Comparing Recovery Timelines: External Fixation vs. Internal Fixation

For the treatment of bone fractures, two common methods of stabilization are used: external fixation and internal fixation.

Both of these methods are critical for orthopedic surgeons to ensure better results for the patients. A thorough understanding of the rehabilitation timelines can contribute to making an informed decision for the delivery of the desired patient care.

In this article, we shall discuss both fixation methods in detail by dividing them into their definition, application, and recovery timelines. This information serves as a guide to make a decision that aligns with the specific needs of their patients individually.

What is Internal Fixation Surgery?

Internal fixation surgery is performed to repair the broken bones by realigning and stabilizing them in the correct position internally. These affected bones are properly stabilized and supported till the time they are properly healed to bear the person’s body weight without any discomfort. The types of orthopedic equipment used for ensuring a successful internal fixation surgery are - intramedullary interlocking nails, orthopedic plates, and screws.

The most common types of fractures that are treated using the internal fixation method include:

• Comminuted fracture
• Compound fracture (Open fracture)
• Displaced fracture (in these cases, the pieces of bone move away from each other to form a gap)
• Joint fractures
• Spinal stabilization

The majority of surgeons prefer this method because:

• It allows shorter hospital stays
• There is a reduced chance of nonunion (incomplete healing) and malunion (incorrectly positioned bone healing) of broken bones
• It allows patients to restore and regain their normal functions quicker
• creates a stable condition for the patient for earlier mobilization and weight-bearing activities

What is an External Fixation Method?

External fixation is an orthopedic surgical procedure used for the optimal alignment and stabilization of fractured bones with the help of an external fixation device placed outside the body. The device is connected to the affected bone through orthopedic pins, wires, and screws.

The main indications of the external fixation method are:

Orthopedic surgeons consider the external fixation method in various cases because:

• An external fixation protects the surrounding soft tissue from injury during treatment
• It can be applied quickly to stabilize fractures and even develop bone-related deformities
• Preferred in cases where infection risk is higher, such as in diabetic foot ulcers
• Excellent approach for limb lengthening and deformity correction

What Are the Key Factors That Impact the Recovery Process after Orthopedic Surgery?

• Patient’s Age: As aging happens, the capacity for healing in an individual decreases. It is why older patients are always at risk of complications after fracture treatment.
• Comorbidities: Diseases like arthritis, diabetes, or any auto-immune disease can degrade the healing process.
• Medication Usage: A few medicines, such as corticosteroids and NSAIDs, intervene in bone healing and increase the chances of non-union.
• Fracture Type and Severity: The complexity of the fracture (e.g., comminuted, displaced) significantly impacts healing time and recovery outcomes.
• Surgical Technique: Recovery time and results can be influenced by the surgeon's ability and the fixation technique's accuracy.
• Rehabilitation and Patient Compliance: Staying adherent to the physical therapy and postoperative care instructions provided by surgeons plays a major role in accelerating recovery and also promises better results.

Comparative Analysis of Recovery Timelines of Internal and External Fixation

Analyzing the recovery periods for internal and external fixation offers important information about the healing mechanisms involved in each technique. Although both methods fix fractures, they use different approaches, affecting rehabilitation.

Initial Recovery Phase (0-3 months)

The early recovery period for both surgical techniques lasts for the first three months. Every phase impacts various aspects of a patient’s life differently.

Attributes	Internal Fixation	External Fixation
Activity Level	The patient can move freely without limitation; even the physical therapy begins sooner.	Restrained activity, as there is a completed focus on healing and bone alignment.
Focus	Restoring and regaining strength of fractured bone.	Wound care and infection monitoring are crucial in this case because they are performed mainly in patients with higher infection risk.
Functional Results	Early mobility is easy to attain; thus, the functional results are always better.	There is a delay in reviving joint mobility and grip strength.
Potential Complications	There is a lower risk of complications because the technique is performed in individuals with healthier daily lifestyles and habits.	There is a higher risk of minor complications, such as pin site infections, in immunocompromised patients.

Intermediate Recovery Phase (3-6 months)

Attributes	Internal Fixation	External Fixation
Functional Outcomes	Better outcomes, as there is improvement in the ability to move, with an increasing range of motion and enhanced grip strength	Delay in the grip strength and overall joint functioning
Mobility	Significant boost in mobility due to the stabilized orthopedic implants, such as plates, nails, and screws	Restriction due to the external frame, but gradual improvement is noticeable steadily
Rehabilitation Focus	Extensive physical therapy that aims at increasing strength for performing daily activities	Managing the remaining discomfort while gradually increasing activity levels
Patient Experience	Patients report greater satisfaction in these cases due to easier recovery without any restrictions	Patients may get irritated due to the inconvenience and limitations caused by the external fixation device
Activity Level	It helps to resume normal routines quickly and even allows sportspeople to get back on the track earlier	Longer time required for resuming normal activities
Risks Associated	There is a lesser risk of complications; however, too much physical exertion on treated bone can hamper recovery.	The risk of complications is higher due to infections and external elements.

Final Recovery Phase (6-12 months)

Attributes	Internal Fixation	External Fixation
Device Removal	These orthopedic devices stay intact to the bone and are not removed unless there is a medical complication caused by it	The majority of the patients will have their external fixation device removed by this time
Mobility	Patients achieve significant improvement in mobility and function	A few patients with diseases like foot ulcers might still experience trouble with mobility and stiffness
Recovery Duration	The healing process is completed, which allows for quicker recovery	Potential issues like delayed or malunion may cause full recovery to take longer.
Functional Outcomes	The majority of people can resume their regular activities and sports.	Because of past medical issues, patients may have trouble reaching optimal function.
Rehabilitation Focus	Patients often continue therapy to maintain strength and flexibility, enjoying fewer restrictions.	Ongoing rehabilitation is essential to help regain full function and adapt to any residual limitations.

Clinical Cases and The Right Fixation Method for Them

External Fixation:

Sharma Orthopedic: Promise Quality Production of Implants for Proper & Faster Recovery

We at Sharma Orthopedic ensure that our highly advanced manufacturing processes and multilayered quality control assist in streamlining the recovery process. As a trusted orthopedic implant manufacturer, we aim to ensure that recovery is not delayed or hampered due to any quality-related issue.

Our certifications from the country’s authorized organizations prove our product quality. They also promise a comfortable and convenient healing after the surgical placement of our implants.

• Certified for the ISO 13485 and ISO 9001-2015 along with WHO-GMP and Indian FDA (CDSCO)
• Implement the recent technology for superior and highly compatible implant design
• Provide stability and minimize implant failure risks
• Ensure seamless integration of implants with the human body

Final Thoughts

Overall, one can conclude that both internal and external fixation have different effects on every aspect of the patient during their recovery timeline. Many factors decide the entire journey of healing, soft tissue preservation, and mobility for patients.

Orthopedic surgeons must assess each case in a specific way to optimize patient outcomes. Being updated with the latest advancements in orthopedics will improve surgical accuracy and patient recovery.