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4Frame construction / reduction and fixation (tibial shaft)

Pearl: Prevent plantar flexion contracture

In patients with severe soft-tissue involvement, it may be helpful to add a pin in the foot (one of the tarsal or metatarsal bones) to maintain the ankle at a 90° angle and prevent a plantar flexion contracture.

The pin may be inserted in either the navicular bone, in one of the cuneiforms, in the first metatarsal base, or in the first and fifth metatarsal base, and connected with a rod to the tibial external fixator. Care should be taken to insert the pin bicortically and to avoid the intra-articular spaces.