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Hybrid and Spanning External Fixation
Wayne Cheng, MD Assistant Professor Department of Orthopaedic Surgery Loma Linda University Medical Center SEP 17, 2006
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History Jean-Francois Malgaigne, 1840 Clayton Parkhill, 1897 Lambotte
Malgaigne’s point Malgaigne’s claw Clayton Parkhill, 1897 Bone clamp Lambotte Lambotte ext fixator
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1940 to 1970 x
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Hybrid External fixator
Soft tissue reaction Affixing smaller metaphyseal fragm Cancellous bone Trampoline effect Half pins
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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)
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Location at proximal tibia
Tornetta et al, JOT 2000
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Knee capsular reflection
14 MM 10% Spence Reid, MD
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Safe corridors distal tibia
Vives JOT 15 (8) 2001
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Ankle capsule Superior capsular reflection 21 mm from antmed joint line
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Insertion technique
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Case example 1
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Case example 1 – post op
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Case 2
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Case example 2
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Case 2 - final
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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
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Why did hybrid fall out of favor?
High maintenance/malunion/nonunion Cumbersome/bulky Pin tract infection Meticulous insertion/assembly Fracture through pin sites expensive
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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%
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Spanning external fixation
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Spanning external fixation
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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.
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THANK Y0U
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