Temporizing and Definitive Skeletal Fixation for the Mangled Lower Extremity

Mangled extremities comprise a spectrum of soft tissue and osseous injury ultimately resulting in a limb- and sometimes life-threatening state. Wound complexity and size, osseous stability, and the state of the neurovascular structures will all influence the ultimate outcome of these injuries. A comprehensive assessment of the extremity accompanied by a timely and thorough debridement of the injury is of paramount importance. If a decision for reconstruction is made, skeletal fixation is one of the necessary components of this process. Skeletal fixation strategies for the mangled extremity must not only account for the complexity of the osseous injury but also should consider the state of the soft tissues, need for further surgical intervention, and ultimate function of the salvaged limb. External fixation is often indicated for temporary skeletal stability in these injuries. Final treatment will vary based upon the status of the soft tissues and various patient factors but may include definitive treatment with external fixation, wires, screws, plates, intramedullary implants, or some combination of multiple constructs.