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MUSCULOSKELETAL TRAUMA
Basic Technique of External Fixation
Nurahmat Lubis, MD
Istan Irmansyah Irsan, MD
Fractures
Limb deformity correction
Arthrodesis
Indications
Trauma
Open Fractures
Severe soft tissue injury
Comminution
Bone loss
Temporizing or Definitive
means of fixation
Indications
Deformity Correction
Congenital
Post-traumatic
Acquired
Indications
Reconstruction
Arthrodesis
Malunion
Nonunion
Infection
External Fixation
Uniplanar
Biplanar
Circular (Ilizarov)
Hybrid
Advantages
• Joint contractures
Pin/Wire Location
Pin/Wire Number
Pin/Wire Size
Torsional strength
proportional to its radius4
Thread-Shank junction
is weakest point
Pre-drilling
HA coating increases
pullout strength
Carbon Fiber Rods
Lightweight
Radiolucent
Stability Factors
Lower Bone-Rod distance
increases stiffness
In-line stacking
increases stiffness
Portable Traction
Span intra-articular
fracture
Arthrodesis in the
setting of infection
Distraction External Fixators
Limb Lengthening
through
Distraction Osteogenesis
1mm / day
Multiplanar corrections
Damage Control and Temporary
Frames
Pins
Pin Geometry
Lower Extremity “safe” sites
• Avoid
– Nerves
– Vessels
– Joint capsules
• Minimize
– Muscle transfixion
Pin Insertion Technique
Incise skin
Spread soft tissues to bone
Use sharp drill with sleeve
Irrigate while drilling
Place appropriate pin using sleeve
Pin insertion
Clamps
Connecting Rods and/or Frames
Pin-track Infection
Union Fx infection Malunion Pin Infection
Mendes, ‘81 100% 4% NA 0
• Treatment:
– Stage I: aggressive pin-site care and oral
cephalosporin
– Stage II: same as Stage I and +/- Parenteral Abx
– Stage III: Removal/exchange of pin plus
Parenteral Abx
– Stage IV: same as Stage III, culture pin site for
offending organism, specific IV Abx for 10 to 14
days, surgical debridement of pin site
Construct Tips
Chose optimal pin diameter
Use good insertion technique
Place clamps and frames close to skin
Frame in plane of deforming forces
Stack frame (2 bars)
Re-use/Recycle components (requires
certified inspection).
Summary
Multiple applications
NOT FOR
Pathological fracture
BASIC PLATING PRINCIPLE FOR
SIMPLE FRACTURE
NOT FOR
Osteoporotic fracture
Complicated fracture
Reduction Techniques