Aftercare following application of a ring fixator
Immediate postoperative care
Immediately after surgery, while the patient is still in the hospital, emphasis is given to:
- Pain control
- Infection and deep veinous thrombosis (DVT) prophylaxis
- Early recognition of complications
The patient’s leg should be slightly elevated, with the leg placed on a pillow, 4 cm above the level of the heart.
Advise the patient about foot positioning in order to avoid equinus deformity.
Proper pin/wire insertion
To prevent postoperative complications, pin/wire-insertion technique is more important than any pin/wire-care protocol:
- Correct placement of pins/wires (see safe zones) avoiding ligaments and tendons, eg tibia anterior
- Correct insertion of pins/wires (eg trajectory, depth) avoiding heat necrosis
- Extending skin incisions to release soft-tissue tension around the pin/wire insertion (see inspection and treatment of skin incisions)
Various aftercare protocols to prevent pin tract infection have been established by experts worldwide. Therefore no standard protocol for pin-site care can be stated here. Nevertheless, the following points are recommended:
- The aftercare should follow the same protocol until removal of the external fixator.
- The pin/wire-insertion sites should be kept clean. Any crusts or exudates should be removed. The pins/wires may be cleaned with saline and/or disinfectant solution/alcohol. The frequency of cleaning depends on the circumstances and varies from daily to weekly but should be done in moderation.
- No ointments or antibiotic solutions are recommended for routine pin-site care.
- Dressings are not usually necessary once wound drainage has ceased.
- Pin/wire-insertion sites need not be protected for showering or bathing with clean water.
- The patient or the carer should learn and apply the cleaning routine.
Pin/wire loosening or pin tract infection
In case of pin/wire loosening or pin tract infection, the following steps need to be taken:
- Remove all involved pins/wires and place new pins/wires in a healthy location.
- Debride the pin sites in the operating theater, using curettage and irrigation.
- Take specimens for a microbiological study to guide appropriate antibiotic treatment if necessary.
Before changing to a definitive internal fixation an infected pin tract needs to heal. Otherwise infection will result.
Immediately postoperatively, all joints (hip, knee, ankle) are actively mobilized.
Partial weight-bearing with crutches should begin as soon as possible.
Depending on the consolidation, weight bearing can be increased after 6-8 weeks with full weight bearing when the fracture has healed.
Clinical and radiological follow-up is recommended after 2, 6 and 12 weeks.
Remove the fixator after clinical and radiographical bony healing.