Additional bar(s) may need to be placed on each side and connected to the other bars via bar-to-bar clamps for joint-spanning external fixatores in particular (Figures 6-9).

3. Apply longitudinal traction to restore length and correct the coronal and sagittal alignment of the limb (“make the leg look like a leg”). If fluoroscopy is available, the reduction can be optimized, but an anatomic reduction is not required. Bony apposition improves stability, but can be difficult to maintain with damage control fixators and quickly restoring overall alignment without delaying additional treatment or transfer in the acute phase is preferable.

4.Tighten all components (Figure 6 and Figure 7).

5. Confirm clinical alignment, as well as radiographic alignment if fluoroscopy is available.

6. Dress pins with petroleum gauze (if desired) and Kerlix wrapping between skin and pin connector. (Figure 8 and 9).