external fixation

外固定

WordNet

1. purely outward or superficial; "external composure"; "an external concern for reputation"- A.R.Gurney,Jr.
2. outward features; "he enjoyed the solemn externals of religion"
3. coming from the outside; "extraneous light in the camera spoiled the photograph"; "relying upon an extraneous income"; "disdaining outside pressure groups" (同)extraneous, outside
4. from or between other countries; "external commerce"; "international trade"; "developing nations need outside help" (同)international, outside
5. happening or arising or located outside or beyond some limits or especially surface; "the external auditory canal"; "external pressures"
6. (histology) the preservation and hardening of a tissue sample to retain as nearly as possible the same relations they had in the living body (同)fixing
7. the activity of fastening something firmly in position
8. a nonresident doctor or medical student; connected with a hospital but not living there (同)medical extern

PrepTutorEJDIC

1. 『外側の』,外部の / (作用・動作などが)『外側からの』,外部からの / 表面上の,見せかけの / 体外の;体外用の / 外国の(foreign) / (…の)外観,外形《+『of』+『名』》
2. 固定,固着 / (…に対する)愛着,執着《+『on』+『名』》 / (写真のネガの)定着;(染料の)色留め

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/12/16 22:59:12」(JST)

wiki en

[Wiki en表示]

External fixation
Intervention
An Ilizarov apparatus is a type of external fixation used to treat limb deformities.
ICD-9-CM	78.1, 79,93.51-93.56, 93.59
MeSH	D016267

External fixation is a surgical treatment used to stabilize bone and soft tissues at a distance from the operative or injury focus. They provide unobstructed access to the relevant skeletal and soft tissue structures for their initial assessment and also for secondary interventions needed to restore bony continuity and a functional soft tissue cover.

The parts of an external fixator include:

1. Schanz pin

2. Connecting rods

3. Clamps.

Indications

1. Stabilization of severe open fractures
2. Stabilization of infected nonunions
3. Correction of extremity malalignments and length discrepancies
4. Initial stabilization of soft tissue and bony disruption in poly trauma patients (damage control orthopaedics)
5. Closed fracture with associated severe soft tissue injuries
6. Severely comminuted diaphyseal and periarticular lesions
7. Temporary transarticular stabilization of severe soft tissue and ligamentous injuries
8. Pelvic ring disruptions
9. Certain pediatric fractures
10. Arthrodesis
11. Ligamentotaxis
12. Osteotomies
13. Open fractures that have significant soft tissue disruption (e.g., type II or III open fractures)
14. Soft tissue injury (e.g., burns)
15. Acetabular and pelvic fractures
16. Severely comminuted and unstable fractures
17. Fractures that are associated with bony deficits
18. Limb-lengthening procedures
19. Fractures associated with infection or nonunion

Contraindications

1. Patient with compromised immune system
2. Non compliant patient who would not be able to ensure proper wire and pin care
3. Pre-existing internal fixation that prohibits proper wire or pin placement
4. Bone pathology precluding pin fixation

Method

In this kind of reduction, holes are drilled into uninjured areas of bones around the fracture and special bolts or wires are screwed into the holes. Outside the body, a rod or a curved piece of metal with special ball-and-socket joints joins the bolts to make a rigid support. The fracture can be set in the proper anatomical configuration by adjusting the ball-and-socket joints. Since the bolts pierce the skin, proper cleaning to prevent infection at the site of surgery must be performed.

Installation of the external fixator is performed in an operating room, normally under general anesthesia. Removal of the external frame and bolts usually requires special wrenches and can be done with no anesthesia in an office visit.

External fixation is usually used when internal fixation is contraindicated- often to treat open fractures, or as a temporary solution.

External fixation is also used in limb lengthening. People with short limbs can have, for example, legs lengthened. In most cases the thigh bone (femur) is cut diagonally in a surgical procedure under anesthesia. External fixator pins or wires (as above) are placed each side of the 'man made fracture' and the external metal apparatus is used to very gradually push the two sides of the bone apart millimetre by millimetre day by day and week by week. Bone will gradually grow into the small gap created by this 'distraction' technique. Such a process can take many months. In most cases it may be necessary for the external fixator to be in place for many weeks or even months. Most fractures heal in between 6 and 12 weeks. However, in complicated fractures and where there are problems with the healing of the fracture this may take longer still. It is known that bearing weight through fracture by walking on it, for example, with the added support of the external fixator frame actually helps fractures to heal.

History

an X-ray image of an external fixator being used for reduction of a broken bone, in this case, a Colles' fracture which involves a fractured radius bone.

Almost 2400 years ago Hippocrates described a form of external fixation to splint a fracture of the tibia. The device consisted of closely fitting proximal and distal Egyptian leather rings connected by four wooden rods from a cornel tree.

In 1840, Jean-Francois Malgaigne described a spike driven into the tibia and held by straps to immobilise a fractured tibia. In 1843 he used a claw-like device to percutaneously hold the fragments of a fractured patella.

Clayton Parkhill of Denver, Colorado and Albine Lambotte of Antwerp, Belgium independently invented the modern concept of unilateral external fixation, in 1894 and 1902, respectively. Lambotte was the first to use threaded pins, however, his device necessitated initial, open fracture reduction and then pin insertion and fixator placement.

In 1938, Raoul Hoffmann of Geneva, Switzerland, building on the work of others, realized that major improvements were essential to make the external fixator more clinically relevant. He developed a technique based on closed reduction with guided percutaneous pin placement. Hoffmann’s technique exemplified the first application of minimally invasive orthopaedic surgery.

In the 1950s, Gavriil Ilizarov of Kurgan, Soviet Union, devised and developed a new method for treating fractures, deformities and other bone defects. A metal frame that encircles the limb is attached to the underlying bone by crossing (X) pins inserted through the bone and limb. The external rings are linked to each other by threaded rods and hinges that allow to move the position of the bone fragments without opening the fracture site, then the fragments can be fixed in rigid position until complete healing.

Types

• Ilizarov apparatus
• Taylor Spatial Frame
• Hoffmann external fixation system
• Rail external fixator

See also

• Internal fixation
• Distraction osteogenesis
• Bone fracture
• Trauma surgery
• Traumatology
• AO Foundation

External links

• The Ilizarov and External Fixator Wearer's Support Group
• Fracture Fixation Overview

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

• 1. 重度の四肢外傷の外科的マネージメント surgical management of severe extremity injury
• 2. 成人における脛骨骨幹部骨折 tibial shaft fractures in adults
• 3. 成人外傷患者における重症骨盤骨折 severe pelvic fracture in the adult trauma patient
• 4. 小児における大腿骨遠位部骨折 distal femoral fractures in children
• 5. 外傷後の骨髄炎の治療および予防 treatment and prevention of osteomyelitis following trauma

English Journal

• Preoperative virtual reduction reduces femoral malrotation in the treatment of bilateral femoral shaft fractures.

• Omar M1, Suero EM2, Hawi N2, Decker S2, Krettek C2, Citak M2.
• Archives of orthopaedic and trauma surgery.Arch Orthop Trauma Surg.2015 Oct;135(10):1385-9. doi: 10.1007/s00402-015-2285-8. Epub 2015 Jul 17.
• INTRODUCTION: In bilateral femoral shaft fractures, significant malrotation (>15°) occurs in about 40 % of cases after intramedullary nailing. Most of the methods that provide rotational control during surgery are based on a comparison to the intact femur and, thus, not applicable for bilateral
• PMID 26185053

• One miniplate compared with two in the fixation of isolated fractures of the mandibular angle.

• Al-Moraissi EA1.
• The British journal of oral & maxillofacial surgery.Br J Oral Maxillofac Surg.2015 Oct;53(8):690-8. doi: 10.1016/j.bjoms.2015.05.006. Epub 2015 Jun 3.
• The purpose of this study was to compare one miniplate with two in the management of isolated fractures of the mandibular angle as regards wound healing, failure of hardware, scarring, weakness of the facial nerve, and overall morbidity, by making a systematic review with a meta-analysis. I made a c
• PMID 26048097

• Lengthening With External Fixation Is Effective in Congenital Femoral Deficiency.

• Prince DE1, Herzenberg JE, Standard SC, Paley D.
• Clinical orthopaedics and related research.Clin Orthop Relat Res.2015 Oct;473(10):3261-71. doi: 10.1007/s11999-015-4461-0. Epub 2015 Jul 21.
• BACKGROUND: Treatment of congenital femoral deficiency is a complex, multistage protocol and a variety of strategies have been devised to address joint instability, limb length inequality, and deformities. Despite being an important part of the algorithmic approach to the overall treatment of patien
• PMID 26194561

Japanese Journal

• A Gustilo Type IIIB Open Forearm Fracture Treated by Negative Pressure Wound Therapy and Locking Compression Plates : A Case Report

• Takeuchi Naohide,Mae Takao,Hotokezaka Shunsuke,Sasaki Kosuke,Matsushita Akinobu,Miake Go,Kuchishi Rintaro,Noguchi Yasuo,竹内 直英,前 隆男,佛坂 俊輔,佐々木 宏介,松下 昌史,見明 豪,口石 倫太朗,野口 康男,タケウチ ナオヒデ,マエ タカオ,ホトケザカ シュンスケ,ササキ コウスケ,マツシタ アキノブ,ミアケ ゴウ,クチイシ リンタロウ,ノグチ ヤスオ
• 福岡医学雑誌 102(10), 293-297, 2011-10-25
• … On the day of admission, irrigation and debridement of the open wound, and temporary fixation of theradius and ulna using an external fixator and a Kirschner wire were peformed. … Thirteen days after the first surgery, definitive fixation was performed by using locking compression plates, and full thickness skin grafting was undertaken for the open wound. …
• NAID 120003614922

• マウスプレート固定骨折モデルを用いたGFP骨髄キメラマウスにおける骨髄由来細胞の分布

• UENO Masaki,UCHIDA Kentaro,TAKASO Masashi,MINEHARA Hiroaki,SUTO Kaori,TAKAHIRA Naonobu,STECK Roland,SCHUETZ Michael A.,ITOMAN Moritoshi
• Experimental animals 60(5), 455-462, 2011-10-01
• … To clarify the distribution of bone-marrow-derived cells in fractures treated by plate fixation, fracture models were created using the green fluorescent protein (GFP) chimeric mouse. … We observed 2 types of fracture healing processes with different types of callus formation and cellular events by using Mouse Fix™, a device allowing plate fixation on the mouse femur, and differences in the distribution of bone-marrow-derived cells between the 2 types. …
• NAID 10029835335

Related Pictures

---

★リンクテーブル★

リンク元	「創外固定」「外固定」
関連記事	「fixation」「external」

「創外固定」

　　[★]

同

external fixation, skeletal fixation

同

創外固定法

関

創外固定器

参考

• wiki en

• http://en.wikipedia.org/wiki/External_fixation

「外固定」

　　[★]

英

external fixation

関

内固定

「fixation」

　　[★]

• n.

• 固定化、固定法、固定、修復、(生理)固視

関

anchorage、clamp、consolidation、fix、fixed、immobilisation、immobilise、immobilization、immobilize、repair、reparative、restoration、restore、retrieval

　 　 　

「external」

　　[★]

• adj.

• 外部の、外側の、外の

関

exo、exterior、externally、extra、lateral、laterale、lateralis、laterally、outer、outside