Repairing Bone Fractures With External Fixation

External fixation is a surgical method of immobilizing bones to allow a fracture to heal properly. It is used to provide stability to bone and soft tissue after a serious break but can also be applied as a procedure to correct bone misalignment, restore limb length, or protect soft tissue after a serious burn or injury.

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A man recovering after ankle surgery

Jonathan Cluett, M.D.

External Fixation to Repair Broken Bone

External fixation is accomplished by placing pins or screws into the bone on both sides of the fracture. The pins are secured together outside of the skin using a series of clamps and rods known as the external frame.

External fixation is performed by an orthopedic surgeon and is usually done under a general anesthetic. The procedure itself typically follows the following steps:

  1. Holes are drilled into the undamaged areas of bones around the fracture.
  2. Special bolts are screwed into the holes.
  3. Outside of the body, rods with ball-and-socket joints are joined with the bolts.
  4. Adjustments can be made to the ball-and-socket joint to ensure the bone is aligned properly with as little, if any, shortening of a bone.

The areas of skin that have been pierced by the procedure need to be cleaned regularly to prevent infection. In some cases, a cast may need to be applied.

The removal of the bolts and external frame can usually be done in a doctor’s office with no anesthesia. Fractures have been known to occur at the drill sites and, as such, extended protection may be needed after removal of the device.

Advantages and Considerations of External Fixation

The main advantage of external fixation is that it is quickly and easily applied. The risk of infection at the site of the fracture is minimal, although there is a chance of infection where the rods have been inserted through the skin

External fixators are often used in severe traumatic injuries as they allow for rapid stabilization while allowing access to soft tissues that may also need treating. This is particularly important when there is significant damage to skin, muscle, nerves, or blood vessels.

The external fixation also ensures the ideal compression, extension, or neutralization of bone placement while allowing for movement of the nearby joints. This not only aids in setting the bones correctly, but it can also help minimize muscle atrophy and edema (the buildup of excess fluid) caused by the total immobilization of a limb.

External fixation is contraindicated under the following circumstances:

  • Bone-related disorders or deterioration that make stabilization less assured.
  • Persons who are not able or willing to properly care for the pins and wires.
  • A person with severely compromised immune systems who are at higher risk of infection.

Other Uses of External Fixation

Beyond the immediate repair of severe or compound fractures, external fixation can be used to treat or repair other conditions. These include surgeries to correct bone malformations that result in the ​shortening of a limb.

External fixation can also be used to retain the integrity of bone structures (such as the hand) after a serious burn or injury. Without fixation, the exposed or damaged tissue can contract from the accumulation of scar, causing long-term or even permanent restriction of movement.

4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Bible JE, Mir HR. External Fixation: Principles and Applications. J Am Acad Orthop Surg. 2015;23(11):683-690. doi:10.5435/JAAOS-D-14-00281

  2. Hadeed A, Werntz RL, Varacallo M. External Fixation Principles and Overview. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2019.

  3. Salcedo Cánovas C. Bone elongation using monolateral external fixation: a practical guide. Strategies Trauma Limb Reconstr. 2015;10(3):175-188. doi:10.1007/s11751-015-0236-0

  4. Carmichael K, Torres D, Jimenez CJ, Comley MC, Evans EB. Spanning External Fixation for the Treatment of Open Joint Injuries in Pediatric Burn Patients. Cureus. 2018;10(4):e2484. doi:10.7759/cureus.2484

Additional Reading

By Jonathan Cluett, MD
Jonathan Cluett, MD, is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams.