Erector spinae plane block vs interscalene brachial plexus block for postoperative analgesia management in patients who underwent shoulder arthroscopy.

BACKGROUND: Interscalene brachial plexus block (ISB) is the gold standard method used for postoperative analgesia after arthroscopic shoulder surgery. Ultrasound guided erector spinae plane block (ESPB) is an interfascial plane block. The aim of this study is to compare the analgesic efficacy of ESPB and ISB after shoulder arthroscopy. The primary outcome is the comparison of the perioperative and postoperative opioid consumptions. METHODS: Sixty patients with ASA score I-II planned for arthroscopic shoulder surgery were included in the study. ESPB was planned in Group ESPB (n = 30), and ISB was planned in Group ISB (n = 30). Intravenous fentanyl patient-controlled analgesia was administered to both groups in the postoperative period. Intraoperative and postoperative opioid and analgesic consumption of both groups, side effects and complications related to opioid use, postoperative pain scores and rescue analgesic use were recorded in the first 48 h postoperatively. RESULTS: Pain scores were significantly higher in the ESPB group in the first 4 h postoperatively than in the ISB group (p < 0.05). The total fentanyl consumption and number of patients using rescue analgesics in the postoperative period were significantly higher in the ESPB group (p < 0.05). The incidence of nausea in the postoperative period was significantly higher in the ESPB group (p < 0.05). CONCLUSIONS: In our study, it was seen that ISB provided more effective analgesia management compared to ESPB in patients underwent shoulder arthroscopy surgery.

Is plantar foot sensation affected in patients with gonarthrosis.

OBJECTIVE: The aim of this study was to compare pain, plantar foot sensation, postural control, fear of movement, and functional level between women patients with early-stage gonarthrosis and those with late-stage gonarthrosis. METHODS: A total of 62 women with gonarthrosis were included in the study. Patients were then divided into two groups: earlystage gonarthrosis group (31 women) and late-stage gonarthrosis group (31 women) according to Kellgren Lawrence criteria. Light touch-pressure sensation (Semmes Weinstein Monofilaments), two-point discrimination sensation (esthesiometer), and vibration sensation (128 Hz diapason) were used to evaluate plantar foot sensation. Pain intensity was assessed by the numeric rating scale, postural control by Berg balance scale, fear of movement by the Tampa kinesiophobia scale, functional mobility by the Timed Up and Go test and knee injury and osteoarthritis outcome score. RESULTS: Early-stage patients were found to have higher light-touch pressure sensation on 1st metatarsal head of dominant side, 5th metatarsal head of non-dominant side, heel of non-dominant side than late stage patients. Early-stage patients had a higher sensation of vibration than late stage patients. The patients in the early stage were found to have higher two-point discrimination sensation on middle of dominant side, heel of dominant side, trans-metatarsal of non-dominant side, middle of non-dominant side, heel of non-dominant side than late stage. Postural control of early-stage patients were found to be higher than late-stage patients. Early-stage patients had lower kinesophobia and higher functional levels than late-stage patients. CONCLUSION: The light touch sensation, vibration sensation, and two-point discrimination deteriorated by the progression of the disease should be important criteria in patients with gonarthrosis. LEVEL OF EVIDENCE: Level III, Therapeutic Study.

Is shoulder geometry important for rotator cuff tears?

PURPOSE: This study is aiming to evaluate some specific anatomic shoulder parameters such as the lateral acromial angle (LAA), acromial index (AI), coracohumeral distance (CHD) and critical shoulder angle (CSA) in rotator cuff tears. METHODS: A total of 100 cases consisting of 50 patients with rotator cuff tears and 50 patients without rotator cuff tears, who underwent shoulder MRI (mangnetic resonance imaging) examination in Istanbul Medipol University Orthopedics and Traumatology Department, participated in this study. In this retrospective study, CCA, LAA, AI and CSA were evaluated in MRI in order to shed light on the theories of rotator cuff tears. RESULTS: There was no significant difference (P Ëƒ .05) in acromial index and coracohumeral distance in the patient group. Lateral acromial angle and critical shoulder angle were significantly different in the patient group compared to the control group (P < .05). There was a weak negative correlation between CSA and CHD. CONCLUSION: In our study, we found that patients with smaller LAA and higher CSA values in MRI images are prone to have rotator cuff tears. Further studies are needed in order to evaluate whether this association has predictive value.

A comparison of adductor canal block before and after thigh tourniquet during knee arthroscopy: a randomized, blinded study.

BACKGROUND: Adductor canal block (ACB) provides effective analgesia after arthroscopic knee surgery. However, there is insufficient data regarding whether ACB should be performed before or after inflation of a thigh tourniquet. We aimed to investigate the efficacy of ACB performed before and after placement of a thigh tourniquet and evaluate associated quadriceps motor weakness. METHODS: ACB was performed before tourniquet inflation in the PreT group, and it was performed after inflation in the PostT group. In the PO group, ACB was performed at the end of surgery after deflation of the tourniquet. RESULTS: There were no statistically significant differences between the groups in terms of demographic data. There was no statistically significant difference among the three groups in terms of total postoperative opioid consumption (P = 0.513). Patient satisfaction and the amount of rescue analgesia administered were also not significantly different between the groups. There was no significant difference in terms of static and dynamic visual analog scale scores between the groups (for 24 h: P = 0.306 and P = 0.271, respectively). The incidence of motor block was higher in the PreT group (eight patients) than in the PostT group (no patients) and the PO group (one patient) (P = 0.005). CONCLUSIONS: Using a tourniquet before or after ACB did not result in differences in terms of analgesia quality; however, applying a tourniquet immediately after ACB may lead to quadriceps weakness.

High Thoracic Erector Spinae Plane Block for Arthroscopic Shoulder Surgery: A Randomized Prospective Double-Blind Study.

OBJECTIVE: Moderate to severe pain may occur following arthroscopic shoulder surgery. An erector spinae plane block (ESPB) may be used for painful conditions of the shoulder. The primary hypothesis of this trial is that ultrasound-guided ESPB would provide effective analgesia by reducing opioid consumption. The secondary hypothesis is that ESPB would result in low pain scores and reduce the use of rescue analgesia. DESIGN: Randomized prospective double-blind study. SETTING: Academic university hospital. SUBJECTS: Sixty patients aged between 18 and 65 years designated as American Society of Anesthesiologists (ASA) class I or II who underwent unilateral arthroscopic shoulder surgery under general anesthesia were included in the study. METHODS: Patients were equally divided into two groups-either the ESPB group (n=30) or the sham block group (n=30). ESPB was performed with 30 mL 0.25% bupivacaine at the T2 level in the ESPB group and sham block with 30 mL saline at the T2 level in the sham block group. Twenty minutes before the end of the operation, 100 mg tramadol was administered intravenously to the patients. Intravenous ibuprofen 400 mg 3 × 1 was ordered for the patients during the postoperative period. A patient control analgesia device including a dose of 10 µg/mL fentanyl was connected to the patients. RESULTS: There were no statistical differences between groups in terms of demographical data. Postoperative fentanyl consumption was significantly lower in the ESPB group than in the sham block group (96.66 µg ±105.57 µg and 230 µg ±247.17 µg, respectively) (P=0.009). The need for rescue analgesia was significantly lower in the ESPB group than in the sham block group (26.66 mg ±35.43 mg and 48.5 mg ±35.45 mg, respectively) (P=0.020). Overall, the visual analog scale scores were significantly lower in the ESPB group than in the sham block group. CONCLUSIONS: ESPB may provide effective analgesia treatment following arthroscopic shoulder surgery.

Correction to: Arthroscopic treatment of focal osteochondral lesions of the first metatarsophalangeal joint.

This article [2] was published twice [1] due to a production error. The original article [1] should be considered the version of record and used for citation purposes. The publisher apologizes to the authors and readers for the error and any inconvenience caused.

Application of hybrid external fixation by the "joystick method" in bicondylar tibial plateau fractures: Technical note.

BACKGROUND: This study aimed to present clinical outcomes in patients with tibial plateau fractures who were treated with hybrid external fixators and describe the details of our technique. Schanz screws were synchronously applied and used as a joystick for fracture reduction. METHODS: The study population included 72 patients with bicondylar tibial plateau fractures classified as type 41-C2 according to the AO classification. Joint reduction was maintained using Schanz screws transmitted through tibial condyles as a joystick under fluoroscopy. The patients then underwent surgery with these Schanz screws and a hybrid external fixation system. RESULTS: The median age of the patients was 39 (21-67) years, and the median follow-up time was 21 (12-35) months. The mean knee flexion and extension were 105° (80°-125°) and 0° (-5°-7°), respectively. The mean varus laxity and valgus laxity were 4.30° (2°-7°) and 3.10° (2°-5°), respectively. Four patients had leg shortness of 0.4-1.1 cm. The external fixators were removed between 8 and 16 weeks (mean = 11 weeks) postoperatively. The KSS scores at the end of 1 year were "excellent" for 48 patients, "good" for 19 patients, and "inadequate" for 5 patients. CONCLUSION: With the synchronous application of the two Schanz screws of 6.5-mm thickness and the two-drill technique under fluoroscopic guidance, we obtained stable reductions over a short period. No patient experienced major complications, and this enabled early weight bearing and a return to daily living activities.

Which unicondylar prosthesis is better in the mid- term in obese patients: fixed or mobile?

As it is mentioned in the literature, rates of complications and revision are higher in the obese compared to non-obese patients, although obesity does not a contraindication for unicompartmental knee arthroplasty and successful outcomes are achieved. However, there is not any study in the literature comparing the outcomes of fixed and mobile unicompartmental prostheses which are applied in the obese patients. Objective of this study was to compare outcomes of our obese patients who we applied fixed or mobile unicompartmental arthroplasty and followed up for 8 years and over. Of 293 patients in whom we performed unicompartmental knee prosthesis due to medial gonarthrosis between 2003 and 2014, 239 patients who were regularly followed-up at least for 18 months were included in this study. Total 248 knees with 193 (77.8%) fixed including bilateral prosthesis in 9 patients and 55 (22.2%) mobile prostheses were retrospectively assessed. The study included 57 patients having BMI >30 kg/ m2 who were regularly followed-up. In the final controls; mean flexion was found as 107° (100-128°)(p < 0.05), mean extension as 3° (0-5°) and mean tibio femoral angle as 4° (1-5°) (p < 0.05) valgus. Postoperative mean WOMAC value was found as 91.23 ± 3.02 (92-96) (p < 0.05) and mean KSS score as 88.3 ± 3.94 (85-100) (p < 0.05). In the final controls, respective knee flexions were seen to be 105° (100-125°) and 108°(105-128°) in the fixed and mobile insert subgroups (p > 0.05). Unicompartmental knee prosthesis is a good treatment option which can be applied also in obese patients and has high survival rates. No significant difference was found between the prostheses with fixed and mobile insert in terms of function and knee scores. However, fixed unicompartmental prosthesis should primarily be preferred in obese patients because of the challenging surgical technique, difficult learning curve and insert dislocation that we encounter with mobile prostheses.

Assessment of the kinesiotherapy's efficacy in male athletes with calcaneal apophysitis.

BACKGROUND: The aim of the present study was to assess the efficacy of kinesiotherapy used for treating various disorders in athletes on pain and pedal functions in patients with calcaneal apophysitis. METHODS: This prospective randomized controlled study included 22 patients with calcaneal apophysitis aged 8 to 16 years presenting with heel pain among junior athletes of a professional football club. The patients were randomly grouped into two groups, with one group receiving sham tape only and the other kinesio tape. American Orthopedic Foot & Ankle Society (AOFAS) and visual analog scale (VAS) scores were recorded before and after the treatment. RESULTS: The preoperative VAS score of the kinesio tape was 7, and AOFAS score was 62.4; the corresponding figures of the sham group were 6.81 and 70.5, respectively. The kinesio-tape group had a better AOFAS scores at 1st and 3rd month (p < 0.05). Posttreatment AOFAS score was 99.7 ± 0.9 for the kinesio-tape group and 97.4 ± 3.9 for the sham-tape group. Posttreatment VAS score was 0.1 ± 0.3 for the kinesio-tape group and 0.4 ± 0.5 for the sham-tape group (p > 0.05). DISCUSSION: Conservative treatment modalities are preferentially used for its treatment. Kinesiotherapy is one of the treatment methods for the apophysitis. In the literature, our study is the first prospective randomized trial on the efficacy of kinesio taping in calcaneal apophysitis. CONCLUSIONS: Although kinesio taping can be effectively used for the restoration of ankle functions of athletes with calcaneal apophysitis, its role in pain is limited. Since it lacks serious side effects, it can be used in combination with or as an alternative to pharmacological treatment in this patient group.

Compression neuropathy of the common peroneal nerve caused by an intraosseous ganglion cyst of fibula.

We present a case of a compression neuropathy of the common peroneal nerve caused by an intraosseous Ganglion cyst of fibula.

Difference between biomarkers of tibial bone marrow and adipose tissue.

BACKGROUND: Stem cells, with their regeneration capacity, long-term viability, and differentiation characteristics, have indispensable biological properties. As described by Hauner and Grigoradis et al., mesenchymal stem cell originating from adipose or bone marrow can be differentiated into many tissues such as adipocyte, chondrocyte, myeloblast, and osteoblast. The aim of our study is to compare the use of adipose and tibial bone marrow derived stem cells for therapeutic purposes in orthopedic surgery, which has not been clearly evaluated in the literature to our knowledge and to also evaluate their use. MATERIAL AND METHOD: Our study was performed between May 2014 and December 2016 in our clinic (Istanbul Medipol University, Department of Orthopedics and Traumatology) in 40 patients. Twelve patients were excluded. The ages of the 28 included patients ranged from 19 to 61 years, with a mean of 41.18 ± 13.39 years. The stem cell samples of these patients were analyzed by flow cytometry. RESULTS: Tibial bone marrow stem cells were used in 15 cases and the mean age was 49.33 ± 9.15. Adipose-derived stem cells were used in 13 patients and the mean age was 31.77 ± 11.25. None of the patients had any minor/major complication in the areas where stem cells were collected. DISCUSSION: Tibial-derived bone marrow has better results with regard to the complications, economic burden, and surgery time. Tibial-derived bone marrow harvesting and stem cell preparation time are one-fourth of the stem cell treatment prepared from adipose tissue and the surgical duration is shortened by 45 min. CONCLUSION: If stem cell use is the preference of the surgeon, we have found that the tibial-derived stem cell system is more advantageous for ease of acquisition, cost analysis, and surgical time.

Arthroscopic treatment of focal osteochondral lesions of the first metatarsophalangeal joint.

BACKGROUND: Although arthroscopic surgical treatment of the first metatarsophalangeal (MTP) joint involves painful sesamoid excision, synovectomy, debridement, and partial cheilectomy, no gold standard treatment technique has been defined in the literature for hallux rigidus and focal osteochondral lesions. This study aimed to assess the arthroscopic treatment for early-grade focal osteochondral lesions of the first MTP joint and to determine the impact of arthroscopic microhole drill surgery on foot function and activities of daily living in a group of patients who failed conservative treatment. METHODS: This prospective study included 14 patients with hallux rigidus and focal osteochondral lesions of the first MTP joint who underwent surgery in 2014 and were followed on a regular basis thereafter. RESULTS: The patients had mean preoperative VPS (visual pain scale) and AOFAS (American Orthopedic Foot and Ankle Society)-Hallux scores of 8.14 ± 0.86 SD and 48.64 ± 4.27, respectively; the corresponding postoperative values of both scores were 1.86 ± 0.66 SD and 87.00 ± 3.70, respectively. Both VPS and AOFAS-Hallux scores changed significantly. DISCUSSION: In this prospective study, we explored the impact of arthroscopic microhole drill surgery on foot function and activities of daily living in patients with focal osteochondral lesions of the first MTP joint. Our results showed significant improvements in VPS and AOFAS scores with this treatment. CONCLUSIONS: An arthroscopic microhole drill technique can be used with impressive functional scores and without any complications in patients who failed conservative therapy for hallux rigidus with focal chondral injury.

Exenatide promotes regeneration of injured rat sciatic nerve.

Damage to peripheral nerves results in partial or complete dysfunction. After peripheral nerve injuries, a full functional recovery usually cannot be achieved despite the standard surgical repairs. Neurotrophic factors and growth factors stimulate axonal growth and support the viability of nerve cells. The objective of this study is to investigate the neurotrophic effect of exenatide (glucagon like peptide-1 analog) in a rat sciatic nerve neurotmesis model. We injected 10 µg/d exenatide for 12 weeks in the experimental group (n = 12) and 0.1 mL/d saline for 12 weeks in the control group (n = 12). We evaluated nerve regeneration by conducting electrophysiological and motor functional tests. Histological changes were evaluated at weeks 1, 3, 6, and 9. Nerve regeneration was monitored using stereomicroscopy. The electrophysiological and motor functions in rats treated with exenatide were improved at 12 weeks after surgery. Histological examination revealed a significant increase in the number of axons in injured sciatic nerve following exenatide treatment confirmed by stereomicroscopy. In an experimentally induced neurotmesis model in rats, exenatide had a positive effect on nerve regeneration evidenced by electromyography, functional motor tests, histological and stereomicroscopic findings.

Arthroscopic treatment of focal osteochondral lesions of the first metatarsophalangeal joint.

BACKGROUND: Although arthroscopic surgical treatment of the first metatarsophalangeal (MTP) joint involves painful sesamoid excision, synovectomy, debridement, and partial cheilectomy, no gold standard treatment technique has been defined in the literature for hallux rigidus and focal osteochondral lesions. This study aimed to assess the arthroscopic treatment for early grade focal osteochondral lesions of the first MTP joint and to determine the impact of arthroscopic microhole drill surgery on foot function and activities of daily living in a group of patients who failed conservative treatment. METHODS: This prospective study included 14 patients with hallux rigidus and focal osteochondral lesions of the first MTP joint who underwent surgery in 2014 and were followed on a regular basis thereafter. RESULTS: The patients had mean preoperative VPS (visual pain score) and AOFAS (American Orthopedic Foot and ankle Society)-Hallux scores of 8.14 ± 0.86 SD and 48.64 ± 4.27, respectively; the corresponding postoperative values of both scores were 1.86 ± 0.66 SD and 87.00 ± 3.70. Both VPS and AOFAS-Hallux scores changed significantly. DISCUSSION: In this prospective study, we explored the impact of arthroscopic microhole drill surgery on foot function and activities of daily living in patients with focal osteochondral lesions of the first MTP joint. Our results showed significant improvements in VPS and AOFAS scores with this treatment. CONCLUSIONS: An arthroscopic microhole drill technique can be used with impressive functional scores and without any complications in patients who failed conservative therapy for hallux rigidus with focal chondral injury.

Orthopedic surgeons' knowledge regarding risk of radiation exposition: a survey analysis.

INTRODUCTION: The purpose of this study is to evaluate the knowledge levels of orthopedic surgeons working in Turkey about the uses and possible risks of fluoroscopy and assess methods for preventing radiation damage. METHODS: A questionnaire with a total of 12 questions was sent to 1121 orthopedic surgeons working in Turkey. The questionnaire evaluated participants' knowledge about the uses and risks of fluoroscopy and methods for preventing damage. One thousand and twenty-four orthopedic surgeons were found to be suitable for inclusion in the study. The effects of fluoroscopy on patients were not assessed in our study. RESULTS: The data obtained were statistically evaluated. Of the surveyed surgeons, 313 (30%) had used fluoroscopy in over 50% of their operations. The average number of fluoroscopy shots per case was 54.5. A lead apron was the most commonly used (88%) protection from the harmful effects of radiation. Fluoroscopy shots were performed with the help of operating room personnel (86%). A dosimeter was used 5% of the time. CONCLUSION: According to the survey results, the need for fluoroscopy was very high in orthopedic surgery. However, orthopedic surgeons have inadequate knowledge about the uses and risks of fluoroscopy and methods for preventing damage. Therefore, we believe that training on this topic should be provided to all orthopedic surgeons.

Which Unicondylar Prosthesis Is Better In The Mid-Term In Obese Patients : Fixed Or Mobile?

As it is mentioned in the literature, rates of complications and revision are higher in the obese compared to non-obese patients, although obesity does not a contraindication for unicompartmental knee arthroplasty and successful outcomes are achieved. However, there is not any study in the literature comparing the outcomes of fixed and mobile unicompartmental prostheses which are applied in the obese patients. Objective of this study was to compare outcomes of our obese patients who we applied fixed or mobile unicompartmental arthroplasty and followed up for 8 years and over. Of 293 patients in whom we performed unicompartmental knee prosthesis due to medial gonarthrosis between 2003 and 2014, 239 patients who were regularly followed-up at least for 18 months were included in this study. Total 248 knees with 193 (77.8%) fixed including bilateral prosthesis in 9 patients and 55 (22.2%) mobile prostheses were retrospectively assessed. The study included 57 patients having BMI >30 kg/ m2 who were regularly followed-up. In the final controls; mean flexion was found as 107° (100-128°)(p<0.05), mean extension as 3° (0-5°) and mean tibio femoral angle as 4° (1-5°) (p<0.05) valgus. Postoperative mean WOMAC value was found as 91.23 ± 3.02 (92-96) (p<0.05) and mean KSS score as 88.3 ± 3.94 (85-100) (p<0.05). In the final controls, respective knee flexions were seen to be 105° (100- 125°) and 108°(105-128°) in the fixed and mobile insert subgroups (p>0.05). Unicompartmental knee prosthesis is a good treatment option which can be applied also in obese patients and has high survival rates. No significant difference was found between the prostheses with fixed and mobile insert in terms of function and knee scores. However, fixed unicompartmental prosthesis should primarily be preferred in obese patients because of the challenging surgical technique, difficult learning curve and insert dislocation that we encounter with mobile prostheses.

A suture technique for easier reduction and repair of bucket-handle meniscal tears while using the all-inside devices.

Arthroscopic repair of bucket-handle meniscal tears is difficult due to their complex pathology. Many meniscal repair techniques such as all-inside, inside-out, and outside-in have been described for the treatment of these tears. Loss of reduction is a likely complication with the use of new-generation, all-inside suture instruments, as the tip of the needle is extracted following advancement of the first implant behind the capsule. The complication may be encountered quite often and renders the use of the meniscus repair instrument unusable and causes an irreparable iatrogenic injury in the meniscus. The application of a simpler and more efficient technique is necessary until surgical experience is gained. The aim of this study was to define a new, simpler, and more efficient combination of suturing method in the treatment of bucket-handle meniscal repairs and minimize the rate of complications which may be caused by this technique.

Kinesio taping or just taping in shoulder subacromial impingement syndrome? A randomized, double-blind, placebo-controlled trial.

OBJECTIVE: To verify effects of kinesio taping (KT) in shoulder subacromial impingement syndrome (SIS) when compared to sham taping applied in the same way with KT. PATIENTS AND METHODS: Patients were randomized as group 1 (n = 21) KT group and group 2 (n = 20) sham-taping group. Taping was applied every three days, three times during the study period. We assessed all the patients at baseline, at the end of the taping period (12th day), and at one-month post-intervention. We assessed pain on the 100 mm visual analog scale (VAS). Shoulder range of motion (ROM), Constant Scores, and Nottingham Health Profile (NHP) scores were evaluated. RESULTS: Of the 41 participants, 13 were males (32%) and 28 were females (68%). The mean age was 45 ± 15 years (range 20-65 years). We documented a significant decrease in VAS for nocturnal pain, and Constant Score in both groups. The KT group showed additional significant change in NHP pain and physical activity scores. CONCLUSION: KT and sham taping generated similar results regarding pain and Constant Scores.

Treatment of open fractures with a computer-assisted external fixator system without the use of fluoroscopy.

BACKGROUND: Developed for the treatment of deformity correction, computer-assisted circular external fixators in recent years have also been used for fracture fixation. In this study, we aimed to present the efficacy of computer-assisted circular external fixator use in open long bone fractures with our new technique. METHODS: Between February 2013 and June 2014, 14 patients (mean age 24.5 (range 20-32)) with open tibial or femoral open fractures were treated with the computer-assisted fixation system (Spider Frame-Tasarim Medikal, Istanbul, Turkey). In all patients, appropriate positions of the rings and Schanz screws were determined by measurements on preoperative radiographs. The length of the Schanz screws were determined by depth measure marks on drill bits. Obvious deformities were corrected intraoperatively by manipulations, but residual deformities were corrected by a software program (Spiderfix, Tasarim Medikal, Istanbul, Turkey). We did not use fluoroscopy during the procedures. RESULTS: Ten patients had tibia diaphyseal and four patients had femoral diaphyseal fractures. Mean surgical time was 24.2 (range 18-28) min. Average follow-up time was 10.2 (range 9-14) months. Mean time for deformity correction was 3.1 (2-5) days. Complete union was observed in all patients with a mean of 4.9 (range 3-9) months. There were two grade 2 pin site infections treated with oral antibiotherapy and pin site care. We did not detect any Schanz screw breakage, loosening, deep infection, nonunion, or malunion. CONCLUSIONS: Computer-assisted external fixation systems can be used in the treatment of open fractures, and they provide the chance for acute or gradual correction. Preoperative planning and assistant devices with depth measures may decrease the procedure time and the need for fluoroscopy use.