What is the recommended postoperative care for a patient with an external fixator?

External Fixator Care in Post-Operative Period

The recommended postoperative care for external fixators includes implementing general strategies to reduce cross-infection, with regular pin site cleaning using saline solution without additives, and avoiding occlusive dressings that can lead to skin maceration. 1

Pin Site Care Protocol

Immediate Post-Operative Care

• Apply sterile Y dressings (non-fiber shedding) under external disc plates, followed by skin-friendly breathable dressings 1
• Avoid excessive tension when placing dressings under exterior bumpers to prevent tissue compression 1
• Avoid occlusive dressings as they promote moisture and can lead to skin maceration 1
• For initial cleaning, use 0.9% sodium chloride, sterile water, or freshly boiled and cooled water 1

Ongoing Pin Site Care

• Simple dry dressing changes are as effective as more complex pin site care protocols 2
• No significant difference in infection rates has been found between using hydrogen peroxide solutions, chlorhexidine-impregnated dressings, or simple dry sterile dressings 2
• Cleanse pin sites twice weekly with clean cloth using fresh tap water and soap once the wound has healed (approximately after one week) 1
• Gently and thoroughly dry the skin after cleansing 1

Fixator Preparation During Additional Surgeries

• When additional surgeries are needed with the external fixator in place, prepare the fixator with 70% alcohol on sterile gauze followed by either ChloraPrep (for closed wounds) or povidone iodine (for open wounds) 3
• Consider performing additional surgical prep after loosening any external fixator component during surgery, as this exposes new surfaces that may harbor bacteria 4
• No significant difference in effectiveness has been found between chlorhexidine and povidone-iodine solutions, or between spray versus scrub application methods 4

Mobilization and Activity

• Implement early active finger motion exercises immediately following external fixator placement to prevent stiffness, which is one of the most functionally disabling adverse effects 5
• Active motion does not adversely affect adequately stabilized fractures in terms of reduction or healing 5
• For patients with external fixators near joints, consider the benefits of early mobilization to prevent stiffness 5

Monitoring for Complications

• Monitor for pin-track infections, which remain one of the most common complications of external fixation 2
• Watch for signs of infection including erythema, cellulitis, drainage, and pin loosening 2
• Approximately 19% of patients may experience pin site complications, with most being minor and manageable with observation or oral antibiotics 2
• Older patients have a significantly higher risk of postoperative pin-track complications 2
• Monitor for buried bumper syndrome in gastrostomy tubes, which presents with difficulty mobilizing the tube, leakage around insertion site, frequent feeding pump alarms, abdominal pain, chronic site infections, or resistance with administering enteral nutrition 1

Pin Site Wound Management After Fixator Removal

• Both primary wound closure and secondary wound healing are acceptable approaches after removal of external fixators 6
• No significant difference in infection rates has been observed between primary closure and secondary healing of pin sites 6
• Consider patient preferences and cosmetic outcomes when deciding between primary closure and secondary healing 6

Patient Education and Discharge Planning

• Provide clear verbal communication and written or visual materials for caregivers and patients regarding fixator care 1
• Identify which department or service can be contacted for emergency advice 1
• Educate patients about showering, bathing, and swimming (with waterproof dressing coverage recommended for public pools) once the exit site has healed well 1

Special Considerations

• Consider additional fixation or securement to minimize traction on the fixator site for some patients 1
• For definitive fixation of fractures at initial débridement, primary closure of wounds may be considered in selected patients 1
• Temporizing external fixation remains a viable option for treatment of open fractures in major extremity trauma 1