EXTERNAL FIXATION OF

THE LOWER LIMB

• The term 'external fixation' is normally
reserved for systems of fixation, which
utilize an external frame to connect screws
or pins transfixing the main bone
fragments. The systems currently in use
vary in both the number and diameter of
the pins and in the size and shape of the
external frames
Types of exernal fixator

• Unilateral and bilateral frames:

unilateral frames typically have a frame on
one side to which pins may be connected.
The frames differ in the degree of
complexity of the connecting unit and also
in the facility to add extra connecting bars,
which may lie in different planes, or on
the opposite side of the limb
 Bomechanics

• In general, the main bone fragments should be fixed at

a minimum of two levels. The stability of the external
fixation is increased by having a larger number of pins
and by spacing them as far apart as possible on each
fragment. There should also be as small a distance as
possible between the bone and the bar of the external
fixator, while still allowing pin track and wound care.
The biomechanical requirements of the external fixator
depend on the condition it is being used for.
Fracture management
• During fracture healing, the external
fixator acts to:
– Stabilize the skeleton

– Enhance soft tissue healing

– Hold the limb in the correct alignment

– Provide a suitable mechanical environment for

fracture healing.
INDICATION OF EXTERNAL
FIXATION
Stabilization
• Trauma
o Open fractures
o Pelvic fractures
o Multiple long bone fracture
o Certain unstable fractures in long bones
o Non-union
• Arthrodesis
• Osteogenesis
• Limb lengthening
• Filling segmental defects resulting from:
– Tauma
– Osteomyelitis
– Tumour surgery
• Correction of deformity
• • Joint contractures
• • Severe club foot
• • Repeat club foot surgery
Advantages of external fixation

General advantages
• Mechanical environment can be controlled during
fracture healing
• Gradual correction of deformity if possible
• Gradual increase in load can be taken the skeleton as
the frame is destabilized
• Stiffness of the healthy bone be measured easily to test
for adequate healing
• Rapid stabilizing is possible using unilateral frames
• Comparatively short learning curve (especially for
unilateral frames)
• The limb can be suspended from the frame after skin
grafting, so that no pressure is put on the skin graft
• Allows compression and closure of soft tissue wounds
Advantages over plaster
casts
• Allows early movement of adjacent joints

• Regular dressings can be carried out easily

•
• Soft tissues can be observed (eg the
perfursion of skin flaps can be monitored
and the neurovascular status of the limb
can be observe for evidence of a
compartment syndrome)
Advantages over internal
fixation
• Does not cause stripping or devascularization of the
fracture fragments.

• Low blood loss

• Less hazardous to carry out if the sterility of the

operating area is suboptimal (eg in field hospital
units)

• Does not always require intensification (which is

essential for distal locking of intramedullary nails)
Disadvantages

• Time-consuming to construct (particularly circular

frames)
• Constant meticulous pin care is essential – a major
drawback with non-compliant patients or those living in
an unhygienic environment
• Fractures can occur though the pin holes
• pin track infection
• Neurovascular impalement:. Vessel penetration,
thrombosis, aneurysms and intravenous fistulas .
• Muscle and tendon transfixion: The subcutaneous
surfaces of the tibia is a good site to insert pins because
muscle or tendon transfixion is unlikely. Other sites of
insertion for unilateral pins and transfixing wires may
lead to muscle Bellies being tethered .
THANK YOU