Skip to main content
Erschienen in: Skeletal Radiology 3/2020

12.09.2019 | Review Article

External fixators: looking beyond the hardware maze

verfasst von: Kimia Khalatbari Kani, Jack A. Porrino, Felix S. Chew

Erschienen in: Skeletal Radiology | Ausgabe 3/2020

Einloggen, um Zugang zu erhalten

Abstract

External fixation has a wide variety of orthopedic applications. Although external fixator frames may have a complex appearance, these constructs are formed from several basic components and can be broadly categorized into unilateral, circular, or hybrid designs. The introduction of computer-aided circular external fixation devices (hexapod frames) has simplified the treatment of multiaxial and especially rotational deformities. Serial radiography plays a central role in the evaluation of callus formation (at the level of treated fracture or nonunion as well as the regenerate and docking site with distraction osteogenesis), tailoring the rate and rhythm of distraction during distraction osteogenesis, evaluation of frame complications, and determination of the timing of frame removal. The goals of this article are to review: the components, types, and relevant terminology of external fixator constructs with special emphasis on the Taylor spatial frame, the principles and techniques of distraction osteogenesis, and complications of external fixation.
Literatur
1.
Zurück zum Zitat Fragomen AT, Rozbruch SR. The mechanics of external fixation. HSS J. 2007;3(1):13–29.PubMed Fragomen AT, Rozbruch SR. The mechanics of external fixation. HSS J. 2007;3(1):13–29.PubMed
2.
Zurück zum Zitat Moss DP, Tejwani NC. Biomechanics of external fixation: a review of the literature. Bull NYU Hosp Jt Dis. 2007;65(4):294–9.PubMed Moss DP, Tejwani NC. Biomechanics of external fixation: a review of the literature. Bull NYU Hosp Jt Dis. 2007;65(4):294–9.PubMed
3.
Zurück zum Zitat Behrens F. A primer of fixator devices and configurations. Clin Orthop Relat Res. 1989;241:5–14. Behrens F. A primer of fixator devices and configurations. Clin Orthop Relat Res. 1989;241:5–14.
4.
Zurück zum Zitat Lowenberg DW, Githens M, Boone C. Principles of tibial fracture management with circular external fixation. Orthop Clin North Am. 2014;45(2):191–206.PubMed Lowenberg DW, Githens M, Boone C. Principles of tibial fracture management with circular external fixation. Orthop Clin North Am. 2014;45(2):191–206.PubMed
5.
Zurück zum Zitat Watson JT. Principles of external fixation. In: Court-Brown CM, Heckman JD, McKee M, McQueen M, Ricci W, Torentta P, editors. Rockwood and Green’s fractures in adults, 8th ed, vol. 1. Philadelphia: Lippincott Williams & Wilkins/Wolters Kluwer Health; 2015. p. 227–305. Watson JT. Principles of external fixation. In: Court-Brown CM, Heckman JD, McKee M, McQueen M, Ricci W, Torentta P, editors. Rockwood and Green’s fractures in adults, 8th ed, vol. 1. Philadelphia: Lippincott Williams & Wilkins/Wolters Kluwer Health; 2015. p. 227–305.
6.
Zurück zum Zitat Hernigou P. History of external fixation for treatment of fractures. Int Orthop. 2017;41(4):845–53.PubMed Hernigou P. History of external fixation for treatment of fractures. Int Orthop. 2017;41(4):845–53.PubMed
7.
Zurück zum Zitat Bible JE, Mir HR. External fixation: principles and applications. J Am Acad Orthop Surg. 2015;23(11):683–90.PubMed Bible JE, Mir HR. External fixation: principles and applications. J Am Acad Orthop Surg. 2015;23(11):683–90.PubMed
8.
Zurück zum Zitat Modi CS, Ho K, Smith CD, Boer R, Turner SM. Dynamic and static external fixation for distal radius fractures—a systematic review. Injury. 2010;41(10):1006–11.PubMed Modi CS, Ho K, Smith CD, Boer R, Turner SM. Dynamic and static external fixation for distal radius fractures—a systematic review. Injury. 2010;41(10):1006–11.PubMed
9.
Zurück zum Zitat Miyazaki AN, Fregoneze M, Santos PD, Silva LA, Junior NG, Checchia SL. Stiff elbow treatment by interposing arthroplasty associated to hinged external fixator. Rev Bras Ortop. 2009;44(4):336–41.PubMed Miyazaki AN, Fregoneze M, Santos PD, Silva LA, Junior NG, Checchia SL. Stiff elbow treatment by interposing arthroplasty associated to hinged external fixator. Rev Bras Ortop. 2009;44(4):336–41.PubMed
10.
Zurück zum Zitat Zaffagnini S, Iacono F, Lo Presti M, Di Martino A, Chochlidakis S, Elkin DJ, et al. A new hinged dynamic distractor, for immediate mobilization after knee dislocations: Technical note. Arch Orthop Trauma Surg. 2008;128(11):1233–7.PubMed Zaffagnini S, Iacono F, Lo Presti M, Di Martino A, Chochlidakis S, Elkin DJ, et al. A new hinged dynamic distractor, for immediate mobilization after knee dislocations: Technical note. Arch Orthop Trauma Surg. 2008;128(11):1233–7.PubMed
11.
Zurück zum Zitat Kulkarni GS, Kulkarni VS, Shyam AK, Kulkarni RM, Kulkarni MG, Nayak P. Management of severe extra-articular contracture of the elbow by open arthrolysis and a monolateral hinged external fixator. J Bone Joint Surg (Br). 2010;92(1):92–7. Kulkarni GS, Kulkarni VS, Shyam AK, Kulkarni RM, Kulkarni MG, Nayak P. Management of severe extra-articular contracture of the elbow by open arthrolysis and a monolateral hinged external fixator. J Bone Joint Surg (Br). 2010;92(1):92–7.
12.
Zurück zum Zitat Abou Elatta MM, Assal F, Basheer HM, El Morshidy AF, Elglaind SM, Abdalla MA. The use of dynamic external fixation in the treatment of dorsal fracture subluxations and pilon fractures of finger proximal interphalangeal joints. J Hand Surg Eur Vol. 2017;42(2):182–7.PubMed Abou Elatta MM, Assal F, Basheer HM, El Morshidy AF, Elglaind SM, Abdalla MA. The use of dynamic external fixation in the treatment of dorsal fracture subluxations and pilon fractures of finger proximal interphalangeal joints. J Hand Surg Eur Vol. 2017;42(2):182–7.PubMed
13.
Zurück zum Zitat Nikkhah D, Ruston J, Toft N. Refinements in dynamic external fixation for optimal fracture distraction in pilon-type fractures of the proximal interphalangeal joint. J Plast Reconstr Aesthet Surg. 2016;69(8):1153–5.PubMed Nikkhah D, Ruston J, Toft N. Refinements in dynamic external fixation for optimal fracture distraction in pilon-type fractures of the proximal interphalangeal joint. J Plast Reconstr Aesthet Surg. 2016;69(8):1153–5.PubMed
14.
Zurück zum Zitat Augat P, Claes L, Hanselmann KF, Suger G, Fleischmann W. Increase of stability in external fracture fixation by hydroxyapatite-coated bone screws. J Appl Biomater. 1995;6(2):99–104.PubMed Augat P, Claes L, Hanselmann KF, Suger G, Fleischmann W. Increase of stability in external fracture fixation by hydroxyapatite-coated bone screws. J Appl Biomater. 1995;6(2):99–104.PubMed
15.
Zurück zum Zitat Caja VL, Piza G, Navarro A. Hydroxyapatite coating of external fixation pins to decrease axial deformity during tibial lengthening for short stature. J Bone Joint Surg Am. 2003;85-a(8):1527–31. Caja VL, Piza G, Navarro A. Hydroxyapatite coating of external fixation pins to decrease axial deformity during tibial lengthening for short stature. J Bone Joint Surg Am. 2003;85-a(8):1527–31.
16.
Zurück zum Zitat Kloen P. Supercutaneous plating: use of a locking compression plate as an external fixator. J Orthop Trauma. 2009;23(1):72–5.PubMed Kloen P. Supercutaneous plating: use of a locking compression plate as an external fixator. J Orthop Trauma. 2009;23(1):72–5.PubMed
17.
Zurück zum Zitat He X, Zhang J, Li M, Yu Y, Zhu L. Treatment of segmental tibial fractures with supercutaneous plating. Orthopedics. 2014;37(8):e712–6.PubMed He X, Zhang J, Li M, Yu Y, Zhu L. Treatment of segmental tibial fractures with supercutaneous plating. Orthopedics. 2014;37(8):e712–6.PubMed
18.
Zurück zum Zitat Ang BFH, Chen JY, Yew AKS, Chua SK, Chou SM, Chia SL, et al. Externalised locking compression plate as an alternative to the unilateral external fixator: a biomechanical comparative study of axial and torsional stiffness. Bone Joint Res. 2017;6(4):216–23.PubMedPubMedCentral Ang BFH, Chen JY, Yew AKS, Chua SK, Chou SM, Chia SL, et al. Externalised locking compression plate as an alternative to the unilateral external fixator: a biomechanical comparative study of axial and torsional stiffness. Bone Joint Res. 2017;6(4):216–23.PubMedPubMedCentral
19.
Zurück zum Zitat Behrens F, Johnson W. Unilateral external fixation. Methods to increase and reduce frame stiffness. Clin Orthop Relat Res. 1989;241:48–56. Behrens F, Johnson W. Unilateral external fixation. Methods to increase and reduce frame stiffness. Clin Orthop Relat Res. 1989;241:48–56.
20.
Zurück zum Zitat Behrens F, Johnson WD, Koch TW, Kovacevic N. Bending stiffness of unilateral and bilateral fixator frames. Clin Orthop Relat Res. 1983;178:103–10. Behrens F, Johnson WD, Koch TW, Kovacevic N. Bending stiffness of unilateral and bilateral fixator frames. Clin Orthop Relat Res. 1983;178:103–10.
21.
Zurück zum Zitat Arazi M, Yalcin H, Tarakcioglu N, Dasci Z, Kutlu A. The effects of dynamization and destabilization of the external fixator on fracture healing: a comparative biomechanical study in dogs. Orthopedics. 2002;25(5):521–4.PubMed Arazi M, Yalcin H, Tarakcioglu N, Dasci Z, Kutlu A. The effects of dynamization and destabilization of the external fixator on fracture healing: a comparative biomechanical study in dogs. Orthopedics. 2002;25(5):521–4.PubMed
22.
Zurück zum Zitat Augat P, Burger J, Schorlemmer S, Henke T, Peraus M, Claes L. Shear movement at the fracture site delays healing in a diaphyseal fracture model. J Orthop Res. 2003;21(6):1011–7.PubMed Augat P, Burger J, Schorlemmer S, Henke T, Peraus M, Claes L. Shear movement at the fracture site delays healing in a diaphyseal fracture model. J Orthop Res. 2003;21(6):1011–7.PubMed
23.
Zurück zum Zitat Windhagen H, Glockner R, Bail H, Kolbeck S, Raschke M. Stiffness characteristics of composite hybrid external fixators. Clin Orthop Relat Res. 2002;405:267–76. Windhagen H, Glockner R, Bail H, Kolbeck S, Raschke M. Stiffness characteristics of composite hybrid external fixators. Clin Orthop Relat Res. 2002;405:267–76.
24.
Zurück zum Zitat Podolsky A, Chao EY. Mechanical performance of Ilizarov circular external fixators in comparison with other external fixators. Clin Orthop Relat Res. 1993;293:61–70. Podolsky A, Chao EY. Mechanical performance of Ilizarov circular external fixators in comparison with other external fixators. Clin Orthop Relat Res. 1993;293:61–70.
25.
Zurück zum Zitat Lowenberg DW, Nork S, Abruzzo FM. Correlation of shear to compression for progressive fracture obliquity. Clin Orthop Relat Res. 2008;466(12):2947–54.PubMedPubMedCentral Lowenberg DW, Nork S, Abruzzo FM. Correlation of shear to compression for progressive fracture obliquity. Clin Orthop Relat Res. 2008;466(12):2947–54.PubMedPubMedCentral
26.
Zurück zum Zitat Metcalfe AJ, Saleh M, Yang L. Techniques for improving stability in oblique fractures treated by circular fixation with particular reference to the sagittal plane. J Bone Joint Surg (Br). 2005;87(6):868–72. Metcalfe AJ, Saleh M, Yang L. Techniques for improving stability in oblique fractures treated by circular fixation with particular reference to the sagittal plane. J Bone Joint Surg (Br). 2005;87(6):868–72.
27.
Zurück zum Zitat Pinzur MS. Simple solutions for difficult problems: a beginner’s guide to ring fixation. Foot Ankle Clin. 2008;13(1):1–13.PubMed Pinzur MS. Simple solutions for difficult problems: a beginner’s guide to ring fixation. Foot Ankle Clin. 2008;13(1):1–13.PubMed
28.
Zurück zum Zitat Lewis RA, Lewis DD, Anderson CL, Hudson CC, Coggeshall JD, Iorgulescu AD, et al. Mechanics of supplemental drop wire and half-pin fixation elements in single ring circular external fixator constructs. Vet Surg. 2016;45(4):471–9.PubMed Lewis RA, Lewis DD, Anderson CL, Hudson CC, Coggeshall JD, Iorgulescu AD, et al. Mechanics of supplemental drop wire and half-pin fixation elements in single ring circular external fixator constructs. Vet Surg. 2016;45(4):471–9.PubMed
29.
Zurück zum Zitat Seide K, Wolter D, Kortmann HR. Fracture reduction and deformity correction with the hexapod Ilizarov fixator. Clin Orthop Relat Res. 1999;363:186–95. Seide K, Wolter D, Kortmann HR. Fracture reduction and deformity correction with the hexapod Ilizarov fixator. Clin Orthop Relat Res. 1999;363:186–95.
30.
Zurück zum Zitat Keshet D, Eidelman M. Clinical utility of the Taylor spatial frame for limb deformities. Orthop Res Rev. 2017;9:51–61.PubMedPubMedCentral Keshet D, Eidelman M. Clinical utility of the Taylor spatial frame for limb deformities. Orthop Res Rev. 2017;9:51–61.PubMedPubMedCentral
32.
Zurück zum Zitat Naqui SZ, Thiryayi W, Foster A, Tselentakis G, Evans M, Day JB. Correction of simple and complex pediatric deformities using the Taylor-spatial Frame. J Pediatr Orthop. 2008;28(6):640–7.PubMed Naqui SZ, Thiryayi W, Foster A, Tselentakis G, Evans M, Day JB. Correction of simple and complex pediatric deformities using the Taylor-spatial Frame. J Pediatr Orthop. 2008;28(6):640–7.PubMed
34.
Zurück zum Zitat Wright J, Sabah SA, Patel S, Spence G. The silhouette technique: improving post-operative radiographs for planning of correction with a hexapod external fixator. Strategies Trauma Limb Reconstr. 2017;12(2):127–31.PubMedPubMedCentral Wright J, Sabah SA, Patel S, Spence G. The silhouette technique: improving post-operative radiographs for planning of correction with a hexapod external fixator. Strategies Trauma Limb Reconstr. 2017;12(2):127–31.PubMedPubMedCentral
35.
Zurück zum Zitat Goodship AE, Watkins PE, Rigby HS, Kenwright J. The role of fixator frame stiffness in the control of fracture healing. An experimental study. J Biomech. 1993;26(9):1027–35.PubMed Goodship AE, Watkins PE, Rigby HS, Kenwright J. The role of fixator frame stiffness in the control of fracture healing. An experimental study. J Biomech. 1993;26(9):1027–35.PubMed
36.
Zurück zum Zitat Cross AR, Lewis DD, Murphy ST, Rigaud S, Madison JB, Kehoe MM, et al. Effects of ring diameter and wire tension on the axial biomechanics of four-ring circular external skeletal fixator constructs. Am J Vet Res. 2001;62(7):1025–30.PubMed Cross AR, Lewis DD, Murphy ST, Rigaud S, Madison JB, Kehoe MM, et al. Effects of ring diameter and wire tension on the axial biomechanics of four-ring circular external skeletal fixator constructs. Am J Vet Res. 2001;62(7):1025–30.PubMed
37.
Zurück zum Zitat Yang L, Nayagam S, Saleh M. Stiffness characteristics and inter-fragmentary displacements with different hybrid external fixators. Clin Biomech (Bristol, Avon). 2003;18(2):166–72. Yang L, Nayagam S, Saleh M. Stiffness characteristics and inter-fragmentary displacements with different hybrid external fixators. Clin Biomech (Bristol, Avon). 2003;18(2):166–72.
38.
Zurück zum Zitat Runyan CM. Flores RL, McCarthy JG. Distraction osteogenesis: biologic and biomechanical principles. In: JG M, editor. Craniofacial distraction. Springer International Publishing; 2017. p. 11–43. Runyan CM. Flores RL, McCarthy JG. Distraction osteogenesis: biologic and biomechanical principles. In: JG M, editor. Craniofacial distraction. Springer International Publishing; 2017. p. 11–43.
39.
Zurück zum Zitat Ilizarov GA. The tension-stress effect on the genesis and growth of tissues. Part I. The influence of stability of fixation and soft-tissue preservation. Clin Orthop Relat Res. 1989;238:249–81. Ilizarov GA. The tension-stress effect on the genesis and growth of tissues. Part I. The influence of stability of fixation and soft-tissue preservation. Clin Orthop Relat Res. 1989;238:249–81.
40.
Zurück zum Zitat Ilizarov GA. The tension-stress effect on the genesis and growth of tissues: Part II. The influence of the rate and frequency of distraction. Clin Orthop Relat Res. 1989;239:263–85. Ilizarov GA. The tension-stress effect on the genesis and growth of tissues: Part II. The influence of the rate and frequency of distraction. Clin Orthop Relat Res. 1989;239:263–85.
41.
Zurück zum Zitat Hamdy RC, Bernstein M, Fragomen AT, Rozbruch SR. What’s new in limb lengthening and deformity correction. J Bone Joint Surg Am. 2018;100(16):1436–42.PubMed Hamdy RC, Bernstein M, Fragomen AT, Rozbruch SR. What’s new in limb lengthening and deformity correction. J Bone Joint Surg Am. 2018;100(16):1436–42.PubMed
42.
Zurück zum Zitat Matsubara H, Tsuchiya H. Treatment of bone tumor using external fixator. J Orthop Sci. 2019;24(1):1–8.PubMed Matsubara H, Tsuchiya H. Treatment of bone tumor using external fixator. J Orthop Sci. 2019;24(1):1–8.PubMed
44.
Zurück zum Zitat Calder PR, Laubscher M, Goodier WD. The role of the intramedullary implant in limb lengthening. Injury. 2017;48(Suppl 1):S52–s8.PubMed Calder PR, Laubscher M, Goodier WD. The role of the intramedullary implant in limb lengthening. Injury. 2017;48(Suppl 1):S52–s8.PubMed
45.
Zurück zum Zitat Codivilla A. The classic: On the means of lengthening, in the lower limbs, the muscles and tissues which are shortened through deformity. 1905. Clin Orthop Relat Res. 2008;466(12):2903–9.PubMedPubMedCentral Codivilla A. The classic: On the means of lengthening, in the lower limbs, the muscles and tissues which are shortened through deformity. 1905. Clin Orthop Relat Res. 2008;466(12):2903–9.PubMedPubMedCentral
46.
Zurück zum Zitat Karp NS, McCarthy JG, Schreiber JS, Sissons HA, Thorne CH. Membranous bone lengthening: a serial histological study. Ann Plast Surg. 1992;29(1):2–7.PubMed Karp NS, McCarthy JG, Schreiber JS, Sissons HA, Thorne CH. Membranous bone lengthening: a serial histological study. Ann Plast Surg. 1992;29(1):2–7.PubMed
47.
Zurück zum Zitat Vauhkonen M, Peltonen J, Karaharju E, Aalto K, Alitalo I. Collagen synthesis and mineralization in the early phase of distraction bone healing. Bone Miner. 1990;10(3):171–81.PubMed Vauhkonen M, Peltonen J, Karaharju E, Aalto K, Alitalo I. Collagen synthesis and mineralization in the early phase of distraction bone healing. Bone Miner. 1990;10(3):171–81.PubMed
48.
49.
Zurück zum Zitat Aronson J, Harp JH Jr. Mechanical considerations in using tensioned wires in a transosseous external fixation system. Clin Orthop Relat Res. 1992;280:23–9. Aronson J, Harp JH Jr. Mechanical considerations in using tensioned wires in a transosseous external fixation system. Clin Orthop Relat Res. 1992;280:23–9.
50.
Zurück zum Zitat Emara KM, Ghafar KA, Al Kersh MA. Methods to shorten the duration of an external fixator in the management of tibial infections. World J Orthop. 2011;2(9):85–92.PubMedPubMedCentral Emara KM, Ghafar KA, Al Kersh MA. Methods to shorten the duration of an external fixator in the management of tibial infections. World J Orthop. 2011;2(9):85–92.PubMedPubMedCentral
51.
Zurück zum Zitat Forriol F, Iglesias A, Arias M, Aquerreta D, Canadell J. Relationship between radiologic morphology of the bone lengthening formation and its complications. J Pediatr Orthop B. 1999;8(4):292–8.PubMed Forriol F, Iglesias A, Arias M, Aquerreta D, Canadell J. Relationship between radiologic morphology of the bone lengthening formation and its complications. J Pediatr Orthop B. 1999;8(4):292–8.PubMed
52.
Zurück zum Zitat Li R, Saleh M, Yang L, Coulton L. Radiographic classification of osteogenesis during bone distraction. J Orthop Res. 2006;24(3):339–47.PubMed Li R, Saleh M, Yang L, Coulton L. Radiographic classification of osteogenesis during bone distraction. J Orthop Res. 2006;24(3):339–47.PubMed
53.
Zurück zum Zitat Fischgrund J, Paley D, Suter C. Variables affecting time to bone healing during limb lengthening. Clin Orthop Relat Res. 1994;301:31–7. Fischgrund J, Paley D, Suter C. Variables affecting time to bone healing during limb lengthening. Clin Orthop Relat Res. 1994;301:31–7.
54.
Zurück zum Zitat Rozbruch SR, Fragomen AT, Ilizarov S. Correction of tibial deformity with use of the Ilizarov-Taylor spatial frame. J Bone Joint Surg Am. 2006;88(Suppl 4):156–74.PubMed Rozbruch SR, Fragomen AT, Ilizarov S. Correction of tibial deformity with use of the Ilizarov-Taylor spatial frame. J Bone Joint Surg Am. 2006;88(Suppl 4):156–74.PubMed
55.
Zurück zum Zitat Kabata T, Tsuchiya H, Sakurakichi K, Yamashiro T, Watanabe K, Tomita K. Reconstruction with distraction osteogenesis for juxta-articular nonunions with bone loss. J Trauma. 2005;58(6):1213–22.PubMed Kabata T, Tsuchiya H, Sakurakichi K, Yamashiro T, Watanabe K, Tomita K. Reconstruction with distraction osteogenesis for juxta-articular nonunions with bone loss. J Trauma. 2005;58(6):1213–22.PubMed
56.
Zurück zum Zitat D’Hooghe P, Defoort K, Lammens J, Stuyck J. Management of a large post-traumatic skin and bone defect using an Ilizarov frame. Acta Orthop Belg. 2006;72(2):214–8.PubMed D’Hooghe P, Defoort K, Lammens J, Stuyck J. Management of a large post-traumatic skin and bone defect using an Ilizarov frame. Acta Orthop Belg. 2006;72(2):214–8.PubMed
57.
Zurück zum Zitat Panagopoulos GN, Mavrogenis AF, Mauffrey C, Lesensky J, Angelini A, Megaloikonomos PD, et al. Intercalary reconstructions after bone tumor resections: a review of treatments. Eur J Orthop Surg Traumatol. 2017;27(6):737–46.PubMed Panagopoulos GN, Mavrogenis AF, Mauffrey C, Lesensky J, Angelini A, Megaloikonomos PD, et al. Intercalary reconstructions after bone tumor resections: a review of treatments. Eur J Orthop Surg Traumatol. 2017;27(6):737–46.PubMed
58.
Zurück zum Zitat Quinnan SM. Segmental bone loss reconstruction using ring fixation. J Orthop Trauma. 2017;31(Suppl 5):S42–s6.PubMed Quinnan SM. Segmental bone loss reconstruction using ring fixation. J Orthop Trauma. 2017;31(Suppl 5):S42–s6.PubMed
59.
Zurück zum Zitat Papakostidis C, Bhandari M, Giannoudis PV. Distraction osteogenesis in the treatment of long bone defects of the lower limbs: effectiveness, complications and clinical results; a systematic review and meta-analysis. Bone Joint J. 2013;95-b(12):1673–80.PubMed Papakostidis C, Bhandari M, Giannoudis PV. Distraction osteogenesis in the treatment of long bone defects of the lower limbs: effectiveness, complications and clinical results; a systematic review and meta-analysis. Bone Joint J. 2013;95-b(12):1673–80.PubMed
60.
Zurück zum Zitat Watson JT. Distraction osteogenesis. J Am Acad Orthop Surg. 2006;14(10):S168–74.PubMed Watson JT. Distraction osteogenesis. J Am Acad Orthop Surg. 2006;14(10):S168–74.PubMed
61.
Zurück zum Zitat Green SA. Skeletal defects: A comparison of bone grafting and bone transport for segmental skeletal defects. Clin Orthop Relat Res. 1994;301:111–7. Green SA. Skeletal defects: A comparison of bone grafting and bone transport for segmental skeletal defects. Clin Orthop Relat Res. 1994;301:111–7.
62.
Zurück zum Zitat Green SA, Jackson JM, Wall DM, Marinow H, Ishkanian J. Management of segmental defects by the Ilizarov intercalary bone transport method. Clin Orthop Relat Res. 1992;280:136–42. Green SA, Jackson JM, Wall DM, Marinow H, Ishkanian J. Management of segmental defects by the Ilizarov intercalary bone transport method. Clin Orthop Relat Res. 1992;280:136–42.
63.
Zurück zum Zitat Girard PJ, Kuhn KM, Bailey JR, Lynott JA, Mazurek MT. Bone transport combined with locking bridge plate fixation for the treatment of tibial segmental defects: a report of 2 cases. J Orthop Trauma. 2013;27(9):e220–6.PubMed Girard PJ, Kuhn KM, Bailey JR, Lynott JA, Mazurek MT. Bone transport combined with locking bridge plate fixation for the treatment of tibial segmental defects: a report of 2 cases. J Orthop Trauma. 2013;27(9):e220–6.PubMed
64.
Zurück zum Zitat Lesensky J, Prince DE. Distraction osteogenesis reconstruction of large segmental bone defects after primary tumor resection: pitfalls and benefits. Eur J Orthop Surg Traumatol. 2017;27(6):715–27.PubMed Lesensky J, Prince DE. Distraction osteogenesis reconstruction of large segmental bone defects after primary tumor resection: pitfalls and benefits. Eur J Orthop Surg Traumatol. 2017;27(6):715–27.PubMed
65.
Zurück zum Zitat Iobst CA, Mohammed W, Colley R. Determining when it is safe to remove the external fixator: results from a survey of the Limb Lengthening and Reconstruction Society. Orthopedics. 2017;40(5):e876–e9.PubMed Iobst CA, Mohammed W, Colley R. Determining when it is safe to remove the external fixator: results from a survey of the Limb Lengthening and Reconstruction Society. Orthopedics. 2017;40(5):e876–e9.PubMed
66.
Zurück zum Zitat Starr KA, Fillman R, Raney EM. Reliability of radiographic assessment of distraction osteogenesis site. J Pediatr Orthop. 2004;24(1):26–9.PubMed Starr KA, Fillman R, Raney EM. Reliability of radiographic assessment of distraction osteogenesis site. J Pediatr Orthop. 2004;24(1):26–9.PubMed
67.
Zurück zum Zitat Hazra S, Song HR, Biswal S, Lee SH, Jang KM, Modi HN. Quantitative assessment of mineralization in distraction osteogenesis. Skelet Radiol. 2008;37(9):843–7. Hazra S, Song HR, Biswal S, Lee SH, Jang KM, Modi HN. Quantitative assessment of mineralization in distraction osteogenesis. Skelet Radiol. 2008;37(9):843–7.
68.
Zurück zum Zitat Zhao L, Fan Q, Venkatesh KP, Park MS, Song HR. Objective guidelines for removing an external fixator after tibial lengthening using pixel value ratio: a pilot study. Clin Orthop Relat Res. 2009;467(12):3321–6.PubMedPubMedCentral Zhao L, Fan Q, Venkatesh KP, Park MS, Song HR. Objective guidelines for removing an external fixator after tibial lengthening using pixel value ratio: a pilot study. Clin Orthop Relat Res. 2009;467(12):3321–6.PubMedPubMedCentral
69.
Zurück zum Zitat Saran N, Hamdy RC. DEXA as a predictor of fixator removal in distraction osteogenesis. Clin Orthop Relat Res. 2008;466(12):2955–61.PubMedPubMedCentral Saran N, Hamdy RC. DEXA as a predictor of fixator removal in distraction osteogenesis. Clin Orthop Relat Res. 2008;466(12):2955–61.PubMedPubMedCentral
70.
Zurück zum Zitat Simpson AH, Kenwright J. Fracture after distraction osteogenesis. J Bone Joint Surg (Br). 2000;82(5):659–65. Simpson AH, Kenwright J. Fracture after distraction osteogenesis. J Bone Joint Surg (Br). 2000;82(5):659–65.
71.
Zurück zum Zitat Danziger MB, Kumar A, DeWeese J. Fractures after femoral lengthening using the Ilizarov method. J Pediatr Orthop. 1995;15(2):220–3.PubMed Danziger MB, Kumar A, DeWeese J. Fractures after femoral lengthening using the Ilizarov method. J Pediatr Orthop. 1995;15(2):220–3.PubMed
73.
Zurück zum Zitat Nguyen VD, London J, Cone RO 3rd. Ring sequestrum: radiographic characteristics of skeletal fixation pin-tract osteomyelitis. Radiology. 1986;158(1):129–31.PubMed Nguyen VD, London J, Cone RO 3rd. Ring sequestrum: radiographic characteristics of skeletal fixation pin-tract osteomyelitis. Radiology. 1986;158(1):129–31.PubMed
74.
Zurück zum Zitat Kazmers NH, Fragomen AT, Rozbruch SR. Prevention of pin site infection in external fixation: a review of the literature. Strategies Trauma Limb Reconstr. 2016;11(2):75–85.PubMedPubMedCentral Kazmers NH, Fragomen AT, Rozbruch SR. Prevention of pin site infection in external fixation: a review of the literature. Strategies Trauma Limb Reconstr. 2016;11(2):75–85.PubMedPubMedCentral
75.
Zurück zum Zitat Dahl MT, Gulli B, Berg T. Complications of limb lengthening. A learning curve. Clin Orthop Relat Res. 1994;301:10–8. Dahl MT, Gulli B, Berg T. Complications of limb lengthening. A learning curve. Clin Orthop Relat Res. 1994;301:10–8.
76.
Zurück zum Zitat Ward P. Care of skeletal pins: a literature review. Nurs Stand. 1998;12(39):34–8.PubMed Ward P. Care of skeletal pins: a literature review. Nurs Stand. 1998;12(39):34–8.PubMed
77.
Zurück zum Zitat Parameswaran AD, Roberts CS, Seligson D, Voor M. Pin tract infection with contemporary external fixation: how much of a problem? J Orthop Trauma. 2003;17(7):503–7.PubMed Parameswaran AD, Roberts CS, Seligson D, Voor M. Pin tract infection with contemporary external fixation: how much of a problem? J Orthop Trauma. 2003;17(7):503–7.PubMed
78.
Zurück zum Zitat Pommer A, Muhr G, David A. Hydroxyapatite-coated Schanz pins in external fixators used for distraction osteogenesis: a randomized, controlled trial. J Bone Joint Surg Am. 2002;84-a(7):1162–6. Pommer A, Muhr G, David A. Hydroxyapatite-coated Schanz pins in external fixators used for distraction osteogenesis: a randomized, controlled trial. J Bone Joint Surg Am. 2002;84-a(7):1162–6.
79.
Zurück zum Zitat Shyam AK, Singh SU, Modi HN, Song HR, Lee SH, An H. Leg lengthening by distraction osteogenesis using the Ilizarov apparatus: a novel concept of tibia callus subsidence and its influencing factors. Int Orthop. 2009;33(6):1753–9.PubMed Shyam AK, Singh SU, Modi HN, Song HR, Lee SH, An H. Leg lengthening by distraction osteogenesis using the Ilizarov apparatus: a novel concept of tibia callus subsidence and its influencing factors. Int Orthop. 2009;33(6):1753–9.PubMed
80.
Zurück zum Zitat Simpson AH, Cunningham JL, Kenwright J. The forces which develop in the tissues during leg lengthening. A clinical study. J Bone Joint Surg (Br). 1996;78(6):979–83. Simpson AH, Cunningham JL, Kenwright J. The forces which develop in the tissues during leg lengthening. A clinical study. J Bone Joint Surg (Br). 1996;78(6):979–83.
Metadaten
Titel
External fixators: looking beyond the hardware maze
verfasst von
Kimia Khalatbari Kani
Jack A. Porrino
Felix S. Chew
Publikationsdatum
12.09.2019
Verlag
Springer Berlin Heidelberg
Erschienen in
Skeletal Radiology / Ausgabe 3/2020
Print ISSN: 0364-2348
Elektronische ISSN: 1432-2161
DOI
https://doi.org/10.1007/s00256-019-03306-w

Weitere Artikel der Ausgabe 3/2020

Skeletal Radiology 3/2020 Zur Ausgabe

Update Radiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.