External Fixation

External fixation a method of immobilizing

bones to allow a fracture to heal.

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”.

can also be indicated for bony non-union if fracture healing has not been successful.

EXTERNAL FIXATI0N

Common Sites for External Fixations

Extremities

Pelvis

Face

Jaw

Common Sites for External Fixations

Ribs

Toes

Fingers

Advantages Allows clients to use contagious

joints while the affected area remains immobilized.

supports areas with tissue or bone infections.

maintains position for unstable fractures and for weakened muscles

it is quickly and easily applied. The risk of infection at the site of

the fracture is minimal.

Disadvantages of external fixation

Meticulous pin insertion technique and skin and pin tract care are required to prevent pin tract infection.

The pin and fixator frame can be mechanically difficult to assemble by the uninitiated surgeon.

The equipment is expensive. The frame can be cumbersome, and the

patient may reject it for aesthetic reasons.

Fracture through pin tracts may occur.

It is difficult to do delicate surgery such as skin flaps once the exfix apparatus is in place. Rather do this type of surgery before the frame is applied.

Re fracture after exfix removal may occur unless the limb is adequately protected (e.g. by walking cast application), until the underlying

bone can again become accustomed to stress. The noncompliant patient may disturb the

appliance adjustments. The head injured patient may injure himself by

thrashing his pin studded limb against other parts. Joint stiffness may occur if the fracture requires that

the fixator immobilize the adjacent joint. e.g. an exfix placed over the ankle for a pilon fracture as there was insufficient space for pins in the distal tibial fragment.

Complications There are many potential complications

with sepsis being the most common. Pin tract infection. Neurovascular impalement. Muscle or tendon impalement. Delayed union. Compartment syndrome Refracture.

AssessmentASSESS:

Neurovascular Assessment

-compare the affected extremities to unaffected extremities

Pain and bleeding

Assessment Signs of infections

-assess pin sites Nutritional Status

-Pay attention to the adequacy of food intake, ability to eat and swallow

Abnormal laboratory values should be determined

Nursing Interventions

Administer antibiotics Wound care

- may involve wet to dry dressing

- presence of loosen pins must be reported

Assess adherence to any weight bearing restrictions and correct use of ambulatory aids

Nursing Interventions

Administer antiemetic agents as ordered

Client and family education- Client should have begin to accept change in body image that accompanies use of external fixation by the time of discharge

- Client should be responsible for pin and wound care

Nursing Interventions- Client should be aware for sings of

infections, neurovascular changes/ integumentary changes

- Client should be instructed about the use of antibiotics and analgesics

- Alternative methods of pain management -Visualization-Massage-Distraction

Nursing Interventions

-Teach client about good hygiene

-Reduce intake of gas forming foods which can lead to abdominal distention

-Once affected bone is healed, fixator is removed.

Avoid causing osteomyelitis

Place pins away from fracture lines. Organisms

may gain access and infect the bone about the

fracture area.

Skin "tenting" i.e. folds caused by skin

compression against the pin must not be tolerated - these folds lead to pin

tract sepsis. Make a relaxing incision on the

side of the fold, and suture any resulting

wound.

Causes of pin sepsis Site selection

-The more soft tissue there is, the greater is the chance for sepsis. Site the pin where the bone is as superficial as possible.

Skin tethering-Place the pin so as not to tension the skin. Close wounds, if possible before inserting the pin, as closure will be likely to move the skin. Make relaxing incisions to relieve skin tension - suture the resulting defect if necessary.

Use of power instruments-Drilling wide diameter pins directly into bone will generate heat, this may lead to sequestrum formation and sepsis. Either pre drill the pins with a helical drill, or use hand instruments to insert the pin.

Pin Care-Inadequate pin care and poor hygiene may lead to sepsis

Pin Care

Clean the skin / pin interface of all discharges twice daily

Antiseptic dressings - "Betadine" (povidone) ointment

Inflamed or septic skin about a pin (not loose) - Appropriate (oral) antibiotic

Septic Loose Pin - remove, and replace with another through normal skin

THANK YOU!

Prepared by:

Ma. Glory Fel E. MapaZarah Jean O. Masote

Natalie Young MacayanFrances Magno

BSN 3B