Management Algorithm of External Fixation in Lower Leg Arterial Injury for Limb Salvages

Purpose: The purpose of this study was to review the roles of using external fixation to rescue the patients who sustained arterial injuries in the lower legs.Methods: Demographics, surgical treatment and outcomes in 88 patients with lower leg arterial injuries treated by external fixation at two trauma centers from 2009 to 2018 were reviewed. The primary outcome was the rate of successful lower leg salvage, while secondary outcomes were complications and functional recovery.Results:80 patients (90 legs) maintained a successful lower leg salvage. The patients were followed up for an average of 15.5±5.5 months. 6 patients (8 pins) experienced pin-tract infection, pins loosening happened in 2 patients (4 pins), 7 patients (7 legs) developed wound superficial infection, 3 patients (3 legs) with a deep infection developed osteomyelitis, 16 patients (17 legs) suffered the bone nonunion or bone defect. The average healing time of fracture was 5.6±4.3months. The maintain of external fixation average time was 5.8±3.6 months. Conclusion: With correctly judging the condition of limb ischemia, mastering reasonably the operation indications, and preventing complications, good clinical effects can be achieved when external fixation is used.Level of evidence: Retrospective cohort, level IV.