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EXTERNAL FIXATIONINTERNAL FIXATIONDYNAMIC COMPRESSION PLATES (DCP)CAST SYNDROMEDr Amith Kamath, MBBS

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EXTERNAL FIXATIONDEFINITION: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.

HIGHLIGHTS OF EXTERNAL FIXATIONPROVIDES 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.

INDICATIONS FOR EXTERNAL FIXATIONOPEN FRACTURES WITH SEVERE SOFT TISSUE INJURY.CLOSED FRACTURE WITH SOFT TISSUE COMPROMISEFOR FIXATION OF PELVIC FRACTURESSTABILIZE LONG BONE AND PERIARTICULAR FRACTURES IN POLYTRAUMA OR FOR DAMAGE CONTROL IN PATIENTS.FOR DEFINITIVE TREATMENT OF SOME FRACTURES OF LONG BONES AND PELVIS.

EXTERNAL FIXATION

COMPONENTS OF EXTERNAL FIXATORSPIN

CLAMPS

EXTERNAL RODS

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TYPES OF EXTERNAL FIXATORS UNILATERAL FRAME

BILATERAL FRAME

MULTIPLANE FIXATORS

RING FIXATORS

UNILATERAL FIXATORSINGLE BAR

UNILATERAL FIXATORZ FRAME

BILATERAL FIXATOR

MULTI-PLANE FIXATOR

RING FIXATOR

MODE OF ACTIONCOMPRESSION FORCES

DISTRACTION FORCES

NEUTRALIZATION FORCES

ANGULAR FORCES

BIOTECHNICAL PRINCIPLES OF EXTERNAL FIXATIONPIN SIZE

PIN NUMBER

PIN PLACEMENT

ROD PLACEMENT

CLAMPS

COMPLICATIONSPIN TRACT INFECTION

PIN LOOSENING

PIN MIGRATION or PIN BREAKAGE

IMPALEMENT OF NERVES, MUSCLES, LIGAMENTS & TENDONS.

CHRONIC OSTEOMYELITIS

SOFT TISSUE CONTACTURES

MALALIGNMENT

MALUNION/NON UNION

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.

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.

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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.

METHODSSTEEL WIREKIRSCHNER WIREINTRA MEDULLARY NAILSCREWSPLATES AND SCREWSSPECIAL FRACTURE SPECIFIC IMPLANTSCOMBINATIONS

STEEL WIREGAUGE : 18 or 20USED FOR INTERNAL FIXATION OF SMALL FRACTURESEXAMPLE: FRACTURE OF PATELLA HOLDING COMMINUTED FRAGMENTS

KIRSCHNER WIREKirschner wiresorK-wiresorpinsaresterilized, sharpened, smoothstainless steelpins.They come in different sizes and are used to hold bone fragments together (pin fixation) or to provide an anchor forskeletal 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 theIlizarov apparatus.

INTRA MEDULLARY NAILIT IS A HOLLOW ROD MADE OF STAINLESS STEEL.

IT IS INTRODUCED INTO THE MEDULLARY CAVITY OF LONG BONES SUCH AS FEMUR AND TIBIA.

SCREWSUSED FOR FIXING SMALL FRAGMENTS OF THE BONE TO THE MAIN BONE.EXAMPLE : FIXATION OF MEDIAL MALLEOLUS.TYPES ARE CORTICAL AND CANCELLOUS

PLATES AND SCREWSTHIS 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.

SPECIAL FRACTURE SPECIFIC IMPLANTS

THEY INCLUDE SPECIAL DEVICES USED IN PARTICULAR FRACTURESTHEY 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

ADVANTAGES AND DISADVANTAGES ADVANTAGESDISADVANTAGESALLOWS 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.

DYNAMIC COMPRESSION PLATEIN 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.

DYNAMIC COMPRESSION PLATESADVANTAGES DISADVANTAGESLESS 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

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.

CAST SYNDROMEALSO KNOWN AS CAST DISEASE

IT IS DUE TO THE COMPLICATION OF PLASTER OF PARIS.

UNPLEASANT FACTS OF CAST DISEASE

MUSCLE ATROPHY

OSTEOPOROSIS

JOINT STIFFNESS

SKIN BREAKDOWN

COMPATMENT SYNDROME

BLISTER FORMATION

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