(9)external fixation indications and techniques(bonatus)
DESCRIPTION
(9)External Fixation Indications and Techniques(BONATUS)TRANSCRIPT
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External FixationIndicationsand Techniques
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ObjectivesIdentify the following as they pertain to external fixation:Advantages & disadvantagesIndicationsTypes of framesBiomechanics stabilityPre-operative planningCommon complications
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External FixatorA device placed outside the skin that stabilizes bone fragments with pins or wires connected to barsRelative stability Healing with callus
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External FixationAdvantagesMinimal damage to blood supply Minimal damage to soft tissuesFixation is away from site of injuryGood option when significant infection risk
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External FixationDisadvantages
Restricted joint motionPin tract infectionCumbersome Inadequate stability for certain fractures
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IndicationsMost commonly used: TibiaDistal radius
Less commonly used:FemurHumerus Forearm
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IndicationsOpen fracturesClosed fractures with soft tissue compromisePeriarticular fracturesPolytrauma/Damage controlPelvic fracturesChildrens fractures
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Open FracturesAvoids injury siteAvoids additional injury to soft tissues and vascularity
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Open Fractures
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Open FracturesSegmental bone loss
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Open FracturesFractures needing nerve or vessel repair
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Closed Fractures with Soft Tissue Compromise
SwellingFracture blisters
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Closed Fractures with Soft Tissue Compromise
Crush injuriesBurns
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Closed Fractures with Soft Tissue CompromiseCompartment syndrome
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Periarticular FracturesSevere fractures with joint involvement and shaft extension
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Periarticular Fractures Spanning ex-fix if axially unstable
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Periarticular FracturesHybrid Fixator:Thin wires near jointPins (Schanz Screws) in shaft
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Periarticular FracturesReduce and fix the joint surfaceSpan the diaphyseal segment without disturbing soft tissues
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Periarticular FracturesExternal fixation can be combined with internal fixation
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PolytraumaTemporary stabilization of long bone injuries in unstable patientMinimally invasiveDecreases bleedingPain controlNursing careDamage control
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Pelvic FracturesTemporary stabilization for closed fracturesControls hemorrhageDecreases clot shear
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Pelvic FracturesOpen pelvic fractures = The lethal injury
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Pelvic FracturesQuick applicationOpen or percutaneous pin insertionEasily removed for definitive ORIF
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Childrens FracturesFemoral fracturesOne alternative to weeks of skeletal tractionUsed less with use of flexible nails
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Childrens FracturesPin placement must avoid growth plateWatch for pin tract infectionOccasional joint stiffness
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External FixationFixator construct will depend on treatment strategy: Emergency care Provisional care Definitive care
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External Fixator ConstructsUni-planeBi-planeMulti-planeRing
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Uni-plane Bi-plane Multi-plane
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Uni-plane FixatorSingle Bar
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Uni-plane FixatorZ Frame
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Uni-plane FixatorDouble Stacked
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Bi-plane Fixator
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Multi-plane Fixator
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Spanning External Fixation
Built as uni- and multi- plane constructsAreas prone to soft tissue problemsKneeAnkleOpen FracturesWhen multiple injuries prevent definitive fixation
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Spanning Ex FixAdjunct to Internal FixationTemporaryDefinitive
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Increase StabilityPinsLarger diameterMore pins Closer to fracture site
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Increase StabilityBars:Closer to limbMore barsSecond plane at right angle to decrease torsion (twisting)
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Increase StabilityRings:Smaller is stifferUse smallest diamaeter ring possible but allow for swellingMore rings = more stable
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External Fixation AnatomySafe pin placementSafe corridors Know your anatomy to safely place pins!
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Intraop SetupCircumferential prep of entire limbRadiolucent tableC-arm
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Intraop SetupAssociated proceduresIrrigationDebridementInternal FixationBone graft
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Intraop SetupAdequate fixator componentsCannulated screwsLarge/small fragment sets
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Intraop TechniqueKeep bars close to bone but. . . allow access for soft tissue careAllow for swellingCan be re-adjusted as needed
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Complications Neurovascular injury Pin loosening Pin tract infection Joint stiffness Malalignment Malunion Nonunion
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ComplicationsPin tract infections:Most common complicationAvoid fracture areaDont burn bone pre-drillInsert pin completelyRelease skin
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ComplicationsKnow where pins are going!
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THANK YOU!
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