Operative technique for external fixation. Thomas Beck Allgemeine und Unfallchirurgie Spitalzentrum Oberwallis

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Transcription:

Operative technique for external fixation Thomas Beck Allgemeine und Unfallchirurgie Spitalzentrum Oberwallis

Operative technique of external fixation Basic principles Operative technique & Introduction to the workshop 2 22.10.17

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 3 22.10.17

Basic principles Force translation

Basic principles Force translation

Basic principles Force translation Relative stability

Basic principles Pins Rods Clamps

Basic principles

Basic principles

Basic principles

Basic principles

Basic principles Fixator types: unilateral 12 22.10.17

Basic principles Fixator types: bilateral 13 22.10.17

Basic principles Fixator types: Ring fixator 14 22.10.17

Basic principles Fixator types: Monotube fixator 15 22.10.17

Basic principles Fixator types: Hybrid fixator 16 22.10.17

Basic principles Fixator types: Wallis frame 17 22.10.17

Basic principles Fixator types: hinged

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

Basic principles Stability factors: Pins Pin direction convergent Pins per fragment

Basic principles Stability factors: Rods Rod type (steel or carbon) Rod diameter

Basic principles Stability factors: Clamps Is the weakest link Tube to tube more stable than pin to tube

Basic principles Stability factors: the frame <

Basic principles Stability factors: the frame < <

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

Basic principles Complications: - Pin track infections - Secondary dislocations - Material failure

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

Basic principles

Workshop for external fixation Thomas Beck Allgemeine und Unfallchirurgie Spitalzentrum Oberwallis

Goals: Perform different types of external fixators Understand factors that influence frame stability with different fixator models

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

Distal radius joint spanning fixator (modular) The frame

Distal radius joint spanning fixator (modular) The pins

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

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

ankle joint spanning fixator The frame

ankle joint spanning fixator The pins

ankle joint spanning fixator The pins

ankle joint spanning fixator The pins

ankle joint spanning fixator The pins

ankle joint spanning fixator Discuss with the faculty: Frame type Pins Size Position Reduction technique Stability complications

Proximal tibia hybrid fixator The frame

The pins From proximal to distal

The pins

Proximal tibia hybrid fixator Discuss with the faculty: Frame type Pins Size Position (anatomical structures at risk) Reduction technique Stability complications

tibia shaft modular fixator The frame

The pins From proximal to distal

The pins

The reduction

Additional stability Double rod

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

Stability comparing fixators The frame

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

Stability comparing fixators Discuss with the faculty: Factors influencing fixator stability Pins Rods Clamps

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