2. ObjectivesObjectives
Identify the following as they pertain to
external fixation:
– Advantages & disadvantages
– Indications
– Types of frames
– Biomechanics stability
– Pre-operative planning
– Common complications
3. External FixatorExternal Fixator
A device placed outsideA device placed outside
the skin that stabilizesthe skin that stabilizes
bone fragments with pinsbone fragments with pins
or wires connected to barsor wires connected to bars
““Relative stability “Relative stability “
Healing with callusHealing with callus
4. External FixationExternal Fixation
AdvantagesAdvantages
Minimal damage to blood supplyMinimal damage to blood supply
Minimal damage to soft tissuesMinimal damage to soft tissues
Fixation is away from site of injuryFixation is away from site of injury
Good option when significant infection riskGood option when significant infection risk
18. Periarticular FracturesPeriarticular Fractures
Reduce and fix the joint surfaceReduce and fix the joint surface
Span the diaphysealSpan the diaphyseal
segment withoutsegment without
disturbing soft tissuesdisturbing soft tissues
20. PolytraumaPolytrauma
Temporary stabilization of long boneTemporary stabilization of long bone
injuries in unstable patientinjuries in unstable patient
– Minimally invasiveMinimally invasive
– Decreases bleedingDecreases bleeding
– Pain controlPain control
– Nursing careNursing care
– ““Damage control”Damage control”
23. Pelvic FracturesPelvic Fractures
Quick applicationQuick application
Open or percutaneous pinOpen or percutaneous pin
insertioninsertion
Easily removed forEasily removed for
definitive ORIFdefinitive ORIF
24. Children’s FracturesChildren’s Fractures
Femoral fracturesFemoral fractures
One alternative to weeks ofOne alternative to weeks of
skeletal tractionskeletal traction
Used less with use of flexibleUsed less with use of flexible
nailsnails
25. Children’s FracturesChildren’s Fractures
Pin placement must avoidPin placement must avoid
growth plategrowth plate
Watch for pin tract infectionWatch for pin tract infection
Occasional joint stiffnessOccasional joint stiffness
26. External FixationExternal Fixation
Fixator construct will depend on treatmentFixator construct will depend on treatment
strategy:strategy:
– Emergency careEmergency care
– Provisional careProvisional care
– Definitive careDefinitive care
34. Spanning External FixationSpanning External Fixation
Built as uni- and multi- plane
constructs
Areas prone to soft tissue
problems
– Knee
– Ankle
– Open Fractures
When multiple injuries
prevent definitive fixation
35. Spanning Ex Fix
Adjunct to Internal FixationAdjunct to Internal Fixation
– TemporaryTemporary
– DefinitiveDefinitive
37. Increase StabilityIncrease Stability
Bars:Bars:
– Closer to limbCloser to limb
– More barsMore bars
– Second plane at rightSecond plane at right
angle to decrease torsionangle to decrease torsion
(twisting)(twisting)
38. Increase StabilityIncrease Stability
Rings:Rings:
– Smaller is stifferSmaller is stiffer
Use smallest diamaeter ringUse smallest diamaeter ring
possible but allow for swellingpossible but allow for swelling
– More rings = more stableMore rings = more stable
39. External Fixation AnatomyExternal Fixation Anatomy
Safe pin placementSafe pin placement
““Safe corridors”Safe corridors”
Know your anatomy toKnow your anatomy to
safely place pins!safely place pins!
42. Intraop SetupIntraop Setup
Adequate fixator componentsAdequate fixator components
Cannulated screwsCannulated screws
Large/small fragment setsLarge/small fragment sets
43. Intraop Technique
Keep bars close to bone but…Keep bars close to bone but…
. . . allow access for soft tissue. . . allow access for soft tissue
carecare
Allow for swellingAllow for swelling
Can be re-adjusted as neededCan be re-adjusted as needed