Psychological impact of external fixation: can it affect treatment success?


The use of external fixation for deformity correction has advantages over other methods, allowing for early ambulation, correction of complex deformities, and having less risk of neurovascular injuries. Having relatively straightforward general principles for application and management, the use of external fixators such as circular, hexapod, or monolateral fixators has become widespread in recent years.

Although the treatment with external fixators is highly effective, their visual impact along with the need for long treatment periods can have considerable psychological effects on patients. Therefore, surgeons and nurses should be aware that patients might need psychological support, and that the success of treatment may be affected by severe psychological effects such as fear, changes in body image, and decreased self-esteem.

In this article, we will explore the psychological effects of external fixation, how to manage patients’ expectations, and how to minimize the psychological impact of the treatment.

Psychological effects of external fixation

Despite careful planning before the surgery for deformity correction takes place, there is often a surprise element when the patient wakes from anesthesia and is confronted with a bulky external fixator. This is especially true for a circular frame, but even monolateral frames such as the LRS Advanced can prove to be a hindrance to activities of daily living such as bathing or sleeping. This may result in a previously independent patient suddenly needing additional help, which may be a challenge for certain patients and cause mental distress.

Even patients who react well initially may have trouble coping with treatment in the long run, since treatments for bone deformities often take weeks or months and may be accompanied by other complications, such as pain and/or pin tract infections.

Although the correction of a bone deformity is intended to restore limb functionality and aspect, ultimately resulting in improved self-image, the patient may need to adjust to a new body image, which may be harder in populations where bodily changes are already plentiful, such as adolescents.

Taken together, the changes in daily life and self-image imposed by the treatment with external fixation can result in substantial psychological issues for the patients, which may lead to poor compliance and higher rates of other complications.

Managing patient expectations

Patients who undergo deformity correction with external fixators require ongoing support from their family, as well as a multidisciplinary healthcare team, during the entirety of treatment.

However, many patients may be reluctant to ask for help due to embarrassment. Others, namely children, may not be able to clearly articulate their needs and instead display unusual behavior. Health professionals should be proactive and initiate conversations regarding strategies for managing tasks of daily living. They should also be able to recognize the impact of the disruption caused by the external fixator on the patient’s mental health and body image.

Active involvement of the patient and their family in treatment includes a two-way conversation with the healthcare staff member, who should be able to identify concerns and respond to expectations about care.


Prolonged treatment with external fixation can have a negative impact on a patient's psychological status, which may in turn hinder clinical outcomes. Problems such as anxiety, depression, and lack of self-esteem may become so severe that they impair compliance with treatment.

Patients often struggle to cope with external fixators, even if they are reluctant or unable to ask for help from their family and healthcare team. By taking a proactive stance and holistic view of the patient, it is possible to identify psychological problems as soon as they start emerging and minimize their impact on treatment success.


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