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RLE Orthopaedic Injury Management
Published in Mansoor Khan, David Nott, Fundamentals of Frontline Surgery, 2021
Jowan Penn-Barwell, Daniel Christopher Allison
For cases where stability cannot be reliably or practicably achieved through splinting/casting or traction, external fixation represents a secure and durable technique which stabilises the fracture through skeletal fixation applied above and below the fracture site, which is in turn linked to a rigid construct (carbon fibre bars) that lies outside the body. There are two main types of external fixation: circular (multi-planar) frames and unilateral (uniplanar) fixators. Circular frames (also referred to as Ilizarov frames or fine-wire frames) are robust and used for definitive treatment, while unilateral external fixators are quicker and easier to apply but are less robust and normally will not be durable enough to support a bone to definitive union. In austere combat setting, unilateral fixators are the only practical form of external fixation.
Lengthening the Human Mandible by Gradual Distraction
Published in Niall MH McLeod, Peter A Brennan, 50 Landmark Papers every Oral & Maxillofacial Surgeon Should Know, 2020
David M McGoldrick, Kevin McMillan
The authors reported a mean expansion of 20 mm with a range of 18–24 mm. Patients were maintained in external fixation for an average of 9 weeks and no perioperative complications were reported.
Damage Control
Published in Kenneth D Boffard, Manual of Definitive Surgical Trauma Care: Incorporating Definitive Anaesthetic Trauma Care, 2019
The goals of damage control orthopaedics are to limit ongoing haemorrhage and soft tissue through efficient fracture stabilization, while minimizing additional physiological insult. Care is to follow normal damage control principles, such as avoiding the triad of hypothermia, coagulopathy, and acidosis, and minimizing secondary injury to organ systems (kidney, brain, etc.). External fixation is employed for long-bone fractures and pelvic injuries. In addition to wound toilet and removal of devitalized tissues, surgical management of haemorrhage and fasciotomies for potential or actual compartment syndrome are performed.
Distraction plating for bilaterally severely comminuted distal radius fracture: a case report
Published in Case Reports in Plastic Surgery and Hand Surgery, 2023
Yuta Izawa, Hiroko Murakami, Tetsuya Shirakawa, Kazuo Sato, Toshiki Yoshino, Yoshihiko Tsuchida
The goal of treating distal radius fractures is to obtain a stable and movable wrist joint. Various treatment options are available, including conservative treatment, but open reduction and internal fixation are required in cases with severe instability or high disposition. The gold standard for internal fixation is volar locking plate fixation [1,2], and fragment-specific fixation is recommended when the articular surface is severely comminuted [3,4]. However, high-energy trauma may be accompanied by severe comminution and soft tissue damage, which are difficult to treat using a traditional internal fixation strategy. In such cases, external fixation is generally regarded as the next best treatment option [5,6]. External fixation spans the wrist joint continuously to maintain alignment until bone union; however, pin site infection and inconvenience owing to the fixation apparatus that the patient has to wear are common problems with this approach. Distraction plating is a method of bridging fixation from the radial shaft to the third metacarpal bone subcutaneously on the dorsal side and is used as an alternative to external fixation [7–10]. Although there is concern that the limitation of range of motion will remain due to the fixation of the wrist joint until implant removal, it has been reported that an acceptable range of motion of the wrist joint will eventually be obtained. Herein, we report a case in which distraction plating was performed for a bilateral highly comminuted distal radius fracture, with acceptable results obtained in the wrist joint’s range of motion and function.
Perinatal pubic symphysis separation combined with pubic fracture: a case report and literature review
Published in Journal of Obstetrics and Gynaecology, 2022
Liang Deng, Liang-Yu Xiong, Ji-Huan Zeng, Qiang Xiao, Yuan-Huan Xiong
In terms of the treatment, for pubic symphysis separation with separation distance ≤ 40 mm, conservative treatment can be performed with a pelvic correction belt. The elasticity of the pelvic correction belt can fix the crotch, tighten the separated pelvis, protect the pubis, and relieve the pain of pubic. Hence, the mechanical distribution of pelvis, back and buttock can be further improved, and the pubic symphysis can be recovered and maintained in the normal anatomical position (Culligan et al. 2002). For the parturient with a separation distance > 40 mm or combined with the persistent pain and pelvic instability, the active surgical intervention may be a sensible choice. With regard to this, the common surgical methods include external fixation and internal fixation, in which the internal fixation is the preferred method (Sujana et al. 2017). The internal fixation mainly includes the screws and steel plates fixation, which can provide sufficient mechanical stability and effective compression resistance and anti-rotation ability. In recent years, the minimally invasive surgeries represented by percutaneous cannulated screws have obtained remarkable results, which can effectively reduce the surgical trauma, shorten the operation time, and further contribute to the rapid postoperative recovery (Saeed et al. 2015). In this case, we have applied the conventional open reduction and internal fixation, and fixed with screws and steel plates. After one year of follow-up, the screws and steel plates were still fixed firmly and the separation distance of pubic symphysis was also effectively controlled.
The Adipo-Fascial ALT Flap in Lower Extremities Reconstruction Gustillo IIIC-B Fractures. An Osteogenic Inducer?
Published in Journal of Investigative Surgery, 2021
Mario Cherubino, Martina Corno, Mario Ronga, Giacomo Riva, Pietro G. di Summa, Davide Sallam, Federico Tamborini, Francesca Maggiulli, Michele Surace, Luigi Valdatta
All the flaps survived without any re-exploration (The results are summarized in Table 1). There were none vascular compromised. All patients were men. The mean time from injury to flap coverage was 72 hours (22 h–56h). The mechanisms of injury were motorbike accidents in all patients except for one case, who was involved in a job accident. At the time of injury, tibial nerve palsy was observed in one case. The mean size of the soft tissue defects before the operation was 50 cm2. The receiving vessels were the anterior tibial artery (end-to-end anastomosis) and posterior tibial artery (end-to-side anastomosis). None of the patients required vein grafting because of short pedicle length. In two patients the external fixator was kept the same kind till the end because were hybrid circular type. In other 3 cases, after the damage control period, internal fixation was used to allow a better quality of life of the patients. Solid bone union was reached, and full weight bearing present at 11 weeks (range 4–20) after the injury. All wounds healed without evidence of infection. An efficient bone union was reached at a mean of 6 months (range 2–10) after the injury and the lower limb was saved in 100% of the cases (Figure 8).