What is External Fixation for Foot and Ankle Trauma?
External fixation for foot and ankle trauma is a surgical method that uses external fixators to immobilize broken bones of the foot and ankle to enable them to heal properly. Foot and ankle trauma refers to injuries that most commonly occur during sports, exercise, or other physical activity. They can include sprains, strains, fractures, and dislocations. Trauma to the foot and ankle can damage muscles, ligaments, tendons, and bones, resulting in significant pain, disability, and wearing of joint cartilage (arthritis).
An external fixator is a stabilizing frame to hold the broken bones in the correct position while they heal. With an external fixator, screws or metal pins are positioned into the bone through small incisions made in the skin and muscle. The screws and pins are attached to a frame or bar outside the skin.
External fixation helps to provide stability to soft tissue and bone after a serious fracture, but can also be used to protect soft tissue following a serious injury or burn, to restore limb length, or to correct bone misalignment. It is commonly employed to hold bones together temporarily when skin and muscle have been injured.
Anatomy of the Foot and Ankle
The foot and ankle are complex joints providing movement, stability, and balance to the body. They are flexible structures made of soft tissues, muscles, bones, and joints. The foot is usually differentiated into 3 parts: the forefoot, comprising 5 toes, the midfoot, with 5 bones that form the arch of the foot, and the hindfoot, forming the heel and ankle. The ankle is a large joint made up of 3 bones: the tibia, fibula, and talus. Ligaments and tendons run along the surface of the foot, promoting easy and flexible movement.
Indications for External Fixation for Foot and Ankle Trauma
Your physician may recommend external fixation for foot and ankle trauma when you have sustained fractures or dislocations as a result of a motor vehicle accident, sports mishap, fall from a height, athletic injury, or other sources of physical trauma. Common indications include:
- Severe pain and tenderness
- Swelling and bruising
- Inability to bear weight
- Bone deformity
- Reduced range of motion
Preparation for External Fixation for Foot and Ankle Trauma
Preparation for external fixation for foot and ankle trauma may involve the following steps:
- A review of your medical history and physical examination is performed to check for any medical issues that need to be addressed prior to the procedure.
- Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging studies to help detect any abnormalities that could compromise the safety of the procedure.
- You will be asked if you have allergies to medications, anesthesia, or latex.
- You should inform your doctor of any medications or supplements you are taking, or any conditions you have such as heart or lung disease.
- You may be asked to stop taking certain medications, such as blood-thinners, anti-inflammatories, or other supplements for a week or two.
- You should refrain from alcohol and tobacco for at least a few days prior to surgery and several weeks after, as these can hinder the healing process.
- You should not consume any solids or liquids at least 8 hours prior to the procedure.
- You should arrange for someone to drive you home after the procedure.
- A signed informed consent form will be obtained from you after the pros and cons of the surgery have been explained.
Procedure for External Fixation for Foot and Ankle Trauma
External fixation for foot and ankle trauma is performed by an orthopedic surgeon, usually under general anesthesia and typically involves the following steps:
- The fractured bones are repositioned or realigned into a normal position by pulling, pushing, or turning the foot or ankle.
- Using a fluoroscope (live x-ray), holes are drilled into the undamaged portions of the bone around the fracture.
- Metal pins or screws are then placed into these bone holes on both sides of the fracture.
- The pins are secured together outside of the skin, utilizing a series of rods and clamps known as the external frame that holds the bones in the correct position as they heal.
- Adjustments can be made to this frame to ensure the bone is aligned properly with little, if any, shortening of a bone.
- Bandages are wrapped around the sections where the pins are placed and secured.
Postoperative Care and Recovery
In general, postoperative care instructions and recovery after external fixation for foot and ankle trauma involve the following steps:
- You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover.
- You may notice pain and swelling in the treated area. Medications are provided as needed to address these.
- Antibiotics are also prescribed to address the risk of surgery-related infection.
- You are advised to keep your leg elevated as much as possible while resting to prevent swelling and pain.
- Do not weight-bear on the operated leg. Assistive devices such as crutches or walkers are recommended throughout the healing period to support the foot.
- You should start rehabilitation (physical therapy) as recommended by your surgeon to strengthen the foot muscles and improve the range of motion.
- Instructions on surgical site care and bathing will be provided to keep the wound clean and dry.
- Refrain from strenuous activities for at least 6 months. A gradual increase in activities is recommended, with your doctor’s guidance.
- A periodic follow-up appointment will be scheduled to monitor your progress.
Risks and Complications
External fixation for foot and ankle trauma is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:
- Postoperative pain
- Damage to nerves and vessels
- Blood clots or deep-vein thrombosis (DVT)
- Anesthetic/allergic reactions
- Non-union of bones
- Failure of fixation devices