External fixator device care for an infant, child and young person

Introduction

An external fixator is an orthopaedic device wherein an external frame is affixed to the skeleton through pins to facilitate healing, in the case of fracture management, or limb lengthening to manage growth abnormalities. Framed ex-fixes are usually made up of rings made from stainless steel or carbon-fiber. Pins attached to the frame then pass through the skin, soft tissue and into the bone. Simple ex-fix devices typically consist on the external linear frame or strut, with pins attaching to the bone. Rods may be used to adjust the frames or length once they’re in place.

External fixators used at Starship Child Health:

• Ilizarov frames

• Taylor Spatial frames (picture left)

• Simple Ex-fix- Usually named for the limb it is applied to (pictured right)

External fixators in practice

The rationale for external fixators may be to manage complex fracture or fractures which have failed to unionize satisfactorily. Non-union or mal-union may occur due to infection or other complications, using traditional fixation such as internal metal-ware and therefore require further reconstruction. In this context the application of an external fixator is to maintain the corrected position. Alternatively, an ex-fix such as a Taylor Spatial frame may be applied to facilitate bone growth to correct bone length abnormalities.

Nursing considerations

External fixators in practice contribute to significant disruption of both lifestyle and comfort. Activities of daily living such as bathing and toileting with an external fixator may create new areas of dependency for previously independent patients. This can be particularly challenging for adolescent patients. Nursing care should include early referral to allied health as well as initiating conversations around strategies for managing daily tasks, and recognising the impact these disruptions may have on the patients mental health and body image.

Ongoing difficulty in coping with the external fixator can be associated with poor care compliance and therefore higher rates of complication. Concerns around a patient’s coping with the frame should be promptly escalated to their nurse specialist or registrar.

Initiating early education on pin site assessment and care empowers patients and their whānau to have confidence to care for their child on discharge.

Neurovascular monitoring as per guideline.