External Fixation For Leg Fractures In Children


  • External (eks-TER-nal) fixation (fik-SA-shun) of a leg fracture is surgery to repair your child's broken leg. A leg fracture is a break in the bones of his leg, such as the femur, tibia, fibula, and patella. The femur, or the thigh bone, is the longest bone in your child's body. The tibia, or shin bone, and the fibula, located behind the tibia, make up the lower leg. The leg bones help support your child's weight, and may break in different locations depending on the cause. Bad injuries caused by a fall, car accident, sports injury, or physical abuse may cause leg fractures. Your child may feel severe pain, have bruising and swelling, or have his bones sticking out through deep cuts on his skin.

  • External fixation is usually done if leg bones are broken at several places, or if bones are showing through deep cuts. It may be done if the tissues directly above the fracture has been badly damaged. It may also be done if the fractures are found at the ends of the leg bones. During this surgery, broken bones are aligned together by carefully pushing, pulling, and turning the broken leg. He will do this without making a cut on your child's skin. He may need to use drills, pins, rods, and screws to align the broken bones and hold them together. While being held steady, the chips of broken bone will grow together and get stronger. With an external fixation, your child's leg fracture may be treated and he may resume his usual activities.


You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child.


  • There are always risks with surgery, such as bleeding and infection. Other parts of the leg, such as nerves, blood vessels, ligaments, muscles, and bones may be damaged. Your child's leg, foot, or toes may become stiff, swollen, painful, numb, or weak. Even after surgery, your child's broken leg may not heal quite right. His leg movements may not be the same as they were before. His legs may not grow evenly, causing one to be shorter than the other. Some nearby joints may get stiff and muscles may get weak. Your child may have trouble going back to his usual activities, including sports.

  • If left untreated, the pain and problems he may have with his leg may get worse. His broken leg may even grow out of shape and get crooked. His legs may also not grow together with each other, causing one leg to be shorter than the other. Call your caregiver if you are worried or have questions about your child's surgery, medicine, or care.


Before your child's surgery:

  • Informed consent is a legal document that explains the tests, treatments, or procedures that your child may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your child's medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done to your child. Make sure all of your questions are answered.

  • General anesthesia will keep your child asleep and free from pain during surgery. Anesthesia may be given through your child's IV. He may instead breathe it in through a mask or a tube placed down his throat. The tube may cause your child to have a sore throat when he wakes up.

  • Emotional support: Stay with your child for comfort and support as often as possible while he is in the hospital. Ask another family member or someone close to the family to stay with your child when you cannot be there. Bring items from home that will comfort your child, such as a favorite blanket or toy.

  • An IV is a small tube placed in your child's vein that is used to give him medicine or liquids.

  • Preoperative care: Medicine may be given to help your child relax. Your child will be taken to the room where the procedure or surgery will be done.

  • Monitoring:

    • Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your child's skin record the electrical activity of his heart.

    • Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your child's blood. A cord with a clip or sticky strip is placed on your child's foot, toe, hand, finger, or earlobe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your child's oxygen level is low or cannot be read.

    • Vital signs: Caregivers will check your child's blood pressure, heart rate, breathing rate, and temperature. They will also ask you or your child about his pain. These vital signs give caregivers information about your child's current health.

    • Intake and output: Caregivers may need to know how much liquid your child is getting and urinating. Your child may need to urinate into a container in bed or in the toilet. A caregiver will measure the amount of urine. If your child wears diapers, a caregiver may need to weigh them. Do not throw away diapers or flush urine down the toilet before asking a caregiver.

During your child's surgery:

  • Your child is asked to lie on his back on the operating table. His leg and hips are cleaned and covered with clean sheets to keep the surgery area clean.

  • Your child's caregiver aligns the broken bones by carefully pushing, pulling, and turning the broken leg. He will do this without making a cut on your child's skin. Holes are made on the broken bones by using a drill to insert screws and long thin pins. The pins will stick out through your child's skin and other rods and devices will be attached to them. These devices will hold the properly aligned bones in place while they heal. An x-ray may be done to see if the bones were set in the right way. Bandages are wrapped around the areas where pins were inserted.

After surgery:

Your child is taken to a room where he can stay until he wakes up and is comfortable. Your child may be allowed to go home. If not, your child will be taken to a bed on one of the units in the hospital. Your child may be sleepy and have some pain after surgery. Your child should not get out of bed until caregivers say it is OK. Leave any bandages on your child until a caregiver takes them off.

  • Eating: Your child may be able to eat when caregivers hear bowel sounds (stomach growling). A caregiver will listen for bowel sounds by putting a stethoscope on your child's belly. Ice chips are usually given first. Then liquids like water, broth, apple juice, or clear soda are given. If your child does not have problems after drinking liquids, a caregiver may let your child eat soft foods. Some examples of soft foods are ice cream, applesauce, or pudding. If your child can eat soft food without problems, he may begin eating a regular diet.

  • Medicines: Your child may need any of the following:

    • Antibiotics: This medicine is given to help prevent or treat an infection caused by bacteria.

    • Anti-nausea medicine: This medicine may be given to calm your child's stomach and control vomiting (throwing up). Your child may have an upset stomach after surgery or taking pain medication.

    • Pain medicine: Your child may need medicine to take away or decrease pain. Know how often your child should get the medicine and how much. Watch for signs of pain in your child. Tell caregivers if his pain continues or gets worse. To prevent falls, stay with your child to help him get out of bed.

  • Oxygen: Your child may need oxygen if his blood oxygen level is lower than it should be. Oxygen will help your child breathe easier. Your child may get oxygen through small tubes placed in his nostrils, or through a mask. He may instead be placed in an oxygen tent. Never take off your child's oxygen tubes or mask or remove him from the tent without asking his caregiver first.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Learn more about External Fixation For Leg Fractures In Children (Inpatient Care)