Functional Outcomes After Modern External Ring Fixation or Internal Fixation for Severe Open Tibial Shaft Fractures

Justin Solarczyk; Natasha M. Simske; Austin R. Thompson; Lisa Reider; Eben A. Carroll; Joshua L. Gary; Renan Castillo; Stephen M. Quinnan; William Obremskey; Robert V. O'toole; Heather A. Vallier; Saam Morshed; Michael J. Bosse; Madhav A. Karunakar; Rachel B. Seymour; Stephen H. Sims; Christine Churchill; Anna N. Miller; James Brett Goodman; Martha B. Holden; Daniel J. Stinner; Michael J. Beltran; Debra L. Sietsema; Philip F. Stahel; Hassan Mir; Andrew H. Schmidt; Gudrun E. Mirick Mueller; Patrick Yoon; Greg E. Gaski; Stephen J. Warner; Mark R. Brinker; Andrew Choo; John W. Munz; Matthew C. Galpin; John K. Sontich; H. Michael Frisch; Adam M. Kaufman; Thomas M. Large; Joshua Langford; J. Spence Reid; W. Andrew Eglseder; Christopher Lebrun; Theodore T. Manson; Jason Nascone; Raymond A. Pensy; Marcus F. Sciadini; Gerard Slobogean; Yasmin Degani; Michael J. Gardner; Theodore Miclau; Utku Kandemir; Patrick F. Bergin; Matt L. Graves; Clay A. Spitler; Conor P. Kleweno; Paul S. Whiting; David C. Goodspeed; Gerald J. Lang; Alexander B. Siy; Eduardo J. Burgos; Vamshi Gajari; A. Alex Jahangir; Wade T. Gordon; Lauren E. Allen

doi:10.2106/JBJS.24.00888

Functional Outcomes After Modern External Ring Fixation or Internal Fixation for Severe Open Tibial Shaft Fractures

Justin Solarczyk, Natasha M. Simske, Austin R. Thompson, Lisa Reider, Eben A. Carroll, Joshua L. Gary, Renan Castillo, Stephen M. Quinnan, William Obremskey, Robert V. O'toole, Heather A. Vallier, Saam Morshed, Michael J. Bosse, Madhav A. Karunakar, Rachel B. Seymour, Stephen H. Sims, Christine Churchill, Anna N. Miller, James Brett Goodman, Martha B. HoldenDaniel J. Stinner, Michael J. Beltran, Debra L. Sietsema, Philip F. Stahel, Hassan Mir, Andrew H. Schmidt, Gudrun E. Mirick Mueller, Patrick Yoon, Greg E. Gaski, Stephen J. Warner, Mark R. Brinker, Andrew Choo, John W. Munz, Matthew C. Galpin, John K. Sontich, H. Michael Frisch, Adam M. Kaufman, Thomas M. Large, Joshua Langford, J. Spence Reid, W. Andrew Eglseder, Christopher Lebrun, Theodore T. Manson, Jason Nascone, Raymond A. Pensy, Marcus F. Sciadini, Gerard Slobogean, Yasmin Degani, Michael J. Gardner, Theodore Miclau, Utku Kandemir, Patrick F. Bergin, Matt L. Graves, Clay A. Spitler, Conor P. Kleweno, Paul S. Whiting, David C. Goodspeed, Gerald J. Lang, Alexander B. Siy, Eduardo J. Burgos, Vamshi Gajari, A. Alex Jahangir, Wade T. Gordon, Lauren E. Allen

Research output: Contribution to journal › Article › peer-review

Abstract

Background:This study compared the functional outcomes of patients with open tibial shaft fractures who were randomized to either modern external ring fixation (EF) or internal fixation (IF). We hypothesized that there would be differences in patient-reported function between the treatment groups.Methods:This preplanned analysis of secondary outcomes from the FIXIT study, a multicenter randomized clinical trial, included patients 18 to 64 years of age with a Gustilo-Anderson Type-IIIB or severe-Type IIIA diaphyseal or metaphyseal tibial fracture who were randomly assigned to either IF (n = 132) or EF (n = 122). Follow-up visits occurred at 6 weeks and 3, 6, and 12 months after randomization. Outcomes included Short Musculoskeletal Function Assessment (SMFA) scores, the Veterans RAND 12-Item Health Survey (VR-12) physical component score (PCS), use of ambulatory assistive devices, and ability to ambulate.Results:The mean VR-12 PCS was slightly higher (better) for IF (24.8) than for EF (22.6) at 3 months (mean difference, 2.2 [95% confidence interval (CI): 0.2, 4.3]; p = 0.03) and trended higher for IF (27.0) compared with EF (25.3) at 6 months (mean difference, 1.8 [95% CI: -0.9, 4.4]; p = 0.19). However, there was no difference between the groups at 12 months. There were no clinically important or significant differences in SMFA Dysfunction and Bother scores between the treatment groups at any time point. EF was associated with a higher risk of using any ambulatory assistive device at 6 months (relative risk, 1.5 [95% CI: 1.21, 1.82]; p < 0.0001). The absolute percentage of patients using any ambulatory device was 37.6% for IF and 45.4% for EF at 1 year. There was no difference in ambulatory status between the treatment groups at any time point.Conclusions:We found no difference in physical function between patients with severe tibial fractures treated with IF versus EF. There was a high rate of impairment overall. Assistive devices for walking were more often utilized in the EF group at 6 months, and both treatment groups demonstrated similar overall impairment.Level of Evidence:Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Original language	English (US)
Pages (from-to)	694-701
Number of pages	8
Journal	Journal of Bone and Joint Surgery
Volume	107
Issue number	7
DOIs	https://doi.org/10.2106/JBJS.24.00888
State	Published - Apr 2 2025

All Science Journal Classification (ASJC) codes

Surgery
Orthopedics and Sports Medicine

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10.2106/JBJS.24.00888

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Solarczyk, J., Simske, N. M., Thompson, A. R., Reider, L., Carroll, E. A., Gary, J. L., Castillo, R., Quinnan, S. M., Obremskey, W., O'toole, R. V., Vallier, H. A., Morshed, S., Bosse, M. J., Karunakar, M. A., Seymour, R. B., Sims, S. H., Churchill, C., Miller, A. N., Goodman, J. B., ... Allen, L. E. (2025). Functional Outcomes After Modern External Ring Fixation or Internal Fixation for Severe Open Tibial Shaft Fractures. Journal of Bone and Joint Surgery, 107(7), 694-701. https://doi.org/10.2106/JBJS.24.00888

@article{037e060566014bc5b236d7a60f967648,

title = "Functional Outcomes After Modern External Ring Fixation or Internal Fixation for Severe Open Tibial Shaft Fractures",

abstract = "Background:This study compared the functional outcomes of patients with open tibial shaft fractures who were randomized to either modern external ring fixation (EF) or internal fixation (IF). We hypothesized that there would be differences in patient-reported function between the treatment groups.Methods:This preplanned analysis of secondary outcomes from the FIXIT study, a multicenter randomized clinical trial, included patients 18 to 64 years of age with a Gustilo-Anderson Type-IIIB or severe-Type IIIA diaphyseal or metaphyseal tibial fracture who were randomly assigned to either IF (n = 132) or EF (n = 122). Follow-up visits occurred at 6 weeks and 3, 6, and 12 months after randomization. Outcomes included Short Musculoskeletal Function Assessment (SMFA) scores, the Veterans RAND 12-Item Health Survey (VR-12) physical component score (PCS), use of ambulatory assistive devices, and ability to ambulate.Results:The mean VR-12 PCS was slightly higher (better) for IF (24.8) than for EF (22.6) at 3 months (mean difference, 2.2 [95% confidence interval (CI): 0.2, 4.3]; p = 0.03) and trended higher for IF (27.0) compared with EF (25.3) at 6 months (mean difference, 1.8 [95% CI: -0.9, 4.4]; p = 0.19). However, there was no difference between the groups at 12 months. There were no clinically important or significant differences in SMFA Dysfunction and Bother scores between the treatment groups at any time point. EF was associated with a higher risk of using any ambulatory assistive device at 6 months (relative risk, 1.5 [95% CI: 1.21, 1.82]; p < 0.0001). The absolute percentage of patients using any ambulatory device was 37.6% for IF and 45.4% for EF at 1 year. There was no difference in ambulatory status between the treatment groups at any time point.Conclusions:We found no difference in physical function between patients with severe tibial fractures treated with IF versus EF. There was a high rate of impairment overall. Assistive devices for walking were more often utilized in the EF group at 6 months, and both treatment groups demonstrated similar overall impairment.Level of Evidence:Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.",

author = "Justin Solarczyk and Simske, {Natasha M.} and Thompson, {Austin R.} and Lisa Reider and Carroll, {Eben A.} and Gary, {Joshua L.} and Renan Castillo and Quinnan, {Stephen M.} and William Obremskey and O'toole, {Robert V.} and Vallier, {Heather A.} and Saam Morshed and Bosse, {Michael J.} and Karunakar, {Madhav A.} and Seymour, {Rachel B.} and Sims, {Stephen H.} and Christine Churchill and Miller, {Anna N.} and Goodman, {James Brett} and Holden, {Martha B.} and Stinner, {Daniel J.} and Beltran, {Michael J.} and Sietsema, {Debra L.} and Stahel, {Philip F.} and Hassan Mir and Schmidt, {Andrew H.} and {Mirick Mueller}, {Gudrun E.} and Patrick Yoon and Gaski, {Greg E.} and Warner, {Stephen J.} and Brinker, {Mark R.} and Andrew Choo and Munz, {John W.} and Galpin, {Matthew C.} and Sontich, {John K.} and Frisch, {H. Michael} and Kaufman, {Adam M.} and Large, {Thomas M.} and Joshua Langford and Reid, {J. Spence} and Eglseder, {W. Andrew} and Christopher Lebrun and Manson, {Theodore T.} and Jason Nascone and Pensy, {Raymond A.} and Sciadini, {Marcus F.} and Gerard Slobogean and Yasmin Degani and Gardner, {Michael J.} and Theodore Miclau and Utku Kandemir and Bergin, {Patrick F.} and Graves, {Matt L.} and Spitler, {Clay A.} and Kleweno, {Conor P.} and Whiting, {Paul S.} and Goodspeed, {David C.} and Lang, {Gerald J.} and Siy, {Alexander B.} and Burgos, {Eduardo J.} and Vamshi Gajari and Jahangir, {A. Alex} and Gordon, {Wade T.} and Allen, {Lauren E.}",

year = "2025",

month = apr,

day = "2",

doi = "10.2106/JBJS.24.00888",

language = "English (US)",

volume = "107",

pages = "694--701",

journal = "Journal of Bone and Joint Surgery",

issn = "0021-9355",

publisher = "Lippincott Williams and Wilkins",

number = "7",

}

Solarczyk, J, Simske, NM, Thompson, AR, Reider, L, Carroll, EA, Gary, JL, Castillo, R, Quinnan, SM, Obremskey, W, O'toole, RV, Vallier, HA, Morshed, S, Bosse, MJ, Karunakar, MA, Seymour, RB, Sims, SH, Churchill, C, Miller, AN, Goodman, JB, Holden, MB, Stinner, DJ, Beltran, MJ, Sietsema, DL, Stahel, PF, Mir, H, Schmidt, AH, Mirick Mueller, GE, Yoon, P, Gaski, GE, Warner, SJ, Brinker, MR, Choo, A, Munz, JW, Galpin, MC, Sontich, JK, Frisch, HM, Kaufman, AM, Large, TM, Langford, J, Reid, JS, Eglseder, WA, Lebrun, C, Manson, TT, Nascone, J, Pensy, RA, Sciadini, MF, Slobogean, G, Degani, Y, Gardner, MJ, Miclau, T, Kandemir, U, Bergin, PF, Graves, ML, Spitler, CA, Kleweno, CP, Whiting, PS, Goodspeed, DC, Lang, GJ, Siy, AB, Burgos, EJ, Gajari, V, Jahangir, AA, Gordon, WT & Allen, LE 2025, 'Functional Outcomes After Modern External Ring Fixation or Internal Fixation for Severe Open Tibial Shaft Fractures', Journal of Bone and Joint Surgery, vol. 107, no. 7, pp. 694-701. https://doi.org/10.2106/JBJS.24.00888

TY - JOUR

T1 - Functional Outcomes After Modern External Ring Fixation or Internal Fixation for Severe Open Tibial Shaft Fractures

AU - Solarczyk, Justin

AU - Simske, Natasha M.

AU - Thompson, Austin R.

AU - Reider, Lisa

AU - Carroll, Eben A.

AU - Gary, Joshua L.

AU - Castillo, Renan

AU - Quinnan, Stephen M.

AU - Obremskey, William

AU - O'toole, Robert V.

AU - Vallier, Heather A.

AU - Morshed, Saam

AU - Bosse, Michael J.

AU - Karunakar, Madhav A.

AU - Seymour, Rachel B.

AU - Sims, Stephen H.

AU - Churchill, Christine

AU - Miller, Anna N.

AU - Goodman, James Brett

AU - Holden, Martha B.

AU - Stinner, Daniel J.

AU - Beltran, Michael J.

AU - Sietsema, Debra L.

AU - Stahel, Philip F.

AU - Mir, Hassan

AU - Schmidt, Andrew H.

AU - Mirick Mueller, Gudrun E.

AU - Yoon, Patrick

AU - Gaski, Greg E.

AU - Warner, Stephen J.

AU - Brinker, Mark R.

AU - Choo, Andrew

AU - Munz, John W.

AU - Galpin, Matthew C.

AU - Sontich, John K.

AU - Frisch, H. Michael

AU - Kaufman, Adam M.

AU - Large, Thomas M.

AU - Langford, Joshua

AU - Reid, J. Spence

AU - Eglseder, W. Andrew

AU - Lebrun, Christopher

AU - Manson, Theodore T.

AU - Nascone, Jason

AU - Pensy, Raymond A.

AU - Sciadini, Marcus F.

AU - Slobogean, Gerard

AU - Degani, Yasmin

AU - Gardner, Michael J.

AU - Miclau, Theodore

AU - Kandemir, Utku

AU - Bergin, Patrick F.

AU - Graves, Matt L.

AU - Spitler, Clay A.

AU - Kleweno, Conor P.

AU - Whiting, Paul S.

AU - Goodspeed, David C.

AU - Lang, Gerald J.

AU - Siy, Alexander B.

AU - Burgos, Eduardo J.

AU - Gajari, Vamshi

AU - Jahangir, A. Alex

AU - Gordon, Wade T.

AU - Allen, Lauren E.

PY - 2025/4/2

Y1 - 2025/4/2

N2 - Background:This study compared the functional outcomes of patients with open tibial shaft fractures who were randomized to either modern external ring fixation (EF) or internal fixation (IF). We hypothesized that there would be differences in patient-reported function between the treatment groups.Methods:This preplanned analysis of secondary outcomes from the FIXIT study, a multicenter randomized clinical trial, included patients 18 to 64 years of age with a Gustilo-Anderson Type-IIIB or severe-Type IIIA diaphyseal or metaphyseal tibial fracture who were randomly assigned to either IF (n = 132) or EF (n = 122). Follow-up visits occurred at 6 weeks and 3, 6, and 12 months after randomization. Outcomes included Short Musculoskeletal Function Assessment (SMFA) scores, the Veterans RAND 12-Item Health Survey (VR-12) physical component score (PCS), use of ambulatory assistive devices, and ability to ambulate.Results:The mean VR-12 PCS was slightly higher (better) for IF (24.8) than for EF (22.6) at 3 months (mean difference, 2.2 [95% confidence interval (CI): 0.2, 4.3]; p = 0.03) and trended higher for IF (27.0) compared with EF (25.3) at 6 months (mean difference, 1.8 [95% CI: -0.9, 4.4]; p = 0.19). However, there was no difference between the groups at 12 months. There were no clinically important or significant differences in SMFA Dysfunction and Bother scores between the treatment groups at any time point. EF was associated with a higher risk of using any ambulatory assistive device at 6 months (relative risk, 1.5 [95% CI: 1.21, 1.82]; p < 0.0001). The absolute percentage of patients using any ambulatory device was 37.6% for IF and 45.4% for EF at 1 year. There was no difference in ambulatory status between the treatment groups at any time point.Conclusions:We found no difference in physical function between patients with severe tibial fractures treated with IF versus EF. There was a high rate of impairment overall. Assistive devices for walking were more often utilized in the EF group at 6 months, and both treatment groups demonstrated similar overall impairment.Level of Evidence:Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

AB - Background:This study compared the functional outcomes of patients with open tibial shaft fractures who were randomized to either modern external ring fixation (EF) or internal fixation (IF). We hypothesized that there would be differences in patient-reported function between the treatment groups.Methods:This preplanned analysis of secondary outcomes from the FIXIT study, a multicenter randomized clinical trial, included patients 18 to 64 years of age with a Gustilo-Anderson Type-IIIB or severe-Type IIIA diaphyseal or metaphyseal tibial fracture who were randomly assigned to either IF (n = 132) or EF (n = 122). Follow-up visits occurred at 6 weeks and 3, 6, and 12 months after randomization. Outcomes included Short Musculoskeletal Function Assessment (SMFA) scores, the Veterans RAND 12-Item Health Survey (VR-12) physical component score (PCS), use of ambulatory assistive devices, and ability to ambulate.Results:The mean VR-12 PCS was slightly higher (better) for IF (24.8) than for EF (22.6) at 3 months (mean difference, 2.2 [95% confidence interval (CI): 0.2, 4.3]; p = 0.03) and trended higher for IF (27.0) compared with EF (25.3) at 6 months (mean difference, 1.8 [95% CI: -0.9, 4.4]; p = 0.19). However, there was no difference between the groups at 12 months. There were no clinically important or significant differences in SMFA Dysfunction and Bother scores between the treatment groups at any time point. EF was associated with a higher risk of using any ambulatory assistive device at 6 months (relative risk, 1.5 [95% CI: 1.21, 1.82]; p < 0.0001). The absolute percentage of patients using any ambulatory device was 37.6% for IF and 45.4% for EF at 1 year. There was no difference in ambulatory status between the treatment groups at any time point.Conclusions:We found no difference in physical function between patients with severe tibial fractures treated with IF versus EF. There was a high rate of impairment overall. Assistive devices for walking were more often utilized in the EF group at 6 months, and both treatment groups demonstrated similar overall impairment.Level of Evidence:Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

UR - http://www.scopus.com/inward/record.url?scp=85219744106&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85219744106&partnerID=8YFLogxK

U2 - 10.2106/JBJS.24.00888

DO - 10.2106/JBJS.24.00888

M3 - Article

C2 - 39977529

AN - SCOPUS:85219744106

SN - 0021-9355

VL - 107

SP - 694

EP - 701

JO - Journal of Bone and Joint Surgery

JF - Journal of Bone and Joint Surgery

IS - 7

ER -

Functional Outcomes After Modern External Ring Fixation or Internal Fixation for Severe Open Tibial Shaft Fractures

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