1. 1st Zliten Orthopedic Symposium (ZOS) 10th March,2016
External Fixation
Dr.Mohamed Ali Gwila
MRCS(Edinburgh), MSOrth(Malaysia)
Department of Orthopaedic & Trauma Surgery
Zliten Teaching Hospital (ZTH)

2. Definition “A device place outside the skin which stabilizes the bone
through wires or pins
connected to one or more longitudinal bars”
AO principles of Fracture management

3. Types Available in Our Hospital
Stryker-Hoffmann II (Large ,Medium & small )
Galaxy –Orthofix.

4. Types

5. Why / When do we use External Fixators?
Open fractures stabilization
When internal fixation contraindicated
For dressing purposes
Definitive surgery later

6. Why / When do we use External Fixators?
Initial stabilization of polytrauma patients
Prevents “secondary insult” to the body
“Damage Control Orthopedics”
By stabilizing fractures early,
surgeons are able to limit blood loss,
decrease patient pain,
improve short- and long-term patient outcomes
and take additional time to plan for definitive treatment.

7. Why / When do we use External Fixators?
Closed fracture with severe soft tissue injury
i.e burn / severe abrasion
Internal fixation contraindicated
In Children’s fractures
Primary treatment for fracture of the femur

8. Why / When do we use External Fixators?
Bridging the articular fractures
Reduction by ligamentotaxis

9. Why / When do we use External Fixators?
Pelvic ring fractures
For stabilization of the ring

10. Why / When do we use External Fixators?
Correction of deformities
Correction of limb length discrepancy
Arthrodesis

11. ADVANTAGES / DISADVANTAGES

12. Advantages
Stabilizes bone - distant from the operative or injury focus
Minimal additional vascular trauma to bone
Lower risk of infection
Access for wound care
Easy to apply
Easy to remove

13. Disadvantages Pin tract infection / loosening Delayed fracture union
Patient discomfort
Restricted joint motion – across joint
Not as rigid as internal fixation

14. COMPONENTS Pins Stainless steel Tubes or carbon fibre rods
Schanz screw / steinman pin
Stainless steel Tubes or carbon fibre rods
Clamps / connectors
Pins to tubes
Tubes to tubes
Illizarov : Olive / K-wire , rings

15. 6 Basic Configurations Unilateral frame, One plane
Unilateral frame, Two planes
Bilateral frame, one plane
Bilateral frame, two planes
Multi-planar
Hybrid

16. Unilateral Frame, One Plane

17. Unilateral frame, two planes (Delta Frame)

18. Bilateral Frame, One Plane

19. Bilateral frame, Two plane
Now seldom used

20. Multi-planar

21. Hybrid

22. Principles

23. 4 Basic Principles of Application
Vital limb anatomy
Injury access
Mechanical Stability
Patient comfort

24. Vital limb anatomy DO: Remember Safe pin insertion sites
insert Pin / screw into opposite cortex,
Subcutaneous insertion, avoiding muscular impalement which decreases pain and increases function
DON’T:
Protrude too far from opposite cortex
Injure nerves or vessels
Place into the joint
Place into fracture line

25. Injury Access Fixator frame not to interfere with wound care
Bars / rods not too low to the skin
Schanz screws / pins not too near / inside the wound

26. Increasing Mechanical Stability
Increasing pin diameter:
- most important factor in fixator stability;
- adult tibia: usually requires fixation w/ 4.5 to 6.0 mm pins
- pins must be < 1/3 bone diameter to prevent pin hole fractures;

27. Increasing Mechanical Stability
widely separated pins within single fragment
Increasing number of shanz screw
Preloading shanz screw
Reducing distance btw bar and bone
Add 2nd bar to frame
Use of multi-planar fixator

28. Patient comfort
Simple unilateral fixator
Short shanz screw

29. Complications Pin tract infection
Presented with pain, redness, discharge, loosening
X-ray = osteolysis around pin
Chronic osteomyelitis = ring sequestra

30. Thank you for attention