Damage control and austere environment external fixation: techniques for the civilian provider

Extremity injuries associated with natural disasters and combat are typically high-energy, often open injuries, and routinely represent only part of the scope of injury to a poly-traumatized patient. The early management of these injuries is normally performed in austere environments, and relies heavily on the principles of damage control orthopaedics, with external fixation of associated long bone and peri-articular fractures. While the general principles of ATLS, wound management, and external fixation do not differ from that performed in the setting of civilian trauma, there are special considerations and alterations in standard practice that become necessary when providing this care in an austere environment. The purpose of this article is to review the principles and techniques of damage control orthopaedics and external fixation in the management of extremity trauma in the setting of combat- and natural disaster-related injuries.