Boyd W. Haynes III, MD
External Fixation is a term that references a method for temporarily stabilizing fractured bones outside the body, typically using pins, wires, screws, rods, etc. This stabilization technique is often used when the patient has been badly injured where other, more severe, life-threatening injuries must be treated first, or where the skin/tissue over the fracture has been badly damaged. Sometimes, the patient’s overall condition must be stabilized before orthopaedic surgery can be attempted. This may be only a day or two or possibly weeks or months, depending on the severity of the patient’s injuries.
External fixation involves aligning the broken bone and drilling screws, wires, or pins through the skin into the bone and affixing rods or hardware externally to the body to keep the bone(s) in alignment. Often, the external fixator will also allow for some adjustment so that alignment can be maintained over time.
Notwithstanding the trauma to the patient from the accident, the penetration of the skin by the external fixation screws/pins can introduce infection, so care must be taken to keep the wounds clean and to monitor for any redness or inflammation. If infection occurs, it is typically managed with antibiotics, whether oral or intravenous.
From an orthopaedic surgeon’s standpoint, I prefer not to perform external fixation, if possible, due to the risk of infection. Contraindications for external fixation include conditions that put patients at a higher risk for infection with traditional fixation, those with bone disorders or those who can’t care for their external fixators and keep them meticulously clean. Performing one internal fixation surgery is the much better option, rather than one external fixator procedure and one internal fixator surgery, for the patient’s overall health, their recovery and their outcome related to bone union and healing.