INTERNAL AND EXTERNAL FIXATION

EXTERNAL FIXATION
a method of immobilizing bones to allow a fracture to heal. External fixation is accomplished by placing pins or screws into the bone on both sides of the fracture. The pins are then secured together outside the skin with clamps and rods. The clamps and rods are known as the "external frame."

NURSING CONSIDERATIONS FOR EXTERNAL FIXATION DEVICE

Alleviate Pain Elevate the extremity as prescribed by the doctor- to help prevent swelling and pain Make sure the leg is safely and securely positioned With an open lesion, the patient is likely to have had the external fixation device applied with very little explanation. Take time to have therapeutic communication with the family and the patient, to promote relaxation that can help reduce the pain.

NURSING CONSIDERATIONS FOR EXTERNAL FIXATION DEVICE Increase Mobility After surgery, make sure the leg with external fixation is to be positioned higher than the heart; therefore, the patient may be asked to not have the HOB elevated more than a few degrees. The leg and the external fixator must be moved as a unit.

Do not place your hands under the fracture site to assist with the movement as this may cause you to apply stress and even slightly manipulate the fracture site. Active and passive range-of-motion exercises for all unaffected extremities should be stressed

Patient Teaching and Home Care Considerations Provide emotional support Patients with open lesions go home with the external fixation device in place, instruct the family and patient on how to do pin site care and how to cleanse the skin under the device. Some physicians believe that washing with soap and water during the daily shower is best for closed fractures.

Avoid tub baths Open fracture sites will need to sponge bathe Educate patient on how to detect a possible infection Provide a step of care and the signs and symptoms of infection for the patient to take home and use as a reference.

INTERNAL FIXATION SURGERY

is a type of surgery used to fix broken bones. This is a two-part surgery. First, the broken bone is reduced or put back into place. Next, an internal fixation device is placed on the bone; this can be screws, plates, rods, or pins used to hold the broken bone together.

Reasons for Procedure This surgery is done to repair fractures that would not heal correctly with casting or splinting alone.
Possible Complications Complications are rare, but no procedure is completely free of risk. If you are planning to have this procedure, your doctor will review a list of possible complications which may include:
Infection Bleeding Reaction to anesthesia Blood clots

Prior to Procedure Since broken bones are caused by trauma or an accident, an ORIF surgery is typically an emergency procedure. Before your surgery, you may have:

Physical examto check your blood circulation and nerves affected by the broken bone X-ray, CT scan, or MRI scantests that take a picture of your broken bone and surrounding areas Blood tests Tetanus shotdepending on the type of fracture and if your immunization is current Questions your doctor may ask include: How did you break your bone? How much pain do you feel? Do you take any blood-thinning medicines? Questions you should ask include: Will I need rehabilitation after surgery? What will I need to assist in my recovery (eg, wheelchair, crutches)?

An anesthesiologist will talk to you about anesthesia for your surgery. Arrange for a ride home from surgery. If your surgery is urgent, you may not have time to fast beforehand; make sure to tell your doctor and the anesthesiologist when you last ate and drank. If your surgery is scheduled, you may be asked to stop taking medicines that thin the blood, like warfarin (Coumadin), clopidogrel (Plavix), or aspirin. If surgery is urgent, make sure to let your doctor know if you take any bloodthinners or other medicines.

Anesthesia General anesthesia may be used. It will block any pain and keep you asleep during the surgery. It is given through an IV (needle in your vein) in your hand or arm. In some instances, a spinal anesthetic, or more rarely a local block, may be used to numb only the area where the surgery will be done. This will depend on where the fracture is located and the time it will take to perform the procedure.

Description of Procedure Each ORIF surgery differs based on the location and type of fracture. In general, a breathing tube may be placed to help you breathe while you are asleep. Then, the surgeon will wash your skin with an antiseptic and make an incision. Next, the broken bone will be put back into place. Next, a plate with screws, a pin, or a rod that goes through the bone will be attached to the bone to hold the broken parts together. The incision will be closed with staples or stitches. A dressing and/or cast will then be applied.

OPEN REDUCTION AND INTERNAL FIXATION SURGERY OF THE ANKLE

INTERNAL FIXATION FOR HIP FRACTURES

Perioperative Nursing Considerations

Have x-ray capabilities in the room. Notify x-ray department when patient is being positioned on the table. Observe radiologic precautions. The extremity may be supported postoperatively in a cast, depending on the location/ severity of the fracture.

Post-operative Nursing Considerations

During the first 24 to 48 hours, relief of pain and prevention of complications are important, and continuous neurovascular assessment is essential. Encourage deep breathing and dorsiflexion and plantar flexion exercises every 1 to 2 hours. Thigh high and anti-embolism stockings or pnuematic compression devices are used, and anti-coagulants are administered as prescribed to prevent the formation of venous thrombemboli.

The nurse administers prescribed prophylactic antibiotics and monitors the patient's hydration, nutritional status and urine output. A pillow placed between the legs is essential to maintain abduction and alignment and provide need support when turning the patient.

DISTAL INTERLOCKING DEVICE

SPINE MODEL WITH 2 INSTRUMENTED FIXATION

SURGICAL PROCEDURE CALLED OPEN REDUCTION INTERNAL FIXATION