Preliminary exploration of safety and efficiency of external traction fixation in early-stage treatment of severe lower leg injuries--A retrospective cohort study

Background: Staged treatment is commonly used for severe limb injuries, and optimizing early stabilization is crucial for successful definitive surgery. Calcaneal traction and external skeletal fixation are widely applied; however, both have limitations— discomfort of bedrest and traction line swing, or infection risk and surgical planning difficulty. Meanwhile, external traction fixation, a hybrid technique structurally similar to external fixation but biomechanically akin to skeletal traction, offers both mechanical stability and procedural convenience. This study aims to evaluate the safety and efficacy of external traction fixation as an early-stage treatment for severe lower leg injuries. Methods: We retrospectively analysed data from 92 patients with severe lower leg injuries treated at our hospital between May 2016 and May 2022. Patients (72 males, 20 females; mean age 46.6 ± 13.3 years) were divided into three groups based on the initial temporary fixation method: external traction fixation (Group A), calcaneal traction (Group B), and external skeletal fixation (Group C). Outcomes included peak creatine kinase and lactate levels within 48 hours post-injury, peak Visual Analog Scale (VAS) scores within 24 hours post-fixation, duration of the temporary fixation procedure, time to definitive surgery, and duration of definitive internal fixation. Limb function was evaluated at final follow-up using the Johner-Wruhs criteria. Results: Peak lactate levels were significantly lower in the external traction fixation group (Group A) compared to the other groups. The mean duration of definitive surgery was 69 ± 17 minutes (Group A), 89 ± 15 minutes (Group B), and 88 ± 15 minutes (Group C). After adjusting for confounders, definitive surgery was significantly shorter in Group A compared to Group B (mean difference: 20.60 minutes; 95% CI: 12.76–28.45; p < 0.001) and Group C (mean difference: 19.59 minutes; 95% CI: 11.62–27.50; p < 0.001). Postoperative infection rates were 7% (Group A), 3% (Group B), and 23% (Group C), with no significant difference after adjustment. The final excellent-good outcome rates (Johner-Wruhs criteria) were 93% (Group A), 78% (Group B), and 73% (Group C), with a significant difference between Group A and Group C. Conclusion: In the early-stage treatment of severe lower leg injuries, using external traction fixation to stabilize the injured limb is a safe and efficient technical choice. It is well compatible with subsequent definitive surgery and better facilitates the staged treatment strategy for severe limb injuries.