Spanning External Fixation

Indications

Principles of External Fixation, external fixator applied to the forearm
External fixator applied to the forearm. Image by The original uploader was Dekkanar at English Wikipedia., Wikimedia Commons, CC BY-SA 3.0.
  • Damage control for unstable high energy periarticular fractures of the knee, ankle and pilon
  • Soft tissue swelling or blistering that prevents early fixation
  • Polytrauma physiology
  • Damage control in the polytrauma patient

Position

  • Supine on a radiolucent table with a bump under the limb
  • Radiolucent table, image intensifier

Operative Steps

  1. Restore length and alignment with traction under fluoroscopy
  2. Place pins outside the zone of injury and away from future incisions
  3. Knee spanning frame uses two femoral pins anterolaterally and two tibial pins anteromedially
  4. Ankle spanning frame uses two tibial pins and a transcalcaneal pin, with or without a first metatarsal pin
  5. Connect clamps and bars, bar close to the skin for stiffness
  6. Check reduction and pin positions on fluoroscopy
  7. Avoid placing pins in the zone of future definitive fixation
  8. Two pins in each main segment, placed through safe corridors
  9. Check length, alignment and rotation before tightening

Postoperative Care

  • Elevate and wait for soft tissues, usually 7 to 14 days
  • CT with the frame on to plan definitive fixation
  • Daily pin site care
  • Elevation and swelling control

Complications

  • Pin site infection
  • Loss of reduction
  • Neurovascular injury during pin insertion
  • Pin site infection

Related Pages

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.