External fixation involves inserting rods into the bone to attach to a stabilizing device on the outside. It is an alternative to inner fixation, where the components that provide stability are located entirely within the patient’s body. It stabilizes soft and bone tissues away from the injury or operative focus. They allow for unimpeded access to the relevant skeletal or soft-tissue structures to be assessed and secondary interventions to restore bony continuity or cover functional soft tissues.
How is external fixation performed?
An orthopedic surgeon performs external fixation under general anesthesia. These are the steps that are most commonly followed during an operation:
- The fracture area is drilled with holes.
- Bolts are inserted into the holes.
- The bolts are joined to the rods by ball-and-socket joints.
- To ensure that the bone is aligned correctly, minimal bone shortening can be done to the ball-and-socket joint.
Incision sites are cleaned frequently to prevent infection. Sometimes, a cast might be necessary.
It is often possible to remove the bolts and frame in a doctor’s office without any anesthesia. Fractures can occur at drill sites, and extended protection may be required after removing the device.
The following conditions make external fixation dangerous:
- Bone disorders or degradation can compromise stabilization.
- Pins and wires that are not adequately cared for can prove problematic.
- People with severely compromised immune systems are at greater risk of infection.
Cost of the external fixation
| Description | Cost |
|---|---|
|
Average Cost of surgery in Hyderabad |
Around Rs. 4,00,000 |
|
Average Cost of surgery in India |
Around Rs. 4,00,000 |
| Surgery details | Description |
|---|---|
|
Number of days in the hospital |
2-3 days |
|
Type of surgery |
Major |
|
Type of Anaesthesia |
General |
|
Number of days required to recover |
Six months |
|
Duration of the procedure |
Several hours |
|
Type of surgical options available |
Minimally invasive |
Risks and complications of external fixation
Significant complications that can affect the healing process are problems with the fixing device to sustain reduction, ineffective bone-pin interfacing, and non-healing fractures. Some minor issues include pin tract drainage, poor limb use, and neurovascular injuries.
External fixation devices can pose the following risks:
- Pin site Infections and osteomyelitis
- Deep vein thrombosis and pulmonary embolisms (DVT) are both possible.
- Aseptic loosening
- Fracture nonunion or refracture
- Loss of reduction
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Frequently Asked Questions about External Fixation Surgery
The average external fixator patient wears the device for four to twelve months, depending on the severity of the problem, weight, and other factors. The surgeon will provide a time frame based on the severity of the case.
Many patients can tolerate the external fixator and walk but cannot run or jump with the external fixator. After surgery, the patient should contact the physician immediately in case of any questions about his weight-bearing capacity.
Pin tract infection and pin loosening are possible side effects of any external fixator. Loss of reduction can also occur if the fixation is removed before the fracture heals. Ankle stiffness may also occur due to half-pin fixators that span the ankle and subtalar joints.
The area of the insertion may cause pain or other abnormal sensations. The patient will receive elbow crutches for support, independence, and protection when he has external fixators in the lower leg.
After the external fixators have been removed, the patient may experience pain, swelling, and stiffness around the fracture site. As a result of prolonged immobilization post-surgery, the lower leg will experience decreased strength, range of motion, and muscle control.
The patient can only sleep on his back with an external fixator. For security and comfort, it is advised to elevate the limb using the external device.
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