External Fixation in Orthopaedic Trauma and Limb Reconstruction

COPYRIGHT © 2021 BY THE JOURNAL OF BONE AND JOINT SURGERY, INCORPORATED. Advanced practice providers (APPs) play an instrumental role in the perioperative management of complex trauma patients, and it is essential that they are familiar with the indications, advantages, andutilizationof circular ring fixation (RF) in the management of these patients. This review aims to describe modern and advanced uses of external fixation, primarily focusing on the use of circular RF in both an acute setting and its pivotal role in deformity correction, critical bone loss, and soft-tissue deformity. Further discussion will focus on the essential components of circular RF, the novel approaches, and the perioperative considerations compared with internal or traditional external fixation. Although traditional external fixation devices have been used in the treatmentof fractures since the1800s, itwasnot until the mid-1900s that Raoul Hoffman began using more progressive and adjustable pin-to-bar clamps to further address fracture deformity.After improvements in Hoffman’s design and the subsequent genesis of the circular ring fixator in the mid-1900s to late 1900s byGavril Ilizarov, the creation of modern-day circular fixation was born. Ilizarov further advanced traditional fixation methods through creation of the multiplanar fixator. This technique uses tensioned fine wires to maintain periarticular fracture reduction while allowing continual modifications to loadmechanics. Furtheradvancements to Ilizarov’s design led to the development of newer generation circular multiplanar fixators with the ability to perform correction in 3-dimensions concurrently. These fixators use a hexapod designwith 6 struts and computer modeling to assist in correctiveplanningofbonydeformities. In addition, modern RF has advanced from Ilizarov’s original “fine wire only” systems to include fixationwhich uses the addition of half-pins to increase stability in the frame while ensuring the construct is not toostiff.Toorganize theunderstandingof circular RF mechanics, it is important to recognize the essential componentry before beginning a discussion of its indications for use and perioperative considerations and potential complications.