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Today's VeTerinary PracTice | november/december 2015 | tvpjournal.com a PracTiTioner's Guide To FracTure ManaGeMenT Peer reviewed 34 transfixation pins or K-wires that are attached to a linear connecting bar using a clamp (Figure 3, page 33). • Circular external fixators or ring external fixators allow the wires to engage the bone, with full or partial ring structure support, which consequently allows engagement of the bone circumferentially. This type of ESF can be very useful when available bone fragment size is small or short in length. • Hybrid fixators can be created by combining ring and linear fixator components and are used to address, for example, distal tibial fractures or angular limb deformity of the distal tibia (Figure 4). Indications External skeletal fxation is diverse in its use and can be applied in a variety of fracture scenarios. It is an especially useful technique in patients with open contaminated fractures in which the open wound over the fracture requires local wound therapy and bandage changes. Another reason external skeletal fxation is often chosen to treat open fractures (and eventually removed altogether once the fracture has healed) is due to concern that placing implants, such as plates or IM pins, in a contaminated fracture may lead to infection of the implant and osteomyelitis, with eventual need for explantation. Benefts Versus Risks A beneft of ESFs is the ability to segmentally destabilize them over time as the fracture begins to heal, allowing more load bearing by the bone itself in a slow, controlled manner. Once the fracture has been assessed by radiographs and determined completely healed, the construct is removed entirely. However, caring for ESFs can be challenging for owners because the constructs are often bulky and may damage furniture or get caught on household items. Technique Regardless of construct, an ESF requires placement of at least 2 pins proximally and 2 pins distally. However, it is ideal to place at least 3 pins proximally and 3 pins distally, engaging a total of 6 cortices on either side FIGURE 5. Lateral ( A ) and craniocaudal (B) radio- graphs of right mid-diaphyseal femoral fracture stabilized with a locking plate and IM pin (plate/ rod combination). FIGURE 4. Example of a hybrid external fxator to correct a distal angular limb deformity; note the proximal pins and their attachment to a connecting bar via clamps. The connecting bar is tied into a circular ring with wires distally. B A