The role of hinged external fixation in the treatment of knee dislocation, subluxation and fracture-dislocation: A systematic review of indications.

Purpose: While rigid knee-spanning external fixation is more commonly utilized in the treatment of complex knee injuries compared to hinged external fixation (HEF), HEF has the added benefit of providing stability while also permitting early controlled range of motion. However, there is limited existing literature on the indications for HEF of the knee. The aim of this study was to review the clinical indications for HEF in the management of acute and chronic knee dislocations (KD), tibiofemoral subluxations and knee fracture-dislocations. Methods: Five databases, including PubMed, CINAHL, Cochrane, Scopus and SPORTDiscus, were systematically searched. Included studies were those that involved comparative or non-comparative evaluation of patients with an HEF applied for an acute or chronic KD, tibiofemoral subluxation or knee fracture-dislocation. Results: Fourteen studies ranging from 1998 to 2023 met inclusion criteria, with a total of 184 knees treated with HEF for an acute or chronic KD, tibiofemoral subluxation, or knee fracture-dislocation. The most common primary indication for HEF was acute or chronic KD. The most common secondary indications included combined osseous and ligamentous deficiency, associated vascular or soft-tissue injury, status post extensive capsular release for arthrofibrosis, and associated extensor mechanism disruption. Conclusion: While uncommon, HEF is a valuable option in the treatment of complex knee injuries where both stability and controlled mobilization are essential. Due to limitations in the available evidence, further high-quality research is needed to establish guidelines for the utilization of HEF about the knee. Level of Evidence: Level IV.