Development of a low-cost external fixation system: an off-label solution for resource-limited settings

External fixators are essential for the surgical management of long-bone fractures, particularly in resource-limited settings where access to commercial systems is often restricted by cost and logistics. This study aimed to develop a low-cost external fixation concept using widely available construction materials and evaluate its biomechanical performance under axial loading.

An external fixator composed of M10 threaded rods, washers, and nuts was developed. Five configurations were tested: SP (Steinmann pins), KT (threaded K-wires), KS (smooth K-wires), and BKS (bilaterally applied, smooth K-wires). A commercial external fixator served as control (CG). Juvenile bovine ulnae with a standardized fracture gap were subjected to cyclic axial loading. Construct stiffness, elastic deformation, and plastic deformation were assessed.

CG showed the highest stiffness (107.80 ± 14.12 N/mm), followed by SP (87.73 ± 17.92 N/mm), BKS (83.81 ± 10.01 N/mm), KS (49.84 ± 3.80 N/mm), and KT (46.66 ± 2.39 N/mm). Post-hoc analyses showed no significant differences between CG vs. SP and CG vs. BKS, whereas KT and KS were significantly less stiff. Elastic deformation followed a similar pattern. Plastic deformation was greatest in CG, while SP and BKS showed significantly lower values.

The threaded-rod fixator provides relevant mechanical stability at extremely low material cost. As a first biomechanical proof-of-concept, this approach may offer a practical and immediately deployable stabilization method for resource-limited settings when standard external fixators are unavailable. It could serve either as a definitive treatment or as part of a damage control strategy prior to transfer. Further biomechanical, cadaveric, and clinical studies are required before clinical application can be considered.