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J Am Acad Orthop Surg, Vol 14, No 10, September 2006, S124-S127.
© 2006 the American Academy of Orthopaedic Surgeons
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Conversion From Temporary External Fixation to Definitive Fixation: Shaft Fractures

Paul J. Dougherty, MD, Craig Silverton, DO, Yener Yeni, PhD, Scott Tashman, PhD and Robb Weir, MD

Dr. Dougherty is Chief, Orthopaedic Trauma Division, and Program Director, Orthopaedic Surgery Residency, Henry Ford Hospital, Detroit, MI. Dr. Silverton is Chief, Adult Reconstruction Division, Henry Ford Hospital. Dr. Yeni is Chief, Biomechanics Section, Henry Ford Hospital. Dr. Tashman is Chief, Motion Analysis Laboratory, Henry Ford Hospital. Dr. Weir is Resident, Orthopaedic Surgery, Henry Ford Hospital.

None of the following authors or the departments with which they are affiliated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Dougherty, Dr. Silverton, Dr. Yeni, Dr. Tashman, and Dr. Weir.

Temporary external fixation is the most common method of initial stabilization of diaphyseal fractures in forward surgical hospitals. Once the patient arrives at a stable environment, usually the United States, the fracture is managed with intramedullary nailing, small-pin external fixation, or a modified external fixator. Future research should be directed toward improving methods of care. It is not precisely known when is the best time to convert to definitive fixation without increasing the risk of infection. The risk factors leading to infection and nonunion are not well-established, making that determination even more difficult. Clinical studies of a suitable size should provide insight into these problems. Although temporary external fixation is commonly used, an optimal construct has not been determined. Data from studies of in vivo fracture-site motion after application of the temporary external fixator should be compared with biomechanical testing of similar constructs. These data could be used to recommend optimal temporary external fixation constructs of tibia, femur, and humerus fractures using currently available devices as well as to provide groundwork for the next generation of fixators.




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C. T. Born, S. M. Briggs, D. L. Ciraulo, E. R. Frykberg, J. S. Hammond, A. Hirshberg, D. W. Lhowe, P. A. O'Neill, and J. Mead
Disasters and Mass Casualties: II. Explosive, Biologic, Chemical, and Nuclear Agents
J. Am. Acad. Ortho. Surg., August 1, 2007; 15(8): 461 - 473.
[Abstract] [Full Text] [PDF]


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