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Frame construction (triangular external fixation)

Construction of tibial frame and insertion of Steinmann pin

Insert two pins in the sagittal plane and slightly medial to the anterior tibial crest at an adequate distance above the fracture zone. Connect them with a short rod and tighten the rod-to-pin clamps. Placement more proximally gives room for later definitive open fixation and avoids damaged soft tissue in the fracture zone. Place the pins far enough apart to ensure adequate stability.

Then insert a Steinmann pin, or a threaded pin, from medial to lateral through the calcaneal tuberosity. Take care to avoid damage to the posterior tibial neurovascular bundle.