What is an External Fixation?

Mary McMahon

An external fixation is a fracture repair with the use of a device that applies pressure to keep the fracture immobilized from outside the body. Known as a fixation frame, this device is installed in an operating room, usually on a patient under general anesthesia, and can be removed once the fracture is healed. Installation and management of an external fixation is usually overseen by an orthopedic surgeon, a medical specialist who focuses on the care of bones. Healing times for patients who need this kind of treatment vary depending on the nature of the fracture and the patient's general level of health.

It is necessary to immobilize a fractured bone during healing, no matter whether that is done through bracing or external fixation.
It is necessary to immobilize a fractured bone during healing, no matter whether that is done through bracing or external fixation.

In an external fixation procedure, pins are set through the bone at strategic points to allow a surgeon to attach the frame. The frame is adjustable so the physician can create the desired level of compression and tension. It can be cumbersome, as it protrudes outside the body, but will fix the bones in place more precisely than a cast. In addition, the lack of need for traction or a bulky cast can allow the patient to become mobile again more quickly, speeding healing time and reducing the risk of atrophy, blood clots, and other complications of prolonged immobility.

A fixation frame is installed while a patient is under general anesthesia.
A fixation frame is installed while a patient is under general anesthesia.

This procedure may be recommended in the cases of open fractures where casts and splints would obscure access to the wounds associated with the fracture, making it difficult to provide appropriate care to the patient. If there are concerns that a cast will not adequately immobilize the bone during healing, an external fixation may also be recommended. Surgeons evaluate each case individually, considering the nature of the injury, the patient's history, and other factors when deciding on the best treatment.

Some risks associated with an external fixation include infection around the pin insertion sites, injuries caused by jarring or wrenching the frame, and infections of open wounds around the fracture caused by inadequate wound care. Patients are provided with detailed wound care directions and will be advised on the best way to clean and maintain the wound during the healing process. It may also be necessary to adapt clothing and gear like backpacks to accommodate the fixation frame while the patient is recovering.

When the fracture appears to have healed, X-rays will be taken to confirm the healing, and the external frame can be removed. Some pins may be left inside the body. They can be permanently left in place or removed in another surgery at a later date, depending on the needs of the patient and the nature of the situation.

An rthopedic surgeon will likely oversee the installation and management of an external fixation.
An rthopedic surgeon will likely oversee the installation and management of an external fixation.

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