There was a time when an open fracture was synonymous with amputation. Young Blakeney had his right arm amputated in the sea battle between the the British ship HMS Surprise and the French ship Acheron in the Napoleonic Wars in the nineteenth century in Peter Weir's film Master and Commander [1]. Since the time of Napoleon, a lot of progress has been achieved in this field due to medical and surgical (r)evolutions, such as the introduction of the external frxator at the beginning of the twentieth century [2]. In 1992 we still asked "external fixator, what next?" [3], and presented options for the conversion from external to internal fixation. Today external fixation is less popular; unreamed nailing procedures and bridging plate procedures using angle-stable implants are favored, even in severe situations such as high-degree open fractures [4], provided that accurate repeat debridement and early soft tissue coverage is respected [5]. However, the reconstruction of large (post-)traumatic diaphyseal bone defects remains a special surgical challenge.
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