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2Primary operative management

The external fixator provides stability for the bony components of the foot. The soft tissues are put to rest and soft-tissue deficits are identified, should flaps or grafting be needed.
The external fixator is placed by the surgeon using bony anatomy that is stable and spanning areas of instability and soft-tissue loss.
Occasionally, percutaneous pinning is also advisable because of gross instability within the hindfoot and midfoot.