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The wooden external fixator
Domres et al.: The wooden external fixator
67
Ideas and innovations
The wooden external fixator B. Dosmres, P. Diirner and Th. K&s Chirurgische
Universitatsklinik,
Tubingen,
Hoppe-Seyler-Str.
7400 Tubingen,
Germany
Lambotte developed the external fixator in 1907. We use it today for the following indications: Open fractures. Infected fractures. Arthrodesis. Unstable fractures of the pelvis. Holding the legs in appropriate position during a cross leg flap. 6. Leg lengthening. 7. Fracture treatment when internal fixation would be impracticable or dangerous, as in developing countries in major disasters or wars when sterile conditions cannot be ensured. 1. 2. 3. 4. 5.
It is in just these situations where external fixation is of paramount importance, that the appliances are not- available for financial or logistical reasons. This was my regular experience when engaged in surgery in Nigeria, in Algeria during the earthquake disaster of 1980, in Lebanon during the war of 1982, in Cambodia in 1980 and 1983 and finally in Afghanistan in 1984. In 1983, while working in a Red Cross field hospital I started on the construction and application of external fixators made of wood. In between the wooden fixator was used in hospitals of the following countries: Nigeria, Tanzania, Saudi Arabia, Bangladesh, Afghanistan, India, Thailand.
Design and construction of wooden fixators Cylindrical rods of 1.5 and 2.0 cm diameter and of a series of lengths were made out of wood of the rubber tree (ficus elastica), using a saw, plane and chisel. To accommodate the Steinmann pins, two holes were drilled proximally and distally, 4.0 cm apart. The rods were sterilized and placed in plastic bags.
Application of the wooden fixator These fixators were used satisfactorily in the first series of 46 open fractures including one of the mandible, six of the femur and 39 of the tibia. Of these, 21 were treated primarily with a metal fixator and the metal rods were replaced after 2 days with the wooden fixators, so that the metal sets could be used again. The patients with the wooden fixator could be discharged as soon as they could walk. The holes for the Steinmann pins were drilled in the bone with a gimlet. Kirschner wires are adequate for first-aid use. The different functions of an orthodox fixator comprising stabilization, compression or distraction, can also be ‘c 1992 Butterworth-Heinemann 0020-1383/92/010067-02
Ltd
Figure 1. a, Injured Khmer treated with a fixateur exteme in field hospital Khao I Dang (1983). b, Change from metal fixator to wooden hator. c, Wooden frame fixator for care of a pseudarthrosis on the lower leg. d, Wooden clamp fixator for fixation of an infected thigh-shot-fracture. e, Simple assembly of wooden fixator on lower leg. f, The radiolucency of the wooden Axator permits a good radiograph.
Injury:
68
achieved with the wooden device if properly applied. When compression is needed, the drill holes in the bone are made 0.5 cm further apart than those in the wooden rods. Compression was needed, for example to treat a pseudarthrosis following a gunshot wound, when 3 months in a plaster cast had failed. Union was eventually secured by the wooden fixator, shown in position in Figure l(3). The fixator can be used to assemble frames for providing an addition in the immobilization of a femur or for spanning a knee joint.
Associated operations Supplementary procedures were needed for 46 patients, of whom 21 had been treated primarily for 48 h with metal fixators. The operations included 46 wound excisions, 14 skin grafts, 3 cancellous bone autografts, 4 sequestrectomies, 8 corrections of alignment and 4 vascular operations, one of which involved insertion of a prosthesis to deal with a femoral arteriovenous fistula.
Complications One wounded man with multiple injuries died from blast lesions. One case needed a below-knee amputation for vascular reasons. Osteitis occurred in 5 of 46 cases (11%). One destroyed ankle joint was treated by arthrodesis.
the British Journal of Accident Surgery (1992) Vol. 23/No.
1
2. Making good radiographs in two projections as wood is radiolucent. 3. The ready availability of wood and the ease of fabrication. 4. Its cheapness, being only 2-4 per cent of the cost of the metal fixator. 5. The shorter time spent in hospital. There is one important disadvantage. It can only be a trouble-free method in the hands of an experienced surgeon. The rigidity obtainable is certainly not as good as that with a metal fixator and adjustments of position usually involve a full reapplication.
Acknowledgement With thanks to Dr A. Hagelmayer
Bibliography Heuwinkel R., Klammer H.-L., Kloss H. P. et al. (1982) Der Fixateur exteme als alternatives Transport-Fixation-System auf dem Hauptverbandsplatz. Wehmzed.Mschr. 3,66. Lambotte A. (1907) L’inlervention opt+ufoire Lrzs les fracfwes. Edit. Lamertin, Bruxelles, 1907. Wedel K.-W. (1980) Bedeutung
Katastrophenchimrgie.
des Fixateur
exteme
fi.ir die
Wehmed. A&&. 11, 342.
Paper accepted 17 May 1991.
Advantages of the wooden fixator The advantages
of the wooden
fixator are:
1. The short time needed for its application.
ReqMesfs for reprints should be a&dressed fo: Prof. Dr med B. Domres, Chirurgische Universitatsklinik, Tubingen, Hoppe-Seyler-Str. 7400 Tubingen, Germany.
67
Ideas and innovations
The wooden external fixator B. Dosmres, P. Diirner and Th. K&s Chirurgische
Universitatsklinik,
Tubingen,
Hoppe-Seyler-Str.
7400 Tubingen,
Germany
Lambotte developed the external fixator in 1907. We use it today for the following indications: Open fractures. Infected fractures. Arthrodesis. Unstable fractures of the pelvis. Holding the legs in appropriate position during a cross leg flap. 6. Leg lengthening. 7. Fracture treatment when internal fixation would be impracticable or dangerous, as in developing countries in major disasters or wars when sterile conditions cannot be ensured. 1. 2. 3. 4. 5.
It is in just these situations where external fixation is of paramount importance, that the appliances are not- available for financial or logistical reasons. This was my regular experience when engaged in surgery in Nigeria, in Algeria during the earthquake disaster of 1980, in Lebanon during the war of 1982, in Cambodia in 1980 and 1983 and finally in Afghanistan in 1984. In 1983, while working in a Red Cross field hospital I started on the construction and application of external fixators made of wood. In between the wooden fixator was used in hospitals of the following countries: Nigeria, Tanzania, Saudi Arabia, Bangladesh, Afghanistan, India, Thailand.
Design and construction of wooden fixators Cylindrical rods of 1.5 and 2.0 cm diameter and of a series of lengths were made out of wood of the rubber tree (ficus elastica), using a saw, plane and chisel. To accommodate the Steinmann pins, two holes were drilled proximally and distally, 4.0 cm apart. The rods were sterilized and placed in plastic bags.
Application of the wooden fixator These fixators were used satisfactorily in the first series of 46 open fractures including one of the mandible, six of the femur and 39 of the tibia. Of these, 21 were treated primarily with a metal fixator and the metal rods were replaced after 2 days with the wooden fixators, so that the metal sets could be used again. The patients with the wooden fixator could be discharged as soon as they could walk. The holes for the Steinmann pins were drilled in the bone with a gimlet. Kirschner wires are adequate for first-aid use. The different functions of an orthodox fixator comprising stabilization, compression or distraction, can also be ‘c 1992 Butterworth-Heinemann 0020-1383/92/010067-02
Ltd
Figure 1. a, Injured Khmer treated with a fixateur exteme in field hospital Khao I Dang (1983). b, Change from metal fixator to wooden hator. c, Wooden frame fixator for care of a pseudarthrosis on the lower leg. d, Wooden clamp fixator for fixation of an infected thigh-shot-fracture. e, Simple assembly of wooden fixator on lower leg. f, The radiolucency of the wooden Axator permits a good radiograph.
Injury:
68
achieved with the wooden device if properly applied. When compression is needed, the drill holes in the bone are made 0.5 cm further apart than those in the wooden rods. Compression was needed, for example to treat a pseudarthrosis following a gunshot wound, when 3 months in a plaster cast had failed. Union was eventually secured by the wooden fixator, shown in position in Figure l(3). The fixator can be used to assemble frames for providing an addition in the immobilization of a femur or for spanning a knee joint.
Associated operations Supplementary procedures were needed for 46 patients, of whom 21 had been treated primarily for 48 h with metal fixators. The operations included 46 wound excisions, 14 skin grafts, 3 cancellous bone autografts, 4 sequestrectomies, 8 corrections of alignment and 4 vascular operations, one of which involved insertion of a prosthesis to deal with a femoral arteriovenous fistula.
Complications One wounded man with multiple injuries died from blast lesions. One case needed a below-knee amputation for vascular reasons. Osteitis occurred in 5 of 46 cases (11%). One destroyed ankle joint was treated by arthrodesis.
the British Journal of Accident Surgery (1992) Vol. 23/No.
1
2. Making good radiographs in two projections as wood is radiolucent. 3. The ready availability of wood and the ease of fabrication. 4. Its cheapness, being only 2-4 per cent of the cost of the metal fixator. 5. The shorter time spent in hospital. There is one important disadvantage. It can only be a trouble-free method in the hands of an experienced surgeon. The rigidity obtainable is certainly not as good as that with a metal fixator and adjustments of position usually involve a full reapplication.
Acknowledgement With thanks to Dr A. Hagelmayer
Bibliography Heuwinkel R., Klammer H.-L., Kloss H. P. et al. (1982) Der Fixateur exteme als alternatives Transport-Fixation-System auf dem Hauptverbandsplatz. Wehmzed.Mschr. 3,66. Lambotte A. (1907) L’inlervention opt+ufoire Lrzs les fracfwes. Edit. Lamertin, Bruxelles, 1907. Wedel K.-W. (1980) Bedeutung
Katastrophenchimrgie.
des Fixateur
exteme
fi.ir die
Wehmed. A&&. 11, 342.
Paper accepted 17 May 1991.
Advantages of the wooden fixator The advantages
of the wooden
fixator are:
1. The short time needed for its application.
ReqMesfs for reprints should be a&dressed fo: Prof. Dr med B. Domres, Chirurgische Universitatsklinik, Tubingen, Hoppe-Seyler-Str. 7400 Tubingen, Germany.