Complications of Circular Ring External Fixation of the Foot and Ankle

Circular ring external fixation has been found to be successful in the treatment of a wide range of foot and ankle pathologies, particularly in patients with multiple comorbidities and soft-tissue compromise, but the procedures are technically demanding, and complications are common. The primary goal of this study was to identify complications associated with circular ring external fixation, and the secondary aim was to identify any independent risk factors associated with them.

Institutional review board approval was obtained, and a retrospective review was performed of 99 consecutive patients undergoing 100 foot or ankle procedures involving circular ring external fixation. Patient demographics, duration of fixator use, indications for the procedures, and outcomes were recorded. Clinical characteristics and indications for circular ring external fixation were tested for association with complications.

Sixty-one patients experienced 67 complications. Forty-six complications were minor and 21 were major. Body mass index was the only preoperative variable demonstrating a significant increase in complications (P < .001). Obese patients had 3.2 times the odds of having a complication as nonobese patients (95% confidence interval, 1.4-7.6). Patients with diabetes or Charcot's arthropathy showed an increase in complications.

Complications are common with circular ring external fixation of the foot and ankle, and most are minor fine wire complications. There are many variables that may contribute to complications, but obesity was most predictive in this study.