What is an external fixator?
An external fixator is a holding device that is used in the initial treatment of bone fractures. It consists of a rigid frame and long screws. As the name suggests, the frame of the external fixator is attached externally and secured in the bone with screws. This stabilizes the individual bone fragments resulting from a fracture and prevents them from shifting against each other.
When is an external fixator used?
There are various options for restoring a broken bone, for example the use of metal plates, screws or wires. All of these are placed in the body and the wound is closed immediately after insertion. However, in the case of open injuries, which carry a high risk of infection per se, pathogens would be trapped in the body with such procedures; the infection could spread and progress to the loss of the limb.
In such cases, an external fixator is often used. It serves to temporarily stabilize the bone parts until the infection has healed. An external fixator is therefore often used for initial treatment in the following situations:
- Severe open bone fractures
- Closed bone fractures with extensive damage to the soft tissue
- double fracture of the same bone
- Pseudarthrosis (“false” joint that can develop after incomplete bone healing)
- Polytrauma (multiple, simultaneous life-threatening injuries)
How is an external fixator applied?
Before the operation, the anesthetist administers general anesthesia to the patient so that he or she spends the operation asleep and pain-free. The positioning of the patient in the operating room depends on the part of the body to be treated. If, for example, a bone in the wrist is broken, the patient’s arm is placed slightly elevated and angled away from the body.
As the surgeon uses an X-ray to check repeatedly during the operation whether the fixator is positioning the bone pieces correctly, the positioning table for the broken limb must be permeable to X-rays. The surgeon then carefully disinfects the patient’s skin and covers the patient with sterile drapes, avoiding the surgical area.
The operation
After the operation
Once the external fixator is in place, a final X-ray check is carried out. If all bone fragments and all metal parts are in place as desired, the doctor covers the entry points of the metal rods with sterile drapes to prevent infection. The anesthetist then takes the patient to the recovery room, where they can recover from the general anesthetic and the procedure.
What are the risks of an external fixator?
As with almost every operation, the following general problems can occur during or after the application of the external fixator:
- Incidents under anesthesia
- Bleeding during or after the operation
- Injury to nerves
- Wound infection
- Aesthetically unsatisfactory scarring
Specific risks of treatment with an external fixator are
- Delayed or non-healing of the fracture
- malalignment
- Bone infections
- considerable, sometimes permanent restriction of movement of adjacent joints
As the external fixator is usually only one option for the initial treatment of a fracture, the success of the treatment also depends on the subsequent restoration of the bone (osteosynthesis). Some problems can be avoided by precise and forward-looking treatment planning.
What do I need to consider after an external fixator has been applied?
Your doctor will carry out further X-ray checks every two to six weeks after the operation. This will allow him or her to determine whether the bone pieces have shifted again or whether they are healing in the correct position. When your external fixator can be removed depends on the healing of the bone, the type of fracture and the planned further treatment. Removal usually does not require anesthesia or hospitalization.
External fixator: care
As the metal rods of the external fixator represent a direct connection between the environment and the inside of the bone, germs can penetrate the wound cavity relatively easily. To prevent this, you should clean the pins carefully every day: You should carefully remove scabs or wound secretions using sterile compresses and disinfectant solutions for wounds and mucous membranes. You should also wipe the frame of the external fixator daily with disinfectant. Avoid contact with dust and dirt and ensure that the wounds remain dry.
