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Principles and Overview of External Fixators

Handbook of Orthopaedic Trauma Implantology

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Abstract

External fixation as a device for fracture stabilization is known since early 1900s. In the initial days, it was mostly used as a transport device for patients with fractures, but the indications of its use continued to evolve and presently it is used even as a definitive mode for fracture fixation to achieve union.

External fixation primarily works as a stabilizing method using multiple pins inserted into the bone in various angles and planes and those are connected outside the skin by a strong support of a bar. Depending on the configuration of application, external fixation can be a load-bearing device thereby completely protecting the fracture from collapse or a load sharing device enabling compression at fracture interface. Various technical adjustments can be made to make the assembly more stiff by adding more pins or bars as well as less stiff by various techniques of dynamization or enabling micromotion. In both situations, the goal remains creating a biologically friendly atmosphere at fracture interface to enable union.

The clinical indications of external fixation are evolving. From its origin, the traditional indication was for open fracture management. Later its role was extended for definitive treatment till recent times when the external fixator is an integral part of Damage Control Orthopaedics (DCO). Other than acute situations, external fixations are well established today for management of chronic conditions like infected nonunion of fractures, correction of deformity due to malunion, or managing bone gaps by distraction osteogenesis.

The technique of application of external fixation is precise and attention should be paid to every detail about holding the fracture alignment, pin insertion, and preparing the fixator assembly. At the end of the application, checks should be made so that there are no loose nuts or wires are tensioned appropriately. As the patient recovers from anesthesia, neurovascular status of the limb and movements of the adjoining joints should be assessed. Mobility of the patient with the fixator in place depends upon the indication, mode of application, and surgeons’ choice.

External fixation is not without complications. The most dreadful ones are pin tract infection, injuries to neurovascular structures, and stiffness of joints. Most of these complications are preventable if precise techniques of application are followed. If still happens, they can be managed by standard principles.

Overall external fixation is a very versatile form of stabilization of broken bones which can be used as a temporary as well as permanent means of fixation if required.

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Authors and Affiliations

  1. Department of Orthopaedics, IQ City Medical College Hospital, Durgapur, India

    Dipankar Sen

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  1. Dipankar Sen
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Correspondence to Dipankar Sen .

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Editors and Affiliations

  1. Narayana Health, West Bengal, India

    Arindam Banerjee

  2. Klinik u. Poliklinik fĂĽr Unfallchirurgie, TU MĂĽnchen Klinikum rechts der Isar, MĂĽnchen, Bayern, Germany

    Peter Biberthaler

  3. Department of Orthopedics, Apollo Hospital Muscat, Muscat, Oman

    Saseendar Shanmugasundaram

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  1. AMRI, Kolkata, West Bengal, India

    RS Gaheer

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Sen, D. (2022). Principles and Overview of External Fixators. In: Banerjee, A., Biberthaler, P., Shanmugasundaram, S. (eds) Handbook of Orthopaedic Trauma Implantology. Springer, Singapore. https://doi.org/10.1007/978-981-15-6278-5_16-1

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  • DOI: https://doi.org/10.1007/978-981-15-6278-5_16-1

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  1. Latest

    Principles and Overview of External Fixators in Orthopaedic Traumatology
    Published:
    19 July 2023

    DOI: https://doi.org/10.1007/978-981-15-6278-5_16-2

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    Principles and Overview of External Fixators
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    24 November 2022

    DOI: https://doi.org/10.1007/978-981-15-6278-5_16-1

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