Table of ContentsView AllTable of ContentsBroken Bone RepairBenefitsContraindicationsApplicationTypesRisk of Infection
Table of ContentsView All
View All
Table of Contents
Broken Bone Repair
Benefits
Contraindications
Application
Types
Risk of Infection
An external fixator is a surgical device that allows a fractured or misaligned bone to heal properly. By immobilizing the bones, the external fixator providesstability to boneand soft tissue. The device is commonly used to help children heal or to protect skin that is damaged around the bone.
This article explains when and how an external fixator is used, the types of devices, and how to avoid infection or other possible risks.
This photo contains content that some people may find graphic or disturbing.See PhotoJonathan Cluett, M.D.
This photo contains content that some people may find graphic or disturbing.See Photo
This photo contains content that some people may find graphic or disturbing.
Jonathan Cluett, M.D.
External Fixation to Repair Broken Bone
Benefits of an External Fixator
The main advantage of external fixation is that it is quickly and easily applied. The risk of infection at the site of the fracture is minimal, although there is a chance ofinfectionwhere the rods go through the skin.
External fixators are often used in severe traumatic injuries. They allow for rapid stabilization while allowing access to soft tissues that may also need treatment. This is particularly important when there is significant damage to skin, muscle, nerves, or blood vessels.
Fractures
Limb Alignment and Lengthening
External fixators can help with limb lengthening if one leg is shorter than the other and alignment if a child has a condition such as bowed legs. In these procedures, the external fixator is placed and a surgical procedure is done to make space for new bone to grow.
After the procedure, you will need to turn the struts daily to help lengthen the bone. Your child will also have stretching andstrengthening exercisesthey will need to complete daily. Your care team will instruct you how often your child needs to come back for follow-up, help set upphysical therapyappointments, and provide any additional instructions, such as pin care to avoid infection.
Other Uses
External fixators are also used in other procedures. Two examples arearthrodesisproceduresand the treatment plan forosteomyelitis. Arthrodesis is a joint fusion procedure. External fixation can help stabilize the joint, allowing it to fuse.
Osteomyelitisis a bone infection that can occur due to trauma. External fixation helps stabilize the bone so that it can heal.
External fixation can also be used to retain the integrity of bone structures (such as the hand) after aserious burnor injury. Without fixation, the exposed or damaged tissue can contract from the accumulation of scar tissue, causing long-term or even permanent restriction of movement.
Contraindications for External Fixation
External fixation is contraindicated under the following circumstances:
How an External Fixator Is Applied
Orthopedic surgeons do external fixation procedures undergeneral anesthesia. The procedure itself typically follows the following steps:
The bolts and external frame can usually be removed without anesthesia in a healthcare provider’s office. Fractures have been known to occur at the drill sites, so extended protection may be needed after the device is removed.
Types of External Fixators
There are several different types of external fixator devices. The two main types are circular external fixators and monolateral external fixators.
There are two main types of circular external fixators: the Taylor spatial frame (TSF) and theIlizarovexternal fixator. The TSF is more commonly used than the Ilizarov. Both require adjustments to achieve the desired length of the bone.
The Ilizarove fixator requires a wrench to adjust the device, and the TSF is more easily adjusted. However, the Ilizarove is sometimes the preferred design for small children.
Monolateral external fixators:A monolateral external fixator is a straight bar that runs parallel to the treated bone instead of going around the bone. Screws are placed in the bone. The screws are often coated inhydroxyapatiteso that they adhere to the bone better. These fixators have knobs on them that may need adjusting if the goal is lengthening the bone.
The mainrisk of infectionis at the pin sites where the external fixator is connected to the bone since this is where broken skin is present. To help prevent infection, following the pin care instructions from your healthcare team is essential. They will explain how to care for the pin sites and tell you how often you should clean them (typically once per day).
Your healthcare team will provide you with specific instructions. However, pin care generally includes the following steps:
It is important to note that germs from one pin site can contaminate another. So, tohelp prevent infection, use a new piece of gauze or cotton swab for each pin site you are working with.
Signs of Infection
Some redness and crusting around the pin sites are expected. However, if you notice the pin sites are redder or swollen, they feel more painful, there is pus, or you develop a fever, contact your healthcare team for advice. You may needantibioticsto clear an infection.
Summary
External fixators allow a healthcare provider to stabilize a broken bone quickly. They are especially useful in traumas. They are also beneficial in correcting limb alignment or when a limb needs to be lengthened. External fixators can serve other uses, too, such as in joint fusions. Several different types of external fixators exist, and your healthcare provider will use the one best suited to your condition.
8 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Bible JE, Mir HR.External Fixation: Principles and Applications.J Am Acad Orthop Surg. 2015;23(11):683-690. doi:10.5435/JAAOS-D-14-00281Nemours Children’s Health.Limb lengthening surgery: external fixator.Matsubara H, Watanabe K, Takata M, Nomura I, Tsuchiya H.A new classification for ankle arthrodesis when using an external fixator.Strategies Trauma Limb Reconstr. 2019;14(3):148-154.Zhang H, Zhao X, Yang X, et al.Comparison of internal and external fixation after debridement in the Masquelet technique for Cierny-Mader type IV tibial post-traumatic osteomyelitis.Injury. 2023;54(2):422-428.Carmichael K, Torres D, Jimenez CJ, Comley MC, Evans EB.Spanning External Fixation for the Treatment of Open Joint Injuries in Pediatric Burn Patients.Cureus. 2018;10(4):e2484. doi:10.7759/cureus.2484Hadeed A, Werntz RL, Varacallo M.External Fixation Principles and Overview. In:StatPearls. Treasure Island, FL: StatPearls Publishing; 2019.International Center for Limb Lengthening.External fixators.Nemours Children’s Health.External fixator: pin care.Additional ReadingDe Bastiani G, Apley AG, Goldberg AAJ, eds.Orthofix External Fixation in Trauma and Orthopaedics. 1st ed. London: Springer; 2000.
8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Bible JE, Mir HR.External Fixation: Principles and Applications.J Am Acad Orthop Surg. 2015;23(11):683-690. doi:10.5435/JAAOS-D-14-00281Nemours Children’s Health.Limb lengthening surgery: external fixator.Matsubara H, Watanabe K, Takata M, Nomura I, Tsuchiya H.A new classification for ankle arthrodesis when using an external fixator.Strategies Trauma Limb Reconstr. 2019;14(3):148-154.Zhang H, Zhao X, Yang X, et al.Comparison of internal and external fixation after debridement in the Masquelet technique for Cierny-Mader type IV tibial post-traumatic osteomyelitis.Injury. 2023;54(2):422-428.Carmichael K, Torres D, Jimenez CJ, Comley MC, Evans EB.Spanning External Fixation for the Treatment of Open Joint Injuries in Pediatric Burn Patients.Cureus. 2018;10(4):e2484. doi:10.7759/cureus.2484Hadeed A, Werntz RL, Varacallo M.External Fixation Principles and Overview. In:StatPearls. Treasure Island, FL: StatPearls Publishing; 2019.International Center for Limb Lengthening.External fixators.Nemours Children’s Health.External fixator: pin care.Additional ReadingDe Bastiani G, Apley AG, Goldberg AAJ, eds.Orthofix External Fixation in Trauma and Orthopaedics. 1st ed. London: Springer; 2000.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Bible JE, Mir HR.External Fixation: Principles and Applications.J Am Acad Orthop Surg. 2015;23(11):683-690. doi:10.5435/JAAOS-D-14-00281Nemours Children’s Health.Limb lengthening surgery: external fixator.Matsubara H, Watanabe K, Takata M, Nomura I, Tsuchiya H.A new classification for ankle arthrodesis when using an external fixator.Strategies Trauma Limb Reconstr. 2019;14(3):148-154.Zhang H, Zhao X, Yang X, et al.Comparison of internal and external fixation after debridement in the Masquelet technique for Cierny-Mader type IV tibial post-traumatic osteomyelitis.Injury. 2023;54(2):422-428.Carmichael K, Torres D, Jimenez CJ, Comley MC, Evans EB.Spanning External Fixation for the Treatment of Open Joint Injuries in Pediatric Burn Patients.Cureus. 2018;10(4):e2484. doi:10.7759/cureus.2484Hadeed A, Werntz RL, Varacallo M.External Fixation Principles and Overview. In:StatPearls. Treasure Island, FL: StatPearls Publishing; 2019.International Center for Limb Lengthening.External fixators.Nemours Children’s Health.External fixator: pin care.
Bible JE, Mir HR.External Fixation: Principles and Applications.J Am Acad Orthop Surg. 2015;23(11):683-690. doi:10.5435/JAAOS-D-14-00281
Nemours Children’s Health.Limb lengthening surgery: external fixator.
Matsubara H, Watanabe K, Takata M, Nomura I, Tsuchiya H.A new classification for ankle arthrodesis when using an external fixator.Strategies Trauma Limb Reconstr. 2019;14(3):148-154.
Zhang H, Zhao X, Yang X, et al.Comparison of internal and external fixation after debridement in the Masquelet technique for Cierny-Mader type IV tibial post-traumatic osteomyelitis.Injury. 2023;54(2):422-428.
Carmichael K, Torres D, Jimenez CJ, Comley MC, Evans EB.Spanning External Fixation for the Treatment of Open Joint Injuries in Pediatric Burn Patients.Cureus. 2018;10(4):e2484. doi:10.7759/cureus.2484
Hadeed A, Werntz RL, Varacallo M.External Fixation Principles and Overview. In:StatPearls. Treasure Island, FL: StatPearls Publishing; 2019.
International Center for Limb Lengthening.External fixators.
Nemours Children’s Health.External fixator: pin care.
De Bastiani G, Apley AG, Goldberg AAJ, eds.Orthofix External Fixation in Trauma and Orthopaedics. 1st ed. London: Springer; 2000.
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