External Fixation Methods Research Articles

The role of external osteosynthesis in treatment of unstable pelvic osseous injuries

Objective. To specify the role and indications for application of аpparatus of external fixation (АEF) in treatment of unstable pelvic osseous injuries (UPOI); to study up the advantages and faults of the external fixation method; to share the experience of treatment, using this procedure.
 Маterials and methods. There were 229 patients, suffering pelvic injuries, examined on the base of orthopedic-traumatological centre of Kyiv’s Regional Clinical Hospital in 2005 - 2017 yrs and distributed into three Groups. In Group I 143 (62.4%) injured persons were included, in whom external osteosynthesis played the function of temporary measures of fixation, in Group II - 27 (11.8%) patients, in whom while hospitalization a fracture was fixed, using AEF, аnd after stabilization of the state the posterior pelvis osteosynthesis and reposition was conducted, in Group III - 59 (25.8%) patients, who, using several indications, were definitely treated, applying the external fixation method only.
 Results. Excellent effect of treatment in Group I was registered in 23 (19.0%), a good one - in 58 (47.9%), satisfactory - in 32 (26.4%), poor - in 8 (6.6%) of 121 patients; in Group II - accordingly, - in 5 (20.8%), 11 (45.8%), 7 (29.2%) and 1 (4.2%) of 24 patients; in Group III - accordingly, in 4 (8.3%), 12 (25%), 23 (47.9%) and 9 (18.6%) of 48 patients.
 Conclusion. Best results of treatment of patients with unstable pelvic osseous injuries were obtained while applying the tactics of change from external fixation into internal one. On the first stage the pelvic ring fixation, using AEF, was performed, аnd after stabilization of a patient general status - internal osteosynthesis. Application of the internal osteosynthesis method permits to control and stabilize the reposition achieved, to conduct the sacro-ileal joint revision.

Naša iskustva u liječenju preloma dijafize potkoljenice spoljnom fiksacijom

Introduction. Lower leg fractures are most frequent of all fractures of long bones because a lower leg is very exposed part of a leg, especially it is anteromedial side of tibia, located immediately under skin. Aim of this paper is to analyse results of teatment of open and closed diaphysial tibial fractures using method of external fixation. Patients and methods. We analyzed the results of treatment of open and closed diaphysial tibial fractures using method of external fixation at Department of Ortopedics od Doboj hospital in period from 2005 until 2009. All patients with open fractures been treated first with surgical treatment of the wound up to 8 hours and with installation of external fixator. Patients with closed fractures which did not have satisfactory reposition have been installed external fixator which was worn from 4 to 8 weeks and then taken off, they have been applied a closed lower leg walking cast which was worn pending fracture healing verified by a clinical and xray examination. Patients in wich there was no healing process have undergone a subseqent surgical treatment which in all cases was positive. After surgical treatment all patients were sent for physical therapy. Results. Out of 124 patients with diaphysial tibial fractures, 56 (45,2%) were with open fractures and 68 of them (54,8%) were with closed fractures. After a primary treatment, there were 49 (87,5%) open fractures and 39 (57,4%) closed fractures with complications. Conclusion. Treatment of closed and open diaphysial tibial fractures by means of external fixation in open fractures as standard and selected closed fractures have shown good results with a small number of complications which were removed by a second surgical teatment. This method of treatment fractures is recommendable method in a primary as well as in final treatment of these fractures due to a positive treatment outcome.

Results of external fixator treatment in distal radius intra-articular fractures

Objectives: Assessing the outcomes of treatment of the radius distal end joint fractures by using the closed reduction external fixation method. Methods: 41 intra-articular distal radius fractures of 38 patients treated in the Department of Orthopedics and Traumatology in the Medical Faculty of Trakya University between September 1997 and December 2004 were retrospectively examined. All of the fractures were treated by using closed reduction and uniplanar radiocarpal external wrist fixator. The affected limbs were assessed functionally and radiologically during the follow-up period. Results: Mean duration of external fixation application was 7.3 weeks. Mean follow-up time was 41.6 months. From the functional aspect, very good outcomes were obtained in 10 cases, good outcomes in 14 cases, medium outcomes in 15 cases, and bad outcomes in 2 cases. In radiologic scoring, very good outcomes were reported in 3 cases, good outcomes in 28 cases, medium outcomes in 8 cases, and bad outcomes in 2 cases. In total, 22 complications were observed. Reflex sympathetic dystrophy was observed in 15 cases, pain in the distal radioulnar joint in 8 cases, pain in distal radioulnar joint, and eburnation in 4 cases. In some cases, multiple complications were observed. There were also cases with early-stage sensation disorder and nail tip sensitivity. However, the complaints ended after the removal of the fixator. Conclusion: In intra-articular distal radius fractures, successful outcomes might be achieved by treating with external fixation without opening the fracture line.

The Use of External Fixation for the Management of the Unstable Anterior Pelvic Ring.

The objective of this article was to highlight the indications and various methods of external fixation for management of the unstable anterior pelvic ring. Although most often used temporarily in the setting of significant hemorrhage from a pelvic ring fracture, external fixation remains an option for definitive stabilization of select pelvic ring injuries. Classically, the iliac crest frame has been used, although use of the supra-acetabular frame has gained favor due to its superior bone purchase and improved biomechanics. Common complications from external fixation include pin site infections, loss of reduction, and the "external fixator deformity."

Methyl methacrylate in external fixation of supracondylar humerus fractures: An experimental study.

Supracondylar humerus fractures are common fractures around the elbow. Open fractures, comminuted metaphyseal fractures and also fractures with bone loss may need to be treated with external fixators. The aim of this study is to compare two different external fixators, tubular external fixators and polymethyl methacrylate with K wires external fixators, with regard to stiffness and stability for metaphyseal-diaphyseal osteotomies of distal humerus close to the joint. Six matched pairs (24 specimens) of second-generation sawbone humerus were prepared in a standard fashion to create a metaphyseal fracture, 5 cm proximal to the distal joint line of humerus and were randomly divided into two groups of 12 specimens each. Each sawbone humerus was osteotomized transversely at the mid-olecranon fossa with a 2-mm oscillating saw to simulate a Gartland type III fracture. The osteotomy was then reduced and stabilized using two different external fixation methods: carbon tubular external fixator with Schanz screws and methyl methacrylate with multiple K wires. Three-point bending and torsion tests were performed on the specimens. Bending and torsional stiffness of specimens were obtained for the fixation methods. According to the results of the study, the methyl methacrylate group has provided higher stiffness than classical tubular fixator with Schanz screws in three-point bending test (7.79 ± 2.33 N/mm vs 3.78 ± 1.18 N/mm, p = 0.006). The methyl methacrylate group also showed better stiffness in torsion test (0.12 ± 0.042 N m/° vs 0.067 ± 0.013 N m/°, p = 0.02). We determined for the first time in literature that external fixation with methyl methacrylate was significantly superior to the classical tubular external fixator with Schanz screws with regard to stiffness and stability under three-point bending and torsional loads. Moreover, methyl methacrylate is inexpensive and easily applied.

Correlation study of external fixation method with catheter associated urinary tract infection

Objective To observe and analyze the effect of different external fixation methods on catheter related urinary tract infection (CAUTI). Methods The clinical data of 86 patients suffered from indwelling catheters were retrospectively analyzed.According to the different external fixation of indwelling catheter, the patients were divided into observation group (n=43) and control group (n=43). The control group received drainage tube fixed in the bedside the legs go below, the observation group received drainage tube fixed on the bed after upper thigh walking.The incidence of complications was analyzed in the two groups. Results The incidence rates of CAUTI, leakage of urine, skin indentation of the observation group were 13.95%, 6.98% and 2.33%, respectively, which were lower than those of the control group (34.88%, 30.23% and 23.26%), there were statistically significant differences between the two groups (χ2=11.869, 17.848, 19.630, all P 0.05). Conclusion For the patients of indwelling catheter, drainage tube is fixed on the bed by the upper thigh walking is helpful to reduce skin pressure, reduce catheter infection and urine leakage rate, and can improve the comfort degree of patients, it is worthy of clinical popularization and application. Key words: Urinary tract infection; Urinary catheterization; Pain

Distal humerus nonunions after failed internal fixation: Treatment with Ilizarov external fixator

Introduction/Objective. Nonunions of distal humerus after unsuccessful surgical treatment represents challenging surgical problem. The complexity of this condition is increased by bone atrophy, scar tissue, poorly vascularized bone fragment, limited elbow mobility, osteomyelitis and local neurological damage. The advantages of using Ilizarov external fixation method are stable fixation, adequate fracture reduction and fragment compression accompanied by minimal soft tissue trauma, with the possibility of early elbow mobilization. This aim of this paper is to present the treatment results of 19 patients with nonunion of distal humerus after internal osteosynthesis managed by Ilizarov external fixation method. Methods. nineteen consecutive patients were treated with the Ilizarov external fixator. The study group includes 11 male and 8 female patients with an average age of 42 years. Surgical technique consisted of approaching the nonunion, removing loose fixation material, making resection and debridement of bone fragments, after which Ilizarov fixator was placed. Rehabilitation of the elbow started in early postoperative period. The functional status of the arm was evaluated using the DASH score (Disabilities of the Arm, Shoulder and Head). Results. All patients achieved solid bony union after average 7 months from application of external fixator. In 17 patients radiographic analysis indicated the preservation of joint space, while two showed degenerative changes. All patients showed improvement in elbow range of motion and significantly better DASH score with postoperative value of 21. Conclusion. As treatment of distal humerus nonunion, Ilizarov external fixation method provides successful healing and increased range of motion in the elbow.

Comparison of therapeutic results of plateau tibia fracture by hybrid method with double-plate classic methods

Background: Finding and choice the best treatment for the plateau tibia complex fracture has always been discussed. The present study aimed to compare the therapeutic outcomes of the external hybrid fixation method with a double-plate classic method in the treatment of plateau tibia complex fracture. Methods: Forty patients with plateau tibia complex fracture were treated with either a double plate or an external hybrid fixation. A knee score and clinical-functional table were used to evaluate patients after surgery. Level of evidence for this article is level one. Results: Knee score in the double and hybrid group was good to excellent in 60% and 75% of patients, respectively (P = 0.675). In patients, the union was formed correctly and skin necrosis was not observed in any of the cases. There were no significant differences between the two groups in the complications. In the double group, the risk of deep infection of the surgical site was 2.33 times in the patients. The pin-tract infection was observed in only 8 patients (40%) of the hybrid group. Depression was observed in 5 patients in the double group (25%) and 9 patients in the hybrid group (45%) (P > 0.05). Conclusion: In the treatment of plateau tibia complex fracture, both double plate and external hybrid fixation methods have almost the same therapeutic results and complications. However, the rate of pin-tract infection in the external hybrid surgical technique of fixation and the degree of deep infection is more common in double-plate surgery.

ХИРУРГИЧЕСКОЕ ЛЕЧЕНИЕ ПОСТРАДАВШИХ ПРИ ПОВРЕЖДЕНИИ МЯГКИХ ТКАНЕЙ ВСЛЕДСТВИЕ ОТКРЫТЫХ ПЕРЕЛОМОВ КОСТЕЙ ГОЛЕНИ

Вступление. Открытые переломы костей голени со значительным повреждением мягких тканей относят к повреждениям III степени (по классификации Густильо – Андерсена), их частота составляет от 45,8 до 64% в структуре открытых переломов.
 Материалы и методы. Проанализированы результаты лечения в клинике 76 пострадавших с открытыми переломами костей голени в 2008 – 2015 гг. У пациентов І группы метод с внешней фиксацией заменен на внутреннюю фиксацию, во ІІ группе – окончательное лечение перелома проводили с использованием аппарата внешней фиксации (АВФ) без замены.
 Результаты. При оценке результатов хирургического лечения открытых переломов костей голени с использованием шкалы Neer–Grantham–Shelton в І группе хорошие результаты отмечены у 27 (57,45%) пациентов, во ІІ группе – у 9 (31,03%).
 Выводы. Лечение пострадавших по поводу высокоэнергетической травмы нижних конечностей является длительным, сопровождается высокой частотой неудовлетворительных результатов. Основными критериями для замены метода с наружной фиксацией на внутреннюю является неосложненное заживление раны, отсутствие лабораторных и клинических признаков воспаления.

The psychological impact of external fixation using the Ilizarov or Orthofix LRS method to treat tibial osteomyelitis with a bone defect

ObjectiveTo examine the psychological impact of external fixation for a tibial bone defect due to osteomyelitis, and to compare the Orthofix limb reconstruction system (LRS) with the Ilizarov external fixator. Materials and methodsThe SCL-90-R questionnaire was administered at four different time points (before surgery, while patients wore the external fixation device, when the device was removed, and two to three months after). The scores at the four time points were compared, as were the two different methods of external fixation (Orthofix LRS vs. Ilizarov). ResultsThe patients experienced a significant adverse impact on their mental health, with the worst outcomes at Time 2 (while wearing the external fixator), but with some negative effects still present even several months after removal of the fixation device. Although the Orthofix LRS and Ilizarov groups showed similar mental health scores at Time 1 (preoperatively) and Time 3 (upon removal of the fixation device), the Orthofix LRS was associated with better scores, specifically in the Hostility (Time 2), Phobic Anxiety (Time 2), Psychoticism (Times 2 and 4), and Other (Time 2) sub-scores, as well as the total score (Times 2 and 4). ConclusionsAlthough both Ilizarov and Orthofix LRS fixation resolved the bone defects, external fixation had a negative impact on the patients’ mental health, which persisted even after removal of the devices. Although both methods led to negative effects on the patients’ mental, the impact of the Orthofix LRS was less severe.

Comparison study for internal and external modes of fixation for fractures of distal end radius

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Fractures of the distal radius continue to be one of the most common skeletal injuries. The methods which are commonly practiced are closed manipulation and plaster cast, pins and plaster, percutaneous pinning, external fixation and open reduction and internal fixation with or without bone graft. Surgeons are increasingly faced with the dilemma of when to consider operative management and when cast immobilization is the optimal treatment.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">47 cases of distal end radius fractures were operated in the orthopedic department of a tertiary care centre. The purpose of the present study was to compare the results of external and internal fixation methods for the treatment of fractures of distal end of radius. Patients operated by external fixation were classified as Group A and those operated by internal fixation were classified as group B. Patients were classified according to AO Classification. Patients were followed at regular intervals depending on the case and time of operation and evaluated by Gartland and Werley score</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">In our study, 29 patients were of extraarticular type, of which 86.20% had an excellent score and 18 patients were of intraarticular type, of which 83.33% had an excellent score. But when compared to groups A and B, the percentage of excellent score obtained in group B was more than that in group A in both extraarticular and intraarticular fractures. Yuan-kun et al did a study on intraarticular distal end radius fractures and evaluated the patients by Gartland and Werley point system, concluding that plating gives better results than external fixation supplemented by K wiring. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">We concluded that no method of fixation can be said superior to the other. Each method has fracture-specific indication. The results of open reduction and internal fixation can be better than external fixation in initial months, but in the long run, both the methods can have excellent score, provided the fixation is good and properly indicated.</span></p>

In this issue – May 2017

In this issue – May 2017

Proximal femoral osteotomy in Legg-Calvé-Perthes disease using a monolateral external fixator: surgical technique, outcome, and complications.

Level IV, case series.

Surgical management of delayed irreducible Gartland III supracondylar fractures in children: open reduction and internal fixation versus external fixation

Percutaneous pinning has been accepted as the "gold standard" for displaced supracondylar humeral fracture (SHF) in children. However, to secure an anatomic reduction and to reduce the rotated fragment, open reduction is often necessary when there is inadequate stabilization or a satisfactory reduction has failed to be achieved. The study aimed to compare the efficacy of the open reduction and bioabsorbable poly-d,l-lactic acid (PDLLA) pin fixation method with the closed reduction and lateral external fixation method in irreducible delayed Gartland type III SHF in children. In this study, 124 consecutive patients with irreducible delayed Gartland type III SHF were included between 2005 and 2013. Two different surgical methods were performed in patients separately. Group I had 64 patients undergoing bioabsorbable PDLLA pin fixation after open reduction, whereas group II had 60 patients treated by lateral external fixation after closed reduction. The outcome of treatment was evaluated by the Mayo Elbow Performance Score and the criteria of Flynn. Operation duration was longer in group I than in group II. Scoring of function showed that all patients had satisfactory results in both groups. The cosmetic result was satisfactory in all patients except 1 in group I. Both bioabsorbable PDLLA pin fixation and lateral external fixation are reliable, safe treatment alternatives for irreducible delayed SHF. Neither open nor closed reduction is linked to an increased rate of perioperative complications or unsatisfactory functional results.

Results of using the Ilizarov method for correction of complex foot and ankle deformities in skeletally mature patients

Objective Our aim was to study the results of correction of complex foot and ankle deformities in skeletally mature patients using the Ilizarov method with either osteotomy or arthrodesis. Background Complex foot and ankle deformity is a multiplanar one with shortening of the foot. Different corrective procedures have been described for correction of these deformities in skeletally mature patients, such as extensive soft tissue release with capsulotomy, tendon transfer, multiple osteotomies, and arthrodesis. Acute correction with internal fixation methods has many disadvantages such as excessive shortening of the foot, risk for neurovascular bundle injury, high risk for recurrence due to extensive scar formation, and high risk for wound complications. Patients and methods In this study, an Ilizarov external fixator was used for correction of 25 complex foot and ankle deformities in 23 patients with either bone osteotomy, which was done in 12 feet, or arthrodesis in another 13 feet. Results Complete clinical correction of all feet to a plantigrade position was obtained, gait was improved in all cases, and pain was the same, improved, or completely eliminated. Partial relapse of the deformity with recurrence of symptoms occurred in three cases. Conclusion The Ilizarov method of external fixation is an effective, safe, and reliable method for correction of complex foot and ankle deformities in skeletally mature patients, where correction is achieved by performing gradual distraction of foot osteotomies or arthrodesis.

Mid-Term Results of Minimally Invasive Plate Osteosynthesis and Circular External Fixation in the Treatment of Complex Distal Tibia Fractures.

The treatment of pilon tibia fractures is challenging. Anatomical reduction of the joint surface is essential. Excessive soft-tissue dissection may interfere with the blood supply and can result in nonunion. We sought to compare the outcomes of distal tibia fractures treated with medial locking plates versus circular external fixators. We retrospectively evaluated 41 consecutive patients with closed pilon tibia fractures treated with either minimally invasive locking plate osteosynthesis (n = 21) or external fixation (EF) (n = 20). According to the Ruedi and Allgower classification, 23 fractures were type B and 18 were type C. Soft-tissue injury was evaluated according to the Oestern and Tscherne classification. Time to fracture union, complications, and functional outcomes were assessed annually for 3 years with the American Orthopaedic Foot and Ankle Society (AOFAS) ankle score. Mean ± SD values in the plate group were as follows: age, 42.4 ± 14 years; union time, 19.4 ± 2.89 weeks (range, 12-26 weeks); and AOFAS ankle scores, 86.4 ± 2.06, 79.5 ± 1.03, and 77.9 ± 0.80 at 1, 2, and 3 years, respectively. Four patients in the plate group needed secondary bone grafting during follow-up. In the EF group (mean ± SD age, 40.7 ± 12.3 years), all of the patients achieved union without secondary bone grafting at a mean ± SD of 22.1 ± 1.7 weeks (range, 18-24 weeks). In the EF group, mean ± SD AOFAS ankle scores were 86.6 ± 1.69, 82.1 ± 0.77, and 79.7 ± 1.06 at 1, 2, and 3 years, respectively. There were no major complications. However, there were soft-tissue infections over the medial malleolus in five patients in the plate group and grade 1-2 pin-tract infections in 13 patients and grade 3 pin-tract infections in one patient in the EF group. Post-traumatic arthritis was detected in eight plate group patients and seven EF group patients. Minimally invasive plating and circular EF methods have favorable union rates with fewer complications.

Clinical observation of minor external fixation combined with Kirschner wire for open comminuted fracture of metacarpophalangeal joint

To explore the method and therapeutic effect of minor external fixation combined with Kirschner Treatment for open comminuted fracture of metacarpophalangeal joint. From January 2013 to December 2014, 13 patients with open comminuted fracture of metacarpophalangeal joint were treated by minor external fixation combined with Kirschner wire, including 9 males and 4 females, aged from 18 to 56 years old with an average of 35 years old.According to Gustilo classification, 8 cases were type II, 4 cases were type IIIA, and 1 case was type IIIB. The time from injury to operation ranged from 2 to 7 h with an average of 5 h. All fractures were involved with metacarpal phalangeal joint surface. Fracture healing time and postoperative complications were observed, TAM scoring system by Hand Surgery Association of Chinese Medical Association was used to evaluate functional recovery. All patients were followed up from 3 to 12 months with an average of 7 months. All fractures were obtained bone healing, and the time ranged from 4 to 6 weeks with an average of (4.6±1.0) weeks. No broken and loose needle, pin track infections, malunion, loose bracket, reflection sexual sense of neurological malnutrition occurred. According to TAM scoring system, 7 cases obtained excellent results, 4 cases good, 1 case moderate and 1 case poor. Minor external fixation combined with Kirschner wire for open comminuted fracture of metacarpophalangeal joint has advantages of simple operation, good stability and which could be adjusted at the later stage, less damage for soft tissue periosteum, low inflammatory, earlier functional exercise. It is worth to be popularized and applied.

The methods of treatment of long fractures and physiological fundamentals of osteosynthesis (the dynamics of views and modern state-of-art)

The spreading of AO philosophy, the traditions of native orthopedics-traumatology school and socio-economic peculiarities of the country have influenced on the tactics and technology of the treatment bone fractures in Ukraine. Simultaneously with modern AO technique skeletal traction and fixation method are used but the indications for their application are still uncertain. It was noticed many decades ago, that success of treatment is strongly correlated with early functioning of injured segment. The criteria of functionality of technology are still among the main ones to define the degree of its correspondence to the principles of physiological treatment of fractures. It was noticed, that osteosynthesis is considered as successful if it does not require any additional external fixation, allow early function and minimize negative influence on the vitality of damaged tissues. Tactical-technological items of fracture treatment require an analysis and reconsideration taking into consideration the state of orthopedics-traumatology service in Ukraine concerning the supply of high-grade licensed fixators and instruments for osteosynthesis, equipment for intraoperative radiographic monitoring and theoretical and practical training of specialists. The method of skeletal traction is still being used to treat inoperable patients and on the stages of preoperative preparation and planning. The fixing bandages and orthesises are the necessary components in complex treatment of trauma patients as the main immobilizing means and patient-specific functional orthesises to provide early functional rehabilitation. It’s emphasize, that the use of AO technology should not exclude from practice the method of external fixation that has no alternatives in the treatment of complications, open and gunshot fractures. The absence of serial production of external fixators influenced negatively on the quality of treatment of war casualties from South East part of Ukraine.

Establishment of a regional multicenter traumatic spine fracture/dislocation registry

ObjectiveTrauma is one of the leading causes of mortality and morbidity in adults and a major contributor to health care expenditures. Although spine-related injuries constitute a small proportion of trauma cases, they need special consideration due to poor functional outcomes and substantial burden. Despite relatively extensive previous studies on traumatic spinal injuries, there is still obscurity in some aspects of the issue. The purpose of this study is to establish a regional multicenter traumatic spine fracture/dislocation registry. MethodsThis is a prospective case series study, including all patients with acute traumatic spine lesions admitted to a regional multicenter since 2014. Data is extracted based upon a form developed by Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran. Novel electronic data entry software is initiated and data will be entered to the software. Information remains confidential and security considerations will be taken based on standards of data entry systems. ResultsThe results of this study will include age and gender distribution of the patients, causes of injury, location of pain and neurological deficit, the American Spinal Injury Association score and Frankel grade on admission, at discharge, after 6 and 12months and at the latest annual follow-up, radiologic findings, details of operative procedures and methods of external fixation. ConclusionThis study will identify prognostic factors that influence the ultimate fate of spine fracture patients and determine short and long-term outcome of different treatment methods. It can lead to a considerable improvement in patient care and will have a great national and transnational impact.

Management of an Open Comminuted Fracture of the Metacarpus using Circular External Skeletal Fixation in a Korean Water Deer (Hydropotes inermis argyopus)

A Korean water deer was rescued after being hit by a motor vehicle. Clinical and radiographic examination revealed a grade III open fracture of the right metacarpus with severe soft tissue injury. The water deer underwent closed reduction of the fracture, which was stabilized by the application of the Ilizarov method of 4-ring circular external skeletal fixation (CESF) as a minimally invasive technique. The water deer was successfully released into the wild. CESF was advantageous for the stabilization of open comminuted fracture and the management of a severely contaminated wound in a Korean water deer. CESF can be used successfully in wild deer with good tolerance and minimal complications.