External fixation

A device placed outside the skin that stabilizes bone fragments with pins or wires connected to bars

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Outline

Indications

Open fracture

Closed fracture with soft tissue compromised

Periarticular fracture

Pediatric fracture

Damage control

Pelvic ring injury

Malunion/nonunion

Infected fracture

Limb deformity / length inequality

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Indication

1.Open fracture

This is to allow for wound inspection and proper wound care until the soft tissue heal.

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2.Close fracture with soft tissue compromised

This is to allow for wound inspection and proper wound care until the soft tissue heal.

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3.Periarticular fracture

Fracture with extension or involvement of joint is usually unstable, in which by using external fixation this type of fracture can be held out to length until healing commence. Furthermore, placement of internal fixation in this type of fracture can be difficult technically as it involving bone end.

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4.Pediatric fracture

External fixation is favored in children fracture, compare to internal fixation for example in femur fracture. This is because in children the bone is still growing, therefore, we want to avoid from causing damage to the growth plate, which is likely to occur if internal fixation is used.

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5.Damage control

In polytrauma patient, in which there are multiple fracture, external fixation is commonly used, if not definitive, as temporary measure, as it can be applied quickly. Early stabilization of fracture in polytrauma case can reduce risk of severe complication.

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6.Pelvic ring injury

External fixation is indicated in pelvic fracture when it can not be stabilized quickly by other method.

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7.Nonunion

Certain parts of bone (e.g excess bone in malunion, sclerotic bone ends in nonunion) is usually excised(osteotomy) and the remaining ends is brought together in the external fixator, and sometimes this is combined with lengthening of bone, as the parts of bone being excised (bone loss) can be quite significant, to cause shortening.

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8.Infected fracture

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9.Limb deformity (deformity correction) /length inequality (limb lengthening)

By using external fixation, the limb lengthening and deformity correction process work on the principle of distraction osteogenesis. In this process, a bone that has been cut during surgery (osteotomy) can be gradually distracted (pulled apart), in proper alignment, leading to new bone formation (osteogenesis) at the site of the lengthening. In this way, bone segments can be lengthened by 15 to 100 percent of their original length.

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