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Circular external fixation for revision of failed tibia internal fixation

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Background

The management of failed tibial fracture fixation remains a challenge for orthopaedic surgeons. This study investigate the utility and outcomes of circular external fixation in the management of failed internal fixation of tibial fractures.

Methods

Retrospective review of a prospectively collected database of a complex limb reconstruction unit at a major trauma centre was done during December 2022. Patients with failed internal fixation of tibial fracture who underwent revision surgery with circular external fixation frame were included.

Results

20 patients with a mean age of 47.8 ± 16.5 years (range: 15–69) were included. Fourteen (70.0%) patients had failed plate and screws fixations, and the remaining six (30.0%) failed intramedullary nail fixation. The most common indication for revision surgery was development of early postoperative surgical site infection (5 patients; 25.0%). The mean duration of frame treatment was 199.5 ± 80.1 days (range = 49–364), while the mean follow-up duration following frame removal was 3.2 ± 1.8 years (range = 2–8). The overall union rate in this series was 100%; and all infected cases had complete resolution from infection. The total number of complications was 11, however, only two complications required surgical intervention. The most common complications reported were pin site infection (6; 30.0%) and limb length discrepancy of 2 cm (2; 10.0%).

Conclusions

Circular external fixation is a reliable surgical option in the treatment of failed internal fixation of tibia fractures. This technique can provide limb salvage in complex infected and noninfected cases with a high union rate and minimal major complications.

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Data availability

Available upon request.

Code availability

Not applicable.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Surgery, College of Medicine, Health Sciences Centre, Kuwait University, Kuwait City, Kuwait

    Yousef Marwan

  2. Limb Reconstruction Unit, Department of Trauma and Orthopaedic Surgery, Hull University Teaching Hospitals, Hull, UK

    Jeffrey Turner, Rahul Senan, Ross Muir, Elizabeth Barron, Yvonne Hadland, Elizabeth Moulder & Hemant Sharma

Authors
  1. Yousef Marwan
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  2. Jeffrey Turner
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  3. Rahul Senan
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  4. Ross Muir
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  5. Elizabeth Barron
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  6. Yvonne Hadland
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  7. Elizabeth Moulder
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  8. Hemant Sharma
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Contributions

YM contributed to all steps of the research. JT and RS contributed to data collection, analysis, interpretation and manuscript preparation. RM, EB, YH and EM contributed to data interpretation and manuscript preparation. HS was the senior author supervising and contributing to all steps of the research.

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Correspondence to Yousef Marwan.

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The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

The study protocol was reviewed and approved by our institutional governance board (protocol number: 2022.231).

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Marwan, Y., Turner, J., Senan, R. et al. Circular external fixation for revision of failed tibia internal fixation. Eur J Orthop Surg Traumatol 34, 353–361 (2024). https://doi.org/10.1007/s00590-023-03660-5

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  • DOI: https://doi.org/10.1007/s00590-023-03660-5

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