plating Flashcards
Biological osteosynthesis principle
bridging plate in multifragmentary diaphyseal fracture
- intermediate fragments untouched
- restores length rotation and angulation
- respects biology of fracture
Why leave several holes of bridging plate empty
less stress at each hole
Impact of sustained pressure on bone
if sustained and not excessive, may lead to osteogenesis
Impact of intermittent pressure on bone
bone erosion
Factors affecting stiffness and stability of ex fix
- shorter distance of rods from bones (the closer to skin, the more stiff)
- number of tubes (the more the more stiff)
- the separation of tubes on the same pins (the further away the parallel rods from each other, the better)
- the number of pins (the more pins the better)
- The wider the pins are separated in each fragment the stiffer the construct
- the closer the pins to the fracture site, the stiffer the construct
- system configuration
System configs for ex fix
Stainless teel or titanium stiffness
Titanium
- less stiff
- susceptible to weakening if pierced by holes or abraided during insertion
Solid vs hollow nails
Solid:
- more stiff
- cannot adapt to curvature mismatch between nail and bone
Hollow:
- provides environment for bacteria to proliferate inside
Factors affecting nail stiffness
- material
- solid or hollow
- slotted or unslotted
- diameter
- thickness of the wall
Tscherne classification of soft tissue injury
Significance of red blisters in fractures
indicates deeper dermal injury
When are blisters overlying fractures safe to operate on
Clear: 3-7 days
haemorrhagic: 10-14 days
What is wrinkle test
squeezing skin over fracture, if wrinkles appear, swelling has settled and safer to operate
What is wrinkle test
squeezing skin over fracture, if wrinkles appear, swelling has settled and safer to operate
Compartment syndrome immediate mx
Release circumferential dressing
Limb at heart level
Re-assess in 30 mins
Open fracture immediate management
- gross debridement
- abx
- pictures
- splint
Which open fractures need immediate operative mx
Vascular compromise
Sewage/farm injury
polytrauma
What to do with bony fragments in open fracture
If you can easily remove them (tug test) that means it was devitalised anyway
Guistillo-anderson classification
When can you consider internal fixation in trauma
if no contamination
And wound could be closed or covered
Plates function and their related stability (absolute vs relative)
Absolute:
- neutralisation
- buttress
- compression
- tenson band
Relative: bridging
Function of lag screw technique
Compression of fracture site
Which forces does the lag screw technique not protect against
Shear
Banding
Torsion
Axial loading