Clin Orthop Surg.  2011 Mar;3(1):62-68. 10.4055/cios.2011.3.1.62.

Complication Rate and Pitfalls of Temporary Bridging External Fixator in Periarticular Communited Fractures

• Oh JK
• Hwang JH
• Sahu D
• Jun SH

• KMID: 999462
• DOI: http://doi.org/10.4055/cios.2011.3.1.62

Abstract

BACKGROUND
A second staged operation using temporary bridging external fixation (TBEF) has been widely used in patients with periarticular complex fracture, yet few papers have been published on the related complications. The purpose of this study was to report the complication rate and pitfalls directly related to TBEF through a retrospective study and to suggest some solutions.
METHODS
Fifty-nine cases that were treated by using TBEF were studied among 195 periarticular complex fractures. We retrospectively collected the clinical and radiological data and then the study data was evaluated for 1) cases with unsatisfactory restoration of length, 2) cases with deep infection caused by half pins invading the zone of definitive fixation, and 3) neurovascular injuries related to half pins.
RESULTS
Complications were observed in 7/59 cases (11%). Problems related to the achievement of length were observed in one case of distal tibia fracture and 2 cases of distal femur fracture. Half pin related infection was observed in 2 cases of distal femur fracture. Neurovascular injury (medial calcaneal nerve injury in a distal tibia fracture) was observed in 2 cases. Among 7 complications, four were related to using TBEF in distal femur fracture. This is because the abundant leg muscles have strong deforming force and infection might be increased due to frequent irritation by the half pins.
CONCLUSIONS
TBEF is a simple procedure with several advantages. However, complications might be observed if certain principles are not followed. It is thought that many complications due to TBEF can be reduced if the half pins are not inserted in the zone of injury, restoration of length is fully achieved and the neurovascular characteristics are carefully considered. In particular, much more caution is needed in the distal femur, which has abundant muscles surrounding it.

Keyword

Periarticular fractures; Bridging external fixator; Complication

MeSH Terms

Adult
Aged
External Fixators/*adverse effects
Female
Femoral Fractures/*surgery
Fracture Fixation/*adverse effects/methods
Fractures, Comminuted/*surgery
Humans
Leg Length Inequality/etiology
Male
Middle Aged
Peripheral Nerves/injuries
Retrospective Studies
Surgical Wound Infection/*etiology
Tibial Fractures/*surgery
Young Adult

Figure

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  Fig. 1 (A) Radiographs showing the severe external rotation of the proximal femur (white arrow), shortening and flexion deformity of the distal femur (arrow head) and valgus deformity of the proximal tibia (star). The proximal and distal half pins were placed without considering the definitive fixation. (B) A fluoroscopy image shows obtaining lengthening with the use of the push technique during the operation. (C) Restoration of all alignments after surgery.

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  Fig. 2 (A) Distal half pins were inserted in the medial calcaneal side and the 1st metatarsal base. (B, C) A medial calcaneal pin was inserted almost at the end of the heel.

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  Fig. 3 (A) The proximal half pins were invading the zone of definitive fixation (white arrow). Also, the distal half pins were invading the infected areas of the open fracture. (B) Just before converting, the displaced half pins and debridement wound are shown (arrow heads). (C) A photo showing the invasion to the zone of definitive fixation even after the surgery was performed without the findings of infection at 2 weeks after re-frame and debridement. (D) The infected area at 10 days after surgery.

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  Fig. 4 (A) Distal two half pins were inserted and traction was performed to restore the length (big white arrow). After that, another half pin was inserted in the proximal femur to correct the internal rotation (small white arrow). Then two proximal half pins were inserted. (B) Restoration of length during the operation. (C, D) The internal rotation after proximal external rotation during the operation. (E) A photo after surgery shows that the length and external rotation were corrected.

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