The Basic Biomechanical Principles of

External Fixation

Leonid N. Solomin, Russia

2018
Objectives

1. The relationships between the transosseous

elements (wires, half-pins) and the surrounding
tissues

2. Bone fragments reduction control

3. Bone fragments fixation control

Objectives

1. The relationships between the transosseous

elements (wires, half-pins) and the surrounding
tissues

2. Bone fragments reduction control

3. Bone fragments fixation control

Transfixion pin-induced joint stiffness
(TPJS)
Reason: fixing soft tissue to bone
Reason: fixing soft tissue to bone
Method of Unified Designation of External
Fixation

Levels
Method of Unified Designation of External
Fixation

Levels

Positions

3 – medially
12 – anteriorly
Cadaver lab step-by-step RP identification
Cadaver lab step-by-step RP identification
Cadaver lab step-by-step RP identification
Cadaver lab step-by-step RP identification

12 markers
touch the skin
only
Skin displacement

knee extension
Skin displacement

knee extension knee flexion

Skin displacement

maximum
displacement
Skin displacement

maximum
displacement

zero displacement
Fascia displacement

knee extension
Fascia displacement

knee extension knee flexion

Muscles displacement

knee extension knee flexion

Diagrams of the soft-tissue
displacement
in knee joint flexion
Level VI

skin displacement
fascia displacement
muscle displacement
Diagrams of the soft-tissue
displacement
in knee joint flexion
Level VI

skin displacement
fascia displacement
muscle displacement
Diagrams of the soft-tissue
displacement
in knee joint flexion
at Level VI

skin displacement
fascia displacement
muscle displacement
Basis for:
Variants of wires cutting ends
Variants of wires cutting ends
Variants of wires cutting ends
Variants of wires cutting ends
 Half-pin types

diaphyseal and metaphyseal hydroxyapatite-coated self tappi

Pin placement

conventional

self tapping

(AO Foundation, Switzerland)

Biomechanics of external fixation:

1. The relationships between the transosseous

elements (wires, half-pins) and the surrounding
tissues

2. Bone fragments reduction control

3. Bone fragments fixation control

Principal ways of bone fragment reduction

Inside of frame
Principal ways of bone fragment reduction

Inside of frame Module relative to module

Principal ways of bone fragment reduction

Inside of frame Module relative to module

Reduction using olive-wires
Reduction using olive-wires
Reduction using olive-wires
Reduction using olive-wires
Reduction using olive-wires
Reduction using olive-wires
Reduction using half-pin
Reduction using half-pin
Reduction using half-pin
Reduction using half-pin
Reduction using half-pin
Reduction using half-pin
Reduction using half-pin
Reduction using half-pin
Reduction using half-pin
Occurrence of displacing forces
Occurrence of displacing forces
Occurrence of displacing forces
Occurrence of displacing forces
Principal ways of bone fragment reduction

Inside of frame Module relative to module

Principal ways of bone fragment reduction

Inside of frame Module relative to module

Basic ways of modules moving

using unified “Ilizarov hinges”

Basic ways of modules moving

using unified “Ilizarov hinges” using universal units

(hexapod)
Basic ways of modules moving

using unified “Ilizarov hinges” using universal units

(hexapod)
The effect of the eccentricity
The effect of the eccentricity
The effect of the eccentricity
The effect of the eccentricity
The effect of the eccentricity
Acute translation unit
Acute translation unit
Acute translation unit
Acute translation unit
Gradual translation
unit
Gradual translation
unit
Gradual translation
unit
Unit for correction of angular deformity
Unit for correction of angular deformity
Gradual angular deformity correction
Gradual angular deformity correction
Gradual angular deformity correction
Gradual angular deformity correction
Gradual angular
deformity correction
+ lengthening
Gradual angular
deformity correction
+ lengthening
Gradual angular
deformity correction
+ lengthening
Gradual angular
deformity correction
+ lengthening
Gradual angular
deformity correction
+ lengthening
Acute torsion unit
Acute torsion unit
Acute torsion unit
Acute torsion unit
Gradual torsion unit
Gradual torsion unit
Gradual torsion unit
Ilizarov step-by-step method of gradual
deformity correction

Before
treatment
Ilizarov step-by-step method of gradual
deformity correction

Step 1 – lengthening and

Before
angular deformity correction
treatment
Ilizarov step-by-step method of gradual
deformity correction

Step 1 – lengthening and Step 2 – torsion correction

Before
angular deformity correction
treatment
Ilizarov step-by-step method of gradual
deformity correction

Step 1 – lengthening and Step 2 – torsion correction

Before
angular deformity correction
treatment

Step 3 – translation
elimination
Ilizarov step-by-step method of gradual
deformity correction

Step 1 – lengthening and Step 2 – torsion correction

Before
angular deformity correction
treatment

Step 3 – translation
Step 4 - fixation
elimination
Ilizarov step-by-step method of gradual
deformity correction

Step 1 – lengthening and Step 2 – torsion correction

Before
angular deformity correction
treatment

Step 3 – translation
Step 4 - fixation
Result elimination
Basic ways of modules moving

Using unified “Ilizarov hinges” Using universal units

(hexapods)
Reduction units: unified and universal

Angular
Reduction units: unified and universal

Angular Translation Rotation Lengthening

Reduction units: unified and universal

Angular Translation Rotation

Reduction units: unified and universal

Angular Translation Rotation Lengthening

Conventional Ilizarov vs. Hexapod

1 2 3

5
Conventional Ilizarov vs. Hexapod

1 2 3

5
Conventional Ilizarov vs. Hexapod

1 2 3

5
Biomechanics of external fixation:

1. The relationships between the transosseous

elements (wires, half-pins) and the surrounding
tissues

2. Bone fragments reduction control

3. Bone fragments fixation control

-frame module transformation
Rigidity (stiffness) types
Rigidity (stiffness)

of frame of bone-fragments fixation

(“bone-less”)

“frame-dependent” stabilization “frame-bone-dependent” stabilization

Rigidity (stiffness) types
Rigidity (stiffness)

of frame of bone-fragments fixation

(“bone-less”)
depends on:
- the material which
frame is made
- frame geometry “frame-dependent” stabilization “frame-bone-dependent” stabilization
(tubular and their
configurations;
monolateral, sectorial,
semicircular, circular,
hybrid)
Rigidity (stiffness) types
Rigidity (stiffness)

of frame of bone-fragments fixation

(“bone-less”)
depends on:
- the material which
frame is made
- frame geometry “frame-dependent” stabilization “frame-bone-dependent” stabilization
(tubular and their
configurations;
monolateral, sectorial, depends on:
semicircular, circular, - type of transosseous elements (wire, pin)
hybrid) and their diameters
- ?? - degree of wire tension
- the health of the pin-bone interfaces
- the number of wires and pins
- separation of the pins within each
fragment
- the distance of the frame from the bone
- the number of planes of the frame system
and - any cross-linkages (external support
geometry, type of frame: tubular and their
configurations; monolateral, sectorial,
semicircular, circular, hybrid)
Rigidity (stiffness) types
Rigidity (stiffness)

of frame of bone-fragments fixation

(“bone-less”)
depends on:
- the material which
frame is made
- frame geometry “frame-dependent” stabilization “frame-bone-dependent” stabilization
(tubular and their
configurations;
monolateral, sectorial, depends on:
semicircular, circular, - type of transosseous elements (wire, pin) depends on:
hybrid) and their diameters - all parameters for “frame-
- degree of wire tension dependent” stabilization
- the health of the pin-bone interfaces - bone quality
- the number of wires and pins - size of bone fragments
- separation of the pins within each - contact area
fragment - possibility of interfragmentary
- the distance of the frame from the bone compression
- the number of planes of the frame system
and - any cross-linkages (external support
geometry, type of frame: tubular and their
configurations; monolateral, sectorial,
semicircular, circular, hybrid)
Rigidity (stiffness) types
Rigidity (stiffness)

of frame of bone-fragments fixation

(“bone-less”)
depends on:
- the material which
frame is made
- frame geometry “frame-dependent” stabilization “frame-bone-dependent” stabilization
(tubular and their Osteosynthesis Rigidity
configurations; (“frame-bone construct”)
monolateral, sectorial,
semicircular, circular, depends on: depends on:
hybrid) - type of transosseous elements (wire, pin) - all parameters for “frame-
and their diameters dependent” stabilization
- degree of wire tension - bone quality
- the health of the pin-bone interfaces - size of bone fragments
- the number of wires and pins - contact area
- separation of the pins within each - possibility of interfragmentary
fragment compression
- the distance of the frame from the bone
- the number of planes of the frame system
and - any cross-linkages (external support
geometry, type of frame: tubular and their
configurations; monolateral, sectorial,
semicircular, circular, hybrid)
Osteosynthesis rigidity depends on:
- external support geometry
- external support geometry

Circular > Semicircular > Sectorial > Monolateral

- distance from bone to ring

1 2
- distance from bone to ring

1 2

1>2
- type and diameter of transosseus
elements

•Equipped with stopper and

thread > smooth
- type and diameter of transosseus
elements

•Equipped with stopper and

thread > smooth
•Transsegmental > consol
- type and diameter of transosseus
elements

•Equipped with stopper and

thread > smooth
•Transsegmental > consol

•“Thick” > “thin”

- type and diameter of transosseus
elements

•Equipped with stopper and

thread > smooth
•Transsegmental > consol

•“Thick” > “thin”

<20%
- degree of wire tension

•in ring - 900–1100 N

•in half-ring - 500–700 N

- number of Transosseous Elements

It would be better to have one half-pin (wire)

more, than one half-pin (wire) less
- number of Transosseous Elements

It would be better to have one half-pin (wire)

more, than one half-pin (wire) less

but…
- number of Transosseous Elements

It would be better to have one half-pin (wire)

more, than one half-pin (wire) less

but…
- number of Transosseous Elements

It would be better to have one half-pin (wire)

more, than one half-pin (wire) less

but…
- number of Transosseous Elements

It would be better to have one half-pin (wire)

more, than one half-pin (wire) less

but…
- number of transosseous elements
- number of transosseous elements
- fixation rigidity of proximal fragment

P1
- fixation rigidity of proximal fragment

P1 P2
- fixation rigidity of proximal fragment

P1 P2

P1 = P2
- fixation rigidity of proximal fragment

P1 P2

P1 = P2

P3
- fixation rigidity of proximal fragment

P1 P2

P1 = P2
P3 > P1

P3
- fixation rigidity of proximal fragment

P1 P2

P1 = P2
P3 > P1

P3 P4
- fixation rigidity of proximal fragment

P1 P2

P1 = P2
P3 > P1
P3 = P4

P3 P4
- fixation rigidity of proximal fragment

P1 P2

P1 = P2
P3 > P1
P3 = P4

P3 P4
- orientation of wires and pins
- orientation of wires and pins
- orientation of wires and pins
- orientation of wires and pins
- orientation of wires and pins

4>3>2>1
- orientation of wires and pins

4>3>2>1

Four- hole post forever!

- orientation of wires and pins

4>3>2>1

Four- hole post forever!

- orientation of wires and pins

4>3>2>1

Four- hole post forever!

- wires and pins orientation (crossing)

α β α
α
- wires and pins orientation (crossing)

α β α
α

 = 60 (75+15)
 = 70 (70+10)
- wires and pins orientation (crossing)

β1 α

β2
- wires and pins orientation (crossing)

β1 α

β2

=60+10
1=120+10
2=70+10
- lever length (one ring module)
Four- hole post forever!
- lever length (one ring module)
Four- hole post forever!
- lever length (one ring module)
Four- hole post forever!
- lever length (one ring module)
Four- hole post forever!

… if possible
- lever length (two ring module)

a a

P1
P2
- lever length (two ring module)

a a

A< B

P1 < P2

P1
P2
- lever length (two ring module)

a a

A< B

P1 < P2

P1
P2

 = 90
- lever length (two ring module)

Four- hole post forever!

a a

A< B

P1 < P2

P1
P2

 = 90
- lever length (two ring module)

Four- hole post forever!

a a

A< B

P1 < P2

P1
P2

 = 90
Stability spectrum

relative stability

absolute stability
Frame Module Transformation (MT)
Frame Module Transformation (MT)

•step-by-step
decrease in the
quantity of wires,
pins and rings

•change the
geometry of the
external supports
Frame Module Transformation (MT)
MT provides:

•step-by-step •frime dinamisation

decrease in the
quantity of wires, •decrease of danger
pins and rings of pin-induced joint
stiffness and pin-tract
infection

•change the •decrease of frame

geometry of the bulkiness
external supports
MT
MT
Take-home message

•reduction possibilities
•osteosynthesis rigidity
Take-home message

1. The relationships between the transosseous

elements (wires, half-pins) and the surrounding
tissues

Safe
Positions
Take-home message

1. The relationships between the transosseous

elements (wires, half-pins) and the surrounding
tissues

Minimal
Safe displacement
Positions of the soft
tissues
Take-home message

1. The relationships between the transosseous

elements (wires, half-pins) and the surrounding
tissues

Minimal
Safe displacement
Positions RP
of the soft
tissues
Take-home message

2. Bone fragments reduction control

Take-home message

2. Bone fragments reduction control

Take-home message

2. Bone fragments reduction control

Take-home message

2. Bone fragments reduction control

Take-home message

β β
1 2

3. Bone fragments fixation control

Take-home message

β β
1 2

3. Bone fragments fixation control

Reference
Reference

Thank you!