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. 2025 Jun 18;107(Suppl 1):43-50.
doi: 10.2106/JBJS.24.01250.

Differences in Practice Patterns in the Use of Temporary External Fixation for the Management of Open Lower-Extremity Fractures

Augustine M Saiz Jr  1 , Christina A Stennett  2 , Nicholas M Romeo  3 , Kevin D Phelps  4 , Joshua L Gary  5 , Christopher M Domes  6 , Mark J Gage  7 , Nathan N O'Hara  2 , Sheila Sprague  8   9 , Gerard P Slobogean  2 , Stephen J Warner  10 ; the PREP-IT Investigators
Collaborators, Affiliations

Differences in Practice Patterns in the Use of Temporary External Fixation for the Management of Open Lower-Extremity Fractures

Augustine M Saiz Jr et al. J Bone Joint Surg Am. .

Abstract

Background: External fixation is often used in the management of open lower-extremity fractures. The objectives of this study were to identify hospital characteristics that are associated with greater use of temporary external fixation and to determine if external fixation reduces the odds of surgical site infection (SSI) and unplanned reoperation among patients with open lower-extremity fractures.

Methods: This is a secondary analysis of the Aqueous-PREP and PREPARE-Open trials involving open lower-extremity fractures. Wilcoxon rank-sum and Fisher exact tests were used to assess if temporary external fixation use varied between hospital clusters. Mixed-effects logistic regression models controlling for hospital cluster and participant characteristics estimated the associations between temporary external fixation and SSI or unplanned reoperation.

Results: There were 2,438 patients with an open lower-extremity fracture identified, with 568 (23.3%) undergoing temporary external fixation. There were 34 participating hospitals with a median external fixation rate of 21.5%. Hospitals with higher temporary external fixation use had a higher number of surgeons treating patients with fracture (p = 0.02). There was no difference in SSI at 90 days (odds ratio [OR], 1.16 [95% confidence interval (CI), 0.82 to 1.66]; p = 0.40) or 1 year (OR, 1.30 [95% CI, 0.97 to 1.75]; p = 0.08) between patients who did and did not undergo temporary external fixation. Patients who underwent temporary external fixation were more likely to have unplanned reoperations within 1 year (OR, 1.40 [95% CI, 0.96 to 1.79]; p = 0.05).

Conclusions: More temporary external fixation for open lower-extremity fractures was performed at hospitals with more surgeons treating fractures. There was no difference in SSI at 90 days or 1 year between patients who did and did not undergo temporary external fixation. Temporary external fixation tended to be used in more critically ill patients and patients with more severe fractures but was not associated with increased unplanned reoperations at 90 days or at 1 year.

Level of evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

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Conflict of interest statement

Disclosure: The Aqueous-PREP trial was funded by the U.S. Department of Defense (W81XWH-17-1-070), a Canadian Institutes of Health Research Foundation Grant, McMaster University Surgical Associates, and the PSI (Physicians’ Services Incorporated) Foundation. The PREPARE trial was funded by the Patient-Centered Outcomes Research Institute (PCS-1609-36512) and a Canadian Institutes of Health Research Foundation Grant. The present study was partially supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award Number 2K24AR076445. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/I605).

References

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