THE USE OF CIRCULAR EXTERNAL FIXATORS FOR FRACTURE STABILISATION AND MANAGEMENT OF FRACTURE NON-UNION. A REVIEW OF 15 YEARS EXPERIENCE

Abstract

Background: Ilizarov and Taylor Spatial Fixators are commonly used in the management of complex fractures and in the management of fracture non-union at our institute. We aim to review 15 years of circular frame use by a single surgeon to assess the incidence of successful treatment of fractures and fracture non-unions.

Methods: We retrospectively reviewed the case notes, theatre lists, and radiology records of all patients who had been treated with a circular fixator over the past 15 years. We identified 134 procedures in 114 patients where a circular fixator was used for fracture stabilisation or treatment of non-union of fracture. We documented the length of time each frame was in-situ and the outcome of treatment.

Results: We identified 60 fractures in 54 patients and 74 fracture non-unions in 73 patients. Of the fracture non-unions 20 were known to be infected and 74 were considered sterile. Average length of time with a fixator in -situ was 243 days for the fracture group, 301 days for the sterile non-union group, and 343 days for the infected non-union group. 50 of 60 (83.3%) fractures united satisfactorily and four mal-united. Five fractures developed sterile non-union and one developed infected non-union. Of 54 sterile non-unions 42 united (77.8%), five with significant mal-union. Three were thought to have united but re-fractured after removal of frame. Eight failed to unite and one patient died of unrelated cause with fixator in-situ. Of 20 infected non-unions, fourteen united (70%), three with significant mal-union. One non-union was thought to have healed but re-fractured when the fixator was removed. Four remained infected and failed to unite and one failed due to soft tissue complications not associated with the fixator.

Conclusions: Circular External Fixators are an appropriate method of treatment for complex fractures and fractures that have failed to unite when treated with alternative fixation devices.