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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.
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Bone deformity is a three-dimensional issue, considering the three-dimensional shape of bones and joints. All basic considerations of deformity correction by using an external device should include the fundamental concepts of Anatomical and Mechanical Axis. These concepts allow a better understanding of the effects of adjustments or modifications in one plane when managing a three-dimensional problem such as bone deformity.
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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.
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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.
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The bone transport technique allows regeneration of the bony tissue in the patient’s limb, in those cases associated with significant bone loss or defect – such as acute fractures, aseptic or infected nonunions, chronic bone infections, tumors, osteomyelitis. Bony regeneration is generally used to fill a gap or missing bone.
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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.
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The term arthrodiatasis was first coined in 1979 in Verona, Italy. It comes from Greek, meaning “joint-through-to stretch out”, in a few words articulated distraction of the joint. It is a technique exclusively referring to external fixation, which was developed initially for the conservative treatment of the osteoarthritis of the hip, and later successfully used to cure other conditions.
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Arthrodesis may be defined as the surgical immobilization of a joint by fusion of the bones. It is commonly referred to as joint fusion, also known as artificial ankylosis or syndesis. It can be performed in several parts of the body, and it is indicated in the presence of painful joints, often due to arthritis or osteoarthritis, with highly compromised mobility.
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“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.
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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.
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