Kinematic adjustability of unilateral external fixators for fracture reduction and alignment of axial dynamization

Bone fracture reduction and bone axial dynamization are important operations which effectiveness can be further enhanced by the use of a unilateral external fixator. By design, axial dynamization can be performed through reciprocating one of its translational joints. However, non-axial dynamization may occur after correcting residual fracture deformity. To explore and to maximize its full potential, the joint adjustment constraint equations for fracture reduction and alignment of axial dynamization under unilateral external fixation are derived. Their physical implications and criteria on the kinematic structure of a fixator are then established. In order to correctly make the alignment of axial dynamization with the proper fracture reduction, this study shows that the linkage of a bone-fixator system should have a minimum of eight degrees-of-freedom (DOFs) with at least two nonparallel rotational DOFs adjacent to both ends of the designated single translational DOF for axial dynamization. Thus, the adjustment of the connection between bone pin/pin clamp of Othofix fixator is required, while the alignment of one of the translational joints of Dynafix fixator with its bone segment axis during fracture stabilization procedure is a crucial step. A conceptual fixator that requires neither an adjustment of the pin/pin clamp connection nor special pre-alignment is demonstrated. Based on the constraint equations and criteria developed throughout this study, the creation of an effective frame design of external fixation device becomes feasible.