25/6/2020

Question 1: Types of External fixation, indication, post operative care and

complications.

Introduction:
There are two mode of fixation used in trauma patients following bone fractures such
as the internal fixator and the external fixator. Internal fixators are management done
surgically where the fixators are placed within the body. External fixator are known as
external fixator because the bone fixators are placed externally. This external fixators
are surgical management of trauman whereby the rods that is available in the external
fixators are inserted into the bone and it is screwed in a manner where there is a
stabilizing structure supporting the external fixator rods. External fixator are used in
order to achieve stabilization of the bone and the surrounding soft tissues where there
will be a distance from the injury focus. External fixator hold bone fractures to be
aligned in position and allow healing to take place.

Type of external fixators:

The types of external fixators are such as the uniplanar, multiplanar, unilateral,
bilateral and circular external fixators. Uniplanar external fixator frame consists of at
least two pins in each main fracture fragment connected with one single rod. Thus it is
called uni planar. It is commonly used in tibial fracture. Multiplanar external fixators
has more than one plane involved. For example when the frame has bars going up
(one plane) and across (another plane), the device is called as multiplanar external
fixators. Multiplanar external fixature used in humeral fracture and tibial fracture.
Unilateral external fixator consists of a collection of pins, clamps and sidebars to form
a construct on one side of the limb that can be used to stabilise bone fractures and
promote healing to occur. It is used in polytrauma, tibial fracture and to stabilize open
tibia fracture. Bilateral external fixators has collection of pins and sidebar at both side
of the limb to stablize the fracture. It is used in open fracture of tibia. Circular external
fixator is also known as the ring type of external fixator. It is also known as the
Illizarov frame whereby it involves circular rings and wires. It can be used in
stabilization of bfracture with mal-union.

Indication for external fixators:

There are several indications of external fixators. The below list are some of the
indications of an externak fixators to be used in management of fracture:
 Unstable pelvic ring injuries
 Comminuted periarticular fractures such as pilon, distal femur, tibial plateau,
elbow, and distal radius fractures
 Fractures with large amounts of soft tissue swelling
 Fractures in a patient that is hemodynamically unstable or cannot undergo an
open procedure
 Comminuted long bone fractures
 Fractures with significant bone loss
 Open fractures with soft tissue loss
 Limb deformity and limb lengthening
 Osteomyelitis with bone loss
 Immobilization of joint after soft tissue flap
 Arthrodesis
 Nonunion
 Malunion
 Infection
 Traction to aid in intraoperative fracture reduction
Post operative care:
Post operative care is the care need to be taken after the external fixators are fixed to
the patient. The objective of post operative care is to prevent complication as there are
few known complications of external fixators that can occur in the patients. The post
operative care can be divideed into three phase. The first phase where it is the
immediate after fixation. The post operative care that must do immediately is
regarding the pin or wire care. It can be done by taking appropriate antibitic to prevent
infection , and cleaning the wound and the external fixator to avoid contamination
with organism which can result in infections. Pain management aslso comes under the
immediate post operative acre of external fixators as patient can experience severe
pain following fixation of external fixator. Thus, painkiller are given to reduce the
pain. Regular dressings also done at the wound area with negative pressure wound
therapy to make sure disconnection of this negative pressure wound theraphy device.
Patient with high risk to develop deep vein thrombosis will be given anticoagulant to
prevent this occurence of deep vein thrombosis. The second phase of post operative
care occurs during the hospital discharge. Patient should be discharged with proper
medication such as antibiotics if indicated and pain killers. Patient also must be given
follow up dates to reassess the fixators. Furthermore, dressing ppointment also will be
given to clean the wound and the fixators. The hird phase is during the postoperative
clinic visit whereby the most prone phase to develop complications. The doctor must
assess the mal union or non union if present and manage properply. Repeated xrays
can be taken to follow up with the healing process.

Complications:
There are several known complications that are associated with fixation of external
fixators. Pin site infection is the commonest one if tye fixators was not handled in
aseptic manner. Pin site gives an entry portal for organism to enter and cause
infection. Thus, aseptic management should be followed at all time until fixation and
removal to avoid pin site infection to occur. Osteomyelitis which is the bone infection
can also occur following the fixation of external fixator due to infection which can
also be caused by the infection which entered through the pin site entry or during the
fixator fixation due to aseptic handling. Pin or wire looseining is also one part of the
complication whereby it is not fixed properly and will interrupt with the healing
process. Malunion is when there is misalignment in the healing where the healing
does not occur at the exact position. Non union is another complication whereby the
bones does not unite and remain fractured. Other complication of external fixator are
such as the implament of the soft tissue, neurovascular injury which can be
devastating and compartment syndrome where the pressure within the muscles are
raised.

Question 2: Indication of Iilizarov external fixation and support each indications with
x-rays

Illizarox fixator is an external fixator which is used in many conditions. There are
several indications for Illizarov fixators. The indication of illizarov fixator are such as
the limb lengthening, foot deformities, recontruction of the bones and lentghening in
dwarfism. The table below illustrates the indication and also the xrays to support the
indication of such in the patients.
INDICATIONS XRAY
Limb lengthening

Deformity Correction
Infected Non-unions
Congenital
Pseudarthrosis

Joint Contractures
Fixation of complex
fractures

Bone transport
Arthrodesis