Objective The aim of this study was to prospectively study the effectiveness of external fixation for war injuries during the recent Gulf conflict.

Patients and Methods We studied all patients seen at 202 Field Hospital, which received the majority of patients who had external fixators applied by the British Armed Forces.

Results Fifteen patients had external fixators applied with follow-up available for 14 (15 external fixators). Of the 15, 13 (87%) required early revision or removal due to complications of the injury or the fixator. Seven required early removal at a mean of 9.1 days (range 1–19). Six required early revision at a mean of 5.9 days (range 1–22).

Instability was a problem with 10 fixators (67%). Seven fixators were revised and 3 were removed. Pin loosening was noted with 5 fixators (33%) involving twelve pins. The cause was multifactorial, but was related to injury severity and frame design.

A significant pin track infection developed at 14 pin sites (3 fixators – 20%). All 3 fixators were removed after a mean of 15.5 days (range 14–19).

Only 2 fixators did not require early removal or revision.

Conclusion We have demonstrated a high early failure rate with the use of external fixation and would caution against its universal acceptance. For many fractures plaster or skeletal traction provide an alternative option. When external fixation is required, stability must be achieved. Even with this there is likely to be a high complication rate due to pin track infection and loosening, and amputation must still be considered as a possible outcome for military injuries.