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External Fixation Indications and Techniques

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Presentation on theme: "External Fixation Indications and Techniques"— Presentation transcript:

1 External Fixation Indications and Techniques

2 Objectives Identify the following as they pertain to external fixation: Advantages & disadvantages Indications Types of frames Biomechanics stability Pre-operative planning Common complications

3 External Fixator A device placed outside the skin that stabilizes bone fragments with pins or wires connected to bars “Relative stability “ Healing with callus

4 External Fixation Advantages
Minimal damage to blood supply Minimal damage to soft tissues Fixation is away from site of injury Good option when significant infection risk

5 External Fixation Disadvantages
Restricted joint motion Pin tract infection Cumbersome Inadequate stability for certain fractures

6 Indications Most commonly used: Less commonly used: Tibia
Distal radius Less commonly used: Femur Humerus Forearm

7 Indications Open fractures
Closed fractures with soft tissue compromise Periarticular fractures Polytrauma/Damage control Pelvic fractures Children’s fractures

8 Open Fractures Avoids injury site
Avoids additional injury to soft tissues and vascularity

9 Open Fractures

10 Open Fractures Segmental bone loss

11 Open Fractures Fractures needing nerve or vessel repair

12 Closed Fractures with Soft Tissue Compromise
Swelling Fracture blisters

13 Closed Fractures with Soft Tissue Compromise
Crush injuries Burns

14 Closed Fractures with Soft Tissue Compromise
Compartment syndrome

15 Periarticular Fractures
Severe fractures with joint involvement and shaft extension

16 Periarticular Fractures
Spanning ex-fix if axially unstable

17 Periarticular Fractures
Hybrid Fixator: Thin wires near joint Pins (Schanz Screws) in shaft

18 Periarticular Fractures
Reduce and fix the joint surface Span the diaphyseal segment without disturbing soft tissues

19 Periarticular Fractures
External fixation can be combined with internal fixation

20 Polytrauma Temporary stabilization of long bone injuries in unstable patient Minimally invasive Decreases bleeding Pain control Nursing care “Damage control”

21 Pelvic Fractures Temporary stabilization for closed fractures
Controls hemorrhage Decreases clot shear

22 Pelvic Fractures Open pelvic fractures = “The lethal injury”

23 Pelvic Fractures Quick application Open or percutaneous pin insertion
Easily removed for definitive ORIF

24 Children’s Fractures Femoral fractures
One alternative to weeks of skeletal traction Used less with use of flexible nails

25 Children’s Fractures Pin placement must avoid growth plate
Watch for pin tract infection Occasional joint stiffness

26 External Fixation Fixator construct will depend on treatment strategy:
Emergency care Provisional care Definitive care

27 External Fixator Constructs
Uni-plane Bi-plane Multi-plane Ring

28 Uni-plane Bi-plane Multi-plane

29 Uni-plane Fixator Single Bar

30 Uni-plane Fixator “Z Frame”

31 Uni-plane Fixator Double Stacked

32 Bi-plane Fixator

33 Multi-plane Fixator

34 Spanning External Fixation
Built as uni- and multi- plane constructs Areas prone to soft tissue problems Knee Ankle Open Fractures When multiple injuries prevent definitive fixation Animation. 1st click. Title and graphic Bullets come in separately.

35 Spanning Ex Fix Adjunct to Internal Fixation Temporary Definitive
Animation. 1st click. Title and graphic Bullets come in separately.

36 Increase Stability Pins Larger diameter More pins
Closer to fracture site

37 Increase Stability Bars: Closer to limb More bars
Second plane at right angle to decrease torsion (twisting)

38 Increase Stability Rings: Smaller is stiffer More rings = more stable
Use smallest diamaeter ring possible but allow for swelling More rings = more stable

39 External Fixation Anatomy
Safe pin placement “Safe corridors” Know your anatomy to safely place pins!

40 Intraop Setup Circumferential prep of entire limb Radiolucent table
C-arm

41 Intraop Setup Associated procedures Irrigation Debridement
Internal Fixation Bone graft

42 Intraop Setup Adequate fixator components Cannulated screws
Large/small fragment sets

43 Intraop Technique Keep bars close to bone but…
. . . allow access for soft tissue care Allow for swelling Can be re-adjusted as needed

44 Complications Neurovascular injury Pin loosening Pin tract infection
Joint stiffness Malalignment Malunion Nonunion

45 Complications Pin tract infections: Most common complication
Avoid fracture area Don’t “burn” bone – pre-drill Insert pin completely Release skin

46 Complications Know where pins are going!

47 THANK YOU!


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