External fixation is a surgical treatment utilized to stabilize soft tissues and bone at a distance from the injury or operative focus. They offer unobstructed access to the relevant soft tissue and skeletal structures for their starting assessment and for secondary interventions required for restoration of bony continuity and a functional soft tissue cover. It is a substitute of internal fixation, where the components used to offer stability are placed totally within the body of patient.
The surgical treatment is done using orthopedic instruments that are provided by the orthopedic instrument manufacturers in India.
There are several potential complications with sepsis as it is the most common.
Pin tract infection– Without proper technique for insertion of pin and meticulous pin tract care, this may be the complication that is most common, occurring in 30 percent of patients. It differs in minor inflammation remedied by local wound care, to superficial infection requiring local wound care, antibiotics, and occasional pin removal, to osteomyelitis requiring sequestrectomy. A “ring sequestrum” is the radiological presence of a sclerotic ring about the hole remain left from a transfixion pin.
Neurovascular impalement- Have knowledge of the anatomy of the underlying limb and prevent major neurovascular structures. The surgeon must be aware of the cross-sectional limb anatomy and of the relatively danger zones and safe zones for pin insertion. The radial nerve in the proximal half of the forearm and the distal half of the arm, the anterior tibial artery, the dorsal sensory radial nerve just above the wrist, and deep peroneal nerve at the junction of the 3rd and 4th quarters of the leg are the structures most frequently involved. Thrombosis, vessel penetration, late erosion, arteriovenous fistulas and the aneurysms formation have also been observed.
Tendon or muscle impalement– Pins inserted through muscle bellies or tendons restrain the muscle from its usual excursion and can lead to rupture of tendon, or muscle fibrosis. Stiffness in ankle is common if multiple transfixing pins (an orthopedic implant) are utilized in tibial fractures.
Delayed union– The rigid frames and pins can “unload” the fracture site, with weakening and cancellization of the cortex same as that noted with internal rigid compression plate fixation if the fixator remains in position for many weeks or months. The callus produced is totally endosteal, and delayed unions in 20% to 30% (and as many as 80%) of fractures have been reported in the literature with lengthy use of the rigid fixator.
Compartment syndrome– May occur in the limb which is treated with an external fixator. Unlike open surgery which opens facial planes, an external fixator is essentially a closed process and there is a higher degree of compartmental syndrome.
Refracture– Union because of the rigid fixation is largely endosteal, with very little peripheral formation of callus. The de stressing of the cortical bone by the rigid fixation outcomes in cancellization of the cortex; refracture is possible after removal of fixator unless the limb is adequately protected by crutches, supports, or supplemental casts. Limitation of future alternatives. Such procedures as open reduction become impossible or difficult if pin tracts become infected. If an external fixator is left in more than one week, there is a higher degree of infection if open reduction and internal fixation (ORIF) is later tried. Don’t use an exfix for an extended period, if you anticipate open reduction will later be needed. It is safe to perform ORIF, however if the exfix removed within one week of application.
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