Weigh bearing is considered a significant clinical issue particularly when an external fixator has been applied to a lower limb. If mechanical stability is in fact a mandatory condition for promoting fracture healing, other key components for a full recovery of the bone are early weight bearing and dynamization.
To prevent and manage pin site problems, the patient should be clearly informed of the protocol he/she needs to follow for pin site care in the post-operative phase. And not only the patient, but all people involved in the healing process outside the hospital should know the protocol.
Dynamization (dynamic loading and controlled motion at the fracture site) is considered a controversial and evolving issue, besides the positive functional results observed both in experimental studies based on animal models, and in human clinical cases in the last 30 years. Currently one crucial matter is to understand the biomechanical, biological and physiological effects of dynamization on the bone healing process, in order to show its safety and effectiveness.
A typical question that a surgeon has to face when deciding the treatment of a bony injury is when to use internal fixation instead of external fixation. A common answer is “when the patient is compliant, with sufficient bone and soft tissue quality, and presents less complex fractures”. Surgeon’s expertise and preference may also affect the final surgical plan.
The multifocal procedure, in which two osteotomies are performed, is indicated in the presence of large bone defects, extreme shortening, shortening combined with metaphyseal deformity where lengthening takes place in more than one site, and fractures with soft tissue defects and exposed bone. The application technique of the external device is quite similar to that for bone transport, with the only difference being that in this procedure two compression-distraction units are used simultaneously.
The monofocal procedure is performed for lengthening at a single osteotomy site, for deformity correction with or without lengthening, and when increased stability is required. This procedure may be also used in bone and soft tissue defects when the bone loss is less than 2cm.
Preserving healthy pin sites is essential to effective external fixation, for the prevention of pin track infection and related complications. All people involved in the healing process – general practitioner, surgeon, nursing staff, patient and family – play a fundamental role in order to achieve the best result. Here are some useful key points.
“Respect for, and enhancement of the natural physiological process of fracture healing” may be considered the philosophy which has inspired the research and design of all products developed by Orthofix in the last 40 years, starting with the set of devices belonging to the internal and external fixation system.
The Orthofix history began at the end of the 70s in Italy with the work of orthopedic researcher Giovanni De Bastiani. He proposed the concept of “dynamization” and developed a modular external fixation device designed to allow the release of axial forces at the proper time during the healing process, thus transferring a progressive load to the fracture site. After this first device, other devices were developed by Orthofix to better satisfy patients’ and doctors’ needs.
Stability does not mean rigidity. Medical philosophy has evolved from the aim to eliminate micromotion between the bony fragments to the idea of controlling it. Micromotion is necessary for external callus formation, and therefore for a functional bone healing. External fixation offers the opportunity to control both micromovement and load at the fracture site, which corresponds to the concept of dynamization.
When a bone breaks, all the systems work for the bone healing. Fracture healing is a natural, physiological process, and the surgeon may help nature to restore the biological, structural and mechanical properties of the bone as they were before the break, transforming the fracture into a healed, normal and straight bone.
Weigh bearing is considered a significant clinical issue particularly when an external fixator has been applied to a lower limb. If mechanical stability is in fact a mandatory condition for promoting fracture healing, other key components for a full recovery of the bone are early weight bearing and dynamization.
To prevent and manage pin site problems, the patient should be clearly informed of the protocol he/she needs to follow for pin site care in the post-operative phase. And not only the patient, but all people involved in the healing process outside the hospital should know the protocol.
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