External fixation is a surgical procedure used to treat and fix fractures. It is done by inserting pins, screws, rods, or wires into the bones through the skin. These devices hold the bones together with a fixation frame on the outside of the skin.
External fixation procedures aim to provide alignment and stability to the bones so that they can heal properly. It is mainly used for those with open fractures with severely damaged soft tissue and who may also have contaminated wounds. However, it may also be used to treat those with limb deformities or for limb lengthening.
This procedure may also be used if there is a lot of swelling at the site of injury which can make internal fixation, where devices are inserted inside the skin, difficult and dangerous. However, it depends on the individual case as sometimes partial internal fixation is possible.
As there is less chance of infection compared to internal fixation, external fixation is often recommended for those who have medical conditions that impair healing, as well as those with certain skin conditions. This includes diabetes, osteomyelitis (bone infection), and peripheral vascular disease.
How does external fixation work?
An external fixation procedure involves an orthopaedic surgeon drilling holes into the parts of the bone that are not damaged or fractured, then installing bolts, screws, pins, or wires into these holes. These are connected to rods attached to an external frame that is outside the skin.
The external fixation procedure is typically done in an operating theatre under general anaesthesia so the patient does not feel any pain during the surgery. When it is time to remove the external frame and bolts, it is typically done without anaesthesia in an office visit using special wrenches.
Depending on the severity of the fractured bones, this surgery can take several hours. You may be required to stay for a couple of days at the hospital while you recover from the procedure.
Benefits of external fixation
Reduced risk of infection compared to internal fixation
Stabilises and aligns the bones to enable proper healing
Repairs fractured bones
Ideal for those with certain conditions such as diabetes
What conditions does external fixation treat?
External fixation can be used to treat the following conditions:
Fractures with severe tissue damage
What results can I expect?
After external fixation surgery, you will have a bulky bandage around the external fixator. You will experience pain, swelling, and stiffness and will be prescribed painkillers to help you manage these symptoms. You will also be unable to move the limb that the external fixation is attached to. You will be advised to rest as much as possible during the recovery process.
Depending on the site of injury, you may also have to use crutches or a wheelchair to move around as you recover. You will need to visit your orthopaedist for follow-up appointments to monitor your progress, clean the dressing, or remove the fixators. After you have recovered, you may also need to undergo physiotherapy as you will have lost significant muscle strength and flexibility during the injury.
Results will vary from person to person, depending on the treatment area, severity of the issue, and your overall health. Your orthopaedist can give you a better idea of what to expect based on your individual needs and circumstances.
How many treatment sessions are needed?
Typically, only one external fixation procedure at a time is needed.
However, it depends on the severity of the injury and if there are multiple fractures on the body. Physiotherapy sessions and follow-up appointments are also normally required, and the duration depends on the severity of the injury and how fast the body heals.
Your orthopaedic surgeon will be able to provide you with a bespoke treatment plan, tailored to your needs and requirements.
Dr Puah KL is our Senior Consultant Orthopaedic Surgeon at Artisan Sports & Orthopaedic Surgery. He used to serve the sports service of Singapore General Hospital - the highest volume trauma centre for orthopaedics in Singapore.