Circular External Fixation Use Among Orthopaedic Foot and Ankle Surgeons: A National Survey Study

Despite the safety and versatility of circular external fixators (CEFs) for many indications, there is limited information on their contemporary usage and the factors contributing to their potential underutilization. This study aims to estimate the prevalence of contemporary CEF use, characterize barriers to adoption, and identify potential solutions among American Orthopaedic Foot & Ankle Society (AOFAS) members.

A multibranched survey was designed for distribution to all active practicing members of the AOFAS to collect data on demographics, training background, CEF usage profile, provider opinions, barriers to device adoption, and factors that could encourage greater use. Data were collected through Qualtrics XM. Statistical analysis analyzing respondent differences included descriptive statistics, χ² tests for independence, and unpaired t tests.

Of 169 participants, 27.81% reported not using CEFs in their practice despite 94.08% of respondents agreeing that their use is critical for certain patients. Overall, 70.21% of nonusers believed it could have a role in their practice but had hesitations. In addition, 59.76% of participants received minimal to no exposure in residency, and this was a significant predictor for current usage (P = .0119). CEFs are most commonly used for Charcot neuroarthropathy (86.07%), infection management (83.60%), and other deformity corrections (65.67%). Nonusers are more likely to believe CEFs take too long to assemble intraoperatively, express greater concern about postoperative burden, and are less confident in postoperative care compared to users (all P < .01). The most popular interventions that would facilitate usage were access to longitudinal mentorship, further technological advancement, and attending non-industry-sponsored courses.

Perceived lengthy operative time, postoperative burden, and lack of postoperative management confidence were predominant reasons for the lack of CEF use. This survey suggests that these barriers could be addressed by more exposure during training, attending non-industry-sponsored courses, and longitudinal mentorship.

Level IV, cross-sectional study.