{
  "abstract": "Introduction Orthopaedic injuries including long-bone fractures are common in polytrauma and combat injury settings due to high-energy mechanisms such as blasts, gunshots, and vehicular accidents. 1–3 As noted by Kazmirchuk et al., analysing combat injuries treated by the National Military Medical Clinical Center in Kyiv in 2022, during the first year of full-scale war 89% of the patients had injuries to the extremities of which 36% were long-bone fractures.3 Many of those fractures showed significant bone loss or involved multiple extremities. These injuries pose challenges from the first-aid temporary stabilization for damage control and evacuation, to definite fracture treatment and through the drawn-out process of fracture healing during long-term rehab. Standard orthopaedic treatment principles are difficult to maintain in combat settings, and the logistical challenges increase the risk of complications such as soft tissue infection, osteomyelitis, malunion, amputation and, ultimately, the return to functional recovery. External fixation is a cornerstone for stabilizing both a fracture and the medical situation in the acute phase of a severe injury, typically involving the lower limbs. In an advanced surgical setting, the use of external ring fixators might substantially improve fracture position and long-term healing, especially in cases with concomitant soft-tissue damage and bone loss.Methods In situations where both the immediate and long-term orthopaedic care is limited or delayed, we suggest that an improved external fixation system for seamless adaptation might be of substantial help.Results In a unique collaboration between Karolinska Institute and KTH Royal Institute of Technology, we are developing new techniques for external fixation to improve fracture care from the trauma event to final healing. Our aim is to develop a system that can be applied by one less educated initial care giver, to later be adjusted by instruction of a specialized orthopaedic surgeon, to optimize bone healing while reducing infection and other complications.Discussion Low-cost external fixators for field use have been presented for use in low-income countries, 4 although most are meant to be replaced by internal fixation solutions, such as intramedullary nails or plates within the first weeks. However, as noted by Bunzel et al., infection rates are high after conversion from external to internal fixation.1 A few systems of ring fixators for early use have been suggested, albeit their application might require a doctor or nurse trained in orthopaedic surgery.Conclusion We suggest a system that combines a simple application, fracture reduction with the stability allowing long-term use. After mechanical simulation studies, our system is ready for in-vivo studies.Disclosures No relevant disclosures.References Bunzel EW, Wilkinson B, Rothberg D, Higgins T, Marchand L, Haller J. Conversion of external fixator to intramedullary nail in tibial fractures. J Am Acad Orthop Surg. 2023 Jan 1;31(1):41–48. PMID: 36215677.Holtenius J, Berg HE, Enocson A. Musculoskeletal injuries in trauma patients: a Swedish nationwide register study including 37,266 patients. Acta Orthop. 2023 Apr 17;94:171–177. PMID: 37074086.Kazmirchuk A, Yarmoliuk Y, Lurin I, Gybalo R, Burianov O, Derkach S, Karpenko K. Ukraine’s experience with management of combat casualties using NATO’s four-tier ‘changing as needed’ healthcare system. World J Surg. 2022 Dec;46(12):2858–2862. PMID: 36070013.Milandri G, Wijesinghe PCI, Munidasa D, Pathmanathan C, Saeidi M, Bull AMJ, Silva P. Clinical trial of a low-cost external fixator for global surgery use. Int Orthop. 2023 Jul;47(7):1663–1669. PMID: 37074376.",
  "authors": [
    {
      "affiliations": [
        "Department of Trauma and Orthopaedics, Karolinska University Hospital, Stockholm, Sweden",
        "Division of Orthopaedics and Biotechnology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden"
      ],
      "name": "Hans Berg"
    },
    {
      "affiliations": [
        "Department of Trauma and Orthopaedics, Karolinska University Hospital, Stockholm, Sweden",
        "Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden"
      ],
      "name": "Mathias Mosfeldt"
    },
    {
      "affiliations": [
        "KTH Royal Institute of Technology, Dept Production Engineering, Precision Engineering and Metrology, Stockholm, Sweden"
      ],
      "name": "Andreas Archenti"
    }
  ],
  "title": "P10 Development of an external fixation system for complete fracture care in non-permissive environments",
  "uid": "9e97921e-37c5-536f-83ab-b063a66bb292"
}