What are the latest fixation techniques in orthopedics?

Latest Fixation Techniques in Orthopedics

The most significant advancement in orthopedic fixation is the combined use of external fixation (Ilizarov method) with intramedullary fixation, which achieves 84% primary union rates and reduces refracture rates to 22.3%, representing the optimal balance between stability and complication prevention. 1

Combined External and Intramedullary Fixation

This technique achieved 84% consensus agreement among orthopedic specialists as the preferred method for preventing refractures and axial deformities. 1

Key Performance Metrics

• Primary union rate: 84% with final union reaching 93.3% 1
• Refracture rate: 22.3%, significantly lower than single-modality approaches 1
• Non-union rate: 6%, substantially better than isolated techniques 1
• Mean union time: 5.3 months, faster than most alternatives 1

Clinical Advantages

• External fixation provides excellent alignment control and high fusion rates 1
• Intramedullary stabilization effectively prevents refractures, reducing rates by over 50% compared to external fixation alone 1
• Allows simultaneous correction of angular deformities and limb length discrepancies exceeding 5 cm 1
• Particularly effective for complex or recurrent cases requiring both axial alignment correction and long-term stabilization 1

Cross-Union Technique: The Newest Innovation

The cross-union technique represents the latest alternative in orthopedic fixation, achieving 100% primary union rates with no non-union cases reported. 1

Performance Data

• 100% primary union rate across all cases 1
• Mean union time: 4.5 months, the fastest among all techniques 1
• Refracture rate: 22.5%, though this comes from a single study with 18 cases 1
• Four other cross-union studies with 4.2-year follow-up reported zero refractures 1

Clinical Application

• Focuses on tibiofibular fusion to increase mechanical stability 1
• Achieved 26% consensus agreement with 68% neutral opinion, indicating emerging acceptance 1
• When combined with locking compression plates (LCP) and Fassier-Duval rods (FDR), achieved 100% union with zero refractures 1

Telescopic Intramedullary Nails (Fassier-Duval Rods)

Fassier-Duval rods improved primary union rates to 85.7% with zero reported refractures, though consensus remains divided (53% disagreement for use alone). 1

Key Features

• Can be lengthened without additional surgical intervention 1
• Provides stability equivalent to standard intramedullary nails 1
• Best used in combination with external fixation rather than as standalone fixation 1
• Mean follow-up of 4.2 years demonstrates sustained benefits 1

Locking Compression Plates (LCP)

LCP fixation achieved 84% primary union and 96% final union rates with only 16% refracture rates. 1

Performance Characteristics

• Mean union time: 4.9 months 1
• Non-union rate: 4%, among the lowest reported 1
• Success probability: 70.6% (primary union × [1-refracture rate]) 1
• Received 74% neutral consensus, with 21% agreement for standalone use 1

Optimal Application

• Most effective when combined with FDR using cross-union technique 1
• This combination achieved 100% union with zero refractures and 3-month mean union time 1

Techniques to Avoid as Standalone Methods

Intramedullary Rods Alone

74% of specialists disagreed with using intramedullary rods (IMR) alone, citing high complication rates. 1

• Primary union rate: only 67.7% 1
• Refracture rate: 48.1%, unacceptably high 1
• Non-union rate: 17% 1
• Mean union time: 12.6 months, significantly prolonged 1
• Success probability: 34.3%, the lowest among all techniques 1

Rush Rods (Fixed Nails)

74% consensus disagreement for standalone use, showing no improvement over standard IMR. 1

Timing Considerations for Pelvic Trauma

Early fixation within 24 hours of admission in stable or borderline resuscitated patients reduces complications and improves outcomes. 1

• Damage control orthopedics with external fixation allows almost all patients, including those with closed head injuries, to receive at least external stabilization 1
• Multidisciplinary approach with dedicated pelvic orthopedic surgeons significantly improves (p=0.004) the number of patients receiving definitive unstable pelvic fracture repair 1

Adjunctive Therapies: Limited Evidence

89% of specialists disagreed with using recombinant human BMPs (rhBMP-2 and rhBMP-7) due to insufficient evidence for promoting bone healing. 1

• Bisphosphonates received 84% neutral consensus, indicating unclear benefit 1
• Electric/electromagnetic stimulation: 74% neutral consensus 1
• Low-intensity pulsed ultrasound: 63% neutral consensus with 21% no opinion 1
• These adjuvants are complementary to primary surgical procedures, not substitutes 1

Critical Pitfalls to Avoid

• Never use IMR alone when combined techniques are available—refracture rates approach 50% 1
• Avoid vascularized fibular grafts as first-line treatment—45% refracture rate and technically challenging with donor site morbidity 1
• Do not delay fixation in hemodynamically stable patients—early intervention within 24 hours improves outcomes 1
• Ilizarov method alone shows 42.2% refracture rates despite 86.5% primary union, requiring supplementation with intramedullary fixation 1

Specific Anatomical Applications

Small Bone Fractures (Fifth Digit PIP Joint)

• Buddy taping with adjacent digit provides stability while allowing early active motion for stable volar fractures 2
• Dorsal night splinting in 10° flexion maintains alignment 2
• Early active motion immediately following diagnosis prevents joint stiffness 2

Radial and Ulnar Diaphyseal Fractures

• Volar plates provide earlier functional recovery at 3 months compared to other fixation techniques for volar-ulnar corner fractures 3
• Anatomical plate placement requires adequate preoperative imaging with three projections 3