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

Area of Science:

• Orthopedic Surgery
• Trauma Management
• Health Services Research

Background:

• External fixation is a common treatment for open lower-extremity fractures.
• Understanding factors influencing its use and its impact on outcomes is crucial.

Purpose of the Study:

• Identify hospital characteristics associated with higher temporary external fixation use.
• Determine if temporary external fixation affects surgical site infection (SSI) and unplanned reoperation rates.

Main Methods:

• Secondary analysis of Aqueous-PREP and PREPARE-Open trials.
• Statistical analysis included Wilcoxon rank-sum and Fisher exact tests.
• Mixed-effects logistic regression models controlled for hospital and patient factors.

Main Results:

• 23.3% of 2,438 patients with open lower-extremity fractures received temporary external fixation.
• Higher fixation rates were associated with more surgeons per hospital (p=0.02).
• No significant difference in SSI at 90 days or 1 year; a trend towards increased unplanned reoperations (OR 1.40, p=0.05).

Conclusions:

• Temporary external fixation use varies by hospital, correlating with the number of treating surgeons.
• External fixation did not increase SSI rates but showed a trend toward more reoperations.
• The device was utilized more in critically ill patients and those with severe fractures.