Abstract
Faced with the challenge of managing war trauma in Afghanistan (1984–86), within limited resources and compromised conditions, we started managing open fractures with the pin and plaster method. With time a new External Fixation System evolved, which helped save hundreds of limbs and lives. Encouraged with the results, this system was used in the civilian practice, in India. There were further improvements in the design and refinements in technique. Subsequently biomechanical studies were conducted in Liverpool. The Fixator has been used at other centers in India and the UK with good results.
This paper describes evolution of the model, and its use in 116 patients by a single surgeon between February 1987 and July 1990. It has been used on every limb segment and indications included open fractures, infected non-unions, arthrodesis, osteotomy, etc. Analysis of results in 41 open tibial fractures showed 97.3% united at an average of 21.4 weeks. Delayed union occurred in 5.2 %. There was no malunion and pin tract infection was 6.3%. The system has proved to be simple yet versatile, cheap, easy to use, and an effective alternative to more costly and complex designs. It has been used as a modular system for varieties of conditions encountered in general orthopedic practice. Customized configurations can be produced and rigidity of fixation can also be altered in the same configuration, to meet biomechanical and biological demands in each patient.
With advent of newer techniques during last decade, the use of ExFix in our practice has been more selective and judicious.
Correspondence should be addressed to the editorial secretary: Associate Professor Jean-Claude Theis, Department of Orthopaedic Surgery, Dunedin Hospital, Private Bag 1921, Dunedin, New Zealand.
