External fixation in the management of severe musculoskeletal trauma

External fixation was employed in 33 open extremity fractures in 29 patients. These high energy injuries were characterized by massive soft tissue injury, contamination, instability, comminution, and/or segmental bone loss. Initial management consisted of irrigation and debridement, and application of the external fixator. In an attempt to obtain limb salvage, 92 additional procedures were performed to attain soft tissue coverage and insure bony stability. Six patients required subsequent below knee amputation at the level of the fracture site. All other cases achieved soft tissue coverage, bone union and are ambulatory on functional extremities without orthotic aids. Complications relating to the fixator included pin tract infections in eight patients and refracture in three.External fixation has application in limb salvage in severe extremity injuries associated with massive skin or muscle damage, neurovascular injuries and segmental bone loss. The advantages of the technique include rigid stabilization of the fracture and surrounding soft tissues, unencumbered wound access, motion of contiguous joints and simplified nursing care, indexing terms: External fixation, open extremity fractures, and musculoskeletal trauma.