Hybrid and Spanning External Fixation

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Presentation transcript:

Hybrid and Spanning External Fixation Wayne Cheng, MD Assistant Professor Department of Orthopaedic Surgery Loma Linda University Medical Center SEP 17, 2006

History Jean-Francois Malgaigne, 1840 Clayton Parkhill, 1897 Lambotte Malgaigne’s point Malgaigne’s claw Clayton Parkhill, 1897 Bone clamp Lambotte Lambotte ext fixator

1940 to 1970 x

Hybrid External fixator Soft tissue reaction Affixing smaller metaphyseal fragm Cancellous bone Trampoline effect Half pins

Biomechanics - stability S = r 4 Wire diameter Wire tension Crossing angle Distance ring to bone # of wire Olive wire Center bone Optimal = 50% of yield strength (80 – 90 kg)

Location at proximal tibia Tornetta et al, JOT 2000

Knee capsular reflection 14 MM 10% Spence Reid, MD

Safe corridors distal tibia Vives JOT 15 (8) 2001

Ankle capsule Superior capsular reflection 21 mm from antmed joint line

Insertion technique

Case example 1

Case example 1 – post op

Case 2

Case example 2

Case 2 - final

Is hybrid any good? 31 complex proxm tibia fx. 3.7 year f/u Functional grading (rasmussen) 84% good 12% fair 3% poor Complication 23% pin tract infx. 1 AKA

Why did hybrid fall out of favor? High maintenance/malunion/nonunion Cumbersome/bulky Pin tract infection Meticulous insertion/assembly Fracture through pin sites expensive

Spanning External fixation + secondary internal fixation year author journal #pts Infx rate 2005 Egol, Koval JOT 62 plateau 5% 2004 Sirkin, sanders 56 pilon 0% closed 11% open 2001 Dickson Injury 35 pilon 8%

Spanning external fixation

Spanning external fixation

Conclusion Spanning external fixation is a valuable tool for initial soft tissue management 2nd stage internal fixation is attractive. Hybrid external fixation is a tool that may be valuable in selected cases.

THANK Y0U