The aim of the study is to determine the outcomesin patients who underwent conversion from anexternal fixator to an internal fixation device. This is a retrospectivereview of 18 patients (24 limbs) who underwentconversion from external to internal fixation. The patientshad external fixators applied for traumatic bone defects orcongenital deformities. Conversion to internal fixation wasperformed for reasons of patient dissatisfaction with externalfixation, pin track sepsis, persistent non-union or refracture.The complexity of cases was graded using Paley’s level ofdifficulty score. Patients were either converted acutely ordelayed. Internal fixation devices were either intramedullarynails or plate and screws. Outcome was regarded as excellentif the patients were fully weight-bearing and pain-free on amechanically well-aligned limb and without need for furthersurgery: good if the patient required subsequent surgery toachieve union and poor if irreversible complications occurred.Acute conversions (fixator removal and introduction ofinternal fixation device at same surgery) were done in 19limbs and delayed conversion (interval between fixatorremoval and internal fixation) in 5. In the acute group, 17limbs (89.4 %) had at least a good outcome, 16 of theselimbs had an excellent result. Two limbs (10.6 %) had a poorresult and required amputation. Both cases were after acute conversion to intramedullary nails; the original presentingdiagnosis was of an infected non-union of the tibia and bothhad Paley scores above 7. In the delayed conversion group,all limbs (100 %) had at least a good outcome, with 4 limbs(80 %) having an excellent result. The mean external fixatortime was 185 days (61–370). Both the cases with poor outcomeshad longer external fixation times. This series supportsthe practice of conversion of external fixation tointernal fixation with the majority of patients attaining goodresults. It identifies that plate devices appear to producefewer deep sepsis complications, as compared to intramedullarynails, particularly when the original presenting diagnosisis a septic non-union.
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