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Hybrid and Spanning External Fixation

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Presentation on theme: "Hybrid and Spanning External Fixation"— Presentation transcript:

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

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

3 1940 to 1970 x

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

5 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)

6

7 Location at proximal tibia
Tornetta et al, JOT 2000

8 Knee capsular reflection
14 MM 10% Spence Reid, MD

9 Safe corridors distal tibia
Vives JOT 15 (8) 2001

10 Ankle capsule Superior capsular reflection 21 mm from antmed joint line

11 Insertion technique

12 Case example 1

13 Case example 1 – post op

14 Case 2

15 Case example 2

16 Case 2 - final

17 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

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

19 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%

20 Spanning external fixation

21 Spanning external fixation

22 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.

23 THANK Y0U


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