An orthopedic operative procedure which stabilizes and aligns the fractured segment with the help of externally placed mechanical devices holding up the intact bone.

1. EXTERNAL FIXATORS
RADHIKA CHINTAMANI

2. CONTENTS
• Definition
• Principles of surgical treatment
• Biomechanics
• Types
• Indications
• Contraindications
• Advantages
• Disadvantges
• Complications
• Brief about Callotasis

3. DEFINITION
• A surgical procedure that stabilizes and joins the ends of fractured
bones by externally placed mechanical devices.

4. LAMBOTTE’S PRINCIPLES OF SURGICAL
TREATMENT OF FRACTURES
• Anatomical reduction
• Stable internal fixation
• Preservation of blood supply
• Active, pain-free mobilization of adjacent muscles and joints

5. METHODS OF APPLYING
• Exposure of the fracture
• Reduction of fracture
• Provisional stabilization of fracture
• Definitive stabilization of fracture

6. BIOMECHANICS OF EXTERNAL FIXATOR
A. Number of pins:
- 2 pins per segment
- Addition of third pin
adds mo stability
- Third pin if out of
plane adds greater
stability
B. Pin location:
- Avoid zone of injury or
fracture ORIF
- Pins close to fracture as
possible
- Pins spread far apart in each
fragment
- Wire: 90 degree tensioned
wires
C. Pin Preload:
- Bending preload
not
recommended
- Radical preload
decreases
loosening and
increases fixation
D. Bone frame distance
- Rods and Rings: if more closer; more stable the fracture site
- Dynamization is attained by stacked frames.

7. MALGAIGNE FIXATOR
• Developed by Malgaigne in
1843 to treat fracture of the
knee cap and olecranon
• The mechanism was made up
of clamp that approximated 4
(transcutaneous) metal
pronges.

8. KEETLEY FIXATOR
• Developed by Keetley in 1839 to
treat fracture of the knee cap
and olecranon
• Rigid pins (of stainless steel)
were inserted in to the bone and
connected to the external
system (2 horizontal braces) of
splint with the main objective of
reducing pseudoarthrosis.

9. MONOLATERAL EXTERNAL FIXATION
• Discovered by Clayton Parkhill in
1897
• 4 screws (two inserted into each
fragment above and below the
fracture)
• Ends of the screws were fixed
together by interlocking small
interlocking small plates and bolts
• Useful in wrist and paediatric
fractures as suggested by Prof
Caraffa and Dr. Michhele Bisaccia

10. FREEMAN FIXATOR
• Discovered by Freeman
• Similar to that of Parkhill technique.
• Single pin was inserted above and
below the fracture segment which
were connected to each other by
metal bar covered in wood.
• He also affirmed that pins should
be inserted at a certain distance
away from the fracture site.

11. LAMBOTTE’S EXTERNAL FIXATOR
• Discovered by Lambotte in
1902.
• Unilateral frame consisting of
metal pins that penetrated into
the bone and protruded through
skin in a systematic manner. .
• The pins were connected to
each other by an external
device.

12. HOFFMANN’S EXTERNAL FIXATOR
• Discovered by Hoffmann in 1938.
• He coined the modern term osteosynthesis:
put the bone in its place.
• The fixator composed of an incorporated
universal ball joint connecting the external
ball of the fixator to strong pin-gripping
clamps.
• This universal joint allowed for a reduction of
the fracture in 3 planes of space even after
fixator was applied.
• In this fixator technique it was possible to
apply a sliding compression distraction bar
that allowed to apply the either the
compression or the distraction at the centre
of the fracture site.

13. ANDERSON’S DEVICE WITH TRANSFIXION PINS
• Discovered by Anderson.
• The system was made up of
transfixion pins connected to metal
clamps.
• Through-and-through transpin
fixation device
• The fixator composed of a multi-
plain reduction as well as
compression.

14. STADER DEVICE
• Discovered by Otto Stader.
• This is a stabilization system for
fractures that lead to reduction of the
fractures on 3 planes.
• The advantage of this system is
positioning the pins as far as possible
from fracture.
• The stressed is over importance of
positioning of the pins at angles from
each other (not parallel) which
increases its stability.
• Known to reduce risk of mal-alignment

15. VIDAL’S QUADRILATERAL FRAME
• Discovered by
Vidal.
• Fixation is
more rigid and
stable

16. DE BASTIANI EXTERNAL FIXATOR
• Discovered by De Bastiani, also
known as dynamic axial fixator
• These fixators were composed of
four pins (2 at both the sides) at
the extremes from fracture site.
The pins were connected to each
other by a telescopic tubular rod of
a greater diameter.
• The frame permitted micro-
movements and axial loading
during ambulation thus enhancing
healing.

17. AO ASIF EXTERNAL FIXATOR
• Discovered in 1977

18. HOFFMANN’S 3 MRI
• Useful for MRI examination with the implant

19. ILLIZAROV’S EXTERNAL
FIXATOR
• Permits stabilization of high energy fractures
with minimal operative trauma to soft tissues
preserving critical blood supply
• Early use of limb, weight bearing permitted and
encouraged
• Eliminates need of extensive soft tissue
procedures and bone grafting
• Salvage arthrodesis of knee, ankle and hindfoot
• Illizarov pin-to-ring concept

20. ADVANTAGES
• Rigid fixation
• Compression, neutralization or fixed distraction
• Direct surveillance
• Immediate motion of proximal and distal joints is allowed
• Early patient mobilization is allowed
• Early weight bearing compared to Internal fixation

21. DISADVANTAGES
• Meticulous pin insertion technique and skin and pin track care are
required to prevent pin track infection
• Pin and fixator frame can be mechanically difficulty to assembly by
uninitiated surgeon
• Frame can be cumbersome and patient may reject due to esthetic
reasons
• Fracture through pin track may occur
• Refracture after frame removal may occur
• Equipment is expensive
• A non compliant patient may disturb appliance, adjustments

22. COMPLICATIONS
• Pin track infection
• Neurovascular impalement
• Muscle or tendon impalement
• Delayed union
• Compartment syndrome
• Refracture

23. CALLOTASIS
• It is a limb lengthening technique involving slow distraction of the
callus formed in response to a proximal submetaphyseal corticotomy.
(callus distraction).
• Introduced by De Bastiani et al during 1980.
• Long bone is sectioned at diaphysis and stabilized for two weeks and
then subjected to gradual distraction using a rigid fixation device.
• The distraction gap fills with growing callus.
• A slow rate of distraction does not break the callus, in fact stimulating
osteogenesis.

24. REFERENCES
• Bisaccia. M, Vicente C, Meccariello L, Rinonapoli G, Falzarano G,
Colleluori G. et al. Canadian Open Orthopaedics and Traumatology
Journal.2016;3(4):1-9
• Canale S T, Beaty J H. Campbell’s operative orthopaedics. 11th
edition
• Rockwood and Green. Fractures in adults. 7th
edition
• Maheshwari J. Essential orthopaedics . 4th
edition

25. CONTACT DETAILS
radds2009@gmail.com