The Leeds Teaching Hospitals NHS Trust

Children's External Fixation Device

General Information

Children who are having an external fixation device are usually off school for the initial stay in hospital whilst the frame is being applied, plus the first week or two afterwards. After this the expectation is that all children should attend school with the frame on.

There is no danger to the child or others if the frame is knocked, however to minimise the risk and to assist the patient on their return to school, the school should be made aware of the frame to allow for small modification to take place if they are required I.E allowing the pupil to elevate the leg whilst seated, uniform modifications and making allowance for the pupil to attend regular outpatient appointments and physiotherapy.

If the fixation of the device is being done as an elective (planned) procedure such as for lengthening, we wil ltry to time the treatment to avoid important events such as major exams and change of school.

Clothing and Footwear

The width of the rings on the fixation device can be up to double that of the leg itself. Therefore shorts, baggy trousers or tracksuit bottoms are often used or modified to allow for this. Whilst the frame does not have to be covered up we understand that some patients can be self-conscious when out in public.

We aim to get patients back to normal footwear as soon as possible, but in most cases for the first few weeks we apply a black post-operative shoes with a theraband.

Normal footwear can be worn once our physiotherapists are happy that patients have good ankle control. Most patients will experience a degree of foot swelling (with or without wires) so a patients should allow for this. Specialist footwear may need to be created or modified to fit around the metalwork in cases were wires or rings are applied around the heel and foot.

Swelling, Pain Control and Problems with Wires

All patients suffer from swelling during the first few weeks, this is not painful. We encourage full weight-bearing and walking whenever possible which can lead to increased swelling, so we advise resting the leg on a stool or pillow after exercise.

If the swelling is associated with localised pain, redness or discharge around a pin site area then this may represent an infection to the area. If the the swelling causes the skin to touch the inside of the ring then the patient should elevate the leg and inform our team as this can cause pressure on the skin.

Deep Vein Thrombosis is possible to develop but is extremely rare, particularly in children. We advise patients to contact or attend the frame clinic before attending A&E, unless there are features suggestive of Pulmonary Embolus such as shortness of breath or chest pain.

Following discharge for the first few weeks patients will need to take simple painkillers I.E paracetamol and codeine to help with discomfort. Patients should avoid anti-inflamatory medicines such as ibuprofen and diclofenac as these can slow down bone healing. If the pain is getting worse or a new pain develops patients should inform the team.

Wires are tensioned and connected to the rings at the time of a patients operation. Although rare, post-operative these wires can disconnect from the ring or snap. If the does happen patients should not treat it as an emergency. We advise patients to stop putting weight through that leg and let the team know within a day or two. If this happens we will reconnect or remove the wire in clinic. In some cases another minor procedure under general anaesthetic to replace the wire.
Bathing and Showers

It is important that patients try to keep the leg as dry as possible. The leg can be covered with a seal in the bath and special products can be obtained for this purpose. If pin site care is weekly then patients often have showers on the day the dressing is due to be changed. We advise not to go into the sea, lakes or rivers as this will increase the chance of infection.

Frame Removal

We are never able to predict exactly when the frame will be ready to be removed. The frame will be removed when the consultant is happy that it has been on for a reasonable amount of time for the case and is happy with the appearance of the leg from detailed examination of x-rays or scans.

Patients may undergo a period of a few weeks when the frame is deliberately loosened or 'dynamised', this is done to test the leg so that no damage occurs one the frame is completely removed.

Nearly all children , and some adults undergo a short procedure to remove the frame. This is done under general anaesthetic and after patients are free to walk on the leg without cast but it is advisable to stay off sports and strenuous activity until after a patients six week review.