International Orthopaedics

, Volume 43, Issue 8, pp 1779–1785 | Cite as

Standards for external fixation application: national survey under the auspices of the German Trauma Society

  • Simon TizianiEmail author
  • Thomas Dienstknecht
  • Georg Osterhoff
  • Thomas L. Hand
  • Michel Teuben
  • Clément M. L. Werner
  • Hans-Christoph Pape
Original Paper



External fixation is widely accepted as a provisional or sometimes definitive treatment for long-bone fractures. Indications include but are not limited to damage control surgery in poly-traumatized patients as well as provisional bridging to definite treatment with soft tissue at risk. As little is known about surgeon’s habits in applying this treatment strategy, we performed a national survey.


We utilized the member database of the German Trauma Society (DGU). The questionnaire encompassed 15 questions that addresses topics including participants’ position, experience, workplace, and questions regarding specifics of external fixation application in different anatomical regions. Furthermore, we compared differences between trauma centre levels and surgeon-related factors.


The participants predominantly worked in level 1 trauma centres (42.7%) and were employed as attendings (54.7%). There was widespread consensus for planning and intra-operative radiographical control of external fixation. Surgeons appointed at a level I trauma centre preferred significantly more often supra-acetabular pin placement in external fixation of the pelvis rather than the utilization of iliac pins (75.8%, p = 0.0001). Moreover, they were more likely to favor a mini-open approach to insert humeral pins (42.4%, p = 0.003). Overall, blunt dissection and mini-open approaches seemed equally popular (38.2 and 34.1%). Department chairmen indicated more often than their colleagues to follow written pin-care protocols for minimization of infection (16.7%, p = 0.003).


Despite the fact that external fixation usage is widespread and well established among trauma surgeons in Germany, there are substantial differences in the method of application.


External fixation Application standards Pelvic external fixation Pin-tract infection 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  • Simon Tiziani
    • 1
    Email author
  • Thomas Dienstknecht
    • 2
  • Georg Osterhoff
    • 1
  • Thomas L. Hand
    • 3
  • Michel Teuben
    • 1
  • Clément M. L. Werner
    • 1
  • Hans-Christoph Pape
    • 1
  1. 1.Department of TraumaUniversity Hospital ZurichZurichSwitzerland
  2. 2.Department of Orthopaedic SurgerySt. Augustinus Hospital LendersdorfDuerenGermany
  3. 3.Department of Orthopaedic SurgeryUniversity of Texas Health Science Center at San AntonioSan AntonioUSA

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