Devices to hold reduction in fracture

Cotical Screws

Cnacellous Screws

Locking Screws

 gives angular stability

 prevents bending because of interference between screw head and plate

Compression plate

  maintains reduction

Bridging Plate

  restores length,axial alignment and rotation

Tension Band

 distraction force changed into compression force

  Plate applied on tension surface

  components - circlage wire , lag screw ,external fixator , plate

Neutralization Plate

 1/3rd tubular plate and lag screw

  lag screw reduces fracture and and holds it. Plate maintains support.


Buttress Plate
Plate perpendicular to force. Resists axial load .

Plate Tyes

 DCP - First used in 1969.

  Disadvantage - foot print - surface of plate in contact with bone.

 later foot print decreased.


Principle  - screw eccentrically applied. On final tightening , screw slides on plate and it moves.

LC-DCP

Locking compression plate

 locking mode - its works as an internal fixator.


Reconstruction Plate

Tubular plate

 3.5 mm reconstruction plate , thickness 1 mm.

 where there is less soft tissue , 1/3rd, 1/4 and 1/2 semitubular plate applied.


IM devices

Ist Gen - Splints , rotation support is minimal.

                e.g. K-Nail , V Nail

2nd Gen - e.g. Russel Taylor , Proximal locking into femoral head

3rd Gen . - Various designs ,
     
                    axial , angular and rotation stability

                  e.g.  Tibial nail with malleolar fixation

                           Gamma nail

                 stability for  torsion , compression, tension and bending
               
                 Statically and dyanmically locked.

                Nailing without reaming and locking - Solid nails

                 Nailing without reaming - Enders Nails , Rush Nails

                 Reaming Advantages

                                      grafts

                                      increases blood supply with reactive hyperaemia

                   Disadvantages

                                     fat embolism
 
                                      infection dissemination

                                     malignancy metastasis

                                     bone necrosis


           External Fixator

                                     Malgaigne in 1840

                                    Unilateral Uniplanar

                                    Uniplanar bilateral


                                   Biomechanics


                                                stability = E * I / L

                                       Stability of fixator depends on
                                       
                                           Pins , rod close to skin , number of rods  and multiple directions

                                            stability factors multiplied in ring fixators .

                                         Schanz Pins
                                               4.5 , 5mm

                                         Clamps - Universal , Open ended

                                          Tubes

                                         Drill , Drill bits - 3.5, 4.5
 
                                         Indications

                                                        Open Fractures  (Gu IIIB and C )

                                                         Soft tissue Injury

                                                          Compartment syndrome with fractures

                                                           As definite choice in some fractures

                                                          Damage control Surgery


                                        Complications

                                                       Pin tract infection
                     
                                                       Late Union

                                                       Compartment Syndrome

                                                       Cumbersome
                                                 
                                                       Tendon, NV injury

                                                         Joint Stiffness




                  Tibia safe zone for schanz pin insertion

                                                      Proximal part of tibia


                                                      proximal third
                         
                                                       mid shaft

                                                        Distal third portion of tibial shaft



                    Ilizarov Fixation

                                                    Gavril Abramovich Iilizarov
                                   

                                                   Principle - Distraction Osteogenesis

                                                      bone distraction in controlled ,gradual way of pulling

                          Indications - like other ex -fixators (Not mention DCS )

                      Components

                                       Rings, Wire , rods , connecting rods , tensioner


Histology at Distraction site

                1 week - fibrous interzone

                  2 weeks - osteoblasts

                 3 weeks  -   new bone in microcolumn

                6 weeks - gap fills and corticomedullary differentiation


            ring removed when bone apparent radilogically and no tenderness on corticotomy site and

           fracture site.






                         

























                                                   


















         
           

















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