External fixation is a surgical technique used to stabilize bone and soft tissue without internal fixation. It involves inserting pins or wires through the bone above and below a fracture, and attaching them to an external frame. This allows fractures to be held without opening the fracture site. Complications can include pin tract infections, joint stiffness, and damage to soft tissues if not placed correctly. However, it provides minimally invasive stabilization and flexibility to treat complex fractures.

1. External Fixation

2. External Fixation
• A surgical treatment used to stabilize the bone and
soft tissue at a distance from the operative or injured
focus.
• A fracture may be held by transfixing screws or
tensioned wires that pass through the bone above and
below the fracture and are attached to an external
frame.
• This is especially applicable to the long bones and
pelvis but the method can be used for fractures of
almost any part of the skeleton.

3. History
• In the 1950s, Ilizarov , Soviet Union developed
a new method for treating fractures, deformities and
other bone defects. A metal frame that encircles the
limb is attached to the underlying bone by crossing
(X) pins inserted through the bone and limb. The
external rings are linked to each other by threaded
rods and hinges that allow to move the position of the
bone fragments without opening the fracture site, then
the fragments can be fixed in rigid position until
complete healing.

4. Ilizarov External Fixator

5. Components of the External Fixator
• Pins
• Clamps
• Connecting rods

6. Technique
• Holes are drilled into the uninjured area of bones
around the fracture (above and below the fracture)
• Special bolts or wire (schanz screw, steinman pin) are
screwed into the hole.
• Outside the body, a rod made up of stainless steel or
carbon fibre with special ball and socket joints join
the bolt to make a rigid support.

7. Indications
1. Fractures associated with severe soft-tissue damage
where the wound can be left open for inspection,
dressing or plastic surgery.
2. Fractures around the joints that are potentially
suitable for internal fixation but the soft tissues are
too swollen to allow safe surgery. So, external
fixator provides stability until the soft tissue
condition improves.
3. Patients with severe multiple injuries especially if
there are bilateral femoral fractures, pelvic fractures
with severe bleeding and those with limb and
associated chest or head injuries.

8. 4. Severely comminuted and unstable fractures
which can be held out to length until healing
commences.
5. Infected fractures for which internal fixation
might not be suitable.
6. Ununited fractures where dead or sclerotic
fragments can be excised and the remaining ends
brought together in the external fixator,
sometimes this is combined with elongation in
the normal part of the shaft.

9. Contraindications
• Patient with compromised immune system.
• Non compliant patient who would not be able to
ensure proper wire and pin care.
• Pre-existing internal fixation that prohibit proper wire
and pin replacement.
• Bone pathology that precluding the pin fixation.

10. Advantages
• Minimally invasive
• Less damage to the blood supply of the bone.
• Flexibility (build to fit)
• Useful in both as a temporizing or definitive
stabilization device.
• Can be used in situation with risk of infection and
useful in case of bone infection.
• Reconstructive and salvage application.

11. Disadvantages
• Meticulous pin insertion technique, skin and pin tract
care are required to prevent pin tract infection.
• The pin and fixator frame can be mechanically
difficult to assemble by the uninitiated surgeon.
• Equipment is expensive.
• The frame might be cumbersome.
• Delicate surgery such as skin flaps is difficult to be
done once the external fixator apparatus is in place.

12. Disadvantages
• Refracture after the external fixator removal
may occur unless the limb is adequately
protected until the underlying bone can again
become accustomed to stress.
• Non compliant patient may also disturb the
appliance adjustment.
• Joint stiffness may occur if the fracture
requires the fixator immobilize the adjacent
joint.

13. Complications
• Damage to soft-tissue structures:
 Transfixing pins or wires may injure nerves or
vessels, or may tether ligaments and inhibit joint
movement.
• Over-distractions:
 If there is no contact between the fragments,
union may be delayed or prevented.
• Pin-track infection:
 One of the most troublesome complications.
 Meticulous pin-site care is essential and
antibiotics should be administered immediately if
infection occurs.