Treatment modalities for fractures. About Dynamic Compression Plates and a note on Cast Syndrome. For MBBS Undergraduate level

1. EXTERNAL FIXATION
INTERNAL FIXATION
DYNAMIC COMPRESSION PLATES
(DCP)
CAST SYNDROME

2. EXTERNAL FIXATION
 DEFINITION:
An External Fixation is the method of
fixing the fracture with a cluster of pins
connected to external environment.
An external fixator is a device placed
outside the skin that stabilizes bone
fragments with pins or wires connected to
bars.

3. HIGHLIGHTS OF EXTERNAL FIXATION
 PROVIDES A STABLE FIXATION OF FRACTURES
AND JOINTS.
 HELPS IN WOUND CARE AND RECONSTRUCTION
SURGERIES.
 AXIAL COMPRESSION, ROTATION, DISTRACTION,
TRANSLATION AND ANGULATORY FORCES CAN
BE APPLIED.

4. INDICATIONS FOR EXTERNAL FIXATION
 OPEN FRACTURES WITH SEVERE SOFT TISSUE
INJURY.
 CLOSED FRACTURE WITH SOFT TISSUE
COMPROMISE
 FOR FIXATION OF PELVIC FRACTURES
 STABILIZE LONG BONE AND PERIARTICULAR
FRACTURES IN POLYTRAUMA OR FOR DAMAGE
CONTROL IN PATIENTS.
 FOR DEFINITIVE TREATMENT OF SOME
FRACTURES OF LONG BONES AND PELVIS.

5. EXTERNAL FIXATION

6. COMPONENTS OF EXTERNAL FIXATORS
PIN
CLAMPS
EXTERNAL RODS

7. TYPES OF EXTERNAL FIXATORS
UNILATERAL FRAME
BILATERAL FRAME
MULTIPLANE FIXATORS
RING FIXATORS

8. UNILATERAL FIXATOR
SINGLE BAR

9. UNILATERAL FIXATOR
‘Z FRAME’

10. BILATERAL FIXATOR

11. MULTI-PLANE FIXATOR

12. RING FIXATOR

13. MODE OF ACTION
A. COMPRESSION FORCES
B. DISTRACTION FORCES
C. NEUTRALIZATION FORCES
D. ANGULAR FORCES

14. BIOTECHNICAL PRINCIPLES OF
EXTERNAL FIXATION
a) PIN SIZE
b) PIN NUMBER
a) PIN PLACEMENT
b) ROD PLACEMENT
c) CLAMPS

15. COMPLICATIONS
 PIN TRACT INFECTION
 PIN LOOSENING
 PIN MIGRATION or PIN BREAKAGE
 IMPALEMENT OF NERVES, MUSCLES, LIGAMENTS & TENDONS.
 CHRONIC OSTEOMYELITIS
 SOFT TISSUE CONTACTURES
 MALALIGNMENT
 MALUNION/NON UNION

16. PIN TRACT INFECTION
MOST COMMON COMPLICATION
OCCURS WHEN INADEQUATE
MEASURES ARE TAKEN TO KEEP
THE POINT OF ENTRY AND
SUTURES AROUND THE PINS
CLEAN AND ASEPTIC.

17. INTERNAL FIXATION
 IN THIS METHOD THE FRACTURE, ONCE
REDUCED ,IS HELD INTERNALLY WITH THE HELP
OF SOME METALLIC OR NON-METALLIC DEVICE
(IMPLANT).
 THESE IMPLANTS ARE MADE OF HIGH
QUALITY STAINLESS STEEL TO WHICH BODY IS
INERT.

18. INDICATIONS
WHEN A FRACTURE IS SO UNSTABLE THAT IT IS TO
DIFFICULT TO MAINTAIN IT IN AN UNACCEPTABLE
POSITION BY NON –OPERATIVE MEANS.
AS A TREATMENT OF CHOICE IN SOME FRACTURES
IN ORDER TO SECURE RIGID IMMOBILISATION AND
TO ALLOW EARLY MOBILITY OF THE PATIENT.
WHEN IT HAS BEEN NECESSARY TO PERFORM OPEN
REDUCTION FOR ANY OTHER REASON SUCH AS AN
ASSOCIATED NEUROVASCULAR SURGERY.

19. METHODS
 STEEL WIRE
 KIRSCHNER WIRE
 INTRA MEDULLARY NAIL
 SCREWS
 PLATES AND SCREWS
 SPECIAL FRACTURE SPECIFIC IMPLANTS
 COMBINATIONS

20. STEEL WIRE
 GAUGE : 18 or 20
 USED FOR INTERNAL FIXATION OF SMALL
FRACTURES
 EXAMPLE: FRACTURE OF PATELLA
HOLDING COMMINUTED FRAGMENTS

21. KIRSCHNER WIRE
 Kirschner wires or K-wires or pins are sterilized,
sharpened, smooth stainless steel pins.
 They come in different sizes and are used to hold bone
fragments together (pin fixation) or to provide an anchor
for skeletal traction.
 The pins are often driven into the bone through the skin
(percutaneous pin fixation) using a power or hand drill.
 They also form part of the Ilizarov apparatus.

22. INTRA MEDULLARY NAIL
 IT IS A HOLLOW ROD MADE OF STAINLESS STEEL.
 IT IS INTRODUCED INTO THE MEDULLARY
CAVITY OF LONG BONES SUCH AS FEMUR AND
TIBIA.

23. SCREWS
 USED FOR FIXING SMALL FRAGMENTS OF THE
BONE TO THE MAIN BONE.
 EXAMPLE : FIXATION OF MEDIAL MALLEOLUS.
 TYPES ARE CORTICAL AND CANCELLOUS

24. PLATES AND SCREWS
 THIS IS A DEVICE WHICH CAN BE FIXED ON THE
SURFACE OF THE BONE WITH THE HELP OF SCREWS.
 THEY ARE AVAILABLE IN DIFFERENT THICKNESS,
SHAPE AND SIZES.

25. SPECIAL FRACTURE SPECIFIC IMPLANTS
 THEY INCLUDE SPECIAL DEVICES USED IN
PARTICULAR FRACTURES
 THEY INCLUDE:
SP NAIL PLATE - INTER TROCHANTRIC FRACTURE
DYNAMIC HIP SCREW (DHS) - INTER TROCHANTRIC FRACTURE
CONDYLAR BLADE PLATE – CONDYLAR FRACTURE OF FEMUR
T PLATE - CONDYLAR FRACTURE OF TIBIA
SPOON PLATE – FRACTURE OF LOWER END OF TIBIA
COBRA PLATE - HIP ARTHRODESIS

26. ADVANTAGES AND DISADVANTAGES
ADVANTAGES DISADVANTAGES
 ALLOWS EARLY MOBILITY
OF THE PATIENT OUT OF
THE BED & HOSPITAL.
 JOINTS DO NOT GET STIFF
AND MUSCLE FUNCTION
REMAINS GOOD.
 COMPLICATIONS WITH
CONFINEMENT OF THE
PATIENT TO BED ARE
AVOIDED
 INFECTION & NON-
UNION
 NEEDS A TRAINED
ORTHOPAEDIC SURGEON
 FREE AVAILABILITY OF
IMPLANTS & A GOOD
OPERATION THEATRE.

27. DYNAMIC COMPRESSION PLATE
IN DYNAMIC COMPRESSION PLATES (DCP) SCREW HOLES ARE
DESIGNES TO UTILIZE GLIDING PRINCIPLE WITH THE INCLINED
CONTOUR OF THE SCREW HOLES AND THE SLOPE ON THE
UNDERSIDE OF THE SCREW HEAD.
AS THE SCREW IS TIGHTENED, ITS HEAD IS GUIDED BY THE
CONTOURS OF THE SCREW HOLE IN SUCH A WAY THAT THE HEAD
GLIDES TOWARDS THE CENTRE OF THE PLATE UNTIL THE DEEPEST
PORTION OF THE WHOLE IS REACHED.
AS A RESULT OF THIS, THE BONE FRAGMENT INTO WHICH THE
SCREW IS BEING DRIVEN INTO, IS DISPLACED AT THE SAME TIME
AND IN THE SAME DIRECTION PROVIDING RIGID COMPRESSION.
IT IS CALLED DYNAMIC BECAUSE THE BONE FRAGMENT MOVES
WHEN THE SCREW IS TIGHTENED.

28. DYNAMIC COMPRESSION PLATES
ADVANTAGES DISADVANTAGES
 LESS SURGICAL EXPOSURE
THAN THE CONVENTIONAL
SURGERY.
 SCREW & PLATE FIT
CONGRUENTLY IN ANY
POSITION.
 SCREW MAY BE INSERTED IN
ANY ANGLE.
 ALL OTHER ADVANTAGES OF
RIGID FIXATION.
 HEALS BY PRIMARY
INTENTION HENCE CALLUS
IS NOT SEEN ON
RADIOGRAPHS.
 POOR FRACTURE
WELDING,AS THERE IS NO
EXTERNAL CALLUS.
 EXCESSIVE COMPRESSION
CAUSES OSTEONECROSIS.
 REFRACTURE IS COMMON
AFTER REMOVAL

29. LIMITED CONTACT DYNAMIC
COMPRESSION PLATE (LC-DCP)
 LC-DCP IS A DYNAMIC
COMPRESSION PLATE WITH LIMITED
CONTACT TO THE UNDERLYING
BONE WHICH MINIMIZES
DISRUPTION TO PERIOSTEAL
CAPILLARY NETWORK AND THE
FRACTUE ZONE.
 ALSO IT HAS MORE UNIFORM
BENDING CHARACTERS THAN AN
ORDINARY DCP DUE TO LESS
INCLINATION TO BEND IN THE AREA
OF HOLES IN THE PLATE.

30. CAST SYNDROME
 ALSO KNOWN AS CAST DISEASE
 IT IS DUE TO THE COMPLICATION OF PLASTER OF PARIS.
 UNPLEASANT FACTS OF CAST DISEASE
1) MUSCLE ATROPHY
2) OSTEOPOROSIS
3) JOINT STIFFNESS
4) SKIN BREAKDOWN
5) COMPATMENT SYNDROME
6) BLISTER FORMATION

31. THANK YOU