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ORIGINAL ARTICLE
Year : 2021  |  Volume : 7  |  Issue : 1  |  Page : 1-7

Circular external fixation as an alternative method of stabilization for extra-articular tibia fractures in the elderly


1 Department of Orthopaedics and Traumatology, Menaggio Hospital, ASST Lariana, Como, Italy
2 Department of Orthopedics, Columbia University, Chairman of Orthopedic Surgery, Mount Sinai Medical Center, Miami Beach, FL, USA
3 Department of Orthopedic Foot and Ankle Surgery, Limb Lengthening and Reconstruction, Mount Sinai West, New York, USA
4 Department of Orthopaedics and Traumatology, ASST Grande Ospedale Metropolitano Niguarda, Level 1 Trauma Center, Milano, Italy
5 Department of Orthopaedic Surgery, New York Presbyterian Hospital, Columbia University Irving Medical Center, New York, USA

Correspondence Address:
Dr. Tazio Talamonti
Department of Orthopaedics and Traumatology, ASST Grande Ospedale Metropolitano Niguarda, Level 1 Trauma Center, Piazza Ospedale Maggiore, 3, 20162 Milan
Italy
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jllr.jllr_30_20

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Background: Recent epidemiologic reports from national fracture registries demonstrate an increase in the incidence of tibia fractures in the elderlies. Objectives: the objective of this retrospective study is to evaluate Circular External Fixation (CEF) for primary and definitive fixation of tibia extra-articular fractures (TEF) in the elderly treated at a level I trauma center. Materials and Methods: we evaluated a subset of 31 elderly patients (over 70 years) with 31 TEF (mean age 76 years, range 70-89) of which six (19.4%) were open treated with CEF between 2010 and 2017. 29 (93.5%) fractures underwent definitive fixation with traditional Ilizarov, 2 were treated with Sheffield and Taylor Spatial frames and evaluated clinically and radiologically accordingly to ASAMI bone and functional scores. Results: All fractures consolidated without additional procedures at an average of 21.3 weeks (range 9-42). No deep infections were observed. Four malunions within 8° occurred. ASAMI bone results were excellent in 93.6% of patients and revealed an excellent result in 21 (67.7%) of patients, eight patients (25.8%) had a good result, and 2 (6.5%) a fair result. Conclusions: CEF gave excellent results in the treatment of a variety of tibial shaft fractures in an elderly population, in terms of early return to ambulation, with average time to union, rate of delayed union, and misalignment rate comparable or superior to intramedullary nail and plate osteosynthesis, that represent the options more frequently proposed in clinical practice and literature. Advantages of circular external fixation in osteosynthesis of extra-articular tibia fractures in these patients are the minimal impact on soft tissues and the stability of the construct, that allows immediate weight bearing and early return to ambulation.


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