Ortho House’s External Fixators

An Ortho House’s external fixator is a metal device attached to the bones of the arms, legs, or feet with pins or threaded wires. These threaded pins or wires go through the skin and muscles and into the bones. Most of the device is outside the body, which is why it is called an external fixator. Many cases only need Ortho House’s one external fixator, but some people need two or more external fixators.

Orthopedic surgeons have been using the technique of external fixation to treat fractures for more than 2000 years, as a method for fixing fractures while maintaining the integrity of soft tissue. The technique of external fixation was further popularized in the mid-20th century by Hoffman.

The design and biomechanics of external fixation changed dramatically for many years, but the principles are the same. The main purpose of the Ortho House’s external fixation is to maintain the length of the fracture, the alignment, and the rotation. Ortho House’s external fixators are useful for temporary fixation or critical fixation purposes. If necessary, both methods can be implemented in combination with partial internal fixation.

Ortho House believes it is important for orthopedic surgeons to be familiar with external fixation technologies and their principles for fixing different fractures of the upper extremities, lower extremities, and pelvis.

The physiology of fracture healing depends to a large extent on the mode of fixation and stability. With absolute fracture stability such as compression plating, the bone will undergo primary intramembranous bone healing. On the other hand, relative fracture stability, such as external fixation, results in secondary endochondral bone healing.

Ortho House also recommends several ways to alter the external fixation construct to make the fracture more or less stable.

When Are Ortho House’s External Fixators Used?

External fixators can be used to gradually lengthen a bone, straighten a deformed bone or reduce pressure on a joint through joint distraction.

Moreover, Ortho House believes external fixators are a beneficial technique in the following indications:

• Limb length discrepancy surgeries
• Arthrodesis or joint fusion
• Correction of angulation or rotator deformity
• Bone segment transportation to fill the bone gap
• Temporary fixation of open fractures
• Maintaining stability
• Eases dressing
• When definitive surgery is delayed for some reason
• Rapid Stabilization
• Unstable pelvic ring injuries
• Pelvic fixation to stop bleeding
• Rapid fixation of polytrauma patients
• Definitive external fixation of fractures especially intraarticular fractures
• Ligamentotaxis – a technique of using continuous longitudinal force in order to bring fracture fragments more closely together
• To position limb in the desired position as in nerve or tendon repair
• Infected fractures
• Traction to aid in intraoperative fracture reduction
• Burns

How are Ortho House’s External Fixators Applied?

Ortho House’s external fixators are applied during surgery. In the operation, the doctor will create small incisions or cuts and then insert pins or wires into the bone. The external fixing frame will be connected to these pins and wires and fixed with clamps and rods. If the bone is to be lengthened or straightened, the doctor will perform a surgical cut to the bone, also known as osteotomy, to create two separate bone segments.

Ortho House external fixation is more successful on superficial bones (such as the tibia) than on deeper bones (such as the femur or humerus); in this case, pin tract sepsis is more likely.

External fixators consist of modular components that are assembled together to form a stable structure between the bone fragments and the adjustable beam system. The Ortho House beam system is connected to the bone by a series of metal dowels screwed into the bone.

What are the Advantages of Ortho House’s External Fixation Technique?

According to Ortho House, external fixators can be extremely beneficial in the aforementioned cases. They also provide several benefits such as:

• Provides rigid fixation when other forms of immobilization are not feasible
• For example, severe open fractures
• Frequent debridement and irrigation
• Allows joint mobilization
• Allows limb elevation by suspending frame if needed
• Allows compression, neutralization, or fixed distraction of the fracture fragments.
• Allows limb surveillance and wound care without disturbing the alignment
• Dressing changes
• Bone and skin grafting
• Allows early patient ambulation
• They cause less disruption of soft tissues, osseous blood supply, and periosteum.

What Are the Different Types of External Fixators?

In the strictest sense, we can consider that there are two types of fixators – unilateral and circular. A combination of two is called hybrid fixators.

However, there are many other types. Ortho House’s external fixator types divide into several different subcategories, including:

• Uniplanar: They are fast and easy to apply.
• Multiplanar: By adding pins in different planes (i.e., placed perpendicular to each other).
• Unilateral or Monolateral: Fixators that have a straight bar that is placed on one side of the arm, leg, or foot.
• Bilateral: Created when the pins are on both sides of the bone and can also add additional stability.
• Circular fixators: They have gained popularity with limb lengthening procedures – are especially effective at allowing the patient to weight bear and maintain some joint motion during the treatment.

There are many different ways to change and enhance the external fixation construct. There are Ortho House’s hybrid fixators – where surgeons combine more than one of the previously mentioned types.

The purpose of these different types is to enable the surgeon to create the utmost level of stability that is appropriate for optimal healing. Ortho House works closely with surgeons to ensure that they understand the technique well. As it is essential also to have the appropriate knowledge and understanding of basic fracture principles to utilize the technology correctly; because stiffer is not always better when it comes to external fixation.

What are the Disadvantages of External Fixators?

Ortho  House always ensures transparency in their conduct of work. We work closely with physicians and patients to ensure safety in almost every orthopedic procedure. Surgeons are always recommended to educate their patients about the risks of this procedure and technique.

• Risk of pin tract infection
• Fracture through pin tracts after frame removal.
• Cumbersome and needs meticulous care.
• Joint stiffness when the joint is immobilized

7. When Are Revision Knee Surgeries Needed?

Total knee replacement is one of the most successful Ortho House’s orthopedic procedures in all medicine. In most cases, it enables people to live a richer and more active life without chronic knee pain. However, over time, knee replacement may fail for a variety of reasons. When this happens, the knee will become painful and swollen – leaving a feeling of stiffness or instability that it becomes difficult to perform daily activities.

Generally, the procedure is safe. However, if the knee replacement fails, the surgeon may recommend a second surgery — revision total knee replacement. In this procedure, the surgeon removes some or all of the parts of the original prosthesis and replaces them with new Ortho House ones.

The goal of both knee procedures is to relieve pain and improve function. However, revision surgery is different than primary total knee replacement. Revision knee replacement surgery is a longer, more complex procedure that requires extensive planning, and specialized Ortho House implants and tools to achieve a good result.

Ortho House’s Knee Replacement Surgery Revision: Procedure

During primary total knee replacement, the knee joint is replaced with an Ortho House implant, or prosthesis, made of metal and plastic components. Although most total knee replacements are very successful, over time, problems such as implant wear and loosening may require a revision procedure to replace the original components.

There are different types of revision surgery. In some cases, one implant or a single component of the prosthesis must be revised. In other cases, all three components (femur, tibia, and patella) of the previous replacement must be removed or replaced to reconstruct the bone around the knee with Ortho House augments (metal pieces that substitute for missing bone) or bone graft.

Bone damage can make it difficult for doctors to perform revision knee arthroplasty using standard Ortho House total knee arthroplasty technologies. In most cases, the surgeon will use a special implant with a longer, thicker system that fits deep into the bone for additional support.

When are knee revision surgeries required?

A knee revision may be necessary for anyone whose previously installed prosthetic knee implant fails due to injury or wear, or the area around the implant gets infected.

For elders undergoing knee arthroplasty, knee implants can last a lifetime. However, younger patients, especially those who maintain an active lifestyle, may eventually need a second replacement after the knee stops working.

Why Do Knee Implants Fail?

Usually, knee arthroplasty is successful. But there is a chance of failure after time. Here Ortho House will mention reasons knee implants fail:

• Loosening

Gradually, small particles are separated from the arthroplasty by friction applied to the arthroplasty. This loosens the bond between the bone and the implant, causing small particles that sometimes break the plastic spacer to gather around the knee joint and attack the body’s immune system. Unfortunately, this immune response also attacks the bone around the implant, resulting in a condition called osteolysis.  As the bone around the implant deteriorates, the implant becomes loose or unstable. When this happens, the knees become swollen and painful, making daily activities difficult.

• Infection

Infection, a complication that can occur with any surgery, including total knee arthroplasty. It can occur at any time, from immediately after surgery to several years later. When the artificial knee joint becomes infected, there is often swelling, pain, and cracking. An infection can cause the implant to lose its attachment to the bone. Infections around knee replacement surgery require one or more revision surgeries to treat the infection.

• Instability

Most implants are designed for knee arthroplasty to work properly and rely on the patient’s existing ligaments. If the ligaments around the knee are damaged or out of balance during or after surgery, the knee may feel unstable and loose. The patient may experience recurrent swelling and a sensation that the knee is ‘giving in’. Corrective revision surgery may be required if knee instability cannot be treated with non-surgical procedures such as physical therapy and bracing.

• Stiffness

In rare cases, the patient may not properly rehabilitate after the knee replacement surgery and the knee may become stiff. If this is not treated within the first few months by physical therapy or manipulation under anesthesia, the stiffness persists. In this case, revision surgery may be needed to remove extensive scar tissue or to improve the patient’s range of motion by changing the knee’s components.

• Fractures

A periprosthetic fracture is a broken bone around the components of a total knee replacement. A fall most often causes this type of fracture, and usually requires revision surgery.

These are considered the most common reasons why Ortho House knee revision arthroplasty may be required.

In establishing the extent of the Ortho House revision required, the orthopedic specialist will take into account a number of factors, including the location and the type of fracture, the quality of the remaining bone, and if the implant is loose.

Ortho House’s knee revision surgery may either require fixing the fracture alone, fixing the fracture and revising the implant or completely removing the implant and fracture pieces and replacing them with a larger more complex Ortho House total knee replacement.

Why Revision Surgery is More Complicated than the Initial Surgery?

It is important to note that an Ortho House revision knee replacement does not offer the same lifespan as the original knee replacement (usually around 10 years instead of 20). Accumulation of injuries, scar tissue, and mechanical degradation of components lead to reduced performance. Revisions are also more prone to complications.

The Ortho House revision procedure is often more complicated than the original knee replacement surgery because the surgeon must remove the original implant, which would have pushed and grown into the existing bone.

Also, once the surgeon removes the prosthesis, there is less bone left. In some cases, a bone graft – a part of the bone transplanted from another part of the body or from a donor – may be needed to support a new restoration. Bone grafts support and encourage new bone growth.

However, the procedure requires additional preoperative planning, specialized tools, and greater surgical skill – all of which Ortho House works relentlessly to provide to their surgeons and patients.