Across 30 observational studies (957 patients; 970 feet), pooled single-arm estimates indicate that limb salvage and osseous fusion were achieved in most cases across internal, external, and hybrid fixation. External fixation was typically selected for infected or more complex reconstructions and was associated with higher amputation and lower fusion proportions, whereas internal and hybrid constructs showed higher fusion with more hardware-related reoperations. Given substantial heterogeneity and confounding by indication, these patterns should be viewed as descriptive rather than comparative; they do not establish indications or superiority.
Chinnaswamy et al. (Tue,) studied this question.