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What is external fixation?

An external fixator is a metal bar or circular (round) metal rings that fit around the leg. Pins and wires attach the bar or rings to the bone. The pins and wires move through the skin and bone to connect to the external bar or metal ring. A variety of different external fixation devices are available to lengthen or straighten deformed bones, or both. Be sure to ask your doctor about potential risks and complications of limb lengthening surgery.

How does it work?

Small adjustments are made to the external fixator three or four times a day. The bone slowly lengthens at an average rate of 1mm/day. The body heals and makes new bone. The skin, muscles, nerves, and blood vessels also lengthen with the bone. The process takes many months.

The surgical technique was developed by Dr. Gavril A. Ilizarov in Russia in the early 1950s and employs the following principles:

  • Latency Phase: Period of rest 3-5 days immediately after surgery
  • Distraction Phase: Period of gradual lengthening (1mm/day on average)
  • Consolidation Phase: Period of bone healing (typically twice the lengthening period) 

How long will my child have to stay in the hospital?

Your child will rest the evening after surgery. It is important to elevate (raise) the leg on a pillow. The day after surgery the physical therapist will teach your child how to walk with crutches or a walker. Most patients leave the hospital in one to three days.

Will it hurt?

After the surgery, your child will be given medicine to help with pain. In general, the gradual process of the bones moving does not hurt. The frame can be initially uncomfortable, especially when the skin stretches, but most children quickly adjust to the device. Prescription pain medicine will be provided when you leave the hospital to take home.

How many doctor's visits will my child have after the surgery?

The doctor will teach you how to begin lengthening the bone 5-7 days after surgery. You will return to the doctor one time per week or one time every two weeks during the lengthening phase. Clinic visits may occur monthly during the bone healing process. 

How do I take care of the pin sites?

It is important to clean the pin sites 1-2 times per day as directed by your doctor. Pin sites can become infected and require antibiotic treatment. Notify the doctor right away if you develop signs of infection, including:

  • Painful pin site
  • Redness
  • Drainage

Will my child need physical therapy?

Physical therapy is an important part of recovery to minimize (decrease) complications associated with joint stiffness. After discharge from the hospital, focus on walking each day. Your child may require sessions with your therapist 1-2 times per week, especially during the lengthening period when the bone and muscles stretch. The therapist will teach your child how to perform daily exercises to increase strength and improve joint range of motion. The external fixator is stable to support the bone for full weight bearing and many recreational activities.