Single-Stage External Fixation for Compound Fractures of Both Bones of the Leg in the Elderly: A Retrospective Study

Background: Compound fractures of both bones of the leg in elderly patients combine a contaminated, poorly vascularised soft-tissue envelope with a host whose comorbidities make repeated anaesthesia hazardous. Staged reconstruction multiplies that exposure. Methods: We retrospectively reviewed ten consecutive patients older than 60 years with comminuted, extra-articular Gustilo–Anderson Grade II, IIIA or IIIB compound fractures of both bones of the leg treated between September 2022 and September 2024. All reached theatre within ten hours for lavage, debridement, intramedullary curettage, provisional K-wire reduction and definitive external fixation using a uniplanar or delta frame, with wound cover attempted in the same sitting. The frame was retained until radiological union and exchanged for a patellar tendon-bearing cast. Functional outcome was graded by the Karlström–Olerud score. Results: Six fractures (60%) were Grade IIIB, three (30%) Grade IIIA and one (10%) Grade II; seven involved the distal third of the tibia. Skin closed primarily in eight patients; two needed a local rotation muscle flap. Pin-tract infection occurred in two patients and settled with debridement. The fixator was removed at 12–14 weeks in eight patients and at 20–24 weeks in two, both Grade IIIB. Patients underwent a mean of 2.4 procedures. No amputation, deep infection or death occurred. Conclusion: Single-stage debridement, external fixation and soft-tissue cover limited elderly comorbid patients to few anaesthetic exposures while achieving union and limb salvage in all ten. External fixation merits consideration as a definitive rather than temporising strategy.