There are various methods of internal fixation for the treatment of fractures, but at certain times it is inappropriate to perform internal fixation as primary treatment.
External fixation should be considered for damage-control surgery in polytrauma (ISS > 25) and it is probably the safest way to achieve initial stabilization of fractures in the severly injured with an ISS > 40. It can be performed rapidly and, because it is a minimally invasive technique, it will minimize any additional surgical insult to the patient .External fixation can be used for almost every long-bone and large-joint fracture. The main advantage of this approach is the rapid achievement of relative stability that helps to control pain, decrease bleeding, and facilitate nursing care. Perfect joint reconstruction with interfragmentary compression and absolute stability, allowing early pain-free motion, is the treatment goal for articular fractures. This goal can be achieved by ORIF or, for simpler fracture patterns, by a combination of interfragmentary lag screw fixation with an external or hybrid fixator.
External fixators provide the surgeon with the unique opportunity to manage major soft-tissue and bone loss by primary shortening of the limb followed by secondary distraction osteogenesis to restore limb length. In exceptional cases this will avoid the need for major plastic surgical reconstruction.