External fixator

General considerations on the external fixator can be found here.

In the tibia, the type 1 fixator should be placed medially. Type 1 a, 1b, 2 and 3 frames can be used in the tibia.

A) Comminuted, unreduced fracture
B) Comminuted fracture aligned biologically
C) Fracture aligned and biologically stabilized

This procedure is performed with the patient in dorsal recumbency.

The fixator pins must be placed in the center of the bone. Two hypodermic needles or palpation can be used to locate the bone during closed application of the fixator.

A stab incision is performed at the desired location of pin placement. It is preferred to incise between muscles mass.

The pin diameter should be 20-25% of the bone diameter. Positive profile pins should be used.

Pre-drilling the hole is strongly recommended prior to pin insertion. The diameter of the drill bit should be 1mm smaller than the pin diameter.

The illustration shows the appropriate pin placement centered in the bone.

The illustration shows the appropriate pin placement centered in the bone protruding 2mm through the trans cortices.

In the illustration, the green, yellow and red zone show the low, mild, and high morbidity respectively.

Note: In the proximal tibia the cross section remains a triangular shape. Therefore, placing the pins caudally is preferable for better bone purchase.

The first pins inserted are the ones furthest from the fracture.

The frame is used to align the fracture. Alternatively a distractor device can be used for this purpose.

The remaining pins are inserted.

Note: One pin in each segment needs to be placed near the fracture line.

Note: The clamps and connecting bars should be approximately 1cm away from the skin. The soft tissues will swell and be in contact with the fixator if placed any closer.

The aim is to reduce the edema, inflammation and pain. Integrative medical therapies, anti-inflammatory and analgesics medications are indicated.

In order to avoid the contact between the skin and the connecting bars, sterile sponges should be placed in between.

The pin-skin interface should be cleaned and adequately protected.

In most cases, 10-20 minutes of ice therapy is recommended every 8 hours.

The aim is to resolve the hematoma, the edema and control the pain, as well as to prevent muscle contracture. Anti-inflammatory and analgesic medications may still be needed. Rehabilitation and integrative medical therapies can be used.

If the dog is not starting to use the limb within few days after surgery, a careful evaluation is recommended.

10-14 days after surgery the sutures are removed.

Radiographic assessment is performed every 4-8 weeks until bone healing is confirmed.

Patients with external fixators should be checked every 7-10 days. The pin track infection and fixator stability should be assessed.

When there is evidence of good callus formation, staged disassembly of the construct can be considered.

Complete removal of ESF is indicated once the fracture is healed.