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General Editor: Chris Colton

Pediatric distal forearm 23-M/3.1 External fixation

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External fixators require special pin care, which should be adapted according to the local protocol.

It is important to keep the interface between skin and screws clean and dry rather than using antiseptic solutions. Pin care should ideally be done on a weekly basis, either by a dedicated practitioner or by an informed compliant parent/carer.

A sample local protocol could be as follows:

  • Early movement of the wrist and fingers should be encouraged as soon as pain allows.
  • Parents/carers should be advised not to disturb the dressings unless they have been instructed how to undertake pin care. If there is pain around the pin site, medical review should be undertaken urgently. Any signs of infection, such as redness, pus, or discharge are likely to indicate infection and should prompt appropriate treatment (pin site cleansing, topical or oral antibiotics).
  • First clinical follow-up will be determined by the needs of the fracture. Pine site inspection by the treating surgeon should be undertaken no later than two weeks after surgery.
  • At each follow-up the pin sites should be assessed and necessary care instituted.
  • Subsequent follow-up x-rays, to evaluate healing of the fracture by callus formation, can be performed 4-6 weeks postoperatively. For complete fractures of the methaphysis, follow-up has to be monitored with AP and lateral x-rays no later than 10-12 days after treatment and subsequently every 15-20 days until fracture is consolidated.
  • The external fixator is removed according to local practice, once the fracture is determined to be healed.

v1.0 2016-12-01