Discharge Instructions for the Patient with an External Fixator

Unless otherwise instructed, you may bear weight as tolerated with an assistive device (crutches/walker). Avoid contact sports and running while in the fixator. 

Eat a diet high in calcium and low in phosphorous. Examples of foods high in calcium are milk, yogurt, and dark green vegetables. A multi-vitamin that contains calcium is encouraged. Avoid foods that are high in phosphorous, such as cola, dark sodas, beets, and beef products.

If you’re undergoing a limb lengthening or correction, turn struts manually or turn nuts with a wrench as directed. You must turn the fixator nuts at the same time of day, every day, for proper bone regeneration. Your provider will give you a specific schedule and instructions for turning.

Pins and wires are necessary for limb lengthening, deformity correction, and external fixation. The purpose of pin/wire site care is to prevent trauma and bacterial growth in the area where the pin (or wire) touches your skin. Keeping the skin clean helps prevent infection. Pin/wire site care is done weekly and increased to daily if there are signs of inflammation or infection. If you shower, bathe, or swim, pin care must be done afterward.  (Do not shower, bathe, or swim until your sutures are removed and you have been seen for your postoperative visit). 

Pin/ wire site care will be done in the hospital on the first or second postoperative day. You will review site care at this time and will be given supplies for home, which will include: 

Supplies for Pin/Wire Site Care

• Sterile cotton-tipped applicators
• Sterile normal saline
• Hydrogen peroxide (use half-strength by mixing half hydrogen peroxide and half normal saline during pin/wire site infections)
• Sterile specimen containers
• Sterile 2” x 2” split gauze squares (SOF-SICK* l.V. Sponges 2” x 2” - y ply)
• Foam squares with nylon backing (for Ilizarov fixator-pin/wire sites)
• Custom-cut felt strips (for Orthofix fixator pin sites)

Instructions for Cleaning Pin/Wire Sites

1. Wash hands thoroughly with Dial (or other antibacterial soap) for at least one minute, using a nailbrush, before pin/ wire site care.
2. Push up the red/white plastic clips on the pin/wire (red clips on pins and white clips on wires for Ilizarov fixators; Orthofix fixators do not have clips). 
3. Remove foam sponges (felt pads with Orthofix) and gauze dressings. You may soak the hard-to-remove ones with normal saline or run clear water over the site until they loosen. Slowly “teasing” the sponge off causes less pain and bleeding. 
4. Inspect all sites for redness, tenderness, and drainage. If the sites are clear, normal saline can be used for cleaning. If signs of infection are present, use the "Pin/Wire Site Infection and Treatment" section for care instructions. 
5. Put several cotton-tipped applicators in normal saline and allow to soak for several seconds.
6. Take one applicator and use a rolling motion to apply gentle pressure with the cotton tip at the junction of the skin and pin/wire site. Do not use excessive force, but remove the scab.
7. Once the site is cleaned, you may clean the site of the pin or wire if needed. Do not use the same applicator on the skin that you use to clean the pin and/or wire. 
8. Use a new application at each site. 
9. Cover the site with a split 2” x 2” gauze, followed by foam sponge and plastic clip (for Ilizarov fixators) and felt pad over gauze (for Orthofix fixators). You may reuse the sponges by cleaning them with soap and water, then boiling them for one minute and allowing them to air dry. 
10. Compress the clip, sponge, and gauze gently (excessive pressure may cause skin indentation, especially if swelling is present).

Check under the pin/ wire site dressings daily for signs of infection like:

• Redness
• Drainage
• Swelling and/or fever 

If you suspect an infection, use the "Pin/Wire Site Infection and Treatment" section of this education for care instructions.

Pin/wire site infections are common with the use of external fixators. Nearly all patients will experience several pin/wire site infections throughout treatment. The severity of the infection will determine treatment. The following guidelines outline the grade, appearance, and appropriate action for each infection. Communication with the clinic is extremely important if you have questions regarding the signs of infection. 

Contact Telehealth Nursing at 651-229-3890 if you see any of the following:

• Fever over 101.5 F
• Throat irritation
• Severe pain