Lavini F, Maluta T, Carpeggiani G, Dall'Oca C, Samaila E, Marconato G, Magnan B
Surgical Department, Orthopaedic and Traumatology, AOUI Verona, Piazzale A. Stefani, 1, 37136, Verona, Italy.
Musculoskelet Surg. 2017 Dec;101(3):229-235. doi: 10.1007/s12306-017-0472-1. Epub 2017 Apr 20.
Ankle fracture dislocations represent a great threat for soft tissue viability and articular instability. The use of a temporary ankle bridging ExFix plays a fundamental role in the local damage control orthopaedics while waiting for definitive synthesis.
For this prospective research, we have developed a full application protocol of innovative diaphyseal monocortical screws fixator (Unyco-Orthofix) exclusively under local anaesthesia. Rigid selection criteria allowed us to collect nine patients during a period of almost 2 years. VAS score was analysed for the feasibility of the procedure, and a thorough radiologic evaluation was performed.
Results pointed out that the calcaneus pin insertion (VAS: 3.44) followed by the local anaesthetics injection (VAS: 3.22) was the most painful, without precluding to continue the procedure; fracture temporary stability was achieved in all the cases.
The procedure of monocortical diaphyseal application in bridging external fixation is comparable to the conventional transcalcaneal traction maintaining the advantage in terms of speediness, independence from anaesthetists and feasibility within few minutes from hospital admittance even in patients under anticoagulants therapy, but increasing the stability of the reduction and improving the quality of nursing (so-called portable traction).
踝关节骨折脱位对软组织活力和关节稳定性构成巨大威胁。在等待确定性固定期间，使用临时踝关节桥接外固定架在局部损伤控制骨科中起着重要作用。
在这项前瞻性研究中，我们专门在局部麻醉下制定了创新型骨干单皮质螺钉固定器（Unyco-Orthofix）的完整应用方案。严格的选择标准使我们在近2年的时间里收集了9例患者。分析视觉模拟评分（VAS）以评估该手术的可行性，并进行了全面的影像学评估。
结果指出，跟骨针插入（VAS：3.44）和局部麻醉剂注射（VAS：3.22）时疼痛最为明显，但这并不妨碍继续手术；所有病例均实现了骨折的临时稳定。
骨干单皮质应用于桥接外固定的手术与传统经跟骨牵引相当，在速度方面具有优势，无需麻醉师参与，即使是接受抗凝治疗的患者，入院后几分钟内即可完成，且增加了复位的稳定性，提高了护理质量（即所谓的便携式牵引）。
