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External Fixation in Orthopedic Traumatology.

D. Seligson, C. Mauffrey, C. S. Roberts (eds) pp. 228 New York: Springer, 2012 ISBN: 978-1-4471-2199-2

With the advent of angular stable plates and screws, the role of external fixators in trauma has changed and this slim 220-page book is intended to re-appraise that role and this intent has been achieved with some success.

70% of contributors to this book are from the United States with three from Europe, two from India and one from Peru. This therefore gives the book a rather North American bias; the interesting and highly relevant chapter on the role of external fixation in the war zone only gives the US military doctrine (there was me thinking we were ‘allies’). The short chapter at the end of the book on medico-legal aspects was limited to the American legal system.

For a Springer book, the illustrations are surprisingly variable in quality, notwithstanding the disclaimer from the editors at the start of Chapter 4 (External fixation in economically disadvantaged areas). Some of the figures have been mislabelled (Figures 6.1, 6.10, 10.9) and astonishingly, some of the x-rays have not been anonymised (Figures 1.3c, 4.3.) I hope June Cash from Leeds has recovered from her tibial plateau fracture.

There are excellent chapters on Damage Control Orthopaedics (DCO), both the concept and on the practical aspects of external fixation in DCO, useful chapters on the bio-mechanics of external fixation, the use of external fixators in the war zone and external fixation in economically disadvantaged areas. Chapters on tibial plateau and pilon fractures are not too controversial. A final chapter on timing and strategies for definitive fixation is important especially in the context of DCO.

The holistic care of the patient with an external fixator is addressed but only partially. The role of physical therapy is mentioned in passing but should have been expanded on, perhaps even given a whole chapter. The psychological aspects of the traumatised patient with an external fixator are not addressed at all. A method of pin site care is described with little if any critical appraisal of alternative ways to care for the pin site; what about the use of chlorhexhidene to clean the pins, should the pins be kept covered and what should the pins be covered with?

Other chapters are a bit of a disappointment. The comprehensive chapter on pelvic external fixation makes no mention of the anterior internal fixator (In-fix). The chapter on wrist external fixators is far too long – the use of spanning external fixators across the wrist has been almost totally superseded by locking plates. If the fracture cannot be fixed with a plate, the authors should have discussed the alternatives such as a dorsally placed, per-cutaneous locking plate spanning the wrist.

In summary, this book is a reasonable overview of the current ‘state of play’ of external fixation but perhaps, a bit like external fixators, the precise role of this book is not defined.

M. Barry

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