Indications for Fine Wire Frame Fixation
(Ilizarov, TSF)
"Trampolining" effect of a loaded beam.
If anywhere else, Fine Wire Frame Fixation does not have absolute and relative indications, neither does it have absolute and relative contra-indications. In my understanding this is relatively unique in surgical if not the whole medical sphere. Why not?
In my understanding Fine Wire Frame Fixation method is the method which can be used when everything else fails. And the reason for it is the contact area between bone and foreign material. Contact area between metal/bone is the smallest comparing to any other type of fixation enabling easier defence against bacterial infection (bacteria like to adhere to any foreign material). Weight-bearing on injured leg (broken bone) stimulates muscle activities hence is improving blood supply to the area. Increased blood supply can be correlated to the faster and better healing.
Why can patients weight-bear on Fine Wire Frame Fixation but not on a plate or nail type of fixation?
Certain types of fracture (transverse) and fixations (Poller screws) will allow patients to walk straight away putting the whole body weight through the fixed limb. When other types of fracture fixations (oblique, comminuted, spiral) will not be suitable for early weight bearing due to the possibility of early metalwork failure, which can easily end in either "bent" limb of broken metalwork and bone. Any unnecessary/additional procedures on any bone just increase infection risk.
Due to the trampolining effect in Fine Wire Frame Fixation patients can walk, run, exercise without any significant risk of early metalwork failure. The worst thing which can happen is a broken wire. And as a rule, one broken wire gets replaced by two wires. Patients with Fine Wire Frame Fixation are advised from the beginning to use the limb as much as possible to speed up the recovery and minimise the risk of complications.
If all above is true, why don't we use only Fine Wire Frame Fixation for all fractures?
Fixations with plates, screws or nails result in fixation devices buried underneath the skin with no part of them visible through the skin. In vast majority of cases discomfort patients are getting as a result of them early post fixation but also on a long term is minimal, providing that fracture union proceeds according to the plan. As a surgeon you can fix it and forget about it. Complication level is low and no additional care/management is necessary, except physiotherapy, which is required in all cases.
Fine Wire Frame Fixation is just the opposite. Almost everything is above the skin level. There are multiple pin sites with different amount of oozing, discharging fluid. The components are hitting the other leg whilst walking and wires are cutting through the muscles and skin on each move. More on upper than on lower leg. But patients can walk and risk of infection is significantly lower.
My rule is simple. If I can fix a fracture using plate and screws or a nail without increasing the risk of infection, delayed union or non-union and if the fracture configuration allows it, my first choice is always internal fixation with minimal discomfort for the patient. If I can't then will use Fine Wire Frame Fixation. In my hands this is almost always used for complex open fractures with bone and soft tissue defects, infections and non-unions which are very slow to heal.
In my understanding Fine Wire Frame Fixation method is the method which can be used when everything else fails. And the reason for it is the contact area between bone and foreign material. Contact area between metal/bone is the smallest comparing to any other type of fixation enabling easier defence against bacterial infection (bacteria like to adhere to any foreign material). Weight-bearing on injured leg (broken bone) stimulates muscle activities hence is improving blood supply to the area. Increased blood supply can be correlated to the faster and better healing.
Why can patients weight-bear on Fine Wire Frame Fixation but not on a plate or nail type of fixation?
Certain types of fracture (transverse) and fixations (Poller screws) will allow patients to walk straight away putting the whole body weight through the fixed limb. When other types of fracture fixations (oblique, comminuted, spiral) will not be suitable for early weight bearing due to the possibility of early metalwork failure, which can easily end in either "bent" limb of broken metalwork and bone. Any unnecessary/additional procedures on any bone just increase infection risk.
Due to the trampolining effect in Fine Wire Frame Fixation patients can walk, run, exercise without any significant risk of early metalwork failure. The worst thing which can happen is a broken wire. And as a rule, one broken wire gets replaced by two wires. Patients with Fine Wire Frame Fixation are advised from the beginning to use the limb as much as possible to speed up the recovery and minimise the risk of complications.
If all above is true, why don't we use only Fine Wire Frame Fixation for all fractures?
Fixations with plates, screws or nails result in fixation devices buried underneath the skin with no part of them visible through the skin. In vast majority of cases discomfort patients are getting as a result of them early post fixation but also on a long term is minimal, providing that fracture union proceeds according to the plan. As a surgeon you can fix it and forget about it. Complication level is low and no additional care/management is necessary, except physiotherapy, which is required in all cases.
Fine Wire Frame Fixation is just the opposite. Almost everything is above the skin level. There are multiple pin sites with different amount of oozing, discharging fluid. The components are hitting the other leg whilst walking and wires are cutting through the muscles and skin on each move. More on upper than on lower leg. But patients can walk and risk of infection is significantly lower.
My rule is simple. If I can fix a fracture using plate and screws or a nail without increasing the risk of infection, delayed union or non-union and if the fracture configuration allows it, my first choice is always internal fixation with minimal discomfort for the patient. If I can't then will use Fine Wire Frame Fixation. In my hands this is almost always used for complex open fractures with bone and soft tissue defects, infections and non-unions which are very slow to heal.
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Indications for Fine Wire Frame Fixation
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Contra-indications for Fine Wire Frame Fixation
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