General principles and techniques of external skeletal fixation

The general techniques for using external fixators are demanding, regardless of the specific fixator selected. Attention to detail is absolutely essential if maximum advantage of the device is to be gained and potentially serious complications are to be minimized. The initial treatment of the condition for which the external fixator is chosen must be considered first: irrigation, debridement, and reduction of the severe, open fracture; drainage, debridement, and sequestrectomy of the infected fracture or nonunion; removal of the components and cement in the infected failed arthroplasty, etc. Primary treatment in these and other conditions must be appropriately administered prior to fixator application. Fixator type, frame and pin configuration and application, care of the fracture, and maintenance of the fixation appliance are discussed.