In the field of orthopedics, external fixators play a crucial role in the treatment of complex fractures, bone deformities, and limb length discrepancies. These innovative orthopedic implants provide stability and support, allowing bones to heal properly. 

The external fixator is a vital tool in surgical fracture treatment. It serves as a means of “local damage control” for fractures accompanied by significant soft tissue damage and can also be used as a definitive treatment option for various fractures. This device offers a form of stability that promotes the formation of callus, facilitating the healing process. In this blog post, we will explore the different types of external fixators, their features, and the benefits they offer to patients and orthopedic surgeons.

Understanding of External Fixators

If you were to consult an orthopedic instrument supplier, they would explain that external fixators serve as an alternative to internal fixators, which are implanted within the patient’s body to provide stability for fractured bones. Typically, external fixators are chosen when internal fixation is not suitable. They are primarily employed in the treatment of open fractures. These fixators consist of pins and wires connected to bars and rings using clamps. They exert compression, distraction, or neutral forces on the affected bone, aiding in the healing process.

External Fixators in Orthopedics

External Fixation Implants

An external fixation implant is a specialized device designed to provide stability and alignment to fractured bones. It can be externally adjusted to promote proper healing. While a portion of the device remains external, it is partially implanted in the surrounding tissue and bone. These implants typically consist of external elements like bars or rods, connector elements such as clamps, and anchorage elements like pins, screws, or wires. They are commonly used to treat fractures in areas like the forearms, legs, hands, and feet resulting from traumatic injuries.

When it comes to magnetic resonance imaging (MRI), external fixation devices behave differently compared to implants that are entirely internal. These devices can exhibit unique characteristics in terms of radiofrequency (RF)-induced heating. For instance, the conductivity of the external components when in contact with air can cause a significant rise in temperature within the anchorage elements located within the bone and surrounding tissue. To ensure patient comfort and avoid potential harm, it is essential to assess the MRI safety of external fixation devices and appropriately label them for use.

Types of External Fixators

External fixators have many different designs. The two main types are circular/ring external fixators and monolateral external fixators. Both types of external fixators can be hinged to allow the elbow, hip, knee or ankle joint to move during treatment.

Unilateral External Fixator

This type of external fixator consists of one or more pins or wires that are inserted into the bone on one side of the fracture. The pins are connected to an external frame, which provides stability and holds the bone fragments in place during the healing process.

Circular External Fixator

Circular fixators are composed of multiple rings or half rings that encircle the limb. These rings are connected by wires or struts, forming a stable framework. This design allows for greater adjustability and control, enabling precise correction of bone deformities and lengthening procedures.

Hybrid External Fixator

Hybrid fixators combine the benefits of both unilateral and circular fixators. They consist of a combination of pins, wires, and rings, providing a versatile and adaptable solution for complex fractures or deformities.

Advantages of External Fixators

Stability and Alignment: External fixators offer excellent stability, ensuring proper alignment of fractured bones. By immobilizing the bone fragments, they promote correct healing and reduce the risk of malunion or nonunion.

Adjustability: External fixators allow for easy adjustment during the healing process. Surgeons can modify the position of the pins, wires, or rings to realign the bones as they heal. This adaptability is particularly useful in cases where gradual correction or lengthening is required.

Preservation of Soft Tissues: External fixators provide an external support system that minimizes the need for invasive internal fixation methods. This reduces damage to surrounding soft tissues, such as muscles and blood vessels, leading to faster recovery and reduced postoperative complications.

Early Mobilization: Compared to traditional casts or internal fixation methods, external fixators permit early mobilization of the affected limb. Patients can perform gentle range-of-motion exercises, reducing muscle atrophy and improving joint function while the bone heals.

Flexibility in Complex Cases: External fixators offer a high degree of flexibility in treating complex fractures, deformities, or infections. They can be customized to meet the specific needs of each patient, accommodating variations in bone structure, size, and condition.

Non-invasive Healing: External fixators allow the bone to heal naturally, without the need for additional surgeries to remove hardware. Once the bone has fully healed, the external fixator is simply removed, minimizing discomfort and recovery time.

Disadvantages of External Fixators

Here are some drawbacks to consider when using external fixators:

Risk to Anatomic Structures: The use of external fixators can potentially jeopardize surrounding anatomical structures. Improper pin or wire placement may lead to damage to nerves, blood vessels, or soft tissues near the site of insertion.

Infection Risk: There is a possibility of infection at the sites where the pins and wires enter the body. These entry points provide a pathway for bacteria, increasing the risk of localized infections that may require additional treatment.

Joint Contractures: Prolonged use of external fixators can sometimes result in joint contractures. The fixed position of the limb may restrict joint mobility, leading to stiffness and reduced range of motion once the fixator is removed.

Extended Healing Time: While fractures typically heal within six to 12 weeks, the use of external fixators can extend the healing period. Complex fractures or instances where bone healing is compromised may require a longer duration of fixator placement to achieve complete healing.

How Does External Fixation Cause Pin-site Infections?

Pin-site infections are the primary concern associated with external fixation treatment. These infections typically initiate at the skin level and, if detected early, can be easily managed. However, if left untreated, they have the potential to progress deeper into the soft tissues and even reach the bone.

It is crucial for patients and their families to be aware of the symptoms indicating a pin-site infection. The most common indicators include tenderness in an area surrounding a pin site that was not previously tender, as well as increased redness at the pin site. In some cases, the affected area may exhibit warmth, swelling, pain, or drainage that surpasses the other pin sites.

More severe infections may present with pin-site pain accompanied by one or more of the following symptoms: fever, fatigue, rashes, nausea, vomiting, and a glassy-eyed, pale, or flushed appearance.

How to Manage Daily Activities with an External Fixator in Place?

Managing daily activities with an external fixator:

  1. Mobility: Use a walking aid to support movement, as the frame can be heavy and tiring to carry.
  2. Weight handling: Avoid lifting heavy objects to prevent damage to the fixator and maintain bone alignment.
  3. Bathing: Take showers instead of submerging the frame in water. Pat dry the frame and pin sites carefully.
  4. Sleeping: Use a mattress protector and additional pillows for comfort and to protect the mattress.
  5. Clothing: Have loose-fitting clothes tailored, preferably with Velcro closures, to accommodate the frame easily.

By considering these tips, you can navigate daily activities more effectively while wearing an external fixator.


Zealmax Ortho offers meticulously crafted external fixator implants that prioritize patient safety, biocompatibility, and optimal healing. With robustness and resilience, our implants provide stability and support for managing fractures, deformities, and limb length discrepancies. Trust our commitment to excellence in orthopedic care, as we enable patients to regain their quality of life.

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