Parameters of Conversion from Temporary External Fixation to Internal Fixation in Open Fractures in Adults

Abstract

Background Open fractures often have extensive soft-tissue damage requiring multiple procedures such as debridement, soft-tissue coverage, and definitive fixation through the cooperative work of orthopedic and plastic surgeons. Combined treatment for both the fracture and soft-tissue. Patients obtain many benefits from early fixation. Early stabilization facilitates patient mobility and alleviates pain and discomfort. Aim of the Work Systematically reviewing available evidence from published articles to assess points of conversion from this temporary external fixation to internal fixation in open fractures. Patients and Methods We performed this systematic review and meta-analysis in accordance to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) statement. PRISMA and MOOSE are reporting checklists for Authors, Editors, and Reviewers of the interventional and observational studies. According to International committee of medical journal association (ICJME), reviewers must report their findings according to each of the items listed in those checklists. Results The moderate negative correlation between CRP and duration of conversion from EF to IF is probably because the downward trend of CRP from the peak value was considered one factor in the timing of conversion to IF, Strategy to perform definitive IF as early as possible resulted in 91% of patients undergoing definitive IF within 3 weeks after injury. In addition, this strategy is described to be beneficial for early soft-tissue repair with low infection rate. Subsequent conversion to ORIF can safely be performed once the patient is hemodynamically and systemically stable and any local soft-tissue injury has resolved, union rate of 91%, an infection rate of 16% and one fixation failure. All the infections occurred in open fractures, of which 75% were Gustilo grade III. Conclusion In conclusion, temporary external fixation for open fracture of the lower limb followed by conversion to internal fixation, as early as soft tissue and general condition permit, may be a safe and effective procedure for patients with open fracture. It is not precisely known when is the best time to convert to definitive fixation without increasing the risk of infection.