External skeletal fixation - Linear fixations

External skeletal fixators (ESFs) have been used in human and veterinary me dicine since the development of the Parkhill clamp in 1897. ESFs became pop ular in human medicine during World War II but soon lost support in the hum an orthopedic community. This was primarily due to poor results and a high incidence of major complications such as premature pin loosening and pin tr act sepsis, leading to delayed union and nonunion. Therefore, ESFs experien ced limited use and development from the late 1940s to the 1970s.(7,) (46) Increased knowledge of proper pin insertion techniques and advancements in pin design have greatly enhanced the longevity of the pin-bone interface, r esulting in fewer complications and a resurgence in the use of ESFs in the past two decades.(7, 16) ESFs offer some unique advantages over other fixat ion systems. They are mechanically versatile and minimize surgical trauma t o the fracture environment. They are also the only fixation system that all ows for simple staged disassembly to help in the promotion of bone healing by increasing the loading forces on the fracture after initial healing has begun. This article reviews some of the potential advantages of linear ESFs and principles of application to help in minimizing complications associat ed with the use of ESFs.