Developments in circular external fixators: A review

Area of Science:

• Orthopedic biomechanics
• Biomaterials engineering
• Medical device design

Background:

• Circular external fixators (CEFs) offer superior stiffness for bone healing.
• Optimal biomechanical performance through CEF structural and component design is not fully understood.
• A comprehensive review is needed to consolidate current knowledge and identify future research directions.

Purpose of the Study:

• To systematically review circular external fixator designs and their biomechanical implications.
• To identify trends, research gaps, and future directions in CEF development.
• To follow PRISMA guidelines for a rigorous and transparent review process.

Main Methods:

• Systematic literature search on Scopus and PubMed using relevant keywords.
• Patent search conducted on the Google Patent database.
• PRISMA-compliant review of 126 eligible records, including bibliometric analysis.

Main Results:

• Summarized and tabulated various CEF designs based on specific features.
• Discussed developments in materials, automation, adjustment methods, component design, wire-clamping, and performance evaluation.
• Identified significant research gaps, including ease of assembly, effective wire-clamping, and integrated patient-monitoring systems.

Conclusions:

• CEF design has advanced significantly, but key areas require further research for enhanced clinical application.
• Future research should focus on improving assembly, developing robust clamping mechanisms, and incorporating real-time monitoring.
• Increased research engagement from low- and middle-income countries is crucial for global advancement in CEF technology.