External fixation is a method of immobilization that uses percutaneous pins placed in bone and linked with external connectors to maintain the fracture segments in a desired spatial relationship. It is a valuable clinical treatment option, providing surgeons with the ability to affect the spatial relationship of tissues, both statically and dynamically, via minimally invasive techniques. The ease and speed of application, adjustability of the frame, and minimization of blood loss with preservation of blood supply at the cutaneous and osseous levels are advantages of the external fixation technique. Care of the trauma patient remains one of the major applications for external fixation. Open fractures with severe soft tissue injuries and/or massive contamination are ideally suited to this technique. External fixation is also a versatile salvage technique for the complications arising from extremity trauma. The management of residual fracture deformity, bone loss, infections, and complex post-traumatic arthritis are often facilitated by external fixation.

Treatment of nonunion has radically changed in recent years. We define nonunion as a fracture of bone induced either by trauma or surgery which does not show clinical or radiographic signs of progression to healing within a reasonable time span. The reparative processes are present but inadequate. Fracture healing may be considered to be a balance between repair and breakdown processes at the fracture site. When breakdown exceeds repair, nonunion is the result. Altering the conditions at the fracture site even marginally in favour of repair will eventually lead to bony continuity being restored. Nonunion treatment should follow three principles: a) realignment; b) stabilization; and c) stimulation. Any surgical proce dure should address one or all of these areas. In this article the principles of nonunion management are explained, together with different bone healing stimulation techniques and our clinical results.