Far-forward fracture stabilization: external fixation versus splinting.
With improvements in body armor, soldiers often survive previously fatal injuries but incur devastating extremity trauma. Orthopaedic and general surgeons in forward-deployed areas must be well-versed in the selection and application of both external fixation and splinting devices in order to best preserve life and limb of the wounded. The surgeon must consider tactical environment, injury severity, injury location, available resources, and his or her own level of experience. Advantages to using external fixation in the field include preventing future injury to the traumatized soft-tissue envelope, reducing the risk of infection, minimizing fracture hemorrhage, providing pain control, and facilitating medical evacuation. Splinting is reserved for closed, low-energy, stable fractures of either the upper or lower extremity and for unstable fractures that are not amenable to battlefield external fixation; because of the risks of compartment syndrome, casts are avoided.