External skeletal fixation for the general practitioner (Proceedings)

A number of fractures can be managed conservatively or with external coaptation. Still others can be dealt with using combinations of pins and wire. It is only when clinicians are able to utilize bone plating or external fixators that the number of manageable fractures truly expands. Although indications and uses for bone plates and external fixators overlap in many areas, external fixators are arguably adaptable to more situations and are more cost effective for the practice owner. The use of these devices will be reviewed and some tips for their application will be presented.

Basic indications and advantages for external fixator use

External fixators can reliably overcome the torsional forces that bedevil many fracture repairs. Additionally, a construct can be designed to provide adequate resistance to most bending, compression and distraction forces that are likely to be encountered. Additionally, the temporary nature of their presence on the patient enables them to be used in open wounds or those that require management of soft-tissue injuries. Furthermore, in some configurations, external fixators are amenable to very distal or proximal fractures where sufficient space for the screws in a bone plate might not exist. Lastly, in most cases fixators can be applied in a closed manner thus avoiding the necessity to disturb the healing process at the fracture site and possibly minimizing surgical time.

Components

In a basic sense, an external fixator construct consists of pins that anchor into the bone, an external bar, and some means of connecting the two. In reality, this means either pins connected with an acrylic column or any of a variety of commercial products using various systems of clamps to connect bars to the pins. Although the acrylic columns are cheap, light, and can be configured in various shapes, I prefer the commercial clamp and bar systems. The acrylic columns are hard to modify, look somewhat unprofessional and are subject to weakness due to bubbles or poor application. This presentation will cover a variety of pin choices, but will not go into detail about the differences between the various commercial clamp systems.

In addition to the components, this session will review the styles and advantages of common fixator constructs as well as the indications for their use.

Tips for using external fixators

Although the fundamental principles of fixator use are simple, the details of application will make the difference in whether or not a successful outcome is achieved. This session will cover principles such as safe corridors as well as tips for application and post-operative care.