Clinical outcome of conversion from external fixation to definitive internal fixation for open fracture of the lower limb

• Published in: Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association Vol. 24; no. 5; pp. 888 - 893
• Main Authors: Matsumura, Tomohiro, Takahashi, Tsuneari, Miyamoto, Osamu, Saito, Tomohiro, Kimura, Atsushi, Takeshita, Katsushi
• Format: Journal Article
• Language: English
• Published: Japan Elsevier B.V 01.09.2019
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; External Fixators; Female; Fracture Fixation, Internal - methods; Fractures, Open - surgery; Humans; Lower Extremity - injuries; Lower Extremity - surgery; Male; Middle Aged; Open Fracture Reduction - methods; Postoperative Complications; Retrospective Studies; Treatment Outcome; Young Adult
• ISSN: 0949-2658; 1436-2023
• DOI: 10.1016/j.jos.2019.01.009

Few reports have examined the outcomes and complications of temporary bridging external fixation (EF) in open fracture of the lower limb followed by conversion to open reduction internal fixation (ORIF). The purpose of this study was to evaluate healing rates and complications in patients treated with conversion from external fixation to definitive internal fixation for open fracture of the lower limb. Patients who underwent temporary bridging EF and subsequent conversion to internal fixation (IF) for open fracture of the lower limb, with follow-up period ≥12 months were included in this study. Demographic data, Gustilo-Anderson classification, fracture type, duration to definitive surgery, surgical procedure, perioperative complications, and additional procedures for cases with complications were obtained. In total, 58 patients (43 males, 15 females), 63 fractures were included in this study. Four fractures (6.3%) were Gustilo grade I, 11 fractures (17.5%) were grade II, 34 fractures (54.0%) were grade IIIa, 12 fractures (19.0%) were grade IIIb, and two fractures (3.2%) were grade IIIc. Mean duration of the application of EF was 12.4 days (range, 3–45 days) until conversion to definitive IF. Rates of deep infection and nonunion were both 9.5%, with two cases showing concomitant infection and nonunion. Rates of infection were 8.8% (3/34) in grade IIIa and 25% (3/12) in grade IIIb. Rates of nonunion were 9.1% (1/11) in grade II, 2.9% (1/34) in grade IIIa and 33% (4/12) in grade IIIb. Temporary EF for open fracture of the lower limb followed by conversion to IF, as early as soft tissue and general condition permit, may be a safe and effective procedure for patients with lower-limb open fracture of Gustilo grade IIIa or less. Level IV, Case series.