In this section
Coping with a child in an external fixator can seem like a
daunting task. The aim of this page is to provide parents and
carers with information and ideas about ways to cope at home.
Please share this information with grandparents, babysitters and
schoolteachers, or anyone who assists you in caring for your
There are a number of ways that your family and child can
prepare for treatment. Attendance at a preadmission clinic will
assist you to plan for surgery.
As it is common for children to lose their appetite whilst
undergoing treatment, overall fitness and good eating habits prior
to surgery will assist in a more rapid recovery. During treatment
it is important that your child receives a healthy diet to assist
with tissue repair, growth and bone healing. If eating or weight
loss become a problem, a dieticians help may be required.
You will meet with the physiotherapist who will give you some
simple stretching and muscle strengthening exercises to do before
surgery. Following surgery, physiotherapy execrices will be
presecribed for your child.
The Limb Reconstruction service adopts a NON-SMOKING policy.
Active and passive smoking is known to have a delaying effect on
bone formation, which will prolong healing time (and therefore
It is important that we know about every medication your child
is taking. This includes 'over the counter' drugs, such as Nurofen
and aspirin, as well as any vitamins or 'natural remedies'. Some of
these drugs affect bone healing and may lead to serious
Open discussion about the treatment amongst family is
encouraged, as it helps the child come to terms with the treatment
plan. If you think that your child is not coping with the idea of
the fixator, please let us know so that we can address these issues
prior to the fixator going on.
If your child is going to be wheelchair bound post operatively,
the home environment may need to be modified. The Occupational
Therapist and Limb reconstruction nurse will discuss with you
ways in which you can manage the stairs, toilet and bathroom, and
bedroom. Equipment required can be hired from the hospital.
Let your child's school know of the planned surgery. If your
child is to be wheel chair bound post operatively, the school may
need to install ramps for easy access. The Limb Reconstruction and
Lengthening team will liase with the school to advocate for your
child if you wish. Children returning to school need to be able to
toilet themselves unassisted.
Clothes may need to be modified to fit over the fixator. The
external fixator can be bulky and can catch on clothing. (it can
also damage bedding, soft furnishings and car seats.) Clothing
needs to be bigger than usual. At preadmission you will be shown
examples of clothing to get some ideas.
Admission to hospital is the day of surgery. The length of stay
is usually 3-5 days. We recommend no visitors other than immediate
family for the first 2 days to allow your child time to recuperate
During your hospital stay, you will be encouraged to participate in
your child's care. This is to ensure that you gain confidence and
ease with handling the external fixator. Ward nursing staff and the
Limb Reconstruction nurse are available to answer any queries you
may have, and discuss ways in which you can manage at home.
The time spent in the operating suite is generally between 3-4 hrs.
One parent is allowed to accompany the child to the induction room,
where the anaesthetic is started, and both parents will be invited
to the recovery room as your child wakes up. Once the operation has
finished, a member of the surgical team will come and speak to the
Nursing staff will continually monitor your child through out
the hospital stay. They will be assessing vital signs, (heart rate,
breathing rate, temperature and blood pressure) and the operated
Treatment with an external fixator will involve some pain and
discomfort. For the first days following surgery, pain relief will
be given intravenously by either a patient or nurse controlled
system (these methods will be explained to you fully by the nursing
staff at preadmission and anaethestist). This is then followed
by tablets or medicine, which the child will continue to take at
Pain medication is required regularly during early part of the
treatment time, however once this is past, many children only
require occasional medication.
The pin sites are dressed throughout treatment. Dressings will
be changed daily for the first three days and then approximately
every 7 days. Some children find the cleaning of the pin sites
uncomfortable to begin with, but this usually settles. We have
strong support networks for children who find this difficult, from
the Play Therapist on the ward, to Comfort Kids in the Outpatient
phase should this be needed.
All parents (and older children) are given the opportunity
to learn to perform the dressings. Children are reviewed as an
outpatient regularly and any porblematic pin sites dressings will
be done with these visits. Routine pin site care is not done at
All children are referred to our RCH@Home service, who will teach parents
and caregivers how to do dressings. This service is provided for up
to 4 weekes.
Be sure that your child does not poke things around the
pin sites, or play with them. This can become a focus for
infection. The only time that pin sites are to be touched is during
the dressing procedure.
This is a vital part of successful limb reconstruction. The
amount of physiotherapy required will be determined on an
individual basis. Your child will be seen on the ward the day after
surgery, and gentle stretches will be started. The Physiotherapist
will need the help and support of the parents from the beginning.
This may involve encouragement in the initial phase, and then
supervision of exercises as they are carried out at home.
A lot of children with a fixator are able to walk, and are
encouraged to do so. Putting weight through the treated leg can
help with bone healing. Walking also helps with independence
of the child.
You will be seen in orthopaedic out patients the week after your
discharge. After this, you will be seen weekly to fortnightly
whilst you are correcting your frame, and monthly after this time.
Xrays will be done at these appointments.
Certain equipment may need to be hired from the
hospital. This may include:
You will also need to purchase dressing products, so that the
pin site dressings can be done at home. The approximate costs of
these are $50.00
Most children will spend some time in a wheelchair but
eventually, we like all children to be up walking. It is important
that walking is encouraged once allowed, as this helps the child
gain independence, which in turn helps with acceptance of
treatment. Once your child can safely use the crutches/frame then
the wheelchair should be used only for long distances, or
In the early stages, the use of interactive toys and frequent
scenery changes can help to alleviate boredom. Put some thought
into activities that your child can participate in to help pass the
time. When visiting new places, it is often useful to do some
'research' into the place you intend to visit. Check that there are
facilities for the disabled - wheelchair access is vital if your
child is using one.
Most children are able to travel in the car with some minor
adjustments. Many children travel in the front seat of the car with
the affected leg elevated on pillows or a small beanbag. A
seat belt or other approved safety restraint must be used at all
times. To travel without your child being safely restrained is
Correct positioning will be taught by the physiotherapist. This
is to prevent the complication of contracture. A contracture is an
abnormal shortening of the soft tissues and muscles around the
joint. It results in stiffness and deformity. Common sites of
contracture are hip, knee, foot and toes.
Careful positioning, splinting and following your physiotherapy
regime can prevent contractures developing. To prevent a foot
deformity, always use the splint or sandal provided, particularly
when resting in bed. To prevent knee contractures, it is vital that
the child does not have a pillow placed under the knee. The use of
pillows or a rolled up towel under the ankle will ensure that the
knee remains straight.
Older children with fixators can be very heavy, particularly if
both legs are treated. If you have any concerns about lifting your
child or about the amount of support you have at home please
discuss them with the Physiotherapist and/Occupational Therapist
who will be seeing your child on the ward.
Ask the Limb Reconstruction nurse for an application form for a
temporary Disability Sticker for your car. It can be very difficult
getting your child in and out of a car in a confined car space.
Your surgeon will sign the medical section of the form, then you
must complete the rest and take the form to your local council to
have the sticker issued.
If you have to travel more than 100kms or 500 kms for 5 weeks or
more to the nearest medical or dental specialist from home you may
be eligible for travel assistance through the Victorian Patient
Transport Assistance scheme. Forms are available from the Limb
Reconstruction Nurse, the Care Manager on the ward or from the
Social Work department on the 5th Floor of the South East Building.
Forms are also available at Department of Human services Regional
offices. Your GP and surgeon will need to complete some sections of
the form before you can claim
There are a number of sites that have information about external
fixation devices. Please note that these sites will have some
information and practices that vary from ours. This is not to say
that some are right and others are wrong, rather, all are