External fixator
All content is checked by medical journalists.An external fixator is a holding device used in trauma surgery to immobilize broken bones. The external fixator is mainly used for complicated fractures with open wounds on the extremities. Read everything about applying an external fixator, when it is necessary and what risks it entails.
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 outside and fixed in the bone with screws. In this way, the individual bone fragments that arise from a fracture are stabilized and do not shift against each other.
When do you apply an external fixator?
There are various ways to restore a broken bone, for example using metal plates, screws or wires. All of these are in the body, the wound is closed again immediately after insertion. In the case of open injuries, which per se carry a high risk of infection, 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 is used temporarily to stabilize the bone parts until the infection has healed. The first treatment with an external fixator is therefore often performed in the following situations:
- severe open bone fractures
- closed fractures with extensive damage to the soft tissues
- double fracture of the same bone
- Infection with broken bones
- Pseudarthrosis ("wrong" joint that can develop after incomplete bone healing)
- Multiple trauma (multiple, simultaneously existing life-threatening injuries)
How is an external fixator applied?
Before the operation, the anesthetist gives the patient a general anesthetic so that he or she spends the procedure asleep and pain-free. The position of the patient in the operating room depends on the part of the body to be treated. For example, if a bone in the wrist is broken, the patient's arm is angled away from the body and placed slightly elevated.
Since the doctor repeatedly checks with an X-ray image during the operation whether the fixator is bringing the bone pieces into the correct position, the positioning table for the broken extremity must be transparent to X-rays. Then the surgeon carefully disinfects the patient's skin and covers him with sterile cloths, leaving out the surgical area.
The operation
When a bone breaks, the fragments sometimes shift so that they are not in the correct position in relation to one another. While pulling on the broken limb, the surgeon pushes the bone fragments back into their original position. Now he makes several small incisions in the skin along the broken bone, through which he can gain access to the bone. Through these cuts he drills holes in the bone into which long metal rods (pins) are screwed or pushed. These later connect the outer frame of the external fixator to the bone.
After the operation
If the external fixator is attached, a final X-ray check is carried out. If all bone fragments and all metal parts are as desired, the doctor covers the entry points of the metal rods in a sterile manner so that no infection occurs there. The anesthetist then takes the patient to the recovery room, where he can recover from the general anesthesia and the procedure.
What are the risks of an external fixator?
As with almost every operation, the following general problems can arise during or after the external fixator is applied:
- Incidents of anesthesia
- Bleeding during or after surgery
- Injury to nerves
- Wound infection
- aesthetically unsatisfactory scarring
Special risks of therapy with an external fixator are:
- delayed or no healing of the fracture
- Misalignment
- Bone infections
- considerable, sometimes permanent restriction of movement in adjacent joints
Since the external fixator is usually only an option for the initial treatment of a broken bone, the success of the therapy also depends on the subsequent restoration of the bone (osteosynthesis). Some problems can be avoided through precise and forward-looking therapy planning.
What should I watch out for after applying an external fixator?
As a rule, you should start physiotherapy exercises two or three days after applying the external fixator. Your physiotherapist will instruct you in exercises in the hospital, which you can then carry out independently. Pay particular attention to regular movement of the joints that have not been immobilized.
Your doctor will carry out another x-ray examination two to six weeks after the operation. In this way he can determine whether the pieces of bone have shifted again or whether they are healing in the correct position. When your external fixator can be removed depends on the bone healing, the type of bone fracture and the planned restoration. As a rule, anesthesia and an inpatient hospital stay are no longer necessary for removal.
External fixator: care
Since the metal rods of the external fixator represent a direct connection between the environment and the interior of the bone, germs can penetrate the wound cavity relatively easily. To prevent this, you should carefully clean the pins daily: Use sterile compresses and disinfectant solutions for wounds and mucous membranes to carefully remove scabs or wound secretions. You should also wipe the frame of the external fixator daily with disinfectant. Avoid contact with dust and dirt and make sure that the wounds remain dry.
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