External Fixators (ESF)

A guide on how to manage patients following external skeletal fixator (ESF) placement.

External Fixator Post-Operative Care

INITIAL INFORMATION:

External fixators are placed for fracture fixation or to temporarily immobilise joints after ligament injuries. Patients require close attention whilst the frame is in place. Please follow the information below to prevent any problems and ensure a successful outcome.

• Print off a Rata information sheet on External Fixators and discuss the aftercare with the client.

• Antibiotics, anti-inflammatories and analgesics should be prescribed as per the surgeon’s instructions.

• Book once weekly appointments to ensure adequate frame checks.

• Provisionally book an appointment for post-operative radiographs. The surgeon will note when these are required with the view to staged removal of the frame (generally 6-8 weeks post-op to confirm that bone healing is progressing).

• The connective bars and clamps are re-usable components of the external fixator. We require that these are kept for us to collect (unless it is one of our surgeons removing the frame).

• Strict cage rest is vital. For dogs, a lead should be used to restrict activity anywhere outside of the house including the garden. Allow just 5 minutes of lead restricted exercise, three times a day, until you are advised to the contrary. For cats, ideally no exercise. If a cat becomes overly distressed in the cage then they can be allowed a maximum of 5 minutes out at a time – under 100% supervision. For both species, running/jumping/climbing (into cars, upstairs, onto furniture, onto kitchen work tops etc.) should be prevented.

• Take photos (of the frame as a whole and insertion points) once a week for the first 3 weeks and send them to info@ratavetsurgery.co.uk so that they can be forwarded to the relevant surgeon for review. This allows assessment of the frame and for us to identify any potential problems early. Please also ensure that you include clinical details on the patients progress and note any areas of concern.

• Monitor dressings. Swelling is often quite significant in the first few days after external fixator placement.

• Once dressings are removed, wounds and pin tracts can be cleaned by gentle blotting with a swab and sterile saline. A small amount of discharge (clear to blood tinged) is normal. Increased/excessive discharge around any single pin compared with others is a worry although please be aware that pins in specific areas are naturally prone to a little more discharge due to increased muscle mass. For example, femoral pins having a little more discharge proximally due to the size of the muscle on the lateral aspect and proximal lateral tibial pins from the cranial tibial muscle. All discharge should dry up by 4 days post-op.

• If in doubt please take a culture and sensitivity swab BEFORE starting antibiotics i.e. in a consult, take a quick swab before cleaning and administering antibiotics if this is what you want to do.

• Pins sometimes loosen prematurely. There may be a need to replace pins if loosening occurs early in the healing process.

• We will often disassemble the external fixator in a series of stages in the weeks following placement.

TIPS:

• Avoid patient interference – an Elizabethan collar may be necessary.

• The patient should be using their leg within 3-4 days post-op.

• Skin-clamp contact can cause tissue damage to the underlying soft tissues. If the tissues swell and the skin comes into contact with any of the clamps so that a length of each pin is not visible, please contact Rata for advice.

• Any increase in lameness is a worry. If you notice any of the following then please contact Rata immediately:

• Deviation or change in alignment of the leg

• Swelling of the leg (especially distal to ex fix)

• Change in outward appearance of the fixator

• Remember that the fixator can hook up on the cage itself. Placing cardboard (up to the patient’s shoulder height) on the inside of the cage can prevent this by keeping the fixator away from the cage bars.

• It is important to increase the frequency of checks of the pin tracts by the client in warm weather, as there is an increased chance of infection.