Improvisation in External Fixation in the Management of Open Extremity Fractures at the University of Port Harcourt Teaching Hospital

Richard C. Echem^1, , Phillip D. Eyimina¹, Vincent U.E. Adiela¹ and Tamunokuro Diamond¹

¹Department of Orthopaedic Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Post code - 500001, Rivers State, Nigeria

Cite this paper:
Richard C. Echem, Phillip D. Eyimina, Vincent U.E. Adiela and Tamunokuro Diamond. Improvisation in External Fixation in the Management of Open Extremity Fractures at the University of Port Harcourt Teaching Hospital. American Journal of Medical Sciences and Medicine. 2020; 8(1):34-38. doi: 10.12691/ajmsm-8-1-5

Abstract

Background: External fixation is an important modality in fracture management. It is a method that utilises a combination of pins, wires, clamps and bars or rings. Clamps link a pin or wire to a rod or ring. Sometimes all the components of an external fixator may not be available and there will be need to improvise. Aim: To document the use of a synthetic cast as an improvised external fixator clamp in open fracture management. Methods: A prospective study of consecutive patients with open extremity fractures at the University of Port Harcourt Teaching Hospital, Port Harcourt from October 2012 to October 2017. A synthetic cast was utilised either partially or wholly as clamps for external fixation. The patients’ sociodemographics and information relevant to the injury were obtained. Data was analysed using SPSS version 23. Results: Twenty-eight patients were managed with improvised clamp. Ages ranged from 16 to 47 years, consisting of 18 males and 10 females. Majority resulted from road traffic crashes. There were three humeral and 25 tibial fractures with majority being in the middle third. Majority were Gustilo type IIIB. Twenty-five fractures united although two of these were malunited. One had non-union. Other complications were delayed union and pin tract infection. Two patients had below knee amputation for gangrene. Duration of hospital stay ranged from 26 to 151 days. Follow up period ranged from four to 24 months. Conclusion: Improvisation of synthetic cast for external fixator clamp is effective in acute management of open extremity fractures as well as during subsequent care.

Keywords:
improvisation external fixation clamps open fractures management

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]	Moss DP, Tejwani NC. Biomechanics of external fixation: a review of the literature. Bull NYU Hosp Jt Dis 2007;65(4):294-299.
[2]	Behrens F. A primer of fixator devices and configurations. Clin Orthop Relat Res 1989;(241):5-14.
[3]	Pontarelli WR. External fixation of tibial fractures. Iowa Orthop J 1982; 2: 80-88.
[4]	Giotakis N, Narayan B. Stability with unilateral external fixation in the tibia. Strategies Trauma Limb Reconstr 2007; 2(1): 13-20.
[5]	Beltsios M, Savvidou O, Kovanis J, Alexandropoulos P, Papagelopoulos P. External fixation as a primary and definitive treatment for tibial diaphyseal fractures. Strategies Trauma Limb Reconstr 2009; 4(2): 81-87.
[6]	Smith MK. Hospitals in developing countries: a weak link in a weak chain. Lancet 1999;351 Suppl:SIV 26.
[7]	Grimes CE, Henry JA, Maraka J, Mkandawire NC, Cotton M. Cost-effectiveness of surgery in low- and middle-income countries: a systematic review. World J Surg 2014; 38(1): 252-263.
[8]	Padhi NR, Padhi P. Use of external fixators for open tibial injuries in the rural third world: panacea of the poor? Injury 2007; 38(2): 150-159.
[9]	Agaja SB, Ogunye WK. Improvised external fixators for the treatment of open fractures at a private hospital in Ilorin, Kwara State. Niger J Orthop Trauma 2005; 4(1-2): 70-78.
[10]	Musa A. How I improvised an external fixator to manage open fractures. South Sudan Med J 2013; 6(2): 31-32.
[11]	Gustilo RB, Merkow RL, Templeman D. The management of open fractures. J Bone Joint Surg Am 1990; 72(2): 299-304.
[12]	Rezaian SM. A new external fixation device for treatment of complicated fractures of the leg. Injury 1977; 9(1): 17-22.
[13]	Behrens F. General theory and principles of external fixation. Clin Orthop Relat Res 1989; (241): 15-23.
[14]	Sisk TD. External fixation. Historic review, advantages, disadvantages, complications, and indications. Clin Orthop Relat Res 1983; (180): 15-22.
[15]	Checketts RG, Young CF. External fixation of diaphyseal fractures of the tibia. Curr Orthop 2003; 17(3): 176-189.
[16]	Pathak G, Atkinson R. Military external fixation of fractures. Aust Def Forces Health 2001; 2: 24-28.
[17]	Gordon WT, Grijalva S, Potter BK. Damage control and austere environment external fixation: Techniques for the civilian provider. J Surg Orthop Adv 2012; 21(1): 22-31.
[18]	Carroll EA, Koman LA. External fixation and temporary stabilization of femoral and tibial trauma. J Surg Orthop Adv 2011; 20(1): 74-81.
[19]	3M Health Care. 3M Scotchcast casting products: Instructions for use. Document ID number: 34-7036-3759-4. St. Paul, MN: 3M Health Care, 1994.
[20]	Pirhonen E, Parssinen A, Pelto M. Comparative study on stiffness properties of woodcast and conventional casting materials. Prosthet Orthot Int 2012; 37(4): 336-339.
[21]	Bassey LO. The use of P.O.P integrated transfixation pins as an improvisation on the Hoffmann’s apparatus: contribution to open fracture management in the tropics. J Trauma 1989; 29(1): 59-64.
[22]	Oni OO, Orhewere FA. Per-cutaneous pins and external fixation of compound fractures of the tibia: the Benin experience. Niger Med J 1982; 12: 255-257.
[23]	Aron JD. Using methylmethacrylate to make external fixation splints. J Bone Joint Surg Am 1976; 58(1): 151.
[24]	Inoue S, Ichida M, Imai R, Suzu F, Ohashi T, Sakakida K. External skeletal fixation using methylmethacrylate- technique and indication with clinical report. Int Orthop 1977; 1(1): 64-69.
[25]	Edge AJ, Denham RA. The Portsmouth method of external fixation of complicated tibial fractures. Injury 1979; 11(1): 13-18.
[26]	Edge AJ, Denham RA. External fixation for complicated tibial fractures. J Bone Joint Surg Br 1981; 63(1): 92-97.
[27]	Allerton KE, Miles AE. External fixation of tibial fractures at Groote Schuur Hospital, Cape Town. S Afr Med J 1981; 60(13): 496-501.
[28]	Ohashi T, Inoue S, Kajikawa K. External skeletal fixation using methylmethacrylate. Current technique, clinical results and indications. Clin Orthop Relat Res 1983; (178): 121-129.
[29]	Demetriades D, Nikolaides N, Filiopoulos K, Hager J. The use of methylmethacrylate as an external fixator in children and adolescents. J Pediatr Orthop 1995; 15(4): 499-503.
[30]	Onuminya JE. External skeletal fixation of open tibial shaft fractures in Nigeria. Niger Med Pract 2002; 40(3/5): 37-39.
[31]	Thanni LO. Current concepts in external fixation. Niger J Orthop Trauma 2011; 10(1): 1-6.