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External Fixators

External Fixation in Foot and Ankle Surgery: A Patient’s Guide

An external fixator is a medical device used to stabilize bones and soft tissues from the outside of the body. While it may look intimidating, it is a powerful tool that allows surgeons to treat complex injuries and deformities that cannot be managed with internal plates and screws.

A Brief History

The concept of external fixation dates back to the mid-1800s, but the modern "Gold Standard" was developed in the 1950s by Dr. Gavriil Ilizarov. He discovered that by slowly pulling bone segments apart, the body would naturally grow new bone and soft tissue in the gap. This revolutionized the treatment of limb shortening, non-healing fractures, and severe deformities.

Who Needs an External Fixator?

External fixation is typically reserved for complex cases where the "skin is at risk" or the bone is severely damaged. Common candidates include:

  • Trauma Patients: Those with "open fractures" where the bone has broken through the skin and the risk of infection is high.
  • Charcot Foot Patients: To stabilize a collapsed foot and ankle in patients with diabetes.
  • Limb Lengthening/Realignment: Patients with one leg shorter than the other or severe bow-legged/knock-kneed deformities.
  • Non-Union/Infection: When a bone has failed to heal or has become infected, requiring the removal of internal hardware.

The Surgical Treatment Process

  1. Application: Under anesthesia, the surgeon places thin stainless steel wires or "half-pins" through the skin and into the bone. These pins are then attached to the external frame.
  2. Stability: The frame takes the stress off the bone, acting as an "external skeleton."
  3. Adjustments (Optional): If the goal is deformity correction or bone growth growth (like with the TrueLok Elevate), the patient or doctor will turn small dials on the frame daily to slowly shift the bone.
  4. Removal: Once the bone is fully healed and stable (usually 3–6 months), the frame is removed in a minor outpatient procedure.

Patient Outcomes & Success Rates

Clinical data consistently shows that external fixation is highly effective for high-risk patients.

  • Limb Salvage Success: Studies show success rates as high as 90–94% in preventing amputation for severe diabetic foot complications.
  • Infection Control: Because the metal stays mostly outside the body, the risk of deep bone infection is significantly lower than with internal plates.
  • Weight-Bearing: Many circular frames allow for "immediate weight-bearing," meaning you can walk on the frame shortly after surgery, which helps prevent bone loss.

Patient Life with a Frame

  • Pin Site Care: You will be taught how to clean the areas where the pins enter the skin to prevent minor infections.
  • Clothing: Most patients wear "tear-away" pants or loose-fitting clothing that can fit over the frame.
  • Mobility: While bulky, most patients are able to move around with crutches, a walker, or even walk directly on the frame depending on the surgeon's instructions.

Schedule an appointment with Dr Sandhu today to discuss your options!

2120 N. MacArthur Blvd
Irving, TX 75061
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