Unplanned 10-year retention of an external fixator for a proximal tibial fracture

A 45-year-old homeless male patient did not return for follow-up for routine removal 72 days after an external fixator had been placed for a grade II open fracture of the proximal tibia. Ten years later, he was accidentally referred to our institution for newly incurred fractures of the femoral neck on the same side and also for an opposite-side medial malleolus fracture. The patient was still homeless, with signs of poor personal hygiene, but the original external fixator was in place. Union of his previous proximal tibia fracture had occurred, and there were no signs of any pin-tract infection. Possibilities for this successful outcome include fracture stability, subsequent healing without pin breakage, and 7 weeks of professional wound care before the patient's initial discharge from the hospital, resulting in a scarred skin barrier at the pin-skin interface.