Septic arthritis of the major joints of the lower limb after periarticular external fixation application: are conventional safe corridors enough to prevent it?

Septic arthritis as a result of pin track infection, following application of external fixators in periarticular fractures of the lower limb, is a rare, but serious complication. Several studies, combining cadaver dissection and MRI scans or conventional X-ray measurements, have tried to define the exact anatomy of the capsular reflection in the major joints of the lower limb (hip, knee and ankle), in order to provide specific safe corridors for extra-capsular wire and pin placement. These studies are reviewed, their methods and results are presented, and their conclusions are evaluated as suggested guidelines for safe extra-capsular wire and pin insertion.

Unilateral hinged external fixator of the elbow in complex elbow injuries.

We present the outcome of treating complex injuries of the elbow with the "Orthofix" external fixator in patients where the condition of the soft tissues did not permit extensile surgical approach or where the internal fixation would not be stable enough to permit safe early joint mobilization postoperatively. Eight patients were treated, three with supra-intercondylar fracture in the presence of marked osteoporosis and five with fracture-dislocation of the elbow and excessive soft tissue impairment. The fixator was applied for a mean of 8.5 weeks (5-13 weeks). Great care was taken to use the appropriate technique in applying the fixator, especially to define the correct centre of rotation. All the fractures were united, and no instability of the joint was noted. All the patients maintained a functional range of motion, with lack of extension less than 30 degrees and flexion more than 120 degrees . One patient who developed transient palsy of the radial nerve and two patients who developed pin track infection were treated with oral antibiotics. Despite the technical difficulties, external fixation of the elbow could be a salvage procedure in difficult cases of elbow trauma, where open procedures are not indicated.