External Skeletal Fixator (ESF) can be used to repair almost any fracture.
– Aseptic Technique
– Targetting proper location- tension side, minimize soft tissue injury
– Selection of appropriate frame type based on fracture assessment
– Auxillary fixation if indicated- IM pin +/- tie in, lag screw, ciclage wire
– Maintain reduction and stability during pin and frame placement
– Avoid soft tissue impingement- stab incision, between muscle bellies
– Proper pin insertion technique- pre-drill if possible, avoid insertion wabble, low speed drill to prevent thermal damage
– Engage pin in cis and trans cortex
– Smooth pins and negative profile pins inserted at 70 degree angle to long axis of bone
– Insert pins in same plane when using straight connecting bars
– Far near, near far configuration. Keep half bone diameter or 3 x implant diameter from fracture edge.
– 3-4 pins in each fragment
– Appropriate choice of pin and connecting bar diameter. Pins no more than 20-25% bone diameter
– Optimise distance from connecting bar to skin. Shortest working distance of pins.
– Bone graft if defects