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.

Various modalities of treatment for intra/extra articular fractures of proximal tibia include, traction, open reduction and internal fixation by plates and screws, percutaneous screw fixation with or without external fixation, and recently introduced minimally invasive techniques. These methods have achieved varied success rates but the problems encountered have been prolonged recumbency with traction and dangers of extensive soft tissue stripping, infection and knee stiffness with internal fixation methods. Pin problems continue to haunt external fixators apart from poor acceptability of the frame by the patients. Encouraged with the excellent results achieved by us with intra- medullary inter-locking nail for complex fractures of distal femur, we have used the same device for selected cases of fractures of the proximal tibia during the last 5 years.

We used this method in 46 patients of which 43 were available for analysis. Twenty-one were open fractures and 34 had intra-articular extension. Six were floating knee injuries and 2 had an associated fracture of the patella. In all cases knee mobilization was started within 48 hours after the surgery. If associated injuries did not prevent, non-weight bearing crutch walking was started within a week and partial weight bearing within 3 weeks. Thirty-nine of the fractures have united at an average of 14 weeks and four are still being followed up. Thirty-seven have regained at least 90% of the original movement. There has been no infection except in two patients with Grade III open fracture, which settled after the implant was removed following fracture healing. There has been one delayed union, which is progressing to union after bone grafting.

Our early experiences with this implant are extremely encouraging as it provides adequate stabilization of the fracture without any soft tissue stripping and allows early mobilization of the joint and the patient.