Outcomes of segmental tibia fractures treated with circular external fixation at a single centre in a developing world setting


  • Megan O'Connor University of KwaZulu-Natal
  • Leonard C Marais University of KwaZulu-Natal
  • N Ferreira Stellenbosch University


tibia, segmental fracture, circular fixator, Ilizarov, non-union, infection


Background: Segmental tibia fractures historically are treated with special consideration due to their complexity, high complication rate and the propensity for associated injuries. Circular external fixators (CEFs) offer several potential advantages in this situation due to their modularity and minimally invasive application. These advantages have been demonstrated in several developed countries but not as yet in the developing world. This analysis aimed to evaluate if these beneficial outcomes are reproducible in a developing world environment.

Methods: We retrospectively assessed the data pertaining to skeletally mature patients who sustained segmental tibia fractures and were treated with CEFs between January 2008 to December 2015. These cases were performed in our tertiary hospital and overseen by a consultant with limb reconstruction experience. Union rates, time to union and complications encountered over a median of 10 months (range 6–20 months) follow-up period were among the outcomes measured.

Results: Fourteen male and three female patients with a median age of 34 years were included. Sixteen patients (94%) were injured as a result of high energy trauma, nine patients (53%) had associated injuries,  fourteen cases (83%) were compound injuries and there were no cases of compartment syndrome. Fifteen patients (88%) united with the use of the initial CEF at a median of 25 weeks (16–52 weeks), the two cases of non-union were treated with adjustments to the CEF and distraction across the affected fracture site with ultimate union. Two cases (12%) of superficial pin infection were encountered and one case (6%) of deep infection occurred after union of the fractures necessitating removal of the CEF. Three cases (18%) developed malunion.

Conclusion: Circular external fixators used for segmental tibia fractures, when applied in a developing setting by clinicians with limb reconstruction experience, display a satisfactory union rate and acceptable complication frequency, as compared to that achieved in developed countries.

Level of evidence: Level 4

Author Biographies

Megan O'Connor, University of KwaZulu-Natal

MBBCh, Orthopaedic registrar, Department of Orthopaedic Surgery, Grey’s Hospital, Nelson R Mandela School of Clinical Medicine, University of KwaZulu-Natal

Leonard C Marais, University of KwaZulu-Natal

MBChB, FC Orth(SA), MMed(Orth), PhD, Associate Professor and Head of Department of Orthopaedic Surgery, Nelson R Mandela School of Clinical Medicine, University of KwaZulu-Natal

N Ferreira, Stellenbosch University

BSc, MBChB, FC Orth(SA), MMed(Orth), PhD, Associate Professor and Head of Clinical Unit: Tumour, Sepsis and Reconstruction, Division of Orthopaedic Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town




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