Fracture Treatment
Application of non-invasive treatment
CAMBfix non-invasive fixator system addresses the problems with current fracture treatment modalities. The following table gives an overview of the commonly accepted problems and their solution with the CAMBfix system.
Current Methods of Tracture Treatment
|
Plaster of Paris (POP) / Fibreglass cast (± Kirchner-wires) |
Conventional External Fixators |
Open reduction & Plate osteosynthesis (± plaster) |
CAMBfix |
| Early joint movement |
– |
± |
+ |
+ |
| Radiolucent |
– |
± |
– |
+ |
| Cost effective |
+ |
– |
– |
+ |
| Water proof |
– |
– |
– |
+ |
| Surgeon friendly |
– |
– |
– |
+++ |
| Military field use |
– |
+ |
– |
+ |
| Outpatient treatment |
+ |
– |
– |
++ |
| Non-invasive |
+ |
– |
– |
+ |
| Skin access (cryotherapy) |
– |
+ |
+ (not if plaster) |
+ |
| Stiffness |
+ |
++ |
+ |
– |
| Infection |
+ (if K-wires) |
++ |
+ |
– |
| Drilling of bone |
+(if K-wires) |
++ |
++ |
– |
| Prolonged rehabilitation |
++ |
++ |
+ |
– |
| Op theatre visit |
+ |
++ |
+ |
– |
| Loss of fracture position |
++ |
+ |
– |
– |
| Further surgery |
± |
++ |
± |
– |
| Reduction of sterilisation |
+ |
– |
– |
+ |
| Reduced patient morbidity |
– |
– |
– |
+ |
Wrist (Distal radius) and ankle fractures are amongst the most common upper and lower limb fractures. It is estimated that 1.5 million wrist and ankle fractures occur annually in the US and Europe (of these 900,000 are wrist fractures). The treatments currently available vary depend on multiple factors. There are, however, inherent problems with each treatment. The aim of fracture treatment is to achieve anatomical reduction of fracture, maintenance of fracture reduction until bony union and to achieve a good functional result. Outlined below are the various treatment options currently used and the problems inherent with each.
Simple non-invasive adustments
Non-operative Treatment
Plaster of Paris (POP) cast
This is commonly employed in undisplaced fractures or where patients’ general health precludes operative intervention. It is non-invasive and cheap. However it is associated with significant problems including joint stiffness which necessitates prolonged rehabilitation and physiotherapy needs in a large proportion of cases. In acute fractures a POP cast can compromise the blood supply to the limb and can lead to ‘compartment syndrome’. In addition, fracture position can be compromised. Present day casts cannot be used in water, are bulky, warm and generally not liked by patients.
Braces/ Fibreglass cast
Fibreglass cast and Braces are used for fracture and soft tissue injuries (sprains) respectively. They are considerably more expensive than POP cast and their use in fracture treatment is limited because they do not aid fracture reduction. Hence the available braces have the same problems as outlined above with POP cast and in addition rigidity is also compromised.
Operative Treatment
Manipulation and Kirchner-wire (K-wire) fixation combined with POP
This is used in displaced fractures, which are reduced under anaesthesia and held in place with a number of temporary wires going through the skin to the bone fragments (usually two K-wires). The wrist is then immobilised in a POP cast. It has all the disadvantages of the POP cast and in addition involves an operation, invasive wire fixation and is expensive due to theatre time use. The wires have high infection rates which increase patient morbidity and treatment costs. Socially they are even less acceptable than plaster cast alone. It also necessitates removal of wires at a later date thereby increasing treatment cost and patient inconvenience further.
External fixators (Invasive)
External fixators have been used for a long time in fracture fixation. It involves an operation where pins are drilled into the bone proximal to the fracture site (usually 2-3 pins) and also in the bone distal to it (another 2 – 3 pins). It provides fracture immobilisation by distraction and ligamentotaxis. It can be used in a bridging, non-bridging or dynamic mode. Its use has been plagued with a high number of complications. These include infection, stiffness across joint, need for an operation, bony infection and ring sequestrum, costly apparatus, operative theatre time and need for subsequent procedure to remove the external fixator.
Open reduction and Internal fixation
This involves an operation, exploration of the fracture site, direct reduction of the fracture and application of an implant such as a ‘plating device’ to keep the fracture immobilised. The advantage is accuracy of reduction, however, it involves opening the fracture site. It has complications of infection, neurovascular damage, possible subsequent removal of metal work, stiffness, scarring and a possible need for a period of immobilisation in a POP cast.
Intramedullary nailing (IM nailing)
This technique is suitable for long bones (e.g. Tibia and Femur). It involves passing a metal rod through the intra-medullary canal across the fracture site. This approach has its use in long bone fractures, however, it has limited or no role in peri-articular distal radius and ankle fractures.
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