Adult Limb Lengthening & Deformity Service

      External Fixation Patient Care Protocol

      Inpatient Protocol & Discharge
      POD #1 ROM & Ambulation w/ PT
      IV ABX for 24 hrs.
      POD #2 Pin care daily
      OT neutral foot plate
      Start PO keflex 500mg QID
      POD#4 Showering allowed


      1. Pin care supplies (Sterile saline, Xeroform, sterile cotton swabs, Hydrogen peroxide, Kerlix roll for monolateral frames)
      2. Antibiotics: Keflex 500mg PO QID x 10 days w/ 5 refills. First course for 10 days then stop. Start another 10 day course if new pin infection is suspected (increased pain, swelling, new drainage, redness).
      3. Pain medication: Norco (Hydrocodone/Acetaminophen) 10/325 1-2 tabs PO Q4-6 hrs. PRN OR Percocet if patients have had a bad reaction to Vicodin or hydrocodone in the past.
      4. DVT prophylaxis: EC-ASA 325mg PO BID x 4 weeks. If going to Nursing Home then continue Lovenox.

      Pin Care-Daily

        Remove all dressings & Xeroform
        Shower (may use antibacterial soap)
        Using a new sterile cotton swab for each pin-site:

        1. Dip swab in cup filled with ½ hydrogen peroxide & ½ saline solution
        2. Clean the pin site well removing any eschar (scab)
        Wrap a small piece of xeroform around the base of each pin

      Adjustment Schedules for External Fixators

        Some patients will be taught the schedule in the hospital and start in the hospital
        Some will be taught the schedule in the hospital and start at home 5-10 days later.
        Some will be discharged without a schedule and will be taught in the office.
        This is done on an individual basis.

      Outpatient (Ambulatory) Discharge Protocol post Frame Removal
        Prescription for oral pain medication
        Partial Weight bearing x 2 weeks, use crutches
        Use brace for all Weight Bearing activities
        Remove dressing Post Op day #2
        Shower Post Op day #2
        If you have a cast: keep it dry. Do not attempt to remove it. Do not put objects into it to scratch.

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external fixation