{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T23:30:57Z","timestamp":1792625457873,"version":"4.5.0"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,6,15]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Modern external ring fixation has been hypothesized to reduce complications requiring hospital readmission compared with internal fixation when treating patients with high-energy open tibial shaft fractures. In this study, the 1-year probability of a major limb complication was compared between external and internal fixation of severe open tibial fractures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This multicenter randomized clinical trial included patients 18 to 64 years of age with severe open tibial shaft fractures randomly assigned to either modern external ring fixation (n = 127) or internal fixation (n = 133). The primary outcome was a major limb complication within 365 days after randomization; these complications included amputation, infection, a soft-tissue problem, nonunion, malunion, and a loss of reduction\/implant failure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Of 260 randomized patients, 254 were included in the final analysis. Their mean age (standard deviation) was 39 (13) years; 214 (84%) were men. The probability of at least 1 major limb complication was higher for external fixation (62.1% [95% confidence interval (CI): 53.4% to 70.8%]) than internal fixation (43.7% [95% CI: 35.5% to 52.9%]), with a risk difference of 18.4% (95% CI: 5.8% to 30.4%); p = 0.005). The most notable difference was in loss of reduction\/implant failure, the rate of which was higher for external fixation (risk difference: 14.4% [95% CI: 7.0% to 21.6%]; p = 0.002). There was no appreciable difference in the probability of deep infection between external fixation (26.1%) and internal fixation (29.7%) (risk difference: \u22123.5% [95% CI: \u221214.8% to 7.8%]; p = 0.54). There were also no appreciable differences in the probabilities of amputation, nonunion, soft-tissue problems, malunion, or fracture healing between the groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>These results argue against routine use of modern external ring fixation for the treatment of these severe open tibial fractures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level I<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.21.01126","type":"journal-article","created":{"date-parts":[[2022,6,15]],"date-time":"2022-06-15T13:47:15Z","timestamp":1655300835000},"page":"1061-1067","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":40,"title":["Modern External Ring Fixation Versus Internal Fixation for Treatment of Severe Open Tibial Fractures"],"prefix":"10.2106","volume":"104","author":[{"name":"Major Extremity Trauma Research Consortium (METRC)","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2022,3,29]]},"reference":[{"issue":"24","key":"bib1-20250430","doi-asserted-by":"crossref","first-page":"1924","DOI":"10.1056\/NEJMoa012604","article-title":"An analysis of outcomes of reconstruction or amputation after leg-threatening injuries","volume":"347","author":"Bosse","year":"2002","journal-title":"N Engl J Med."},{"issue":"4","key":"bib2-20250430","doi-asserted-by":"crossref","first-page":"1212","DOI":"10.1097\/00006534-199904010-00017","article-title":"Salvage after severe lower-extremity trauma: are the outcomes worth the means?","volume":"103","author":"Dagum","year":"1999","journal-title":"Plast Reconstr Surg."},{"issue":"1","key":"bib3-20250430","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/BOT.0b013e31818e43dd","article-title":"Lower Extremity Assessment Project (LEAP) Study Group. 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