External fixator

definition

With the term 'External fixator ' an operative procedure is described with which Broken bones or other bone diseases can be treated. Usually, fractures can occur depending on the severity with the attachment of one Plaster of paris or surgically with screws and plates are supplied.
The external fixator is usually used when the bone surrounding soft tissues so injured are that an operation with the classical methods of reconstruction are not possible. Also in Emergency situations and in patients with many injuries The installation of an external fixator is an established treatment method.

Using the external fixator technique, screws are inserted into the affected bone fragments. In contrast to the usual surgical methods, however, the inserted screws protrude from the body and are connected with a metal bar. In this way, fixation and healing of the bone fragments can be achieved without the soft tissues surrounding the bone being excessively damaged.

Indications

The application of an external fixator can be necessary for a number of different diseases and injuries. The application is carried out particularly often after severe bone fractures in which the soft tissue surrounding the bone has been severely damaged. By fixing the bones from the outside, the damaged soft tissue and the damaged bones can heal optimally. The external fixator is used particularly frequently for fractures in the cervical spine.

Read more here Injuries to the cervical vertebrae.

Another indication is the so-called callus distraction. Here bones are surgically punctured and the ends are pulled apart with the external fixator to stimulate the tissue to form a "callus", the scar tissue of the bone, which later hardens and becomes a stronger material so the bone is elongated. With this method, for example, leg length differences can be corrected.

In order to alleviate the symptoms of certain diseases, it can be useful to artificially stiffen a joint with an external fixator. In the case of severe osteoarthritis, for example, you can connect bones via the joint in between to permanently stiffen it.

Read more about finger arthrosis, knee arthrosis and wrist arthrosis here.

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How does the external fixator work?

An external fixator should provide a Connection between two bones or bone fragments can be created via a metallic bridge. To do this, be Screws inserted into the affected bones. These screws protrude from the skin above. In order to be able to connect the screws, and thus the bone fragments, stably, so-called to bake be attached to the screws, to which in turn the metallic bridge can be attached. This bar can be used in broken bones Temporarily support or replace boneif it is no longer able to guarantee sufficient stability due to a break. Soft tissue injuries are also spared, in contrast to conventional treatment options for bone injuries, which is why the external fixator is used optimal solution for extreme bone fractures with soft tissue injuries represents.

The different types

Since there are different indications for the application of an external fixator, there are different types of fixator constructions.

A relatively common localization which requires an external fixator to be applied in the event of a bone fracture is a Break at the elbow. This is formed by the humerus as well as the bones of the forearm, the radius and the ulna. In the case of fractures of the elbow joint, a so-called Motion fixator used, which allows movement in the elbow joint and thus complications such as a Stiffness in the elbow joint is far less common after the fracture has healed occur.

An external fixator is also suitable for use Break in wrist. The wrist consists of a multitude of small bones, the interaction of which with muscles and tendon attachments enables a multitude of different movements in the joint. Also injuries to the Forearm bones like the spoke can result in the installation of an external fixator. Depending on the injury, one or two connecting rods are used to connect the screws implanted in the bone. The connection of the screws can go beyond the wrist and this stiffen temporarily. Whether this is necessary also depends on the bones involved and the extent of the injury.

Fractures of the pelvic ring represent massive injuries, which can also be partially treated with an external fixator. Especially if it is a Injury in an emergency acts, represents the The simplicity of the installation of the fixator and therefore the short time it takes to fix the pelvis is a great advantage this method. Depending on the injury pattern, a fixator system may be required combined with other methods in order to achieve sufficient stability of the pelvis. Since a large number of different pelvic bone fractures are possible, at least as many different types of fixator systems are possible. The most variants connect one half of the pelvic ring to the other.

The upper ankle is one of the joints in the human body most commonly affected by fractures. In the case of certain injuries, the application of an external fixator is also indicated here. Depending on the injury, different fixator systems may be used. The main differences are in the number of screws and connecting bars and their implantation location.
Even with one Calcaneal fracture an external fixator may be required.

Duration of treatment

The length of time an attached external fixator must remain on the patient varies depending on the underlying injury or disease. In the case of bone fractures, the correct fit of the screws and connecting bars should be checked at regular intervals. The external fixator may also be used in addition to other bone healing procedures and can therefore be removed earlier than usual. The healing of a bone with sufficient stability usually takes about 6 weeks, which corresponds to the duration of the usual fixator application. Since there are usually severe and complex injuries and fractures when an external fixator is used, the construction can remain in place for more than 2 months.

The duration of treatment with a fixator for artificially stiffening a joint or for callus distraction is usually longer.

maintenance

After the operation and the installation of an external fixator, the bone structures involved should be connected to one another in a sufficiently stable manner. However, in order not to jeopardize the success of the treatment, it is urgently necessary after the operation Properly care for the wound and external fixator. This is particularly important because the screws that are inserted into the bone protrude from the skin and therefore a possible gateway for bacteria represent. A infection is an extremely dreaded complication of external fixators, that Risk can be significantly reduced with the right care.

Showering with an external fixator is not recommended. So the construction should be covered with waterproof film when showering and to Cleaning sterile liquids only be used. Cleaning with these fluids should be done every day while the fixator is in place. After cleaning, a Disinfection of the exit points of the screws. To prevent dirt from getting into the fixator area, a dry bandage after cleaning be created. Both Signs of infection, for example in the case of sudden redness, swelling or severe pain, should always be Doctor for clarification to be visited.