Rehabilitation Following External Fixation for Lower Limb Trauma: A Service Evaluation Mapping the Gaps in Practice and Evidence

Background: Definitive external fixation is commonly used in the management of complex lower limb fractures.Holistic pre-and post-operative rehabilitation is considered essential; however, rehabilitation practices vary considerably, with limited supporting evidence and no validated outcome measures for this population.Aim: To describe rehabilitation provision for adults with lower limb injuries managed with definitive external fixation at a single NHS Trust, with secondary evaluation of post-operative mobility outcomes, patient demographics, and exploratory factors associated with return to baseline mobility.Materials and methods: A retrospective, single-site, service evaluation was conducted including adult patients treated with definitive external fixation between 2022 and 2025.Descriptive statistics summarised the data and univariate analyses explored factors associated with return to baseline mobility.Results: Seventy-four patients were included, with a median age of 46 years.Fifty-three percent regained baseline mobility post-operatively.Rehabilitation showed poor compliance with national guidelines across multiple phases of recovery.Few individual rehabilitation variables were associated with return to baseline mobility in univariate analysis.Conclusion: This study provides descriptive evidence regarding rehabilitation provision, patient characteristics, and mobility recovery following definitive external fixation at a single NHS Trust.Findings highlight variation in rehabilitation delivery, poor compliance with national guidelines, and ongoing uncertainty regarding optimal rehabilitation pathways for this patient population.Clinical significance: These findings highlight the need for prospective, multicentre research to evaluate rehabilitation pathways, develop standardised outcome measures, and strengthen the evidence base for rehabilitation following definitive external fixation.Future research should capture acute and long-term recovery and include functional, psychological, and socioeconomic outcomes.