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External, internal fixation, DCP and Cast Syndrome

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Treatment modalities for fractures. About Dynamic Compression Plates and a note on Cast Syndrome. For MBBS Undergraduate level

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External, internal fixation, DCP and Cast Syndrome

  1. 1. EXTERNAL FIXATION INTERNAL FIXATION DYNAMIC COMPRESSION PLATES (DCP) CAST SYNDROME
  2. 2. EXTERNAL FIXATION  DEFINITION: An External Fixation is the method of fixing the fracture with a cluster of pins connected to external environment. An external fixator is a device placed outside the skin that stabilizes bone fragments with pins or wires connected to bars.
  3. 3. HIGHLIGHTS OF EXTERNAL FIXATION  PROVIDES A STABLE FIXATION OF FRACTURES AND JOINTS.  HELPS IN WOUND CARE AND RECONSTRUCTION SURGERIES.  AXIAL COMPRESSION, ROTATION, DISTRACTION, TRANSLATION AND ANGULATORY FORCES CAN BE APPLIED.
  4. 4. INDICATIONS FOR EXTERNAL FIXATION  OPEN FRACTURES WITH SEVERE SOFT TISSUE INJURY.  CLOSED FRACTURE WITH SOFT TISSUE COMPROMISE  FOR FIXATION OF PELVIC FRACTURES  STABILIZE LONG BONE AND PERIARTICULAR FRACTURES IN POLYTRAUMA OR FOR DAMAGE CONTROL IN PATIENTS.  FOR DEFINITIVE TREATMENT OF SOME FRACTURES OF LONG BONES AND PELVIS.
  5. 5. EXTERNAL FIXATION
  6. 6. COMPONENTS OF EXTERNAL FIXATORS PIN CLAMPS EXTERNAL RODS
  7. 7. TYPES OF EXTERNAL FIXATORS UNILATERAL FRAME BILATERAL FRAME MULTIPLANE FIXATORS RING FIXATORS
  8. 8. UNILATERAL FIXATOR SINGLE BAR
  9. 9. UNILATERAL FIXATOR ‘Z FRAME’
  10. 10. BILATERAL FIXATOR
  11. 11. MULTI-PLANE FIXATOR
  12. 12. RING FIXATOR
  13. 13. MODE OF ACTION A. COMPRESSION FORCES B. DISTRACTION FORCES C. NEUTRALIZATION FORCES D. ANGULAR FORCES
  14. 14. BIOTECHNICAL PRINCIPLES OF EXTERNAL FIXATION a) PIN SIZE b) PIN NUMBER a) PIN PLACEMENT b) ROD PLACEMENT c) CLAMPS
  15. 15. COMPLICATIONS  PIN TRACT INFECTION  PIN LOOSENING  PIN MIGRATION or PIN BREAKAGE  IMPALEMENT OF NERVES, MUSCLES, LIGAMENTS & TENDONS.  CHRONIC OSTEOMYELITIS  SOFT TISSUE CONTACTURES  MALALIGNMENT  MALUNION/NON UNION
  16. 16. PIN TRACT INFECTION MOST COMMON COMPLICATION OCCURS WHEN INADEQUATE MEASURES ARE TAKEN TO KEEP THE POINT OF ENTRY AND SUTURES AROUND THE PINS CLEAN AND ASEPTIC.
  17. 17. INTERNAL FIXATION  IN THIS METHOD THE FRACTURE, ONCE REDUCED ,IS HELD INTERNALLY WITH THE HELP OF SOME METALLIC OR NON-METALLIC DEVICE (IMPLANT).  THESE IMPLANTS ARE MADE OF HIGH QUALITY STAINLESS STEEL TO WHICH BODY IS INERT.
  18. 18. INDICATIONS WHEN A FRACTURE IS SO UNSTABLE THAT IT IS TO DIFFICULT TO MAINTAIN IT IN AN UNACCEPTABLE POSITION BY NON –OPERATIVE MEANS. AS A TREATMENT OF CHOICE IN SOME FRACTURES IN ORDER TO SECURE RIGID IMMOBILISATION AND TO ALLOW EARLY MOBILITY OF THE PATIENT. WHEN IT HAS BEEN NECESSARY TO PERFORM OPEN REDUCTION FOR ANY OTHER REASON SUCH AS AN ASSOCIATED NEUROVASCULAR SURGERY.
  19. 19. METHODS  STEEL WIRE  KIRSCHNER WIRE  INTRA MEDULLARY NAIL  SCREWS  PLATES AND SCREWS  SPECIAL FRACTURE SPECIFIC IMPLANTS  COMBINATIONS
  20. 20. STEEL WIRE  GAUGE : 18 or 20  USED FOR INTERNAL FIXATION OF SMALL FRACTURES  EXAMPLE: FRACTURE OF PATELLA HOLDING COMMINUTED FRAGMENTS
  21. 21. KIRSCHNER WIRE  Kirschner wires or K-wires or pins are sterilized, sharpened, smooth stainless steel pins.  They come in different sizes and are used to hold bone fragments together (pin fixation) or to provide an anchor for skeletal traction.  The pins are often driven into the bone through the skin (percutaneous pin fixation) using a power or hand drill.  They also form part of the Ilizarov apparatus.
  22. 22. INTRA MEDULLARY NAIL  IT IS A HOLLOW ROD MADE OF STAINLESS STEEL.  IT IS INTRODUCED INTO THE MEDULLARY CAVITY OF LONG BONES SUCH AS FEMUR AND TIBIA.
  23. 23. SCREWS  USED FOR FIXING SMALL FRAGMENTS OF THE BONE TO THE MAIN BONE.  EXAMPLE : FIXATION OF MEDIAL MALLEOLUS.  TYPES ARE CORTICAL AND CANCELLOUS
  24. 24. PLATES AND SCREWS  THIS IS A DEVICE WHICH CAN BE FIXED ON THE SURFACE OF THE BONE WITH THE HELP OF SCREWS.  THEY ARE AVAILABLE IN DIFFERENT THICKNESS, SHAPE AND SIZES.
  25. 25. SPECIAL FRACTURE SPECIFIC IMPLANTS  THEY INCLUDE SPECIAL DEVICES USED IN PARTICULAR FRACTURES  THEY INCLUDE: SP NAIL PLATE - INTER TROCHANTRIC FRACTURE DYNAMIC HIP SCREW (DHS) - INTER TROCHANTRIC FRACTURE CONDYLAR BLADE PLATE – CONDYLAR FRACTURE OF FEMUR T PLATE - CONDYLAR FRACTURE OF TIBIA SPOON PLATE – FRACTURE OF LOWER END OF TIBIA COBRA PLATE - HIP ARTHRODESIS
  26. 26. ADVANTAGES AND DISADVANTAGES ADVANTAGES DISADVANTAGES  ALLOWS EARLY MOBILITY OF THE PATIENT OUT OF THE BED & HOSPITAL.  JOINTS DO NOT GET STIFF AND MUSCLE FUNCTION REMAINS GOOD.  COMPLICATIONS WITH CONFINEMENT OF THE PATIENT TO BED ARE AVOIDED  INFECTION & NON- UNION  NEEDS A TRAINED ORTHOPAEDIC SURGEON  FREE AVAILABILITY OF IMPLANTS & A GOOD OPERATION THEATRE.
  27. 27. DYNAMIC COMPRESSION PLATE IN DYNAMIC COMPRESSION PLATES (DCP) SCREW HOLES ARE DESIGNES TO UTILIZE GLIDING PRINCIPLE WITH THE INCLINED CONTOUR OF THE SCREW HOLES AND THE SLOPE ON THE UNDERSIDE OF THE SCREW HEAD. AS THE SCREW IS TIGHTENED, ITS HEAD IS GUIDED BY THE CONTOURS OF THE SCREW HOLE IN SUCH A WAY THAT THE HEAD GLIDES TOWARDS THE CENTRE OF THE PLATE UNTIL THE DEEPEST PORTION OF THE WHOLE IS REACHED. AS A RESULT OF THIS, THE BONE FRAGMENT INTO WHICH THE SCREW IS BEING DRIVEN INTO, IS DISPLACED AT THE SAME TIME AND IN THE SAME DIRECTION PROVIDING RIGID COMPRESSION. IT IS CALLED DYNAMIC BECAUSE THE BONE FRAGMENT MOVES WHEN THE SCREW IS TIGHTENED.
  28. 28. DYNAMIC COMPRESSION PLATES ADVANTAGES DISADVANTAGES  LESS SURGICAL EXPOSURE THAN THE CONVENTIONAL SURGERY.  SCREW & PLATE FIT CONGRUENTLY IN ANY POSITION.  SCREW MAY BE INSERTED IN ANY ANGLE.  ALL OTHER ADVANTAGES OF RIGID FIXATION.  HEALS BY PRIMARY INTENTION HENCE CALLUS IS NOT SEEN ON RADIOGRAPHS.  POOR FRACTURE WELDING,AS THERE IS NO EXTERNAL CALLUS.  EXCESSIVE COMPRESSION CAUSES OSTEONECROSIS.  REFRACTURE IS COMMON AFTER REMOVAL
  29. 29. LIMITED CONTACT DYNAMIC COMPRESSION PLATE (LC-DCP)  LC-DCP IS A DYNAMIC COMPRESSION PLATE WITH LIMITED CONTACT TO THE UNDERLYING BONE WHICH MINIMIZES DISRUPTION TO PERIOSTEAL CAPILLARY NETWORK AND THE FRACTUE ZONE.  ALSO IT HAS MORE UNIFORM BENDING CHARACTERS THAN AN ORDINARY DCP DUE TO LESS INCLINATION TO BEND IN THE AREA OF HOLES IN THE PLATE.
  30. 30. CAST SYNDROME  ALSO KNOWN AS CAST DISEASE  IT IS DUE TO THE COMPLICATION OF PLASTER OF PARIS.  UNPLEASANT FACTS OF CAST DISEASE 1) MUSCLE ATROPHY 2) OSTEOPOROSIS 3) JOINT STIFFNESS 4) SKIN BREAKDOWN 5) COMPATMENT SYNDROME 6) BLISTER FORMATION
  31. 31. THANK YOU

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