External Fixation of Bone Fractures

Definition

External fixation involves the use of pins through the bone attached to a steel rod outside the limb. External fixation is used primarily to stabilize transverse fractures.

Description

Some limb fractures can be readily realigned by a physician and then firmly immobilized to allow healing, but complicated fractures may require surgery if the limb is to recover fully in both strength and sensitivity. Some fractures need the surgical application of traction. Surgery thus forms an essential part of fracture therapies.

The initial aim of surgery is to realign the ends of bone at the break so that they exactly reconstitute the original bone. This may be done by:

• External manipulation - the bone is pulled from the outer end. Anesthesia may be used.

• Open surgery performed under general anesthesia. In complicated fractures, additional surgical techniques will also be required to repair damage to associated tissues surrounding the break.

The second aim of the physician is to retain the alignment by immobilizing the limb through the use of:

• Plaster casts

• Splints

• External fixators, by which the bone fragments are secured to a strong external steel rod by means of steel pins.

• Traction (the gentle but continuous application of weight). Traction is commonly applied through attachments to a plaster cast, although some methods may require additional minor surgery.

External Fixation

External fixation is used primarily to stabilize transverse fractures. No other form of immobilization, such as a plaster cast, is required.

Some external fixators allow a degree of compression at the fracture site. It has been suggested that this may contribute to more rapid healing. External fixation offers very secure immobilization and allows almost immediate mobility.

Method of External Fixation

To apply a fixator, the surgeon first selects a device made from noncorrosive steel, makes a long incision to expose the areas of the bone where the pins will be inserted, drills the bone, and screws in the threaded pins, passing them through additional small incisions. Alignment need not be perfect because the brackets that secure the squared-off top ends of the pins to the external longitudinal steel rod allow for some sideward adjustment. The skin incision is then closed.

Removal of External Fixation Device

The length of time such external fixation devices are left in place varies from a few weeks to many months. Once the fracture is healed, all parts of the device are removed.

To remove the surgical elements of external fixation involves the unbolting of the brackets securing the pins to the rod and removal of the rod. The surgeon checks the healed fracture for solidity, and the pins are screwed out of the bone using a wrench on their squared-off heads. This causes a dull, aching pain that lasts only during this procedure. Antiseptic is applied where the pins penetrated the skin surface, and the small holes are left to heal (no stitches are needed).

Questions to Ask Your Doctor

Will surgery be required for the external fixation?

What type of anesthesia will be used?

How is the surgery performed?

What can be expected after the surgery?

How long is the hospital stay?

How long will the pins and steel rods be required?

How will the pins and steel rods be removed?