Complications in the Combined and Consecutive Use of External and Internal Fixation of the Femur with Reference to Use of the Extracortical Clamp Device

Abstract

Aim
The Extracortical Clamp Device (ECD) is a novel external fixation component which unlike conventional implants does not 
perforate long bone cortices. Therefore, it simplifies methods of combined and consecutive internal and external fixation, periprosthetic fracture osteosynthesis and deformity correction. This study compared the incidence of complications with the use of 
the ECD in combined external fixation of the femur.
Methods
A prospective controlled study was designed with one group including 66 frames assembled using the ECD. These were compared 
with the second group of 29 frames utilising a combination of external and internal fixation, the latter comprising conventional 
wires and pins only.
Results
In the ECD group, pin tract infection was identified in 14.8% of cases. In these patients, infection occurred in 45.5% of all fixation elements; of these, 18.2% occurred around the ECD. In the WP (only wired and pins) group pin tract infection occurred 
in 29.2% cases. ECD fracture occurred in one case (3.7%). In the WP group, transosseous element breakage occurred in 3 cases 
(13.6%). In the treatment of periprosthetic fractures and deformities using the ECD, pin tract infection was seen in 16.7%. In 
the treatment of similar fractures and deformities not associated with an endoprosthesis, pin tract infections were seen in 21.5% 
of cases. 
Conclusion
In this study we have demonstrated that the ECD does not increase the number of complications specific to external fixation. 
All resultant complications applicable to the ECD were addressed by conservative measures, and did not affect the outcome. 
The use of the ECD eliminates complications and concerns in combined osteosynthesis such as obstruction and jamming of an 
intramedullary device; fretting wear due to contact with half pins or wires and endoprosthesis; loss of torsional control as seen 
not uncommonly with half pins; the reduction in frame stability due to the use of smaller pins; and the risk of pin or wire cut-out 
due to eccentric placement