Using internal fixation as an alternative to circular external fixation as a results of covid 19 pandemic; Lessons learnt

S Shamoon, E Thompson, A Qureshi, J Round, N Hancock

University Hospital Southampton NHS trust

Circular frames are fundamental to lower limb reconstruction, particularly in open fractures. During the pandemic, use of circular frames in our unit decreased in keeping with BOA guidelines “consider alternative techniques for patients who require soft tissue reconstruction to avoid multiple operations”. These alternatives included the use of internal fixation (plates and IM nailing).
This change in practice has continued in part following the pandemic with the increased use of internal fixation in cases previously deemed unsuitable for such techniques. We present our experience of this treatment strategy.

Retrospective review of complex lower limb injuries treated before, during & after lockdown, External fixation as definitive treatment vs internal fixation performed by senior authors. Deformity/correctional & DCO frames excluded.

77 Frame and 116 internal fixation cases were identified. A notable reduction in the number of circular frames applied was observed. Data suggest comparable outcomes between circular frames and alternative techniques, Frame fixation was associated with more outpatient review and the associated implications for resource management. 4 patients underwent amputation, 2 in Frame Group, 2 in Internal Fixation Group. None from the Covid period. 4 patients from the Covid Internal Fixation Group failed and required conversion to Circular Frame Fixation

Alternatives to traditional techniques have proven feasible and potentially more cost effective, prompting their adoption in the post pandemic era. However, this change of practice is not without potential consequences and continued investigation is warranted.