title: The use of circular external fixators in the management of lower limb trauma in Dublin: a single surgeon's 20-year experience.
abstract: BACKGROUND
  It has been estimated that approximately 520,000 injury presentations are made to Irish accident and emergency departments each year. Fractures account for 20 % of these injuries. Circular external fixators (frames) have been shown to be a safe and effective method of treatment for long bone fractures where internal fixation is impossible or in-advisable. We present the outcomes of all frames applied at our institution for stabilisation of acute fractures over a 20-year period.
  
  
  METHODS
  We retrospectively reviewed a prospectively compiled database of all frames applied in our institution and identified all frames which were applied for acute lower limb trauma.
  
  
  RESULTS
  We identified 68 fractures in 63 patients. There were 11 femoral fractures and 57 tibial fractures. All fractures were classified using the AO Classification system, and most fractures were Type C fractures. We used an Ilizarov frame for 53 fractures and a Taylor Spatial Frame for 15 fractures. The mean time in frame was 365 days for a femoral fracture and 230 days for a tibial fracture. There were five tibial non-unions giving an overall union rate of 93 %. Factors associated with non-union included high-energy trauma and cigarette smoking.
  
  
  CONCLUSIONS
  The vast majority of lower limb fractures can be treated using 'conventional' methods. Complex fractures which are not amenable to open reduction and internal fixation or cast immobilisation can be treated in a frame with excellent results. The paucity of published reports regarding the use of frames for complex trauma reflects the under-utilisation of the technique.
authors.affiliation: Department of Orthopaedics, The Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland. barryoneill1922@gmail.com.
authors.forename: B J
authors.initials: BJ
authors.lastname: O'Neill
authors.affiliation: Department of Orthopaedics, The Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland.
authors.forename: C M
authors.initials: CM
authors.lastname: Fox
authors.affiliation: Department of Orthopaedics, The Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland.
authors.forename: A P
authors.initials: AP
authors.lastname: Molloy
authors.affiliation: Department of Orthopaedics, The Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland.
authors.forename: S
authors.initials: S
authors.lastname: O'hEireamhoin
authors.affiliation: Department of Orthopaedics, The Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland.
authors.forename: D P
authors.initials: DP
authors.lastname: Moore
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016267:External Fixators / Q000706:statistics & numerical data*; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005592:Fracture Fixation / Q000379:methods*; D005593:Fracture Fixation, Internal / Q000379:methods; D006801:Humans; D007494:Ireland; D035002:Lower Extremity / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009984:Orthopedic Fixation Devices / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000601:surgery*
keywords: External fixator; Lower limb; Outcomes; Trauma