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External fixation – Indications, Types, Working principle, Complications

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External fixator

To maintain the stability and alignment of broken bones, an external fixation device may be employed. The device can be externally adjusted to make sure the bones stay in the best possible position throughout the healing process. When the skin around the fracture has been injured and children are involved, this device is frequently employed.

1. Indications :

1. Open fractures :

  • Especially those who have soft tissue damage.
  • Can be administered minimal trauma, preventing further harm to soft tissues and bone vascularity.

2. Closed fractures :

  • Severe closed soft-tissue contusions or degloving injuries with temporary bridging.

3. Polytrauma :

  • For polytrauma damage management surgery.
  • The most secure method to initially stabilize fractures in severely injured patients.
  • Can be completed quickly, uses a less invasive approach, and lessens the risk of the patient suffering extra surgical trauma.

4. Articular fractures :

  • When it can be used in a joint-bridging manner, it is advised in situations of open or closed articular fracture with severe soft-tissue damage.

5. Bone or soft-tissue loss :

  • Incase of this types of situation, we can use fixator to provide support.

6. Tool for direct reduction :

  • Utilizing the modular external fixator as an external reduction device is one technique to accomplish minimally invasive intraoperative reduction.

7. Others :

Limb lengthening, segment transportation, distraction osteogenesis, and corrections.

2. Types of external fixator :

External fixator types
External fixator – Types
  1. Uniplaner fixator : Four pins are used, two in the upper portion of fracture and two in the lower portion of the fracture.
  2. Bilplaner fixator : Two fixator frames are used in two opposite planes of the fracture, and then pins gets attached to the frames bilaterally.
  3. Ring fixator : Pin gets attached to the ring, and all the components forms a conical structure around the fracture part.
  4. Hybrid fixator : This combines both ring and planer frames.

3. Working principles :

Main principle of the Fixator is to provide Stability to an injured bone. So that it can heal well. Working principle mainly occurs by Fracture factor, Pin factor, Rod factor, and Ring factor.

  1. Fracture factor : Fracture should be aligned end-to-end at first.
  2. Pin factor : This minimise cantilever bending and shear at fracture. This depends on ‘Increasing pin diameter’, ‘Increasing pin spread’, ‘Increasing number of pins’, ‘Decreasing distance from pin to fracture’.
  3. Rod factor : This depends on ‘Decreasing distance from bar to bone’, ‘Increasing number of rods’, ‘Increasing diameter of rod’, ‘Allowing sufficient space for soft tissue swelling’.
  4. Ring factor : ‘Decreasing ring size’, ‘Increasing number of rings’, ‘Separation of rings each other’, ‘Increasing wire tension and size’.

4. Complications :

  1. Insertion through muscles, nerves, tendons and ligaments.
  2. Pin breakage
  3. Pin loosening
  4. Pin displacement
  5. Pin path infection
  6. Chronic osteomyelitis
  7. Septic arthritis

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