External Fixation in Orthopedics: Everything You Need to Know

External Fixation in Orthopedics: Everything You Need to Know

Ex fix, also known as external fixation devices, are medical devices used to stabilize broken bones during the healing process. They are often used as a temporary measure to align and hold bones in place after traumatic injuries such as serious fractures. Ex fix get attached directly to the skin rather than implanted inside the body. They allow surgeons to securely hold bones without casting or brace, while avoiding some risks associated with internal fixation devices such as pins or plates.

How do External Fixators Work?

Ex fix work by connecting bone fragments mechanically using elements that are placed directly into the bone and then connected on the outside of the body. The basic components of ex fix include metal pins or screws, rotating bolts, and rigid bar structures. The pins are carefully drilled into the bone above and below the fracture site. They are connected together using bars, clamps, and connectors on the outside of the skin. This setup creates a rigid scaffold that supports the bone fragments and maintains reduction of the fracture. It allows the bone to heal without weight-bearing or movement at the fracture site during recovery.

Advantages of Using Ex fix

Enhanced Visualization and Access

Since ex fix are attached externally, it gives surgeons better visualization and surgical access to bone fragments during placement. This minimized soft tissue disruption, blood loss, and infection risk compared to internal fixation procedures that require extensive soft tissue dissection.

Minimally Invasive Procedure

Applying External Fixation is generally a less invasive surgical procedure compared to operations that require opening up soft tissues and inserting metal plates or screws inside the bone. They involve only minimal incisions for drilling bone pins.

Temporary or Definitive Use

Ex fix can be used as either a temporary or definitive treatment. They are often applied initially to stabilize high-energy injuries before surgeons consider definitive internal fixation or bone grafting. This "damage control" approach allows acute problems to be addressed first before definitive stabilization.

Allows Early Mobilization

Ex fix provide stable fixation without encasing the limb in plaster or restricting joint movement. This feature allows for early mobilization and rehabilitation with limited weight bearing, improving long term functional outcomes.

Avoids Risks of Internal Fixation

Ex fix eliminate complications associated with retained internal metalware such as stress shielding, implants failure or breakage, implant migration or extrusion. They also avoid risks of deep infections within bones.

Potential Disadvantages of Ex fix

Risk of Pin-Site Infections

One of the most common disadvantages is the increased risk of pin-site infections due to transcutaneous pins that penetrate skin and provide interface for contamination. Up to 65% of patients may develop pin-site infections requiring specific wound care and antibiotic use.

Less Stable Fixation

Compared to rigid internal fixation, external frames provide fixation that is generally less stable which carries higher risk of loss of reduction, mal-alignment or non-union if weight bearing is permitted too early in the healing process.

Uneven Stress Distribution

External fixation does not distribute forces evenly across the fracture site like internal plates or screws. This can impair vascularity and delay healing in some cases.

Aesthetic Concerns

Having pins, wires and visible hardware protruding from the skin creates discomfort and psychological issues related to appearance especially when worn over long periods.

Best Candidates for Ex fix

Ex fix are commonly used for:

- Complex open fractures with significant soft tissue damage where internal fixation poses high infection risk.

- Pelvic and acetabular fractures where internal hardware placement is technically difficult.

- Fractures in osteoporotic or poorly vascularized bone to minimize risk of hardware failure.

- Limb-lengthening and deformity correction procedures.

- Temporary fixation of fractures prior to definitive open reduction and internal fixation or bone grafting procedures.

- In pediatric patients, external fixation is favored over internal fixation given their growing bones.

ex fix are important medical devices that provide stable but minimally invasive fracture stabilization in situations where internal fixation may not be suitable or safe. Continued improvements to fixator design aim to reduce complications and improve clinical and functional outcomes for patients requiring external fixation. With proper surgical technique and post-operative management, ex fix remain a valuable tool for orthopedic trauma and reconstructive surgeons.