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2Primary operative management

External fixation

Initial operative treatment consists of irrigation and debridement which is followed by reduction and stabilization. Because of the complexity of the fractures and soft-tissue injuries, external fixation is all that one uses initially. Each case has to be considered on its own merits. However, in each instance one should use the well-proven principles of treatment.
As elsewhere in the body, application of an external fixator after soft-tissue care creates the best environment for initial limb management. The external fixator should be placed outside the zone of injury, with normal anatomy restored. The foot is best positioned at 90 degrees to the limb with pins in the tibia, talus, midfoot, or forefoot, as needed in the particular case.