It is often possible to walk with an external fixator, though the ability to do so depends on several factors, including the nature of the injury, the type of fixator, and the specific instructions provided by medical professionals. This device is used to stabilize broken bones or correct deformities, and understanding its impact on mobility is important for patients during their recovery.
Understanding External Fixators
An external fixator is a medical device that stabilizes bone fractures or deformities from outside the body. It consists of metal pins or screws inserted into the bone through small incisions in the skin and muscle, connected to an external frame made of rods, clamps, and sometimes rings. This external frame provides stability to the bone fragments, holding them in proper alignment to facilitate healing.
External fixators are employed for various reasons, including stabilizing severe or complex fractures, correcting limb deformities, or gradually lengthening bones. They are particularly useful in cases where internal fixation (implants inside the body) is not suitable, such as with significant soft tissue damage or when rapid stabilization is required after trauma. The design of the fixator can vary, with some being straight bars (monolateral) and others forming circular rings around the limb.
Walking with an External Fixator
Circular external fixators are frequently designed to allow weight-bearing, which can promote bone healing. If the fixator does not span across joints, patients might find it easier to achieve mobility. However, the added weight and size of the device can make walking more challenging.
Patients will receive specific weight-bearing instructions from their healthcare provider, which can range from non-weight-bearing to full weight-bearing. Non-weight-bearing means no pressure should be put on the affected limb, often requiring the use of crutches or a walker to keep the foot or leg off the ground. Partial weight-bearing allows a limited amount of weight, such as 15-30% of body weight, to be placed on the limb, often with the aid of crutches or a walker. Full weight-bearing, as tolerated, means the patient can put their entire body weight on the limb, though running or jumping is typically restricted.
Initially, patients may experience balance issues and discomfort around the pin sites. Swelling around the affected limb, foot, or ankle is common after surgery, and elevating the limb can help reduce it.
Aids and Physical Therapy for Mobility
Mobility with an external fixator is significantly supported by the use of walking aids and structured physical therapy. Common aids include crutches and walkers, which provide stability and help manage weight-bearing restrictions. For longer distances or when fatigue is a factor, a wheelchair might be recommended to conserve energy. Physical therapists teach patients how to properly use these devices, ensuring safe movement and preventing falls.
Physical therapy begins early in recovery, often the day after surgery. Therapists guide patients through exercises designed to maintain strength and flexibility in muscles and joints above and below the fixator. This includes movements like heel slides, straight leg raises, and quadriceps exercises, which help improve range of motion and prevent stiffness. For limb lengthening procedures, full weight-bearing is encouraged and helps with the development and consolidation of new bone.
The rehabilitation plan is tailored to the individual’s progress, with the goal of gradually increasing activity and independence. Regular physical therapy sessions, often one to two times per week, are common, especially during the bone lengthening phase when muscles can tighten. Adherence to the home exercise program prescribed by the therapist is important for a successful outcome.
Managing Daily Life and Recovery
Living with an external fixator requires consistent daily care routines and adaptations to maintain comfort and prevent complications. Pin site care is a primary responsibility, involving daily cleaning to prevent infection, which is a common concern. This typically involves washing hands thoroughly, then cleaning around each pin site with a sterile cotton swab and a prescribed solution, moving from the pin outwards to remove any drainage or crust. Gently massaging the skin around the pins can help prevent the skin from sticking to the pins and promote drainage.
Monitoring pin sites for signs of infection such as new or increased pain, redness, swelling, or unusual discharge is important, and these signs should be reported to a healthcare provider. Pain management is also a focus, as discomfort can arise from pin site irritation, tissue tension, or swelling. Effective pain control, along with physical therapy support, can significantly improve a patient’s ability to engage in mobility and daily activities.
Adapting daily habits, such as clothing choices, is also necessary; loose-fitting clothing, wide dresses, or modified garments are often worn to accommodate the device. Sleeping positions may need adjustment, with extra pillows or foam wedges used to position the limb and prevent rubbing against the fixator. Maintaining hygiene, including showering, is possible once cleared by a surgeon, often with specific instructions for protecting the fixator and cleaning pin sites during the shower. The recovery journey demands patience and adherence to medical advice until the device is safely removed.