Circular external fixation in complex tibia fractures: a case series and review of the literature

Objectives: To analyze indications and results of circular external fixation applied to complex tibia fracture cases in the authors' experience and in the literature. Methods: 17 cases of complex tibia fracture treated with circular external fixation in 17 patients were retrospectively evaluated to assess clinical and radiographic results. Results: There were 9/17 open fractures and 8/17 closed fractures. Union was achieved in 16 on 17 cases (94.1%), with mean union time 6.7 months (range 4-18). A septic nonunion case occurred. Malunion occurred in 3 cases. At least one unplanned surgery was necessary in 6 cases (0.6 surgeries per patient). VAS mean values were 1.6 for pain (range 0-4), 2.7 for functional impairment (range 1-8) and 8.9 for satisfaction (range 6-10). Paley scores in bone transport cases were excellent or good in most cases. Superficial pin tract infection was common (64.7% of cases), while deep pin tract infections were not recorded. Other septic and non septic complications were recorded in 3 and 7 cases respectively. Conclusions: circular external fixation still represents a viable method to treat tibia fractures when fracture pattern is particularly complex, soft tissues are severely compromised or when acute bone or bone and soft tissue loss in present. Despite frequent complications, long treatment duration and unplanned surgeries clinical results and patients satisfaction are meanly good.