Management of Failed External Fixation by Two-Staged Internal Osteosynthesis in the Lower Limb

Abstract

Objective: This study aims to evaluate the result of a two-stage (delayed conversion) management of nonunion after failed external fixation of the lower limb. Methods: A case series of 25 patients (19 males and six females) enrolled in this study between February 2008 and October 2016, mean age 33.4 years (range, 22–65 years). Eight had femoral fractures, and 17 had tibial fractures. All were due to high-energy trauma and were open fractures. All cases were presented by non-union after external fixation in the lower limb long bones. All patients were managed by two stages (delayed conversion) osteosynthesis. The patients have been assessed for rate and time for union, range of motion of adjacent joints, the Modified functional outcome score of Karlstrom-Olerud, and Trauma outcomes measure score. Results: The mean follow-up was 36.5 months (range 24–54 months). Twenty-two cases (88%) were fully united on an average of 5.3 months. According to the Karlstrom-Olerud scores, the final functional outcome score was excellent 12 cases, good 9 cases, accepted 2 cases, and poor in two cases. As regards the trauma outcome measure score, the mean TOM after 3 months was 26.1 (25.3–27.3), 30.4 (29.3–32.1) after 12 months, and 33.4 (32.3–40) after 24 months. Conclusions: The technique of two-stage treatment of nonunions of long bone after external fixation is a successful tool to achieve bony union. It could be a favorable option with a low risk of complications and a high level of functional outcomes.