Safety and Complication Rate of Ring External Fixation in the Foot and Ankle

Abstract

External fixation is a powerful tool for foot and ankle surgeons. Currently, there is no consensus on true complication rate. The purpose of this study was to report our institution's complication rate of ring external fixation performed by a single surgeon. We retrospectively evaluated electronic medical record of 224 patients with 238 circular frames between 2009 to 2021 at a single institution. We defined minor complications as a frame managed without early frame removal or return to operating room. Major complications were defined as early return to operative room or early removal defined by our institution as less than two months. We recorded over 1,642 Ilizarov wires and 278 half pins; 10% (n=163) of wires and 7% (n=19) of half pins had a complication. We recorded 44% (n=104) minor complications and 9% (n=22) major complications. Minor complications average (mean) onset was four weeks, 89% (n=93) involved wires, and 73% resolved without additional care. Major complications average (mean) onset was 3.7 weeks. Of these, 32% (n=7) went on to successful revision. This revealed a significant correlation between minor complications and history of osteomyelitis (p<0.05). While minor complications do appear high, we find this was due to wire irritation and local erythema which resolved without additional intervention. To better assess complications with external fixation we believe that wire irritation and pin site erythema should be recognized as an expected outcome. A better understanding of ring external fixation in foot and ankle surgery is vital to appropriate perioperative management and patient care. Clinical level of Evidence: IV, retrospective chart review.