1. Diaphyseal tibia fracture.

2. Select the fixator of the proper size. It should span the whole length of the tibia.

3. Check that the fixator is in the locked position, i.e. not dynamized. You can use it for intraop distraction only in this state

4. Connect the fixator to each bone stump by means of one threaded pin each, as close as possible to their proximal and distal extremity, respectively. Use clamps with the extension, in order to be able to direct the pins in every plane.

5. Distract the fracture by lengthening the fixator. Turn the coupled nuts on the C part of the fixator by a wrench, holding the extremity of the fixator by a second wrench.

6. Proceed up to when the fragments are distracted so that they are no more superimposed. The fixator will lengthen during the procedure.

7. Perform the maneuvers required to correct the fragment axis and position. The clamp with extension will allow adjustments on every plane

8. Achieve the correct fracture reduction BEFORE adding any further pin.

9. When you are satisfied with the reduction, add at least one pin to each fragment. For the intermediate pins it’s not usually necessary to use extensions, but remember the pin will stay perpendicular to the fixator’s axis.

10. If you need to have inclined pins due to the fracture features, it’s possible to use all the clamps with extensions, in order to hold them at the required angle.