External Fixators

External fixators have been widely used to stabilize open fractures. A fixator is preferred over cast immobilization because it allows the physician access to the soft-tissue injury. External fixators also may be used to temporarily stabilize an extremity while life- or limb-threatening surgery is performed. Certain types of closed fractures, such as distal radius fractures, may require an external fixator to maintain an adequate reduction of the fracture.

Nontraumatic uses of external fixators include stabilization of arthrodeses; special clamps may be used to add compression that enhances union. More recently, complex wire and ring (Ilizarov) fixators have been used to lengthen bones and correct deformities.

The external fixator is divided into two components: the fixation pins or wires and the external frame. The threaded pins or wires are inserted into each fragment at a distance from the fracture site. When connected to the frame, they are able to rigidly hold the bone so that union occurs ( Fig 272-9).

FIG. 272-9. This external fixator is used to stabilize the open tibia fracture while still allowing access to the soft tissue wound.

COMPLICATIONS Because external fixation is usually chosen for severe open fractures, which have a higher rate of infection, emergency department visits are not uncommon. Patients present with increased redness, swelling, or drainage at the previous open wound site. The skin should be prepared and deep cultures obtained by aspiration or swab. The fixation pins and wires very commonly sustain pin tract infections, which may easily be treated by releasing the skin around the pin site with a no. 11 blade after adequate local anesthesia. Oral antibiotics may be given empirically. With time, the fixator pins may loosen in the bone. The clamps connecting the pins to the frame may also loosen. This may result in instability or loss of reduction at the fracture site. This will usually be detectable clinically (unstable fractures are painful when stressed) or by radiographs.

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