An external fixator, or “frame”, is a device that is constructed around a limb, with wires and pins going through skin and holding the bone in a certain position. It is made of metal, and is built during your operation with lots of little components, that are connected together very firmly. he external fixator is applied at the time of your operation, and can only be removed in the operating theatre at the conclusion of treatment.
An external fixator allows us to change the position of the bones slowly, with time, by making easy and gradual adjustments to the frame on the outside. Each individual adjustment is very small, so that the bones move very slowly, and they are simple enough that the adjustments can be made by the patient and their family while at home, following a carefully written plan.
By ‘slowly moving bones’ using an external fixator, we can correct the shape of bones, correct the position of jones, or make bones longer.
There are many different types of external fixator, and the one chosen for treatment depends on a number of factors.
Follow this link to the Pin Site Care Guide for All Frame Types, which can be printed.
Does wearing an external fixator hurt ?
There will be pain following surgery like many operations. After this, there will likely be some aching as the muscles, nerves, and bones are stretched during the correction. Most children go home on some oral pain medication, which will gradually be decreased with time. We have found that most children do not need any pain medications after a few weeks.
How do I manage clothing, with an external fixator?
Clothes may need to be modified to fit over a cast or fixator. Additionally, be mindful that the pointed corners on an external fixator may catch on clothing, bedding or soft furnishings. Creative solutions may include pull away track suit pants with Velcro or press-studs down the outside seam, and underwear or boxer shorts can be modified with press-studs or velcro down the seam. It is also simple to make a "sleeve" to go over the external fixator, using a tube of material with elastic at each end.
Children with an external fixator on the thigh are able to wear their usual flat shoes, however those with lower leg fixators may need modification of their footwear. This can be addressed whilst you are in hospital. For lower leg external fixator short ankle socks are also needed.
Can I walk with the fixator?
The Limb Reconstruction Team will let you know whether you are allowed to walk with your external fixator. If you are, walking with the fixator on is encouraged as weight bearing assists with bone healing. The physiotherapist will work very closely with the child to teach mobilisation skills.
Can the get the external fixator wet ?
In the initial stages of treatment, we advise that the frame and dressings do not get wet. This means showering with a plastic bag covering the leg. After the frame has been on for a while, we will assess each case individually, and advise you on whether you are able to shower or go swimming.
Can I go back to school ?
Yes! The Limb Reconstruction Team advocates for our patients to get back to school as soon as appropriate. A gradual return is commenced after discussion with the family and the school.
How do I adjust the external fixator?
Prior to discharge from hospital, you will be instructed with regard to making adjustments to the frame. A “plan” will be provided for you, so that you can make the appropriate adjustments each day, and mark them off as they are complete. If you require wrenches (spanners) or any other tools to do so, these will be provided. Download the "Lengthening your frame brochure" (PDF 536 KB)
How many X-rays will be needed ?
X-rays are taken during the operation, and often are required after the operation to assist in planning the correction. After this, appointments will be made at one or two week interviews, and an x-ray is required each time. Positioning for these x-rays is very important, so they must be obtained at the RCH, or the clinic taking the x-rays requires very careful and specific instructions from the LR team.
Once the correction is complete, the interval between x-rays will be extended to between 4 and 6 weeks.
When should I contact the LR team ?
- If there is an increase in pain of the affected limb.
- If there is any redness, swelling or tenderness around any of the pin sites.
- If there is any discharge from the pin sites.
- If there is a fever that can't be explained by a cold, ear infection or other illness.
- If there are problems with the fixator, such as broken wires or pressure areas on the skin under the rings.
When can an external fixator be removed?
This depends on many different factors. These factors include the amount of correction that has been achieved, the rate at which the bone has healed or regenerated, and whether there are any complications. When a frame is being used to lengthen a bone, the general rule of thumb is that the fixator needs to stay on for one month for every cm gained. Taking a frame off too early could lead to loss of the achieved correction, bone shortening, or place you at risk of a fracture.
Caring for Pin Sites
The complete guide to pin site care can be found here.
A PDF version can be printed from here.
What about Pin Site Infections?
Pin site problems are a common problem with children with external fixator in situ. These may range from minor irritation, to a small infection, to a quite serious infection.ften, children may require a course of oral (taken by mouth) antibiotics to treat pin site infections. A prescription may be obtained from your General Practitioner.
It is recommended that the dressing of the affected pin site be increased to 2nd to 3rd daily, along with the medication. Should this not improve a course of Intravenous Antibiotics (into a drip) can sometimes be required. The child should be referred back to the LR team at RCH for this treatment. You and your GP can use the chart below, when communicating with the team.
| Grade | Description | Instructions |
| 0 | Pin/Wire sites are clear of any redness, drainage, pain. Normal Pin sites. | Clean pin/wire sites once a week with sterile water, and use prescribed ACTICOAT EXFIX dressings. |
| 1 | Slight redness or inflammation at sites. | Inspect sites and clean every day or two days, using sterile water, and continue use of prescribed ACTICOAT EXFIX dressings. |
| 2 | Area around site is red (erythema) and tender, with a colourless, watery or clear fluid exudate. | Talk to RCH LR Team. The team may recommend daily site cleaning, and simple, gauze based dressings that are absorbent and can be changed every day. |
| 3 | Area around the site is painful, red, and swollen with a purulent (thick, pus-like) exudate. | Talk to RCH LR Team. Start antibiotics using the provided prescription, and follow the plan for Grade 2. Pain medication may help temporarily. If there is no improvement after 2-3 days, The LR team will likely wish to review you in person |
| 4 | Deep redness/severe discomfort at site, with x-ray evidence of bone infection or pin/wire loosening, and/or fever. | Talk to RCH LR Team, requires in-person review. Start antibiotics, but likely IV antibiotics are required. Follow the plan as per Grade 3. The pin/wire will require removal . |
| 5 | All of the above and deep bone infection | Start antibiotics and follow the plan as per Grade 3. More extensive surgery may be required. |
* Adapted from: Dahl MT, Gulli B, Berg T (1994) Complications of limb lengthening. A learning curve. Clin Orthop Relat Res 301:10–18