Return to Sport or Military Duty After Lower Extremity Open Fracture: Systematic Review of Athletes and Active Military.

Background: Open fractures are complex injuries with high complication rates and infection risks, often resulting in prolonged recovery and limited return to physical activities. Despite this, data on return to sport (RTS) or return to military duty (RTD) are limited. This study evaluates RTS or RTD in individuals with lower extremity open fractures, hypothesizing extended recovery times and limited return rates, particularly for amateur athletes and military personnel compared with professional athletes. Methods: A systematic review of studies from 1990 to 2024 was conducted using Embase, Ovid MEDLINE, Clinicaltrials.gov, Cochrane databases, SPORTDiscus, and Scopus. Studies investigating lower extremity open fractures with RTS or RTD outcomes were included. Data extracted included patient demographics, Gustilo-Anderson classifications, recovery timelines, and return rates. Results: Eleven studies were included, with 10 involving adults and 1 including pediatric patients. The analysis covered 722 open fractures. Two studies reported an average return to sport time of 44.0 weeks (17 individuals) in amateur athletes, whereas 3 studies reported an average return to sport time of 61.8 weeks (26 individuals) in professional athletes. Five studies reported 27.3% of amateur athletes had returned to sports at final follow-up (mean = 19.5 months), and 1 study reported that 18.3% of military members returned to full duty at final follow-up. In the 3 studies reporting on professional athletes, 80.8% returned to playing at the professional level. Conclusions: Lower extremity open fractures often result in prolonged recovery times and significantly limit RTS or RTD. Although professional athletes demonstrated higher return rates, the outcomes for the general amateur athlete and military populations were substantially poorer. Further research with discrete fracture and treatment details is needed to better understand recovery trajectories for open fractures, disparity in outcomes between professional and amateur athletes, and the influence of resources and motivation on returning to activity.