Temporary External Fixation for the Management of Complex Intra- and Periarticular Fractures of the Lower Extremity

Complex intra-articular and periarticular fractures of the lower extremity are challenging injuries to treat. Recently, the concept of utilizing a staged approach with temporary external fixation, a delay to allow soft-tissue healing followed by open reduction and internal fixation, has gained popularity. Historically high complication rates appear to be significantly improved with this strategy. Temporary external fixation is also useful in other settings, such as in the initial management of polytraumatized patients with multiple complex fractures, augmentation of internal fixation in osteoporotic bone, etc. This article reviews current indications, techniques, potential complications, and results of temporary external fixation for complex fractures of the lower extremity.

[1]  L. Bolano,et al.  Ilizarov Treatment of Pilon Fractures , 1996, Clinical orthopaedics and related research.

[2]  R. Gustilo,et al.  Update on the management of open fractures of the tibial shaft. , 1998, Clinical orthopaedics and related research.

[3]  R. Gustilo,et al.  Infection after intramedullary nailing of severe open tibial fractures initially treated with external fixation. , 1989, The Journal of bone and joint surgery. American volume.

[4]  J. B. Kneeland,et al.  Impact of CT scan on treatment plan and fracture classification of tibial plateau fractures. , 1997, Journal of orthopaedic trauma.

[5]  M. Evans,et al.  The Use of Combination Internal Fixation and Hybrid External Fixation in Severe Proximal Tibia Fractures , 1995, Journal of orthopaedic trauma.

[6]  J. Borrelli,et al.  Open reduction and internal fixation of pilon fractures. , 1999, Journal of orthopaedic trauma.

[7]  D. Wiss,et al.  Open reduction and internal fixation of tibial plafond fractures. Variables contributing to poor results and complications. , 1993 .

[8]  R. Sanders,et al.  A staged protocol for soft-tissue management in the treatment of complex pilon fractures , 1999, Journal of orthopaedic trauma.

[9]  J. Anglen Early outcome of hybrid external fixation for fracture of the distal tibia. , 1999, Journal of orthopaedic trauma.

[10]  M. J. Patterson,et al.  Two-staged delayed open reduction and internal fixation of severe pilon fractures. , 1999, Journal of orthopaedic trauma.

[11]  T. Limbird,et al.  Operative Treatment of Fractures of the Tibial Plafond. A Randomized, Prospective Study* , 1996, The Journal of bone and joint surgery. American volume.

[12]  L. Weiner,et al.  Displaced pilon fractures. An update. , 1994, The Orthopedic clinics of North America.

[13]  B. Moed,et al.  Perioperative external fixator management during secondary surgical procedures , 2000 .

[14]  T. Mcconnell,et al.  Percutaneous Pin Placement in the Medial Calcaneus: Is Anywhere Safe? , 2002, Journal of orthopaedic trauma.

[15]  R. Sanders,et al.  Treatment of Complex Tibial Periarticular Fractures Using Percutaneous Techniques , 2000, Clinical orthopaedics and related research.

[16]  K. Koval,et al.  Hybrid External Fixation in the Treatment of Tibial Plafond Fractures , 1996, Clinical orthopaedics and related research.

[17]  J L Marsh,et al.  Use of an articulated external fixator for fractures of the tibial plafond. , 1995, The Journal of bone and joint surgery. American volume.

[18]  O. Trentz,et al.  Critical Soft Tissue Conditions and Pilon Fractures , 1993 .

[19]  P. Tornetta,et al.  Axial Computed Tomography of Pilon Fractures , 1996, Clinical orthopaedics and related research.

[20]  F. Lavini,et al.  Fractures of the Tibial Pilon , 2004, Springer Milan.

[21]  P. Tornetta,et al.  Hybrid external fixation of tibial pilon fractures. , 2000, Foot and ankle clinics.

[22]  J. L. Marsh,et al.  External fixation and limited internal fixation for complex fractures of the tibial plateau. , 1995, The Journal of bone and joint surgery. American volume.

[23]  C. Krettek,et al.  Surgical Options for the Treatment of Severe Tibial Pilon Fractures: A Study of Three Techniques , 2001, Journal of orthopaedic trauma.

[24]  Robert N. Hensinger,et al.  Annual Meeting of the American Academy of Orthopaedic Surgeons , 1995 .

[25]  J. Watson,et al.  Treatment of Complex Lateral Plateau Fractures Using Ilizarov Techniques , 1998, Clinical orthopaedics and related research.

[26]  P. Broos,et al.  Open fractures of the femoral shaft, treated with osteosynthesis or temporary external fixation. , 1995, Injury.

[27]  A. Mallik,et al.  Hybrid External Fixation of Comminuted Tibial Plateau Fractures , 1996, Clinical orthopaedics and related research.

[28]  K. Koval,et al.  Intraarticular "pilon" fracture of the tibia. , 1994, Clinical orthopaedics and related research.

[29]  J. Watson High-energy fractures of the tibial plateau. , 1994, The Orthopedic clinics of North America.

[30]  J. Anglen,et al.  Temporary transarticular external fixation of the knee and ankle. , 1998, Journal of orthopaedic trauma.

[31]  Watson Jt,et al.  High-energy fractures of the tibial plateau , 1994 .

[32]  Gustilo Rb,et al.  Immediate internal fixation in open fractures. , 1980 .

[33]  P. Tornetta,et al.  Pilon Fractures: Treatment With Combined Internal and External Fixation , 1993, Journal of orthopaedic trauma.

[34]  C. Bono,et al.  Percutaneous methods of tibial plateau fixation. , 2000, Clinical orthopaedics and related research.

[35]  R. Brumback,et al.  Fractures of the tibial plafond. Evolving treatment concepts for the pilon fracture. , 1995, The Orthopedic clinics of North America.

[36]  M. Swiontkowski,et al.  Clinical and functional outcomes of internal fixation of displaced pilon fractures. , 1998, Clinical orthopaedics and related research.

[37]  R. Ruland,et al.  The management of the soft tissues in pilon fractures. , 1993, Clinical orthopaedics and related research.

[38]  J. Borrelli,et al.  Minimally invasive plate osteosynthesis of distal fractures of the tibia. , 1997, Injury.

[39]  W. Ls,et al.  Displaced pilon fractures. An update. , 1994 .

[40]  R. Sanders Intra‐Articular Fractures of the Calcaneus: Present State of the Art , 1992, Journal of orthopaedic trauma.

[41]  R. Gustilo,et al.  Immediate internal fixation in open fractures. , 1980, The Orthopedic clinics of North America.

[42]  R. Sanders Operative Principles of Ilizarov , 1992 .

[43]  J. Watson,et al.  Pilon Fractures: Treatment Protocol Based on Severity of Soft Tissue Injury , 2000, Clinical orthopaedics and related research.

[44]  R. Seibel,et al.  External fixation of severely comminuted and open tibial pilon fractures. , 1993, Clinical orthopaedics and related research.

[45]  A. Mallik,et al.  Hybrid external fixation in tibial plafond fractures. , 1996, Clinical orthopaedics and related research.