Basic concepts and applications in open tibial fractures.
These data indicate that unilateral frames erected with rather stiff pins and rods carry few of the serious problems that were typical for the traditional half frames characterized by weak components, routine medial application, and limited pin spread. In comparison with one- and two-plane bilateral fixator configurations, unilateral frames are safer and more versatile, provide better access to limb and injury, do not interfere with knee and ankle motion, facilitate patient mobility, allow full unsupported weight bearing, and have a low rate of serious complications. While the successful and effective use of unilateral half frames is predicated on the use of relatively stiff components, they can be erected with most presently available devices. If a modular fixator is employed, long clamps, which allow for an extended pin spread, are desirable. The routine use of partial and full weight bearing increases patient comfort and mobility and may have beneficial effects on the healing process. In order to have the fracture site accept larger loads toward the end of the treatment period, we have recently started to sequentially decrease the rigidity of our fixator frames by moving the longitudinal rods further away from the tibia and selectively loosening the two clamps closest to the fracture site. This allows for the transmission of almost all compressive and transverse bending loads across the fracture site but provides considerable protection from sagittal bending moments, which often cause anterior bowing late in the healing period.
D000293:Adolescent; D000328:Adult; D000843:Ankle Joint / Q000502:physiology; D005069:Evaluation Studies as Topic; D005260:Female; D005592:Fracture Fixation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007719:Knee Joint / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009068:Movement; D011446:Prospective Studies; D011859:Radiography; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000601:surgery*