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Problems, Challenge, Complications in Hexapod External Fixation Systems. Contraindications

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Hexapod External Fixator Systems

Abstract

Many intra- and postoperative (early or late) complications are described with the use of circular external fixation, both conventional and hexapod, and the most widespread classification distinguishes between difficulties (divided into “problems” and “obstacles”) and true complications.

Management of these complications is similar, using conventional or hexapod systems, and always requires a perfect knowledge of anatomy, an understanding of the basic clinical and mechanical principles and a complete evaluation of the potential of the apparatus. Intraoperative complications (injuries to vessels and nerves) must be immediately recognized to be treated successfully; numerous postoperative complications can arise during the treatment course, and must be adequately treated.

Indications and contraindications to adoption of classic circular and hexapod external fixators are essentially the same, but some special indications and contraindications to the use of hexapod devices can be highlighted. Special indications are achievement of an exact contact at the docking site in bone transport, correction of deformities appeared during bone lengthening or during bone transport, protection of the growth plate during bone lengthening in pediatric patients; special contraindications may be considered the use in patients with mental disorders, complexity of adjustments, workspace of hexapod fixator, relapsed or neglected clubfoot.

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Abbreviations

DVT:

deep vein thrombosis

PMMA:

polymethylmethacrylate

SUV:

Solomin Utekhin Vilenski

TSF:

Taylor Spatial Frame

References

  1. Paley D. Problems, obstacles and complications of limb lengthening by the Ilizarov technique. Clin Orthop Relat Res. 1990;250:81–104.

    Google Scholar 

  2. Caton J, Dumont P, Bérard U, et al. Etude des résultats à moyen terme d’une série de 33 allongements des membres inférieurs selon la technique de H. Wagner. Rev Chir Orthop. 1985;71:44–8.

    Google Scholar 

  3. Popkov AV. Errors and complications of operative lengthening of the lower extremities in adults by the Ilizarov method. Vestn Khir. 1991;1:113–6.

    Google Scholar 

  4. Donnan LT, Saleh M, Rigby AS. Acute correction of lower limb deformity and simultaneous lengthening with a monolateral fixator. J Bone Joint Surg. 2003;85B:254–60.

    Google Scholar 

  5. Lascombes P, Popkov D, Huber H, et al. Classification of complications after progressive long bone lengthening: proposal for a new classification. Orthop Traumatol Surg Res. 2012;98:629–37.

    Google Scholar 

  6. Green SA. Complications of pin and wire external fixation. AAOS Instr Course. 1990;39:219–28.

    CAS  Google Scholar 

  7. Eycleshymer A, Schoemaker D. A cross-section anatomy. New York: Appleton – Century; 1911.

    Google Scholar 

  8. Kalnberz VK. Compression-distraction apparatus. Stress and rigid system. Riga: LNIITO; 1981.

    Google Scholar 

  9. Green SA. External fixation mounting for difficult locations. Tech Orthop. 1996;11:115–24.

    Article  Google Scholar 

  10. Paley D, Chaudray M, Pirone AM, et al. Treatment of malunions and malnonunions of the femur and tibia by detailed preoperative planning and the Ilizarov techniques. Orthop Clin North Am. 1990;21:667–91.

    Google Scholar 

  11. Caja VL, Moroni A. Hydroxyapatite coated external fixation pins. An experimental study. Clin Orthop Relat Res. 1996;325:269–75.

    Google Scholar 

  12. Trace R. Antimicrobial silver coating reduces external fixation pin-tract infections. Ortop Today. 1997;17:1–2.

    Google Scholar 

  13. Voss K, Rosenberg B, Faghri M, et al. Use of tobramycin-impregnated polymethylmethacrylate pin sleeve for the prevention of pin-tract infection in goats. J Orthop Trauma. 1998;13:98–101.

    Article  Google Scholar 

  14. Toksvig-Larsen S, Aspenberg P. Bisphosphonate coated external fixation pins appear similar to hydroxyapatite-coated pins in the tibial metaphysis and to uncoated pins in the shaft. Acta Orthop. 2013;84:314–8.

    Article  Google Scholar 

  15. Mora R, editor. Nonunion of the long bones. Diagnosis and treatment with compression-distraction techniques. Berlin: Springer; 2006.

    Google Scholar 

  16. Paley D. Problems, obstacles and complications of limb lengthening. In: Bianchi Maiocchi A, Aronson J, editors. Operative principles of Ilizarov. Baltimore: Williams and Wilkins; 1991. p. 352–65.

    Google Scholar 

  17. Papaioannou N, Mastrokalos D, Papagelopulos PJ, et al. Nonunion after primary treatment of tibia fractures with external fixation. Eur J Orthop Surg. 2001;11:231–5.

    Article  Google Scholar 

  18. Kesemenli C, Necmioglu S, Kayikci C. Treatment of refracture occurring after external fixation in paediatric femoral frasctures. Acta Orthop Belg. 2004;70:540–4.

    PubMed  Google Scholar 

  19. DeCoster TA, Crawford WK, Kraut MA. Safe extracapsular placement of proximal tibia transfixation pins. J Orthop Trauma. 1999;13:236–40.

    Google Scholar 

  20. Vora AM, Haddad S, Kadakia A, et al. Extracapsular placement of distal tibial transfixation wires. J Bone Joint Surg Am. 2004;86:988–93.

    Article  Google Scholar 

  21. Changulani M, Bradbury M, Zenios M. Hyperetension as a complication of Taylor Spatial frame. J Pediatr Orthop B. 2009;18(6):392–3.

    Article  Google Scholar 

  22. Rodl R, Leidinger B, Bohm A, et al. Correction of deformities with conventional and hexapod frames – comparison of methods. Z Ortho. 2003;141(1):92–8.

    Google Scholar 

  23. Manner H, Huehl M, Radler C, et al. Accuracy of complex lower-limb deformity correction with external fixation: a comparison of Taylor Spatial Frame with the Ilizarov Ringfixator. J Child Orthop. 2007;1:55–61.

    Article  Google Scholar 

  24. Oganesian OV. Treatment of bone fractures and joint injuries. Moscow: BKL Publishers; 2006.

    Google Scholar 

  25. Young J, Lamm B, Herzenberg JE. Complex foot deformities: correction with the Taylor spatial frame. In: Kocaoglu M, Tsuchiya H, Eralp L, editors. Advanced techniques in limb reconstruction surgery. Berlin: Springer; 2015.

    Google Scholar 

  26. Takata M, Vilenski V, Tsuchiya H, Solomin L. Foot deformity correction with hexapod external fixator, the ortho-SUVFrame™. J Foot Ankle Surg. 2013;52(3):324–30.

    Article  Google Scholar 

  27. Mora R, Pedrotti L, Bertani B, et al. Deformità torsionali del piede. In: Massobrio M, editor. Diagnosi e cura delle deformità rotatorie e torsionali dergli arti. Roma: CIC; 2017. p. 71–8.

    Google Scholar 

  28. Pairon P, Ossendorf C, Kuhn S, et al. Intramedullary nailing after external fixation of the femur and tibia: a review of advantages and limits. Eur J Trauma Emerg Surg. 2015;41(1):25–38.

    Article  CAS  Google Scholar 

  29. Nieto H, Baroan C. Limits of internal fixation in long-bone fracture. Orthop Traumatol Surg Res. 2017;103(1S):S61–6.

    Article  CAS  Google Scholar 

  30. Hamdy RC. Evolution in long bone deformity correction in the post-lizarov era. External to internal devices. JLLR. 2016;2(2):61–7.

    Google Scholar 

  31. Hamdy RC, Bernstein M, Fragomen AT, Rozbruch SR. What’s new in limb lengthening and deformity correction. J Bone Joint Surg Am. 2017;99:1408–14.

    Article  Google Scholar 

  32. Skomoroshko PV, Vilenski VA, Hammouda A, et al. Determination of the maximal corrective ability and optimal placement of the Ortho-SUV frame for femoral deformity with respect to the soft tissue envelope, a biomechanical modelling study. Adv Orthop. 2014;2014:1–11.

    Google Scholar 

  33. Eren I, Eralp L, Kocaoglu M. Comparative clinical study on deformity correction accuracy of different external fixators. Int Orthop. 2013;37(11):2247–52.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Full Professor of Orthopaedic Surgery, Division of Orthopaedics and Traumatology, Department of Surgical, Diagnostic and Pediatric Sciences, University of Pavia, “Città di Pavia Institute” University Hospital, School of Medicine, Pavia, Italy

    Redento Mora

  2. Associate Professor of Orthopaedic Surgery, Division of Orthopaedics and Traumatology, Department of Surgical, Diagnostic and Pediatric Sciences, University of Pavia, “Città di Pavia Institute” University Hospital, School of Medicine, Pavia, Italy

    Luisella Pedrotti

  3. Assistant Surgeon, Division of Orthopaedics and Traumatology, Department of Surgical, Diagnostic and Pediatric Sciences, University of Pavia, “Città di Pavia Institute” University Hospital, School of Medicine, Pavia, Italy

    Barbara Bertani & Gabriella Tuvo

  4. Associate Professor of Infectious Diseases, Consultant in Infectious Diseases, “Città di Pavia Institute” University Hospital, School of Medicine, Pavia, Italy

    Anna Maccabruni

Authors
  1. Redento Mora
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  2. Luisella Pedrotti
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  3. Barbara Bertani
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  4. Gabriella Tuvo
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  5. Anna Maccabruni
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Editors and Affiliations

  1. Department of Orthopaedics and Traumatology, “Sapienza” - University of Rome, Rome, Italy

    Marco Massobrio

  2. Division of Orthopaedics and Traumatology, Department of Surgical, Diagnostic and Pediatric Sciences, University of Pavia, “Città di Pavia” Institute University Hospital, School of Medicine, Pavia, Italy

    Redento Mora

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Mora, R., Pedrotti, L., Bertani, B., Tuvo, G., Maccabruni, A. (2021). Problems, Challenge, Complications in Hexapod External Fixation Systems. Contraindications. In: Massobrio, M., Mora, R. (eds) Hexapod External Fixator Systems. Springer, Cham. https://doi.org/10.1007/978-3-030-40667-7_11

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  • DOI: https://doi.org/10.1007/978-3-030-40667-7_11

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-40666-0

  • Online ISBN: 978-3-030-40667-7

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