An audit of circular external fixation usage in a tertiary hospital in South Africa

Abstract

Background: Circular external fixation is a well-known treatment modality in reconstructive orthopaedic surgery and is frequently used for deformity correction, limb lengthening, limb salvage, and complex diaphyseal and periarticular fractures. The current use of this treatment modality in the South African context remains largely unknown. This retrospective review aims to describe the indications, outcomes and complications of the use of circular external fixation in a tertiary hospital in South Africa. Materials and methods: We retrospectively reviewed the records of 480 patients treated with circular external fixation in a specialist limb reconstruction unit. We report on patient demographics, comorbidities, indications and outcomes. Results: The final cohort consisted of 346 men and 134 women with a mean age of 35.5 years (SD 14.9, range: 5-73). Comorbidities were identified in 163 (34.0%) patients. These included diabetes in 14 (2.9%) patients and smoking in 102 (21%) patients. HIV infection was diagnosed in 120 patients (25%) with a mean CD4 count of 425 cells/mm 3 (SD: 223, range: 82-1056). The mean time in external fixator was 24.6% weeks (SD: 15.3, range 4-159). The treatment objective was achieved in 441 patients (92%). The overall complication rate excluding pin-site infection was 26%. Pin-site infection occurred in 88 patients (18.3%) but had no impact on the outcome of treatment. Conclusion: Circular external fixation treatment objectives can be achieved in a high percentage of patients in the context of a South African specialist reconstruction unit. This study shows favourable outcomes in deformity correction, limb lengthening, limb salvage, and complex diaphyseal and periarticular fractures. Comorbid factors, including HIV, diabetes and smoking had no effect on achieving the planned outcomes, but smoking did increase the overall time in external fixator.

Treatment outcomes of civilian gunshot tibia fractures at a major trauma centre

“…A study conducted by Van der Walt and Ferreira however reported higher union rates of 100% using circular external fixators in their gunshot-induced tibia fracture sample. 21 The lower union rate with the use of circular external fixation observed in the present study may be attributed to the injury characteristics and delay in treatment for patients who were managed with this fixation modality. Furthermore, circular external fixation showed the highest FRI rates when compared to other definitive fixation methods, keeping in mind that circular fixation was reserved for patients with significant soft tissue injury or delay to surgery.…”

Limb Salvage after Lower-Leg Fracture and Popliteal Artery Transection—The Role of Vessel-First Strategy and Bone Fixation Using the Ilizarov External Fixator Device: A Case Report

“…It is well known that fractures of the shaft of the tibia often heal with some angulation, and although the amount of residual deformity that can be accepted is controversial, varus malalignment has been recognized as a cause of osteoarthritis in the medial compartment of the knee [15,16]. Some authors reported a rate of malunion with Ilizarov fixator ranging from 2% to 21.5% [17][18][19], probably due to either inadequate reduction in the fracture before fixation or loss of wire tensioning and subsequent loss of reduction [16,20]. Li et al [21] performed a systematic review and meta-analysis of peer-reviewed published studies on tibial plateau fractures treated with either open reduction with internal fixation (ORIF) or circular external fixation to compare functional, radiological outcomes, postoperative complications, and reoperation rates between the two methods.…”