The modular external fixator is optimal for temporary use. It is rapidly applied without need for intraoperative x-rays and can be adjusted later.
The biggest risk of temporary spanning external fixation of the proximal forearm is iatrogenic neurovascular nerve injury.
Knowing the safe zones and blunt dissection to bone is critical.
The patient is placed in a supine position:
For safe pin placement make use of the safe zones and be familiar with the anatomy of the humerus and the forearm.
Blunt dissection of the soft tissues and the use of small Langenbeck retractors will prevent damage to muscular, vascular and neurological structures.
Prepare a channel for insertion of the pin, using a blunt clamp down to the bone. If there is any doubt an incision should be made big enough to prove that the drill sleeve (mandatory for the humerus) will have direct contact with the bone.
Details of external fixation are described in the basic technique for application of modular external fixator.
The arm is supported in a “collar-and-cuff” sling for comfort.
To prevent postoperative complications, pin-insertion technique is more important than any pin-care protocol:
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:
In case of pin loosening or pin tract infection, the following steps need to be taken:
In the rare event that external fixation has been used as the definitive management of a proximal forearm fracture, there is a significant risk of marked stiffness of the elbow joint. A prolonged program of rehabilitation under the supervision of the surgeon and an experienced physical therapist will be necessary.
See patient 7-10 days after surgery for a wound check. X-rays are taken to check the reduction.