PURPOSETibial pilon fractures remain challenging for an orthopaedic surgeon to repair. External fixation (ExFix) and open reduction and internal fixation (ORIF) are two widely used methods for repairing tibial pilon fractures. However, conclusions of comparative studies regarding which method is superior are controversial. Our aim is to compare ORIF and ExFix and clarify which method is better in terms of reduction and union results and major complications.

METHODSA computerized research of MEDLINE, EMBASE, Springer, and Cochrane Library (before December 2014) for studies of any design comparing ORIF and ExFix was conducted. Weighted mean difference (WMD), risk ratio (RR) and corresponding 95% confidence intervals (CI) were used for esti- mating the effects of the two methods. Statistical analyses were done using Review Manager Version 5.2.

RESULTSTen cohort studies and one randomized clinical trial were included in our ultimate analysis. And the analysis found no significant difference between the two methods in deep infection (p = 0.13), reduction (p = 0.11), clinical evaluation (p = 0.82), post-traumatic arthrosis (p = 0.87), and union time (p = 0.35). Besides, ExFix group was found to have a higher rate of superficial infection (p =0.001), malunion (p = 0.01) and nonunion (p = 0.02), but have a lower risk of unplanned hardware removal (p = 0.0002).

CONCLUSIONSWe suggest that ORIF has a relatively lower incidence rate of superficial infection, malunion and nonunion, but a higher rate of unplanned hardware removal. No difference was found in deep infection, reduction, clinical evaluation, post-traumatic arthrosis and union time.

External Fixators ; adverse effects ; Fracture Fixation, Internal ; adverse effects ; methods ; Humans ; Tibial Fractures ; surgery

PURPOSETo compare the clinical efficacy and complications of limited internal fixation combined with external fixation (LIFEF) and open reduction and internal fixation (ORIF) in the treatment of Pilon fracture.

METHODSWe searched databases including Pubmed, Embase, Web of science, Cochrane Library and China Biology Medicine disc for the studies comparing clinical efficacy and complications of LIFEF and ORIF in the treatment of Pilon fracture. The clinical efficacy was evaluated by the rate of nonunion, malunion/delayed union and the excellent/good rate assessed by Mazur ankle score. The complications including infections and arthritis symptoms after surgery were also investigated.

RESULTSNine trials including 498 pilon fractures of 494 patients were identified. The meta-analysis found no significant differences in nonunion rate (RR = 1.60, 95% CI: 0.66 to 3.86, p = 0.30), and the excellent/good rate (RR = 0.95, 95% CI: 0.86 to 1.04, p = 0.28) between LIFEF group and ORIF group. For assessment of infections, there were significant differences in the rate of deep infection (RR = 2.18, 95% CI: 1.34 to 3.55, p = 0.002), and the rate of arthritis (RR = 1.26, 95% CI: 1.03 to 1.53, p = 0.02) between LIFEF group and ORIF group.

CONCLUSIONLIFEF has similar effect as ORIF in the treatment of pilon fractures, however, LIFEF group has significantly higher risk of complications than ORIF group does. So LIFEF is not recommended in the treatment of pilon fracture.

Combined Modality Therapy ; External Fixators ; Fracture Fixation, Internal ; adverse effects ; methods ; Humans ; Tibial Fractures ; surgery

OBJECTIVETo explore the effect of external fixators on the intertrochanteric fracture in the advanced age patients.

METHODSFrom June 2008 to September 2010,32 cases who failed to be operated by the regular open-sugery were divided into two groups randomly, 16 of those were put in traction and conservative treatment;and the other 16 patients were treated by external fixation under anesthetization. In the traction group, there were 9 males and 7 females with an average age of (79.19 +/- 1.83) years ranging from 78 to 85. In the external fixation group, there were 10 males and 6 females with an average age of (79.69 +/- 2.41) years ranging from 78 to 88 years. Acoording to the Evans-Jensen classification,in the traction group, there were 6 cases of type I ,6 cases of type II, 7 cases of type III and lieing in bed 45 days in average; in the external fixation group, there were 6 cases of type I ,5 cases of type II, 2 cases of type III, 2 cases of type IV, and non-weight loading walking after surgery in a week in average.

RESULTSIn the traction group, 3 of them had decubitus, 3 of them had cardiopulmonary insufficiency, 2 of them had infection from traction needles, and 1 of them had pneumonia; in the external fixatioin group, only 2 of them had coxa vara. Based on the Harris scoring for the assessment of the function of hip join,in the traction group, the results were excellent in 4 cases,good in 3,fair in 3,poor in 6; in the external fixation group,the results were excellent in 10 cases, good in 3, fair in 2, poor in 1.

CONCLUSIONThus, the use of external fixation on the intertrochanteric fracture is a strong safe and effective method in treating intertrochanteric fracture of the advanced age patients.

Aged ; Aged, 80 and over ; External Fixators ; adverse effects ; Female ; Hip Fractures ; surgery ; Humans ; Male ; Traction ; adverse effects

PURPOSE: Upper cervical fractures can heal with conservative treatments such as halo-vest immobilization (HVI) and Minerva jackets without surgery. The most rigid of these, HVI, remains the most frequently used treatment in many centers despite its relatively high frequency of orthosis-related complications. We conducted this study to investigate the clinical outcome, effectiveness, patient satisfaction, and associated complications of HVI. MATERIALS AND METHODS: From April 1997 to December 2008, we treated 23 patients for upper cervical spinal injuries with HVI. For analysis, we divided high cervical fractures into four groups, including C1 fracture, C2 dens fracture, C2 hangman's fracture, and C1-2 associated fracture. We evaluated the clinical outcome, complications, and patient satisfaction through chart reviews and a telephone questionnaire. RESULTS: The healing rate for upper cervical fracture using HVI was 60.9%. In most cases, bony healing occurred within 16 weeks. Older patients required longer fusion time. We observed a 39.1% failure rate, and 60.9% of patients experienced complications. The most common complications were frequent pin loosening (34.8%; 8/23) and pin site infection (17.4%; 4/23). The HVI treatment failed in 66.7% of patients with pin site problems. The patient approval rate was 31.6%. CONCLUSION: The HVI produced frequent complications and low patient satisfaction. Bony fusion succeeded in 60.9% of patients. Pin site complications showed a tendency to influence the outcome of HVI, and would be promptly addressed to prevent treatment failure if they develop. The decision to use HVI requires an explanation to the patient of potential complications and constant vigilance to prevent such complications and unsatisfactory outcomes.
Adult ; Aged ; Cervical Vertebrae/*injuries ; *External Fixators/adverse effects ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Spinal Injuries/*therapy ; Treatment Outcome ; Young Adult

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; External Fixators ; adverse effects ; Female ; Fracture Fixation ; methods ; Humans ; Male ; Middle Aged ; Tibial Fractures ; surgery

OBJECTIVETo investigate the risk factors of pinhole infection in the fractured lower limbs after external fixation.

METHODSThe case-control study was designed. From May 2009 to May 2014, the clinical data of 272 patients with lower limb fracture treated by external fixation device were collected. All the patients were divided into two groups according to post-operative pinhole infection. There were 29 cases in the case group including 23 males and 6 females. The age of patients in case group ranged from 25 to 77 years old,with the average age of (53.41 ± 12.77) years old. There were 243 cases in control group including 217 males and 26 females. The age of patients in the control group ranged from 27 to 78 years old, with the average age of (48.71 ± 11.87) years old. There were nine risk factors observed in our study including age, gender, fixed time by external fixation device, diabetes, time in bed, smoking, operation condition of other parts in the body, infection condition of other parts in the body.

RESULTSThe results of univariate analysis showed that there were statistically significant differences among age (χ² = 15.708, P < 0.001), fixed time by external fixation device (χ² = 11.940, P < 0.001), severity of the lower limb fracture (χ² =15.438, P < 0.001), diabetes (χ² = 8.519, P = 0.004) and time in bed (χ² = 7.165, P = 0.007) between case group and control group. The results of Logistic regression analysis showed that the risk factors of pinhole infection after fixed by external fixation device in the lower limb fracture were the advanced age (OR = 8.327, P < 0.001), fixed time by external fixation device (OR = 6.795, P < 0.001), diabetes (OR = 4.965, P = 0.001) and time in bed (OR = 4.864, P = 0.008).

CONCLUSIONThe advanced age, long fixed time, diabetes and long time in bed could increase the risk of pinhole infection after external fixation in the lower limbs with fracture.

Adult ; Aged ; Case-Control Studies ; External Fixators ; adverse effects ; Female ; Humans ; Lower Extremity ; injuries ; Male ; Middle Aged ; Postoperative Complications ; etiology ; Risk Factors

BACKGROUND: A second staged operation using temporary bridging external fixation (TBEF) has been widely used in patients with periarticular complex fracture, yet few papers have been published on the related complications. The purpose of this study was to report the complication rate and pitfalls directly related to TBEF through a retrospective study and to suggest some solutions. METHODS: Fifty-nine cases that were treated by using TBEF were studied among 195 periarticular complex fractures. We retrospectively collected the clinical and radiological data and then the study data was evaluated for 1) cases with unsatisfactory restoration of length, 2) cases with deep infection caused by half pins invading the zone of definitive fixation, and 3) neurovascular injuries related to half pins. RESULTS: Complications were observed in 7/59 cases (11%). Problems related to the achievement of length were observed in one case of distal tibia fracture and 2 cases of distal femur fracture. Half pin related infection was observed in 2 cases of distal femur fracture. Neurovascular injury (medial calcaneal nerve injury in a distal tibia fracture) was observed in 2 cases. Among 7 complications, four were related to using TBEF in distal femur fracture. This is because the abundant leg muscles have strong deforming force and infection might be increased due to frequent irritation by the half pins. CONCLUSIONS: TBEF is a simple procedure with several advantages. However, complications might be observed if certain principles are not followed. It is thought that many complications due to TBEF can be reduced if the half pins are not inserted in the zone of injury, restoration of length is fully achieved and the neurovascular characteristics are carefully considered. In particular, much more caution is needed in the distal femur, which has abundant muscles surrounding it.
Adult ; Aged ; External Fixators/*adverse effects ; Female ; Femoral Fractures/*surgery ; Fracture Fixation/*adverse effects/methods ; Fractures, Comminuted/*surgery ; Humans ; Leg Length Inequality/etiology ; Male ; Middle Aged ; Peripheral Nerves/injuries ; Retrospective Studies ; Surgical Wound Infection/*etiology ; Tibial Fractures/*surgery ; Young Adult

Anti-Bacterial Agents ; therapeutic use ; Drainage ; External Fixators ; Female ; Fracture Fixation ; methods ; Fracture Fixation, Internal ; adverse effects ; Fractures, Open ; surgery ; Humans ; Male ; Microsurgery ; Soft Tissue Injuries ; surgery ; Surgical Flaps ; Surgical Wound Infection ; therapy ; Tibial Fractures ; surgery ; Treatment Outcome

OBJECTIVETo explore the external fixation for treatment of supracondylar femoral fractures after total knee replacement.

METHODSFrom June 2005 to July 2007, 7 cases of supracondylar femoral fracture after total knee replacement were treated with external fixation included 4 males and 3 females with an average age of 71 years ranging from 55 to 85 years. The fracture healing were observed and the knee function were evaluated by the HSS scoring.

RESULTSAll patients were followed-up for 6 to 23 months with an average of 12.5 months. The fracture healing time was from 6 to 12 weeks after operation (averaged 8.5 weeks). During the followed-up period, there were no infection and loosening, only one case occurred nail crossing delayed healing of skin. The HSS knee score was (60.6 +/- 16.0) before treatment and (77.6 +/- 11.6) after treatment according to HSS knee score criteria, the results were excellent in 2 cases, good in 4, and fair in 1.

CONCLUSIONApplication of external fixation for treatment of supracondylar femoral fracture after total knee replacement, especially in poor physical condition, high age patients is a more appropriate treatment.

Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Knee ; adverse effects ; External Fixators ; Female ; Femoral Fractures ; physiopathology ; surgery ; Fracture Fixation ; methods ; Humans ; Male ; Middle Aged ; Postoperative Complications ; physiopathology ; surgery ; Recovery of Function ; Treatment Outcome