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)

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من • تقديمها و إعدادها تم محاضرات سلسلة من هي المحاضرة هذه , دمشق مشفى في العظمية الجراحة شعبة في المقيمين األطباء قبل

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•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