{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T12:08:43Z","timestamp":1779278923785,"version":"3.51.4"},"reference-count":68,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Knee dislocations (KDs) can be limb\u2010threatening injuries that may require a temporising knee\u2010spanning external fixator (KSEF) for stabilisation. Precise indications for this commonly utilised invasive immobilisation technique remain controversial and poorly defined. The purpose of this study was to establish consensus\u2010driven indications for temporising KSEF use in the initial management of KDs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A working group of fellowship\u2010trained orthopaedic surgeons generated clinical scenarios reflecting commonly debated indications for temporising KSEF application. Utilising a modified Delphi technique, 23 surgeons from the International Knee Dislocation Study Group completed two anonymous online survey rounds. Consensus was defined a priori as \u226570% agreement or disagreement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Response rates were 100% for Round 1 and 96% for Round 2. Four scenarios achieved unanimous consensus: (1) KD without post\u2010reduction instability (100% disagreement), (2) inability to maintain tibiofemoral reduction in the sagittal\/coronal plane with non\u2010invasive knee immobilisation (NIKI) after initial reduction (i.e., redislocation\/subluxation) (100% agreement), (3) tibial plateau fracture\u2010dislocation with post\u2010reduction subluxation (100% agreement), and (4) in bilateral closed KDs where one limb is indicated and the other is NOT, span ONLY the indicated limb (100% agreement). Two scenarios achieved strong positive consensus (90%\u201399.9% agreement): (1) morbid obesity (BMI\u2009\u2265\u200940) without NIKI of sufficient size (91.3% agreement), and (2) extensor mechanism injury with post\u2010reduction subluxation (91.3% agreement). Four and one additional scenarios achieved positive and negative consensus, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This modified Delphi study established consensus\u2010driven indications for temporising KSEF application in the initial management of KDs, which advocate for more selective use than what is demonstrated in the literature.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level V.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ksa.70461","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T11:39:52Z","timestamp":1779277192000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Establishing the indications for temporising knee\u2010spanning external fixation: A modified Delphi study of the International Knee Dislocation Study Group"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1481-3232","authenticated-orcid":false,"given":"Michael J.","family":"Medvecky","sequence":"first","affiliation":[{"name":"Department of Orthopaedics and Rehabilitation Yale School of Medicine New Haven Connecticut USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6923-3449","authenticated-orcid":false,"given":"Ekrem M.","family":"Ayhan","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Rehabilitation Yale School of Medicine New Haven Connecticut USA"},{"name":"Frank H. Netter MD School of Medicine Quinnipiac University North Haven Connecticut USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-6815-6616","authenticated-orcid":false,"given":"Jonathan M.","family":"Salandra","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Rehabilitation Yale School of Medicine New Haven Connecticut USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6247-3047","authenticated-orcid":false,"given":"Jay","family":"Moran","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Rehabilitation Yale School of Medicine New Haven Connecticut USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meghana","family":"Nair","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Rehabilitation Yale School of Medicine New Haven Connecticut USA"},{"name":"Frank H. Netter MD School of Medicine Quinnipiac University North Haven Connecticut USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8003-5737","authenticated-orcid":false,"given":"Michael J.","family":"Alaia","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery NYU Grossman School of Medicine New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2522-7047","authenticated-orcid":false,"given":"T\u00falio V. O.","family":"Campos","sequence":"additional","affiliation":[{"name":"Universidade Federal de Minas Gerais Programa de P\u00f3s\u2010gradua\u00e7\u00e3o em Sa\u00fade P\u00fablica Belo Horizonte Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0671-0439","authenticated-orcid":false,"given":"Michael F. G.","family":"Held","sequence":"additional","affiliation":[{"name":"University of Cape Town Cape Town South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-1987-1664","authenticated-orcid":false,"given":"Bruce A.","family":"Levy","sequence":"additional","affiliation":[{"name":"Orlando Health Jewett Orthopedic Institute Orlando Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8881-6212","authenticated-orcid":false,"given":"Volker","family":"Musahl","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center Pittsburgh Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9935-6493","authenticated-orcid":false,"given":"Dustin L.","family":"Richter","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics &amp; Rehabilitation University of New Mexico Albuquerque New Mexico USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1442-212X","authenticated-orcid":false,"given":"Brian R.","family":"Waterman","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery Wake Forest School of Medicine Winston\u2010Salem North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3106-8609","authenticated-orcid":false,"given":"Daniel B.","family":"Whelan","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery University of Toronto Toronto Ontario Canada"},{"name":"University of Toronto Orthopaedic Sports Medicine (UTOSM), St. Michael's Hospital Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5292-7017","authenticated-orcid":false,"suffix":"Jr.","given":"Robert C.","family":"Schenck","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics &amp; Rehabilitation University of New Mexico Albuquerque New Mexico USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"the International Knee Dislocation Study Group","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,5,20]]},"reference":[{"issue":"2","key":"e_1_2_12_2_1","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1007\/s00402-011-1408-0","article-title":"Compartment syndrome in dislocation and non\u2010dislocation type proximal tibia fractures: analysis of 356 consecutive cases","volume":"132","author":"Acklin YP","year":"2012","journal-title":"Arch Orthop Trauma Surg"},{"issue":"2","key":"e_1_2_12_3_1","doi-asserted-by":"crossref","DOI":"10.1002\/jeo2.70275","article-title":"The role of hinged external fixation in the treatment of knee dislocation, 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