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
Tube to Tube Clamps
Open Clamp

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

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
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
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