This paper is only available as a PDF. To read, Please Download here.
Abstract
In open fractures especially in those with severe soft tissue damage, fracture stabilisation
is best achieved by using external fixators. There are some intrinsic complications
which occur during classical external pin fixation. To overcome the problem of pin
track infection and vascular damage from drilling, the Pinless external fixator was
developed. It is based on the idea of a forceps with trocar points, which only penetrate
the bone cortex superficially.
The function of the device was tested in two mechanical trials and two in vitro tests
in which one pinless clamp was put under a controlled load of 50 N, 150 cycles/day
and studied over a 5 week period in sheep. The loads and time range of the experiment
were chosen to simulate a temporary fracture stabilisation in a patient not bearing
weight. The main question to be answered was whether the Pinless external fixator
would be able to maintain stable fixation. Furthermore, it was to determine the changes
at the trocar-to-bone interface.
The clamp was found to maintain 72 % of the initially applied clamping force after
5 weeks of in vivo application and it was found to be tight at removal. Some decrease
of clamping force was found during the first 20 days and then the force tended to
level off. There was no slippage nor did the clamp penetrate the cortex. There were
no obvious signs of infection around the trocar-holes and in the bacterial tests no
pathological cultures were grown. Histology revealed very localised bone reactions,
the indentation caused by the trocar tips being only 1.2 mm deep.
The study concludes, as far as could be ascertained from these tests, that it is safe
to use pinless external fixation for temporary fracture fixation.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to InjuryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Pin-hole changes after external fixation of tubular bone.Arch. Orthop. Trauma Surg. 1984; 104: 118-120
- Die Marknagelung als Sekundäreingriff nach vorausgegangener Anwendung des Fixateur externe.Unfallchir. 1983; 9: 83-91
- External fixation by Hoffmann-Vidal-Adrey osteotaxis for severe tibial fractures.Clin. Orthop. 1983; 181: 154-164
- External fixation of tibial fractures at Groote Schuur Hospital, Cape Town.SA Med.Tydskrif. 1981; 26: 498-501
- The treatment of fractures with a dynamic axial fixator.J. Bone Joint Surg. 1984; 66B: 538-545
- Bending stiffness of unilateral and bilateral fixator frames.Clin. Orthop. 1983; 178: 103-110
- Unilateral external fixation. methods to increase and reduce frame stiffness.Clin. Orthop. 1989; 241: 48-56
- External fixation of the tibia. basic concepts and prospective evaluation.J. Bone Joint Surg. 1986; 68B: 246-254
- General theory and principles of external fixation.Clin. Orthop. 1989; 241: 15-23
- Tibial fractures treated with Hoffmann's external fixation.Acta Orthop. Scand. 1982; 53: 471-476
- The effect of radial, preload on the implantbone interface: a cadaveric study.J. Orthop. Trauma. 1989; 3: 323-332
- External fixation and delayed intramedullary nailing of open fractures of the tibial shaft. a sequential protocol.J. Bone Joint Surg. 1990; 72A: 729-735
- Stabilitätsprüfung.AO-Bulletin. 1978;
- The Halo skeletal fixator. principles of application and maintenance.Clin. Orthop. 1989; 239: 12-18
- The mechanical performance of the standard Hoffmann-Vidal external fixation apparatus.J. Bone Joint. Surg. 1982; 64A: 566-573
- Elastic external fixation: a biomechanical study of the half-frame.in: Concepts in external fixation. Grune & Stratton, 1982: 67-78
- Simple external fixation of open and complicated fractures.Injury. 1985; 16: 367-370
- An evaluation of the bending stiffness of various tibial fixation methods.Clin. Orthop. 1987; 224: 289-293
- The management of type III open tibial fractures.Injury. 1984; 16: 157-165
- The mechanical basis of external fixation.in: Concepts in external fixation. Grune & Stratton, 1982: 13-39
- Rigidity and stress analyses of external fracture fixation devices — a theoretical approach.J. Biomec. 1982; 15: 971-983
- Complications of external fixation of open fractures of the tibia.Injury. 1987; 18: 174-176
- Hughes external fixator in treatment of tibial fractures.J. Royal Soc. Med. 1985; 78: 830-837
- External Fixation for Complicated Tibial Fractures.J. Bone Joint Surg. 1981; 63B: 92-97
- Severe open tibial fractures. results treating 202 injuries with external fixation.Clin. Orthop. 1988; 230: 98-115
- Staged reconstruction of complex open tibial fractures using Hoffmann external fixation.Clin. Orthop. 1983; 178: 130-161
- Treatment by external fixation of open fracture associated with severe soft tissue damage of the leg.Clin. Orthop. 1983; 178: 80-87
- Analysis of single-sided external fracture fixation.Engineering Med. 1979; 8: 133-137
- Treatment of fractures and pseudarthrosis of the long bone by Hoffmann's transfixation method (osteotaxis).Acta Othop. Scand. 1963; 32: 132-150
- Stability of ten configurations of the Hoffmann external fixation frame.J. Bone Joint Surg. 1987; 69A: 734-744
Ganz R (1990) Pers. com.
- Mechanical induction of bone resorption.Fortschr. Kiefer.-Gesichtschir. 1975; 19: 45-48
- Complications in the use of the Halo fixation device.J. Bone Joint Surg. 1986; 68A: 320-325
- Radialspannung in Knochengewebe, welches Steinemann-Nägel resp.Schanz'sche Schrauben umgibt. Internal Report. 1984;
- Kritische Analyse von 42 primär mit Fixateur externe behandelten Unterschenkel.Unfallchirurgische Vers. und Berufsmittel. 1988; 91: 87-91
- The AO external skeletal fixator in the treatment of severe tibial fractures.J. Trauma. 1983; 23: 986-990
- The influence of induced micromovement upon healing of experimental tibial fractures.J. Bone Joint Surg. 1985; 67B: 650-655
- Chronic osteomyelitis in pin tracks.J. Bone Joint Surg. 1984; 66A: 1092-1098
- Complications of external fixation.in: current concepts of external fixation of fractures. Springer Verlag, Heidelberg1982: 43
- Complications of external skeletal fixation.Charles C.Thomas, Springfield, Illinois, USA1981
- Prevention of infection in the treatment of one-thousand and twenty.five open fractures of long bones.J. Bone Joint Surg. 1976; 58A: 453-458
- External fixation of tibial shaft fractures. a review of 42 fractures treated by the Hoffman-Vidal-Adrey external fixation system.Arch. Orthop. Trauma Surg. 1985; 104: 271-274
- Experimentelle Untersuchungen der Stabilität verschiedener Montageformen des unilateralen Fixateur externe.Unfallheilkunde. 1986; 181: 52-62
- Complicated extremity fractures. The relation between external fixation and nonunion.Clin. Orthop. 1983; 178: 89-95
- Theoretische Grundlagen und Biomechanik der Fixateur externe Osteosynthese.in: Langenbecks Archiv für Chirurgie. 358. Springer Verlag, 1982: 105-112
- Guidelines for external fixation frame rigidity and stresses.J. Orthop. Res. 1986; 4: 68-75
- Parametric analyses of pin-bone stresses in external fracture fixation devices.J. Orthop. Res. 1985; 3: 341-349
- Induction and prevention of pin loosening in external fixation: an in vivo study on sheep tibiae.J Orthop. Trauma. 1991; 5: 485-492
- Delayed intramedullary nailing after failed external fixation of the tibia.Clin. Orthop. 1990; 253: 251-257
- Fractures of the tibial shaft. A critical evaluation of treatment alternatives.Clin. Orthop. 1974; 105: 82-115
- External fixation of severe open tibial fractures with the Hoffmann frame.Clin. Orthop. 1983; 180: 68-78
- Percutaneous pin fixation of open tibial fractures.J. Bone Joint Surg. 1975; 56B: 915-924
- Controlled mechanical stimulation in the treatment of tibial fractures.Clin. Orthop. 1989; 241: 36-47
- Effect of controlled axial micromovement on healing of tibial fractures.Lancet. 1986; 22: 36-47
- Results of treatment using the Hoffmann external fixator for fractures of the tibial diaphysis.J. Trauma. 1982; 22: 960-965
- The use of the Vidal-Adrey external fixation system. Part 2: The treatment of infected and previously infected pseudarthroses.Clin. Orthop. 1979; 140: 122-130
- The use of the Vidal-Adrey external fixation system. Part 1: The treatment of open fractures.Clin. Orthop. 1979; 140: 111-121
- Vorrichtung zum Aneinanderdrücken der Bruchstellen bei Oberschenkelhalsfrakturen.1960 (Oesterreichisches Patentamt. Patent no. 210985)
- Open tibial shaft fractures.Clin. Orthop. 1983; 180: 63-67
- Use of Hoffmann apparatus in the treatment of unstable tibial fractures.J. Bone Joint Surg. 1980; 62A: 1264-1273
- Rigidity of immobilization of oblique fractures.Acta Orthop. Scand. 1964; 35: 39-50
- The thermal effects of skeletal fixation — pin insertion in bone.J. Bone Joint Surg. 1984; 66A: 1077-1083
- Infection after intramedullary nailing of severe open tibial fractures initially treated with external fixation.J. Bone Joint Surg. 1989; 71A: 835-838
- Comparison of mechanical performance in four types of external fixators.Clin. Orthop. 1983; 180: 23-33
- Treatment of open tibial shaft fractures. External fixation and secondary intramedullary nailing.J. Bone Joint Surg. 1988; 70A: 900-911
- Open fractures of the tibia.Clin. Orthop. 1981; 156: 98-104
- The use of a clamp-on plate for forearm fractures.Orthopedics. 1989; 12: 39-43
- How stable should external fixation be?.in: Current concepts of external fixation of fractures. Springer Verlag, Heidelberg1982: 21-26
- External fixation: Choosing a system based on biomechanical stability.J. Orthop. Trauma. 1989; 2: 284-296
- Manual of internal fixation. Springer Verlag, 1991: 367
- External skeletal fixation in the treatment of fractures of the tibia.J. Bone Joint Surg. 1949; 31A: 586-598
- Open tibial fractures treated with Hoffmann external fixation.Arch. Orthop. Trauma Surg. 1988; 107: 248-252
- The Halo. A spinal skeletal traction fixation device.Clin. Orthop. 1989; 239: 4-11
- Cortical bone healing.in: Acta Orthop. Scand. Suppl. 125. Munksgaard, Copenhagen1969
- Oberflächliche Knochenresorption um Implantate.Med.-Orthop. Technik. 1975; 1: 6-10
- Basic aspects and scientific background of internal fixation.AO-Bulletin. 1989;
- Surgical Pin Guide. 1948; (United States Patent Office, 2434431)
- Critical analysis of results of treatment of 201 tibial shaft fractures.Clin. Orthop. 1986; 212: 113-121
- “Ring Fixator” for treatment of lower leg fractures. A review of 30 cases treated by a new external fixation system.Int. Surg. 1988; 73: 170-172
- Ten years of experience with the operative management of tibial shaft fractures.J. Trauma. 1987; 27: 917-927
- External fixation of tibial shaft fractures with severe soft tissue injuries by Hoffmann-Vidal-Adrey osteotaxis.Arch. Orthop. Trauma Surg. 1986; 105: 170-174
- Intrinsic problems with the external fixation device of Hoffmann-Vidal-Adrey: A critical evaluation of 117 patients with complex tibial shaft fractures.J. Trauma. 1989; 29: 630-638
- The halo brace in unstable fractures of the cervical spine: a review of 14 cases.Injury. 1985; 16: 318-320
- Fractures of the tibia treated by flexible external fixation.Clin. Orthop. 1983; 178: 162-172
- A rheologic model for cortical bone.in: Acta Orthop. Scand. Suppl. 83. Munksgaard, Copenhagen1965
- Behandlungsrichtlinien and Ergebnisse schwerst offener Unterschenkelbrüche.Unfallchirurg. 1984; 10: 192-299
- External fixation. Historic review, advantages, disadvantages, complications, and indications.Clin. Orthop. 1983; 180: 15-22
- Induction of bone surface resorption by motion. An in vivo study using passive and active implants.in: At Sec. Int. Symp. on Int. Fix. of Fract, Lyon 16.–18.Sept.1982: 62-64
- Tibia nonunions treated by interlocked nailing: increased risk of infection after previous external fixation.J. Orthop. Trauma. 1990; 4: 109-114
- Open fractures of the tibia treated by the Hoffmann external fixator.Clin. Orthop. 1983; 180: 125-132
- External fixation. Yesterday, today and tomorrow.Clin. Orthop. 1983; 180: 7-14
- Guidelines for the treatment of open fractures and infected pseudarthroses by external fixation.Clin. Orthop. 1983; 180: 83-95
- Möglichkeiten und Grenzen der Therapie von Halswirbelverletzungen mit dem Halo-Fixator.Unfallchirurgie. 1989; 15: 83-94
Article info
Identification
Copyright
© 1992 Published by Elsevier Inc.