For intramedullary pins, pin diameter is based on _____ _____ - if used with just _____ - If used with just _____ - If used with just a _____

adjunct fixation - wires - ESF - plate

Steinmann Pins, ESF's, and Orthopedic Wire (Betance 2) Flashcards by Meleah McMillen

Steinmann pins are often referred to as _______ pins

intramedullary

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What are steinmann pins made from?

round stainless steel rods

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What are some different options for different types of steinmann pins?

Diameter from 1/16 to 1/4 inch (2-5 mm)
Double or single armed
Trochar or chisel point
Smooth or threaded
230-300mm length

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What is the name of the wire that uses small steinmann pins that are usually smooth with a trochar point

Kirschner wires

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What are the disadvantages of steinmann pins? (3)

***Resists bending forces ONLY

cannot maintain bone length

pin migration

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What are some advantages of steinmann pins besides the fact that they involve less surgical time (faster), are smaller to deal with in terms of inventory and inexpensive? (3)

Tech. easier
LESS TISSUE TRAUMA
Easy to place and remove

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What are some different applic. of Steinmann Pins?

\_\_\_\_\_\_\_ placement
Stack pinning
\_\_\_\_\_\_ pinning
Rush pinning
\_\_\_\_\_\_\_ pins
Skewer pin

Intramedullary placement
Stack pinning
Cross pinning
Rush pinning
Diverging pins
Skewer pin

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What is the most common steinnman pin application and where is it placed in the bone?

Intramedullary placement; placed in the medullary cavity

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For intramedullary pins, pin diameter is based on _____ _____

if used with just _____
If used with just _____
If used with just a _____

adjunct fixation

wires
ESF
plate

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Intramedullary pin application only resists these forces only?

Resists bending forces only!

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What bones can IM pins be used in to aid in fracture reduction? (6)

Thoracic limb: Humerus, Ulna, Metacarpal

Pelvic limb: Femur, Tibia, Metatarsal

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What bone in the thoracic limb can we absolutely not use an IM pin in?

Radius!!!!

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What devices are used to place an IM pin? (2)

Jacobs chuck or pin driver

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When using IM pins we avoid _____ surfaces it almost always requires _____ ____ and can be placed _____ or ______

articular; adjunct fixation; normograde or retrograde

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IM pins once again are contraindicated in this bone of the body

radius!!!

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With IM pins, you either cut the end of the pin or leave it long to tie into this device?

External fixator

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What size dogs and type of fracture do we use IM pins for, which size is it contraindicated in?

Indicated for: small breed dogs or cats with a simple stable fracture

Contraindicated for most fractures in medium and large dogs!!!!

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If loretta’s vet recommended IM pins what am I going to do?

Go to a new fucking vet they’re obviously a dumbass who didn’t stay awake listening to Surgery!!!!!

IM pins are contraindicated for most fractures in medium and large breed dogs

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What’s unique about IM pins that we always need todo when using these!!!

Always combine other fixation

Cerclage wire
External fixator
Bone plate

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______ pinning is 2 or more pins to fill the medullary cavity

Stack

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What are some disadvantages of stack pinning that lead to why its rarely praticed?

Clinical results show no advantage
Higher incidence of pin migration
Difficult cutting multiple pins

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Cross pinning uses _____ diameter pins and used for these types of fractures

smaller; simple proximal/distal fractures/ physeal fractures

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Describe the type of forces cross pinning uses and what it engages?

Counteracts rotational and bending forces; engaged both cortices

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For cross pinning the pins cross in the _____ _____ segment

larger fracture

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What type of pin is a medullary pin that does not have a cutting point

Rush pinning

How are rush pins placed and how many point of contact does it have?

Pins are placed in pins and each has 3 points of contact

State the type of pin: The pin is forced to bend to provide dynamic forces on the bone

rush pinning

What type of pin technique is used to stabilize salter harris 1 fractures of proximal humerus and femur

Diverging Pin technique

What must be done when using the diverging pin technique?

must achieve anatomical reduction

Does the diverging pin technique penetrate the joint surface?

NO!

What pin technique uses 3 K wires placed in a triangular fashion

Diverging pin technique

What wire has the largest diameter and the higher tensile strength?

Orthopedic wire

This type of wire is never used as a sole method of fracture fixation except for this instance?

Orthopedic wire; only used solely with interfragmentary

Orthopedic wire is used with ___pins, ____ ____, and plates

IM; external fiaxators

What are the different orthopedic wire uses?

``` Full cerclage Hemicerclage Skewer Pin Tension Band Interfragmentary Wire ```

Cerclage means to ______

encircle

Full cerclage wire can be used for a maximum of ___ fracture segments

Full cerclage wire can only be if the fracture is ________ reduced

anatomically

Full cerclage wire is used in ____ _____ or _____ fractures in which the fracture line is at least ___ times the diameter of the bone

long oblique; spiral; 2

Orthopedic wire is often called _____ wire and is often used to hold fragments in position

cerclage

What do we use in terms of size for full cerclage wire

use the largest diameter wire that seems appropriate to the size and strength of the bone

When placing full cerclage wire place at least ____cm from the fracture ends and ___cm apart

at least (0.5)cm from the fracture ends and (1) cm apart

What do we use to pass and tighten the full cerclage wire around the bone and how many do we have to always at least place?

wire passer; at least 2; wire tightner

We place full cerclage wire ______ to the bone and twist the wire under _____ _____. When we cut the wire we leave __-__ twists or cut leaving ____ twist and then bend it over

perpendicular; tension preload; 2-3; 5

This type of wire is used for short oblique diaphyseal fractures

Hemicerclage wire

Hemicerclage wire ____ rotation in only __ direction

counteracts; 1

State the type of wire where a hole is drilled in proximal and distal aspects of the fracture segment then the wire is passed through the holes and around the IM pin

Hemicerclage wire

This pin us used in short oblique fractures and incorporates full cerclage wire and K-wire?

Skewer pin

Where is the k wire placed in terms of the fracture with skewer pins?

placed on the line that bisects the perpendicular of the long axis of the bone and the fracture

Where is the cerclage wire placed in terms of the fracture with skewer pins?

placed around the k wire and tightened

With skewer pins, the k wire, skewer pin, and full cerclage wire together ultimately _____ the fracture

compresses

What type of wire is indicated for avulsion fractures of tension physes and ______ of _______?

Tension Band wire; closure of osteotomy

With tension band wire 2 ______ forces become _____ forces

2 distractive forces; compressive

State what takes place with tension wire and where the k wire should penetrate?

reduce fragment and 1-2 K wires driven perpendicular to fracture line and parallel to each other k wire should penetrate both cortices

When placing a tension band wire a hole is drilled in the ____ of the bone around the same distance ____ the fracture line and the ___ are placed above. Wire is passed through the hole and around the ends of the pin and back to the other end of the wire creating this shape. Tighten both sides _____. Then bend and twist the ___ wire

cortex; below; pins; figure 8 equally; K

TENSION BAND WIRE INDICATIONS fill in the blank? _____fracture or ______ of the greater ______ "__same as above___" fracture of _____ tuberosity Fracture or osteotomy of the ____ _____ Fracture of tuber ______ Fracture of _____ process of the scapula Fracture or osteotomy of the ______

Avulsion; osteotomy of the greater trochanter Avulsion; tibial tuberosity medial malleolus calcanei acromial olecranon

For interfragmentary wire it is placed like "______" holding bone fragments together

suture

For interfragmentary wire, the hole are drilled in ______fragments and ______

apposing; tightened

The fractures we use interfragmentary wire for are simple fractures of ____, non-_____ _____ bones that ______ well. Also in certain _____ and ______ fractures

flat, non weight bearing, interdigitate well; mandibular and maxillary

State the method of fracture repair: Smooth or threaded pins inserted through cis and trans cortex, pins secured with specialized clamps and connecting bars made of stainless steel, carbon composite, or titanium

External skeletal fixators

This method of fracture repair is a less invasive fixation and has the ability to resist all forces and works well with infection

External Skeletal Fixation

External Skeletal Fixation is not as stable as ____ fixation

plate

Indications for External Skeletal Fixation: Many ___ or ____ fractures Limb ______ When _____ _____ is compromised Need _______ and ______ access When bone purchase is ______ for _____ _______

open; closed Deformities blood supply need stabilization and wound access insufficient for plate arthrodesis

State the pin diameter required for External Skeletal Fixation?

< than or = to 25% of the bone diameter

State the pin angle required for External Skeletal Fixation for smooth pins versus threaded pins?

Smooth pins: 60-65 degrees Threaded pin: 90 degree (to remember The letter T makes this angle)

State the required numbered of pins for External Skeletal Fixation?

at least 2 PER segment

State the required location for pins on the bone for External Skeletal Fixation?

> than or = to 2 pin diameter from the fracture

How do we place the clamps and connecting rods for External Skeletal Fixation?

AS CLOSE to the skin AS POSSIBLE but AT LEAST 1 cm away

SORRY LONG ASS RESPONSE REQUIRED BUT YA WON'T FUCK THIS UP ON THE FINAL SO YOU'LL THANK ME State the bone location indicated for each type of external fixator and the official name combine with the type: Type 1a? Type 1b? Type 2? Type 3?

UNILATERAL-UNIPLANAR Type 1a - Radial fractures (cranial and medial) - Tibia (medial) - Femur and Humerus (Lateral) UNILATERAL BIPLANAR Type 1b - Radius (craniomedial/craniolateral) - Tibia (craniomedial) - Femur and Humerus (lateral) ``` BILATERAL-UNIPLANAR Type 2 (2 "TOO" good for femur and humerus) -Radius (med-lateral) -Tibia (med-lateral) -CANNOT BE USED FOR FEMUR AND HUMERUS ``` BILATERAL BIPLANAR Type 3 (rarely used) - ONLY IN RADIUS ANS TIBIA - to remember type 3: ThRee has T and R in it for radius and tibia

FOR UNILATERAL-UNIPLANAR Type 1a: they are often combined with an ____ pin on the _____(bone) and _____(bone)?

IM pin on femur and humerus

BILATERAL-UNIPLANAR Type 2 CANNOT BE USED on the _____ and ______

femur and humerus

BILATERAL BIPLANAR Type 3 are ONLY USED in the ____ and _____ and connects 2 _____ together

radius and tibia; connect 2 frames together

The femur and humerus cannot be used in this type of external fixator

BILATERAL-UNIPLANAR Type 2

The radius and tibia can only be used in this type of external fixator

BILATERAL BIPLANAR Type 3

IM pin on femur and humerus are often combined with this type of external fixator

UNILATERAL-UNIPLANAR Type 1a:

Complex fractures with no other alternatives use this method of fracture repair, cane general practitioners do this?

Circular/Ring fixators | usually referred to an orthopedic specialist due to complexity of the repair

Besides complex fractures with no other alternatives, state 2 other indications for circular/ring fixators (2)?

Limb shortening or lenghtening procedure Angular deformities

Circular/ring fixators have ___ rings on ____ side of the fracture. __ pairs of wires intersected at ____degrees. Tension by _____

Circular/ring fixators have (2) rings on (each) side of the fracture. (4) pairs of wires intersected at (90) degrees. Tension by (weight)

External Skeletal fixators (fill in the blank) what type of anesthesia? Strict Surgical ______ Placed ____ or _____ (desirable) if fracture adequately ______ Limb often ______ to facilitate reduction and placement ____ ____ ____ accomplished with poly(methyl methacrylate)

(General anesthesia) Strict Surgical ______(asepsis) Placed ____(open) or __closed___ (desirable) if fracture adequately ______(reduced) Limb often (suspended) to facilitate reduction and placement free form fixators

What kinds of things do you do for post op care for external skeletal fixation?

Radiographs immed. post op and at 4 and 8 weeks Leash walks-to prevent joint stiffness, limb edema, disuse atrophy Clean pin ports and bandage changes daily

Complications of external skeletal fixation: -Loosing ___ or ___ -Delayed or __-___ fractures -______ -Loss of ____ ____ -____ or ____ damage (do not place in _____ _____ blindly)

-Loosing pins or wires -non union -Osteomyelitis -joint motion -Nerve/vessel damage do not place in (humeral diaphysis) blindly

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Steinmann Pins, ESF's, and Orthopedic Wire (Betance 2) Flashcards

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