External fixation is a time-tested and widely utilized technique in the treatment of fractures. This method involves the use of devices placed outside the body to stabilize and align fractured bones.
Overview of External Fixation
External fixation is a surgical technique that has been used for centuries to manage fractures. The concept was first introduced by Hippocrates, who used wooden splints to immobilize broken bones. Over time, the technology has evolved, but the fundamental principle remains the same: to provide stability to the fracture site while allowing soft tissue protection and healing.
Objectives of External Fixation:Maintain fracture alignment, length, and rotation.Provide temporary or definitive stabilization.Can be combined with partial internal fixation in complex cases.
Factors Influencing Fixation Stability
Several factors affect the stability of an external fixation device:
Pin Configuration:
Increasing the number of pins, spacing them farther apart, and placing them closer to the fracture site enhances rigidity.
Pins should be distributed evenly to avoid excessive stress on specific areas.
Pin Diameter:
Larger pins provide greater stability but may increase the risk of stress concentration and soft tissue irritation.
Pin Types:
Self-drilling pins, trocar pins, coated pins, carbon fiber rods.
Types of External Fixators
External fixators vary in design, each offering unique advantages:
Uniplanar Fixators:
Simple and easy to apply.
Limited stability compared to multiplanar devices.
Multiplanar Fixators:
Utilize pins in multiple planes, providing enhanced stability.
Ideal for complex fractures.
Unilateral/Bilateral Fixators:
Unilateral fixators are less stable, while bilateral fixators provide greater strength and support.
Circular Fixators:
Commonly used for limb lengthening and complex deformity corrections.
Allows partial weight-bearing and joint mobilization during healing.
Anatomical Considerations and Safety Zones
The placement of pins is critical to avoid complications such as nerve or vascular injury. Key anatomical considerations include:
Femur:
Anterior pins should be placed 5.8 cm below the lesser trochanter and 7.4 cm above the patellar apex.
Posterior pins must avoid the sciatic nerve and surrounding vessels.
Tibia:
Pins should be placed at least 14 mm away from the joint line to prevent intra-articular penetration.
Upper Extremities:
Humerus pins should avoid the axillary and radial nerves.
Forearm pins should be placed in the subcutaneous region of the ulna to minimize nerve damage.
Indications for External Fixation
External fixation is particularly useful in the following scenarios:
Unstable pelvic ring injuries.
Comminuted intra-articular fractures (e.g., pilon, distal femur, tibial plateau, elbow, and distal radius).
Severe soft tissue swelling or ecchymosis.
hemodynamic instability or inability to undergo open surgery.
Osteoporosis, infections, limb lengthening, osteomyelitis, joint immobilization, nonunions, and infection treatment.
Contraindications
External fixation may not be suitable in the following cases:
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Obese patients.
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Non-compliant patients.
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Patients with insufficient bone quality.
Patients who refuse surgery or cannot tolerate the procedure.
Techniques and Applications
Pin-Bone Interface:
Avoid soft tissue traction during pin insertion.
Use trocars and drill sleeves to minimize tissue damage.
Pre-drilling and flushing (irrigation) is essential to minimize contamination.
Pelvic Fixation:
Commonly placed at the iliac crest or anterior inferior iliac spine (AIIS).
C-arm fluoroscopy ensures proper pin placement.
Upper Extremity Fixation:
Humerus pins should avoid neural structures.
Forearm pins are placed in the subcutaneous region of the ulna.
Lower Extremity Fixation:
Femoral pins are placed in the anterolateral position.
Tibial pins are placed in the anteromedial position to avoid joint penetration.
Pilon Fractures:
A delta-frame configuration is used, incorporating both calcaneal and tibial pins to enhance stability.
Complications of External Fixation
Despite its benefits, external fixation is associated with potential complications, including:
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Pin tract infections
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Osteomyelitis
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Device failure or loosening
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Malunion or nonunion
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Soft tissue irritation or penetration
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Nerve or vascular injury
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Compartment syndrome
Refractures
Clinical Significance
External fixation plays a crucial role in trauma management:
Provides rapid stabilization in damage control orthopedics.
Reduces the risk of secondary injury and complications.
Facilitates a multidisciplinary approach involving orthopedic surgeons, nurses, physical therapists, and occupational therapists to optimize patient outcomes.
CZMEDITECH Product
Circular external fixator:
Characteristics: Composed of metal rings and fine wires, encircling the limb and allowing multi-planar adjustments.
The
circular external fixator is a medical device used for fracture fixation and orthopedic rehabilitation. Its design features and advantages are mainly reflected in the following aspects:
Design features
The ring structure: The circular external fixator is designed with a ring shape, forming a complete circle around the fracture site to provide comprehensive support and fixation.
Multiple fixation points: There are usually multiple fixation points on the circular frame, which can be connected to the bone through multiple bone pins or nails. This disperses the fixation force and reduces pressure on a single fixation point.
Adjustability: The design of the circular external fixator allows doctors to make adjustments according to the patient's specific conditions, including the size of the rings, the position of fixation points, and the distribution of force, to accommodate different types of fractures and bone conditions.
Lightweight and durable: Modern circular external fixators are often made of lightweight and high-strength materials such as titanium alloy or carbon fiber, ensuring stability while reducing the burden on the patient.
Easy to install and remove: The ring design makes the installation and removal process more convenient, reducing surgery time and patient discomfort.
Advantages
High stability:
The annular structure provides全方位 support, effectively preventing displacement of the fracture site and ensuring that the bone remains in the correct position during the healing process.
Dispersive force:
Multiple fixation points disperse the fixation force, reducing concentrated pressure on bones and soft tissues, and lowering the risk of complications caused by improper fixation.
Wide range of applications:
The circular external fixator is suitable for various types of fractures, especially complex fractures, open fractures, and cases that require long-term fixation.
Promoting healing:
By providing a stable fixation environment, the circular external fixator helps to accelerate fracture healing and reduce the risk of nonunion or delayed healing.
Reduce complications:
Due to the dispersed fixation force, the circular external fixator reduces soft tissue damage and decreases the incidence of complications such as infection and pin tract inflammation.
Convenient for postoperative care:
The annular design makes it more convenient for patients to take care of themselves after surgery, such as cleaning and changing dressings, without affecting the fixation effect.
Applicable scenarios
Circular external fixators are commonly used in the following situations:
Complex fractures: Suitable for complex fractures involving multiple bone segments or joints.
Open Fractures: Due to its force-dispersing characteristics, the circumferential external fixator is suitable for the management of open fractures and reduces the risk of infection.
Non-union or delayed union: In some cases, circular external fixation frames can aid in bone healing by providing the necessary stability and support.
Postoperative fixation: Used for stabilization and support after orthopedic surgery, ensuring the stability of the surgical site.
The design concept of the circular external fixator is also patient-centered, focusing on stability and comfort, and is an important tool in orthopedic treatment.
Conclusion
External fixation remains a cornerstone in the treatment of fractures, offering versatility and adaptability to various clinical scenarios. By combining this technique with a multidisciplinary approach, clinicians can achieve optimal outcomes for patients. With ongoing advancements in technology, external fixation continues to evolve, ensuring its relevance in modern orthopedic practice.
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