Implants & Instruments for Large External Fixation

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”

Large Ex Fix Graphic Case Organization Sterilization Protection

Large Ex Fix Components Simple: Clamps Bars Pins

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

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

Large Ex Fix Clamps Combination Clamp Connects pins to rods ‘ ‘ rods to rods

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

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

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

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

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

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

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

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

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

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

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

Additional Instruments Rod & pin caps Color coded to pin diameter

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

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

Self drilling pins are recommended for use in all applications 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.

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