External fixation for open fractures of the upper extremity

Recent advances in external fixation hardware, frame application, and pin-site care have resulted in the evolution of external fixation as a safe and versatile technique. It provides skeletal stability, access to the site of injury, and allows early mobilization. It avoids the disadvantages of additional soft-tissue stripping and the foreign body introduction associated with internal fixation of open fractures. The utility of external fixation principles in open hand and wrist fractures is well established. Indications for external fixation in open fractures of the forearm, elbow, and arm are more restricted. External fixation in these locations should probably be limited to situations of marked fracture comminution, bone loss, or extensive soft-tissue damage.