Five-year-old male patient who, after suffering an Improvised Explosive Device (IED) attack in a public place, was evacuated to a local health care centre and was first diagnosed with a diaphyseal fracture of the left femur. The fracture was not adequately reduced and he was immobilised in a splint. He was evacuated to the second Spanish military surgical echelon ROLE 2 in Herat, Afghanistan for definitive treatment.

After noting the unacceptable fracture reduction, it was decided to carry out a surgical procedure of Damage Control Orthopaedics consisting of a reduction and immobilisation by external fixation.
In the absence of TENS-type elastic endomedullary rods or external fixators for the paediatric age group, external fixation by means of an external wrist fixator (used as a circumstantial method) on the left femoral diaphysis was decided upon.
In the operating theatre and after anaesthetic optimisation, the surgical procedure is performed, which involves debridement of the necrotic soft tissues with profuse pulsatile lavage. Scopy confirmed the presence of a transverse and unstable femoral diaphysis fracture. Closed reduction with scopic control of the fracture was performed, and an external fixation technique was carried out by implanting a Stryker™ TRIAX external fixator (wrist and small fragment external fixator used here as a method of circumstance) in a monoplane and monotube configuration. Two proximal pins and two distal pins and check under scopia for correct pin placement.