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Far-Forward Fracture Stabilization: External Fixation Versus Splinting

Dr. Camuso is Clinical Assistant Professor, Keck School of Medicine, University of Southern California, Los Angeles, CA, and Staff Orthopaedic Trauma Surgeon, Navy Trauma Training Center, LAC + USC Medical Center, Los Angeles.

Neither Dr. Camuso nor the department with which he is affiliated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article.

The views expressed in this paper are those of the author and do not reflect the official policy or position of the Department of the Navy, the Department of Defense, or the United States Government.

With improvements in body armor, soldiers often survive previously fatal injuries but incur devastating extremity trauma. Orthopaedic and general surgeons in forward-deployed areas must be well-versed in the selection and application of both external fixation and splinting devices in order to best preserve life and limb of the wounded. The surgeon must consider tactical environment, injury severity, injury location, available resources, and his or her own level of experience. Advantages to using external fixation in the field include preventing future injury to the traumatized soft-tissue envelope, reducing the risk of infection, minimizing fracture hemorrhage, providing pain control, and facilitating medical evacuation. Splinting is reserved for closed, low-energy, stable fractures of either the upper or lower extremity and for unstable fractures that are not amenable to battlefield external fixation; because of the risks of compartment syndrome, casts are avoided.

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				E. M. Schwechter and K. G. Swan Raoul Hoffmann and His External Fixator J. Bone Joint Surg. Am., March 1, 2007; 89(3): 672 - 678. [Full Text] [PDF]