Complication rate and pitfalls of temporary bridging external fixator in periarticular communited fractures

A second staged operation using temporary bridging external fixation (TBEF) has been widely used in patients with periarticular complex fracture, yet few papers have been published on the related complications. The purpose of this study was to report the complication rate and pitfalls directly related to TBEF through a retrospective study and to suggest some solutions.

Fifty-nine cases that were treated by using TBEF were studied among 195 periarticular complex fractures. We retrospectively collected the clinical and radiological data and then the study data was evaluated for 1) cases with unsatisfactory restoration of length, 2) cases with deep infection caused by half pins invading the zone of definitive fixation, and 3) neurovascular injuries related to half pins.

Complications were observed in 7/59 cases (11%). Problems related to the achievement of length were observed in one case of distal tibia fracture and 2 cases of distal femur fracture. Half pin related infection was observed in 2 cases of distal femur fracture. Neurovascular injury (medial calcaneal nerve injury in a distal tibia fracture) was observed in 2 cases. Among 7 complications, four were related to using TBEF in distal femur fracture. This is because the abundant leg muscles have strong deforming force and infection might be increased due to frequent irritation by the half pins.

TBEF is a simple procedure with several advantages. However, complications might be observed if certain principles are not followed. It is thought that many complications due to TBEF can be reduced if the half pins are not inserted in the zone of injury, restoration of length is fully achieved and the neurovascular characteristics are carefully considered. In particular, much more caution is needed in the distal femur, which has abundant muscles surrounding it.