External fixation techniques

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External fixation techniques

  1. 1.  External fixation is also known as External Coaption or limb splinting.  It may serve as a temporary support,first aid or as a secondary support after surgical intervention.  While adopting scientific measures,art of constructing an external coaptation should also be considered simultaneously.  Mechanical forces like Bending,Rotation,Compression,Distraction at the fracture site should be considered Bending,Rotational-Cast application(joint above,joint below) Shear forces-Modified thomas splint
  2. 2.  Fracture reduction-Minimally displaced fractures are best suited for treatment with external coaptation.  Fracture alignment-Care must be taken to keep the fractured bones in proper alignment by ensuring proper joint alignment.  It should be applied keeping limb in neutral standing position(over extension,over flexion should be avoided)  Joint above and joint below of a fracture must be immobilised.
  3. 3. INDICATIONS The primary indication for the Ehmer sling is to provide stability following reduction of a cranial and dorsal dislocation of the hip joint. PURPOSE •To provide abduction and internal rotation of the femur and flexion of the knee, places the femoral head into a position with in the acetabulam. •The Ehmer sling is not useful with ventral dislocation of the hip, since abduction of the leg would be contraindicated and may cause reluxation
  4. 4. • The Velpeau sling is a shoulder bandage that will relieve the forelimb of weight bearing. It keeps the carpus, elbow, and shoulder joints in a flexed position  INDICATIONS:  Immobilization of scapular fractures.  Dislocations of the shoulder joint.  APPLICATION: 1. The bandage is started by applying the combine roll around the dorsal surface of the dog's radius and ulna. 2. Moves up over the shoulder and around the thorax behind the opposite front leg, around to cover the flexed carpus, over the shoulder, around the thorax once more.
  5. 5.  The sling is then taped to the body wall in a way that prevents the elbow from coming out posteriorly.  FIG. 15-3 Application of a Velpeau sling. (A) The Velpeau sling is shown with the first revolution in place. (B) The finished Velpeau sling, with the second and third wrap shown
  6. 6.  Casts is used for providing immobilization, especially after surgery.   Casts immobilize the joint above and the joint below the area that is to be kept straight and without motion TYPES  plaster - white in color.  fiberglass - comes in a variety of colors, patterns, and designs
  7. 7.  STEP WISE PROCEDURE FOR APPLYING CAST:  Strips of adhesive tapes are placed on the cranial and caudal surface of foot and allowed to protrude several inches distal to end.  An orthopedic stockinette is applied to the limb with extra length at top and bottom. • Cotton padding is applied to the limb starting from toe to upward. • Wetted plaster of paris is rolled on to the limb from disital to proximal portion and then return distally. • After hardening stockinette and tape on the digital end are reflected proximally and fixed with single strip of plaster splint. • A final row of plaster may be applied and smoothed in place
  8. 8. FIBRE GLASS CASTING 1. Place adhesive stirrups on the limb. 2. Cover stirrups with stockinette. 3. Apply cast padding firmly over the stockinette using an overlaying pattern. 4. Place four to six layer of casting material on the limb.
  9. 9. SCHROEDER-THOMAS SPLINTS INDICATIONS: 1. The Schroeder-Thomas splint can be used to immobilize any fracture distal to the midfemur or midhumerus. 2. It is also a useful device for immobilization of joints distal to the elbow (including elbow joint) in fore limb. 3. Schroeder-Thomas splint can be useful in immobilizing distal femoral or tibial fractures in hind limb. Fore limb model Hind limb model
  10. 10.  The frame of the splint is made of aluminum rods should be sufficiently stiff that it will not bend.  The first important component to manufacture for the splint is the upper ring, which encompasses the thigh.  The ring should be constructed in a round fashion.  Bend the ring in an approximately 45¡ angle and flatten the ring so that it will conform to the dog's body.  The ring should cover the tuber ischii caudally and tuber coxae proximally in case of hind limb. Bending of lower ring should be in the contour of limb otherwise it may act as a fulcrum to create other complecation.  Tape is usually applied to the ring .  The outside of the aluminum frame is covered with adhesive tape .
  11. 11.  Basic principle behind modified thomas splint is traction with immobilisation after proper alignment of bones.  In fore limb-Anterior arm of thomas splint should be kept straight, posterior arm should be bent according to the contour of leg.  In hind limb –Posterior arm should be kept straight while the anterior arm should be bent according to the contour of leg.  Positioning of limbs while applying the splint should be maintained in such a manner that the inter digital space of the leg should remain parallel to ground so that bone alignments will beproper.
  12. 12.  Methods of application is almost similar to that of small animal.  Mostly made up of G.I wire-5mm to 15 mm -Jute coils or used cloths -Good quality gauge bandages -Plaster of paris -Bamboo splints
  13. 13. OTHER SPLINTS INCLUDE • A.METAL SPOON SPLINT • B.SPICA SPLINT • C.SPOON SPLINT
  14. 14.  Spica splint is used for temporary immobilisation in fracture of hip,shoulder joint along with femur and humerus.  Spica support bandage requires extra manipulation so heavy sedation under G.A is needed.  Reduces soft tissue trauma caused by movement of fractured fragments.
  15. 15.  Strips of adhesive tapes are attached to medial and lateral surface.  Cotton roll bandaging from toe to thorax.  Elastic gauge compresses and confirms the bandage.  Splint rods or cast materials extends from toes to midline of thorax to reinforce the splint.  Wrap with a layer of vent wrap again.
  16. 16. ADVANTAGES OF SPLINTS Advantages •Keeps leg in normal walking angle. •Allows weight bearing of affected limb. •Immobilizes limbs for wound healing, burn therapy and skin grafts •Provides extra support for fractures of the lower limb. •Provides easy access for daily wound therapy. •Lightweight construction increases patient tolerance. •Prevents knuckling of lower limbs associated with nerve paralysis.
  17. 17.  The Robert jones bandage provides excellent support in an injured extremity before or after surgical intervention.  Bulk and mild compression provides support and reduce swelling.  It extends from the toes to mid humerus or mid femur-provides temporary support for fractures below elbow and stifle joint.
  18. 18. MODIFIED ROBERT JONES BANDAGING TECHNIQUES STEP-1 •Place strips of tape on the distal 1/3rd of the limb overlapping the toes and extending approximately an equal length from the end of the leg.
  19. 19. STEP-2 •  Wrap the leg lightly with cast padding starting at the toes and moving proximally. Overlap the bandage 50% as you wrap and try to get 2 layers of padding. Note - it is important not to exceed approximately two layers of cast padding. Excessive padding will cause premature loosening of the bandage as the cotton compresses overtime.
  20. 20. STEP-3 • Wrap the leg tightly with a conforming bandage starting at the toes and moving proximally. This is the step where you create compression. Overlap the bandage 50% as you wrap and make sure the toes are still visible
  21. 21. STEP-4 • Separate the strips of tape , rotate them proximally, and secure them to the compression bandage thus creating a barrier and preventing the bandage from slipping down  Wrap the leg in vent wrap starting at the toes at an angle to cover the distal ends of the bandage and again moving proximally as you progress.
  22. 22.  A Robert jones bandage is frequently reinforced with rigid materials like aluminium splint rods to enhance immobilisation of joints.  Advantage-Large bulk and weight of conventional bandage is avoided.
  23. 23.  Strips of tape must never be applied in a circumferential manner because it may obstruct vascular supply.  Cotton padding should begin from toes and then gradually wrapped around the limb and continued proximally upto the lebel of the mid shaft femur or humerus.  The nails of two middle toes should remain barely visible to access post bandaging vascular blood supply.  Too much of excessive tension should not be applied while final covering with elastic tape which may hinder the vascular supply.
  24. 24. ADVISE OWNER FOR MONITARING ANY • Clients should be instructed to observe any • Warmth, swelling • Odour • Moisture • Bandage should be clean and free from moisture • Cover bandage when animal go outside • In Robert jones bandaging technique watch toe twice a day. • The site also observed for irritation and any discharge • Advice owner to put E-collar to animal to prevent self mutilation.
  25. 25.  Loss of hair around bandaging area.  Erythematous lesion also found in bandaged area.
  26. 26.  Fundamental Techniques in Veterinary Surgery by Charles D Knecht,John R Welsor,Algernon R Allen  Text book of Surgery by Douglas Slatter  Small Animal Surgery by Theresa Welch Fossum

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