PRINCIPLES OF EXTERNAL FIXATION
27/06/2006
Dr. Rami Eid
Frame components
Pins.
Clamps and Rings.
Connecting rods.
Pins
Clamps and Rings
Frame Design
One plane. Two planes. Ilizarov. Hybrid.
One plane frame
Resisting sagittal bending.
Decrease compression.
Biplanar frame
Increase frontal bending stiffness.
Increase resistance to torsion.
Multiplanar frame
Obstructs soft tissue access.
More stability and early weight bearing.
Bone defect reconstruction.
Hybrid frame
Rigid fixation of periarticular fractures with less complexity than a ring fixator.
Factors affecting the stability of external fixation
To Be Safe and Effective :
Avoid injuries to the vital limb anatomy.
Provide access for wound debridement and other procedures.
Meet the mechanical demands of the patient and the injury.
Complications
Loosening and chronic pain.
Pin site infection.
Deformity, delayed union, nonunion.
Nerves and vessels injuries, joint pyarthrosis.
Soft tissues contracture.
Professor De Bastiani started it all in the 1970’s
…. in Verona, Italy
He did not like Plates and Screws for treating fractures
More soft tissue damage Disturbed fracture site Damaged periosteum Significant deep infection Second operation to remove Risk of refracture
And he didn’t like available External Fixation Frames
Difficult to assemble Multilateral types heavy and
cumbersome Too rigid for good callus Second operation to remove
What fractures need to heal ?
Initial stability (but not complete rigidity)
- to reduce pain
- to keep the pieces in the right place
- to help bridging callus to start growing
Additional movement later on
- to help callus to mature and become hard
Rapidly applied Monolateral Lightweight Stable Minimally invasive Half-pins Reduction facility Converted from RIGID to DYNAMIC
Orthofix
Orthofix
The Orthofix (10.000)
The special features of this fixator:
The conical screws and their design
The ball-jointed clamps
The telescopic body
Screw Characteristics
Non-transfixing (half-pins) Conical thread Self-tapping Capable of minimal flexion
on weightbearing
Screw Characteristics
Callus starts to form even before Dynamization begins
CYCLIC MICROMOVEMENT
The fracture gap opens and closes sequentially.
The Ball-Jointed Clamps
Either straight clamps or T-clamps
360° of rotation and 36° of angulation in any plane to assist fracture reduction
The Ball-Jointed Clamps
The Telescopic Body
Central body locking nut can be loosened to convert fixator to the DYNAMIC mode
The Telescopic Body
DYNAMIZATION
Stable fractures: 2 – 4 weeks
Unstable fractures: 5 – 8 weeks
DynamizedDynamized at at4 weeks;4 weeks;FixatorFixatorremoved, andremoved, andbone healed,bone healed,at 12 weeksat 12 weeks
DYNAMIZATION
If Dynamization starts too late
Prolonged healing times
Non-union
Screw loosening
Patient Benefits
Short operation and anaesthetic time Lightweight device Early mobilization Early weightbearing Early hospital discharge (unless polytrauma) Joint function preserved Out-patient removal (no second operation)
MoKazem.com
من • تقديمها و إعدادها تم محاضرات سلسلة من هي المحاضرة هذه , دمشق مشفى في العظمية الجراحة شعبة في المقيمين األطباء قبل
. . ميرعلي بشار د إشراف تحت• . المحاضرة هذه في الواردة األخطاء عن مسؤول غير الموقع
•This lecture is one of a series of lectures were prepared and presented by residents in the department of orthopedics in Damascus hospital, under the supervision of Dr. Bashar Mirali.
•This site is not responsible of any mistake may exist in this lecture.
كاظم. مؤيد Dr. Muayad Kadhimد