External Fixator
<ul><li>“ External Fixator is a device uses for stabilization and immobilization of long bone open fractures.” </li></ul>
History <ul><li>Earliest recognizable External fixations by Malgaigne 1840 pin for tibial fractures,  griffe  for patella ...
<ul><li>Keetley 1893, Ollier, Roux </li></ul>History
<ul><li>Parkhill 1894 Threaded pins and clamp  </li></ul>History
<ul><li>Lambotte 1902, self tapping threaded pins, rod, adjustable clamps </li></ul>History
<ul><li>In 1917. Humphry is the 1 st  man who uses threaded pins, but he uses only one pin above fracture and one below th...
<ul><li>In 1966 and 1974,Anderson et al. uses transfixing pins incorporated into a plaster cast for  management  of large ...
Today's Fixators
<ul><li>Type -1  Unilateral Uniplanar  </li></ul><ul><li>Type -2  Uniplanar Bilateral. </li></ul><ul><li>Type -3  </li></u...
Biomechanics of External Fixator  <ul><li>Intrinsic stability of frame (S) </li></ul><ul><li>EX I  </li></ul><ul><li>S  = ...
<ul><li>Thus Stiffness is inversely proportional to the distance of the assembly from the bone </li></ul><ul><li>(closer t...
Mechanics of Bone Pin Interface   <ul><li>To increase stability of bone –pin interface </li></ul><ul><li>1. Adequate no. o...
<ul><li>A. Schanz screw </li></ul><ul><li>4. 5 short threaded for diaphysis </li></ul><ul><li>5 mm long threaded for metap...
Basic Components
<ul><li>Drill : Hand Drill </li></ul><ul><li>Drill bits – Long drill bits( 200mm) 3.5 and 4.5 mm diameter. </li></ul><ul><...
Required instruments
 
 
<ul><li>External fixation of the tibia is advocated in </li></ul><ul><li>severe open fractures (Gustilo 3b,3c) </li></ul><...
<ul><li>Soft tissue healed  </li></ul><ul><li>If the soft-tissue injuries have healed satisfactorily within 2 weeks withou...
<ul><li>Soft-tissue problems persist   </li></ul><ul><li>Remove the external fixator </li></ul><ul><li>Temporarily stabili...
<ul><li>In the event that soft-tissue healing is not satisfactory after 4-6 weeks, and there is no pin track infection, th...
External fixation as final fixation
<ul><li>Less damage to blood supply of bone </li></ul><ul><li>Minimal interference with soft-tissue cover </li></ul><ul><l...
<ul><li>Pin Track Infection.  </li></ul><ul><li>Neurovascular Impalement. </li></ul><ul><li>Muscle or Tendon Impalement </...
IM nails vs External fixator Henley (Clin. Orth., 1989) randomised study of  104 case  II-IIIB tibial fractures by unreame...
<ul><li>Open fracture Tibia and Fibula </li></ul><ul><li>Open fracture Femur </li></ul><ul><li>Floating Knee </li></ul><ul...
Tibial Safe Zone Proximal part of the proximal tibia
Tibial Safe Zone Proximal 3 rd  distal to tibial tuberosity
Tibial Safe Zone Mid Shaft
Tibial Safe Zone Distal  3 rd  distal of tibial Shaft
Schanz screw insertion
Schanz screw insertion for Metaphysis
Technique of Applications   <ul><li>After adequate skin incision Insert assembled triple sleeve and push onto bone. </li><...
<ul><li>Remove the trocar, insert the long 3.5 drill bit through inner sleeve and drill through both cortices. </li></ul><...
<ul><li>Place a 4.5 mm Schanz screw onto the T-handle. Introduce through the outer sleeve and insert into the bone till th...
<ul><li>Insert the triple sleeve through an adequate skin incision and push onto bone. </li></ul><ul><li>Drill the both co...
<ul><li>Place the most distal Schanz screw using the standard technique. </li></ul><ul><li>Place a universal clamp onto th...
<ul><li>Slide 3 Universal clamps onto this tube. </li></ul><ul><li>Insert most proximal schanz screw. </li></ul><ul><li>Re...
<ul><li>Insert the 3 rd  4 th  schanz screw accordingly. </li></ul><ul><li>Connect frame with another Tube. </li></ul><ul>...
In the OT
In the OT Open fracture Gustilo IIIB with Fixator
In the OT Flap Coverage
<ul><li>Ilizarov External Fixator. </li></ul><ul><li>Universal Mini Fxternal Fixator. </li></ul><ul><li>Modular external F...
Ilizarov External Fixator.
Ilizarov External Fixator.
Ilizarov External Fixator.
Universal Mini External Fixator  <ul><li>Micro-motion at fracture Site. </li></ul><ul><li>It is bi-lateral </li></ul><ul><...
UMEX
Modular variety of External Fixator  <ul><li>The modular external fixator allows the surgeon to reduce the fracture by man...
Modular variety of External Fixator
Other variety of External Fixator  Synthes Adjustable Tibial exfix Hoffman II external fixation system
Conclusion  <ul><li>External Fixator is a good device for the management of open and complicated fractures. </li></ul><ul>...
References  <ul><li>Course manual: The 3 rd  Annual Fracture fixation Course; Eastern India Initiative for Orthopaedic Tra...
Thank You
Upcoming SlideShare
Loading in...5
×

External fixator

30,221

Published on

This is a lecture presentation on applying external fixator on open fracture specially on tibia. This method is a classical method. Various new and dynamic fixators are there but the basics are the same.

Published in: Health & Medicine
2 Comments
18 Likes
Statistics
Notes
  • Thanks Dr. Abdullah for sharing this ppt here, we are a professional supplier of external fixators in China, we do OEM services for several famous chinese and foreign companies, if you are looking for external fixator, please write email to us for the detail product information sales@orthopaedic-china.com, our website www.pnhmedical.com
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • Thanks for sharing external fixator ppt here. if anyone looking for external fixation device plz visit us here: http://bit.ly/UM2u6C

    GPC Medical offering wide range of Dynamic External Fixators, External Fixator Ankle, External Fixator Wrist, External Fixator Removal, External Fixator Knee, Ilizarov External Fixator, Zimmer External Fixator, Internal and External Fixation, Hoffman Device External Fixation, Stryker External Fixator Foot Ankle, Spanning External Fixation Device, Synthes Distal Radius Fixator Set, Synthes External Fixation System, External Fixation Device, Orthopedic External Fixation, Stryker External Fixation.
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
No Downloads
Views
Total Views
30,221
On Slideshare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
7,407
Comments
2
Likes
18
Embeds 0
No embeds

No notes for slide

External fixator

  1. 1. External Fixator
  2. 2. <ul><li>“ External Fixator is a device uses for stabilization and immobilization of long bone open fractures.” </li></ul>
  3. 3. History <ul><li>Earliest recognizable External fixations by Malgaigne 1840 pin for tibial fractures, griffe for patella </li></ul>
  4. 4. <ul><li>Keetley 1893, Ollier, Roux </li></ul>History
  5. 5. <ul><li>Parkhill 1894 Threaded pins and clamp </li></ul>History
  6. 6. <ul><li>Lambotte 1902, self tapping threaded pins, rod, adjustable clamps </li></ul>History
  7. 7. <ul><li>In 1917. Humphry is the 1 st man who uses threaded pins, but he uses only one pin above fracture and one below the fracture site. </li></ul><ul><li>In 1948, Charnley popularized his compression device to facilitate arthrodesis of joints. </li></ul>History
  8. 8. <ul><li>In 1966 and 1974,Anderson et al. uses transfixing pins incorporated into a plaster cast for management of large series of tibial shaft fractures . </li></ul><ul><li>From 1968 to 1970 Vidal and Vidal et al. modified original Hoffmann device from a single half –pin unit to a quadrilateral bicortical frame , greatly increasing rigidity. </li></ul>History
  9. 9. Today's Fixators
  10. 10. <ul><li>Type -1 Unilateral Uniplanar </li></ul><ul><li>Type -2 Uniplanar Bilateral. </li></ul><ul><li>Type -3 </li></ul><ul><ul><li>Classical Bilateral Biplanar. </li></ul></ul><ul><ul><li>Delta Unilateral Biplanar </li></ul></ul><ul><li>According to Planes: </li></ul><ul><ul><li>Planner: Hoffman’s, orthofix etc. </li></ul></ul><ul><ul><li>Circular: Ilizarov </li></ul></ul>Types
  11. 11. Biomechanics of External Fixator <ul><li>Intrinsic stability of frame (S) </li></ul><ul><li>EX I </li></ul><ul><li>S = ----------- </li></ul><ul><li>L </li></ul><ul><li>E=modulus of elasticity =constant </li></ul><ul><li>I= moment of intertia= constant </li></ul><ul><li>L= distance of frame from axis. </li></ul>
  12. 12. <ul><li>Thus Stiffness is inversely proportional to the distance of the assembly from the bone </li></ul><ul><li>(closer the frame to bone -more stable assembly) </li></ul>Biomechanics
  13. 13. Mechanics of Bone Pin Interface <ul><li>To increase stability of bone –pin interface </li></ul><ul><li>1. Adequate no. of pins in each fragments </li></ul><ul><li>( 2 for most bone & 3 for femur) </li></ul><ul><li>2. Increase pin pitch (3.5mm) </li></ul><ul><li>3. Increase size of pin </li></ul>
  14. 14. <ul><li>A. Schanz screw </li></ul><ul><li>4. 5 short threaded for diaphysis </li></ul><ul><li>5 mm long threaded for metaphysis </li></ul><ul><li>B. Clamps </li></ul><ul><li>1) Universal Clamps </li></ul><ul><li>11) Open ended clamps </li></ul><ul><li>111) Transverse pin adjusting clamps </li></ul><ul><li>1v) Tube to tube clamps. </li></ul><ul><li>C. Tubes 11mm </li></ul>Basic Components
  15. 15. Basic Components
  16. 16. <ul><li>Drill : Hand Drill </li></ul><ul><li>Drill bits – Long drill bits( 200mm) 3.5 and 4.5 mm diameter. </li></ul><ul><li>Triple guide assembly , consist of trocar(3.5mm), inner Sleeve and outer sleeve </li></ul><ul><li>T Handle for insertion of the Schanz screw. </li></ul>Required instruments
  17. 17. Required instruments
  18. 20. <ul><li>External fixation of the tibia is advocated in </li></ul><ul><li>severe open fractures (Gustilo 3b,3c) </li></ul><ul><li>closed fractures with severe soft-tissue injury </li></ul><ul><li>open fractures involving bone loss </li></ul><ul><li>compartment syndrome after fasciotomy </li></ul><ul><li>adjunct to internal fixation </li></ul><ul><li>limb lengthening or bone transport </li></ul>Indications
  19. 21. <ul><li>Soft tissue healed </li></ul><ul><li>If the soft-tissue injuries have healed satisfactorily within 2 weeks without pin track infection, the external fixation can be removed. </li></ul><ul><li>It is then replaced by internal fixation with either a plate or a nail. </li></ul>External fixator as temporary device
  20. 22. <ul><li>Soft-tissue problems persist </li></ul><ul><li>Remove the external fixator </li></ul><ul><li>Temporarily stabilize in cast </li></ul><ul><li>Let pin track infection heal </li></ul><ul><li>If there is pin track infection, using a nail (especially with reaming technique) can lead to intramedullary infection. </li></ul><ul><li>In this case plate osteosynthesis is clearly preferable. </li></ul>External fixator as temporary device
  21. 23. <ul><li>In the event that soft-tissue healing is not satisfactory after 4-6 weeks, and there is no pin track infection, the external fixator can be left on until the fracture has healed. </li></ul><ul><li>In children fracture healing is often completed within a period of approximately 6-8 weeks. </li></ul>External fixation as final fixation
  22. 24. External fixation as final fixation
  23. 25. <ul><li>Less damage to blood supply of bone </li></ul><ul><li>Minimal interference with soft-tissue cover </li></ul><ul><li>Useful for stabilizing open fractures </li></ul><ul><li>Rigidity of fixation adjustable without surgery </li></ul><ul><li>Good option in situations with risk of infection </li></ul><ul><li>Requires less experience and surgical skill than standard ORIF </li></ul><ul><li>Quite safe to use in cases of bone infection </li></ul>Advantages
  24. 26. <ul><li>Pin Track Infection. </li></ul><ul><li>Neurovascular Impalement. </li></ul><ul><li>Muscle or Tendon Impalement </li></ul><ul><li>Delayed Union. </li></ul><ul><li>Compartment Syndrome </li></ul><ul><li>Re-fracture </li></ul><ul><li>Limitation of further Alternatives. </li></ul><ul><li>Cosmetic Problem </li></ul>Complications
  25. 27. IM nails vs External fixator Henley (Clin. Orth., 1989) randomised study of 104 case II-IIIB tibial fractures by unreamed IM nail; 70 treated by external fixation. Infection rates 7% IM nail, 11% external fixation. There was no difference in time to union. Follow up in 1998 (Journal Orth. Trauma.): “The severity of soft tissue injury rather than the choice of implant appears to be the predominant factor influencing rapidity of bone healing and rate of infection”.
  26. 28. <ul><li>Open fracture Tibia and Fibula </li></ul><ul><li>Open fracture Femur </li></ul><ul><li>Floating Knee </li></ul><ul><li>Open Fracture Humerus </li></ul><ul><li>Communited fracture distal Radius </li></ul><ul><li>Pelvic fracture. </li></ul>Site of insertion
  27. 29. Tibial Safe Zone Proximal part of the proximal tibia
  28. 30. Tibial Safe Zone Proximal 3 rd distal to tibial tuberosity
  29. 31. Tibial Safe Zone Mid Shaft
  30. 32. Tibial Safe Zone Distal 3 rd distal of tibial Shaft
  31. 33. Schanz screw insertion
  32. 34. Schanz screw insertion for Metaphysis
  33. 35. Technique of Applications <ul><li>After adequate skin incision Insert assembled triple sleeve and push onto bone. </li></ul><ul><li>Hold the sleeve steady and lightly tap the trocer on to the bone surface in order to create the initial impression. This prevents slipping of the drill bit during drilling. </li></ul>
  34. 36. <ul><li>Remove the trocar, insert the long 3.5 drill bit through inner sleeve and drill through both cortices. </li></ul><ul><li>Withdraw the drill bit along with inner sleeve. Insert 4.5 mm drill bit through the outer sleeve and over drill the near cortex. </li></ul>Technique of Applications
  35. 37. <ul><li>Place a 4.5 mm Schanz screw onto the T-handle. Introduce through the outer sleeve and insert into the bone till the thread are securely engaged into the far cortex. </li></ul>Technique of Applications
  36. 38. <ul><li>Insert the triple sleeve through an adequate skin incision and push onto bone. </li></ul><ul><li>Drill the both cortex bone with 3.5 mm drill bit. </li></ul><ul><li>Insert 5mm long threaded Schanz Screw with T-handle. </li></ul>Technique of Applications for metaphysis
  37. 39. <ul><li>Place the most distal Schanz screw using the standard technique. </li></ul><ul><li>Place a universal clamp onto the schanz </li></ul><ul><li>Fix a 11mm tube in this clamp, so that it is posterior to the schanz screw. </li></ul>Application of external fixator
  38. 40. <ul><li>Slide 3 Universal clamps onto this tube. </li></ul><ul><li>Insert most proximal schanz screw. </li></ul><ul><li>Reduction of bone. </li></ul><ul><li>Fix the proximal schanz screw. </li></ul>Application of external fixator…
  39. 41. <ul><li>Insert the 3 rd 4 th schanz screw accordingly. </li></ul><ul><li>Connect frame with another Tube. </li></ul><ul><li>Second tube is clamped in “mirror image” fashion after prestressing. </li></ul>Application of external fixator…
  40. 42. In the OT
  41. 43. In the OT Open fracture Gustilo IIIB with Fixator
  42. 44. In the OT Flap Coverage
  43. 45. <ul><li>Ilizarov External Fixator. </li></ul><ul><li>Universal Mini Fxternal Fixator. </li></ul><ul><li>Modular external Fixator </li></ul>Other External Fixators
  44. 46. Ilizarov External Fixator.
  45. 47. Ilizarov External Fixator.
  46. 48. Ilizarov External Fixator.
  47. 49. Universal Mini External Fixator <ul><li>Micro-motion at fracture Site. </li></ul><ul><li>It is bi-lateral </li></ul><ul><li>More lighter than traditional External Fixator. </li></ul><ul><li>More ligamentotasis </li></ul><ul><li>Less chance of pin tract infections. </li></ul>
  48. 50. UMEX
  49. 51. Modular variety of External Fixator <ul><li>The modular external fixator allows the surgeon to reduce the fracture by manipulation and to hold the reduction. </li></ul><ul><li>Free pin placement allows the surgeon: </li></ul><ul><ul><li>to spread both pins, thereby increasing frame stiffness, </li></ul></ul><ul><ul><li>to position pins according to the fracture pattern or soft-tissue injury, </li></ul></ul><ul><ul><li>to avoid injury to nerves or vessels. </li></ul></ul>
  50. 52. Modular variety of External Fixator
  51. 53. Other variety of External Fixator Synthes Adjustable Tibial exfix Hoffman II external fixation system
  52. 54. Conclusion <ul><li>External Fixator is a good device for the management of open and complicated fractures. </li></ul><ul><li>Surgeon must have knowledge about neurovascular plane of the involved Organ. </li></ul><ul><li>Skill for applying the fixator. </li></ul>
  53. 55. References <ul><li>Course manual: The 3 rd Annual Fracture fixation Course; Eastern India Initiative for Orthopaedic Training </li></ul><ul><li>Uses of External Fixator in orthopaedic surgery; Dr. ABM Golam Farque; a Power Point Presentation. </li></ul><ul><li>Wheeless' Textbook of Orthopaedics http://www.wheelessonline.com/ortho </li></ul><ul><li>Synthes: leading global medical device company. http://us.synthes.com/ </li></ul><ul><li>AO Foundation. <www.aofoundation.com> </li></ul>
  54. 56. Thank You
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×