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Pierrie SN, Beltran MJ. Acute shortening and angulation for complex open fractures: an updated perspective. OTA Int 2023; 6:e245. [PMID: 37448568 PMCID: PMC10337845 DOI: 10.1097/oi9.0000000000000245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 12/22/2022] [Indexed: 07/15/2023]
Abstract
Reestablishing an intact, healthy soft tissue envelope is a critical step in managing lower extremity injuries, particularly high-grade open tibia fractures. Acute shortening and angulation can be used independently or together to address complex soft tissue injuries, particularly when bone loss is present. These techniques facilitate management of difficult wounds and can be combined with local soft tissue rearrangement or pedicled flaps as needed, avoiding the need for free tissue transfer. After angular deformity correction, adjacent bone loss can be addressed with bone grafting or distraction histogenesis. This article discusses the indications for, surgical technique for, and limitations of acute shortening and angulation for management of open lower extremity fractures.
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Affiliation(s)
- Sarah N. Pierrie
- Corresponding author. Address: Sarah N. Pierrie, MD, Department of Orthopaedic Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Room 5553, Cincinnati, OH 45267-0212. E-mail:
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Ugaji S, Matsubara H, Aikawa T, Tsuchiya H. Efficacy of Temporary Intentional Leg Shortening and Deformation for Treatment of Massive Bone and Soft Tissue Defects in Three Patients. Strategies Trauma Limb Reconstr 2022; 17:195-201. [PMID: 36756292 PMCID: PMC9886035 DOI: 10.5005/jp-journals-10080-1567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 08/22/2022] [Indexed: 01/01/2023] Open
Abstract
Aim This study describes the intentional deformation and shortening of a limb using external fixation (EF) in three patients with post-traumatic injury tibial defects and to assess the outcomes. Case description Three patients with infected non-unions and massive bone and soft tissue defects who were treated with temporary intentional leg shortening and deformation using a Taylor Spatial Frame (TSF) EF were retrospectively reviewed. The alignment was restored by gradual deformity correction and lengthening after a 2-week interval. No additional surgical intervention was required for soft tissue reconstruction after primary skin closure. Skin closure and good bone alignment were achieved in all patients. The functional outcomes and bone outcomes were evaluated for all cases according to the Paley criteria modified by the Association for the Study and Application of Methods of Ilizarov. All patients showed excellent bone outcomes. Two patients achieved excellent functional outcomes and one had a good outcome. The patient with a good outcome was unable to descend the stairs comfortably. Conclusion This technique is suitable for treating massive bone and soft tissue defects and should be considered as a treatment option. How to cite this article Ugaji S, Matsubara H, Aikawa T, et al. Efficacy of Temporary Intentional Leg Shortening and Deformation for Treatment of Massive Bone and Soft Tissue Defects in Three Patients. Strategies Trauma Limb Reconstr 2022;17(3):195-201.
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Affiliation(s)
- Shuhei Ugaji
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Hidenori Matsubara
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Takao Aikawa
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
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Halsey JN, Iobst CA, Pearson GD. Acute Intentional Deformation of Open Tibial Fractures for Complex Soft Tissue Closure in the Pediatric Patient. EPLASTY 2022; 22:e35. [PMID: 36072058 PMCID: PMC9412025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background. Lower extremity injuries in the pediatric population that are associated with Gustillo 3B/3C fractures require special consideration. Limb salvage should be attempted in the pediatric patient if at all possible, and oftentimes the soft tissue defect that is present over the bony fracture is substantial. The traditional algorithm used in the management of Gustillo 3B/3C fractures in plastic surgery, referred to as the reconstructive ladder, would recommend flap reconstruction with free tissue transfer in most cases because regional options are often unavailable or do not provide adequate coverage. Free tissue transfer procedures are extensive and necessitate a donor site; they often require multiple procedures and subsequent revisions. Furthermore, when concomitant injuries or medical conditions are present, a patient may not be an appropriate candidate for a free flap. Another option, however, does exist for the pediatric patient with a significant lower extremity injury that is often overlooked by the plastic surgeon. Several articles in the orthopedic literature describe the utility of temporary limb deformation to allow for soft tissue closure, with gradual correction of the bony deformity over time. Although the healing process for these procedures take several months, there is no need for extensive soft tissue reconstruction and the ultimate result is a leg that is functional with adequate coverage. This article reports a case where this type of bone and soft tissue reconstruction was performed in a patient with an excellent overall outcome. This technique could be useful in select cases as an option in pediatric lower extremity reconstruction.
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Affiliation(s)
- Jordan N Halsey
- Division of Pediatric Plastic Surgery, Nationwide Children's Hospital, Columbus, OH
| | - Christopher A Iobst
- Department of Orthopedic Surgery, Nationwide Children's Hospital, Columbus, OH
| | - Gregory D Pearson
- Division of Pediatric Plastic Surgery, Nationwide Children's Hospital, Columbus, OH
- Department of Plastic Surgery, The Ohio State University College of Medicine, Columbus, OH
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Plotnikovs K, Movcans J, Solomin L. Acute Shortening for Open Tibial Fractures with Bone and Soft Tissue Defects: Systematic Review of Literature. Strategies Trauma Limb Reconstr 2022; 17:44-54. [PMID: 35734040 PMCID: PMC9166261 DOI: 10.5005/jp-journals-10080-1551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction The presence of massive soft tissue loss in open tibial fractures is a challenging problem. Acute limb shortening is an alternative solution in situations where the use of flaps is limited. Materials and methods A review was conducted following the Preferred Reported Items for Systematic Reviews and Meta-analyses checklist (PRISMA) guidelines. A complete search of PubMed, EMBASE and MEDLINE was undertaken. Twenty-four articles related to closure of soft tissue defects through acute limb shortening were identified and included in this review. Results All report on restoration of limb function without or with minimal residual shortening. The authors note a decrease in the need for microsurgery. The external fixation devices used for deformity correction after closure of the soft tissue defect by acute shortening, angulation and rotation were the Ilizarov apparatus and circular fixator hexapods mainly. Conclusion Acute shortening is an alternative to microsurgical techniques. A ring external fixator is useful for restoring limb alignment after closing the soft tissue defect through creating a temporary deformity. The use of circular fixator hexapods can enable accurate correction of complex multicomponent deformities without the need to reassembly of individual correction units. How to cite this article Plotnikovs K, Movcans J, Solomin L. Acute Shortening for Open Tibial Fractures with Bone and Soft Tissue Defects: Systematic Review of Literature. Strategies Trauma Limb Reconstr 2022;17(1):44–54.
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Affiliation(s)
- Konstantins Plotnikovs
- Department of Orthopedic Surgeon, Traumatology and Orthopedics, Riga East University Hospital, Rīga Stradiņš University, Riga, Latvia
- Konstantins Plotnikovs, Department of Orthopedic Surgeon, Traumatology and Orthopedics, Riga East University Hospital, Rīga Stradiņš University, Riga, Latvia, e-mail:
| | - Jevgenijs Movcans
- Department of Traumatology and Orthopaedics, Riga East Clinical University Hospital, Riga, Latvia
| | - Leonid Solomin
- Russian Scientific Research Institute of Traumatology and Orthopedics named after RR Vreden, Saint Petersburg, Russia
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Liu Y, Liu J, Zhang X, Li H, Fu X, Liu Q, Ma C, Yusufu A. Correction outcomes of the postoperative malalignment salvaged by the temporary application of the hexapod external fixator in tibial diaphyseal fractures treated by monolateral external fixation. Injury 2021; 52:3478-3482. [PMID: 33487408 DOI: 10.1016/j.injury.2021.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 01/10/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Postoperative malalignment in fractures treated by monolateral external fixation is not uncommon in clinical practice. Accurate reduction without excessive tissue disruption caused by surgical intervention and sequentially manage the fractures using monolateral external fixation for definitive treatment is still a challenge for surgeons. The purpose of our study was to evaluate the feasibility and effectiveness of the temporary application of the hexapod external fixator (HEF) for the postoperative malalignment correction in tibial diaphyseal fractures treated by monolateral external fixation. METHODS We carried out a retrospective analysis of 23 trauma patients with tibial diaphyseal fracture treated by the monolateral external fixation at our institution from January 2016 to May 2019. There were 21 males and 2 females with a mean age of 38 years (range 18-60 years). The hexapod external fixator was temporarily applied due to postoperative malalignment within two weeks and who unwilling to undergo a secondary surgical intervention. For patients with postoperative malalignment requiring correction, the HEF components were installed on the original existing half pins of the monolateral external fixator after removing the connecting rod. The standard anteroposterior and lateral X-rays of the injured limb combined with the temporary HEF were conducted to measure the hexapod external fixator parameters. Any residual deformities were corrected by gradual struts adjustment with the aid of computer-based software. When satisfactory alignment was achieved, the HEF was removed, and the monolateral external fixator was sequentially used as the definitive structure. RESULTS All patients acquired functional reduction, which was evaluated by radiographs. The mean correction time was 4 days (range 2 to 8 days). The mean coronal plane translation (1.3±1.0 mm), coronal plane angulation (0.9±0.7°), sagittal plane translation (1.4±1.1 mm), and sagittal plane angulation (0.7±0.7°) after correction were all less than those (7.0±4.9 mm, 4.7±2.3°, 5.6±3.6 mm, 3.2±2.5°) before correction. CONCLUSIONS The temporary application of the hexapod external fixator is an alternative and feasible method for the postoperative malalignment correction in tibial diaphyseal fractures treated by monolateral external fixation.
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Affiliation(s)
- Yanshi Liu
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Jialin Liu
- Department of Prosthodontics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Xingpeng Zhang
- Department of Orthopedics, Shanghai Pudong New Area People's Hospital, Shanghai, China
| | - Hong Li
- Department of Orthopedics, Zigong Fourth People's Hospital, Zigong, Sichuan, China
| | - Xuefei Fu
- Department of Orthopedics, Anhui No.2 Provincial People's Hospital, Hefei, Anhui, China
| | - Qixin Liu
- Tianjin Medical University, Tianjin, China
| | - Chuang Ma
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
| | - Aihemaitijiang Yusufu
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
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Hernández-Irizarry R, Quinnan SM, Reid JS, Toney CB, Rozbruch SR, Lezak B, Fragomen AT. Intentional Temporary Limb Deformation for Closure of Soft-Tissue Defects in Open Tibial Fractures. J Orthop Trauma 2021; 35:e189-e194. [PMID: 34006796 PMCID: PMC8115737 DOI: 10.1097/bot.0000000000001988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/13/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES (1) Evaluate intentional temporary limb deformation for closure of soft-tissue defects as a reconstruction strategy in open tibia fractures and (2) analyze the deformity parameters required for such reconstruction. DESIGN Multicenter retrospective cohort. SETTING Level I trauma center. PATIENTS/PARTICIPANTS Nineteen patients 18 years of age and older at the time of initial trauma, with a Gustilo-Anderson type IIIB or IIIC open tibia fracture treated with hexapod external fixation and intentional bony deformity created to facilitate soft-tissue closure. INTERVENTION Intentional limb deformation for soft-tissue closure, followed by gradual correction with a hexapod external fixator. OUTCOME MEASUREMENTS Radiographic healing, radiographic assessment of limb alignment, and functional and bony Application of the Method of Ilizarov Group score. RESULTS The average age was 45.3 (20-70), and 79% of patients were men. The most common mechanism of injury was motor vehicle accidents. The distal 1 of 5 of the tibia was the most common fracture location, with 37% of these involving the articular surface at the plafond. After wound closure, deformity correction was initiated after 30 days on average. Varus and apex posterior were the most common initial deformity required for primary soft-tissue closure. Bony and functional Application of the Method of Ilizarov Group outcomes were good or excellent in 94% of patients. CONCLUSION Intentional deformation followed by a gradual correction can be an effective strategy to obtain bone union and soft-tissue coverage in certain open fractures. This technique, in essence, converts these injuries from type IIIB to IIIA. This strategy obviates the need for flap coverage and results in satisfactory outcomes. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | - Stephen M. Quinnan
- Department of Orthopaedic Surgery, University of Miami School of Medicine, Miami, FL
| | - John Spence Reid
- Department of Orthopaedics and Rehabilitation, Pennsylvania State University College of Medicine, Hershey, PA
| | - Clarence Brian Toney
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA; and
| | - S Robert Rozbruch
- Hospital for Special Surgery, Weill Cornell Medicine, Cornell University, New York, NY
| | - Bradley Lezak
- Department of Orthopaedic Surgery, University of Miami School of Medicine, Miami, FL
| | - Austin T. Fragomen
- Hospital for Special Surgery, Weill Cornell Medicine, Cornell University, New York, NY
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Acute limb shortening or creation of an intentional deformity to aid in soft tissue closure for IIIB/IIIC open tibia fractures. J Plast Reconstr Aesthet Surg 2021; 74:2933-2940. [PMID: 34049839 DOI: 10.1016/j.bjps.2021.03.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/26/2021] [Accepted: 03/13/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Ring fixator techniques can precisely correct complex long bone deformities. In select patients, controlled shortening or intentional fracture deformation with delayed correction can also aid in complex wound coverage and limb salvage. METHODS This retrospective cohort study analyzed all patients who underwent acute limb shortening or intentional temporary fracture deformation between 2005 and 2020. Patients were divided into three groups based on reason for acute shortening or intentional deformity: (1) skeletal indications alone, with traditional flap coverage; (2) skeletal and soft tissue indications, to augment traditional reconstructive measures; and (3) skeletal and soft tissue indications, to avoid microsurgery altogether. Comorbidities, orthopedic and reconstructive methods, and functional outcomes were recorded. RESULTS Eighteen patients were identified: six in Group 1, five in Group 2, and seven in Group 3. Fractures were primarily in the distal third of the tibia. On initial assessment, all wounds would have required free tissue transfer. Group 1 patients were reconstructed with free flaps. Among Group 2, closure was accomplished by skin grafting (N = 1), local flaps (N = 1), pedicled muscle flaps (N = 1), and free flaps (N = 2). In Group 3, five wounds were closed primarily and two were skin grafted. All limbs were shortened, averaging 25.1 mm; seven were intentionally deformed, most commonly varus (10-20°). After skeletal correction, residual leg length discrepancy averaged 5.7 mm. No patients required amputation. CONCLUSIONS Acute skeletal shortening with or without intentional temporary deformation in select IIIB/IIIC open tibial fractures can facilitate soft tissue coverage and limb salvage in patients who might otherwise require amputation.
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Liu Y, Liu J, Yushan M, Liu Z, Zhang T, Ma H, Ma C, Yusufu A. Management of high-energy tibial shaft fractures using the hexapod circular external fixator. BMC Surg 2021; 21:95. [PMID: 33612116 PMCID: PMC7897373 DOI: 10.1186/s12893-021-01106-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/15/2021] [Indexed: 01/01/2023] Open
Abstract
Background The hexapod external fixator (HEF) is increasingly used for high-energy tibial shaft fracture care as more general orthopedic surgeons are gaining expertise of this versatile device. The purpose of this study was to evaluate the clinical effectiveness of the HEF for definitive management in patients with high-energy tibial shaft fractures. Methods The study was conducted on 34 patients with tibial shaft fractures who were admitted or referred to our institution and consented to HEF treatment from Jan 2016 to June 2019, including 27 males and 7 females with a mean age of 39 years (range 18 to 65 years). Patients' clinical and radiological data, and the final clinical outcomes at a minimum of 12 months follow-up were collected and retrospectively analyzed. All complications were documented according to Paley’s classification. The clinical outcomes were evaluated using the Association for the Study and Application of the Method of Ilizarov criteria (ASAMI) at the last clinical visit. Results All patients remained in the HEF for a mean of 26 weeks (range 15 to 52 weeks) and acquired complete bone union. The satisfactory alignment was achieved in all patients, and all the patients were able to perform daily activities with no difficulty at the last clinical visit. Complications included pin tract infection (44%), delayed union (6%), nonunion (3%), and joint stiffness (3%). The ASAMI bony result was excellent in 31 patients and good in 3. The ASAMI functional result was excellent in 27 patients, good in 6, and fair in 1. Conclusions Definitive management using the hexapod external fixator is an alternative and effective method for high-energy tibial shaft fractures, including technical advantages of early trauma-control, the versatility of achieving excellent alignment, and the continuity of device until bone union.
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Affiliation(s)
- Yanshi Liu
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Jialin Liu
- Department of Prosthodontics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Maimaiaili Yushan
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Zhenhui Liu
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Tao Zhang
- Department of Orthopaedics and Trauma, Tianjin Hospital, Tianjin, China
| | - He Ma
- Department of Orthopaedics and Trauma, Tianjin Hospital, Tianjin, China
| | - Chuang Ma
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
| | - Aihemaitijiang Yusufu
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
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Swords MP, Weatherford B. High-Energy Pilon Fractures: Role of External Fixation in Acute and Definitive Treatment. What are the Indications and Technique for Primary Ankle Arthrodesis? Foot Ankle Clin 2020; 25:523-536. [PMID: 33543715 DOI: 10.1016/j.fcl.2020.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
External fixation is an essential tool in the management of high-energy pilon fractures. Reduction techniques using the external fixator and fixation constructs for use with external fixation as a part of stage management are reviewed. The concepts of external fixation with limited articular fixation is discussed. The use of circular external fixation in both acute management of high-energy pilon fractures, as well as the indications and technique for acute ankle arthrodesis as part of primary treatment of pilon fractures are outlined.
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Affiliation(s)
- Michael P Swords
- Michigan Orthopedic Center, 2815 South Pennsylvania Avenue, suite 204, Lansing MI 48901, USA.
| | - Brian Weatherford
- Orthopaedic Trauma, Reconstructive Foot and Ankle Surgery; Illinois Bone and Joint Institute, 2401 Ravine Way, Glenview, IL 60025, USA; University of Chicago Pritzker School of Medicine, Chicago, IL, USA
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Liu Y, Yushan M, Liu Z, Liu J, Ma C, Yusufu A. Application of elliptic registration and three-dimensional reconstruction in the postoperative measurement of Taylor spatial frame parameters. Injury 2020; 51:2975-2980. [PMID: 33268078 DOI: 10.1016/j.injury.2020.10.077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/04/2020] [Accepted: 10/16/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The Taylor spatial frame offered the ability of simultaneous correction of the multidirectional deformities without the need to change the frame, and it was widely used for limb lengthening, deformity correction, and fracture reduction in recent years. There are still some inherent limitations that can affect the accuracy of correction, especially for the measurement of the mounting and rotational parameters. The purpose of our study was to propose some more precise postoperative measurement of Taylor spatial frame (TSF) parameters by application of elliptic registration and three-dimensional reconstruction. METHODS This retrospectively study included 28 trauma patients who suffered tibial fracture treated by the TSF at our institution from January 2016 to January 2018, including 25 males and 3 females with a mean age of 43 years (range 14-70 years). We conducted standard full-length anteroposterior and lateral X-rays of the injured extremity and the computed tomographic scans of the bilateral extremities after the operation. Elliptic registration and 3D reconstruction were used to calculate the parameters by two types of software Mimics and CorelDRAW. Correction of the deformity was conducted by adjusting the struts of the TSF according to the electronic prescription. The standard anteroposterior and lateral X-rays after correction were taken to evaluate the effectiveness. RESULTS All patients acquired functional reduction, which was evaluated by digital radiography. The mean coronal plane translation(1.9±2.2 mm), coronal plane angulation(1.2±1.0°), sagittal plane translation(2.7±2.1 mm), and sagittal plane angulation(1.2±1.0°) after correction were all less than those(5.5±4.6 mm, 4.9±3.9°, 4.7±4.0 mm, 2.7±2.3°) before correction. CONCLUSIONS The TSF system can correct the 6-axis deformities simultaneously with the accurate parameters. Elliptic registration and three-dimensional reconstruction are alternative methods to precisely measure the parameters needed by the TSF system, especially for the mounting and rotational parameters of unusually complex cases.
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Affiliation(s)
- Yanshi Liu
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Maimaiaili Yushan
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Zhenhui Liu
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Jialin Liu
- Department of Prosthodontics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Chuang Ma
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
| | - Aihemaitijiang Yusufu
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
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Potgieter MS, Pretorius HS, Preez GD, Burger M, Ferreira N. Complications associated with hexapod circular fixation for acute fractures of the tibia diaphysis: A retrospective descriptive study at a high volume trauma centre. Injury 2020; 51:516-521. [PMID: 31759617 DOI: 10.1016/j.injury.2019.11.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 10/31/2019] [Accepted: 11/09/2019] [Indexed: 02/02/2023]
Abstract
UNLABELLED The use of hexapod circular external fixation in acute tibia fracture care is increasing as more general orthopaedic surgeons are gaining expertise with the use of this treatment modality. Limited data is currently available on the complications that may be encountered with this treatment strategy. AIM To review the complications and outcomes of acute diaphyseal tibia fractures definitively treated with hexapod circular external fixation at a high volume orthopaedic trauma centre. METHODS Retrospective review of clinical and radiological data of adult patients with acute diaphyseal tibia fractures treated with hexapod external fixation between 2012 and 2015 at a single centre. RESULTS A total of 102 diaphyseal fractures were definitively treated with hexapod circular external fixation. Union was achieved in 101 cases with an average time to union of 25.6 weeks. Complications included pin site infection (56%); wound complications (19.67%); osteitis (11.76%); malunion (15.69%) and knee and ankle joint contractures (31.32%). CONCLUSION Hexapod circular external fixation as definitive treatment of for diaphyseal tibia fractures demonstrates an excellent union rate with acceptable time to union. Complications rates are comparable to that of all fine wire circular fixators. Malalignment in is however a concern, considering that this device enables the surgeon to achieve accurate alignment through gradual deformity correction aided by computer software.
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Affiliation(s)
- Maarten Sw Potgieter
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa.
| | - H Sean Pretorius
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Gian Du Preez
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Marilize Burger
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Nando Ferreira
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
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Zhang N, Wan C, Zhang T, Ma J, Liu Z, Wang M, Ge Q. [The assessment of the application of Taylor spatial frame in treatment of intermediate or distal tibiofibula fractures]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:1012-1017. [PMID: 30238728 DOI: 10.7507/1002-1892.201712095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Objective To determine the effectiveness and the safety of the Taylor spatial frame in treatment of intermediate or distal tibiofibula fractures. Methods The clinical data of 74 patients with intermediate or distal tibiofibular fractures treated between January 2015 and January 2017 were retrospectively analyzed. According to fixation methods, they were divided into internal fixation group (26 cases) and external fixation group (48 cases). There was no significant difference in the age, gender, cause of injury, type of fracture, time from injury to operation between 2 groups ( P>0.05). The intraoperative blood loss, fracture healing time, fixator removal time, and complications were recorded and compared. The final function evaluation criteria of Johner-Wruhs humeral shaft fracture were used to evaluate the function of the affected limb. The lower limb force line recovery after operation was evaluated according to the standard evaluation of LUO Congfeng et al. Results Both groups were followed up 6-22 months (median, 14 months). All patients obtained the fracture healing. The intraoperative blood loss, fracture healing time, and fixator removal time were significantly higher in the internal fixation group than those in the external fixation group ( P<0.05). There were 1 case of plate exposure, 1 case of delayed fracture healing, and 1 case of plate fracture in the internal fixation group; and there were 2 cases of delayed fracture healing and 4 cases of soft tissue defect in the external fixation group; no significant difference was found in the incidence of complications between 2 groups ( χ2=0.015, P=0.904). The function of the affected limb was evaluated by Johner-Wruhs standard at 10 months after operation, the results was excellent in 19 cases, good in 5 cases, and fair in 2 cases in the internal fixation group, with an excellent and good rate of 92.3%; the results was excellent in 42 cases, good in 3 cases, and fair in 2 cases in the external fixation group, with an excellent and good rate of 95.7%; showing no significant difference between 2 groups ( χ2=0.392, P=0.531). The lower limb force line recovery after operation was evaluated according to the standard evaluation of LUO Congfeng et al.at 4 months after operation, the results was excellent in 24 cases, fair in 1 case, poor in 1 case in the internal fixation group, with an excellent and good rate of 92.3%; the results was excellent in 46 cases, fair in 1 case, poor in 1 case in the external fixation group, with an excellent and good rate of 95.8%; showing no significant difference between 2 groups ( χ2=0.520, P=0.471). Conclusion The use of Taylor spatial frame in the treatment of the intermediate or distal tibiofibular fractures can obviously reduce the healing time and complications than the internal fixation of the plate. It can reduce the fracture treatment cycle and is beneficial to the fracture healing and limb function recovery, which is relatively safe and reliable.
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Affiliation(s)
- Ningning Zhang
- Graduate School of Tianjin Medical University, Tianjin, 300070, P.R.China
| | - Chunyou Wan
- No.1 Ward of Limb Orthopaedic and Reconstruction, Tianjin Hospital, Tianjin, 300211,
| | - Tao Zhang
- No.1 Ward of Limb Orthopaedic and Reconstruction, Tianjin Hospital, Tianjin, 300211, P.R.China
| | - Jihai Ma
- Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, P.R.China
| | - Zhao Liu
- Graduate School of Tianjin Medical University, Tianjin, 300070, P.R.China
| | - Mingjie Wang
- No.1 Ward of Limb Orthopaedic and Reconstruction, Tianjin Hospital, Tianjin, 300211, P.R.China
| | - Qihang Ge
- Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, P.R.China
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O'Farrell P, Barnard AC, Birkholtz F. The tibial bayonet method of wound closure. Strategies Trauma Limb Reconstr 2018; 13:103-108. [PMID: 29363013 PMCID: PMC6042222 DOI: 10.1007/s11751-018-0304-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 01/13/2018] [Indexed: 11/26/2022] Open
Abstract
Management of open lower limb fractures with soft tissue defects can be a technically challenging orthopaedic problem. Limited availability of orthoplastic services means that alternatives to the fix and flap concept are required in order to prevent infected non-unions from developing. The proposed 'bayonet apposition' allows the surgeon to temporarily shorten the limb without angulating the limb or creating a bone defect and removing viable bone. The viable bone edges are overlapped in a bayonet-like manner in order to appose the wound and skin edges. The limb length is restored by gradually distracting the bone segments once the soft tissues have healed. This is facilitated with a hexapod fixator for stabilization of the fracture and distraction. Prerequisites for utilizing this method are circumferential soft tissue damage to the lower limb with viable distal tissue. The bayonet method allows primary closure of a wound and rapid restoration of the native length of the limb.
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Affiliation(s)
- Peter O'Farrell
- Walk-A-Mile Centre for Advanced Orthopaedics, P.O. Box 11328, Centurion, Pretoria, 0046, South Africa.
| | - Annette-Christi Barnard
- Walk-A-Mile Centre for Advanced Orthopaedics, P.O. Box 11328, Centurion, Pretoria, 0046, South Africa
| | - Franz Birkholtz
- Walk-A-Mile Centre for Advanced Orthopaedics, P.O. Box 11328, Centurion, Pretoria, 0046, South Africa
- Department of Orthopaedic Surgery, University of Pretoria, Pretoria, South Africa
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14
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Liu Z, Tang G, Guo S, Cai B, Li Q. Effects of Taylor Spatial Frame on tumors and tumor-like lesions with pathological fractures of lower extremities. Pak J Med Sci 2018; 34:440-445. [PMID: 29805423 PMCID: PMC5954394 DOI: 10.12669/pjms.342.14920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective: We aimed to evaluate the clinical effects of Taylor spatial frame (TSF) on tumors and tumor-like lesions complicated with pathological fractures of the lower extremities. Methods: Eighty-two patients admitted from September 2013 to January 2015 were selected. Forty-two cases were included in Group-A to receive TSF fixation and forty were included in Group-B to receive locking plate fixation. The surgical time, intraoperative blood loss, postoperative healing rate of primary incision, incidence rate of complications, hospitalization stay length, and fracture healing time as well as rate of excellent and good Enneking scores one year after surgery were compared. Results: The intraoperative blood losses of Group-A and Group-B were (150.0±6.5) ml and (201.9±7.4) ml respectively (P<0.05). The surgical times were (77.3±8.9) minutes and (96.5±5.9) minutes respectively (P<0.05). The postoperative rates of complications in the two groups (4.76% vs. 10.00%) were similar (P>0.05). The primary incision healing rates of Group-A and Group-B were 97.62% and 82.50% respectively. The hospitalization stays were (15.7±0.9) days and (15.2±0.7) days respectively (P>0.05). The fracture healing times were (30.1±2.1) weeks and (32.4±2.2) weeks respectively (P<0.05). The rate of excellent and good Enneking scores one year after surgery was 97.61% in Group-A and 95.00% in Group-B (P>0.05). Conclusions: Tumors and tumor-like lesions complicated with pathological fractures of the lower extremities can be effectively treated by TSF.
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Affiliation(s)
- Zhongbing Liu
- Zhongbing Liu, Department of Orthopedics, Affiliated Taizhou People's Hospital of Nantong University, Taizhou 225300, Jiangsu Province, P. R. China
| | - Genling Tang
- Genling Tang, Department of Orthopedics, Affiliated Taizhou People's Hospital of Nantong University, Taizhou 225300, Jiangsu Province, P. R. China
| | - Shuguang Guo
- Shuguang Guo, Department of Orthopedics, Affiliated Taizhou People's Hospital of Nantong University, Taizhou 225300, Jiangsu Province, P. R. China
| | - Bin Cai
- Bin Cai, Department of Orthopedics, Affiliated Taizhou People's Hospital of Nantong University, Taizhou 225300, Jiangsu Province, P. R. China
| | - Qingsong Li
- Qingsong Li, Department of Orthopedics, Affiliated Taizhou People's Hospital of Nantong University, Taizhou 225300, Jiangsu Province, P. R. China
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15
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Ramasamy PR. Management of Gustilo Anderson III B open tibial fractures by primary fascio-septo-cutaneous local flap and primary fixation: The 'fix and shift' technique. Indian J Orthop 2017; 51:55-68. [PMID: 28216752 PMCID: PMC5296850 DOI: 10.4103/0019-5413.197532] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Open fractures of tibia have posed great difficulty in managing both the soft tissue and the skeletal components of the injured limb. Gustilo Anderson III B open tibial fractures are more difficult to manage than I, II, and III A fractures. Stable skeletal fixation with immediate soft tissue cover has been the key to the successful outcome in treating open tibial fractures, in particular, Gustilo Anderson III B types. If the length of the open wound is larger and if the exposed surface of tibial fracture and tibial shaft is greater, then the management becomes still more difficult. MATERIALS AND METHODS Thirty six Gustilo Anderson III B open tibial fractures managed between June 2002 and December 2013 with "fix and shift" technique were retrospectively reviewed. All the 36 patients managed by this technique had open wounds measuring >5 cm (post debridement). Under fix and shift technique, stable fixation involved primary external fixator application or primary intramedullary nailing of the tibial fracture and immediate soft tissue cover involved septocutaneous shift, i.e., shifting of fasciocutaneous segments based on septocutaneous perforators. RESULTS Primary fracture union rate was 50% and reoperation rate (bone stimulating procedures) was 50%. Overall fracture union rate was 100%. The rate of malunion was 14% and deep infection was 16%. Failure of septocutaneous shift was 2.7%. There was no incidence of amputation. CONCLUSION Management of Gustilo Anderson III B open tibial fractures with "fix and shift" technique has resulted in better outcome in terms of skeletal factors (primary fracture union, overall union, and time for union and malunion) and soft tissue factors (wound healing, flap failure, access to secondary procedures, and esthetic appearance) when compared to standard methods adopted earlier. Hence, "fix and shift" could be recommended as one of the treatment modalities for open III B tibial fractures.
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Affiliation(s)
- P R Ramasamy
- Department of Orthopaedics, Kauvery Hospitals, Trichy, Tamil Nadu, India,Address for correspondence: Dr. P R Ramasamy, H.O.D, Department of Orthopaedics, Kauvery Hospitals, 16, Vishwanathapuram, Tennur, Trichy - 620 017, Tamil Nadu, India. E-mail:
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16
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Kara A, Celik H, Seker A, Karakoyun O, Armagan R, Kuyucu E, Erdil M. Treatment of open fractures with a computer-assisted external fixator system without the use of fluoroscopy. J Orthop Surg Res 2016; 11:51. [PMID: 27117827 PMCID: PMC4847187 DOI: 10.1186/s13018-016-0379-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 03/25/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Developed for the treatment of deformity correction, computer-assisted circular external fixators in recent years have also been used for fracture fixation. In this study, we aimed to present the efficacy of computer-assisted circular external fixator use in open long bone fractures with our new technique. METHODS Between February 2013 and June 2014, 14 patients (mean age 24.5 (range 20-32)) with open tibial or femoral open fractures were treated with the computer-assisted fixation system (Spider Frame-Tasarım Medikal, Istanbul, Turkey). In all patients, appropriate positions of the rings and Schanz screws were determined by measurements on preoperative radiographs. The length of the Schanz screws were determined by depth measure marks on drill bits. Obvious deformities were corrected intraoperatively by manipulations, but residual deformities were corrected by a software program (Spiderfix, Tasarım Medikal, Istanbul, Turkey). We did not use fluoroscopy during the procedures. RESULTS Ten patients had tibia diaphyseal and four patients had femoral diaphyseal fractures. Mean surgical time was 24.2 (range 18-28) min. Average follow-up time was 10.2 (range 9-14) months. Mean time for deformity correction was 3.1 (2-5) days. Complete union was observed in all patients with a mean of 4.9 (range 3-9) months. There were two grade 2 pin site infections treated with oral antibiotherapy and pin site care. We did not detect any Schanz screw breakage, loosening, deep infection, nonunion, or malunion. CONCLUSIONS Computer-assisted external fixation systems can be used in the treatment of open fractures, and they provide the chance for acute or gradual correction. Preoperative planning and assistant devices with depth measures may decrease the procedure time and the need for fluoroscopy use.
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Affiliation(s)
- Adnan Kara
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Haluk Celik
- Department of Orthopaedics and Traumatology, Zonguldak Ataturk State Hospital, Tepebası Mah, Kapuz Cad. Turkuaz apt. No: 28/10, 67030, Zonguldak, Turkey.
| | - Ali Seker
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Ozgur Karakoyun
- Faculty of Medicine, Department of Orthopaedics and Traumatology, Namık Kemal University, Tekirdag, Turkey
| | - Raffi Armagan
- Department of Orthopaedics and Traumatology, Sisli Hamidiye Etfal Research Hospital, Istanbul, Turkey
| | - Ersin Kuyucu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Mehmet Erdil
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
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17
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Fletcher MDA, Solomin LN. Definitive management of significant soft tissue loss associated with open diaphyseal fractures utilising circular external fixation without free tissue transfer, a comprehensive review of the literature and illustrative case. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2015; 25:65-75. [PMID: 24659455 DOI: 10.1007/s00590-014-1441-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 03/12/2014] [Indexed: 11/24/2022]
Abstract
Accepted management of diaphyseal fractures associated with significant tissue loss is rigid intramedullary stabilisation with free or rotational musculocutaneous flap coverage. Circular external fixation is a powerful tool in the management of limb trauma and with recent advances has been developed to provide multiple techniques for which even massive tissue loss can be addressed without the need for free tissue transfer. Gradual and acute shortening, acute fracture deformation and gradual lengthening with restoration of deformity combined with distraction tissue histiogenesis can provide the surgeon with an array of options which can be precisely tailored to the particular personality of a severe open diaphyseal fracture.
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18
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Faschingbauer M, Heuer HJD, Seide K, Wendlandt R, Münch M, Jürgens C, Kirchner R. Accuracy of a hexapod parallel robot kinematics based external fixator. Int J Med Robot 2014; 11:424-35. [DOI: 10.1002/rcs.1620] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 08/19/2014] [Accepted: 08/27/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Maximilian Faschingbauer
- Berufsgenossenschaftliches Unfallkrankenhaus (Trauma Hospital) Hamburg; Department for Trauma Surgery, Orthopaedics and Sportstraumatology; Hamburg Germany
| | - Hinrich J. D. Heuer
- Berufsgenossenschaftliches Unfallkrankenhaus (Trauma Hospital) Hamburg; Department for Trauma Surgery, Orthopaedics and Sportstraumatology; Hamburg Germany
| | - Klaus Seide
- Berufsgenossenschaftliches Unfallkrankenhaus (Trauma Hospital) Hamburg; Department for Trauma Surgery, Orthopaedics and Sportstraumatology; Hamburg Germany
- Berufsgenossenschaftliches Unfallkrankenhaus (Trauma Hospital) Hamburg; Laboratory for Biomechanics; Hamburg Germany
| | - Robert Wendlandt
- University Medical Center Schleswig-Holstein, Campus Luebeck; Biomechanics Laboratory; Luebeck Germany
| | - Matthias Münch
- Berufsgenossenschaftliches Unfallkrankenhaus (Trauma Hospital) Hamburg; Laboratory for Biomechanics; Hamburg Germany
| | - Christian Jürgens
- Berufsgenossenschaftliches Unfallkrankenhaus (Trauma Hospital) Hamburg; Department for Trauma Surgery, Orthopaedics and Sportstraumatology; Hamburg Germany
- University Medical Center Schleswig-Holstein, Campus Luebeck; Clinic for Musculoskeletal Surgery; Luebeck Germany
| | - Rainer Kirchner
- University Medical Center Schleswig-Holstein, Campus Luebeck; Clinic for Musculoskeletal Surgery; Luebeck Germany
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19
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Sabharwal S, Louie KW, Reid JS. What's new in limb-lengthening and deformity correction. J Bone Joint Surg Am 2014; 96:1399-406. [PMID: 25143503 DOI: 10.2106/jbjs.n.00369] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Sanjeev Sabharwal
- Department of Orthopedics, Rutgers-New Jersey Medical School, 90 Bergen Street, Doctor's Office Center, Suite 7300, Newark, NJ 07103. E-mail address for S. Sabharwal:
| | - Kevin W Louie
- Department of Orthopedics, Rutgers-New Jersey Medical School, 90 Bergen Street, Doctor's Office Center, Suite 7300, Newark, NJ 07103. E-mail address for S. Sabharwal:
| | - J Spence Reid
- Department of Orthopedics, Rutgers-New Jersey Medical School, 90 Bergen Street, Doctor's Office Center, Suite 7300, Newark, NJ 07103. E-mail address for S. Sabharwal:
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