When Your Child Has a Fracture: Treatment with External Fixation

When your child’s bone is broken (fractured), the broken ends of the bone must be held together so the bone can heal. External fixation is a method of holding a fractured bone securely in place. It is not often needed for broken bones in children. But it might be needed for more severe breaks that are hard to treat with other methods. External fixation is put into place during surgery. An orthopedic surgeon (a surgeon who specializes in bone and joint problems) will perform the procedure. The surgeon can discuss the procedure with you and answer your questions.Outline of leg showing screws going through skin into femur. Screws are connected to external fixator on outside of leg. External fixator is holding fracture together.

What is external fixation?

During external fixation surgery, metal pins or screws are put into bone on either side of the fracture. The pins extend out through the skin. A metal rod or bar (fixator) is then attached to the pins outside the body. Fixation keeps the bone in the best position for healing. When the bone has healed enough to hold together, the fixation is removed.

How is external fixation placed?

The surgery to place the fixation is done in the hospital. Here is an overview of what to expect:

  • Your child will be given anesthesia. This is medicine that keeps your child free of pain and lets him or her sleep through the procedure.

  • The fractured bone ends are moved back into alignment. This is called reduction.

  • Small incisions are made in the skin on either side of the break. Metal pins or screws are placed into the bone on either side of the break through these incisions.

  • A bar (fixator) is attached to the pins on the ends that sit outside the body.

  • Your child may remain in the hospital for a few days after the surgery. Before your child leaves the hospital, you will be shown how to care for your child at home.

  • If the fractured bone is in the leg, your child may be told not to put their full weight on it. This means crutches or a walker may be used to aid walking.

When is the fixation removed?

Healing of the fracture generally takes a few months. When the surgeon determines that the fracture has healed, the fixation is removed. This is often done in the doctor’s office.

What are the risks and possible complications of external fixation?

  • Infection where pins come through the skin (common)

  • Failure of the bone to heal

  • Refracture of the bone after the fixation is removed

How do I care for the external fixation?

  • Follow any instructions you are given for caring for your child.

  • Don't let your child or your child’s siblings or friends touch or play with the bar or pins.

  • Clean around the pins carefully. Watch for signs of infection (pain, swelling, redness, pus or white fluid, warmth around the pins, fever, or chills).

When to call the healthcare provider

Call the healthcare provider or surgeon if your child has any of these symptoms while the fixation is in place or after it is removed:

  • Fever (see "Fever and children" below)

  • Chills

  • Unusually drowsy or very fussy 

  • A seizure

  • Warmth, redness, swelling, or oozing of the skin around pins

  • Increased pain

  • Tingling or numbness or swelling of the leg

  • Problems with the fixator

  • After the fixation is removed, inability to put weight on the injured leg

  • Any drainage comes through skin or out of the end of the hardware

  • Blisters

  • Decreased ability to move extremity past the hardware

  • A bad odor comes from the hardware or skin incision

Fever and children

Always use a digital thermometer to check your child’s temperature. Never use a mercury thermometer.

For infants and toddlers, be sure to use a rectal thermometer correctly. A rectal thermometer may accidentally poke a hole in (perforate) the rectum. It may also pass on germs from the stool. Always follow the product maker’s directions for proper use. If you don’t feel comfortable taking a rectal temperature, use another method. When you talk to your child’s healthcare provider, tell him or her which method you used to take your child’s temperature.

Here are guidelines for fever temperature. Ear temperatures aren’t accurate before 6 months of age. Don’t take an oral temperature until your child is at least 4 years old.

Infant under 3 months old:

  • Ask your child’s healthcare provider how you should take the temperature.

  • Rectal or forehead (temporal artery) temperature of 100.4°F (38°C) or higher, or as directed by the provider

  • Armpit temperature of 99°F (37.2°C) or higher, or as directed by the provider

Child age 3 to 36 months:

  • Rectal, forehead, or ear temperature of 102°F (38.9°C) or higher, or as directed by the provider

  • Armpit (axillary) temperature of 101°F (38.3°C) or higher, or as directed by the provider

Child of any age:

  • Repeated temperature of 104°F (40°C) or higher, or as directed by the provider

  • Fever that lasts more than 24 hours in a child under 2 years old. Or a fever that lasts for 3 days in a child 2 years or older.