External fixators: looking beyond the hardware maze

Kani, Kimia Khalatbari; Porrino, Jack; Chew, Felix S.

doi:10.1007/s00256-019-03306-w

Cited by 16 publications

(20 citation statements)

References 79 publications

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“…To manage scars induced by external fixation, adequate undermining of the soft tissues and volume replacement are needed. It is important to perform enough subcisions of the adhesions and fibrotic tissues under the scar because scars resulting from the percutaneous placement of transosseous pins or wires are hard to release [1,3].…”

Section: Discussionmentioning

confidence: 99%

“…Applying external fixators or distractors is a common method used to manage complex fractures [1]. Although good alignment and bony union are important, prolonged pin placement may cause epidermal ingrowth and tethering of soft tissues to the underlying bone [2].…”

Section: Introductionmentioning

confidence: 99%

“…Although good alignment and bony union are important, prolonged pin placement may cause epidermal ingrowth and tethering of soft tissues to the underlying bone [2]. These can result in retracted and depressed scars in the site where the pins passed through the skin, and these scars do not resolve or improve spontaneously [1][2][3][4][5]. Several methods have been introduced to manage these scars [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

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Pin-site scar revision with subcisions and acellular dermal matrix

Kim

Cheon

2020

Arch Aesthetic Plast Surg

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External fixation is widely used in orthopedic and reconstructive surgery. However, it may leave retracted and depressed scars because it involves the percutaneous placement of transosseous pins or wires that are secured to an external scaffolding. These scars do not resolve or improve spontaneously, causing patients to experience dissatisfaction and possibly requiring a surgical intervention. Moreover, the management of scars that arise from external fixator pin sites is challenging because of their fibrotic and depressive features. However, by using subcisions and inserting acellular dermal matrix under the scars, the contour of the scars can be improved easily. Therefore, we present a case of pin-site scar revision using a technique that we developed.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pin-site scar revision with subcisions and acellular dermal matrix

Kim

Cheon

2020

Arch Aesthetic Plast Surg

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“…Various types of external fixators were developed for specific types of fractures, including planar, circular and hybrid external fixators [ 12 ]. These different external fixators, designed with different stiffness and stability characteristics, can be classified according to their frame configurations as unilateral, bilateral, quadrilateral, triangular, semi-circular, and circular [ 13 , 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Optimization of a Patient-Specific External Fixation Device for Lower Limb Injuries

et al. 2021

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The use of external fixation devices is considered a valuable approach for the treatment of bone fractures, providing proper alignment to fractured fragments and maintaining fracture stability during the healing process. The need for external fixation devices has increased due to an aging population and increased trauma incidents. The design and fabrication of external fixations are major challenges since the shape and size of the defect vary, as well as the geometry of the human limb. This requires fully personalized external fixators to improve its fit and functionality. This paper presents a methodology to design personalized lightweight external fixator devices for additive manufacturing. This methodology comprises data acquisition, Computer tomography (CT) imaging analysis and processing, Computer Aided Design (CAD) modelling and two methods (imposed predefined patterns and topology optimization) to reduce the weight of the device. Finite element analysis with full factorial design of experiments were used to determine the optimal combination of designs (topology optimization and predefined patterns), materials (polylactic acid, acrylonitrile butadiene styrene, and polyamide) and thickness (3, 4, 5 and 6 mm) to maximize the strength and stiffness of the fixator, while minimizing its weight. The optimal parameters were found to correspond to an external fixator device optimized by topology optimization, made in polylactic acid with 4 mm thickness.

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“…The rationale behind this strategy, as opposed to repeat internal fixation, is to prevent bacterial colonization around new internal implants which could otherwise continue to hinder bony union. However, external fixation has its own drawbacks including patient discomfort over prolonged treatment courses, difficulty walking and maneuvering, and pin site infections 9 . In an effort to avoid external fixation, staged sterilization of the intramedullary (IM) canal was introduced using an antibiotic loaded, cement coated wire to control infection followed by definitive, locked IM nailing.…”

Section: Introductionmentioning

confidence: 99%

Antibiotic Cement-Coated interlocking Intramedullary Nails in the Treatment of Septic Complex Lower Extremity Reconstruction; A Retrospective Analysis with Two year Minimum Follow up

Makhdom¹,

Buksbaum

Rozbruch

et al. 2020

J. Bone Joint Infect.

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Abstract. Background: To report on our experience with antibiotic cement coated interlocking intramedullary nails (ACC-IMNs) for limb salvage in septic complex lower extremity reconstruction with a minimum of 2-year follow up.Methods: We retrospectively reviewed the records of all consecutive patients who underwent a limb salvage procedure with ACC-IMNs. We reviewed patients' demographics, the preoperative infecting organism, and host type, time to bone union, complications, limb salvage rates, and infection control rates.Results: There were 28 patients with a mean age of 62 years (range 22-88). The mean follow up period was 40 months (range 28-84). The ACC-IMNs were used in 14 patients (50 %) to achieve knee fusion after failed revisions of infected total knee arthroplasty, in 8 patients (28%) for septic tibial nonunion, and in 6 patients (21%) with ankle fusion nonunions. Bony union/fusion was achieved in 87 % (21/24) of patients. The infection was controlled in 80% (21/26) of patients. Four out the five patients who had recurrent infection were type B hosts (p=0.63). The limb salvage rate was 89% (25/28). The overall complication rate was 32%.Conclusions: The use of ACC-IMNs was an effective treatment strategy and associated with high limb salvage and bone union rates. Furthermore, the infection recurrence rate was low. Knee fusion patients after failed TKA should be counseled preoperatively for a potential high complication rate.

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External fixators: looking beyond the hardware maze

Cited by 16 publications

References 79 publications

Pin-site scar revision with subcisions and acellular dermal matrix

Pin-site scar revision with subcisions and acellular dermal matrix

Optimization of a Patient-Specific External Fixation Device for Lower Limb Injuries

Antibiotic Cement-Coated interlocking Intramedullary Nails in the Treatment of Septic Complex Lower Extremity Reconstruction; A Retrospective Analysis with Two year Minimum Follow up

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