Abstract
Research Type:
Level 4 – Case series
Introduction/Purpose:
Despite the safety and versatility of external ring fixators for a multitude of indications, there is limited information on their contemporary usage and the factors contributing to their potential underutilization. This study aims to document current indications for ring fixator usage, explore potential barriers to their use, and identify potential solutions to address these barriers among American Orthopaedic Foot and Ankle Society (AOFAS) members.
Methods:
A multi-branched survey with 3- and 5-point Likert scales was designed for distribution to all active practicing members of the AOFAS to collect data on demographics, level of training, usage profile, provider opinions, barriers to device adoption, and factors that could encourage greater utilization. Data was collected and visualized through Qualtrics XM. Statistical analysis included descriptive statistics and unpaired t-tests to determine differences between groups of survey respondents.
Results:
119 participants were included in the preliminary analysis. 31.9% of participants do not utilize ring fixators in their practice despite 92.4% of respondents believing that ring fixation is critical for certain patients. 62.2% of participants received minimal to no exposure in residency. Ring fixation was most commonly used for Charcot joints (83.5%) and infection management (82.1%). 73.7% of non-users believed it could have a role in their practice but had hesitations. Non-users are more likely to believe ring fixators take too long to assemble in the operating room, express greater concern about postoperative burden, and are less confident in postoperative care in comparison to users (p <.01) The most popular intervention that would increase usage of ring fixators was attending non-industry sponsored courses.
Conclusion:
Perceived excessive postoperative burden, operative time burden, and lack of postoperative management confidence were predominant reasons for lack of ring fixator use. Survey responses suggest that these barriers to usage may be overcome by more access to early exposure in training, non-industry sponsored teaching, and longitudinal mentorship.