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PRINCIPLES OF EXTERNAL FIXATION

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.

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PRINCIPLES OF EXTERNAL FIXATION

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  1. PRINCIPLES OF EXTERNAL FIXATION 27/06/2006 Dr. Rami Eid

  2. Frame components • Pins. • Clamps and Rings. • Connecting rods.

  3. Pins

  4. Clamps and Rings

  5. Frame Design • One plane. • Two planes. • Ilizarov. • Hybrid.

  6. One plane frame • Resisting sagittal bending. • Decrease compression.

  7. Biplanar frame • Increase frontal bending stiffness. • Increase resistance to torsion.

  8. Multiplanar frame • Obstructs soft tissue access. • More stability and early weight bearing. • Bone defect reconstruction.

  9. Hybrid frame • Rigid fixation of periarticular fractures with less complexity than a ring fixator.

  10. Factors affecting the stability of external fixation

  11. 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.

  12. Complications • Loosening and chronic pain. • Pin site infection. • Deformity, delayed union, nonunion. • Nerves and vessels injuries, joint pyarthrosis. • Soft tissues contracture.

  13. Professor De Bastiani started it all in the 1970’s …. in Verona, Italy

  14. 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

  15. 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

  16. 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

  17. Orthofix • Rapidly applied • Monolateral • Lightweight • Stable • Minimally invasive • Half-pins • Reduction facility • Converted from RIGID to DYNAMIC

  18. Orthofix

  19. The Orthofix (10.000) The special features of this fixator: • The conical screws and their design • The ball-jointed clamps • The telescopic body

  20. Screw Characteristics • Non-transfixing (half-pins) • Conical thread • Self-tapping • Capable of minimal flexion on weightbearing

  21. Screw Characteristics

  22. Callus starts to form even before Dynamization begins

  23. CYCLIC MICROMOVEMENT • The fracture gap opens and closes sequentially.

  24. The Ball-Jointed Clamps • Either straight clamps or T-clamps • 360° of rotation and 36° of angulation in any plane to assist fracture reduction

  25. The Ball-Jointed Clamps

  26. The Telescopic Body • Central body locking nut can be loosened to convert fixator to the DYNAMIC mode

  27. The Telescopic Body

  28. DYNAMIZATION Stable fractures: 2 – 4 weeks Unstable fractures: 5 – 8 weeks

  29. DYNAMIZATION

  30. If Dynamization starts too late • Prolonged healing times • Non-union • Screw loosening

  31. 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)

  32. MoKazem.com • هذه المحاضرة هي من سلسلة محاضرات تم إعدادها و تقديمها من قبل الأطباء المقيمين في شعبة الجراحة العظمية في مشفى دمشق, تحت إشراف د. بشار ميرعلي. • الموقع غير مسؤول عن الأخطاء الواردة في هذه المحاضرة. • 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. Dr. Muayad Kadhim د. مؤيد كاظم

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