Pins and Nails Flashcards

1
Q

What are pins otherwise known as?

A

K-wires

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2
Q

what kind of point do K wires have?

A

trochar

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3
Q

What parts of the body are commonly pinned?

A
small bones 
upper limb long bones 
children 
foot and hand 
patella
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4
Q

What is flexible wire used to achieve?

A

compression

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5
Q

What is cerclage?

A

encircling or crossing the fragments, pushing them together so that the cleavage lines produced by a fracture are forced together

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6
Q

Other than cerclage, how can wire be used?

A

dynamically as a tension band - utilising the power of surrounding muscles to produce compression at a fracture site - i.e. patellar fractures

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7
Q

What sites of the body are wires used as tension bands?

A

patella
olecranon
medial malleolus

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8
Q

In tension banding, what happens the harder the muscles work?

A

the firmer the fracture is compressed and the more stable it becomes

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9
Q

What important aspect must be considered when using cerclage or crossing bony structures?

A

work beneath the periosteum so that the blood supply will not be damaged

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10
Q

why is wire becoming less popular than it used to be?

A

awkwardness to use

newer techniques more elegant in execution

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11
Q

What is antegrade technique in IM nails?

A

nail is inserted into the bone from one end whilst not disturbing the fracture site at all

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12
Q

What piece of imaging equipment is necessary for antegrade technique?

A

X-ray intensifier

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13
Q

What is retrograde technique?

A

the fracture site was opened by soft tissue dissection and the fracture end delivered into the wound for reaming and insertion of the nail

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14
Q

What is paring off the inner surface of the bone called?

A

reaming

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15
Q

What 3 factors determine effectiveness of a nail?

A

material
how much of the nail is in contact with the bone
dimensions and shape of the nail and wall thickness

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16
Q

Why are titanium nails not used?

A

it is more susceptible to weakening if a hole is drilled across it or if it is abraded - known as notch sensitivity

17
Q

What material are most nails made from?

A

stainless steel

18
Q

What is the working length of a nail?

A

the length of a nail that transmits load from one main fragment of a fractured bone to the other

19
Q

what is the relationship between working length and relive movement at the fracture site?

A

longer length = greater relative movement

20
Q

What is the advantage of having a somewhat flexible nail?

A

it has a little ‘give’ on insertion so that it is easier to put in and permits the nail to deform slightly to conform to the bone shape

21
Q

What is a way of reducing stiffness in a nail?

A

longitudinal slot - makes it much more flexile but that the expense of some bending and torsional strength

22
Q

Why are nails too stiff bad?

A

may damage the bone if there is any discrepancy between shape of nail and bone

23
Q

list some uses of IM nails

A

Transverse and short oblique fractures of the tibial and femoral shafts,

comminuted fractures of tibia and femur, provided cross locking capabilities are
available,

pathological shaft fractures, especially in osteoporotic bone,

delayed or non-union of the shafts of the femur or tibia,

selected open fractures, in the hands of surgeons experienced in the management of trauma.

24
Q

How can the effective working length of a nail be increased?

A

by adding cross screws

25
Q

Give an example of a plate being used together with an IM nail

A

fixing of a femoral neck fracture - lateral side is plated and an Im nail inserted - cross screw acts as a cantilever against the buttressed lateral femoral cortex

26
Q

What are the main functions of cross screws?

A

maintain rotatory control

increase working length