Fracture treatment with circular external fixation

Circular external skeletal fixation (CEF) was used in rudimentary forms as early as 400 Be by the Creek Hippocrates.(34) Modem CEF was introduced by the Russian Gavriil Abramovitch Ilizarov in 1951.(39) Initially, the frames were limited to rings, connecting rods, and cross-wires transfixing bones. Later on, olive wires, posts, hinges, and washers were introduced and allowed surgeons to apply the frames in closed fashion and to adjust bone fragments after frame application. Over a 40-year period, Ilizarov and his colleagues performed a monumental feat in Kurgan, Siberia by transforming a "log cabin" into an 800-bed orthopedic hospital staffed with 350 orthopedic surgeons. Ilizarov is credited with 2000 publications as an author or coauthor.(16) CEF has been used to treat several hundred thousand people in the former Eastern Block countries. The Ilizarov method arrived in the West in the early 1980s and was first used to treat clinical problems of dogs and cats in 1984 by Dr. Antonio Ferretti in Milan, Italy.(5 12) The Ilizarov method has been used on a limited basis over the years by veterinary orthopedic surgeons in Western Europe, North America, and South America. Clinical reports have been published in dogs,(9-11, 13, 21-25. 28. 29, 35, 40, 41) cats,(11) horses,(11,19) cattle,(11) goats,(11) and a llama.(37) Today, veterinarians use CEF to treat acute and chronic fractures and deformities, to stabilize joints while maintaining range of motion, and to perform arthrodeses and limb sparing. The Ilizarov method has created interest in the area of small animal orthopedics because of some limitations of conventional surgical methods. Internal fixation with pins and cerclage has the drawback of providing insufficient stability for treatment of comminuted fractures. Internal plate fixation requires an extensive surgical approach, can only be performed on relatively long bone segments, and lacks postoperative adjustability. Linear external skeletal fixation systems also have limited postoperative adjustability. CEF has several significant advantages over these conventional methods, including the facts that (1) it has excellent mechanical properties (high stiffness when submitted to shear and bending forces and relatively low stiffness when submitted to axial loads), (2) short bone segments (10-15 mm long) can be used for stable fixation with cross-wires and half-pins, and (3) the frames are fully adjustable after bone fixation, allowing acute or progressive translation, rotation, or angulation of bone segments.(27)