Selected Instructional Course Lecture   |    
External Fixation: How to Make It Work
Bruce H. Ziran, MD1; Wade R. Smith, MD2; Jeff O. Anglen, MD3; Paul TornettaIII, MD4
1 Northeastern Ohio Universities College of Medicine, St. Elizabeth Health Center, 1044 Belmont Avenue, Youngstown, OH 44501. E-mail address: Bruce_Ziran@hmis.org
2 Department of Orthopaedics, Denver Health Medical Center, 777 Bannock Street, Denver, CO 80204
3 Department of Orthopaedics, Indiana University, 541 Clinical Drive, Suite 600, Indianapolis, IN 46202
4 Department of Orthopaedic Surgery, Boston Medical Center, 850 Harrison Avenue, D2N, Boston, MA 02118
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. One or more of the authors, or a member of his or her immediate family, received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from commercial entities (Synthes and Stryker). No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Printed with permission of the American Academy of Orthopaedic Surgeons. This article, as well as other lectures presented at the Academy's Annual Meeting, will be available in March 2008 in Instructional Course Lectures, Volume 57. The complete volume can be ordered online at www.aaos.org, or by calling 800-626-6726 (8 a.m.-5 p.m., Central time).
An Instructional Course Lecture, American Academy of Orthopaedic Surgeons

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2007 Jul 01;89(7):1620-1632
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The external fixator has been in use for more than a century. The first use was recorded by Carl Wilhelm Wutzer (1789-1863), who employed pins and an interconnecting rod-and-clamp system. Parkhill (1897) and Lambotte (1900) used devices that were unilateral with four pins and a bar-clamp system. By 1960, Vidal and Hoffmann had popularized the use of an external fixator to treat open fractures and infected pseudarthroses. The problems encountered with external fixation in the late twentieth century were predominantly due to a lack of understanding of the principles of application, the principles of fracture-healing with external fixation, and the use of old technology. Its use was reserved for the most severe injuries and for cases complicated by infection. Thus, pin problems, nonunions, and malunions were common. Since then, better technology and understanding have allowed for greater versatility and better outcomes. Simultaneous with developments in the Western world, Ilizarov developed the principles of external fixation with use of ring-and-wire fixation. It was not until the late 1980s and early 1990s, when more interaction and exchange between the West and East (Russia) was possible, and with the help of Italians who embraced the philosophy of external fixation, that the use of external fixation was proven to be successful. Several variations of external fixation have been developed, and its use is now widespread. Unfortunately, in the United States, all but a minority of surgeons still have substantial apprehension about the use of external fixation.
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