The use of an external fixator (EF) in the emergency department (ED) or the emergency theatre in the ED is reserved for critically ill patients in a life-saving attempt. Hence, usually only fixation/stabilization of the pelvis, tibia, femur and humerus are performed. All other external fixation methods are not indicated in an ED and thus should be performed in the operating room with a sterile environment. Anterior EF is used in unstable pelvic lesions due to anterior-posterior compression, and in stable pelvic fractures in haemodynamically unstable patients. Patients with multiple trauma should be stabilized quickly with EF. The C-clamp has been designed to be used in the ED to stabilize fractures of the sacrum or alterations of the sacroiliac joint in patients with circulatory instability. Choose a modular EF that allows for the free placement of the pins, is radiolucent and is compatible with magnetic resonance imaging (MRI). Planning the type of framework to be used is crucial. Avoid mistakes in the placement of EF. Cite this article: EFORT Open Rev 2020;5:204-214. DOI: 10.1302/2058-5241.5.190029

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Mean age 56 years (range, 19-87). The primary outcome measures were the following: Radiological (radial inclination, ulnar variance and palmar tilt at 3 and 6 months), clinical (the total Mayo wrist score) and the single score of each domain (pain, function, mobility and grip strength). RESULTS: At follow-up, in 79 examined wrists (54.4%) there was no pain, in 55 wrists (37.9%) the pain was mild and in 11 (7.5%) cases the pain was moderate. Wrist function was good, and 83 (58.4%) patients returned to their normal activities; in 55 (38.7%) patients, function was slightly impaired, and function in 1 patient was mildly impaired. Unsatisfactory reduction occurred in 21 (14.4%) wrists, including one case of bilateral fracture. CONCLUSIONS: We found no correlation between the patient's sex or the time between the fracture and surgery and each of the parameters considered. A correlation was found between the type of fracture and three other parameters: the ulnar variance at 3 months, the range of motion and the total score (measured by the Mayo Wrist score). There was a statistically significant difference between type C2 and C3 concerning the ulnar variance at the 3-month followup. There was also a difference between type C1 and C3 concerning the range of motion and the total score, with a better outcome in the patients with a type C1 fracture. Level of evidence: IV (case series).