External fixation as a secondary procedure.

Twenty-two patients were treated by external skeletal fixation as a secondary procedure after failure of primary management with other modes of treatment. Fourteen of these cases were infected at presentation. The average duration from the time of injury to the application of external fixation was 17 months. Ninety-five per cent of fractures united with this treatment, and there have been no recurrent infections, with a minimum follow-up evaluation of one year. Pin tract problems were frequent and consisted of drainage, with or without pin loosening. All patients allowed unrestricted weight-bearing experienced some form of pin problem, whereas only 12% of patients restricted to touch-down weight-bearing with crutches developed pin tract problems; none has had residual pin tract infections. External fixation is an effective secondary measure for injuries that have failed to unite by primary treatment. Use of external fixation requires close supervision of postoperative treatment and, especially, close attention to pin insertion and management.