This study evaluates the biomechanical performance of reused low-cost stainless-steel external fixators compared to new ones in managing midshaft tibial fractures. External fixation is commonly used for open fractures, but branded fixators are costly and often unavailable in low-resource settings. Locally available stainless-steel fixators offer a more affordable alternative. When supply is limited and costs are prohibitive, hospitals frequently reuse non-implanted fixator components (outriggers) after re-sterilization. Understanding the mechanical properties of reused versus new fixators can help guide reuse policies. The study assesses axial stiffness, bending stiffness, torsional stiffness, and ultimate strength of new versus previously used uniplanar tibial external fixator constructs. Additionally, it compares axial stiffness and strength between fixators using five versus six Schanz pins. Forty-five plastic tibiae were osteotomized to simulate fractures and divided into three groups: (1) all-new components, (2) once-used and re-sterilized outriggers, and (3) twice-used and re-sterilized outriggers. Mechanical testing measured fixation stiffness in compression, bending, and torsion, while static loading determined failure strength.

Results showed no significant differences in axial stiffness, axial strength, or bending stiffness among the first three groups. Interestingly, reused fixators exhibited superior torsional stiffness. A fourth group of five specimens was stabilized using six Schanz pins and compared to the five-pin group. An increased number of Schanz pins from five to six in new fixators doubled axial stiffness and quadrupled axial strength.

The study concludes that reusing non-implanted fixator components is viable without compromising mechanical integrity, even after two cycles of clinical use and reprocessing. These findings support cost-effective orthopedic practices and improved resource utilization in low-resource settings.

Geneva S. Khu is an orthopedic surgeon who completed her residency training in orthopedics at the University of the Philippines – Philippine General Hospital and her fellowship training at the Royal Hospital for Sick Children in Glasgow, Scotland, in 2002. This paper was published in the Philippine Journal of Orthopaedics in November 2023.