Surgical Care at the District Hospital
Part 1 2 3 4 5 6 Primary Trauma Care Manual
Traumatology and orthopaedics
Acute Trauma Management
Trauma in perspective
Principles of Primary Trauma Care
Six phases of Primary Trauma Care
Procedures
Orthopaedic Techniques
Traction
Casts and Splints
Application of external fixation
Diagnostic imaging
Physical therapy
Crania burr holes
Orthopaedic Trauma
Upper extremity injuries
The hand
Fractures of the pelvis and hip
Injuries of the lower extremity
Spine injuries
Fractures in children
Amputations
Complications
War related trauma
General Orthopaedics
Congenital and developmental problems
Bone tumours
Infection
Degenerative conditions
Applications of External Fixation
 




MATERIALS

:: Arrange the fixation frame to best accommodate the fracture pattern and the stability needed (Figures 17.41 and 17.42).
Figure 17.41
Figure 17.41
Figure 17.30
Figure 17.42
:: Partially threaded pins, 3–6 mm diameter, work best but smooth pins will work if threaded ones are not available. Half pins are threaded on the end (Figure 17.41) and transfixation pins are threaded in the middle (Figure 17.42).
:: The connector frame consists of clamps to hold the pins to a rod or bar that spans the distance between pin sets. Frames can be purchased or locally made. The simplest frame is constructed of a metal or wooden rod fastened to the pins with plaster of Paris. More complex devices will provide greater stabilization or manoeuvrability.


Application technique

1 Prepare and drape the extremity in a sterile manner. Pin placement is comfortable using local injection anaesthesia at the pin site, but manipulation of the fracture may require a general anaesthetic. Place the pins in safe zones to avoid damage to the vessels and nerves. These areas include:
• Percutaneous borders of the tibia
• Calcaneus
• Radius
• Ulna.
Use only half pins in the radius and ulna. Approach the humerus and femur from the lateral side, following the intermuscular septum; use only half pins for these bones also.
2 Make a small incision over the insertion site in the sterile area. Sharp pins should be advanced to the bone and drilled through both cortices. In areas where half pins are used, be careful not to advance the pins beyond the second cortex. When using transfixation pins, advance the pin through the skin on the opposite side, leaving enough protruding to attach the frame on both sides (Figure 17.42).
3 Apply sterile gauze dressings around the pins and attach the frame. For increased stability, place the frame close to the skin allowing adequate clearance for dressings.
4 Place at least two pins in each major bone fragment to provide rotational stability. A third pin will give more stability, but more than three pins per fragment are of no benefit. Align the pins with the long axis of the bone to allow proper alignment of the connecting frame. A wide separation between the pins in each fragment will provide a more stable total system.

Complications

1 Injury to nerves and vessels by the pins
2 Infection about the pins is common. This can be lessened by careful daily skin cleansing at the pin sites. Most infections are superficial and are controlled by local cleansing and antibiotics. If the infection persists, the pin should be removed and a new pin placed at a different site.

 



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  Kep Points  
External fixation is a technique for immobilizing fractures by placing pins into the bone above and below the fracture and connecting the pins to an external device


The fracture position is adjusted by making changes to the external components in an outpatient setting



 
Wounds are accessible for dressing changes, debridement and secondary closure or skin grafting.