Aftertreatment following temporary external fixation
The patient should be taught appropriate pin-track care.
Whether the external fixation is temporary or definitive must be decided early after its placement. If desired, conversion to a nail or plate should be done within a week or two, before pin sites become infected. Of course, the patient’s general condition and local soft tissues must have become suitable to allow conversion of the external fixator to either a nail or plate.
If soft-tissue problems persist and/or the external fixator has been left on for 3 weeks or longer, the following steps need to be taken:
- Remove the external fixator and curette and wash the pin sites.
- Temporarily stabilize the femoral fracture in a Thomas’s splint.
- Let pin-tracks heal and then proceed to either nailing or plating.
Thick soft tissues around external fixation pins should be stabilized with compressive dressings or sponges. Otherwise, once bleeding has ceased, dressings can be replaced with daily pin site cleansing and an antibacterial ointment.
In the rare event that the fixator becomes the definitive fixation the aftercare should follow the guidelines as for definitive external fixation, as follow:
Unless there are other injuries or complications, mobilization may be started on postoperative day 1. Special emphasis should be placed on active knee and hip flexion. Continuous passive motion may be used, but interrupted from time to time for active muscle strengthening exercises.
Partial weight bearing (touch down, or 10-15 kg) may be performed with crutches or a walker. In transverse fractures weight bearing may be performed more assertively.
Wound healing should be assessed regularly on a short term basis within the first two weeks. Subsequently 6 and 12 week follow-ups are usually undertaken and more as indicated until the fracture has united.
Pin site care should be carried out daily until the frame is removed following fracture healing.