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Surgery Exam 2 > Lecture 7: External Fixation- boring > Flashcards

Lecture 7: External Fixation- boring Flashcards

1
Q

What are advantages of external fixation compared to internal?

A

allows for post op adjustments

minimally invasive

adjustable fracture alignment

can be removed w/o general anesthesia

clamps and rods can be used

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2
Q

Acrylic frames for ESF can be used on ____ bone, but are especially useful in _____ fractures and ____ patients

A

any bone

mandibular fractures

“pocket pets”

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3
Q

Disadvantages of ESF system compared to internal fixation

A

pins penetrate soft tissue- may impair muscles, vessels, nerves, possible entry point for contaminating bacteria

mechanical disadvantage- greater distance from bone

req’s more post op care necessary

not used on aggressive patients

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4
Q

What is a half pin?

A

Basically doesnt go all the way through the leg

threads on one side, always start on friendly side of bone- less muscle and tissue to go through,

half pin threads into bone until full thread of pin is through the far side of far cortex

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5
Q

What is a full pin?

A

BASICALLY goes all the way through the leg

starts on friednly side, push and when see tissue on far side push out then stop, make incision, and then keep going through until thread sare on the outside

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6
Q

What is a type I-a fixation pin?

A

unilateral, uniplanar

all pins in same plane, weak in opp force

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7
Q

What is a Type I-b fixation

A

unilateral, biplanar

two planes neutralize forces

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8
Q

Type I a/b are applicable to what bones? which ones must I-b be modified to be used on?

A

All weight bearing long bones- tibia, radius, femur, humerus

I-b must be modified to be used on femur/humerus

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9
Q

What are the 2 connections used for frames? Which is stronger?

A

traditional linkage

diagonal- stronger

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10
Q

What is IM “tie in” configuration?

A

adds strength when the fixation frame must be placed at great distance away from the bone

useful on femur and humerus

usually included as part of a type I-a or I-b construct

when used on the antebrachium, fixator is applied to the radius,

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11
Q

When is a type II contraindicated?

A

They are NOT applicable on the humerus/femur

they are too close to the trunk

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12
Q

What is a type II configuration?

A

bilateral, uniplanar

most useful on the TIBIA

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13
Q

What is a type III configuration?

A

it is a Type I-a + II

bilateral, biplanar- builds scaffold around 3 sides of the bone

again NOT applicable to humerus/femur

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14
Q

What is meant by minimal emphasis biology/ maximal strength?

A

Has to do with Type II/III configurations

min biology- use full pins strategically, then fill in with half pins

max strength- would use all full pins

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15
Q

What is the key principle of pin diameter?

A

thread diameter 25% of bone diameter-

too large cause fractures, too small doesnt do anything

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16
Q

What is the key principle of appropriate pin number?

A

minimum of 3 per segment, 3 proximal and 3 distal

this distributes force when walking keeping the implant tight

17
Q

What is the key principle of pin placement?

A

place them in mechanically sound bone, try to stay one bone diameter from the fracture to keep intact bone

18
Q

What is the key principle of drilling?

A

pins are applied to pre drilled hoes, use slow speed power insertion

19
Q

What is the key principle of frames?

A

proper frame size and geometry for fracture being fixed

20
Q

What is the key principle of pin/frame lengths?

A

want the optimal, short is best

21
Q

What is the key principle of hygiene?

A

need proper pin tract hygiene until development of granulation tissue

22
Q

What is the key principle of dis-assembly?

A

take advantage of adjustability, “staged dis assembly decrease force as you take it apart

23
Q

What is the key principle of bandaging?

A

need a protective bandage over frame the entire time they have it on

24
Q

Measurements are most accurate in what projection?

A

lateral

25
Q

T/F

Hanging limb technique provides approximate fracture alignment for the femur and humerus but should never be used for the radius or ulna

A

FALSE

opposite is true

26
Q

T/F

it is imperative that radiographs be used and ESF pins are over-layed to determine the correct pin size as part of pre op planning

A

True

27
Q

What two things do you need to pay attention to while drilling?

A

tactile and auditory feedback

28
Q

Because you cannot see your target, what do you need to do to ensure you are in the center of the bone?

A

Drill to bone, walk off either edge to find center, want to start drilling, feel resistance, then punch through, then second resistance, keep spinning and lift hand up

29
Q

T/F

When removing the drill post-drilling pilot hole you must spin in the clockwise direction

A

TRUE

30
Q

What size do you want your pilot hole drill bit?

A

1/10th smaller than the the core diameter of pin, this way the threads will cut into the bone

31
Q

The size of clamp to used is determined by what?

A

the pin diameter

32
Q

What is the difference in drilling between the pilot hole and setting a pin?

A

twist channel in drill bit allows debris to escape, minimizes frictional heat

when setting pins, there is no channel, must go slow to prevent frictional heat, decreases bone death around the pin

33
Q

T/F

To maximize the pin-bone interface, you must make sure that the full diameter of the pin engages the far side of the far cortex

A

True

34
Q

What is the order placement of pins?

A

Far-far, near-near, middle, middle

35
Q

Accurate release incisions are at least __ long

A

1 cm

36
Q

There must be a minimum of __ pins /segment?

A

3

37
Q

LOOK AT TOOMBS REVIEW SLIDE

A

MOST OF IT IS JUST REITERATIONS OF WHAT IS ALREADY COVERED

Surgery Exam 2 (8 decks)

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