External Fixation

Case summary

36 y/o, Malay gentleman

Patient drove car with around 60km/h and was crashed with lorry from front. He was loss of consciousness and was sent to emergency department by ambulance. Multiple fractures and bleeding were noted. There was an open fracture of right leg, grade 3C in Gustillo classification. X-ray of the right leg was done.

Plain x-ray of the right leg.

This is an anterior-posterior view of distal 1/3 of right knee and proximal 2/3 of right leg. The x-ray showed that there is segmented fracture of tibial plateau, both condyles are split and the tibial shaft is wedged between them, there is intraarticular extended and was type 5 in Schatzker classification. There is no shortening, angulation or rotation of the bone was seen in this view.

This is a lateral view of distal 1/3 of right knee and proximal 2/3 of right leg. The x-ray showed that there is segmented fracture of tibial plateau, There is 10 degree angulation of the tibial bone.There is no shortening or rotation of the bone was seen in this view.

External fixation was done.

This is an anterior-posterior view of distal 1/3 of right knee and proximal 2/3 of right leg. The x-ray showed that there is a interfragmentary screw fixing the fragmented tibial bone. Two pins were passed though th femur bone and another two pins were passed through the tibial bone. There is no angulation, shortening or rotation seen in this view.

This is a lateral view of distal 1/3 of right knee and proximal 2/3 of right leg. The x-ray showed that there is an interfragmentary screw on the fragments. there is no angulation, shortening and rotation of the bone was seen in this view.

External fixation is a surgical treatment which is held by transfixing screws, pins or tensioned wires which are pass through the bone above and below of the fracture site. These are then connected to an external frame or rigid bar. While reducing the fracture in all three planes, hold it in the proper alignment (adjustment of the angulation), it also allow some degree of rigidity and stability. besides it also allow adjustment of length of the bone. External fixation is commonly apply to fracture of long bones (esp. femur, tibia and humerus) and pelvic, but it can also be used for fractures of almost any part of the skeleton (example bone of the hand). Insertion of wires and half pins must be with care, by the knowledge of 'safe corridors' is to avoid nerves or vessels injury.

Indications of external fixation include:

1. Fracture associated with severe soft tissue damage.

external fixation was apply, two pins on the femur bone and two pins on the tibia bone. there are two wounds on the anterior aspect of upper half leg. The wound is measuring 5x3cm and 5x4cm. There is bleeding, no slough, granulation tissue present, slope well-defined edge. There is no maculous pin-site infection.

2. Fracture associated with nerve and vessel damage.
3. Severely comminuted and unstable fracture
4. Non-union where dead or sclerotic fracture fragment can be excised and fragments brought together by fixator
5. Fracture of pelvic which cannot be held by other method
6. Infected fracture
7. Severe multiple injuries

Complications

1. Damage to soft tissue structures.
Surgeon must familiar with the anatomy and the 'safe corridor' to prevent injured to the nerves and vessels.

2. Overdistraction.
Fragments of the bone must come to contact for union to be occur. If there is no contact between of the fragments, union may be delayed or prevented.

3. Pin-track infection.
This is rare but is the most complicated. Therefore, meticulous pin-site care is essential. If infection is occur, administered of antibiotics must be immediate.