[External fixation in open fractures of leg. Analysis of traps and complications of the method]

A consecutive series of 51 compound tibial fractures treated by external fixation have been reviewed. All the cases whose progress was marred by complications were analysed separately. From this analysis, the following conclusions have been reached: 1. A gap at the fracture site, due to loss of bone substance or to distraction of the fragments should be treated as soon as possible by bone grafts. 2. Inadequate reduction should be corrected at the time of primary treatment. 3. Pins inserted into the region of the fracture should be repositioned early to prevent infection along the pin tracks. 4. If a sequestrum is evident, it is often necessary to remove such a focus of infection. 5. Weight-bearing, whenever feasible, should be started as soon as possible. A patellar-tendon-bearing orthosis or unilateral semi-elastic external fixation are possible satisfactory solutions in this respect. 6. When the fracture site is infected and contains necrotic fragments, the superiority of external fixation over internal fixation is obvious. The method makes it possible to stabilise the fragments without interfering with local healing and allows the exposed bone to be covered in a stable environment. Because of this analysis of the complications and pitfalls of external fixation, we have been able to put forward a regimen of treatment that may improve results.