Knee-Spanning External Fixation in the Management of Knee Dislocations and Multiligamentous Knee Injuries: A Narrative Review.

Knee dislocations (KD) and multiligamentous knee injuries (MLKI) are challenging injuries to manage due to the high incidence of associated neurovascular compromise, extensive peri-articular soft-tissue trauma, and long-term functional deficits. Knee-spanning external fixation (KSEF) is occasionally utilized in the acute management of these injuries with the aim of maintaining alignment, protecting vascular repairs, allowing soft-tissue recovery prior to definitive treatment, and protecting freshly reconstructed or repaired ligaments. Despite its use in 5% of MLKIs and up to 50% of KDs, the clinical indications, outcomes, and complications associated with KSEF in the setting of KD/MLKI remain incompletely defined. Furthermore, KD/MLKI treatment algorithms incorporating decision-making related to KSEF application are limited both institutionally and within the literature. Thus, the purpose of this study was to consolidate the existing evidence related to the use of KSEF in the setting of KD/MLKI to support clinical decision-making and identify avenues for future investigation. Following a narrative review of the literature, the identified indications for KSEF in the setting of KD/MLKI were vascular injury, knee fracture-dislocation, extensive soft-tissue injury, persistent instability following reduction, open KDs, and when bracing is not feasible due to patient factors such as morbid obesity. Both rigid and hinged KSEF constructs have been described, with hinged fixators potentially permitting early motion while providing joint stability. Reported complications of KSEF include arthrofibrosis, infection, heterotopic ossification, and compartment syndrome, though available data are primarily retrospective and heterogeneous. Other topics that have been addressed in the literature include biomechanics, cost, magnetic resonance imaging (MRI) compatibility, and psychological impact. However, further research is needed to clarify its specific role, define standardized indications, and compare outcomes with non-invasive or alternative fixation and immobilization strategies.