Extract
The external fixator has been in use for more than a century. The first use
was recorded by Carl Wilhelm Wutzer (1789-1863), who employed pins and an
interconnecting rod-and-clamp system. Parkhill (1897) and Lambotte (1900) used
devices that were unilateral with four pins and a bar-clamp system. By 1960,
Vidal and Hoffmann had popularized the use of an external fixator to treat
open fractures and infected pseudarthroses. The problems encountered with
external fixation in the late twentieth century were predominantly due to a
lack of understanding of the principles of application, the principles of
fracture-healing with external fixation, and the use of old technology. Its
use was reserved for the most severe injuries and for cases complicated by
infection. Thus, pin problems, nonunions, and malunions were common. Since
then, better technology and understanding have allowed for greater versatility
and better outcomes. Simultaneous with developments in the Western world,
Ilizarov developed the principles of external fixation with use of
ring-and-wire fixation. It was not until the late 1980s and early 1990s, when
more interaction and exchange between the West and East (Russia) was possible,
and with the help of Italians who embraced the philosophy of external
fixation, that the use of external fixation was proven to be successful.
Several variations of external fixation have been developed, and its use is
now widespread. Unfortunately, in the United States, all but a minority of
surgeons still have substantial apprehension about the use of external
fixation.