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.
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.
Comments
Post a Comment