External
fixation may look very high-tech, and maybe even scary.
However, external fixation has been used in one way or another since
almost 2400 years ago. External fixation techniques were
described by Hippocrates, and were used in treating tibia fractures.
External fixation is a minimally invasive technique to reduce
displaced fractures and has become a very important part of deformity correction and nonunion and pseudo arthrosis repair as well.
Jean
François Malgaigne was one of the many pioneers that made
advancements with external fixation devices. In 1846, Malgaigne
used a device that consisted of a clamp and four metal prongs to
reduce and stabilize a fracture of the patella, or kneecap.
Following this external fixation device many other similar inventions
were used to treat fractures in various locations. In 1938,
Raoul Hoffman made advancements that made external fixation even more
useful, and allowed surgeons to place pins into a fracture for
stabilization with guidance, while being minimally invasive. In
1951, Dr. Gavriil A. Ilizarov developed the external fixation device
that is still in use today. Ilizarov’s fixation device
consists of a metal frame that encircles the limb, and is attached to
underlying bone by pins. Threaded rods and hinges allow
movement of the bone to the correct alignment. Ilizarov’s
external fixator is great because adjustments can be made without
opening the fracture site, and the device provides stability. Also it can be converted to internal fixation once the soft tissues have become less swollen.
Modern
day external fixation not only provides stability to a fracture, but
can also be used for soft tissue deformities, as well as other bony
deformities. External fixation is preferred when slow
correction is required, and even more useful in high risk patients with vascular disease and even open fractures with high risk of infection. The chance of getting a blood clot is
lessened because with external fixation patients can be partial
weight bearing, or weight bearing as tolerated following the
procedure due to the stability that the fixation provides.
External fixators have been used for other bony deformities, such
as Charcot, ankle arthritis, and clubfoot.
External fixation can also be used to lengthen amputated foot and toe
stumps. External fixation has definitely helped many people,
but there are still some cons. Pain and infections are two
issues associated with external fixation, and rates vary depending on
the extent of the procedure, and the location of the device.
External fixation devices are used by specially trained physicians and all three of the doctors at FFLC are capable of utilizing these various techniques for patients that require such interventions.
Brian Timm, DPM, FACFAS
Board Certified by the American Board of Foot and Ankle Surgery in Foot and Reconstructive Rearfoot and Ankle surgery
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