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External Fixation
Jonelle M. Petscavage-Thomas, MD, MPH; Stephanie A. Bernard, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Synonyms

              • Ilizarov spatial frame
                • Type of ring fixator with 4 longitudinal connecting rods used for lengthening
              • Taylor spatial frame
                • Type of hexapod frame used for both lengthening and angular and correction
            • Definitions

              • External fixation: stabilization of bone fragments using external framework (outside body) attaching to bone with combination of pins, half-pins, and wires
                • Rigid form of fixation
                • May be for provisional until definitive fixation possible (e.g., stabilize open, infected fracture until infection controlled) or as definitive method of fixation
                  • Temporary stabilization until swelling decreases or medical condition allows final internal fixation
                  • Pin placement in bone segments above and below fracture; often 2 pins, 1 close to fracture and 1 further away to improve stability
                  • Pins interlinked with rods positioned as close as practical to skin surface
              • Distraction osteogenesis
                • Induction of bone formation between 2 vascularized bone fragments by slowly pulling them apart; new bone produced intramembranous ossification
                • Used for bone lengthening or for transport to replacing bone defect
                • Typically limited to ~ 7 cm of total distraction/lengthening
              • Corticotomy
                • Low-energy surgical fracture through which distraction will be achieved
                • Periosteum left intact
              • Transport site
                • Gap created by bone distraction
              • Bone transport: transfer of portion of diaphyseal bone; distraction bone formation at 1 end and closing gap at other end
                • Typically for fractures with substantial bone loss, creating fracture gap
                • Most commonly distal tibial diaphysis: corticotomy performed proximally and bone transported distally
              • Regenerate
                • New bone formed in transport site
                  • Fine, vertically wispy strands of calcified tissue
              • Docking site
                • Terminal end of where transport meets bone
              • Latent stage
                • Initial 5-10 day period after corticotomy/frame application to allow initiation of callus formation prior to beginning distraction
              • Distraction stage
                • Adjust knobs on frame to distract bone at corticotomy site; patient given prescribed instructions
                  • Distraction 0.5-1 mm per day, stretching callus; divide into 2-4 adjustments/day
                • Distraction of bone at defined rate will promote continued callus formation
              • Consolidation stage
                • Calcification and remodeling of regenerate to form cortical bone
                • Begins after all lengthening/transport ceased
                • Maturation achieved when at least 2 mm of cortical bone is present on at least 3 of 4 cortexes
                  • Requires approximately same amount of time as original lengthening/transport period
              • Dynamize
                • After docking, rods or struts are loosened
                  • Increased weight bearing stimulates regenerate maturation and docking site healing

            IMAGING

            • General Features

              • Radiographic Findings

                • CT Findings

                  • MR Findings

                    • Imaging Recommendations

                      CLINICAL ISSUES

                      • Presentation

                        • Natural History & Prognosis

                          • Treatment

                            DIAGNOSTIC CHECKLIST

                            • Consider

                              • Image Interpretation Pearls

                                • Reporting Tips

                                  Selected References

                                  1. Gessmann J et al: Accuracy of radiographic measurement techniques for the Taylor spatial frame mounting parameters. BMC Musculoskelet Disord. 22(1):284, 2021
                                  2. Salar M et al: Infections associated with temporary external fixation. J Surg Orthop Adv. 29(2):73-6, 2020
                                  3. Bliven EK et al: External fixation of the lower extremities: biomechanical perspective and recent innovations. Injury. 50 Suppl 1:S10-7, 2019
                                  4. Simpson AHRW et al: Non-union: indications for external fixation. Injury. 50 Suppl 1:S73-8, 2019
                                  5. Bible JE et al: External fixation: principles and applications. J Am Acad Orthop Surg. 23(11):683-90, 2015
                                  6. Tresley J et al: "Ilizarov" external fixation: what the radiologist needs to know. Skeletal Radiol. 44(2):179-95, 2015
                                  7. Stubbs DA: Ilizarov for radiologists. Skeletal Radiol. 39(12):1157-60, 2010
                                  8. Fragomen AT et al: The mechanics of external fixation. HSS J. 3(1):13-29, 2007
                                  9. De Kesel R et al: Mini external fixation for hand fractures and dislocations: the current state of the art. Hand Clin. 22(3):307-15, 2006
                                  10. Fernandez DL et al: The treatment of complex carpal dislocations by external fixation. Injury. 31 Suppl 1:92-101, 2000
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Terminology

                                    • Imaging

                                      • Pathology

                                        • Clinical Issues

                                          • Diagnostic Checklist

                                            TERMINOLOGY

                                            • Synonyms

                                              • Ilizarov spatial frame
                                                • Type of ring fixator with 4 longitudinal connecting rods used for lengthening
                                              • Taylor spatial frame
                                                • Type of hexapod frame used for both lengthening and angular and correction
                                            • Definitions

                                              • External fixation: stabilization of bone fragments using external framework (outside body) attaching to bone with combination of pins, half-pins, and wires
                                                • Rigid form of fixation
                                                • May be for provisional until definitive fixation possible (e.g., stabilize open, infected fracture until infection controlled) or as definitive method of fixation
                                                  • Temporary stabilization until swelling decreases or medical condition allows final internal fixation
                                                  • Pin placement in bone segments above and below fracture; often 2 pins, 1 close to fracture and 1 further away to improve stability
                                                  • Pins interlinked with rods positioned as close as practical to skin surface
                                              • Distraction osteogenesis
                                                • Induction of bone formation between 2 vascularized bone fragments by slowly pulling them apart; new bone produced intramembranous ossification
                                                • Used for bone lengthening or for transport to replacing bone defect
                                                • Typically limited to ~ 7 cm of total distraction/lengthening
                                              • Corticotomy
                                                • Low-energy surgical fracture through which distraction will be achieved
                                                • Periosteum left intact
                                              • Transport site
                                                • Gap created by bone distraction
                                              • Bone transport: transfer of portion of diaphyseal bone; distraction bone formation at 1 end and closing gap at other end
                                                • Typically for fractures with substantial bone loss, creating fracture gap
                                                • Most commonly distal tibial diaphysis: corticotomy performed proximally and bone transported distally
                                              • Regenerate
                                                • New bone formed in transport site
                                                  • Fine, vertically wispy strands of calcified tissue
                                              • Docking site
                                                • Terminal end of where transport meets bone
                                              • Latent stage
                                                • Initial 5-10 day period after corticotomy/frame application to allow initiation of callus formation prior to beginning distraction
                                              • Distraction stage
                                                • Adjust knobs on frame to distract bone at corticotomy site; patient given prescribed instructions
                                                  • Distraction 0.5-1 mm per day, stretching callus; divide into 2-4 adjustments/day
                                                • Distraction of bone at defined rate will promote continued callus formation
                                              • Consolidation stage
                                                • Calcification and remodeling of regenerate to form cortical bone
                                                • Begins after all lengthening/transport ceased
                                                • Maturation achieved when at least 2 mm of cortical bone is present on at least 3 of 4 cortexes
                                                  • Requires approximately same amount of time as original lengthening/transport period
                                              • Dynamize
                                                • After docking, rods or struts are loosened
                                                  • Increased weight bearing stimulates regenerate maturation and docking site healing

                                            IMAGING

                                            • General Features

                                              • Radiographic Findings

                                                • CT Findings

                                                  • MR Findings

                                                    • Imaging Recommendations

                                                      CLINICAL ISSUES

                                                      • Presentation

                                                        • Natural History & Prognosis

                                                          • Treatment

                                                            DIAGNOSTIC CHECKLIST

                                                            • Consider

                                                              • Image Interpretation Pearls

                                                                • Reporting Tips

                                                                  Selected References

                                                                  1. Gessmann J et al: Accuracy of radiographic measurement techniques for the Taylor spatial frame mounting parameters. BMC Musculoskelet Disord. 22(1):284, 2021
                                                                  2. Salar M et al: Infections associated with temporary external fixation. J Surg Orthop Adv. 29(2):73-6, 2020
                                                                  3. Bliven EK et al: External fixation of the lower extremities: biomechanical perspective and recent innovations. Injury. 50 Suppl 1:S10-7, 2019
                                                                  4. Simpson AHRW et al: Non-union: indications for external fixation. Injury. 50 Suppl 1:S73-8, 2019
                                                                  5. Bible JE et al: External fixation: principles and applications. J Am Acad Orthop Surg. 23(11):683-90, 2015
                                                                  6. Tresley J et al: "Ilizarov" external fixation: what the radiologist needs to know. Skeletal Radiol. 44(2):179-95, 2015
                                                                  7. Stubbs DA: Ilizarov for radiologists. Skeletal Radiol. 39(12):1157-60, 2010
                                                                  8. Fragomen AT et al: The mechanics of external fixation. HSS J. 3(1):13-29, 2007
                                                                  9. De Kesel R et al: Mini external fixation for hand fractures and dislocations: the current state of the art. Hand Clin. 22(3):307-15, 2006
                                                                  10. Fernandez DL et al: The treatment of complex carpal dislocations by external fixation. Injury. 31 Suppl 1:92-101, 2000