External Fixation
What is External Fixation?
External fixation is a surgical technique used to stabilize fractured bones, correct deformities, or lengthen limbs by attaching an external metal frame to the bone with pins or wires. It’s often employed when internal fixation (e.g., plates, screws) isn’t suitable, such as in open fractures, infections, or complex deformities. In India, external fixation is performed in orthopedic departments at hospitals like Apollo, Fortis, Medanta, and AIIMS, often at affordable costs. Understanding the procedure, costs, recovery, risks, and frequently asked questions (FAQs) is essential for patients.
Why do you need External Fixation?
External fixation is indicated for:
- Complex fractures:
- Open fractures: Bone exposed, high infection risk (e.g., tibia, femur).
- Comminuted fractures: Bone shattered into multiple fragments.
- Infections:
- Osteomyelitis: Bone infection requiring stabilization during treatment.
- Deformity correction:
- Bone malunion/nonunion: Fractures healed incorrectly or not healed.
- Limb length discrepancy: Gradual lengthening using distraction osteogenesis (e.g., Ilizarov frame).
- Trauma:
- Temporary stabilization in polytrauma patients (e.g., pelvis, long bones).
- Pediatric cases:
- Growth plate injuries or congenital deformities (e.g., clubfoot correction).
The procedure aims to stabilize the bone, promote healing, or correct alignment by using an external frame (e.g., Ilizarov, uniplanar, or hybrid fixators), allowing controlled movement or lengthening while minimizing infection risk.
Why Do External Fixation Costs Vary in India?
Costs range from ₹50,000 to ₹2 lakh :
- Procedure Complexity: Simple fracture stabilization (₹50,000–₹1 lakh); deformity correction or lengthening (₹1–2 lakh).
- Hospital/Location: Higher in metro cities (Apollo, Fortis: ₹1–2 lakh); lower in government hospitals (AIIMS: ₹20,000–₹50,000, often subsidized under Ayushman Bharat).
- Surgeon’s Expertise: Experienced orthopedic surgeons charge more.
- Additional Costs: Fixator device (₹10,000–₹50,000), anesthesia (₹5,000–₹15,000), hospital stay (₹5,000–₹15,000/day), antibiotics/physiotherapy (₹5,000–₹20,000).
- Insurance: Covered for medical necessity (e.g., fractures, infections); confirm with your provider.
External Fixation Procedure
- Before Surgery Evaluation:
- Diagnosis:
- X-ray/ct: Assesses fracture type, alignment, and bone fragments.
- Blood tests: Blood sugar, infection markers (e.g., CRP, ESR for osteomyelitis).
- Soft tissue evaluation: Checks for open wounds or infection.
- Medications: Stop blood thinners (e.g., aspirin) 5–7 days prior if safe; antibiotics (e.g., cefazolin) given pre-op for open fractures.
- Consent: Risks, including infection, are explained.
- Diagnosis:
- Surgical Techniques:
- External Fixation:
- Performed under general or regional anesthesia (e.g., spinal), lasting 1–3 hours depending on complexity.
- Pins or wires (e.g., Schanz pins, K-wires) are inserted through the bone above and below the fracture/deformity site.
- The pins/wires are attached to an external frame (e.g., Ilizarov circular frame, uniplanar fixator, or Taylor Spatial Frame).
- Frame components (rods, rings, hinges) are adjusted to stabilize the bone or allow controlled lengthening/correction.
- For lengthening: Distraction osteogenesis begins 5–7 days post-surgery (1 mm/day adjustment).
- Open wounds (if present) are cleaned and dressed; temporary fixators may later be converted to internal fixation.
- Intraoperative Tools:
- Fluoroscopy: Real-time X-ray to guide pin placement.
- External fixator system: Stabilizes bone (e.g., Ilizarov frame).
- Drill: Inserts pins/wires into bone.
- External Fixation:
- After Surgery:
- Hospital stay: 2–5 days (longer for complex cases or infections).
- Care: Pin sites cleaned daily with saline or antiseptic (e.g., chlorhexidine); antibiotics continued if infection present.
- Pain management: Moderate pain for 3–7 days; managed with analgesics (e.g., paracetamol, tramadol).
- Instructions: Partial weight-bearing with crutches (varies by site); avoid getting frame wet; adjust frame as instructed (e.g., for lengthening).
Recovery After External Fixation
- Hospital Stay: 2–5 days.
- Post-Surgery Care:
- Pain/Swelling: Peaks at 3–7 days; ice and elevation help; resolves in 2–3 weeks.
- Pin site care: Clean daily to prevent infection; crusting or redness may need antibiotics.
- Mobility: Partial weight-bearing with crutches (e.g., tibia: 6–12 weeks); full weight-bearing after bone healing (3–6 months).
- Frame adjustments: For lengthening/deformity correction, daily adjustments (1 mm/day); total duration 3–12 months.
- Physiotherapy: Starts at 2–4 weeks; focuses on joint mobility, muscle strength; continues 3–6 months.
- Frame removal: After bone healing (3–12 months); minor procedure under anesthesia (additional cost: ₹10,000–₹30,000).
- Follow-Up:
- Visits every 2–4 weeks to monitor healing, adjust frame, and check for infection.
- X-ray: Monthly to assess bone healing (callus formation).
Most resume normal activities in 3–6 months (after frame removal); full recovery (including sports) takes 6–12 months. Success rate: 85–90% achieve bone healing; deformity correction varies (70–95%).
Risks and Complications
- Surgical Risks:
- Infection (10–20%): Pin site infections common; treated with antibiotics; deep infection (osteomyelitis) may need frame removal.
- Bleeding (1–3%): Hematoma around pins; may need drainage.
- Nerve/vessel injury (<1%): Pin placement may damage nearby structures; rare with fluoroscopy.
- Post-Surgery:
- Pin loosening (5–10%): May need pin replacement or frame adjustment.
- Delayed healing (5–15%): Nonunion or slow union; may need bone grafting.
- Joint stiffness (10–20%): Limited motion (e.g., ankle, knee); managed with physiotherapy.
- Refracture (2–5%): After frame removal; requires prolonged protection.
- Long-Term:
- Chronic pain (5–10%): At pin sites or fracture; usually resolves in 6–12 months.
- Limb length discrepancy (2–5%): If lengthening over/undershot; may need additional correction.
Report fever, severe pain, swelling, or pus at pin sites promptly.
Frequently Asked Questions (FAQs)
When is external fixation needed?
For complex/open fractures, infections, nonunions, or deformity correction when internal fixation isn’t suitable.
Can I avoid external fixation?
Sometimes; internal fixation (plates/screws) or casting may suffice for simpler fractures; external fixation is for high-risk or complex cases.
Is external fixation painful?
Moderate pain for 3–7 days post-surgery, managed with medication; pin site discomfort may persist.
How soon can I resume activities?
Partial weight-bearing in 6–12 weeks; normal activities in 3–6 months; full recovery in 6–12 months.
Is external fixation covered by insurance in India?
Yes, for medical necessity; confirm with your provider.
Signs of complications?
Fever, severe pain, swelling, or pus at pin sites.
How long will the frame stay on?
3–12 months, depending on healing or correction goals; removed after bone consolidation.
Lifestyle changes post-surgery?
Keep pin sites clean, avoid getting frame wet, follow weight-bearing instructions, attend physiotherapy, and monitor for infection.
Conclusion
External fixation is an effective technique for managing complex fractures, infections, or deformities, with a high success rate for bone healing and correction. India’s top hospitals (Apollo, Fortis, AIIMS) provide affordable care, typically covered by insurance. Understanding the procedure, costs, recovery, risks, and FAQs helps patients approach treatment confidently. Consult an orthopedic surgeon for personalized guidance.
Looking for Best Hospitals for External Fixation
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we are not promoting any hospitals we sourced all the details from google and hospitals website, please verify and start with your surgery here we go the list includes government, budget and superspeciality hospitals accreditation bodies are the National Accreditation Board for Hospitals and Healthcare Providers (NABH) and the Joint Commission International (JCI)
- click on your city and schedule your surgery now done in good hands.
| City | Minimum Price (₹) | Maximum Price (₹) |
|---|---|---|
Agra |
50,000 |
2,00,000 |
Ahmedabad |
80,000 |
3,00,000 |
Ajmer |
50,000 |
2,00,000 |
Aligarh |
50,000 |
2,00,000 |
Allahabad |
50,000 |
2,00,000 |
Amritsar |
70,000 |
2,50,000 |
Aurangabad |
70,000 |
2,50,000 |
Bangalore |
80,000 |
3,00,000 |
Bareilly |
50,000 |
2,00,000 |
Belgaum |
70,000 |
2,50,000 |
Bhopal |
70,000 |
2,50,000 |
Bhubaneswar |
70,000 |
2,50,000 |
Bikaner |
50,000 |
2,00,000 |
Chandigarh |
80,000 |
3,00,000 |
Chennai |
80,000 |
3,00,000 |
Coimbatore |
80,000 |
3,00,000 |
Dehradun |
70,000 |
2,50,000 |
Delhi |
80,000 |
3,00,000 |
Dhanbad |
50,000 |
2,00,000 |
Durgapur |
50,000 |
2,00,000 |
Faridabad |
80,000 |
3,00,000 |
Ghaziabad |
80,000 |
3,00,000 |
Gorakhpur |
50,000 |
2,00,000 |
Guntur |
70,000 |
2,50,000 |
Gurgaon |
80,000 |
3,00,000 |
Guwahati |
70,000 |
2,50,000 |
Gwalior |
50,000 |
2,00,000 |
Hyderabad |
80,000 |
3,00,000 |
Indore |
80,000 |
3,00,000 |
Jabalpur |
50,000 |
2,00,000 |
Jaipur |
80,000 |
3,00,000 |
Jalandhar |
70,000 |
2,50,000 |
Jamshedpur |
70,000 |
2,50,000 |
Jodhpur |
50,000 |
2,00,000 |
Kanpur |
50,000 |
2,00,000 |
Kochi |
80,000 |
3,00,000 |
Kolkata |
80,000 |
3,00,000 |
Kollam |
70,000 |
2,50,000 |
Lucknow |
70,000 |
2,50,000 |
Ludhiana |
80,000 |
3,00,000 |
Madurai |
70,000 |
2,50,000 |
Mangalore |
70,000 |
2,50,000 |
Meerut |
50,000 |
2,00,000 |
Moradabad |
50,000 |
2,00,000 |
Mumbai |
80,000 |
3,00,000 |
Mysore |
80,000 |
3,00,000 |
Nagpur |
70,000 |
2,50,000 |
Nashik |
70,000 |
2,50,000 |
Navi Mumbai |
80,000 |
3,00,000 |
Noida |
80,000 |
3,00,000 |
Patna |
50,000 |
2,00,000 |
Pune |
80,000 |
3,00,000 |
Raipur |
70,000 |
2,50,000 |
Rajkot |
70,000 |
2,50,000 |
Ranchi |
50,000 |
2,00,000 |
Surat |
80,000 |
3,00,000 |
Thane |
80,000 |
3,00,000 |
Vadodara |
70,000 |
2,50,000 |
Varanasi |
50,000 |
2,00,000 |
Visakhapatnam |
70,000 |
2,50,000 |
Disclaimer
This information is sourced from open platforms and is for general awareness only. Costs may vary based on individual cases. Please consult a qualified doctor for medical advice and explore options within your budget before deciding on the procedure.