{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:50:17Z","timestamp":1787755817007,"version":"build-2784847793"},"reference-count":12,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\n Background:<\/jats:title>\n \n Temporary ankle-spanning circular fixation aims to provide osseous stability while (1) allowing access to and recovery of the traumatized soft-tissue envelope and (2) facilitating safe, comfortable, and clinically relevant cross-sectional imaging for surgical planning. It is most commonly utilized in a \u201cspan-scan-plan\u201d treatment strategy in cases of peri-articular fractures around the ankle\n 2<\/jats:sup>\n . Conventional monolateral fixators are prone to morbidity at the half-pin sites in the foot and variation in construct stability. Temporary ankle-spanning circular external fixation of the traumatized ankle joint can mitigate these issues.\n <\/jats:p>\n <\/jats:sec>\n \n Description:<\/jats:title>\n \n A circular external fixator construct is assembled beginning with a single tibial ring that is fixed to the tibia by half-pins that are spread on either side of the ring and forming a \u201cvirtual ring block.\u201d A foot ring is attached via 2 crossed tensioned fine wires in the calcaneum and a single midfoot fine wire in order to prevent an equinus deformity. The tibial virtual ring block and the foot ring are interconnected by 3 polyaxial \u201crapid-adjust struts\u201d that are evenly distributed around the limb. The fracture is then reduced, and the polyaxial rapid-adjust struts are locked\n 1<\/jats:sup>\n .\n <\/jats:p>\n <\/jats:sec>\n \n Alternatives:<\/jats:title>\n \n Numerous constructs have been proposed to optimally immobilize the ankle joint while also allowing limb elevation and access to the ankle for soft-tissue care\n 3\u20136<\/jats:sup>\n . A commonly utilized construct is the monolateral \u201cbar-and-clamp\u201d spanning external fixator, which relies on half-pin fixation in the foot that may induce bone lysis, result in pin-site infections, and prevent weight-bearing. Calcaneal half-pins are particularly troublesome and can lead to adjacent lysis, instability, and potential loss of initial reduction as a result of the cancellous bone quality.\n <\/jats:p>\n <\/jats:sec>\n \n Rationale:<\/jats:title>\n \n The principal objective of temporary joint-spanning external fixation is to realign the traumatized joint and to maintain this reduction until definitive surgery while facilitating soft-tissue treatment and surgical planning\n 7\u201311<\/jats:sup>\n . This strategy forms the first step in the \u201cspan-scan-plan\u201d approach to pilon fractures described by Sirkin et al.\n 2<\/jats:sup>\n . Multiple subsequent studies have confirmed the superiority of external fixation over splinting for initial soft-tissue care following distal tibial and ankle trauma\n 12,13<\/jats:sup>\n .\n <\/jats:p>\n <\/jats:sec>\n \n Expected Outcomes:<\/jats:title>\n \n Temporary circular external fixation has been shown to outperform monolateral fixation in terms of both the adequacy of the initial reduction and the maintenance of this reduction\n 1<\/jats:sup>\n . Harrison et al. demonstrated that temporary circular fixation of the traumatized ankle yielded 100% good or excellent initial reduction compared with 91% for monolateral fixation. This initial reduction was also better maintained by circular fixator constructs compared with monolateral ones (96% versus 78%).\n <\/jats:p>\n <\/jats:sec>\n \n Important Tips:<\/jats:title>\n \n \n \n Placement and orientation of the rings should take into account the zone of injury, access for orthoplastic procedures, and the maximum length of adjustable struts.<\/jats:p>\n <\/jats:list-item>\n \n Orthogonal frame application allows the best biomechanical environment for stabilization of fracture and\/or dislocation of the tibiotalar joint to facilitate soft-tissue care. Care should be taken in the operating room to ensure orthogonal mounting of both the proximal and the distal ring to their respective bone segments.<\/jats:p>\n <\/jats:list-item>\n \n Avoid transverse fine wires in the calcaneus to prevent translation while in the frame; consider the use of tensioned olive wires to further protect against translation.<\/jats:p>\n <\/jats:list-item>\n \n Place the midfoot wire through the base of the metatarsals or along the cuneiforms to maximize fixation.<\/jats:p>\n <\/jats:list-item>\n \n Take care to avoid placing the ankle or forefoot in equinus.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Acronyms and Abbreviations:<\/jats:title>\n \n \n \n CEF = circular external fixator<\/jats:p>\n <\/jats:list-item>\n \n PAD = pronation adduction<\/jats:p>\n <\/jats:list-item>\n \n PER = pronation external rotation<\/jats:p>\n <\/jats:list-item>\n \n SAD = supination adduction<\/jats:p>\n <\/jats:list-item>\n \n SER = supination external rotation<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.2106\/jbjs.st.23.00069","type":"journal-article","created":{"date-parts":[[2024,12,11]],"date-time":"2024-12-11T14:37:03Z","timestamp":1733927823000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Temporary Circular External Fixation for Spanning the Traumatized Ankle Joint"],"prefix":"10.2106","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0567-3373","authenticated-orcid":false,"given":"Nando","family":"Ferreira","sequence":"first","affiliation":[{"name":"Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-4689-5180","authenticated-orcid":false,"given":"Niel","family":"Bruwer","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6341-0734","authenticated-orcid":false,"given":"Adriaan Jansen","family":"van Rensburg","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-2839-2398","authenticated-orcid":false,"given":"Ernest","family":"Muserere","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9862-8503","authenticated-orcid":false,"given":"Shao-Ting Jerry","family":"Tsang","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,10]]},"reference":[{"issue":"10","key":"bib1-20250308","doi-asserted-by":"crossref","first-page":"3525","DOI":"10.1016\/j.injury.2022.07.034","article-title":"Temporary circular external fixation for spanning the traumatised ankle joint: A cohort comparison 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