External fixation is a technique to stabilise fractures using pins or wires inserted through the skin into bone, connected by an external frame. It provides rapid stabilisation and is used as temporary or definitive treatment for complex fractures.
Under X-ray guidance, pins (half-pins or through-and-through wires) are inserted into the bone above and below the fracture through small skin incisions. These pins are connected outside the body by rods, bars, or a circular frame (Ilizarov or Taylor Spatial Frame). The fracture is reduced and the frame locks it in position. The operation takes 30–90 minutes depending on complexity.
External fixation is used for open fractures requiring wound access, fractures with severe soft tissue injury where internal fixation would be unsafe, temporary stabilisation (damage control orthopaedics) before definitive fixation, pelvic fractures requiring emergency stabilisation, fractures requiring gradual correction (deformity correction with circular frames), and infected fractures or non-unions.
Internal fixation (plates, screws, nails) is the main alternative for most fractures. Cast or brace for stable fractures.
Often performed as an emergency or urgent procedure. X-rays. CT may be performed after initial stabilisation.
Rapid fracture stabilisation with minimal additional soft tissue disruption. Allows wound access for open fractures. Can be converted to definitive internal fixation when conditions allow.
Very common (up to 30%). Managed with pin care, antibiotics, and occasionally pin replacement.
Discomfort at the pin-skin interface.
Particularly when pins are near joints.
The frame restricts clothing, sleep position, and some activities.
Pins may loosen in bone over time, requiring replacement or alternative fixation.
After frame removal.
From pin insertion near nerves or vessels.
Deep bone infection around pin sites.
Healing in a suboptimal position.
General, spinal, or sometimes local anaesthesia (for emergency application).
Immediate stabilisation allows early mobilisation. Pin site care (daily cleaning) is essential. Frame is worn for weeks to months depending on the indication. Physiotherapy for joint mobility. After frame removal, protection with a cast or brace may be needed. Weight-bearing depends on the fracture and frame configuration.
Regular pin site checks and X-rays every two to four weeks while the frame is on. Planning for frame removal or conversion to internal fixation.
It depends on the indication. Temporary frames for damage control are converted to internal fixation within one to three weeks. Definitive frames for open fractures or deformity correction may be worn for three to twelve months.
Daily cleaning with saline or soap and water as instructed by your surgical team. Keep the pin sites clean and dry. Report any signs of infection early.