Problem fractures

What is this procedure?

Xray after a circular frame has been applied to a complex tibial fracture.

Lower limb fractures often require surgery in order to restore the alignment of the bones, promote healing and allow mobilisation. Sometimes ‘internal fixation’ (using a plate and/or screws or nail down the middle of the bone) is a good option but in some cases it is not ideal. For example if there is a severe injury to the skin and muscles around the fracture site there is a risk that a plate and screws would get infected. In this case ‘external fixation’ also known as a ‘frame’ might be recommended.

Who should consider this operation?

This procedure may be recommended as a first line treatment if the fracture you have sustained is more amenable to fixation with a frame than by other methods. This can include fractures with multiple fragments of bone as well as those with a severe soft tissue injury. Frame fixation can also be used where other methods have failed, for example in a fracture that has previously been plated but has not healed or has an infection.

What happens in the post-operative period?

After surgery you will be taught how to care for your leg whilst it is in the frame, including how to keep the pin-sites (where the wires or pins enter through the skin) clean. Full weight bearing is encouraged wherever possible to stimulate bone healing. It is very common to have some inflammation around the pin sites and sometimes a course of antibiotics is required if the skin becomes infected. When the time comes for the frame to be removed, this is usually done as a day-case procedure under general anaesthetic.