Conversion of external fixation to internal fixation in a non-acute, reconstructive setting: a case series

Abstract

The aim of the study is to determine the outcomes in patients who underwent conversion from an external fixator to an internal fixation device. This is a retrospective review of 18 patients (24 limbs) who underwent conversion from external to internal fixation. The patients had external fixators applied for traumatic bone defects or congenital deformities. Conversion to internal fixation was performed for reasons of patient dissatisfaction with external fixation, pin track sepsis, persistent non-union or refracture. The complexity of cases was graded using Paley’s level of difficulty score. Patients were either converted acutely or delayed. Internal fixation devices were either intramedullary nails or plate and screws. Outcome was regarded as excellent if the patients were fully weight-bearing and pain-free on a mechanically well-aligned limb and without need for further surgery: good if the patient required subsequent surgery to achieve union and poor if irreversible complications occurred. Acute conversions (fixator removal and introduction of internal fixation device at same surgery) were done in 19 limbs and delayed conversion (interval between fixator removal and internal fixation) in 5. In the acute group, 17 limbs (89.4 %) had at least a good outcome, 16 of these limbs had an excellent result. Two limbs (10.6 %) had a poor result and required amputation. Both cases were after acute conversion to intramedullary nails; the original presenting diagnosis was of an infected non-union of the tibia and both had Paley scores above 7. In the delayed conversion group, all limbs (100 %) had at least a good outcome, with 4 limbs (80 %) having an excellent result. The mean external fixator time was 185 days (61–370). Both the cases with poor outcomes had longer external fixation times. This series supports the practice of conversion of external fixation to internal fixation with the majority of patients attaining good results. It identifies that plate devices appear to produce fewer deep sepsis complications, as compared to intramedullary nails, particularly when the original presenting diagnosis is a septic non-union.

Management of Failed External Fixation by Two‐Staged Internal Osteosynthesis in the Lower Limb

“…Complex reconstruction surgery by distraction osteogenesis may lead to prolonged periods of external fixation. Due to the complexity of cases, a need for conversion to internal fixation owing to patient non‐compliance failed progression in treatment or persistent complications with continued use of the external fixator device 14 . It is not precisely proved when is the best time to convert to definitive fixation without increasing the risk of infection 19 .…”

“…It was planned in this study to achieve our objective (healing of nonunion) through the strategy of (delayed conversion). This was to be achived by first converting the infected nonunion into non‐infected one via complete eradication of infection by thorough debridement of all involved soft tissue and removal of the fixator 14 . CRP is a helpful indicator of infection, but it is not necessarily specific and cultures are reliable tools though findings are often negative, especially in patients on antibiotics when cultures have been taken 15 .…”

“…This interval varied and the second procedure was performed when the pin tracks healed with no sign of infection. The second stage included the stabilization of fracture and bone grafting to enhance bone healing and halt nonunion [14][15][16] . This interval varied and the second procedure was performed when infection parameters were negative and pin-tracks site healed with no infection.…”

Staged Procedures after Failing Ring Fixators of Lower Limb? Series of 15 Cases Abstract

“…Bernat et al [21] reported results of 17patients with 100% union, no deep infection but only 2 superficial ones. Monni et al [22] on dealing with 5 limbs for delayed conversion of fixators to internal fixation; they reported 13.3%. infection though all their cases achieve full union.…”

Intramedullary nail after Masquelet bone graft fracture: A case report

“…The timing of this conversion is, however, controversial and the recurrence of infection remains a concern. 12,13 We report a case of successful intramedullary femur nailing following a fracture through a subtrochanteric Masquelet bone graft site.…”