Physician's Resources: Post-Operative Protocols for Circular External Fixation

Weight-Bearing Status:

  • Patients are normally allowed to WB 20-25% on the limb with the external fixation device. This is actually encouraged as this promotes callus formation and bone healing.
  • Patients are normally discharged with either crutches or a walker for assistance with ambulation. Walkers are preferred!
  • Patient needs to be seen by Physical Therapy prior or discharge for gait training and use of assistances devices. Patients should not be discharged prior to completing all Physical Therapy requirements.

Dressing:
  • Original dressing not to be changed for 12-14 days
  • Ex-Fix to be sprayed with alcohol, pins cleaned, and sterile 4x4’s placed around each wire
  • Role of Kerlix to be placed between frame and leg in areas of swelling or when the frame is nearing the skin
  • Foot pad can be made with blue towels or ABD pads and incorporated into dressing for WB assistance
  • Entire frame to be wrapped in ACE Bandage (Normally takes 3 roles of 6 inch ACE)

Warning Signs:
  • If patient is concerned about pin tract infection (redness, swelling, pain, discharge) give patient an Rx for oral antibiotics and should be seen in the office within 24 hours. Also, it is okay to go ahead and give a patient a Rx ahead of time and tell them begin taking the Rx if the above signs/symptoms occur and contact office within 24 hours to make appointment.
  • Superficial erythema and drainage around a wire is normally due to a loose or unstable wire (not due to infection) this can be resolved by tightening the wire with the “Russian Technique”.
  • Painful wires are normally a sign of loose unstable wire or because of high tension on the skin. This can be resolved by tightening the wire and by releasing the skin around the wire with a # 11 blade. This is performed quickly and normally does not require anesthesia
  • Granulomas are common around wires and after the ex-fix are removed. These can be resolved with a silver nitrate stick.
  • Superficial infections are normally cared for with Oral Antibiotics; however, deep or un-resolving infections should be admitted for IV antibiotics to prevent Osteomyelitis.

Antibiotics:
  • Augmentin 875 mg 1 tab PO BID x 14 days (broad spectrum, commonly used)
  • Cipro 500 mg 1 tab PO BID/Clindamycin 300 mg 1 tab PO QID Combo
  • Zyvox 600 mg 1 tab PO q12h

Post-Op Pain:
  • Out patients and patients at discharge should be placed on Tylenol # 3 1-2 tabs PO q4-6h
  • While in the hospital it is okay to use whatever is needed for post-op pain relief however upon d/c they should be switched to Tylenol # 3. Normally post-ops that get admitted will be placed on PCA per anesthesia with either Norco 10/325 or Vicodin ES. Titrated off PCA then titrated down to Tylenol #3 then discharged. Post-ops are normally discharged on post-op day # 2.
  • Never use Toradol, this inhibits bone healing. Ask the Anesthesiologist to please not use Toradol at the end of our cases if orthopedic work was performed.