{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T11:15:16Z","timestamp":1783509316161,"version":"3.55.0"},"reference-count":31,"publisher":"MDPI AG","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:p>\n                    <jats:bold>Background:<\/jats:bold>\n                    Circular ring external fixation has been found to be successful in the treatment of a wide range of foot and ankle pathologies, particularly in patients with multiple comorbidities and soft-tissue compromise, but the procedures are technically demanding, and complications are common. The primary goal of this study was to identify complications associated with circular ring external fixation, and the secondary aim was to identify any independent risk factors associated with them.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Methods:<\/jats:bold>\n                    Institutional review board approval was obtained, and a retrospective review was performed of 99 consecutive patients undergoing 100 foot or ankle procedures involving circular ring external fixation. Patient demographics, duration of fixator use, indications for the procedures, and outcomes were recorded. Clinical characteristics and indications for circular ring external fixation were tested for association with complications.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Results:<\/jats:bold>\n                    Sixty-one patients experienced 67 complications. Forty-six complications were minor and 21 were major. Body mass index was the only preoperative variable demonstrating a significant increase in complications (\n                    <jats:italic>P<\/jats:italic>\n                    &lt; .001). Obese patients had 3.2 times the odds of having a complication as nonobese patients (95% confidence interval, 1.4\u20137.6). Patients with diabetes or Charcot\u2019s arthropathy showed an increase in complications.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusions:<\/jats:bold>\n                    Complications are common with circular ring external fixation of the foot and ankle, and most are minor fine wire complications. There are many variables that may contribute to complications, but obesity was most predictive in this study.\n                  <\/jats:p>","DOI":"10.7547\/22-228","type":"journal-article","created":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T16:58:19Z","timestamp":1756313899000},"source":"Crossref","is-referenced-by-count":0,"title":["Complications of Circular Ring External Fixation of the Foot and Ankle"],"prefix":"10.3390","volume":"115","author":[{"given":"Cody D.","family":"Blazek","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery and Department of Vascular and Endovascular Surgery, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas S.","family":"Powers","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul R.","family":"Leatham","sequence":"additional","affiliation":[{"name":"CHRISTUS Orthopedics & Sports Medicine Institute, Tyler, TX."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick R.","family":"Burns","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, WVU Medicine Wheeling Hospital, Wheeling, WV."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","reference":[{"key":"B1","series-title":"JAPMA","first-page":"3","article-title":"Mid-term results of minimally invasive plate osteosynthesis and circular external fixation in the treatment of complex distal tibia fractures","volume":"107","author":"Imren Y","year":"2017","unstructured":"Imren Y, Desteli EE, Erdil M, et al: Mid-term results of minimally invasive plate osteosynthesis and circular external fixation in the treatment of complex distal tibia fractures. 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Clin Orthop Relat Res 290: 125, 1993."},{"key":"B7","series-title":"J Foot Ankle Surg","first-page":"22","article-title":"The use of circular wire external fixation in the treatment of salvage ankle arthrodesis","volume":"44","author":"Zarutsky E","year":"2005","unstructured":"Zarutsky E, Rush S, Schuberth J: The use of circular wire external fixation in the treatment of salvage ankle arthrodesis. J Foot Ankle Surg 44: 22, 2005."},{"key":"B8","series-title":"Tech Foot Ankle Surg","first-page":"150","article-title":"Ankle arthrodesis using ring external fixation","volume":"5","author":"Easley M","year":"2006","unstructured":"Easley M, Looney C, Wellman S, et al: Ankle arthrodesis using ring external fixation. 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