Complications of external skeletal fixation.

External skeletal fixators (ESF) have a reputation for causing problems. Effective solutions exist for some of these problems. Delayed union can be avoided by accurate reduction, early bone grafting, and early removal of the ESF. Nerve and vessel injury can be avoided by special attention to the anatomy of the lateral arm and forearm, the upper medial thigh, and the junction of the third and fourth quarters of the leg. Pin tract infections continue to haunt ESF systems but are minimized by special attention to necrosis of tissue at the pin-skin and pin-bone interfaces. Undue soft tissue or bone motion can be reduced by bulky pin wraps placed over mobile soft tissue area and by use of threaded rather than smooth pins.