Definitive Treatment of Femoral Shaft Fractures: Comparison between Anterograde Intramedullary Nailing and Monoaxial External Fixation

Testa, Gianluca; Vescio, Andrea; Aloj, Domenico; Papotto, Giacomo; Ferrarotto, Luigi; Massè, Alessandro; Sessa, Giuseppe; Pavone, Vito

doi:10.3390/jcm8081119

Cited by 11 publications

(5 citation statements)

References 17 publications

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“…The Ilizarov external fixation technique has been used for the last five decades for the management of long-bone infected nonunions. This method uses percutaneously-inserted fine wires which are tensioned to provide a stiff and stable frame construct [1][2][3][4][5][6]. It permits the realization of compression, distraction, bone-lengthening, and deformity correction.…”

Section: Introductionmentioning

confidence: 99%

Treatment of Infected Tibial Non-Unions with Ilizarov Technique: A Case Series

Testa

Vescio

Aloj

et al. 2020

JCM

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Background: The Ilizarov external fixation technique has been widely used for the treatment of long-bone infected non-unions. After surgical infected bone resection, to allow filling of the remaining bone gap, biomaterials with antibacterial properties could be used. The aim of this study was to report outcomes of infected tibial non-unions treated using the Ilizarov technique and antibacterial bioactive glass. Methods: Between April 2009 and December 2014, 26 patients with infected tibial non-unions were treated with the Ilizarov technique and possible use of the bioactive glass, S53P4. The Association for the Study and Application of Methods of Ilizarov (ASAMI) criteria, a clinical and radiographic evaluating tool, was used for assessing the sample. Results: The average age at the start of treatment was 51 years. The mean follow-up time was 113 weeks. According to the ASAMI Functional Scoring System, 10 excellent (38.5%) cases and 12 good (46.1%) values were recorded. According to the ASAMI Radiological System, they were excellent in 16 (61.5%) cases and good in nine (34.6%). Conclusions: Treatment of infected tibial non-unions using the Ilizarov technique was effective in bone segment regeneration. To fill the remaining bone gap, additional bioactive glass S53P4 could be used, allowing a decrease in re-interventions and minimizing complications.

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Section: Introductionmentioning

confidence: 99%

Treatment of Infected Tibial Non-Unions with Ilizarov Technique: A Case Series

Testa

Vescio

Aloj

et al. 2020

JCM

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“…With a DOTOR, the operative surgeon might also feel less burdened by the constraints of previously scheduled daytime cases and more comfortable performing a slightly longer case (intramedullary nailing) as opposed to stabilizing the patient with an external fixator. 15 This finding contrasts with that observed in a study conducted by Wixted et al 2 who found a delay from 5.7 to 10.9 hours from presentation to definitive fixation after implementation of a DOTOR. This difference could be due to an increased delay that our institution experienced regarding add-on trauma cases before having the DOTOR in comparison with their institution.…”

Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Advantages of a Dedicated Orthopaedic Trauma Operating Room for Diaphyseal Femur Fractures

Cloud

Fong

Bloise

et al. 2022

Journal of Orthopaedic Trauma

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Objective:To examine the impact of instituting a dedicated orthopaedic trauma operating room (DOTOR) at a Level I trauma center on diaphyseal femur fracture management.Design:Retrospective cohort study.Setting:Regional, university-based Level I trauma center.Patients:Trauma patients 18–65 years of age who presented between October 2016 and December 2018 (approximately 1 year before and after implementation of the DOTOR) and underwent surgery for diaphyseal femur fractures. One hundred twenty-eight patients met eligibility criteria for inclusion: 60 were treated before and 68 after implementation of the DOTOR.Intervention:Implementation of a DOTOR in October 2017.Main Outcome Measures:Percentage of external fixation versus intramedullary nailing, time from emergency department visit to definitive fixation, duration of surgery, and hospital length of stay.Results:The only significant difference in patient demographics between the before and after groups was mechanism of injury (P = 0.003). Percentage of external fixators as an initial procedure decreased from 15% to 2.9% (P = 0.024). Time to definitive fixation with intramedullary nail decreased from 1083 minutes to 659 minutes (P = 0.002). There was no significant change in median operative time of intramedullary nailing (P = 0.573). Although not statistically significant, hospital length of stay decreased from 7 days to 5.5 days after implementation (P = 0.158). Cost analysis revealed annual cost savings of more than $261,678 for diaphyseal femur fractures alone by implementing a DOTOR.Conclusions:For diaphyseal femur fractures, instituting a DOTOR at a Level I trauma center reduced the percentage of patients requiring a 2-stage fixation, reduced the time to definitive fixation, and yielded cost savings.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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“…Internal fixation contributes to anatomic reduction, whereas it is the most invasive form and carries a higher risk of infection, prone to result in devastating complications in the presence of severely compromised soft tissues [5][6][7] . Monolateral external fixation characterized by simple, effective, and minimally invasive, which can preserve the biomechanical microenvironment needed for fracture healing, playing an important role over the years in the treatment of open fractures, or to reconstruct missing or short bones, where internal fixation is impossible or inadvisable [ 1 , 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Correction outcomes of the postoperative malalignment salvaged by the temporary application of the hexapod external fixator in tibial diaphyseal fractures treated by monolateral external fixation

Liu

Liang

et al. 2021

Injury

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Background: Postoperative malalignment in fractures treated by monolateral external fixation is not uncommon in clinical practice. Accurate reduction without excessive tissue disruption caused by surgical intervention and sequentially manage the fractures using monolateral external fixation for definitive treatment is still a challenge for surgeons. The purpose of our study was to evaluate the feasibility and effectiveness of the temporary application of the hexapod external fixator (HEF) for the postoperative malalignment correction in tibial diaphyseal fractures treated by monolateral external fixation. Methods: We carried out a retrospective analysis of 23 trauma patients with tibial diaphyseal fracture treated by the monolateral external fixation at our institution from January 2016 to May 2019. There were 21 males and 2 females with a mean age of 38 years (range 18-60 years). The hexapod external fixator was temporarily applied due to postoperative malalignment within two weeks and who unwilling to undergo a secondary surgical intervention. For patients with postoperative malalignment requiring correction, the HEF components were installed on the original existing half pins of the monolateral external fixator after removing the connecting rod. The standard anteroposterior and lateral X-rays of the injured limb combined with the temporary HEF were conducted to measure the hexapod external fixator parameters. Any residual deformities were corrected by gradual struts adjustment with the aid of computerbased software. When satisfactory alignment was achieved, the HEF was removed, and the monolateral external fixator was sequentially used as the definitive structure. Results: All patients acquired functional reduction, which was evaluated by radiographs. The mean correction time was 4 days (range 2 to 8 days). The mean coronal plane translation (1.3 ±1.0 mm), coronal plane angulation (0.9 ±0.7 °), sagittal plane translation (1.4 ±1.1 mm), and sagittal plane angulation (0.7 ±0.7 °) after correction were all less than those (7.0 ±4.9 mm, 4.7 ±2.3 °, 5.6 ±3.6 mm, 3.2 ±2.5 °) before correction. Conclusions: The temporary application of the hexapod external fixator is an alternative and feasible method for the postoperative malalignment correction in tibial diaphyseal fractures treated by monolateral external fixation.

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Definitive Treatment of Femoral Shaft Fractures: Comparison between Anterograde Intramedullary Nailing and Monoaxial External Fixation

Cited by 11 publications

References 17 publications

Treatment of Infected Tibial Non-Unions with Ilizarov Technique: A Case Series

Treatment of Infected Tibial Non-Unions with Ilizarov Technique: A Case Series

Advantages of a Dedicated Orthopaedic Trauma Operating Room for Diaphyseal Femur Fractures

Correction outcomes of the postoperative malalignment salvaged by the temporary application of the hexapod external fixator in tibial diaphyseal fractures treated by monolateral external fixation

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