Application of the pinless external fixator in severely burned patients

In the treatment of patients with full thickness burns of the limbs adequate positioning is known as a critical condition for a favourable outcome after debridement and skin grafting. Up to now prevention of wound compression, prevention of shear forces and daily wound inspection were facilitated by using halofixators (HF) for the skull and AO external fixation (AO-EF) systems for the limbs. For the skull the HF is still the method of choice. However, in burned limbs the AO-EF has the considerable disadvantage that the pins penetrate the medullary cavity. Pin track infections, which occur quite frequently in burn patients, may thus lead to osteitis and additional impairment of the patient's compromised immune function. For these reasons, a new pinless fixation system has been introduced and tested in a series of eight patients with burns of the lower limbs. The special pin clamp system affects only the external subperiosteal portion of the bone. Application of the clamps is very fast since no drilling is necessary. The advantages of external fixation are retained without the associated disadvantages. Clinical examples are presented and discussed.