Abstract
To review healing rates, complications, alignment, length and function in non-unions treated with Mono-lateral External Fixation.
A cohort of 110 patients (113 segments) treated for non-union, by mono-lateral external fixation in Sheffield between 1987 and 1996 is reviewed. There were 83 males and 27 females with a mean age of 37.2 years. 67 patients had high-energy injuries and there were 56 open fractures. There were 60 tibiae, 38 femora and the rest were upper limb long bones with a mean of 3.2 previous procedures. The mean duration of non-union was 23.4 months (range 3–123). There were 64 monofocal procedures with 41 supported in neutralisation, 20 in compression and three in distraction. There were 49 bifocal procedures (33 compression distraction and 16 bone transport). 71 segments required a bone graft.
The success rate using the initial fixator was 90%. Clinical and radiological union was achieved in 109 segments (96.5%) although seven required further fixation and one subsequently went on to amputation for ischamia. All five amputations were in smokers and three were directly related to vascular failure.
The mean hospital stay was 21.12 days and the mean number of operations per patients was 2.55.The mean time to bony union was 12.69 months (range 2.5-64). The Length gained mean 4.5 cm (range 1.5-12 cm). Angular correction achieved 12° (range 2-39°); The bony and functional results were assessed at the end of treatment by system described by Paley & Catagni (JBJS 77A, 1995).
| Bony results | |
| Excellent | 42% |
| Good | 50% |
| Fair | 0.3% |
| Poor | 0.0% |
| Amputations | 4.4% |
| Functional results | |
| Excellent | 59 cases |
| Good | 34 cases |
| Fair | 03 cases |
| Poor | 00 |
Monolateral external fixation can provide stable fixation for the treatment of established non-unions. The fracture environment may be carefully controlled and angulation and length corrected simultaneously. Interestingly 11 out of 12 problem cases were in smokers.
The abstracts were prepared by Mr Simon Donell. Correspondence should be addressed to him at the Department of Orthopaedics, Norfolk & Norwich Hospital, Level 4, Centre Block, Colney Lane, Norwich NR4 7UY, United Kingdom.
