Staged internal plate fixation of severe lower extremity fractures that use a temporary external fixator for the initial treatment as an intraoperative retention tool: a technical note

Staged treatment for severe lower extremity fractures is coming into widespread use, and some reports have described internal fixation (IF) using a temporary external fixator for primary care as an intraoperative retention tool. However, the infection risk with this procedure has not been examined sufficiently. To our knowledge, this article is the first report focusing exclusively on this specific surgical technique. A key point of our developed protocol for internal plate fixation with this technique to avoid postoperative infection is a precisely structured sterilization procedure, which required multiple changes of sterile surgical gloves. In all 19 fractures treated with our set protocol, postoperative infection did not occur. In this regard, however, a goal of definitive IF at the time of initial treatment is essential for this specific procedure. This technique could help orthopaedic trauma surgeons to import a temporary external fixator into the operative field for definitive IF, with less concern regarding risk of infection.