Annual Report

Executive Editor: Peter Trafton

Authors: Raymond White, Matthew Camuso

Tibial shaft Wedge fracture, intact wedge - Ring fixator (Ilizarov)

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Glossary

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
  • Mobilization
  • 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.

Pin-site care

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)

Pin-site care
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.

Mobilization

Immediately postoperatively, all joints (hip, knee, ankle) are actively mobilized.

Weight bearing

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.

Follow up

Clinical and radiological follow-up is recommended after 2, 6 and 12 weeks.

Implant removal

Remove the fixator after clinical and radiographical bony healing.

v2.0 2012-05-13