title: Forward surgical stabilization of penetrating lower extremity fractures: circular casting versus external fixation.
abstract: OBJECTIVE
  There are two choices for the stabilization of penetrating lower extremity fractures in the forward surgical environment: bivalved circular casting and external fixation. The material and equipment requirements of these methods are of paramount importance in the austere forward surgical environment.
  
  
  METHODS
  Casualties from the Battle of the Black Sea in Somalia 1993 were examined. Penetrating lower extremity fractures requiring immobilization were identified. The relative packing volume and weight for each method of immobilization were analyzed. Finally, the current literature concerning the treatment of penetrating lower extremity fractures sustained in combat was reviewed.
  
  
  RESULTS
  The consumable material requirements of cast immobilization are 22.9 times greater by weight and 3.16 times greater by packing volume. Cast immobilization also has a greater durable equipment requirement. External fixation has multiple clinical advantages but is considerably more expensive.
  
  
  CONCLUSIONS
  Based on these variables, the authors determined that external fixation is the treatment of choice for penetrating lower extremity fractures in the forward surgical environment.
authors.affiliation: Joint Trauma Training Center, Ben Taub General Hospital, 1504 Taub Loop, Houston, TX 77030, USA.
authors.forename: T
authors.initials: T
authors.lastname: McHenry
authors.forename: S
authors.initials: S
authors.lastname: Simmons
authors.forename: C
authors.initials: C
authors.lastname: Alitz
authors.forename: J
authors.initials: J
authors.lastname: Holcomb
mesh_terms: D002370:Casts, Surgical; D016267:External Fixators; D005597:Fractures, Open / Q000628:therapy*; D006801:Humans; D007869:Leg Injuries / Q000628:therapy*; D008887:Military Medicine; D008952:Mobile Health Units; D014481:United States