Hinged external fixation in the treatment of knee dislocations: a prospective randomized study.
BACKGROUND
Our hypothesis was that patients treated with hinged external fixators as an adjunct to multiple-ligament reconstruction would have fewer reconstruction failures than patients treated without external fixation.


METHODS
In this prospective randomized study, patients with a knee dislocation either underwent ligament reconstruction with placement of an external hinged knee brace following surgery (Group A) or underwent ligament reconstruction with placement of a hinged external fixator (Compass Knee Hinge) for six weeks instead of the brace (Group B). The patients were followed clinically and were evaluated with physical examination, Lysholm and International Knee Documentation Committee knee scores, visual analog scale pain scores, and status regarding return to work and activities.


RESULTS
One hundred patients with 103 knee dislocations were enrolled. Seventy-seven patients with seventy-nine dislocations (thirty-two in Group A and forty-seven in Group B), with a minimum follow-up interval of twelve months, were available for evaluation. The mean duration of follow-up was thirty-nine months (range, twelve to eighty-six months). Nine patients (29%) in Group A had failed reconstructions compared with seven (15%) in Group B (p = 0.15). Group-A patients had twenty-two (21%) of 105 reconstructed individual ligaments fail compared with eleven (7%) of 157 reconstructed ligaments in Group B. The difference in ligament failure was significant (p < 0.001; power > 0.8), with more favorable results for the patients managed with the external fixation.


CONCLUSIONS
Hinged external fixation as a supplement to reconstruction following knee dislocation was associated with fewer failed ligament reconstructions compared with external bracing. Patients presenting with highly unstable knee dislocations should be considered for hinged external fixation to supplement initial reconstructive procedures.
Department of Orthopaedic Surgery, University of Missouri, 1100 Virginia Avenue, DC953.00, Columbia, MO 65212. E-mail address for J.P. Stannard: stannardj@health.missouri.edu.
James P
JP
Stannard
Department of Orthopaedic Surgery, University of Missouri, 1100 Virginia Avenue, DC953.00, Columbia, MO 65212. E-mail address for J.P. Stannard: stannardj@health.missouri.edu.
Clayton W
CW
Nuelle
University of Alabama at Birmingham, 510 South 20th Street, FOT 960, Birmingham, AL 35294-3409.
Gerald
G
McGwin
Department of Orthopaedic Surgery, University of Missouri, 1100 Virginia Avenue, DC953.00, Columbia, MO 65212. E-mail address for J.P. Stannard: stannardj@health.missouri.edu.
David A
DA
Volgas
D000328:Adult; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods; D018771:Arthralgia / Q000209:etiology / Q000601:surgery; D001915:Braces; D004867:Equipment Design; D005260:Female; D006801:Humans; D031221:Knee Dislocation / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D016119:Posterior Cruciate Ligament / Q000601:surgery; D011182:Postoperative Care; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology; D016896:Treatment Outcome