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Keywords
Orthopaedic nursing
Orthopaedic devices
Wounds
These key words are based on the subject headings from the British Nursing Index. This article has been subject to double-blind review
NS36 Santy J (2000) Nursing the patient with an external fixator. Nursing Standard. 14, 31, 47-52. Date of acceptance: January 21 2000.
Aims and intended learning outcomes
External fixators have been in use since the 1920s and perhaps even earlier, and their evolution as a form of treatment is seen as one of the major orthopaedic developments of the 20th century. The study of biomechanics and the development of metals has allowed this innovation to advance considerably over the last few decades (Ward 1998). After reading this article you should be able to:
Explain the principles of external fixation and the reasons why such a management option might be chosen.
Reflect on the physical, psychological and social impact on the individual of wearing an external fixator.
Debate the issues surrounding the choice of wound care for skeletal pins.
Identify the major nursing interventions that might be required.
External fixation in fracture management
Bone is a dynamic living tissue. Axial loading (bearing weight) through bone is thought to stimulate electrical activity, increase osteogenesis - the activity of osteoclasts (the cells that make bone cells) and increase bone density and the rate of bone healing (Maiocchi 1998). It is also important to note, however, that other movement at the fracture or surgery site, particularly rotation, leads to poor bone heating.
When a patient has had a fracture or surgery to a bone, external fixation is often used to keep the bone in position, allowing some degree of load bearing and maintaining stability at the fracture or surgery site (Maiocchi 1998). This form of fracture management has received increasing interest over the last 30 years since the development of a wide variety of fixator frames, larger and stronger pins, better metals, and increased knowledge of the techniques and indications (Sisk...