Past, present and future. New techniques, latest advances in traumatology

The possibility of manipulating and immobilizing fractured limbs from outside the body has been known to mankind for a long time. The oldest documented cases correspond to the discovery made in 1903, in the excavations carried out by Professor G. Elliott Smith in the archaeological site of Naga-ed-Der, located to the north of the city of Luxor and correspond to splints for immobilization of extremities.

In the Corpus Hipocraticum of Hippocrates of Cos (460-377 B.C.) reference is made to more elaborate systems of external fixation that made it possible to immobilize fractures. The current concept of external fixation was coined in the second half of the 19th century, after the appearance of anesthesia and before the discovery of antibiotics. At that time, military surgeons were the most documented on the subject.

External fixation should be considered as the immobilization of the various fragments of a fracture by inserting nails through the soft tissues in each of them and in turn joined the nails together by some external fastening system, plaster, mechanical device, etc… …The first designs did not invade the bone, they only relied on the musculotendinous insertions, but progressively became more invasive until today, when the skeletal fixation elements (nails and wires) go through or are screwed directly to the bone.

The concepts of rigidity in external fixation gave way to concepts biologically closer to the natural process of fracture healing, neutralizing the harmful forces and modulating those that favor the healing process. Professor Juan Lazo Zibikowski (Seville) in this sense collaborated, among others, in the elaboration of the current concepts of bone repair.

External fixation is essential in the treatment of severe open fractures of the extremities, also as a means of initial immobilization of fractures close to the joints whose soft parts can evolve badly, compromising internal immobilizations with plates or endomedullary nails, once the correct evolution of these soft parts is confirmed, the external fixation can be changed for an internal one, All this in the so-called “sequential treatment of fractures”, its use is also of vital importance in the initial care of polytraumatic patients, in the “damage control” rapid skeletal stabilization to prioritize on life-threatening injuries of the patient, essential in the stabilization of bones affected by bone infections. It is a common tool for limb lengthening.

Currently, for a few years it has been a powerful tool for its possibility of bone regeneration and reconstruction of the skeletal system, through the so-called “distraction osteogenesis”, the technique consists of surgically performing a fracture and once the process of repairing the fracture has begun, stretching the repairing callus progressively (similar to bone lengthening) at a rate of 1 mm per day, which results in the spontaneous creation of a new bone that has exceptional morphological and physiological characteristics.

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The new bone formed, the “bone regenerated” presents added values of great value in the therapeutic procedures in which it is used, reconstruction of large traumatic diaphyseal bone defects or due to bone resection techniques of tumor type used in the treatment of chronic bone infections, absence of consolidation of fractures or bone tumors.
The bone regenerated and all the bone submitted to the treatment presents a hypervascularization, this is of great value since it increases the defensive mechanisms of the bone against infections and allows a better arrival of the antibiotics.
The new reconstructed bone, unlike the reconstructions carried out by other methods, presents a tubular morphology like that of normal diaphyseal bone, from the biomechanical point of view this form is the lightest and most resistant, it is the best.
The method allows the correction of the associated bone deformations, shortening and angular and rotational deformations.

In the process of bone transportation to obtain the new bone, the soft parts related to the transported fragment also participate, which contributes to the solution of the loss of these soft parts at the moment of the traumatism.
It is an excellent method of reconstruction, superior to the conventional ones, but like the latter, it requires long healing periods, since 2.4 months of treatment are necessary for each centimeter reconstructed until the final discharge with the problem solved.
That is why all efforts at present and in the immediate future will be aimed at reducing healing times, adding internal stabilization to the bones being treated or associating new biological products and drugs that accelerate the formation of new bone.
These methods are currently used in reconstructive surgery of the Locomotor System, distraction osteogenesis allows to solve many osteoarticular pathologies and helps to solve problems that arise during the surgical medical treatment of our patients, all through the “bone transport” based on distraction osteogenesis.

SEFEx’s goal is to disseminate, teach and apply these techniques. The use of our external fixators allows us to practice a grateful osteoarticular reconstruction surgery.