Circular External Fixator Research Articles

The use of circular and hybrid external skeletal fixation systems to repair open tibial fractures in large ruminants: a report of six clinical cases.

A prospective clinical study consisting of six bovines (200-300kg body weight) undergoing open tibial fractures was carried out, to evaluate the use of circular and hybrid external skeletal fixation (ESF) systems for open tibial fracture repair in large ruminants. The ESF systems consisting of 4 full rings (n = 2), 8 half-rings (n = 1), 2 full rings with 2 sidebars (n = 2) or 2 full rings with 4 sidebars (n = 1) were used to treat open tibial fractures. The healing progress of the animals was evaluated based on different clinical and radiographic examinations. The level of fracture reduction, alignment, and fixation ranged between satisfactory to adequate in all the animals. The fixators were well tolerated and maintained by the animals till the complete repair of the fracture. Adequate fracture healing with satisfactory functional recovery was observed in all the animals in about 3-4months. The different designs of ESFs were found to provide adequate stability in open tibial fractures in animals weighing 200-300kg. However, the fixators need to be evaluated in numerous clinical cases to establish their suitability in routine clinical settings.

Treatment of tibial shaft nonunion with a retained nail in morbidly obese patients.

Morbid obesity is a rising worldwide health problem. Tibial shaft nonunion with retained intramedullary nail (IMN) in the morbidly obese is a challenging orthopaedic problem. Prolonged immobilization carries a significant risk of complications. This study aimed to investigate whether decortication and cancellous bone grafting with the application of a circular external fixator (CEF) over the preexisting IMN can achieve fracture union and avoid serious complications. We retrospectively reviewed 27 consecutive morbidly obese patients treated for tibial diaphysis aseptic nonunion after failed IMN. All cases were treated with osteoperiosteal decortication, cancellous bone grafting, and fixation with CEF over the IMN. Peri-operative multidisciplinary patient evaluation included internal medicine, cardiology, chest, vascular surgery, and anesthesia consultations. The union rate, bone results, functional results, and complications were recorded. The mean age of the patients was 37.9years. The mean BMI was 45.8. Sixteen cases (59.3%) were treated for hypertrophic nonunion, while 11 cases (40.7%) were treated for atrophic nonunion. Seven cases (25.9%) had open initial injury, 14 cases (51.9%) had associated comorbidities, and seven cases (25.9%) were smokers. Twenty-six cases united. The mean time to union was 5.2months. Bone results and functional results were good to excellent in 96.3% of the cases. We recorded 25 complications in 21 patients. However, most of the complications were minor. Decortication and cancellous bone grafting with the application of CEF over the preexisting nail is a safe and reliable treatment method for aseptic tibial shaft nonunion with retained IMN in morbidly obese patients.

Periprosthetic Fracture After Hindfoot Fusion Nail Treated With Spanning Antegrade Tibial Nail.

Level V.

Comparative Stiffness Characteristics of Ilizarov- and Hexapod-type External Frame Constructs.

BackgroundThe Ilizarov method and fixator are clinically recognised for the treatment of fractures, limb salvage and deformity correction. There have been extensive studies determining the basic mechanism for fracture healing using this technique. It is generally accepted that circular frames optimise the mechanical environment by reducing shear strain across the fracture while maintaining axial micromotion so as to promote fracture healing. There have been several new hexapod-type frames introduced into the market over the past 20 years with little comparative research into their biomechanical properties and resultant effects on the fracture environment.Questions/purposesTo investigate the biomechanical behaviours of the TrueLok-Hex (TL-HEX) and Taylor spatial frame (TSF) hexapod-type circular external fixators with comparison to traditional Ilizarov-type (TL-Ilizarov and TSF-Ilizarov) constructs and potential performance in vivo.MethodsTesting was performed on standardised four-ring TSF and TL-HEX constructs matched by identical frames using Ilizarov threaded rod constructs for each set of components. All frames were tested under physiological levels of axial, bending and torsional loading. Load-deformation properties for each construct under each mode of loading were calculated and analysed statistically using ANOVA.ResultsUnder axial loading, the Ilizarov construct utilising TL-HEX components demonstrated the greatest rigidity followed by the Ilizarov construct using TSF components. Under bending loads, the difference in rigidity between constructs was similar but less marked. Under torsional loading, both hexapod frames were seen to be significantly more rigid than the Ilizarov constructs. Overall deformation around neutral loading was much higher in the TSF frame due to an observed significant “toe-in” laxity in the strut universal joints. The remaining deformation of both hexapod frames was similar with a higher level of TL-HEX rigidity in axial loading and a higher level of TSF rigidity in bending and torsion.ConclusionIn conclusion, both hexapod frame constructs were less rigid under axial loading but more rigid under bending and torsional loads than their comparative Ilizarov constructs. As a result of their Cardan universal joints, the TSF demonstrated greater overall planar strain due to the observed “toe-in” laxity around neutral loading while the TL-HEX, with ball-and-socket universal joints, demonstrated a minimal level of laxity. Beyond the initial deformation due to the preloaded laxity, both hexapod frames responded to loading in a similar manner. There were significant differences in the frames’ mechanical behaviour under different loading conditions but further research is required to determine whether these translate in vivo into clinical significance.How to cite this articleFenton C, Henderson D, Samchukov M, et al. Comparative Stiffness Characteristics of Ilizarov- and Hexapod-type External Frame Constructs. Strategies Trauma Limb Reconstr 2021;16(3):138–143.

Evaluation of a novel semicircular locking external fixator for treating fractures of long bones: Biomechanical comparison with a circular external fixator

PurposeThis study aimed to investigate the biomechanical properties of a novel semicircular locking external fixator with locking screw mechanism, shape of trapezoidal corrugations, half- ring designed for greater stability. Materials and methodsThe novel external fixator had a half-ring with the shape of trapezoidal corrugations and locking screws fixing the bone at different angles in all three planes (sagittal, axial, and coronal). The biomechanical properties of the semicircular locking external fixator (group 1) were compared with those of a standard Ilizarov-type circular external fixator (group 2) (TST, İstanbul, Turkey) in an experimental study design. Five frames were used in each group. Standard PE 1000 (polyethylene) rod models (n = 10) simulating the tibia bone model were used. Both systems were compared biomechanically by applying axial and torsional loads simultaneously. ResultTwo samples in group 2 were damaged before the test ended during axial loading. All of the samples in group 1 completed the tests without damage after 150,000 cycles. The axial stiffness of the semicircular locking external fixator was found to be significantly higher than that of the Ilizarov-type circular external fixator (p < 0.05). No statistically significant difference was found between the two fixators in torsional loading. The application time of semicircular locking external fixator was significantly shorter than Ilizarov-type circular external fixator (p < 0.05). ConclusionThe novel semicircular locking external fixator was biomechanically stronger than the Ilizarov-type external fixator for treating fractures of long bones. It can be used as a permanent external fixator for the definitive treatment of long bone fractures with soft tissue damage in terms of stability and application time.

Study of surgical and functional outcome in the management of proximal tibial fracture with circular wire-based external fixation

Background: The principle of treatment in proximal tibial fracture includes soft tissue care, restoring articular surface congruity and reduction of anatomical alignment enabling early joint mobility. Aim: Assessing surgical, and functional outcomes by evaluating pain, range of motion (ROM) and muscle power in circular wire-based external fixation procedure in proximal tibial fractures with complications. Objectives: Documenting clinical observations, preoperative, and postoperative symptoms in the study population with time for bony union and complications. Materials and Methods: Thirty patients aged 18–70 years with proximal tibial fractures excluding polytrauma and pathological fracture cases were included in the prospective observational study. Surgery and post-operative follow-up were done at 6, 12, 24 weeks and 6 months. Functional assessment is done by the knee society score system. Removal of fixator followed evidence of clinical and radiological union with advice for full weight bearing. Results: Road traffic accident was a major injury, right laterality more than left. The type of tibial fractures was 41A2, A3 and C3. Eighty per cent of patients had no persistent residual pain after fracture union; 80% showed normal relative to age walking capacity, and 95% showed normal to <10° lack of extension. Fourteen patients had ROM of 125° and 120° in ten. Twenty-six patients showed normal stability in extension and 20° flexion. Twenty-five patients showed excellent knee scores, 24 showed excellent functional scores; four showed good knee scores and five showed good functional scores. Post-operative complications included pin-tract infection in four patients followed by delayed and non-union in one patient each. Conclusion: Circular wire-based external fixation in the proximal tibial fracture is an effective method of treatment even with moderate soft-tissue injury showing excellent to good functional outcome.

Presence of Complications in the Transition of a Bone Transport to a Definite Internal Fixation System without Pin Holiday: Case Report

Category:Trauma; OtherIntroduction/Purpose:Bone transports are an alternative in the treatment of severe injuries of lower extremities. They are generally associated to axis problems, delayed bone union in the docking site and pin infection. There is no evidence in the need of having a window period between the transport system and the definite internal fixation. Objetive: Describe the complications seen in a group of 6 patients that went through a tibial bone transport with circular external fixator and posterior internal fixation without pin holiday.Methods:Restrospective and decriptive study of 6 patient that went through tibial bone transport between 2012-2019, in a level 1 trauma center. Inclusion criteria considered patients >18 years old, with intra or extramedular internal fixation systems. We registered different parameters including patients comorbilities, transport time, transport index, type of internal fixation used and complications during the time of observation and treatment. We registered our clinical evaluation and both laboratory and imagenologic exams.Results:100% of patients were men, with an average of 35.8 years old (22-48 yo). 66% of injuries compromised distal tibia, 83% considered open fractures. Average transport length was 7.43 centimeters (3-11cms) in 3.5 months (1.3-6 months), with average follow up of 52 months (24-72months). Tibial transport index in our study was of 1,2month/cm. The main complication in our study was bone consolidation delay in the docking site (50%), and 33% presented deep infection, all of them in the open fracture group.Conclusion:Pin holiday has been justified by the reduction in pin site infection. In our series there where no pin site infection cases, and only two deep infections which were associated with an important soft tissue injury that required free flap coverage.

Compression of A Midfoot Osteotomy Using A Circular External Fixator: What is the Ideal Pin Configuration?

Category:Midfoot/Forefoot; Diabetes; TraumaIntroduction/Purpose:Foot and ankle deformity correction through midfoot osteotomy can be implemented in a wide variety of clinical situations. Use of a circular ring fixator for osteotomy fixation is particularly useful for patients with poor soft tissue envelopes and/or active infection as can occur in diabetes and Charcot arthropathy. The foot pins in a ring fixator can be configured to apply compression at the osteotomy site. However, the optimal pin configuration and force has yet to be determined. The purpose of this study was to quantify compressive forces achieved across midfoot osteotomies with various wire configurations in a circular ring fixator construct.Methods:Nine through-knee amputation cadavers were stabilized with a standard circular external fixation carbon frame. A midfoot osteotomy through the transverse tarsal joint was performed using an oscillating saw. A 4mm bone wedge was removed from the osteotomy site for placement of a Tekscan pressure sensor. A two-ring frame was applied in the standard fashion and three parallel 1.8mm smooth wires were placed parallel to each other through the foot distal to the osteotomy: wire #1 proximally through the cuneiforms, wire #2 through the base of the metatarsals, wire #3 through the metatarsal shafts. After baseline pressure readings, wires were sequentially attached (wire #1 alone, wire #1-2, wire #1-3) to the ring fixator and tensioned to 90kg. Pressure readings were recorded at the osteotomy site for each sequential wire tensioning both at the hole location where the wire naturally crossed, 'neutral', and again at one hole 'proximal' (e.g., toward the osteotomy).Results:Average compressive load at neutral hole positioning for wire #1 was 382 N. The addition of wire #2 increased the compressive load to 439 N on average. The addition of wire #3 decreased compressive force to 372 N. Similar trends were seen in proximal hole positioning where average compressive force increased following tensioning of wire #2 from 580 N to 600 N but compressive force decreased on wire #3 addition to 425 N. Therefore, tensioning forefoot thin wires in the proximal hole position increases compressive forces by 50% compared to neutral position, and adding a second wire increased compressive force by up to 15% compared to a single forefoot wire.Conclusion:In a circular frame midfoot fusion model, the greatest compressive force was achieved with two wires tensioned in the proximal hole position. The addition of a third wire led to force decrease likely due to off-axis forces that may distract the osteotomy site given the difficulty of passing all wires perfectly parallel in all planes. Ideal positioning and tensioning of forefoot pins may optimize construct stability and compression and improve healing of the midfoot osteotomy.

Early experience managing complex deformities using Autostrut™ robotic-controlled hexapod external fixators

Context: Hexapod circular external fixators allow bone manipulation in all planes to correct complex deformities. However, the patient must perform the strut adjustments consistently and correctly, often multiple times daily for weeks or months, to achieve intended corrections. This presents a potential source of variability, error, and anxiety to the patient. A computer-programmed, robotic automated motorized strut adjustment technology (Maxframe Autostrut™ Multi-Axial Correction System, Orthospin Ltd., Yoqneam, Israel) has been developed which automatically adjusts the struts without patient or clinician involvement. Aims: The aims of this study were as follows: first, to determine whether the motors performed the programmed initial and residual schedules and, second, to identify technology-specific problems and their management. Settings and Design: This was a retrospective observational study of a consecutive series of the first 16 patients who had the motorized hexapod frame applied. Subjects and Methods: A chart review was performed to record demographic information, indications and goals for hexapod frame care, whether the care goals were achieved, and whether unexpected and/or adverse events occurred (such as technical difficulties and medical complications) and the management of those issues. Statistical Analysis Used: Not applicable. Results: All patients achieved the index and residual adjustments as programmed. Conclusions: The Autostrut™ system appears reliable and safe. It executes programmed index and residual adjustments as well as strut change scenarios as directed. The system recognizes unexpected mechanical or programming issues and ensures patient safety by halting progress and alerting the patient. Future versions of the technology may benefit from added features such as remote reprogramming or current strut position monitoring.

Development and Investigation of the Mechanical Behaviour of Circular External Fixators during the Gait Cycle

Development and Investigation of the Mechanical Behaviour of Circular External Fixators during the Gait Cycle

Use of ring fixator in staged primary total ankle arthroplasty

Post-traumatic osteoarthritis of the ankle is the main cause of degenerative joint disease of the ankle. The use of ring fixator has been historically used with the purpose to treat ankle arthritis as definitive treatment to avoid or delay arthrodesis or arthroplasty. To our knowledge, there are no reports in the literature describing the use of a ring fixator as a means of distracting the joint space to correct the shortening of the tibia. We present a case report of 57 year old woman with a tibial plafond fracture who underwent ORIF of both tibia and fibula with complications of pain and stiffness that were alleviated by hardware removal in conjunction with external fixation with the definitive treatment of total ankle arthroplasty. Postoperatively she had a routine course with uneventful wound healing and progression to full weightbearing at eight weeks. This case report demonstrates that the use of a circular external fixator to correct ankle alignment, restore the tibiotalar joint space and stretch the soft tissues prior to TAR is a viable treatment option in patients.

Safety of Tibial Half Pins With Circular External Fixation for Foot and Ankle Reconstruction in Patients With Peripheral Neuropathy

The primary aim of the study was to evaluate the rate of tibial fracture with half pin placement in conjunction with tensioned wires in Ilizarov static external fixator in patients with peripheral neuropathy. Concentric visualization through a rancho cube and careful identification of anterior, posterior, medial, and lateral borders of the tibia, the “perfect circle” technique was used to ensure avoidance of cortical breach. Bivariate analysis was performed comparing the rates of tibia fractures in those who did and did not employ the “perfect circle” technique for placement of tibial half pins; evaluating for demographics, rationale for external fixation use, and postoperative amputation and complication rates. Tibial stress fractures, and early removal of pin/wires from external fixator secondary to breakage both occurred at statistically significant higher rates in patients in which the “perfect circle” technique was not employed (p < .001 and p = .03 respectively). The overall rate of tibia stress fractures was 2.08% (2/96), 0% (0/85) when “perfect circle” technique was used, compared to 18.18% (2/11) when it was not used. This study demonstrates a substantially low rate of tibia stress fractures with half pin use, in contrast to prior literature and should provide foot and ankle surgeons confidence, particularly when appropriate placement is observed in this high-risk population.

The reuse of circular external fixator components: an assessment of safety and potential savings.

Cost-saving strategies are important, especially in a resource-constrained environment. One such strategy well supported in the literature is the reuse of temporary monolateral external fixator components, a strategy we utilize at our institution. The aim of the study was to determine the safety and cost saving associated with the reuse of definitive circular external fixator components in a resource-constrained environment. We performed a retrospective review of all adult patients who were treated with either new or reused circular external fixators from a single manufacturer between January and December 2017. Reused circular external fixator components, excluding half pins and wires, were subjected to an in-house reprocessing protocol. Cost savings were calculated as the difference between the price of a completely new frame and the amount invoiced for new components only in a reused frame. Thirty-three patients were included in the study with an average age of 31.9years. The mean duration of treatment with a circular external fixator was 5.8months. No mechanical failure events were recorded during the study period. Our institution saved approximately 52% (R717 503.89) and 63% (R136 568.19) of expected total cost for hexapod and Ilizarov frames, respectively. The strategy of reusing circular external fixator components is unconventional, and this study was conducted to evaluate the safety and potential savings in a resource-constrained environment. We demonstrated this practice to be reasonably safe and to result in significant cost savings which might be relevant in low-and-middle-income countries.

Complex Decisions in the Management of Congenital Pseudarthrosis of the Tibia: An International Expert Panel Case Discussion

Congenital pseudarthrosis of the tibia, or congenital tibial dysplasia, is one of the most challenging conditions in pediatric orthopaedics. In children who present in a pre-fracture state, the initial goal is fracture prevention. Once the tibia has fractured, the goals of treatment pivot to achieving – and maintaining – union. Treatment approaches are varied and may include: pseudarthrosis resection, intramedullary(IM) fixation, circular external fixation, internal fixation, vascularized fibular grafting, biologics, guided growth, or a combination of approaches. Unfortunately, the treatment of this condition is often fraught with complications and it is not unusual for a child to undergo multiple procedures. &#x0D; The goals of this case discussion are to highlight how experts approach these complex cases, to emphasize the key components of decision-making, to demonstrate clinical and technical pearls, and to feature the heterogeneity of this condition and its treatment.

Fiber-Optic Bragg Grating Sensors for Biomechanical Analysis of Fracture Healing

Despite the complexity of bone callus formation, the evaluation of fracture healing is usually performed based on x-ray visual inspection, a subjective and imprecise method. The main objective of this study is to access the evolution of bone callus. Tests were performed using a synthetic femur and an in vivo subject (preliminary results). Fiber Bragg Grating (FBG) sensors were glued to the Schanz pins of a circular external fixator for the analysis of static and dynamic strain. Three materials of different densities were inserted in the fracture site (synthetic femur) to simulate the formation of bone callus. The results from the static tests with the synthetic femur show that the strain measured on the Schanz pins presented an expected deformation pattern, according to a previous simulation. It was possible to differentiate bone callus stiffness through strain detected in the Schanz pins. The results from the dynamic tests allowed to find the first resonant frequency of each bone callus, with a difference of 4 Hz between them, measured by the FBG sensor. In the preliminary in vivo tests, the FBG sensor results demonstrated its technical viability to detect the bone callus healing stage. Nonetheless, a comprehensive study using a higher number of subjects is necessary. Being a noninvasive technology, it has the potential to become an important tool to assist medical staff in bone healing analysis.

Clinical and Functional Outcomes in Patients with Distal Tibial Fracture Treated by Circular External Fixation: A Retrospective Cohort Study.

Aims and objectivesTo examine clinical and functional outcomes in patients with intra- and extra-articular distal tibial fractures treated definitively by Ilizarov fixation.Materials and methodsPatients with tibial fractures extending within 1 Müller square of the ankle joint were identified from our Ilizarov database over a 5-year period. Data on treatment and outcome were assembled from this database and supplemented by a review of patient records. General measures of health–related quality of life and limb-specific functional outcome scores were recorded. Adverse events were documented according to Paley's classification.ResultsOne hundred and sixty-eight patients with 169 fractures were identified, 28% were open and 63% intra-articular. One hundred and sixty-five (98%) of the fractures united, two following bone grafting in their original frames, at a median of 166.5 days (range 104–537). Three patients with nonunions united with further treatment. One patient (an end-stage diabetic) elected to undergo amputation following multiple early complications during treatment. Closed fractures united more rapidly than open (median 157 vs 183 days; p = 0.005) and true Pilon (43C3) fractures took longer to unite than other fractures (median 157 vs 177 days; p = 0.01).Sixty-seven percent of patients completed functional outcome scores. Sixty-two percent reported good or excellent ankle scores at more than 6 months post frame removal, 38% fair and 10% poor. Patients with intra-articular fractures reported significantly worse ankle scores than those with extra-articular injuries. General measures of health-related quality of life (EuroQol-5D) revealed significant ongoing effects despite good clinical outcomes.ConclusionThis study demonstrates a high union and low serious complication rate, suggesting that external ring fixation is a safe and effective treatment for these injuries.How to cite this articleGiannoudis VP, Ewins E, Taylor DM, et al. Clinical and Functional Outcomes in Patients with Distal Tibial Fracture Treated by Circular External Fixation: A Retrospective Cohort Study. Strategies Trauma Limb Reconstr 2021;16(2):86–95.

Treatment of Tibial Plateau Fractures By Circular External Fixator

Background: Tibial plateau fracture is challenging for orthopaedic surgeons because of the severity of trauma and associated soft tissue injuries. The treatment goals are to anatomically reconstruct the proximal tibial articular surface, restore limb axial alignment, and fix metadiaphyseal comminution to allow early knee mobilization and weight bearing.Aim: To evaluate the functional, clinical and radiological outcomes of treatment of high energy tibial plateau fractures by circular external fixator ± percutaneous screw fixation.Patients and Methods: Between June 2018 and July 2019, 20 tibial plateau fractures in 20 patients were treated with Ilizarov external fixator in Benha University hospital. The mean age was 39 years (range 22–55 years), and the mean follow-up period was 11±2 months (range 8–12 months). Closed reduction was performed by closed means in 70% of cases or through minimal incisions in 30% of cases. Clinical and functional evaluation of patients in the tibial plateau group was performed.Results: All patients started weight bearing the day after the surgery. Functionally, 70% had an excellent result, 20% had a good result. Radiologically 75% of had excellent results. Pin tract infection was controlled in all patients without need to implant removal.Conclusion: The degree of soft tissue injury associated with tibial plateau fracture is an important determinant for both the choice of the treatment modality and the prediction of treatment outcome. The use of Ilizarov external fixator is safe and effective option for the treatment of difficult Schatzker IV, V and VI tibial plateau fractures.

REHABILITATION OF PATIENT WITH TIBIA-FIBULA FRACTURE

An orthopedic surgeon may find compound fractures of tibia-fibula challenging to treat. The degree of joint motion and the adequacy of reduction are the two factors that determine whether or not these fractures can be treated successfully. In many patients, open surgical treatment of comminuted tibial pilon fractures is associated with significant complications. Indirect reduction and stabilization of fractures using a circular external fixator can be a useful way of achieving adequate joint restoration, and it uses closed reduction principles to realign disturbed bones and joint structures. In this report, we describe about the effects of early rehabilitation compound grade IIIB fracture tibia, fibula of right side. The patient co-operation and motivation to return to daily functional activities also prove to very crucial for the rehabilitation process. The defect in bone is usually a result of high velocity trauma or a sudden impact. In present case open reduction and external fixation for distal one-third of tibia and fibula on right side was carried out followed by the rehabilitation protocol. Outcome measure used to check for the pain was NPRS. The patient morale and goal-oriented rehabilitation protocol progressed him to return to his functional activities.

Evaluation of the Quality of Life of Patients Using Circular External Fixator in a Trauma Hospital.

Objective To evaluate the quality of life of patients using an Ilizarov type external fixator for the treatment of complicated fractures and their sequelae. Method This is an observational and cross-sectional study, in which the 36-item short form survey (SF-36) questionnaire (translated into Portuguese) was applied during outpatient consultations in 2 periods, in the months of July 2018 and January 2019. The patients who participated in the study underwent their surgical procedures between January and June 2018. Results We evaluated 36 patients using an external Ilizarov fixator. We observed a predominance of male patients, with a mean age of 37.9 years. Fractures of leg bones and their complications represented half of the sample. Improvement in functional capacity and emotional aspects of the patients was observed throughout the treatment. Conclusion The use of the circular external fixator is an important and effective method for the surgical treatment of complex fractures and their sequelae. This study allowed us to conclude that, after treatment, patients achieved functional return to daily activities with adequate quality of life.

1343 Post-Operative Outcomes of Circular External Fixation in The Treatment of Tibial Plafond Fractures: A Systematic Review

Abstract Introduction Tibial plafond fractures (TPF) are uncommon but potentially devastating injuries to the ankle. Meticulous care of the associated soft tissue injury is imperative in managing these fractures. The reported benefits of circular external fixation (CEF) include the ability to affect fracture reduction and create stable fixation, while limiting further soft tissue insult. This article provides the systematic review of the clinical and functional outcomes of TPF treated definitively with CEF. Method A literature search from inception to 13th November 2020 was performed. Quality and risk of bias was assessed using standardised scoring tools. Results 16 studies were included. 303 patients were analysed. Mean follow-up was 35 months. The mean time in CEF was 18 weeks and mean time to union was 21 weeks. Non-union and malunion occurred in 3.2% and 12.4% respectively. The overall complication rate was 12.3%. The rate of deep infection was 4.8%. No amputations were reported. Minor soft tissue infection (including pin site infections) accounted for 56.7% of complications. Almost two-thirds achieved good-to-anatomic reduction radiologically. Mean range of motion assessments were 11.8 and 24.8 degrees in dorsiflexion and plantarflexion, respectively. Approximately one-third reported excellent functional outcome scores. Quality of the studies was deemed satisfactory. A moderate risk of bias was acknowledged. Conclusions This systematic review provides an evidence-based summary, which highlights CEF as an acceptable treatment option with comparable complication rate and outcome scores to that of internal fixation. However, we acknowledge that high quality evidence is still lacking.