Temporizing External Fixation of the Lower Extremity: A Survey of the Orthopaedic Trauma Association Membership

: This study examined the opinions of practicing traumatologists to aid in the initial treatment of complicated lower extremity fractures in accordance with current staged protocols. A 40-question online survey of the Orthopaedic Trauma Association (OTA) membership was administered from November 2008 to February 2009. The survey investigated surgeons' preferences regarding general principles and routine management of joint-spanning lower extremity external fixators, as well as favored knee- and ankle-spanning constructs and conditions of definitive surgical reconstruction. Data were collected using a 5-point Likert scale ranging from strongly agree (5) to strongly disagree (1). Responses were given numerical weight in descending order (scoring 5-1) and were reported as straight percentages and with a weighted mean called the rating average.Responses were received from half of the OTA membership. Among the strongest preferences (rating average >4) were for obtaining a computed tomography (CT) scan as part of prereconstruction planning (4.8) and obtaining that CT scan after joint-spanning external fixation was applied (4.6). Restoration of length as the most important part of limb realignment at the time of temporizing external fixator application (4.3), the use of soft tissue protection during pin application (4.4), and avoiding overlap of pin sites with a plate at the time of reconstruction (4.3) were highly favored. Survey respondents treated a sizable volume of periarticular lower extremity injuries with temporizing external fixation and staged reconstruction. This consolidation of trends and preferences for constructing and using temporizing external fixation for complex lower extremity injuries hopefully will aid in the treatment of these difficult fractures.