Ring Fixator For Tibial & Femur Fracture

The basic goal of fracture fixation is to stabilize the fractured bone, to enable fast healing of the injured bone, and to return early mobility and full function of the injured extremity.

External fixation is a technique used to help heal severely broken bones. This type of orthopedic treatment involves securing the fracture with a specialized device called a fixator, which is external to the body. Using special bone screws (commonly called pins) that pass through the skin and muscle, the fixator is connected to the damaged bone to keep it in proper alignment as it heals.

What is an external fixator used for?

An external fixation device may be used to keep fractured bones stabilized and in alignment. The device can be adjusted externally to ensure the bones remain in an optimal position during the healing process. This device is commonly used in children and when the skin over the fracture has been damaged.

What are the types of external fixator?

There are three basic types of external fixators: standard uniplanar fixator, ring fixator, and hybrid fixator.

The numerous devices used for internal fixation are roughly divided into a few major categories: wires, pins and screws, plates, and intramedullary nails or rods.

Staples and clamps are also used occasionally for osteotomy or fracture fixation. Autogenous bone grafts, allografts, and bone graft substitutes are frequently used for the treatment of bone defects of various causes. For infected fractures as well as for treatment of bone infections, antibiotic beads are frequently used.

Ring Fixator for Tibial and Femur Fracture: A Comprehensive Guide

Introduction

Tibial and femur fractures are common types of injuries that often require surgical intervention. The traditional treatment options for these fractures include internal fixation with plates and screws, external fixation with pins and rods, or a combination of both. However, these methods have some limitations, such as limited range of motion, infection risk, and failure rates. In recent years, ring fixators have emerged as a promising alternative treatment for tibial and femur fractures. This article aims to provide a comprehensive guide on ring fixators, their indications, techniques, benefits, and potential risks.

What is a Ring Fixator?

A ring fixator is an external fixation device that consists of metal rings connected by struts and wires. The rings are attached to the bone with wires that pass through the skin and muscles. The wires are tensioned to compress the bone fragments and hold them in position. The struts are used to adjust the alignment and length of the bone, as well as to provide stability and support. The fixator is usually worn for several weeks or months until the bone heals.

Indications for Ring Fixator

Ring fixators are indicated for a wide range of tibial and femur fractures, including:

• Complex or comminuted fractures that cannot be treated with internal fixation or casting

• Fractures with bone loss or non-union

• Fractures associated with soft tissue injuries or compartment syndrome

• Fractures with poor bone quality, such as osteoporosis or osteogenesis imperfecta

• Fractures in pediatric patients with growth potential

Ring fixators can also be used for limb lengthening, deformity correction, and joint contracture release.

Ring Fixator Techniques

The ring fixator technique involves several steps:

1. Pre-operative planning: The surgeon uses imaging studies, such as X-rays, CT scans, or MRI, to assess the fracture pattern, bone quality, and soft tissue condition. The surgeon then designs the fixator frame, the wire placement, and the strut configuration.

2. Anesthesia: The patient is given general or regional anesthesia, depending on the type and location of the fracture.

3. Pin insertion: The surgeon inserts the pins through the skin and muscles into the bone fragments, using a power drill or a manual driver. The pins should be placed in a safe zone to avoid injury to the nerves, vessels, or joints.

4. Ring placement: The surgeon connects the rings to the pins with wires and clamps, according to the pre-operative plan. The rings should be positioned in a way that allows for proper bone compression and alignment.

5. Strut attachment: The surgeon attaches the struts to the rings and adjusts their length and orientation, using specialized tools. The struts should be placed in a way that avoids interference with the soft tissues and the joints.

6. Post-operative care: The patient is monitored for pain, swelling, infection, and neurovascular compromise. The patient is also instructed on how to clean and protect the pin sites, how to perform range-of-motion exercises, and how to bear weight gradually.

Benefits of Ring Fixator

Ring fixators offer several advantages over traditional fixation methods:

• Enhanced stability and alignment: Ring fixators provide multi-planar stability and precise control over the bone fragments, which can promote faster and more complete healing.

• Improved range of motion: Ring fixators allow for early mobilization and weight-bearing, which can prevent joint stiffness and muscle atrophy.

• Reduced infection risk: Ring fixators minimize the risk of deep infection, as the pins and wires are exposed to air and can be easily inspected and cleaned.

• Minimal tissue damage: Ring fixators do not require dissection or stripping of the soft tissues, which can preserve the blood supply and reduce the risk of wound complications.

• Customizable and adaptable: Ring fixators can be customized to fit the patient's anatomy and fracture pattern, and can be adjusted throughout the treatment course to accommodate changes in the bone alignment, length, or angulation.

Potential Risks of Ring Fixator

Despite the benefits, ring fixators also carry some potential risks and complications, such as:

• Pin tract infection: The pins and wires can introduce bacteria into the bone, leading to infection. The risk can be minimized by proper pin care, antibiotics, and monitoring.

• Pin loosening or breakage: The pins and wires can become loose or break due to stress, bending, or corrosion. This can result in loss of stability and bone healing. The risk can be minimized by using high-quality pins, avoiding excessive tension, and regular radiographic follow-up.

• Soft tissue damage: The wires and rings can irritate or damage the skin, muscles, tendons, or nerves. This can cause pain, swelling, numbness, or weakness. The risk can be minimized by careful wire placement, avoiding over-tightening, and monitoring for signs of nerve or vessel injury.

• Joint stiffness or contracture: The prolonged use of ring fixators can lead to joint stiffness or contracture, especially in the knee or ankle. This can limit the range of motion and require additional rehabilitation.

• Psychological impact: Ring fixators can be cumbersome, uncomfortable, and aesthetically unappealing. They can also affect the patient's self-esteem, body image, and social interactions. The risk can be minimized by providing adequate psychological support and counseling.

Conclusion

Ring fixators have become a popular option for treating tibial and femur fractures, thanks to their versatility, stability, and mobility. However, they also require proper planning, technique, and care to ensure optimal outcomes and minimize complications. Patients and surgeons should be aware of the indications, benefits, risks, and alternatives of ring fixators, and work together to achieve the best possible result.

FAQs

1. How long does it take to apply a ring fixator?

• The application of a ring fixator usually takes 1-2 hours, depending on the complexity of the fracture and the experience of the surgeon.

1. Does ring fixator hurt?

• The placement of pins and wires can cause some discomfort or pain, but the anesthesia and pain medication can help alleviate it.

1. Can I take a shower with a ring fixator?

• Yes, you can take a shower with a ring fixator, but you should cover the pins and wires with plastic bags or waterproof dressings to prevent contamination.

1. How often should I clean the pin sites?

• You should clean the pin sites daily with soap and water, and apply antibiotic ointment and sterile dressings.

1. Can I play sports with a ring fixator?

• It depends on the type and severity of the fracture, as well as the sport activities. You should consult with your surgeon and physical therapist before resuming any strenuous activity.