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J Trauma. 2010 Jul;69 Suppl 1:S135-9. doi: 10.1097/TA.0b013e3181e44fcb.

Temporary external fixation is safe in a combat environment.

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  • 1United States Army Institute of Surgical Research, Fort Sam Houston, Texas 78234-6315, USA.



External fixation has been used extensively during recent wars as a damage control measure for fractures in coalition forces being evacuated. We hypothesize that external fixation is a safe and effective initial stabilization procedure for combat-related open fractures.


Records on 55 consecutive type III tibia fractures between March 2003 and September 2007 were reviewed. We stratified the complications related to external fixation as major, potential, and minor complications. We defined major complications as neurovascular injury, mechanical failure, septic joint, and pin tract osteomyelitis. Potential complications were defined as pins within 1 inch of the fracture, pin overpenetration (> or = 26 mm), pin without cortical purchase, and intracapsular pin placement. Minor complications were defined as pin tract infections, addition of pins or bars, and pin overpenetration (9-25 mm). "Successful application" was defined as the absence of major or potential complications.


We recorded no major complications. There were 12 of 53 (22.6%) constructs and 21 of 228 (9.2%) pins inserted with potential complications. We detected minor complications in 27 of 53 (50.9%) constructs and 35 of 228 (15.3%) pins inserted; 41 of 53 (77.4%) constructs had no major or potential complications.


Treatment of combat-related open tibia fractures with external fixation was 77% successful in our series. We recorded no major complications but demonstrated the possibility for technical improvement in one of the five constructs with potential complications. Despite the recorded potential and minor complications, external fixation is safe and effective as a temporary damage control in open fractures sustained in combat.

[PubMed - indexed for MEDLINE]
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