Over the years, orthopaedic implants like plates and external fixators are made available for the treatment of articular fractures by the external fixator manufacturers. The goals of treatment for articular fracture are an absolute reconstruction of the joint and a stable fixation inter-fragmentary compression that can allow painless movement. Open reduction and internal fixation (ORIF) in uncomplicated fracture pattern by combining inter-fragmentary lag screw fixation and an external fixator. In case of critical soft-tissue injury, these two alternatives are advisable.

In a joint- uniting manner, the external fixator can be used like a short time measure in complicated on unstable articular fracture so that the frail soft tissues cover can be protected which otherwise do not allow further specific internal fixation. Any major joint other than the shoulder can be united with this technique. Joining external fixation of the wrist is more complicated. And to reduce the fracture by distraction like ligamentotaxis, first the external fixator is used. Secondly, the fragments are held in position. But the extra caution should be taken such as: the wrist joint must not be over distracted, and distraction should be maintained for a continued period of not more than three to four weeks.

In case of open tibia shaft fracture, for holding the ankle and foot in neutral position uniting external fixation is commonly used to the first metatarsal.

Since the external fixation for joint- uniting is generally a short-term measure, the pin placement needs a discreet planning. So that is does not get in the way of final internal fixation after the period of 1-2 weeks. And if there is any defect in large soft tissue, one should consult a plastic surgeon so that compromising the access for reconstructive process afterwards can be avoided.

If the pin loses its hold in the bone, it causes continuous pin-track infection.  Loosing of pin and seam of bone resorption can be seen on the x-ray. This problem can be solved by changing the pin to new site.

Postoperative treatment Pin-track precautions

Correct insertion of pin is the prerequisite. Unnecessary tension of Soft-tissue should be released at the time of surgery. Proper care of pin-track area is necessary to lessen the risk of complications of pin-track. It should be cleaned and sterilized with betadine.

Change to internal fixation

However, the external fixator is widely used in multi-trauma patients and in open fractures as an emergency tool. But there are some disadvantages of these external fixator in the final treatment of a fracture. These disadvantages are the size of device, discomfort due to its bulk, the requirement of daily care of pin and restrictions of movement. Because of these complications, a patient can demand for change to internal stabilization.

Procedure Schedule

If the pin sites are not infected, then within the two weeks of external fixation, unreamed intramedullary nailing is considerably safe. But in case of infection in pin sites and if the change of external fixator to intramedullary nailing is determined after two weeks then removing of external fixator, pin track curette and plaster cast of the limb is required until the complete removal of the infection. A common external fixator by using a pin-less device can be replaced as a substitute to this procedure.

And if there is plan of implanting hand locking plates, in that case, after disinfecting the pin tracks, the fixator can be retained for one or two weeks more prior to the replacement.

While applying MIPO to fix a proximal femoral fracture with a 95º condylar plate, varus malalignment can happen during plate addition. The etched trench is first arranged utilizing standard AO strategies. The 95° condylar plate is then slipped into and submuscular burrow nearby the horizontal cortex of the femur with the edge pointing along the side. The edge is then transformed medially for inclusion into the readied trench. Be that as it may, the heading of the cutting edge and trench as often as possible don’t meet. The cutting edge tends to go off course and make a bogus section, bringing about the proximal piece being fixed in the varus position.

The explanation behind this is the parallel thigh muscles will in general push the cutting edge plate into a varus position. This complexity can be kept away from by implanting a joystick into the proximal section to carry it into an appropriate arrangement to the edge during sharp edge addition. Likewise, the guide pin utilized at first to manage the bearing of the seating etch ought to be left set up to control the course of sharp edge addition. Another helpful hint is to utilize a short edge of 50-60 mm length which makes it simpler to transform into the readied channel.

Tibial Arrangement Matrix

Varus or valgus malalignment of the tibia can be assessed by utilizing a tibial arrangement matrix which has various equal K-wires 3-5 cm separated mounted between two plastic plates. The matrix is set underneath the tibia stretching out from the knee to the lower leg. An AP perspective on the knee is taken with the picture intensifier, with a K-wire corresponding to the knee joint. The C-arm is then moved distally to take an AP perspective on the lower leg joint. The K-wire underneath the lower leg joint is additionally corresponding to the lower leg joint line, there is no varus or valgus malalignment of the tibia. The one-sided outer fixator with the two Schanz fastens developed equal can likewise be applied to utilize a similar rule.

 

Disclaimer: The statements, opinions, and data contained in these publications are solely those of the individual authors and contributors and not of Credihealth and the editor(s). 

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