Open fractures with severe soft tissue damage and complex fractures with high levels of instability require mechanical stabilization to allow alignment of the fragments while healing occurs.1
Some simple fractures can be treated conservatively with casting. Every fracture is different, and less stable, open or complex fractures usually require more support to restore bone position and alignment. Some form of mechanical fixation may be needed, and this fixation may be external or internal, depending on surgeon preference and the type of fracture.2 Bone grafting may also be required to encourage healing.2 External fixation is used as definitive treatment in about 7–10 percent of fracture cases; it may also be used as temporary fixation, later replaced by plating or nailing.
Left untreated, the broken bone or bones may fail to heal correctly, leading to further discomfort, pain and lack of mobility. The severity of the initial injury is an important factor.
Post-trauma conditions include malunited, non-united or infected fractures and can result in abnormal anatomy requiring further correction or treatment.
Performing osteotomy (the surgical cutting or removal of a piece of bone to alter alignment) and applying external fixation in post-traumatic deformity allows for gradual correction and has been shown to improve functional outcomes, including cases complicated by leg length discrepancy and soft tissue compromise.3,4,5
Left untreated, a bone that has not healed correctly or refuses to heal will lead to discomfort, pain and a lack of mobility. A fracture that is infected and not healing is a serious complication that requires treatment by a specialist limb reconstruction surgeon. Modern techniques can usually achieve healing and cure of the infection; however, the treatment may be very prolonged, and necessitate long periods off work. In severe cases amputation may be a preferred solution, especially if the patient has no insurance and is self employed. The various possibilities should all be discussed, considering the whole person and their expectations for the future.4,5
- Paley D, Lamm BM. Correction of the cavus foot using external fixation. Foot Ankle Clin. 2004;9(3):611–24.
- Taljanovic MS, Jones MD, Ruth JT, et al. Fracture fixation. Radiographics. 2003;23(6):1569–90.
- Ganger R, Radler C, Speigner B, Grill F. Correction of post-traumatic lower limb deformities using the Taylor spatial frame. Int Orthop. 2010;34(5):723–30.
- Guidelines for Open Fractures of the Lower Limb, to be found at http://www.bapras.org.uk/professionals/clinical-guidance
- The management of severe open limb fractures, to be found at https://www.boa.ac.uk/wp-content/uploads/2014/12/BOAST-4.pdf