Operative technique for external fixation. Thomas Beck Allgemeine und Unfallchirurgie Spitalzentrum Oberwallis
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1 Operative technique for external fixation Thomas Beck Allgemeine und Unfallchirurgie Spitalzentrum Oberwallis
2 Operative technique of external fixation Basic principles Operative technique & Introduction to the workshop
3 Basic principles Indications for externeal fixators: Open fractures Damage control surgery (polytrauma) Closed fractures with severe soft tissue injury Periarticular fractures Pelvic fractures Osteomyelitis / infection Callus distraction Fractures in children Correction of malunion
4 Basic principles Force translation
5 Basic principles Force translation
6 Basic principles Force translation Relative stability
7 Basic principles Pins Rods Clamps
8 Basic principles
9 Basic principles
10 Basic principles
11 Basic principles
12 Basic principles Fixator types: unilateral
13 Basic principles Fixator types: bilateral
14 Basic principles Fixator types: Ring fixator
15 Basic principles Fixator types: Monotube fixator
16 Basic principles Fixator types: Hybrid fixator
17 Basic principles Fixator types: Wallis frame
18 Basic principles Fixator types: hinged
19 Basic principles Stability factors: Pins - Pin diameter: stiffness = f (r 4 ) - Pin diameter: 30% of bone diameter - Bicortical pin insertion - Central pin insertion - Pin paralell to fx plane
20 Basic principles Stability factors: Pins Pin direction convergent Pins per fragment
21 Basic principles Stability factors: Rods Rod type (steel or carbon) Rod diameter
22 Basic principles Stability factors: Clamps Is the weakest link Tube to tube more stable than pin to tube
23 Basic principles Stability factors: the frame <
24 Basic principles Stability factors: the frame < <
25 Basic principles Stability factors: the frame A Bone to Rod CLOSE C B Pin to Pin WIDE B C Pin to Fx NEAR A DOUBLE BAR
26 Basic principles Complications: - Pin track infections - Secondary dislocations - Material failure
27 Basic principles Summary: Easy and quick Pin/bar in each fragment. Bar to bar connection Different types of fixators Monoplanar Biplanar Ring, Hybrid Stabilitiy factors complications
28 Basic principles
29 Workshop for external fixation Thomas Beck Allgemeine und Unfallchirurgie Spitalzentrum Oberwallis
30 Goals: Perform different types of external fixators Understand factors that influence frame stability with different fixator models
31 5 different exercises (20min each) Distal radius joint spanning fixator (modular) Ankle joint spanning fixator Proximal tibia Hybrid fixator Tibia shaft modular fixator Stability comparing exercises Groups of two participants
32 Distal radius joint spanning fixator (modular) The frame
33 Distal radius joint spanning fixator (modular) The pins
34
35
36
37
38
39 Distal radius joint spanning fixator (modular) Discuss with the faculty: Frame type Pins Size Position (also according to later volar plating) Reduction technique Stability complications
40 Distal radius joint spanning fixator (modular) Discuss with the faculty: Frame type Pins Size Position (also according to later volar plating) Reduction technique Stability complications
41 ankle joint spanning fixator The frame
42 ankle joint spanning fixator The pins
43 ankle joint spanning fixator The pins
44 ankle joint spanning fixator The pins
45 ankle joint spanning fixator The pins
46 ankle joint spanning fixator Discuss with the faculty: Frame type Pins Size Position Reduction technique Stability complications
47 Proximal tibia hybrid fixator The frame
48 The pins From proximal to distal
49 The pins
50 Proximal tibia hybrid fixator Discuss with the faculty: Frame type Pins Size Position (anatomical structures at risk) Reduction technique Stability complications
51 tibia shaft modular fixator The frame
52 The pins From proximal to distal
53 The pins
54 The reduction
55 Additional stability Double rod
56 Proximal tibia hybrid fixator Discuss with the faculty: Frame type Pins Size Position (anatomical structures at risk) Reduction technique How to enhance stability How to use fixator as help for later nailing
57 Stability comparing fixators The frame
58 The exercise: play with the distances Mod. 1: B: small, C: large Mod. 2: B: wide, C: small Mod. 3: B: wide, C: small, A: wide Mod. 4: Correct Model 3 to A:small C A B Compare stability and discuss with faculty
59 Stability comparing fixators Discuss with the faculty: Factors influencing fixator stability Pins Rods Clamps
60
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