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20 Cards in this Set
- Front
- Back
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BENEFITS OF ESF
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- Not as expensive
- Preserves blood flow: faster healing - Able to grown bone at ~ 1mm/day for correction of limb length discrepencies - Versatile |
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DISADVANTAGES OF ESF
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- Large amount of inventory
- Difficult for radiographs - 3-4 months aftercare - Complications |
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RING FIX - CIRCULAR ESF
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- Fully and precisely adjustable
- Can adjust multiple planes of deformity |
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TYPES OF ESF
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LINEAR - pins connecting bars, clamps
- Type Ia: Unilateral, connected to bar - Type Ib: Unilateral, biplanar - Type II: Bilateral, all the way through, clamps on each side - Type III: Bilateral, biplanar CIRCULAR - Wires, rings, threaded rods, clamps FREEFORM: Acrylic, polymthylmethacrylate (PMMA) |
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LINEAR ESF PINS
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END THREADED
- Half pins - Both bone cortices but only one skin surface CENTER THREADED - Full pins - Both bone cortices, both skin surfaces - Cortical or cancellous - cancellous has wider thread |
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CONNECTING BAR MATERIALS
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- Carbon Fiber (radiolucent)
- Aluminum (lightweight) |
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CIRCULAR ESF RINGS AND WIRES
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RINGS
- Various Diameters - Different Angles WIRES - Smooth - Olive (teardrop) |
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KE vs. SK
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KE - Under 50lbs only
SK - Much Stronger |
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WHEN TO USE UNILATERAL OR UNILATERAL BIPLANAR
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- Simple Fractures
- Small Dogs and Cats |
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WHEN TO USE BILATERAL AND BIPLANAR
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- Complex fractures
- All fractures in large dogs |
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PIN PLACEMENT RULES
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- 3 to 4 pins per segment
- If using smooth pins, divergent angles to minimize loosening and maximize stiffness - Distance from fracture at least 3x pin diameter or 1/2 bone diameter - Far:far, Near:near - Far pins placed in metaphysis |
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PIN SIZE
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- Short is good, more stiff and shorter moment arm
- Large is good, more stiff. However, larger hole - weaker in torsion and bending. Pin diameter no larger than 20-30% that or bone - Pine bone interface most highly stressed |
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PIN BONE INTERFACE
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- Determines if pins will loosen
- Greater strength and stiffness of fixator-bone combo, more stable interface FACTORS: - Frame configuration - Pin number, size, placement, position and design - Bar placement |
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CIRCULAR WIRE PLACEMENT AND RING PLACEMENT
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WIRE
- 4 wires per bone segment (2 RINGS) - Far:far, near:near - Wire size based on body weight RING: - At least 1 cm from skin |
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WIRE TENSION
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- Essential for secure bone healing
- Use wire tensioner (predetermined amount of tension) - Based on body weight |
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BONE HEALING - GENERAL STAGES
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- Haematoma and granulation tissue
- Cartilagenous callus - Bony Callus and Cartilagenous Remnants - Re-Modeling |
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BONE HEALING - DIRECT OR INDIRECT
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- More rigid frames: Less callus, more primary osteonal reconstruction
- Faster healing for closed reduction - Less sx time, less healing time |
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SAFE CORRIDORS
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- Prevention of iatrogenic neurologic and muscular damage
TIBIA: Entire length accessible craniomedial, lots of soft tissue laterally RADIUS: Med and Cran-med in distal half, Lat in proximal HUMERUS: Proximal- cran-med; Distal- lat; full pins through condyles. BRACHIALIS MUSCLE AND RADIAL NERVE lat. FEMUR: Proximal - lat and cran-med, distal - lat - Biceps femoris and TF-latae may interfere |
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AFTERCARE
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- Prevent swelling distally, wrap whole leg the first week: Can't do for humerus or Femur (ESF bandage)
- BNP @ each tract w/ seperate Q-tip - Non-adhesive bandage, Fluff and stuff - Modified Robert Jones - toes to top of ESF. Compression of tissue - Bumper bandage once swelling has receded. |
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ESF COMPLICATIONS
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Suboptimal frame
Pin/wire loosening (most common) - Reliant on good pin/bone interface - Excessive micromotion - Thermal/mech damage at insertion - Fatigue failure of cortex - Hemmorhage - Neuropraxia - ROM limitations (PT important) - Pin drainage |
