Development of a low-cost external fixation system: an off-label solution for resource-limited settings

PURPOSE: External fixators are essential for the surgical management of long-bone fractures, particularly in resource-limited settings where access to commercial systems is often restricted by cost and logistics. This study aimed to develop a low-cost external fixation concept using widely available construction materials and evaluate its biomechanical performance under axial loading. METHODS: An external fixator composed of M10 threaded rods, washers, and nuts was developed. Five configurations were tested: SP (Steinmann pins), KT (threaded K-wires), KS (smooth K-wires), and BKS (bilaterally applied, smooth K-wires). A commercial external fixator served as control (CG). Juvenile bovine ulnae with a standardized fracture gap were subjected to cyclic axial loading. Construct stiffness, elastic deformation, and plastic deformation were assessed. RESULTS: CG showed the highest stiffness (107.80 ± 14.12 N/mm), followed by SP (87.73 ± 17.92 N/mm), BKS (83.81 ± 10.01 N/mm), KS (49.84 ± 3.80 N/mm), and KT (46.66 ± 2.39 N/mm). Post-hoc analyses showed no significant differences between CG vs. SP and CG vs. BKS, whereas KT and KS were significantly less stiff. Elastic deformation followed a similar pattern. Plastic deformation was greatest in CG, while SP and BKS showed significantly lower values. CONCLUSIONS: The threaded-rod fixator provides relevant mechanical stability at extremely low material cost. As a first biomechanical proof-of-concept, this approach may offer a practical and immediately deployable stabilization method for resource-limited settings when standard external fixators are unavailable. It could serve either as a definitive treatment or as part of a damage control strategy prior to transfer. Further biomechanical, cadaveric, and clinical studies are required before clinical application can be considered.