External fixation is a medical procedure used to stabilize broken bones, offering a method to hold bone fragments in their correct alignment from outside the body. This approach provides stability to the injured area, allowing the bone to heal while managing associated soft tissue conditions. It serves as a valuable technique in orthopedics for various types of fractures.
What is External Fixation?
Unlike internal fixation, which places hardware inside the body, an external fixator consists of metal pins or wires inserted into the bone through the skin. These pins connect to an external frame, typically made of metal or carbon fiber rods, which provides rigid support and holds the bone fragments in place. This arrangement allows the bone to heal in proper alignment.
The external frame can be adjusted to maintain alignment as the bone heals. Its goal is to keep the length, alignment, and rotation of the fractured bone stable throughout the healing process.
Reasons for External Fixation
External fixation is often chosen for specific types of fractures where other methods might be less suitable. It is frequently used for severe open fractures, where the bone breaks through the skin, or for fractures accompanied by significant soft tissue damage or swelling. This method allows medical professionals to access and manage wounds, minimizing further disruption to the surrounding soft tissues.
It also serves as a temporary measure for patients with severe injuries, stabilizing the fracture until their overall condition improves enough for a definitive surgical procedure. External fixation is also applied to highly comminuted, or shattered, fractures. Conditions that delay skin healing, such as diabetes or peripheral vascular disease, can also make external fixation a preferred option.
The External Fixation Procedure
The application of an external fixator is a surgical procedure, typically performed under general anesthesia. During the operation, the surgeon makes small incisions in the skin near the fracture site. Metal pins or wires are then carefully inserted through these incisions and into the bone, both above and below the fracture.
The pins are strategically placed to ensure stability. The external framework is then assembled and tightened to hold the fractured bone in its correct anatomical position.
Living with an External Fixator
Adjusting to daily life with an external fixator involves specific care routines and adaptations. Maintaining cleanliness around the pin sites, where the pins enter the skin, is crucial to prevent infection. This typically involves regular cleaning with antibacterial soap and water, and sometimes antiseptic solutions, following healthcare provider instructions.
Mobility can be limited, and patients may need to use crutches, a walker, or a wheelchair, depending on the fracture’s location and severity. Clothing adjustments are often necessary to accommodate the frame, such as wearing loose garments or those with side zippers. While some discomfort is common, pain management strategies are usually provided to help. Patients are also advised to monitor for signs of infection, such as increased redness, swelling, or drainage around the pin sites.
Removing the Fixator and Recovery
When the bone has healed sufficiently, typically after several weeks or months, the external fixator is removed. This procedure is usually less involved than the application and often does not require general anesthesia, though local anesthesia may be used. Special wrenches are used to detach the external frame and remove the pins from the bone.
After removal, the pin sites are not typically stitched closed but are cleaned and allowed to heal naturally, usually closing within a few days. Patients may experience some pain, swelling, and stiffness in the affected area immediately after removal. Recovery often includes physical therapy to help regain strength, mobility, and range of motion in the limb. Sometimes, a cast or brace may be applied for a few weeks post-removal to provide continued support as the bone fully consolidates.