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Fractures: Bone Repair01:27

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Treatment for a fracture is based on the type of break, the bone affected, and the patient's age.
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the...
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Circular external fixation for revision of failed tibia internal fixation.

Yousef Marwan1, Jeffrey Turner2, Rahul Senan2

  • 1Department of Surgery, College of Medicine, Health Sciences Centre, Kuwait University, Kuwait City, Kuwait. yousefmarwan@hotmail.com.

European Journal of Orthopaedic Surgery & Traumatology : Orthopedie Traumatologie
|August 2, 2023
PubMed
Summary

Circular external fixation effectively manages failed tibial fracture fixation, offering a reliable limb salvage option. This technique achieves high union rates and resolves infections with minimal major complications.

Keywords:
External fixationHexapodIlizarovInternal fixationMalreductionMalunionNonunionTibia

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Area of Science:

  • Orthopaedic Surgery
  • Trauma Management
  • Limb Reconstruction

Background:

  • Failed tibial fracture fixation presents a significant clinical challenge.
  • Internal fixation methods (plates, screws, nails) can fail, necessitating revision surgery.
  • Circular external fixation is explored as an alternative for complex cases.

Purpose of the Study:

  • To evaluate the utility and outcomes of circular external fixation for failed tibial fracture fixation.
  • To assess the efficacy in both infected and non-infected cases.
  • To determine complication rates and union success.

Main Methods:

  • Retrospective review of a prospectively collected database from a major trauma center.
  • Inclusion criteria: patients with failed internal fixation of tibial fractures undergoing revision with circular external fixation.
  • Data collected: patient demographics, fixation type, indication for revision, treatment duration, follow-up, and outcomes.

Main Results:

  • 20 patients (mean age 47.8 years) were included, with 70% having failed plate/screw fixation and 30% failed nail fixation.
  • The most common indication for revision was early postoperative surgical site infection (25%).
  • 100% union rate achieved, with complete resolution of infection in all infected cases. Common complications included pin site infection (30%) and limb length discrepancy (10%).

Conclusions:

  • Circular external fixation is a reliable and effective surgical option for managing failed tibial fracture fixation.
  • This technique facilitates limb salvage in complex tibial fractures, including infected cases.
  • High union rates and a low incidence of major complications support its use.