Staged Procedures after Failing Ring Fixators of Lower Limb? Series of 15 Cases Abstract

Background: Failure of the fixators is a challenging, especially in the presence of osteoporosis, bone defect, pin track infection and joint stiffness. This study aims at evaluating the functional outcomes of the lower limb proposed two-stage management of non-union after failed ring external fixation. Patients and Methods: 15 patients (six females) with age range 22-65 years enrolled in this study. Four had femoral fractures and eleven with tibial fractures. All were due to high-energy trauma and all were open ones (3 grade (I), 8 grade (II) and 4 grade (III)). Categorised AO classification, 5 type (A), 4 type (B) and 6 type (C). They initially treated by ring external fixators and had radiological signs of non-union. Treatment involved removal of external fixators, pin track and blood tests until no active infection. Non-union managed by refreshing the fracture ends, opening the medullary canal, packing the non-union with autogenous bone grafts then realigning the fracture properly and stabilizing it with locked plate or interlocking nail. Results: Average duration of nonunion 9.8 months. Average delay prior to osteosynthesis after removal of external fixation 15 days. All non-unions healed on an average 5.2 months. According to the Karlstrom-Olerud scores, final functional outcome score was excellent 7cases, good 5 cases, accepted 2 cases and poor one case. Conclusions: Two-stage treatment of non-union of long bone after ring fixation is an effective tool and may be a favorable option with low risk of complications and a high level of functional outcomes.