Complications of Hinged External Fixators of the Elbow

Author(s): Cheung EV, O’Driscoll SW, and Morrey BF

Source: Journal of Shoulder and Elbow 17:3: 447-53, 2008.


This is a retrospective review of 100 consecutive patients treated with hinged external fixators about the elbow.  The complications specifically related to pin placement were recorded.  Complications were divided into major and minor.

The results showed that minor complications including local erythema and drainage, as well as tenting, occurred in 15 percent of patients. Major complications, which included purulent drainage, fixator malalignment, pin tract loosening, and deep infection were recorded and found in 10 percent of patients.  The authors compared the use of the two different commercially available fixators for both major and minor complications.  The authors concluded that there was a lower complication rate associated with the laterally based and more simply applied DJD device.

This paper discusses the expected complication rate when dynamic external fixation is used for the elbow.  The soft-tissue envelope and complexity with respect to proper alignment with the joint axis make these very difficult to apply with significant potential for complications even in experienced hands (such as the authors of this study).  The lateral frame is easier to apply, but it is clearly not as stable as the Ilizaroff type design (Compass hinge) which provides circumferential stability.  Fortunately, the indications for application of these devices are decreasing.