External fixation and temporary stabilization of femoral and tibial trauma

External fixation is an important option in the acute management of unstable femoral and tibial fractures and the temporary stabilization of periarticular injuries of the knee or ankle. The value of external fixation as the modality of choice in selective civilian and military applications is well documented. Primary indications include damage control for multitrauma management in patients with concomitant traumatized integument and/or excessive swelling and/or systemic instability and stabilization for transport in hostile or austere environments. The purpose of this article is to discuss the indications for temporary external fixation of lower extremity long bones and complicated distal femoral, proximal tibia, and tibial plafond fractures; to outline technical considerations in the application of temporary external fixation devices; and to summarize the experience in the use of prepackaged external fixators and their indications in combat.