External Fixation Management
With external fixation, a doctor inserts metal pins and wires through skin and muscle layers into the broken bones and affixes them to an adjustable external frame that maintains their proper alignment during healing. (See Types of external fixation devices.) This procedure is used most commonly to treat open, unstable fractures with extensive soft-tissue damage, comminuted closed fractures, and septic, nonunion fractures and to facilitate surgical immobilization of a joint. Specialized types of external fixators may be used to lengthen leg bones or immobilize the cervical spine.
An advantage of external fixation over other immobilization techniques is that it stabilizes the fracture while allowing full visualization and access to open wounds. It also facilitates early ambulation, which reduces the risk of complications from immobilization.
The Ilizarov fixator is a special type of external fixation device. This device is a combination of rings and tensioned transosseous wires used primarily in limb lengthening, bone transport, and limb salvage. Highly complex, it provides gradual distraction that results in good-quality bone formation with a minimum of complications.
Equipment
Sterile gloves ▪ sterile cotton-tipped applicators ▪ prescribed antiseptic cleaning solution ▪ ice bag ▪ sterile gauze pads ▪ pain medication.
Equipment varies with the type of fixator and the type and location of the fracture. Typically, sets of pins, stabilizing rods, and clips are available from manufacturers. Don’t reuse pins.
Preparation of Equipment
Make sure that the external fixation set includes all the equipment it’s supposed to include and that the equipment has been sterilized according to your facility’s procedure.
Implementation
Verify the doctor’s order.
Confirm that a written informed consent is obtained and that the consent is in the patient’s medical record.1
Confirm the patient’s identity using at least two patient identifiers according to your facility’s policy.2
Explain the procedure to the patient and answer all questions to reduce his anxiety. Emphasize that he’ll feel little pain after the fixation device is in place. Assure him that his feelings of anxiety are normal and that he’ll be able to adjust to the apparatus.
Tell the patient that he’ll be able to move about with the apparatus in place, which may help him resume normal activities more quickly.
Assess the patient for pain and provide medication, as ordered, using safe medication administration practices. Perform a follow-up pain assessment and notify the doctor if pain isn’t adequately controlled.6
After the fixation device is in place, perform neurovascular checks every 2 to 4 hours for 24 hours, then every 4 to 8 hours, according to your facility policy, to assess for possible neurologic damage. Assess color, warmth, motion, sensation, digital movement, edema, capillary refill, and pulses of the affected extremity. Compare with the unaffected side.
Apply an ice bag to the surgical site, as ordered, to reduce swelling, relieve pain, and lessen bleeding.
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