External Fixator -Procedures, Side effects, Recovery time, Costs and alternatives

The majority of the population around the world knows about the non-surgical procedures that are used by an orthopedic doctor to heal the broken bone. Usually, the doctor applies a cast, or brace around the area which is supposed to be fractured for supporting the process of bone healing. However, there are some severe cases every now and then reported where the conventional approaches to healing a fracture cannot be applied. In today;s scenario, the orthopedics believe that in cases of such severity it is best to externally secure the fracture with a device known as external fixator. The external fixator finds its use in the treatment of the following condition:

• External fixation technique is very helpful in the treatment of patients with open fracture.
• A temporary external fixator can be applied in the condition of closed fractures.
• External fixation techniques can also be taken into consideration for the polytrauma damage control surgery as it is one of the most reliable techniques for attaining initial stability in the fractures for the patients who are injured severely.
• Orthopedic doctors prescribe external fixators to be placed in patients suffering from either open or closed articular fracture.
• The use of external fixators provides the doctor with a rare opportunity of managing the loss of major bone or soft tissues.
• Besides providing immediate healing in severe complex fractures, external fixators can also be used for the treatment of other conditions like malformation of bones that restrict the length of the limbs.

The treatment with external fixator helps in maintaining the alignment in the bone that is fractured. As a treatment, the external fixator device is applied on the affected bone by making use of special bone screws which are commonly known as pins. The pins pass through the skin and the muscles while the rest of the device is placed outside the affected area of the body.

Treatment of severe fractures can be accomplished by making use of an external fixator device. In the treatment with an external fixator, the screw or the pins are placed on both the sides of the fractured bone. The process of securing the pins together outside the skin is done by making use of the rods and clamps which are referred to as an external frame. The treatment of a bone fracture with an external fixator is accomplished by an orthopedic surgeon. Before starting the treatment a local anesthetic is given to the patient. The procedure of external fixation takes place in the following order :

• The orthopedic surgeon initially drills the holes into the areas of the bones which are undamaged near the fracture.
• The surgeon then screws the special bolts into the holes.
• Rods or clamps with ball and socket joints are affixed with the bolts.
• If the bone is not aligned properly the orthopedic surgeon makes some changes and adjusts the ball and socket joint in such a way that the bone gets aligned with minimal shortening of a bone if necessary.

The pierced areas of the skin require special attention and are required to be cleaned regularly so that the chances of an infection can be minimized as this treatment involves an invasive procedure. In some rare cases, the use of cast may be needed to be placed. After the patient gets treated external fixator can be removed from the body of the patient at a hospital or at the doctor's personal clinic. No anesthesia is required to be given to the patient when the external fixator is removed. There is a possibility that the places which drilled for placing external fixator might also be fractured thus; special caution must be ensured while removing the external fixator from the body of the patient.

A patient is eligible for the treatment with external fixator if he/she is suffering from the following conditions

• a patient who is suffering from an open fracture require treatment with an external fixator
• A patient who is in polytrauma after being majorly injured and has fractured bones.
• A patient suffering from the condition of articular fractures.
• A patient experiencing severe loss of bone or tissue.
• Patients who require arthrodesis to be performed.
• Patients suffering from the condition of pelvic ring disruption.
• Patients which require lengthening of their limbs.
• Patients with fractures that required alignment.

An orthopedic doctor decides whether a patient is eligible for the treatment with an external fixator. A patient who is suffering from a normal fracture cannot undergo treatment with external fixator as there is no need for it. A simple fracture can be healed using a simple cast thus making the patient ineligible for the treatment. Patients who have disorders associated with the bone that can make stabilization with external fixator difficult are not eligible for treatment. A patient whose immune system is already compromised is not eligible for treatment due to an increased risk of infection. The treatment with an external fixator is ineligible in patients who have some pre-existing internal fixation which restricts the placement of pin appropriately.

A treatment without any side effects is a rarity. Some minor or serious side effects are always associated with every treatment. The side effects which are relatively minor or small disappear after a period of time. When a serious side effect is experienced by a patient then a doctor must be informed immediately. The side effects involved with an external fixator for the treatment are given below :

• There is an increased risk of pin tract infection in patients with an external fixator.
• The potential risk of pins fracturing the undamaged bone is high.
• The external fixator can be heavy and cumbersome.
• Delicate surgeries cannot be performed on a patient when an external fixator has been placed.
• A patient who is non-compliant may disrupt the alignment of the external fixator.
• There is an increased risk of joint stiffness to occur in patients.
• The cost of the external fixator is very high.In case any of these side effects persists or there any other health issues arising during or after treatment, it is advised to kindly consult the health specialist immediately.

A patient that undergoes treatment with external fixator needs tofollow specific post-treatment guidelines. A doctor may prescribe the following guidelines :

• The pin site and device must be cleaned at least twice a day.
• The cleaning must always be done with sterile water and sterile cotton swabs.
• Both before cleaning and after cleaning of hands is necessary for the attendant cleaning the device.
• The cleaning process must be done with soft gentle hands.
• The entire course of antibiotic must be completed by the patient.
• A patient must only take shower when advised by the doctor. The patient is usually advised to take shower after a period of 10 days.
• The patient must not put stress on the site of external fixator as it may cause problems in re-alignment of the bones.
• Pain medications must be taken on time.
• After the external fixator has been removed a patient must undergo some physiotherapy sessions to improve the mobility.

The recovery period for the patient is based on the severity of the condition for which the treatment has been undertaken. The average bone healing time for a normal fracture is 6 to 8 weeks. But the recovery period for the patients who have undergone external fixationtreatment can range from 12 weeks to several months. However, the recovery process may get faster if the patient religiously follows the post-treatment guidelines advised by the doctor. Usually, the patients who have undergone external fixation recover within the prognosis time described by the doctor.

The treatment price for external fixation in India depends on the location of the area, fees of the surgeon, and price of the external fixator. The cost of the external fixation treatment in India is approximately 50,000 rupees all expense included. This cost of treatment may vary depending upon the quality and the type of external fixator required by a patient for his/her treatment.

The result of the treatment when talking in terms of healing of the bone may be permanent. However, it is improbable to assume that the treatment is permanent. A patient is required to visit the doctor for removing the external fixator. A patient may be required to visit the doctor if any infection occurs at the site of external fixation. There are also chances that at the site where thepins have been placed might also be fractured so a patient may again have to visit the doctor for complete healing of the bone after the external fixator has been removed.

A doctor may only prescribe the external fixator to be used when he/she feels that it may be the best line of treatment based on the complexity of the condition. However, with the advent of several technologies, a doctor may prescribe treatment with a supracutaneous plate as a suitable alternative for external fixator.