Publication: Biomecánica y efectividad clínica del fijador externo articulado dinámico de tracción TRAD FIX® en la fractura distal del radio
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2019-02-18
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Universidad Complutense de Madrid
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Abstract
Frecuentemente las fracturas distales del radio presentan lesiones asociadas o tal grado de fragmentación, que no permiten aplicación de tornillos y/o placas de osteosíntesis, ni la disección necesaria para su colocación. En estos casos en particular, los fijadores externos juegan un papel importante, no solo para conseguir la reducción inicial de la fractura, sino también para mantenerla y disminuir las consecuencias derivadas de la misma. El tratamiento moderno de la fractura distal del radio con uso de fijador externo consiste en realizar, bajo visión guiada por fluoroscopio, la adecuada reducción y fijación de los fragmentos óseos utilizando agujas de Kirschner y, posteriormente, aplicar el fijador externo como neutralizador de fuerzas de tensión a través de la articulación de la muñeca. Para evitar las complicaciones derivadas de la inmovilización, es importante, de forma precoz, poder mover la articulación de la muñeca durante el período de consolidación de la fractura y proveer estabilidad y tensión (ligamentotaxia) fisiológica y constante durante los diferentes rangos y planos de movimiento articular. Un principio fundamental de los fijadores externos es que sean dispositivos ergonométricos, es decir, que sean productos cuya construcción esté en consonancia con las características, necesidades y limitaciones funcionales humanas. Obviar este principio, puede producir lesiones importantes que afecten de manera permanente el hueso o la articulación correspondiente. En razón a ello, hemos desarrollado un nuevo dispositivo de fijación externa, especialmente adaptado para neutralizar el conflicto mecánico entre los diferentes componentes del fijador externo y su efecto en la dinámica del carpo durante el movimiento articular que resulta en una terapéutica biomecánica funcionalmente adecuada. Actualmente, a pesar de existir estudios biomecánicos sobre la dinámica del carpo, no se conoce a profundidad qué sucede con los aspectos biomecánicos en relación con los dispositivos de fijación externa dinámicos comercialmente existentes y tampoco con este nuevo sistema de fijador externo, por lo tanto, es necesario estudiarlo para poder aportar información sobre el tema. OBJETIVO: Este estudio tuvo como objetivo desarrollar un nuevo fijador externo dinámico (Trad Fix®), así como, evaluar sus aspectos biomecánicos y su efectividad clínica en el tratamiento de la fractura distal del radio...
Frequently, distal radius fractures of the radius (DRF) have presented associated lesions or such degree of fragmentation that they do not allow the application of screws and/or osteosynthesis plates, nor the dissection necessary for their placement. In these particular cases, the external fixators play an essential role not only to achieve the initial reduction of the fracture but also to maintain it and reduce the consequences derived from the same. The modern treatment of distal radius fractures with the use of an external fixator consists in performing, under the guided fluoroscopic vision, an adequate reduction and fixation of the fragments using Kirschner wires; and subsequently, applying the external fixator as a neutralizer of tension forces through the carpal radio joint. In order to avoid the complications that depend on the immobilization of the joint, it is desirable to be able to move the wrist early during the period of fracture consolidation and provide stability and constant and physiological tension (ligamentotaxis) during the different ranges and planes of joint movement. An important principle that external fixators must comply with is that they are ergonometric devices. That is, they must be constructed in accordance with human characteristics, needs, and functional limitations. Failure to take into account this principle can cause significant injuries that will permanently affect the bone or the corresponding joint. In this sense, we have developed a new external fixation device specially adapted to neutralize the mechanical conflict between the different components of the external fixator and its effect on the carpal dynamics during the joint movement, which results in a biomechanical and functionally adequate therapeutic. Although there are currently biomechanical and kinematic studies on carpal dynamics, it is not known in detail what exactly happens with the biomechanical aspects in relation to the commercially existing conventional external fixation devices, as well as this new external fixator system; therefore, it is necessary to study these issues in order to contribute with more information on this topic. OBJECTIVE: The objective of this work was to develop a new dynamic external fixator (Trad Fix®) as well as to study the biomechanical aspects of the device and evaluate its clinical effectiveness in the treatment of distal radius fracture...
Frequently, distal radius fractures of the radius (DRF) have presented associated lesions or such degree of fragmentation that they do not allow the application of screws and/or osteosynthesis plates, nor the dissection necessary for their placement. In these particular cases, the external fixators play an essential role not only to achieve the initial reduction of the fracture but also to maintain it and reduce the consequences derived from the same. The modern treatment of distal radius fractures with the use of an external fixator consists in performing, under the guided fluoroscopic vision, an adequate reduction and fixation of the fragments using Kirschner wires; and subsequently, applying the external fixator as a neutralizer of tension forces through the carpal radio joint. In order to avoid the complications that depend on the immobilization of the joint, it is desirable to be able to move the wrist early during the period of fracture consolidation and provide stability and constant and physiological tension (ligamentotaxis) during the different ranges and planes of joint movement. An important principle that external fixators must comply with is that they are ergonometric devices. That is, they must be constructed in accordance with human characteristics, needs, and functional limitations. Failure to take into account this principle can cause significant injuries that will permanently affect the bone or the corresponding joint. In this sense, we have developed a new external fixation device specially adapted to neutralize the mechanical conflict between the different components of the external fixator and its effect on the carpal dynamics during the joint movement, which results in a biomechanical and functionally adequate therapeutic. Although there are currently biomechanical and kinematic studies on carpal dynamics, it is not known in detail what exactly happens with the biomechanical aspects in relation to the commercially existing conventional external fixation devices, as well as this new external fixator system; therefore, it is necessary to study these issues in order to contribute with more information on this topic. OBJECTIVE: The objective of this work was to develop a new dynamic external fixator (Trad Fix®) as well as to study the biomechanical aspects of the device and evaluate its clinical effectiveness in the treatment of distal radius fracture...
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Tesis de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Cirugía, leída el 20/11/2018