Limb salvage in high-energy trauma continues to evolve with external fixators, ring fixators, and orthoplastic reconstruction. The Ilizarov apparatus and circular external frames have become essential for mangled extremities that historically would have required amputation. Key applications include popliteal artery injuries with vascular repair, distal tibia high-energy fractures, and open fractures with compartment syndrome. Decision-making between salvage and amputation considers skeletal severity, soft tissue and vascular injury, potential for functional recovery, patient comorbidities, and psychosocial factors. Young patients without significant comorbidities and borderline injury scores benefit from salvage attempts. Multidisciplinary teams and rapid diagnosis are critical; ischemia time exceeding 6 hours increases amputation risk. External fixation provides minimally traumatic stabilization that protects vascular repairs. Bone transport and lengthening using ring fixators, infection management, and staged protocols complete the limb salvage toolkit. Full guidelines available via orthopaedic trauma associations.
Trauma / limb salvage
