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Principles of external fixation
- 1. PRINCIPLES OF EXTERNAL FIXATION Dr BIPUL BORTHAKUR PROF Orthopaedics, SILCHAR ,ASSAM,INDIA
- 2. INTRODUCTION • EXTERNAL FIXATOR – COMPOSED OF BONE ANCHORAGE SYSTEM IN THE FORM OF • WIRES OR PINS • ARTICULATIONS • LONGITUDINAL OR RING SUPPORTS • 2 BASIC TYPES • PIN FIXATOR • RING FIXATOR
- 4. PIN FIXATOR • TYPES • SIMPLE FIXATOR – PROVIDE INDEPENDENT APPLICATION OF SINGLE PINS • CLAMP FIXATORS – PERMIT SPATIALLY CONSTRAINED PIN CLUSTERS
- 5. • CONFIGURATIONS 1. UNILATERAL • 1 PLANE • 2 PLANE 2. BILATERAL • 1 PLANE • 2 PLANE
- 7. MODULAR FRAME • MODIFICATION OF THE UNILATERAL UNIPLANER FRAME • 2 PINS IN EACH SEGMENT CONNECTED TO SHORT TUBE WITHG PIN- TUBE CLAMP • THIRD TUBE & TUBE-TUBE CLAMPS USED TO CONNECT SHORT TUBES IN 2 BONE SEGMENTS • ALL TUBES CAN BE ROTATED W.R.T EACH OTHER & FIXED IN ANY RELATIVE POSITION
- 9. RING FIXATOR • CONSIST OF COMPLETE OR PARTIAL RINGS CONNECTED BY RODS OR ARTICULATED MEMBERS • RINGS ARE ANCHORED TO BONE WITH • HALF PINS • HIGHLY TENSIONED WIRES (1.5-2 mm)
- 10. HYBRID EXTERNAL FIXATION • COMBINE WIRE FIXATION AND PIN FIXATION • USED FREQUENTLY FOR PROXIMAL OR DISTAL TIBIA FRACTURE WITH • COMPROMISED SOFT TISSUE • DIAPHYSEAL EXTENSION • MINIMAL ARTICULAR COMMUNITION
- 11. HYBRID EX-FIX
- 12. GENERAL METHOD FOR HALF PIN FIXATORS • SKIN INCISED • SHARPLY • SHORT LONGITUDINALLY • ALONG SAFE ZONE • BONE REACHED WITH GENTLE BLUNT DISSECTION
- 13. • DRILL SHEATH SHOULD BE USED DURING • DRILLING • TAPPING • PIN INSERTION • NEW DRILL BIT SHOULD BE USED WITH EACH PROCEDURE • HAND DRILLING/LOW SPEED POWER DRILLING WITH PAUSE
- 14. • EX-FIX STIFFNESS INCREASES WITH AN INCREASE IN • PIN NUMBER & DIAMETER • PIN SEPARATION DIAMETER IN A BONE SEGMENT • PIN INSERTION ANGLE • ROD NUMBER & DIAMETER
- 15. • EX-FIX STIFFNESS DECREASES WITH INCREASE IN • PIN SEPARATION DISTANCE ACROSS THE FRACTURE • ROD-BONE DISTANCE
- 16. PIN-BONE INTERFACE STRESS REDUCING FACTORS • PIN • LARGE DIAMETER • HIGH MODULUS MATERIAL • MULTIPLE PIN CLUSTER • REDUCED SPAN • PRELOADING • FIXATOR • 2 PLANE CONSTRUCT • PATIENT • REDUCED WEIGHT BEARING
- 17. GENERAL METHODS FOR CIRCULAR WIRE FIXATORS • INCISION • NOT REQUIRED FOR (1.5 & 1.8) mm WIRES • REQUIRED -- >2mm WIRES & OLIVE WIRES • LOW SPEED POWER DRILL WITH PAUSE OR HAND DRILL SHOULD BE USED • WIRE STABBED THROUGH SKIN & MUSCLE TO BONE
- 18. • WIRES DRIVEN ACROSS THE REMAINING SOFT TISSUES WITH A MALLET AFTER CROSSING THE FAR CORTEX • WIRES ARE FIXED TO EXTERNAL FRAME WITHOUT BENDING • IF REQUIRED, SMALL SPACER CAN BE USED
- 19. • LARGE FRACTURE FRAGMENTS REQUIRE • 2 LEVELS OF FIXATION • 2 WIRES AT EACH LEVEL • SHORT FRACTURE FRAGMENTS CAN BE FIXED WITH • 1 RING & A DROP WIRE • A WIRE OFFSET FROM THE MAIN RING BY A FEW cm • STABILITY INCREASED BY INCREASEING THE ANGLE BETWEEN THE WIRES • MINIMUM OF 3CM SKIN-RING GAP REQUIRED
- 20. FRACTURE HEALING IN EXTERNAL FIXATOR • FAVOURS PERIOSTEAL HEALING • A RIGID FRAME DELAYS HEALING • LESS-RIGID FRAME PROMOTES HEALING
- 21. DYNAMIZATION • EMBRACES BOTH APPOLICATION OF MICROMOVEMENT AND LOADING TO THE FRACTURE SITE • WITHOUT ANGULATION, ROTATION OR DISTRACTION • PROMOTES FRACTURE HEALING
- 22. THANK YOU • क्लैब्यं मा स्म गम: पार्थ नैतत्त्वय्युपपद्यते | क्षुद्रं हृदयदौर्थल्यं त्यक्त्वोत्तिष्ठ परन्तप || 3|| • klaibyaṁ mā sma gamaḥ pārtha naitat tvayyupapadyate kṣhudraṁ hṛidaya-daurbalyaṁ tyaktvottiṣhṭha parantapa • Meaning-O Parth, it does not befit you to yield to this unmanliness. Give up such petty weakness of heart and arise, O vanquisher of enemies.