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ByLawrence DiDomenico, DPM, FACFS
AO Fellow, Illizarov
Fellow
Youngstown, Ohio
Throughout the country, residents look forward to the day
when they can apply their first "frame". It seems as though it is becoming a
"rite of passage" for surgeons in training. We sought out various surgeons who,
we felt, possessed enough expertise and fundamental knowledge to pass this
information on to the next generation of foot and ankle surgeons. When we first
contacted Larry DiDomenico, he was on his way to a small village in Siberia, to
engage in a discourse with the Russians who first developed the technique. Ski
hats off to Dr. DiDomenico. He appears to be the expert in this area.
Dr. DiDomenico, last seen
here, riding to his destination in Siberia
In his presentation, he discusses the basic principles,
advantages and disadvantages of external fixation. The frame assembly,
placement of wires, types of wires, and frame mechanics are explained in
detail.
The natural phenomenon of tissue growth under pressure
becomes a powerful stimulus for healing. For this reason, external fixation
has become the technique of choice for complex intra articular fractures of the
ankle (Pilon). It has also made reconstruction of the Charcot Foot a realistic
possibility. Amazingly, much of this can be done percutaneously, thereby
preserving the soft tissue envelope and the vascularity of the local soft
tissues. Patients can often weight bear immediately after surgery. The need
for casting is eliminated.
Frame fixation can also be used for realignment (angular
correction), lengthening, repair of non unions, and to address complications
associated with osteomyelitis. The surgeon has the ability to adjust the
position in the post operative period to insure accurate anatomic reduction and
maintain the length of the limb. Uniplanar, modular, hybrid and circular frames
are all discussed.
Dr. DiDomenico warns us that the learning curve for use of
external fixators is steep and yet commands a constant desire to learn more.
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