age of the patients was 11-30 years old, of which 1 819 sets (22.23%) were used at the age of 21-25 years. The use of the external fixator covered almost all parts of the limbs, with the ankle and toe areas being the most common, reaching 4 664 sets (57.00%), and the upper extremities the least, with 152 sets (1.86%). The 8 113 cases covered more than a dozen disciplines and more than 150 kinds of diseases. The top 5 diseases were poliomyelitis sequelae, cerebral palsy, deformity of lower extremity after spina bifida, traumatic sequelae, and congenital equinovarus foot. Conclusion Ilizarov technique has been widely used in extremity deformity, disability, and complicated orthopedic diseases caused by vascular, lymphoid, nerve, skin, endocrine, and other diseases. The indication of operation is far beyond the scope of orthopedics. The domestic external fixator and its mounting tools can basically meet the requirements of various treatments. The technique of external fixation has entered a new era of tension tissue regeneration under stress control, natural repair of tissue trauma and deformity, and reconstruction of limb function.
Ilizarov Technique
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The authors show 30 cases of recent tibial fractures treated by external fixation. They study the different types of fractures, the models of external fixation employed, the complications occurring during the treatment and the ultimate results obtained.
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On a group of 30 patients authors present the results they have achieved in the treatment of fractures of distal radius by external fixation. They deal with indications to the treatment of this injury by external fixation and describe in detail the method of such treatment. They discuss the pitfalls of this treatment, potential complications and adequacy of individual types of external fixators. They point out the discrepancy in the evaluation of objective achievements and subjective evaluation of patients. In total they evaluate the results as good and recommend a more consistent diagnostic and therapeutic connsidera-tion of the treatment of these injuries in out-patient departments. Key words: fracture of distal radius, external fixator.
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The aim of this study is to evaluate the influence of the external fixation associated with intramedullary nailing on the healing index in limb lengthening. Material and Methods. This study was based on a series of patients with lower and upper limb length discrepancy of different etiologies. We evaluated results of treatment in patients undergoing limb lengthening with the combination of an external circular fixator and intramedullary nailing (154 cases). The Ilizarov frame (133 cases) or Taylor Spatial Frame (21 cases) were used in combination with flexible intramedullary nailing. Results. In all the groups of patients we observed a significant reduction of the Healing Index – inferior to 30 days/cm. There were 117 complications but only 10 of them influenced on results of treatment. Finally, results are distributed according to categories: I category – 114 cases (74%), IIa – 27 cases (17.5%), IIb – 3 cases (1.9%), IIIa – 9 cases (5.7%), IVa – 1 case (0.9%). Conclusion. Flexible intramedullary nailing provides multiple advantages to a method of limb lengthening. Flexible Intramedullary Nailing, when correctly applied, respects the bone biological features which are essential for successful limb lengthening.The major effect of application of the combination of external circular fixation with FIN is significant decrease of external osteosynthesis duration.
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Orthopaedic trauma patients often require temporary stabilization prior to definitive treatment following the principles of damage control orthopaedics (DCO). DCO includes the use of temporary or supplemental implants including pelvic external fixators, large external fixators, small external fixators, ring external fixators, skeletal traction, cervical traction, and cervical halo fixation. Once provisional stabilization has been obtained, and the patient is optimized medically, further testing can be performed prior to definitive stabilization. Since MRI may be required before definitive fixation, it is necessary to understand MRI safety in patients with external fixation devices.
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Twenty-four patients had a severe open fracture of the tibia that was initially treated by external fixation and subsequently by reamed intramedullary nailing. The external fixation had been maintained for an average of fifty-two days (range, seven to 230 days). The mean interval between removal of the external fixator and intramedullary nailing was sixty-five days (range, three to 360 days). In five of the seven patients who had had an infection at one or more of the pin sites, an infection later developed around the intramedullary nail. In comparison, only one of the seventeen patients who had not had a pin-site infection had an infection later around the nail (p = 0.003). An analysis of other variables, including the duration of external fixation, wound coverage, other injuries, and the type of fracture, showed that none was a predictor of infection either at the pin sites or around the intramedullary nail. We concluded that a pin-site infection that develops during external fixation is a contraindication to the subsequent use of reamed intramedullary nailing in patients who have a fracture of the tibia.
Open fracture
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