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The Evolution of Trans-Skeletal Method Osteosynthesis
Abstract
OBJECTIVE: The purpose of this article is to give a brief overview of the history of trans-skeletal method ostheosynthesis as it relates to the evolution of the Ilizarov external fixation device.
BODY: The pin frame external fixators originated from the idea of bone reduction with pins fixed to fragments before applying the plaster of Paris. Such pins were usually removed after plaster setting. It was Schanz with others who incorporated pins into plaster to prevent secondary displacement10. Lambotte was the first surgeon to introduce fixators that had practical value, utilizing half-pins and rigid frames, which acted as neutralization bars. The idea was taken up and developed in different ways by a number of different surgeons before World War II (Anderson 1934; Hoffmann, 1938; Stader et al 1942). The earliest ring fixators were those of Dicxon, Diveli (1932), which used small diameter wires passed through bones, tensioned and attached to semicircular frames. Exner with others14 introduced threaded connecting rods and wires with attached stoppers for compression and increased stability. Fixation with these frames were not stable, the large distracting devices were cumbersome to patients and made management on strict bed rest mandatory. They were applied after open reduction and the cross-angles of the wires were located outside the bone and this reduced the rigidity of fixation, needing additional support with Plaster of Paris.
CONCLUSION: In conclusion, external fixators have been in existence for more than 100 years before the Ilizarov apparatus. It was proposed because the ones before it did not provide optimal conditions for bone union and patient rehabilitation. It differs from others by its simplicity of construction. It is an ideal fixator which permits closed reduction of fractures, allowing easy access to soft tissue wounds, adaptable to a wide variety of fractures and offers so rigid a fixation that no external support to the frame is needed for stability. It allows compression of fractures or distraction where necessary. Ilizarov apparatus has clearly defined the indications for the use of external fixators.
Nig Jnl Orthopaedics & Trauma Vol.2(1) 2003:1-3
BODY: The pin frame external fixators originated from the idea of bone reduction with pins fixed to fragments before applying the plaster of Paris. Such pins were usually removed after plaster setting. It was Schanz with others who incorporated pins into plaster to prevent secondary displacement10. Lambotte was the first surgeon to introduce fixators that had practical value, utilizing half-pins and rigid frames, which acted as neutralization bars. The idea was taken up and developed in different ways by a number of different surgeons before World War II (Anderson 1934; Hoffmann, 1938; Stader et al 1942). The earliest ring fixators were those of Dicxon, Diveli (1932), which used small diameter wires passed through bones, tensioned and attached to semicircular frames. Exner with others14 introduced threaded connecting rods and wires with attached stoppers for compression and increased stability. Fixation with these frames were not stable, the large distracting devices were cumbersome to patients and made management on strict bed rest mandatory. They were applied after open reduction and the cross-angles of the wires were located outside the bone and this reduced the rigidity of fixation, needing additional support with Plaster of Paris.
CONCLUSION: In conclusion, external fixators have been in existence for more than 100 years before the Ilizarov apparatus. It was proposed because the ones before it did not provide optimal conditions for bone union and patient rehabilitation. It differs from others by its simplicity of construction. It is an ideal fixator which permits closed reduction of fractures, allowing easy access to soft tissue wounds, adaptable to a wide variety of fractures and offers so rigid a fixation that no external support to the frame is needed for stability. It allows compression of fractures or distraction where necessary. Ilizarov apparatus has clearly defined the indications for the use of external fixators.
Nig Jnl Orthopaedics & Trauma Vol.2(1) 2003:1-3
