Unilateral 3D external fixation in SERBIAN traumatology and orthopaedics

Abstract

To the Editor, External fixation with the help of an apparatus— the external fixator is a surgical method that holds an important place in modern orthopaedics and traumatology. There are numerous diseases and fractures of the locomotor apparatus which can successfully be treated using this method. External fixation can be applied alone or combined with minimally invasive osteosynthesis in numerous conditions in traumatology, especially in intraarticular fractures. Although it may have been criticised and questioned by numerous authors, external fixation holds its place in modern orthopaedics and traumatology. There are numerous conditions in everyday practice in which the external fixation is successfully applied not only as a temporary, but also as a definitive method of treatment. In the Republic of Serbia, the Mitkovic unilateral 3D external fixation system has been used in over 30,000 cases. In the city of Nis, external fixation was first applied in 1981, and the first original external fixator according to Mitkovic was applied in 1983. Since then, external fixators are used in everyday practice in Nis as well as in almost all orthopaedic institutions in Serbia. We have successfully applied external fixators on all segments of the locomotor apparatus, usually as a definitive onestage method without subsequent conversion into internal fixation or rarely as a part of the staging protocol. The indication field of applicability of this method is wide. External fixation method was mostly used for the treatment of open and closed tibial fractures at all levels, in open femoral fractures as a part of the staging protocol and in fractures of the upper limbs. We used external fixation for the treatment of nonunions, malunions, in the treatment of osteitis, septic pseudoarthrosis, angular knee deformities, posttraumatic deformities, for limb lengthening and in replantation surgery (Figure 1). This method has also been used to treat various complications after internal fixation methods. The unilateral external fixator enables 3D biomechanical stability and is suitable for use in everyday traumatology and orthopaedics practice.110 We live in a time when bone and joint trauma is on the rise. Today s injuries are not as they used to be, isolated, simple. Injuries are often multiple or are an integral part of polytrauma. The modern way of life also contributes the increase of mass injuries, which can occur as a consequence of natural disasters, wars or major traffic accidents in transport and can be severe and lifethreatening. In the last ten years, we have witnessed great progress in orthopaedics and traumatology, which is reflected in new surgical, minimally invasive methods of treatment and new implants. Although external fixation is not a new method, its significance and applicability in the world is evident. External fixation is successfully used in acuteisolated trauma, multiple trauma or polytrauma, whether it is used for temporary or definitive fixation of bone tissue. The suitability of this system is its simplicity in handling, ease of application, possibility of latter corrections, dictation of biomechanical conditions for fracture healing, possibility of minimally invasive surgery and additional surgical procedures.