AOTrauma Webinar:  Why Do Patients Get Infection?

May 30, 2017 14:00 CET

Main Presenter: Olivier Borens, MD (Switzerland)
Chat Moderator: Stephen Kates, MD (USA)

Surgical site infections after trauma are debilitating and costly. They are feared by the surgeon and the patient alike. The incidence of this complication can be decreased by proper preoperative, intraoperative, and postoperative management.
The goal of this webinar is to present easy-to-use tools and strategies that will lead to a decrease in the incidence of infection.

More information and registration...

Infection

Executive Editor: Peter Trafton

Authors: Theerachai Apivatthakakul, Surapong Anuraklekha, George Babikian, Fabio Castelli, Antonio Pace, Vajara Phiphobmongkol, Raymond White, Kodi Kojima, Matthew Camuso

Tibial shaft 42-C1 CREF

back to skeleton

Glossary

1 Principles and indications top

Principles

As the ring fixator is an external fixator, it gives relative stability.
As pins are inserted across different planes in a multiplanar fixation, the construct provides great stability.
The stiffness of the construction can vary depending on the configuration of the fixation, the number of rings used, and usage of different types of pins such as K-wires or Schanz screws.
Depending on the assembly, the fracture can be distracted, or compressed, and deformities can be corrected.
A common use for the ring fixator is distraction osteogenesis to correct bone loss, shortening and deformity.


Indications

In fresh fractures, there are several indications for using a ring fixator:

  1. Severe soft-tissue compromise
  2. Multifragmentary fractures
  3. Fractures of the proximal or distal diaphysis, possibly with extension into the metaphysis
  4. Bone loss
  5. Delayed presentation of the fracture (>3 weeks)

2 Fixation top

Proximal ring placement enlarge

Proximal ring placement

The proximal ring is placed at the level of the head of the fibula and parallel to the knee joint.
The first wire is inserted from posterolateral to anteromedial going through the fibular head.
A second wire should be inserted as perpendicularly as possible to the first one from anterior to posteromedial.
A third wire is inserted between these two.


Patient positioning enlarge

Distal ring placement

Place the ring at the level of the proximal end of the syndesmosis.
The first K-wire is inserted from posterolateral to anteromedial through the fibula.
A second wire should be inserted as perpendicularly as possible to the first one from anterolateral to posteromedial.
A third wire is inserted between these two.


Patient positioning enlarge

First intermediate ring

Add a second ring in the proximal fragment of the midshaft, connecting it with 4 rods to the proximal ring.
The distance of this third ring to the fracture will determine the working length. More length means more flexibility while a shorter length will give greater rigidity.
Insert 2 K-wires as perpendicular to each other as possible.

Note:
Using a Schanz screw will make the construct more rigid.


Patient positioning enlarge

Second intermediate ring

Add a second ring in the distal fragment of the midshaft, connecting it with 4 rods to the distal ring.
Again, the distance of this fourth ring to the fracture will determine the working length. More length means more flexibility while a shorter length will give greater rigidity.
Insert 2 K-wires as perpendicular to each other as possible.

3 Reduction and final fixation top

Reduction and final fixation enlarge

Connect the two intermediate rings with 4 rods without completely tightening the bolts.
Reduce the fracture by manipulating the rings. When reduction has been achieved, tighten the bolts.

v2.0 2012-05-13