Fischer System

Another system was planned by Fischer at the Department of Orthopaedic Surgery of Minnesota State University in Minneapolis 8 . It is based on a very flexible apparatus, made up of aluminium or titanium rings, connected to each other by special rods that allow movements in each individual plane and that are connected to the bone by steel or titanium pins. These pins are 5 mm in diameter and can be inserted in every spatial plane. Transosseous wires can be used even in this system instead of the...

Patients and Methods

In all, 220 infected nonunion were treated (eight humeral, 26 femoral, and 186 tibial) of the patients 131 were males and 89 females. Four humeral nonunions were type 1 and four were type 2 of the Umiarov classification 1 . Of the femoral nonunions 16 were of type 1, six were of type 2, and four were of type 3. There were 81 tibial nonunions of type 1,28 of type 2,23 of type 3, and 54 of type 4. Our indications are based on the Umiarov principles of treatment 1 . Therefore the treatment of...

Surgical Methods Techniques of Osteosynthesis Plating Osteosynthesis

Plating osteosynthesis can be defined as a kind of static fixation because its rigidity is constant from the beginning to the end of treatment. Classical plating techniques provide environmental stability but cannot provide osteogenic stimulation, mainly in cases of atrophic nonunions in these cases bone grafting should be associated with the treatment 29-31 . These techniques have some advantages in the management of nonunions 30 accurate correction of a malalignment combined with nonunion...

Open and Closed Fractures

The difference between closed and open fractures is sometimes blurred and it is important to try and elucidate the real differences between them. In each diaphyseal fracture both bone and surrounding soft tissues are involved 7 , including the skin, the subcutaneous tissue, fascia, muscles, tendons, ligaments, periostium, vessels, and nerves 8 . Skin lesions appear as excoriations, blister, sharp-edged injury (from stab wound), contused-edges injury (from stab wound and compression),...

Skeletal Trauma

In surgery for skeletal trauma, exact reduction and stabilization are required for long bone fractures. These operations can be performed by means of flu-oroscopy or CT-based navigation 9-11 . These classical techniques have traditionally required large surgical exposure of the deep structures of the pelvis, which can be associated with significant complications, including The majority of these complications are related to the surgical exposure itself rather than to the initial traumatic...

Instrumental Diagnosis

If clinically suspected, especially in patients in whom these factors have been detected, further investigations are indispensable for a detailed diagnosis and an appropriate therapy. The significance of the investigations depends on the anamnestic and clinical data in combination with the evidence for risk factors an accurate study of these parameters is required for a precise diagnosis and appropriate therapeutic procedure. By scoring the symptoms, clinical signs. and other possible diagnoses...

Symbols Used

In MUDEF standard and additional symbols are used (Table 1). By applying additional symbols the comprehensiveness and quality of the information is improved while using MUDEF, but it is not mandatory. MUDEF of long bones is based on the coordinates. With the help of these coordinates each segment of the extremity is divided vertically (into levels) Table 1. The standard and additional symbols Standard Roman numerals from 0 to IX - designation of level of K-wire or S-screw insertion Arabic...

Operative Technique Biofocal Compression Distraction Osteosynthesis

The operative technique with compression-distraction systems (bifocal compression-distraction osteosynthesis) acts at two levels 1 at the nonunion site (where a reshaping of the hypotrophic-hypovascularized bone ends is performed) and at the proximal or distal metaphysis of the long bone (where a corticotomy is performed in order to allow a gradual distraction with bone transport or internal lengthening at the rate of 1 mm per day in only one daily session). The bone fragment, which is...

Designation of Transosseous Elements

In MUDEF of the forearm bones, the symbols of transosseous elements installed through the radial bone are put into round brackets. To record external fixation of the shin bones, the symbols of transosseous elements passed through the fibular bone are put into round brackets. Transosseous elements introduced between the levels (the position) are designated with the symbol of the level (the position) close to which the tran-sosseous elements are located. For transosseous elements passed across a...

Monitoring of Distraction in Hypertrophic Nonunions

The individual steps in gradual distraction during the treatment of hypertrophic nonunions have been followed up at our department with radiographic, echographic, extensimetric, and histological studies. Therefore, qualitative morphological information provided by x-rays and ultrasound scans and whenever possible by histological studies were complemented by quantitative functional information provided by extensimetric data. Some Authors have reported the use of additional methods of monitoring...

Preface

Expressions such as compression-distraction techniques, transosseous osteosynthesis methods, and circular external fixation, born in past decades in the former Soviet Union, are interchangeable and will be used in this book without distinguishing between them. Moreover, the term screw is used throughout this volume instead of fiche, as established in the Instructional Courses External Fixation in Italy which took place in the 1990s. These methods, almost unknown in Western countries until 30...