Skeletal Fixation Research Articles

External spinal fixation of a lumbar fracture in a dog

AbstractAn approximately 1‐year‐old female entire crossbreed dog presented for further assessment of a traumatically induced T3‐L3 myelopathy. CT demonstrated multiple vertebral fractures, a large paravertebral abscess with intracanal extension and an abdominal wall rupture. Given the active infection surrounding the lumbar fracture site, permanent internal fixation devices were deemed less favourable. An external skeletal fixator construct was placed using percutaneously placed positive profile pins and Steinmann pins as connecting bars. Repeat CT 8 weeks following surgery revealed good realignment of the vertebral column and resolution of the sublumbar abscess. The external fixator was removed and gradual return to exercise instructed over the following 8 weeks. This case report describes the use of an external vertebral skeletal fixator in a young dog with traumatic vertebral fracture when traditional methods were considered less favourable.

Effect of Bidirectional Insertion of External Skeletal Fixation Pins on Axial Pullout Strength in Canine Cadaveric Bone.

The aim of this study was to evaluate the effect of bidirectional insertion on axial pullout strength of tapered run out (TRO), traditional negative profile (TNP) and positive profile (PP) pins. Cadaveric adult canine tibiae were harvested. Tapered run out pins (Group 1) were inserted unidirectionally to the desired position; bidirectionally past the desired position, then withdrawn to the desired position (Group 2); and bidirectionally as described for Group 2, repeated twice (Group 3). Traditional negative profile pins (Group 4-6) and PP pins (Group 9-11) were placed in the same manner. Tapered run out (Group 7), TNP (Group 8) and PP pins (Group 12) were driven unidirectionally such that the shaft of the pin violated the cis-cortex. A servohydraulic testing machine extracted the pins and measured axial peak pullout strength. Positive profile pins had significantly greater pullout strength than TRO and TNP pins placed unidirectionally to the desired position. Method of insertion had no effect on peak pullout strength of TNP pins. TRO and PP pins inserted unidirectionally to the desired position had significantly greater peak pullout strengths than insertion bidirectionally or if the shaft of the pin violated the cis-cortex. The authors recommend that pins used for external skeletal fixation should be placed unidirectionally to the desired position with fluoroscopic guidance, intra-operative depth gauge measurements or measurements from preoperative radiographs. Repositioning pins results in loss of peak pullout strength with TRO and PP pins.

Description of and complications associated with reinforced, free-form external skeletal fixation for treatment of appendicular fractures in cats: 46 cases (2010-2019).

To describe a modified technique for reinforced, free-form external skeletal fixation (rFF-ESF) of appendicular fractures in cats and identify factors associated with development of complications. 46 cats with fractures repaired with rFF-ESF at Angell Animal Medical Center between 2010 and 2019. Medical records were reviewed for information on signalment, affected bone, fracture location and orientation, degree of comminution, severity (open vs closed), fixator type, number of fixation pins, use of an intramedullary pin (yes vs no), surgeon experience (staff surgeon vs surgical resident), anesthesia time, surgery time, perioperative antimicrobial administration, concurrent surgical procedures, intraoperative complications, postoperative alignment, whether fixator destabilization was performed, and time to complete fixator removal. Postoperative complications were recorded. 43 of the 46 (93%) cats had a successful outcome, with a median time to complete fixator removal of 8 weeks (range, 3 to 61 weeks). Twelve of the 46 (26%) cats had major (n = 3) or minor (9) complications. In univariable analyses, 4 factors were significantly associated with development of postoperative complications: body weight (OR for each 1-kg increase in weight, 1.8), tibial fracture (vs fracture of any other long bone; OR, 16), use of a type 2 fixator (vs a type 1 fixator; OR, 11), and use of destabilization (vs no destabilization; 7). Results indicated that rFF-ESF can be successfully used to stabilize a variety of appendicular fractures in cats. Further studies are required to compare rFF-ESF with other fracture fixation methods.

Management of open fractures of the lower limb during the COVID-19 pandemic: are the standards of treatment being maintained? A study from a major trauma centre in England

<p class="abstract"><strong>Background: </strong>Coronavirus disease 2019 (COVID 19) has created an immense strain on the NHS. During the height of the pandemic, trauma services were affected by redeployment, reduced theatre capacity and staff illness, and COVID BOAST guidelines were introduced.</p><p class="abstract"><strong>Methods: </strong>This retrospective study aimed to evaluate the standards of management of open fractures of the lower limb at a Major Trauma Centre in the United Kingdom during the COVID-19 pandemic and compare the same with the pre-pandemic period. Patient demographics, mechanism of injury, timing and mechanism of initial debridement and definitive soft tissue and skeletal fixation were noted. Outcomes including duration of hospital stay, 30 day and 1 year mortality were also assessed.</p><p class="abstract"><strong>Results: </strong>There was an overall 21% reduction in admissions with open lower limb fractures during the pandemic period with a 48% reduction during the first lockdown. There was a significant reduction in time taken from Emergency Department presentation to first debridement as well as a notable increase in operating outside of regular theatre hours. There was little difference in operative technique used for skeletal or soft tissue management at initial and definitive surgery, though fewer cases were performed as a two stage procedure. There was no difference in amputation rate in the two years. Length of stay was reduced from 21 days to 17, and 30 day mortality remained the same.</p><p class="abstract"><strong>Conclusions:</strong> Our study shows this Major Trauma Centre was able to provide a trauma service in accordance to the BOAST4 guidelines despite the increased pressures of the COVID-19 pandemic.</p>

Combined internal fixation and transarticular external skeletal fixation to treat traumatic patellar fractures in five dogs

Case history : Medical records were reviewed of dogs (n=5) presented to a single referral hospital in the United Kingdom between 2015 and 2017 with a traumatic patellar fracture treated with transarticular external skeletal fixation (TA-ESF) to augment internal fixation. Clinical findings and treatment : Two dogs had polar patellar fractures, two had comminuted fractures and one dog had a transverse fracture. The median age at the time of the surgery was 21 (min 8, max 132) months and the median body weight was 19.0 (min 8.3, max 28.6) kg. In all cases, TA-ESF (Type IA lateral triangulated or modified Type II) was used in combination with internal fixation with pins and/or orthopaedic wire, supported by nylon leader line (patella-to-tibia mattress suture) and/or absorbable suture in a locking loop and/or circum-patellar pattern. All cases had short-term (6-12 weeks) postoperative radiographic follow-up, which showed evidence of fracture healing in 2/5 cases. All TA-ESF were removed 6 or 7 weeks postoperatively and four dogs had minor complications related to TA-ESF. More than 2 years postoperatively, the owners of all dogs were contacted and questioned regarding the mobility of their pet using the Liverpool Osteoarthritis in Dogs questionnaire. Four of the five cases were re-examined to evaluate their long-term outcomes. Based on the results of goniometric measurement of stifle range of motion, subjective gait assessment and objective gait analysis with a pressure sensitive walkway, all dogs showed a satisfactory outcome at the final follow-up. Clinical relevance : A combination of internal fixation and TA-ESF for stabilisation of traumatic patellar fractures is a valid treatment option. Further investigations with larger case numbers are necessary to evaluate success and complication rates.

Evaluation of post-operative complications, outcome, and long-term owner satisfaction of elbow arthrodesis (EA) in 22 dogs.

The objective of this study was to report post-operative complications and outcomes in canines undergoing elbow arthrodesis (EA) with fixation techniques including bone plate fixation with a non-locking dynamic compression plate (DCP), bone plate fixation with a locking plate (LCP), and external skeletal fixator (ESF). Medical records of twenty-two cases that underwent EA between January 2009-December 2019 from 8 referral hospitals including both private practice and academic institutions were reviewed. Post-operative complications were classified as either minor or major, surgical evaluations were performed 8 weeks post operatively, and a follow-up questionnaire was sent to owners. Of the total 22 cases that met inclusion criteria, a total of 19/22 cases had complications, 12 major and 7 minor. Complications reported in 8/9, 7/9, and 4/4, for the DCP, LCP, and ESF fixation groups, respectively. Mild to moderate mechanical lameness was identified at surgical evaluation in 16/22 cases. Complete radiographic bone healing was achieved after 9 weeks in 19/22 cases. Long term owner follow up was available in 14/22 cases. Owners reported a good to normal quality of life in 13/14 cases and poor in one case. The majority of owners (11/14) reported good to excellent satisfaction with the outcome irrespective of persistent lameness. This study demonstrates that successful EA can be achieved using a variety of fixation methods, but persistent lameness is expected and complication rate is high.

A prospective randomized double-blind clinical trial to assess the effects of leukocyte-reduced platelet-rich plasma on pro-inflammatory, degradative, and anabolic biomarkers after closed pilon fractures.

Posttraumatic osteoarthritis (PTOA) significantly affects patients with pilon fractures even after adequate anatomical reduction, and treatment strategies targeting the biologic mediators of PTOA are needed. This study was designed to determine the effects of intra-articular injection of platelet-rich plasma (PRP) on synovial fluid (SF) biomarkers for patients undergoing open reduction and internal fixation (ORIF) of pilon fractures. Patients undergoing staged management of pilon fractures were enrolled in a prospective, double-blinded, randomized, and placebo-controlled clinical trial to determine the effects of a single intra-articular injection of leukocyte-reduced PRP on SF biomarkers. Arthrocentesis of the injured and uninjured ankles was performed at the time of external skeletal fixation (ESF) and ORIF. Patients were randomized to receive either autogenous leukocyte-reduced PRP or saline (control) via intra-articular injection into the injured ankle at the time of ESF. SF biomarker concentrations were compared-uninjured, injured pretreatment, and saline-injected or PRP-injected. Eleven patients (PRP, n = 5; saline, n = 6) completed the study. Twenty-one uninjured, and 11 injured pretreatment, five PRP-treated, and six saline-treated SF samples were analyzed. PRP-treated SF contained significantly higher levels of PDGF-AA (p = 0.046) and significantly lower levels of MMP-3 (p = 0.042), MMP-9 (p = 0.009), IL-1β (p = 0.049), IL-6 (p < 0.01), IL-8 (p = 0.048), and PGE2 (p < 0.04). This study provided mechanistic data to suggest that a single intraarticular injection of leukocyte-reduced PRP is associated with anti-inflammatory, anti-degradative, and anabolic responses compared with saline control. These findings provide the impetus for investigating long-term clinical outcomes after PRP injection as an orthobiologic adjunct to ORIF for mitigating the incidence and severity of PTOA after pilon fractures.

External fixator for the treatment of narrowed pelvic canal in a cat

The aim of this study was to report the outcome of the use of an external fixator to treat a pelvic canal stenosis in a 5-month-old female cat. The cat was referred with a history of 3 weeks of intermittent signs of constipation refractory to the medical management, occurring after surgical treatment for a bilateral sacroiliac luxation and sacral fracture. The clinical examination revealed instability of the pelvis and a radiograph showed a pelvic canal stenosis and megacolon. External fixator was the method of choice to be used in this case. The manually applied tension on an external fixator resulted in a widening of the pelvic canal. At 45 days after surgery, there were no signs of constipation, and the radiological examination showed progressive bone healing. At 18 months post-op, the cat had no abnormalities both on the clinical examination and on the radiography. In conclusion, the use of an external fixator led to the widening of the pelvic canal using a minimally invasive procedure. To the authors’ knowledge, this case report represents the first surgical description and clinical outcome of the widening of the pelvic canal in cats using an external skeletal fixator.

Perioperative management of open fractures in the lower limb.

An open fracture is a fracture which communicates with the external environment through a wound in the skin. Severe open fractures are managed by both orthopaedic and plastic surgeons to address injuries in both the bone and soft tissue. This review outlines the management of open fractures in the lower limb from the initial patient presentation to operative management (including debridement, skeletal fixation, definitive soft tissue coverage) according to the standards jointly published by the British Orthopaedic Association (BOA) and the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS). Additionally, the decision-making between limb salvage or amputation will be explored. Finally, this review will discuss the patient’s postoperative care including wound care and management of potential complications that may arise such as infection, flap failure and fracture non-union.

Effectiveness of Nursing Guidelines Regarding Self-Care Strategies for Patients with External Skeletal Fixation

Effectiveness of Nursing Guidelines Regarding Self-Care Strategies for Patients with External Skeletal Fixation

Chemical Polishing of Additively Manufactured, Porous, Nickel-Titanium Skeletal Fixation Plates.

Nickel-titanium (NiTi) alloys have shown promise for a variety of biomedical applications because of their unique properties of shape memory, superelasticity, and low modulus of elasticity (Young's modulus). Nevertheless, NiTi bulk components cannot be easily machined (e.g., CNC, rolling, grinding, casting, or press molding) due to their thermomechanical sensitivity as well as inherent superelasticity and shape memory. Thus, powder bed fusion (PBF) additive manufacturing has been used to successfully fabricate NiTi medical devices that match the geometric and mechanical needs of a particular patient's condition. However, NiTi PBF fabrication leaves unmelted particles from the source powder adhered to external surfaces, which cause minor dimensional inaccuracy, increase the risk of mechanical failure, and once loose, may irritate or inflame surrounding tissues. Therefore, there is a need to develop a chemical polishing (cleaning) technique to remove unmelted powder from the surfaces of PBF-fabricated implants, especially from inner surfaces that are difficult to access with mechanical polishing tools. This technique is especially useful for highly porous devices printed at high resolution. In this study, a chemical polishing method utilizing HF/HNO3 solution was used to remove loosely attached (i.e., unmelted) powder particles from surfaces of porous, skeletal fixation plates manufactured by PBF AM. It was observed that 7 min of polishing in an HF/HNO3 solution comprising 7.5 HF: 50 HNO3: 42.5 H2O enabled successful removal of all relatively loose and unmelted powder particles. A microcomputed tomography study examination found that the volumetric accuracy of the polished skeletal fixation plates was ±10% compared with the computer-aided design (CAD) model from which it was rendered. This postprocessing chemical polishing protocol is also likely to be useful for removing loose powder, while maintaining CAD model accuracy and mechanical stability for other complexly shaped, porous, three-dimensional (3D), printed NiTi devices.

A RETROSPECTIVE STUDY OF FEMORAL FRACTURES IN WILD BIRDS OF PREY: 119 CASES.

A retrospective study was performed to describe patient and fracture characteristics, treatments, complications, and outcomes associated with femoral fractures in free-ranging birds of prey. Cases were identified from the electronic database and included raptors admitted with femoral fractures at the Bird of Prey Clinic of the Université de Montréal, from 1986 to 2018. In total, 119 individuals from 24 species, with 123 femoral fractures, were included in the study. Twenty-seven birds (23%) were declared dead upon arrival. Ninety-two birds (77%) were admitted alive; 80 with acute fractures and 12 with a fracture that had already healed. A conservative treatment (cage rest) was used to manage eight fractures. Surgical repair was attempted on 34 femoral fractures in 33 birds. An intramedullary pin alone was used in 28 cases (82%), and an external skeletal fixator-intramedullary pin tie-in fixator was used in 6 cases (18%). For surgically treated fractures, 19 healed (in 18 birds), 4 did not heal, and 11 birds died or were euthanized before healing could be achieved. Of the 23/34 fractures where the healing process could be assessed, healing rate for comminuted fractures (11/23) was 91% (10/11). Surgical complications occurred in 10 cases (including 7 cases of migration and loosening of the pin, and 1 case of osteomyelitis), leading to euthanasia in 4 cases. Out of the 21 birds with acute femoral fracture upon presentation that were released, 14 had received a surgical treatment and 7 had received a conservative treatment. Nine of the 21 released birds (43%) had at least one other fractured bone. The majority of deaths and euthanasia occurred within 2 wk after admission (51/59; 86%). Thirteen birds were euthanized primarily because of their femoral fracture. Thirteen birds died in treatment and 33 were deemed nonreleasable and euthanized because of a comorbidity not related to the femoral fracture.

Biomechanical Comparison of Three Stabilization Methods for Tibial Tuberosity Fractures in Dogs: A Cadaveric Study.

The aim of this study was to compare the biomechanical properties of a hybrid external skeletal fixator (HESF) construct to the placement of paired interfragmentary Kirschner wires alone, and pin and tension band wire (PTBW) fixation for the stabilization of simulated tibial tuberosity fractures in dogs. Tibias were harvested from 12 skeletally mature dog cadavers weighing 20 to 30 kg. An osteotomy was made through the base of the tibial tuberosity, which was subsequently repaired with either paired Kirschner wires, PTBW fixation or a HESF. A tensile load was applied to the tibial tuberosity until failure occurred. Mode of failure was described and biomechanical parameters obtained were compared between fixation groups. The PTBW fixation and HESF construct afforded greater stiffness and load at 3 mm of axial displacement compared with fixation with Kirschner wires alone. There was no significant difference in stiffness and load at 3 mm displacement between PTBW and HESF fixation. Failure occurred by bending and pullout of the Kirschner wires for all fixation groups, preceded by untwisting of the knot in PTBW specimens. The HESF may provide a favourable alternative to PTBW fixation for tibial tuberosity avulsion fracture stabilization in dogs with substantial remaining growth potential.

Type II Resin-acrylic External Skeletal Fixation in the Repair of Proximal Radial and Ulnar Fracture in a Llama (Lama glama)

Type II Resin-acrylic External Skeletal Fixation in the Repair of Proximal Radial and Ulnar Fracture in a Llama (Lama glama)

A novel low-profile external skeletal fixator for type IIIB open tibial fractures: A biomechanical and clinical pilot study.

Although external fixator is standard for managing staged treatment of open tibial fracture, the main disadvantage of this device is too bulky to be tolerated by most patients for longtime use. The purposes of this pilot study were to compare the biomechanical properties of a novel low-profile external fixator (LP-ESF) with a traditional ESF and also to evaluate its performance in patients with Gustilo type IIIb tibial open fractures. A prospective clinical pilot study started from January 2015 to December 2017, and 18 patients with Gustilo type IIIb open tibial fractures underwent the fixation with a novel LP-ESF system. The biomechanical properties of the LP-ESF were compared with the Synthes External Fixation System according to the standard ASTM F1541-02. These patients were divided into two groups according to the size of bony defect. The postoperative clinical outcomes were subsequently collected. The biomechanical properties of the LP-ESF were comparable with those of Synthes External Fixation System and had an improved the axial/torsional stiffness and ultimate strength. In the clinical study, all patients with LP-ESF had fracture union. The duration of application of LP-ESF was 3.5 to 18 months until fracture union. In 10 of 18 patients, their fractures were immobilized with the LP-ESF until bone union, and no pin tract infection and no chronic osteomyelitis were recorded. The 36-Item Short Form Health Survey life quality and health survey were good to excellent in these patients. Notably, the LP-ESF allowed a patient with severe bone and soft-tissue defects to preserve the leg and joints function. In this study, we found that the novel LP-ESFs had improved clinical outcomes. The long-term LP-ESF application seems to be tolerable in our patients. This novel approach permits better controls in deep infection and faster healing of fractures, and thus may provide a viable alternative treatment for Gustilo type IIIb open tibial fractures.

A Standardized Order-Set Improves Variability in Opioid Discharge Prescribing Patterns After Surgical Fixation of Pediatric Supracondylar Humerus Fractures

To evaluate institutional opioid prescribing patterns following percutaneous fixation of pediatric supracondylar humerus fractures before and after implementation of a standardized discharge order set. A retrospective review of patients who underwent closed reduction and percutaneous skeletal fixation of a Type II or III supracondylar humerus fracture in 2017 (prior to pain protocol implementation) and again in 2019 (after pain protocol implementation) SETTING: Single Tertiary Care Children's Hospital PARTICIPANTS: In total, 106 patients met inclusion criteria between years 2017 (n = 49) and 2019 (n = 57). Exclusion criteria included miscoded patients, open fractures, patients who presented with vascular injury or nerve palsy, polytrauma patients with multiple fractures in the same upper extremity, and supracondylar humerus fractures that underwent an open procedure. There were no significant differences between inpatient pain scores (p = 0.91) and MDE prescribed (p = 0.75) between the 2 cohorts. In 2017, large variability was noted in day supply of opioids (0-11.4 days) and MDE (0-8.45 mg/kg), with significant differences between prescribing patterns of junior and senior level residents (mean day supply of opioids (p = 0.045), mean MDE prescribed on discharge (p = 0.001)). After implementation of a standardized opioid discharge order set, there was a tenfold increase in the number of patients discharged without an opioid prescription (2017: 4%, 2019: 44%). Additionally, any discrepancies between prescribing practices of junior and senior level residents were eliminated (mean day supply of opioids (p = 0.65), mean MDE prescribed on discharge (p = 0.69)). The introduction of a standardized post-operative opioid discharge order set led to a 10-fold increase in the number of patients discharged without an opioid prescription. Additionally, the order set decreased the variability in the prescribing patterns of discharge opioid medications without change in pain control. The resident prescribing variability based upon level of experience resolved with the use of the order set.

Outcome of Open Long Bone Fractures in Dogs Stabilized with Linear External Skeletal Fixator

Background: External skeletal fixator (ESF) has been recommended as biological method to stabilize open fracture as it does not involves the wound site, besides protecting adjacent soft tissue structures. Considering the advantages of ESF, this study was envisaged with an objective to study the outcome of open fractures of radius-ulna and tibia-fibula stabilized with linear ESF in dogs.Methods: This study included 17 dogs suffering from open long bone fractures of radius-ulna and tibia-fibula, divided into three groups; linear ESF type I or II (group I, n=8) and type III (group II, n=3). In group III (n=6), open fractures were initially treated using conservative methods i.e management of open wound till complete healing followed by delayed internal fixation using intramedullary pin or bone plating.Result: Majority of the open fractures of radius-ulna and tibia-fibula were transverse (64.71%), involving distal third diaphysis (47.06%) in heavy weight (54.55%), 1-3 year old (64.71%), non-descript (35.29%), male (88.23%) dogs due to automobile accidents (58.82%). Neutrophilic (81.47±4.45%) leukocytosis (24610±2461.88 per cumm) and elevated levels of alkaline phosphatase and creatine kinase were observed. Staphylococcus spp. was the common isolated bacteria sensitive to Gentamicin, Cefotaxime, Tobramycin, Amikacin and Neomycin. High per cent fractures (83.33%) in group III had acceptable functional outcome as compared to fractures treated with linear ESF (55.55%) in groups I and II. Osteomyelitis due to pin tract infections was the major complication (8/11; 72.7%) recorded in ESF groups (Group I and II) that lead to delayed and/or nonunion. Weight bearing score improved markedly after removal of the ESF frame. In conclusions, immediate fixation of the long bone fracture using linear ESF in the presence of open contaminated / infected wounds leads to unacceptable outcome. Poor animal compliance, pin tract discharge, osteomyelitis, delayed union and nonunion are major complications associated with linear ESF. Conservative management of the open fracture wound using standard treatment for 2-3 weeks till complete wound healing followed by internal fixation with intramedullary pin or bone plate is recommended for open long bone fractures in dogs.

Acrylic and Epoxy-pin External Skeletal Fixation Systems for Fracture Management in Dogs

Background: The metallic ESF systems are not easily available in the field and have fixed frames leading to less versatility in size and direction. Free forms of external skeletal fixators (acrylic and epoxy-pin) have advantages as they can be customized. Both acrylic and epoxy-pin ESF systems have been evaluated biomechanically in earlier studies; in the present study both are compared clinically.Methods: Twenty four dogs presented with 27 fractures of long bones, were randomly divided into 4 groups, according to the bones involved, group A was divided into A-I (radius-ulna) and A-II (tibia-fibula) sub-groups and group B was divided into B-I (radius-ulna) and B-II (tibia-fibula) sub-groups.Result: The mean ± SE fracture healing time in animals was 48.85 ± 2.56 days with no significant difference between two groups.The early presented cases and the ones with less soft tissue trauma showed better gait scores during the follow up period. Both acrylic and epoxy-pin fixators provided stable fixation and the technique can be practiced at field conditions with minimal facilities. Epoxy-pin ESF owing to better handling characteristics of epoxy resin is easier to construct than the acrylic ESF.

External skeletal fixation of tibial fracture in a domesticated rabbit

Present case reports a successful diagnosis and surgical management fractured left tibia bone through linear external skeletal fixation system (LESF) in a 1.5 year old male rabbit. Surgery was performed under general anaesthesia. A Rabbit presented in Veterinary clinical complex, CVAS, RAJUVAS, Bikaner, with a history of fall from height and clinical as well as radiographic examination revealed compound, segmental fracture of diaphysis of left tibia bone. LESF was done and owner was advised for further follow-up at regular interval. ESF assembly as well as weight bearing status was evaluated as objective of this study.

The Value of an Orthoplastic Approach to Management of Lower Extremity Trauma: Systematic Review and Meta-analysis.

Background:Management of traumatic lower extremity injuries requires a skill set of orthopedic surgery and plastic surgery to optimize the return of form and function. A systematic review and meta-analysis was performed comparing demographics, injuries, and surgical outcomes of patients sustaining lower extremity traumatic injuries receiving either orthoplastic management or nonorthoplastic management.Methods:Preferred Reporting Items for Systematic Reviews and Meta-Analysis, Cochrane, and GRADE certainty evidence guidelines were implemented for the structure and synthesis of the review. PubMed, Embase, Cochrane Library, Web of Science, Scopus, and CINAHL databases were systematically and independently searched. Nine studies published from 2013 through 2019 compared 1663 orthoplastic managed patients to 692 nonorthoplastic managed patients with traumatic lower extremity injuries.Results:Orthoplastic management, compared to nonorthoplastic management likely decreases time to bone fixation [standard mean differences: −0.35, 95% confidence interval (CI): −0.46 to −0.25, P < 0.0001; participants = 1777; studies = 3; I2 = 0%; moderate certainty evidence], use of negative pressure wound therapy [risk ratios (RR): 0.03, 95% CI: 0.00–0.24, P = 0.0007; participants = 189; studies = 2; I2 = 0%; moderate certainty evidence] with reliance on healing by secondary intention (RR: 0.02, 95% CI: 0.00–0.10, P < 0.0001; participants = 189; studies = 2; I2 = 0%; moderate certainty evidence), and risk of wound/osteomyelitis infections (RR: 0.37, 95% CI: 0.23–0.61, P < 0.0001; participants = 224; studies = 3; I2 = 0%; moderate certainty evidence). Orthoplastic management likely results in more free flaps compared to nonorthoplastic management (RR: 3.46, 95% CI: 1.28–9.33, P = 0.01; participants = 592; studies = 5; I2 = 75%; moderate certainty evidence).Conclusion:Orthoplastic management of traumatic lower extremity injuries provides a synergistic model to optimize and expedite definitive skeletal fixation and free flap-based soft-tissue coverage for return of extremity form and function.