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External fixator
The document provides a history and overview of external fixators. Some key points: - External fixators were first developed in the 1840s and have since been improved, including the addition of threaded pins, rods, and adjustable clamps. - They are used to stabilize and immobilize long bone fractures, especially open or complicated fractures. - Components include Schanz pins, tubes, and universal clamps. Proper placement of pins is important for stability. - External fixators can be used temporarily to stabilize injuries before definitive fixation, or as the final fixation in cases where soft tissue healing is problematic. They provide less invasive fracture stabilization than internal fixation.
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External fixator
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- 2. “External Fixator isa device uses for stabilization and immobilization of long bone open fractures.” 2
- 3. History Earliest recognizable External fixationsby Malgaigne 1840 pin for tibial fractures, griffe for patella 3
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- 5. History Parkhill 1894 Threaded pinsand clamp 5
- 6. History Lambotte 1902, selftapping threaded pins, rod, adjustable clamps 6
- 7. History In 1917. Humphryis the 1st man who uses threaded pins, but he uses only one pin above fracture and one below the fracture site. In 1948, Charnley popularized his compression device to facilitate arthrodesis of joints. 7
- 8. History In 1966 and1974,Anderson et al. uses transfixing pins incorporated into a plaster cast for management of large series of tibial shaft fractures . 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. 8
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- 10. Types Type -1 UnilateralUniplanar Type -2 Uniplanar Bilateral. Type -3 ◦ Classical Bilateral Biplanar. ◦ Delta Unilateral Biplanar According to Planes: ◦ Planner: Hoffman’s, orthofix etc. ◦ Circular: Ilizarov 10
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- 13. For periarticuler fracture Thin wire and ring near joint Schanz pin in shaft 13
- 14. Intrinsic stability of frame(S) EX I S = ----------L E=modulus of elasticity =constant I= moment of intertia= constant L= distance of frame from axis. 14
- 15. Biomechanics Thus Stability isinversely proportional to the distance of the assembly from the bone (closer the frame to bone -more stable assembly) 15
- 16. To increase stabilityof bone –pin interface 1. Adequate no. of pins in each fragments ( 2 for most bone & 3 for femur) 2. Increase pin pitch (3.5mm) 3. Increase size of pin 16
- 17. Basic Components A. SchanzPin 4. 5mm short threaded for diaphysis 5/6 mm long threaded for metaphysis B. Clamps 1) Universal Clamps 11) Open ended clamps 111) Transverse pin adjusting clamps 1v) Tube to tube clamps. C. Tubes 11mm 17
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- 19. Required instruments Drill :Hand Drill Drill bits – Long drill bits( 200mm) 3.5 and 4.5 mm diameter. Triple guide assembly , consist of trocar(3.5mm), inner Sleeve and outer sleeve T Handle for insertion of the Schanz pin. 19
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- 23. Indications severe open fractures(Gustilo 3b,3c) closed fractures with severe soft-tissue injury or severely comminuted fractures or floating knee # open fractures involving bone loss compartment syndrome after fasciotomy adjunct to internal fixation limb lengthening or bone transport fracture associated with severe burn Arthrodesis Infected fractures or nonunions Correction of malunions Fixation after radical tumor excision with autograft or allograft 23
- 24. External fixator astemporary device Soft tissue healed If the soft-tissue injuries have healed satisfactorily within 2 weeks without pin track infection, the external fixation can be removed. It is then replaced by internal fixation with either a plate or a nail. 24
- 25. External fixator astemporary device Soft-tissue problems persist Remove the external fixator Temporarily stabilize in cast Let pin track infection heal If there is pin track infection, using a nail (especially with reaming technique) can lead to intramedullary infection. In this case plate osteosynthesis is clearly preferable. 25
- 26. External fixation asfinal fixation 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. In children fracture healing is often completed within a period of approximately 6-8 weeks. 26
- 27. External fixation asfinal fixation 27
- 28. Advantages Less damage toblood supply of bone Minimal interference with soft-tissue cover Useful for stabilizing open fractures Rigidity of fixation adjustable without surgery Good option in situations with risk of infection Requires less experience and surgical skill than standard ORIF Quite safe to use in cases of bone infection 28
- 29. Complications Pin Track Infection. NeurovascularImpalement. Muscle or Tendon Impalement Delayed Union. Compartment Syndrome Re-fracture Limitation of further Alternatives. Cosmetic Problem 29
- 30. IM nails vsExternal 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”. 30
- 31. Site of insertion Openfracture Tibia and Fibula Open fracture Femur Floating Knee Open Fracture Humerus Communited fracture distal Radius Pelvic fracture. 31
- 32. Tibial Safe Zone Proximalpart of the proximal tibia 32
- 33. Tibial Safe Zone Proximal3rd distal to tibial tuberosity 33
- 34. Tibial Safe Zone MidShaft 34
- 35. Tibial Safe Zone Distal3rd distal of tibial Shaft 35
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- 37. Schanz Pin insertionfor Metaphysis 37
- 38. After adequate skinincision Insert assembled triple sleeve and push onto bone. 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. 38
- 39. Technique of Applications Removethe trocar, insert the long 3.5 drill bit through inner sleeve and drill through both cortices. Withdraw the drill bit along with inner sleeve. Insert 4.5 mm drill bit through the outer sleeve and over drill the near cortex. 39
- 40. Technique of Applications Placea 4.5 mm Schanz Pin onto the T-handle. Introduce through the outer sleeve and insert into the bone till the thread are securely engaged into the far cortex. 40
- 41. Technique of Applicationsfor metaphysis Insert the triple sleeve through an adequate skin incision and push onto bone. Drill the both cortex bone with 3.5 mm drill bit. Insert 5mm long threaded Schanz Pin with T-handle. 41
- 42. Application of externalfixator Place the most distal Schanz Pin using the standard technique. Place a universal clamp onto the schanz pin Fix a 11mm tube in this clamp, so that it is posterior to the schanz pin. 42
- 43. Application of externalfixator… Slide 3 Universal clamps onto this tube. Insert most proximal schanz pin. Reduction of bone. Fix the proximal schanz pin. 43
- 44. Application of externalfixator… Insert the 3rd 4th schanz pin accordingly. Connect frame with another Tube. Second tube is clamped in “mirror image” fashion after prestressing. 44
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- 46. In the OT Openfracture Gustilo IIIB with Fixator 46
- 47. In the OT FlapCoverage 47
- 48. Built as uni-and multi- plane constructs Areas prone to soft tissue problems ◦ Knee ◦ Ankle ◦ Open Fractures When multiple injuries prevent definitive fixation 48
- 49. Spanning ex- fixif axially unstable 49
- 50. External fixation can becombined with internal fixation 50
- 51. Temporary stabilization oflong bone injuries in unstable patient ◦ ◦ ◦ ◦ ◦ Minimally invasive Decreases bleeding Pain control Nursing care “Damage control” 51
- 52. Certain intraarticular fracturecan be treated by ex-fix using traction by fixator on the capsule and ligamentous structure around the joint. This work well for comminuted intraarticular fracture of the distal radius. 52
- 53. Temporary stabilization forclosed fractures Controls hemorrhage Decreases clot shear Open pelvic fractures 53
- 54. Other External Fixators IlizarovExternal Fixator. Universal Mini external Fixator. Modular external Fixator 54
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- 58. Micro-motion at fractureSite. It is bi-lateral More lighter than traditional External Fixator. More ligamentotasis Less chance of pin tract infections. 58
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- 60. The modular externalfixator allows the surgeon to reduce the fracture by manipulation and to hold the reduction. Free pin placement allows the surgeon: ◦ to spread both pins, thereby increasing frame stiffness, ◦ to position pins according to the fracture pattern or soft-tissue injury, ◦ to avoid injury to nerves or vessels. 60
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- 62. Hoffman II externalfixation system Synthes Tibial exfix Adjustable 62
- 63. External Fixator isa good device for the management of open and complicated fractures. Surgeon must have knowledge about neurovascular plane of the involved Organ. Skill for applying the fixator. 63
- 64. Campbell’s operative orthopedics Wheeless' Textbook ofOrthopaedics http://www.wheelessonline.com/ortho Synthes: leading global medical device company. http://us.synthes.com/ AO Foundation. <www.aofoundation.com> 64
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Editor's Notes
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