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Author: Dr. Milorad Mitkovic
Co - authors: Dr. Desimir Mladenovic, Dr. Zoran Golubovic, Dr. Sasa Milenkovic, Dr. Ivan Micic, Dr. Sasa Karalejic.
Country : Serbia y Montenegro
E-mail: milorad@mitkovic.net

Orthopaedic and traumathology clinic University of Nis, Serbia and Montenegro and Al-Salam Hospital, Kuwait

Minimal invasive surgery has been proven as one of the most effective method in the treatment of bone fractures (1, 2, 3, 4). Closed fracture reduction is one unavoidable step in performing minimal invasive methods. Known reduction tables and reduction devices suffer from bulkiness, insufficient exactness, time consuming and fluoroscopy dependence. I have developed one relatively small, portable, motorized, remote controlled device, which is effective on ordinary operating (not orthopaedic) table.

MATERIAL AND METHOD

Reduction device consists of 5 electrical motors connected to device construction. Motors can operate in forward and reverse direction producing angulations of related fragment. Control of motor action is realized using remote technique (Fig. 1). It is possible to perform correction in all directions including translation of two mail fragments, angulations, compression, distraction and rotation. Using of this device is realized via pins which are the same pins if external fixation is definitive fixation method or separate pins if using internal fixation method. Reduction process is performed from distance, using one or two screens so surgical team is not necessary to be exposed to fluoroscopy. After achieving accurate reduction, if used external fixation, then clamps and carriers of external Mitkovic fixator are locked and reduction device removed. If used internal fixation it is performed from free lateral side (if using Mitkovic selfdynamisable internal fixator - SAF) or from proximal side if it is used intramedulary nail. After internal fixation completed, reduction device removed. This device has been investigated experimentally and has been used clinically in 15 patients for closed fracture reduction. External fixator has been later transformed in internal fixator (ordinary after two months).

RESULTS

In all patients it has been achieved satisfactory fracture reduction. There were no one intraoperative or postoperative mechanical complication as relating to reduction device as relenting to Mitkovic external or internal fixator as neurovascular injury , tendons injury or similar. There were no any infection, deep venous thrombosis, joints contracture or similar. Duration of reduction procedure was average 12 minutes.

DISCUSION

Remote controlled accurate closed fracture reduction is one desirable method. Despite of several attempts in construction such device there were no produced device for routine use. Our work is one good step in achieving this goal. In order further to minimized fluoroscopy control I have developed new method for accurate monitoring of achieved fracture reduction. In this regard, big achievement we are expecting in computer assisted surgery methods. Also I have developed a nonmotorized extremely simplified fracture reduction device consistent with Mitkovic internal fixator recently tested experimentally and clinically, which is no expensive and very suitable for using in pore countries. This device is not presented here and will be presented in one of next meeting and on the web site of Mitkovic School ( www.mitkovic.org ).

CONCLUSION

It can be concluded that new motorized reduction device is one helpful tool in closed fracture reduction decreasing fluoroscopy time. More advanced version of this device provides closed fracture reduction even without the use of fluoroscopy or any imaging technique.

REFERENCES

1. Mitkovic M. Results of the application of original minimally invasive methods in fracture treatments, Acta Facultatis Medicae Naissensis, 2003, 3-4:167-179.
2. Mitkovic M.: MANUAL OF EXTERNAL SKELETAL FIXATION - development and application of the Author's devices, Prosveta, Nis , 1992.
3. Mitkovic M.: New concepts in external fixation, Monography, Prosveta, Nis , 1993.
4. Shezar A, Rosenberg N, Soudry M. Technique for closed reduction of femoral shaft fracture using an external support device.
   Injury. 2005 Mar;36(3):450-3.