This book provides a thorough description of hexapod external fixators, from the theoretical basis to their practical application. Indications and practical use in current Orthopaedic practice are addressed in detail, offering the reader essential insights into the strengths and limitations of these devices. The main aspects covered, include primary (congenital) and secondary (acquired) deformities of the limbs: the etiology, pathomechanics, clinics, technical “tips and tricks” and suggested frame assemblies are presented.
Each chapter addresses a specific Orthopaedic problem and includes representative clinical cases commented on by the authors. Illustrations and X-ray images support the discussion of the various themes treated in the textbook. Special attention is also given to deformity morphology and the consequent geometry of correction, as well as economical aspects and the biological risks of radiation exposure. A review of current nomenclature in external fixation is also provided as a quick-reference resource.
Offering clear and straightforward descriptions of these devices and their current use in practice, prepared by leading international experts, this book will benefit expert surgeons and residents alike.
Author(s): Marco Massobrio, Redento Mora
Publisher: Springer
Year: 2021
Language: English
Pages: 312
City: Cham
Foreword
Preface
Contents
1: History and Evolution of Hexapod External Fixators
1.1 History of Hexapod External Fixators
1.2 Theoretical Basis: From the Mozzi-Chasles’ Theorem to the “Screw” Theory
1.3 The Hardware: The Beginning of Parallel Manipulators
1.4 Hexapods in Medicine
1.5 Biographic Notes
References
Part I: Mathematical and Physical Principles
2: Mathematics of the Hexapod
2.1 Vectors
2.2 Rotational Matrix
2.3 Six Degrees of Freedom
2.4 Solution of the Forward Kinematics
2.4.1 Practical Example
References
3: Characteristics and Usage Modalities. Main Systems
3.1 Introduction
3.2 Theoretical Basis
3.3 Properties of Hexapod Systems in Orthopaedics
3.4 Octopods
3.5 The Hardware
3.5.1 Operative Instructions
3.5.2 Hexapod Frame Components
3.5.2.1 The Platform
3.5.2.2 The Struts
3.5.2.3 The Strut Joint
3.5.2.4 Strut–Platform Connection
3.5.2.5 Platform–Bone Connection
3.6 The Virtual Hinge
3.7 Additional Fixation Levels (Second Level of Fixation) and Components
3.8 The Software
3.8.1 Software–Frame Relationship
3.8.2 Correction (End of Correction)
3.9 Engage, Conflict, and Impingement
3.10 Future Perspectives
Appendix
References
Recommended Reading
4: Material Properties Related to Requirements of Hexapodalic Systems
4.1 Mathematical Definition of Stress Forces Inside Materials
4.2 Response of Materials Under Mechanical Stress
4.3 Properties of Dia-, Para-, and Ferromagnetic Materials
References
Part II: Clinical Applications of Hexapod External Fixator
5: Hexapod External Fixation for Fractures and Nonunions
5.1 Introduction
5.1.1 Design and Technology
5.1.2 Biomechanics and Application
5.2 Acute Fractures
5.2.1 Fracture Reduction
5.2.2 Open Fractures
5.2.3 Soft-Tissue Management
5.3 Nonunion
5.3.1 Metaphyseal Nonunion
5.3.2 Hypertrophic Nonunion
5.3.3 Infected Nonunion
5.3.4 Soft-Tissue Coverage
5.3.5 Economic Burden
5.4 Summary
References
6: Hexapod External Fixators in the Treatment of Axial and Rotation Deformities and Limb Length Discrepancies
6.1 Metaphyseal Case
6.1.1 Deformity Screen
6.1.2 Hardware Screen
6.1.3 AP X-Ray Screen
6.1.4 AP Proximal Joint Line and Proximal Center Point
6.1.5 AP Distal Bone Segment Line
6.1.6 AP Osteotomy and Proposed Pivot Point
6.1.7 AP RDP Bony and Soft and Review
6.1.8 ML X-Ray Screen
6.1.9 ML Proximal Joint Line and Proximal Center Point
6.1.10 ML Distal Bone Segment Line
6.1.11 ML Osteotomy and Proposed Pivot Point
6.1.12 ML RDP Bony and Soft and Review
6.1.13 Corrections Screen
6.1.14 3D Preview and Bone Overlap
6.1.15 Schedule Screen
6.1.16 Residual Revision
6.1.17 Residual Corrections
6.2 Diaphyseal Case
6.2.1 Preoperative X-Rays
6.2.2 Deformity Screen
6.2.3 Hardware Screen
6.2.4 AP X-Ray Screen
6.2.5 AP Proximal and Distal Bone Segment Lines
6.2.6 AP Osteotomy and Proposed Pivot Point
6.2.7 AP RDP Bony and Soft and Review
6.2.8 ML X-Ray Screen
6.2.9 ML Proximal and Distal Bone Segment Lines
6.2.10 ML Osteotomy and Proposed Pivot Point
6.2.11 ML RDP Bony and Soft and Review
6.2.12 Corrections Screen
6.2.13 3D Preview and Bone Overlap
6.2.14 Schedule Screen
6.2.15 Final X-Rays (Fig. 6.47)
6.2.16 Foot Case
6.2.17 Deformity Screen
6.2.18 Hardware Screen
6.2.19 ML X-Ray Distal Ring Screen
6.2.20 ML Midline of Talus and First Metatarsal Line
6.2.21 ML Osteotomy and Proposed Pivot Point
6.2.22 ML RDP Bony and Soft and Review
6.2.23 Dorsal X-Ray Distal Ring
6.2.24 Dorsal Midline of Talus and First Metatarsal Line
6.2.25 Dorsal Osteotomy and Proposed Pivot Point
6.2.26 Dorsal RDP Bony and Soft and Review
6.2.27 Corrections Screen
6.2.28 3D Preview and Bone Overlap
6.2.29 Schedule
6.2.30 Final X-Rays After Foot Correction and Frame Removal (Fig. 6.67)
References
7: Hexapod External Fixators in Bone Defect Treatment
7.1 Definition and Classification of Bone Defects
7.2 Phases of Bone Transport Performed with Circular External Fixation: Clinical and Biological Features
7.2.1 Surgery (Initial Phase)
7.2.2 Latency Phase
7.2.3 Transportation Phase (Distraction Phase)
7.2.4 Consolidation Phase
7.2.5 Final Phase (External Fixation Removal)
7.3 Complications
7.4 Indications and Contraindications
7.4.1 Indications in Trauma Situations
7.4.2 Indications in Osteomyelitis Management
7.4.3 Indications in Bone Tumors Management
7.4.4 Contraindications for Bone Transport
7.5 Bone Fixation Devices
7.5.1 Classic Circular External Fixators
7.5.2 Hexapod External Fixators
7.6 Alternatives to Bone Transport with Circular External Fixation
7.7 Techniques of Bone Transport
7.7.1 Bone Transport in Acute Trauma Situations (Emergency Procedure)
7.7.1.1 Open Fractures
7.7.2 Bone Transport in Chronic Trauma Situations (Planned Elective Procedure)
7.7.3 Third Type: Atrophic Infected Nonunions
7.7.4 Fourth Type: Infected Nonunions with Bone and Soft-Tissue Loss
7.8 Bone Transport in Osteomyelitis
7.9 Bone Transport in Bone Tumors
7.10 Conversion from External to Internal Fixation
7.11 Observations on Advantages and Disadvantages of Hexapod External Fixation in Segmental Bone Defects Management
7.12 Discussion
References
8: Hexapod External Fixators in Paediatric Deformities
8.1 Introduction
8.2 Preoperative Planning
8.3 Frame Setup
8.4 Postoperative Management
8.5 Specific Clinical Conditions
8.5.1 Physeal Injuries
8.5.1.1 Clinical Case (Fig. 8.1)
8.5.1.2 Surgical Procedure
8.5.1.3 Key Points
8.5.2 Hereditary Multiple Exostoses (HME)
8.5.2.1 Clinical Case (Fig. 8.2)
8.5.2.2 Surgical Procedure
8.5.2.3 Key Points
8.5.3 Ollier’s Disease
8.5.3.1 Clinical Case (Fig. 8.3)
8.5.3.2 Surgical Procedure
8.5.3.3 Femur
8.5.3.4 Tibia
8.5.3.5 Key Points
8.5.4 Congenital Deformities
8.5.4.1 Clinical Case (Fig. 8.4)
8.5.4.2 Surgical Procedure
8.5.4.3 Femur
8.5.4.4 Tibia
8.5.4.5 Key Points
8.5.5 Clubfoot
8.6 Limitations of the Use of Hexapod External Fixator in Paediatric Patients
References
Introduction
Physeal Injuries
Hereditary Multiple Exostoses (HME)
Ollier’s Disease
Congenital Deformities
Clubfoot
9: Hexapod External Fixators in Ankle and Foot Deformity Correction
9.1 Introduction
9.2 Ilizarov Frame and Orthopaedic Hexapods in Ankle and Foot Deformity Correction: General Principles
9.3 Orthopaedic Hexapod “Ortho-SUV Frame” (OSF): Main Peculiarities
9.4 Planning of Distal Tibia Deformity Correction
9.5 OSF Ankle Hardware and Software
9.5.1 OSF Ankle Hardware
9.5.2 OSF Ankle Software
9.6 Planning of Midfoot and Hindfoot Deformity Correction
9.6.1 RLA and Midfoot Planning of Deformity Correction
9.6.2 RLA and Hindfoot Planning of Deformity Correction
9.7 OSF Midfoot Hardware and Software
9.7.1 OSF Midfoot Hardware
9.7.2 OSF Midfoot Software
9.8 OSF Hindfoot Hardware and Software
9.8.1 OSF Hindfoot Hardware
9.8.2 OSF Hindfoot Software
9.9 Postoperative Care
9.10 Contributions
References
10: Hexapod External Fixators in Articular Stiffness Treatment
10.1 Introduction
10.2 Ilizarov Frame and Orthopaedic Hexapods in Articular Stiffness Surgery: General Principles
10.3 “Multi Total Residual” OSF Software Option
10.4 OSF Knee Hardware and Software
10.4.1 OSF Knee Hardware
10.4.2 OSF Knee Software
10.5 OSF Ankle Joint Hardware and Software
10.5.1 OSF Ankle Hardware
10.5.2 OSF Ankle Software
10.6 Postoperative Care
10.7 Contributions
References
11: Problems, Challenge, Complications in Hexapod External Fixation Systems. Contraindications
11.1 Introduction
11.2 Complications
11.2.1 Intraoperative Complications
11.2.2 Postoperative Complications
11.3 Indications and Contraindications to the Use of Hexapod External Fixation
11.3.1 Indications
11.3.2 Contraindications
11.4 The Problem of Conversion
11.5 Discussion
11.6 Conclusion
References
Part III: Special Applications, Biological and Economical Aspects of Hexapod External Fixators
12: Ancillary Usage of Hexapod External Fixators
12.1 Consecutive Method
12.1.1 FAN and FALP (Fixator-Assisted Nailing and Fixator-Assisted Locking Plate)
12.1.1.1 Advantages and Disadvantages
12.1.1.2 Accuracy and Results of the Technique
12.1.1.3 Indications and Contraindications
12.1.1.4 Complications
12.1.1.5 FAN vs FALP
12.1.2 LATN (Lengthening And Then Nailing)
12.1.2.1 Indications and Contraindications
12.1.2.2 Surgical Technique [25]
12.2 Simultaneous Method
12.2.1 LON (Lengthening Over a Nail)
12.2.1.1 Indications and Contraindications
12.2.1.2 Surgical Technique [27, 28, 31]
12.2.1.3 Advantages and Disadvantages
12.2.1.4 Complications
12.2.2 BTON (Bone Transport Over a Nail)
12.2.2.1 Indications and Contraindications
12.2.2.2 Surgical Technique [23]
12.2.3 Comparison of Alternative Lengthening Techniques
12.3 Computer-Assisted Method, Hexapod Fixators, and Internal Fixation
12.3.1 General Aspects
12.3.2 CHAOS (Computer Hexapod-Assisted Orthopaedic Surgery)
12.3.3 CHATS (Computer Hexapod-Assisted Trauma Surgery)
References
13: External to Internal Fixation Conversion Timing: Infectivologist’s Perspectives
13.1 Introduction
13.2 Pin-Tract Infection
13.3 Conversion
13.4 Surgical Technique
13.5 Pin-Site Care
13.6 Bacterial Agents and Antibiotic Therapy
13.7 Conclusion
References
14: Ionizing Radiation Exposure
14.1 Ionizing Radiation
14.1.1 Charged Particles
14.1.2 Photons
14.1.3 Neutrons
14.2 Generation of Ionizing Radiation
14.3 Radiography and CT
14.3.1 Radiological Image Quality and Optimization
14.4 Biological Effects and Dosimetry
14.5 Radiation Exposure
14.5.1 Radiation Dose in Diagnostic Imaging
References
15: Economic Burden and Practical Considerations
15.1 Introduction
15.2 Economic Burden of the Management with Hexapod External Fixators
15.3 Discussion
References
Part IV: Principles of Deformity’s Geometry
16: Geometry of Deformities
16.1 Upper Limb
16.1.1 Anatomical and Mechanical Axis of the Upper Limb
16.1.2 Upper Limb Angles
16.1.2.1 Proximal Humeral Angle
16.1.2.2 Distal Humeral Angle
16.1.3 Forearm
16.2 Lower Limb
16.2.1 The Femoral Axes
16.2.2 Femoral Angles
16.2.2.1 Proximal Femur
16.2.2.2 Distal Femur
16.2.3 The Tibial Axes
16.2.4 The Tibial Angles
16.2.4.1 Proximal Tibia
16.2.4.2 Distal Tibia
16.2.5 MAD (Mechanical Axis Deviation)
16.2.6 CORA (Center of Rotation of Angulation)
16.2.7 ACA (Angulation Correction Axis)
16.3 Canal Flare Index
16.4 Insall–Salvati Ratio
References
Nomenclature
