Outcomes and Complications With Treatment of Open Tibial Plafond Fractures With Circular External Fixator

Abstract

Background: Open tibial plafond fractures (Orthopaedic Trauma Association and AO Foundation [OTA/AO] 43) are associated with severe complications, including deep infection (closed fractures, 20%; open fractures, 30%), amputation (3%-14%), and nonunion (up to 25%). Circular external fixators (CEFs) can minimize soft tissue injury. This study aimed to report the rate of union and occurrence of severe complications in patients with open tibial plafond fractures treated with CEFs. Methods: A retrospective review of case series was conducted at 3 level I trauma centers. The study included patients older than 18 years with open tibial plafond fractures treated with CEFs. The reported outcomes included union rate, deep infection, operative complications, and limb alignment. The radiographic measurements of anatomic alignment were obtained. Fifty-two patients were included in the study. Results: The primary union rate was 79%. No deep infection occurred in the majority (92%) of patients. No patient required amputation of the affected limb or free flap coverage. Conclusion: Definitive fixation of open tibial plafond fractures with CEFs avoided severe soft tissue complications but resulted in variation in final radiographic alignment. Level of Evidence: Level IV, case series.

Staged correction trajectory with hexapod external fixator for the satisfactory reduction of acute long bone shaft fracture

“…Combined with the Ilizarov circular external xator and the Chasles theorem of six-axis motion 15,16 , the hexapod external xator has played an important role in orthopedic and reconstructive surgery due to the advantages of simultaneous correction of multiplanar spatial deformities without frame modi cation 4,7,8,10,12,[17][18][19] . Initially developed for gradual deformity correction, the hexapod external xator expanded to conduct the management of fracture and bone nonunion 11,12,[19][20][21] .…”

“…The circular external xators with the versatility of eliminating bending and translational shear while maintaining a degree of axial micromotion, providing a three-dimensional stable biomechanical environment that is conducive to bone healing and regenerate formation [1][2][3] . With the advantages of minimal soft tissue disruption and early weight-bearing, it has given satisfactory clinical outcomes especially for high-energy fractures with poor surrounding soft tissues [4][5][6][7] .…”

Staged correction trajectory with hexapod external fixator for the satisfactory reduction of long bone shaft fracture

“…Circular external fixators provide both stable threedimensional fixation and a degree of axial micromotion, promoting bone healing process and regeneration [1][2][3]. Minimal soft tissue damage and possibility of early weight bearing give to expect a good final outcome in bone fractures external fixation, especially in high energy fractures accompanied by poor surrounding soft tissues [4][5][6][7].…”

Significant Factors of High Performance Outcomes for Tibial Plafond Fractures

“…These injuries often result in life-altering disability and reduced quality of life from wound slough, infection, stiffness, deformity, and post-traumatic arthritis that can result in subsequent ankle arthrodesis, amputation, and ankle replacement. 11,14,15,21,30 To determine return to function following these injuries, several patient-reported outcome measures (PROMs) have been developed to evaluate various domains of patient function. Patient Reported Outcome Measurement Information System (PROMIS) physical function (PF) computer adaptive testing (CAT) has been more recently implemented in clinical settings and has demonstrated to be a reliable indicator of outcome.…”