Indications for External Skeletal Fixation Versus Internal Fixation
If we limit ourselves in the use of the external fixator to its strictest indications, then it is not in competition with the standard procedures of internal fixation. The external fixator should be viewed rather as an alternative to the methods of intramedullary nailing or plating, applicable whenever nailing or plating is considered too hazardous. We must remember, however, that bony union of fresh fractures usually takes longer with external fixation than with rigid internal fixation. Exceptions, of course, are the osteotomies carried out in metaphyseal areas of bone, or joint arthrodesis, where broad surfaces of cancellous and well-vascularized bone are brought under compression. These considerations pertain more to the tibia than to other bones that are protected by more circumferential muscle cover, so that both a delay of internal fixation and the different devices are better tolerated.