We sought out various surgeons who, we felt, possessed enough expertise and fundamental knowledge to pass this information on to the next generation of foot and ankle surgeons. When we first contacted Larry DiDomenico, he was on his way to a small village in Siberia, to engage in a discourse with the Russians who first developed the technique. Ski hats off to Dr. DiDomenico. He appears to be the expert in this area.

In his presentation, he discusses the basic principles, advantages and disadvantages of external fixation. The frame assembly, placement of wires, types of wires, and frame mechanics are explained in detail. The natural phenomenon of tissue growth under pressure becomes a powerful stimulus for healing. For this reason, external fixation has become the technique of choice for complex intra articular fractures of the ankle (Pilon). It has also made reconstruction of the Charcot Foot a realistic possibility. Amazingly, much of this can be done percutaneously, thereby preserving the soft tissue envelope and the vascularity of the local soft tissues. Patients can often weight bear immediately after surgery. The need for casting is eliminated.