Hig energy fractures of the lower limb are often associated with tibial or femoral bone loss, skin exposition with vascular and nervous injuries (Gustilo et al.).

The surgical procedure is a real challenge, consisting in a temporary stabilization of the fracture associated with a plastic and/or vascular reconstruction.

Once the skin and vascular injuries are recovered, the orthopaedic surgeon can remove the temporary stabilization performing a circular external fixation with bone lengthening by using the “bifocal” (one site of metaphiseal corticotomy and one site of compression) or “trifocal” (two sites of metaphiseal corticotomy and one site of compression) technique.

We use to do a “docking site” treatment when bone fragments are nearly in contact.

Our experience indicates that circular external fixation, by using the Orthofix system, is a very useful and safe technique in the management of severe lower limb injuries.

Our good clinical results lead us to suggest this surgical technique that allow to obtain a limb reconstruction, avoiding segment amputation.