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Module #13

Basic Techniques in External Fixation. Module #13. Presentation #1: Indications and Biomechanics. Brian C Toolan , MD Shepard Hurwitz, MD.

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Module #13

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  1. Basic Techniques in External Fixation Module #13 Presentation #1: Indications and Biomechanics Brian C Toolan, MD Shepard Hurwitz, MD Developed by the Surgical Skills Task Force of the American Board of Orthopaedic Surgery (ABOS) in collaboration with the American Academy of Orthopaedic Surgeons (AAOS), and the American Orthopaedic Association (AOA)/Council of Orthopaedic Residency Directors (CORD)

  2. Basic Motor SkillsExternal Fixation Indications & Biomechanics Brian C Toolan MD Shepard Hurwitz MD

  3. External Fixation Operative technique for bony realignment and stabilization in trauma and reconstruction Fractures Limb deformity correction Arthrodesis

  4. Indications Trauma Open Fractures Severe soft tissue injury Comminution Bone loss Temporizing or Definitive means of fixation

  5. Indications Deformity Correction Congenital Post-traumatic Acquired

  6. Indications Reconstruction Arthrodesis Malunion Nonunion Infection

  7. External Fixation Constructs use pins and/or wires connected by clamps to bars and/or rings Constructs used to apply compression, distraction or neutral forces on bone

  8. External Fixation Constructs Uniplanar Biplanar Circular (Ilizarov) Hybrid

  9. Advantages • Simplicity and ease of application • Minimal blood loss • Adjustability after surgery • Access for wound management

  10. Disadvantages • Anatomic structures at risk (Safe Zones) • Pin/Wire site infections • Joint contractures • Prolonged time to bony healing

  11. Safety Factors Pin/Wire should not be in the fracture When drilling go slow as not to burn the bone

  12. Stability Factors Pin/Wire Location Maximal pin span

  13. Stability Factors Pin/Wire Number More pins distribute forces and increase construct stiffness

  14. Stability Factors Pin/Wire Size Torsional strength proportional to its radius4 Pin core diameter < 1/3 bone diameter

  15. Stability Factors Insertion Technique Thread-Shank junction is weakest point Insert pin shank to proximal cortex (2x increased stiffness) (threads = bone width) Off plane pin insertion

  16. Stability Factors Insertion Technique Circular frames Wires placed at 90o stiffer than at 45o Increased wire tension stiffens circular frames

  17. Stability Factors Pre-drilling Low-speed drilling reduces thermal necrosis HA coating increases pullout strength

  18. Carbon Fiber Rods Carbon fiber rods stiffer than steel tubes Lightweight Radiolucent

  19. Stability Factors Lower Bone-Rod distance increases stiffness In-line stacking increases stiffness Second sidebar at 90o to first increases stiffness

  20. Spanning External Fixators Portable Traction Span intra-articular fracture Aide reduction through ligamentotaxis

  21. Compression External Fixators Arthrodesis in the setting of infection

  22. Distraction External Fixators Limb Lengthening through Distraction Osteogenesis 1mm / day Multiplanar corrections

  23. Basic Techniques in External Fixation Module #13 Presentation #1: Indications and Biomechanics Brian C Toolan, MD Shepard Hurwitz, MD Developed by the Surgical Skills Task Force of the American Board of Orthopaedic Surgery (ABOS) in collaboration with the American Academy of Orthopaedic Surgeons (AAOS), and the American Orthopaedic Association (AOA)/Council of Orthopaedic Residency Directors (CORD)

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