Indications

External fixation provides ready access to the wound and easy adjustment of the bone fragments. Hence, it is well suited to:

• open fractures with severe soft tissue injury - limb and wound status can be observed directly, and associated treatments such as dressing, and skin or bone grafting, may be performed with minimal disturbance to the fracture
• infected fractures or nonunions - fixation is a critical factor in controlling and eliminating infection, but internal techniques are rarely advised
• severely comminuted and unstable fractures - length can be maintained by pins in the major proximal and distal fragments until healing begins
• limb lengthening
• management of patients with multiple injuries in whom rapid stabilisation of the fracture is required and in which other techniques, though often suitable for the fracture's individually, are not in combination

External fixation is also frequently indicated in pelvic fractures, maxillofacial fractures and unstable fracture dislocations of the cervical spine eg. the 'halo-vest.'

The technique has been successfully used in arthrodesis, promoting fusion between the joint surfaces once remaining articular cartilage has been replaced by cancellous bone graft, and in the management of comminuted intra-articular fractures, especially of the radio-carpal joint, by ligamentotaxis.