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Orthopaedic materials > Esternal Skeletal Fixator - ESF > Flashcards

Esternal Skeletal Fixator - ESF Flashcards

1
Q

What are the three basic elements of ESF?

A

Per cutanous trans osseus pins (ESF pins or K-wires)
Connecting bars
Clamps

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2
Q

Advantages of external skeletal ficators?

A
  • relative easy to apply
    -faster surgical time
  • reduced infection rates
  • faster healing times
  • reduced incidence of delayed or non-union
  • adjustable frame (can de-escalate)
  • wounds can be managed
  • implants can be easily removed
  • generally the systems are economical
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3
Q

Disadvantages of external skeletal fixators include?

A
  • Specliazed equipment
  • less well tolerated by owners
  • pins have to traverse soft tissues
  • frame may fail
  • soft tissue pin tract -> bacteria
  • demanding aftercare
  • ESF can injure patient, owner and environment
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4
Q

Indications for use of ESF?

A

1) open or infected fractures
2) comminuted fractures
3) mandibular fractures
4) fractures of the lower limb
5) correction of angular limb deformidies (hybrid, circular)
6) Immobilization of joints
7) Auxiliary fixation combined with internal repair

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5
Q

What are Ellis pins?

A

Negative threaded pins, with the junction of thread/smooth ending in the medullary canal -> less risk of pin failure

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6
Q

What clamps are available for ESF?

A

KE clamps
Maynard and JAM
IMEX SK
Securos Secur-U clamps

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7
Q

What are the disadvatages of the KE clamp?

A

Once they are assembled on the connecting bar, it is not possible to remove without entirely dissasembling the frame

It is not possible to place positive profile pins through an original KE clamp

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8
Q

What are the advatages of IMEX-SK and Securos Secur-U clamps?

A

Split clamp - allows clamps to be added and removed from ESF without disassembly
Positive profile pins can be placed

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9
Q

What is a Type Ia frame?

A

Unilateral uniplanar, halfpins

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10
Q

What is a Type Ib frame?

A

Unilateral biplanar, halfpins

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11
Q

What is a Type II frame?

A

Bilateral uniplanar, can use full or half pins

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12
Q

What is a Type III frame?

A

Biltaeral and biplanar

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13
Q

What kind of frame can be useful in angular limb deformities?

A

Circular frames - readily adjusted with hinged components and motors

Distraction at 1mm a day (0,5mm increments) untill desired length

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14
Q

At what rate should pins be inserted? what can minimize thermal damage?

A

<140 rpm power drill (if not handchuck)

Saline drip

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15
Q

how many pins should be placed in each fragment?

A

a minimum of two, three or four is ideal

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16
Q

Safe corridor of humerus?

A
17
Q

Safe corridor of radius/ulna?

A
18
Q

Safe corridor of femur?

A
19
Q

Safe corridor of tibia?

A
20
Q

What is wolffs law?

A

The internal architechture and external form of a bone is related to its function and change when that function is altered

21
Q

What is the most common complication of ESF?

A

premature pin loosening

22
Q

How to maximise rigidity with ESF?

A

1) 3 pins per fragment
2) largest pins possible (max 30% of bone diameter)
3) connecting bars close to patient
4) Place pins far-far near near, spacing
5) full pins for comminuted, bilateral, biplanar
6) tie-in intramedullary pin for prox limb fx

23
Q

What is staged dissasembly?

A

conversion of a ridig initial fixation to less rigid, removing parts

24
Q

What is optimal time of staged dissassembly+

A

6 weeks

24
Q

Distance from fracture to pin?

A

half of bone width length away

25
Q

Clamp distance from skin?

A

1cm

26
Q

What can increase resistance to bending and axial compression in type I constructs?

A

Alternating the position of pins on either side of the connecting bar

27
Q

Transarticular external skeletal fixators - useful for? types? consequence of prolonged fication?

A

Useful for periarticular injuries
may be rigid, hinged or flexible
prolonged rigid fication -> DJD
Can be used in emergency to rpevent ongoing trauma

28
Q

What are key points of postoperative care of external fixators?

A
  • careful monitoring of pin tract -> essential to minimise morbidity
  • regular radiographic assessment (every 4-6w)
  • dynamisation (destabilization) at 4-8w following if necessary

Orthopaedic materials (7 decks)

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