| External fixation |
For the treatment of some fractures, their complications and other complex injuries of the musculoskeletal system, an alternative to classic procedures (casts, osteosynthesis - internal metal implants) is currently applied throughout the world, the so-called “external fixation” . Generally used percutaneously, without surgery. There are pathologies where the only option is external fixation .
External fixation is not new. It has been more than 100 years since its proposal. Until after the Second World War it was applied very sporadically. The lack of antibiotics, the little development of metallurgy in surgery, and the limited scientific knowledge, allowed the preponderance of skeptical surgeons.
Based on the experiences of a Russian and other Europeans, in 1970 (Baltimore, USA) the FAITH took an important leap. Practically, since this time, it has grown with the participation of large, transnational companies until the current moment with the sale of sophisticated and expensive devices (one for each fracture), and in others, very simple, cheap, not versatile and limited devices. application. Figure. 1
Currently there is a very wide variety of models, perhaps more than 100 between sophisticated and simple. In all countries, there are self-created models whose use does not go beyond the creative surgeon.
All external fixators consist of two main parts: ( 1 ) the nails that go through the bone (different diameters: 2, 3, 4, 5, 6, up to 6.5 millimeters, some are threaded), and ( 2 ) the external structure or external assembly, frame or external frame whose function is to support the nails and these in turn are the ones that support the fracture, but something else, the external structure must have the capacity to try to accommodate the displaced fracture by applying active compression forces and distraction , and passive forces for accommodation attempts (lengthening, correction of deformities). Some are simple and others with unique pieces to give it versatility (in rings, quadrilateral, unilateral, combinations, etc.). Each fixer has its software.
Health authorities require that nails must be made of an ad-hoc material compatible with bone biology (316 surgical steel, rigid, non-malleable, at least four to six are used per fracture). On the other hand, the external structure does not necessarily have to be compatible with bone biology, since it does not enter the organism. These fixators remain in the fracture area until the end of healing or until they are changed to another means of treatment. If the patient has three fractures, there will be three external fixators. The external structure can be reusable but the nails cannot (sanitary recommendation).
Having acted as president of the Scientific Committee of two world events on external fixators, I had to anonymously “evaluate” more than 100 papers from all over the world. After reading it I am much more motivated by this methodology.
| Disposable external fixation (EDF) |
The FED “disposable external fixation” serves exactly the same purpose as the external fixators described above. The first patient operated on was in June 1977. Now we calculate, combining the cases operated on by other colleagues, more than 5 thousand patients. Its use has not decreased, on the contrary it remains with a slight tendency to increase. It is not something extraordinary, it is just another alternative. By knowing how to apply yourself, your benefits outweigh your failures.
It is not a device. It is a system . It goes hand in hand with the most basic scientific principles of the healing phenomenon of fractures. Nails are used just like everyone else.
The difference with all other external fixators is in the “external structure”. For the application of active and passive forces (accommodation attempts or application of compression-distraction) we use a “tracto-compressor” (TC) instrument, of our own design (patented 20 years ago). Not all fractures require it. After achieving these objectives, in the operative act, the “tracto-compressor” instrument is replaced by the “disposable set” that corresponds to the “external structure”, with which the patient remains until the end of the healing and then is discarded.
The tract-compressor can be used many times a day, a week or a month, for several patients, depending on the case. This instrument, theoretically, should be provided by the hospital or clinic as part of its surgical equipment. Its durability is relative. The ones we have are locally handcrafted.
The “disposable set” consists of the nails (previously mentioned), it also has two to four duralumin rods, of our own design, and two doses of quick-setting acrylic cement (used in dentistry, it is very cheap). The cost of the set depends on the number of nails, their diameter, and the length of the rods; It depends on the specific case. The duralumin rods are also manufactured by hand. The disposable set is the input and is what the patient buys, that is, they do not pay for the compressor tract instrument . Its cost can be equivalent to 10% of a hexapod. This is why we operate a lot and have gained experience. Figure 2
The FED system also has its software (book published 25 years ago, with support from CONCYTEC intellectual property: ISBN Nº 9972 697 00 2) and, we are currently about to launch a new graphic compendium type book of all our experience. The FED is used only in Peru. It requires a learning curve and requires other small auxiliary instruments. We currently have a team of already expert surgeons. Like all techniques, it has its tricks.
If it works and serves in Peru, I think that, for a good part of patients, particularly in the undeveloped world, it should also serve, especially in a social economic dimension.
