Implants & Instruments for Large External Fixation

1. Implants & Instruments for Large External Fixation

2. Large External Fixation(Ex Fix) Objectives: • Identify the components in the large ex fix set • Review the steps for the assembly of a frame • Make sense of the “tinker toys”

3. Large Ex Fix • Graphic Case • Organization • Sterilization • Protection

4. Large Ex Fix Components • Simple: • Clamps • Bars • Pins

5. Terminology • Bars, Rods and Tubes = used interchangeably • Bars & Rods are solid • Tubes are hollow • Pins & Schanz Screws • Same

6. Large Ex Fix Clamps • Large Open Adjustable Clamp • Connects pins to rods Old Version

7. Large Ex Fix Clamps • Combination Clamp • Connects pins to rods • ‘ ‘ rods to rods

8. Large Ex Fix Clamps • Combination Clamp • Replaces several old & new clamps • Reduces inventory Adjustable Clamps Open Clamp Tube to Tube Clamps

9. Large Ex Fix Clamps • Multi-Pin Clamp • 4 & 6 Positions • Use with Rod Attachment Rod Attachment 6-Position

10. Large Ex Fix Clamps • Blue color = MR Safe • Use with carbon fiber rods

11. Large Ex Fix Bars • 11mm stainless steel tubes • 11mm carbon fiber rods -- radiolucent

12. Large Ex Fix Bars • Straight rods: 50 to 650 mm lengths • Curved rod for pelvic applications • Can be cut if necessary

13. Large Ex Fix Pins • Large clamps accommodate 4.0mm to 6.0mm Schanz Screws • 4.0mm for Small Ex Fix • 4.5 & 5.0mm for tibia and pelvis • 6.0mm for femur & Large Distractor 5.0mm Self Drilling 5.0mm 4.5mm Large Ex Fix Schanz Screws

14. Large Ex Fix Pins • Self-drilling Schanz Screws • 4.0mm, 5.0mm & 6.0mm diameters • Designed with drill bit tip • Most surgeons pre-drill • Not recommended in pelvis due to aggressive cutting flutes

15. Large Ex Fix Instruments • To insert pins: • Trocar & 2 sleeves • 3.5mm drill bit • Irrigate to prevent heat & pin loosening ! 5.0mm outer sleeve for Schanz Screw 3.5mm inner sleeve for 3.5mm Drill Bit Trocar

16. Large Ex Fix Instruments • To insert pins: • Chuck with T-handle through outer 5.0mm sleeve

17. Large Ex Fix Instruments • To add rods and clamps to pins: • 11mm Cannulated Socket Wrench or Ratchet Wrench • Have two of each in set for surgeon and assistant

18. Additional Instruments • Pin cutters • Protect contra-lateral extremity • Allow patient movement

19. Additional Instruments • Rod & pin caps • Color coded to pin diameter

20. Tips for Ex Fix Procedures • Know your surgeon’s preferences: • What type of clamps, rods, pins • What frame design • Keep enough components in graphic case for bilateral procedures • Keep sets sterile for emergencies • Check on Friday afternoon

21. Tips for Ex Fix Procedures • Document components used • For patient charges • For ordering replacement parts • Keep back-up for most frequently used items • Long Schanz Screws -- can always cut shorter • 400 - 450 mm rods for tibia • Combo Clamps • For multiple procedures, assign same team • Psycho-social support for patient

23. Self drilling pins are recommended for use in all applications. True or False? • False. The drilling tip is aggressive for pelvic applications. The surgeon does not want pins to go into the pelvic cavity.

24. Pin tract infection is the most common complication with external fixators? True or False? • True. To prevent: • Insert pins within safe zones • Keep pins clean • Prevent skin from tenting