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Orthopedic Hardware and Procedures John Park

Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

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Page 1: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Orthopedic Hardware and

Procedures

John Park

Page 2: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Background

• “Orthopedic Hardware”

– “Hardware” frowned upon

– Often used by orthopedists

Page 3: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Fracture Management

Page 4: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

External fixation

• Materials

– Plaster of Paris

– Fiberglass

Page 5: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

External fixation

• Materials

– Plaster of Paris

Page 6: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

External fixation

• Materials

– Plaster of Paris

• Original casting materials took 2-3 days to harden

• Improved to 6 hours

• Around 1800, British diplomat in Turkey observed

use of Gypsum

• First Plaster of Paris bandages introduced in

1850’s

• Drawbacks: burns, heavy, not waterproof

Page 7: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

External fixation

• Plaster

Page 8: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

External fixation

• Materials

– Fiberglass

Page 9: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

External fixation

• Materials

– Fiberglass

• Fiberglass bandages introduced in early 1970’s

• Benefits: lighter, harder

• 1990’s: waterproof (with special underwrap = $$$)

Page 10: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

External fixation

• Fiberglass

Page 11: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Casting vs Splinting

• Splinting

– Non-circumferential

• 2 layers of fixation with elastic outer wrap

– Allows flexibility in fixation to accommodate

soft tissue swelling

– Immobilize joints proximal and distal to

fracture

– Usually 3-14 days before switch to cast

Page 12: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Casting vs Splinting

• Splint

Page 13: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Casting vs Splinting

• Splint

Page 14: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Casting vs Splinting

• Splint

Page 15: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Casting vs Splinting

• U-Splint

Page 16: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Casting vs Splinting

• U-SplintWith posterior

slab

Page 17: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Casting vs Splinting

• U-Splint

Page 18: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Casting vs Splinting

• Ulnar gutter Splint

Page 19: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Casting vs Splinting

• Coaptation Splint

Page 20: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Casting vs Splinting

• Coaptation Splint

Page 21: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Casting vs Splinting

• Coaptation Splint

Page 22: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Casting vs Splinting

• Coaptation Splint

Page 23: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Casting vs Splinting

• Finger splints

Page 24: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Casting vs Splinting

• Finger splints

Page 25: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Casting vs Splinting

• Casting

– Circumferential

– Immobilize joints proximal and distal to the

fracture

– Usually removed at 4 weeks for radiographs

OOP

– Total length of immobilization usually 6 weeks

Page 26: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Casting vs Splinting

• Cast

Page 27: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Casting vs Splinting

• Short vs Long Arm Casts

Page 28: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Casting vs Splinting

• Long Leg Casts

Page 29: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Casting vs Splinting

• Spica Cast (aka-Hip spica)

Page 30: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Casting vs Splinting

• Thumb spica cast

Page 31: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Casting vs Splinting

• Casting

– Bivalving

• Allows immediate application of cast with flexibility

to accommodate soft tissue swelling

Page 32: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Casting vs Splinting

• Bivalved cast

Page 33: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Casting vs Splinting

• Bivalved cast

Page 34: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Casting vs Splinting

• Bivalved cast

Page 35: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Casting vs Splinting

• Bivalved cast

Page 36: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Casting vs Splinting

• Bivalved cast

Page 37: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Casting vs Splinting

• Cast Fracture!!

Page 38: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Casting vs Splinting

• Cast window– Allows ability to

monitor skin

without loss of

fixation

Page 39: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

External fixator

• External fixator

– Minimally invasive

– Rigid fixation

– The closer the bars are to the body part, the

stronger the construct will be

Page 40: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

External fixator

• External fixator

– Pin

– Clamp

– Bar

Page 41: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

External fixator

• Mexican external fixator

Page 42: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

External fixator

• Mexternal fixator

Page 43: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

External fixator

• External fixator

Page 44: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Internal fixation

Page 45: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

But first…

Page 46: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Nomenclature

• External fixation

– By definition, minimally invasive

• Internal fixation

– Can be either minimally or maximally invasive

Page 47: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Nomenclature

• “ORIF”

– Commonly used to describe the application of

any type of internal fixation to fracture

– This is INCORRECT

Page 48: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Nomenclature

• “ORIF”

– Describes an open surgical procedure where

the fracture site is directly visualized and

reduced by the surgeon

– Internal fixation is then applied across the

reduced fracture

– Thus…OPEN Reduction/Internal Fixation

Page 49: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Nomenclature

• “ORIF”

Page 50: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Nomenclature

• “ORIF”

Page 51: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Nomenclature

• “ORIF”

Page 52: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Nomenclature

• NOT ORIF

Page 53: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Nomenclature

• CRPP

– Closed Reduction/Percutaneous Pinning

– Should be used when fracture is not directly

visualized but is reduced and fixation applied

into the bone

Page 54: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Nomenclature

• CRPP

Page 55: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Nomenclature

• CRPP

Page 56: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Nomenclature

• CRPP

Page 57: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Wires and Pins

Page 58: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Wires

• Kirschner wire (K-wire)

Page 59: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Wires

• Kirschner wire (K-wire)

– Fracture fixation

– Intraoperative joysticks for fx reduction

– Guides for screw placement

– Traction

Page 60: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Wires

• Kirschner wire (K-wire)

Page 61: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Wires

• Kirschner wire (K-wire)

Page 62: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Pin

• Steinmann pin

– Fracture fixation

– Guides for screws

– External fixation

– Traction

Page 63: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Pin

• Steinmann pin

Page 64: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Pin

• Steinmann pin

Page 65: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Pin

• Steinmann pin

Page 66: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Pin

• Steinmann pin

Page 67: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Pin

• Steinmann pin

Page 68: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Pin

• Traction pin

• Traction bow• 2.5cm posterior

and inferior to tibial

tubercle

Page 69: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Pin

• Traction with K-wire

Page 70: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Screws

Page 71: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Screws

• Come in various sizes (length, thickness)

• Basic types

– Cortical

– Cancellous

Page 72: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Screws

• Cortical

Page 73: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Screws

• Cancellous

Page 74: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Screws

Cortical Screw Cancellous Screw

Page 75: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Screws

Cortical Screw Cancellous Screw

Page 76: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Screws

Cortical Screw Cancellous Screw

Page 77: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Screws

Cortical Screw Cancellous Screw

Page 78: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Screws

• Types of cancellous screws

– Fully-threaded

– Partially-threaded (Lag)

Page 79: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Screws

• Cancellous

– Fully-threaded

Page 80: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Screws

• Cancellous

– Partially-threaded (Lag)

Page 81: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Screws

• Cancellous

– Principle of lagging

Page 82: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Screws

• Cancellous

– Principle of lagging

Page 83: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Screws

• Cancellous

– Principle of lagging

Page 84: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Screws

• Cancellous

– Principle of lagging

Page 85: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Screws

• Cancellous

– Principle of lagging

Page 86: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Screws

• Cancellous

– Principle of lagging

Page 87: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Screws

Page 88: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Screws

Page 89: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Screws

Page 90: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Screws

• Bad Lag Screws

Page 91: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Screws

• Specific screw uses

– Interfragmentary

– Plate fixation

– Syndesmotic

– Locking

– Derotation

Page 92: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Screws

• Specific screw uses

– Interfragmentary

Page 93: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Screws

• Specific screw uses

– Interfragmentary

Page 94: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Screws

• Specific screw uses

– Interfragmentary

Page 95: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Screws

• Specific screw uses

– Interfragmentary

Page 96: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Screws

• Specific screw uses

– Plate fixation

Page 97: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Screws

• Specific screw uses

– Syndesmotic

Page 98: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Screws

• Specific screw uses

– Syndesmotic

Page 99: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Screws

• Specific screw uses

– Syndesmotic

Page 100: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Screws

• Specific screw uses

– Locking

Page 101: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Screws

• Specific screw uses

– Locking

Page 102: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Screws

• Specific screw uses

– Locking

Page 103: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Screws

• Specific screw uses

– Dynamization

• Removal of distal locking

screw(s) to allow

compression at fracture

site with weight-bearing

Page 104: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Screws

• Specific screw uses

– Derotation

Page 105: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Screws

• Specific screw uses

– Derotation

Page 106: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Screws

• Specific screw uses

– Derotation

Page 107: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Screws

• Specific screw uses

– Derotation

Page 108: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Screws

• Special screws

– Headless

– Interference

– Dynamic Hip Screw (DHS)

Page 109: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Screws

• Headless-compression with single screw

– Herbert

– Acutrak –variable pitch

Page 110: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Screws

• Headless

– Herbert

Page 111: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Screws

• Interference

Page 112: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Screws

• Interference

Page 113: Orthopedic Hardware and Proceduresbonepit.com/Lectures/Ortho hardware-John Park.pdf · Orthopedic Hardware and Procedures John Park. Background • “Orthopedic Hardware” ... Casting

Screws

• Interference

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Screws

• Interference

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Screws

• Interference

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Screws

• Dynamic Hip Screw

– Large lag screw

attached to side

plate

– Allows dynamic

compression of fx

with weight-bearing

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Internal Fixation Devices

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Intramedullary fixation

• Femur – rod

• Tibia – nail

• Humerus – nail

• Flexible – nail

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Intramedullary fixation

• Principles

– Maintains alignment of fracture fragments

– Does not strip periosteum

– Minimally invasive

• Bone entry site

• Small stab incisions for locking screws

– Can allow for dynamic compression

(dynamization)

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Intramedullary fixation

• Approaches

– Anterograde

• Femur

• Tibia

• Humerus

• Radius

• Ulna

– Retrograde

• Femur only

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Intramedullary fixation

• Femur – rod

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Intramedullary fixation

• Femur – rod

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Intramedullary fixation

• Femur – rod

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Intramedullary fixation

• Femur – rod

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Intramedullary fixation

• Femur – rod

– retrograde

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Intramedullary fixation

• Femur – rod

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Intramedullary fixation

• Femur – rod

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Intramedullary fixation

• Femur – rod

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Intramedullary fixation

• Femur – rod

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Intramedullary fixation

• Femur – rod

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Intramedullary fixation

• Femur – rod

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Intramedullary fixation

• Femur – rod

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Intramedullary fixation

• Femur – rod

– Fractured locking

screw

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Intramedullary fixation

• Tibia - nail

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Intramedullary fixation

• Tibia - nail

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Intramedullary fixation

• Tibia - nail

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Intramedullary fixation

• Tibia - nail

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Special Fixation

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Special Fixation

• Tension band wiring

– Wiring pattern converts tensile force of pull of

muscle/ligament into a compressive force

across fracture

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Special Fixation

• Tension band wiring

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Special Fixation

• Tension band wiring

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Special Fixation

• Tension band wiring

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Special Fixation

• Tension band wiring

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Special Fixation

• Cerclage wiring

– Looped wire provides stabilization in

conjunction with more rigid fixation

– Used for fracture management and in spinal

instrumentation

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Special Fixation

• Cerclage wiring

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Arthroplasties

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Arthroplasties

• Joint replacement

• Total arthroplasty

– Replaces both sides of articulation

• Hemiarthroplasty

– Resurfacing – replaces only 1 surface

– Unipolar – replaces only 1 side of articulation

– Bipolar – replaces both surfaces but only 1

side of articulation

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Arthroplasties

• Total arthroplasty

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Arthroplasties

• Total arthroplasty

– Cemented

– Non-cemented

– Hybrid

• Cement on femoral side only

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Arthroplasties

• Total arthroplasty

– Cemented

– Non-cemented

– Hybrid

• Cement on femoral side only

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Arthroplasties

• Total arthroplasty

– Cemented

– Non-cemented

– Hybrid

• Cement on femoral side only

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Arthroplasties

• Hemiarthroplasty

– Resurfacing

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Arthroplasties

• Hemiarthroplasty

– Unipolar

• Prosthetic head articulates

directly with acetabulum

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Arthroplasties

• Hemiarthroplasty

– Bipolar

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Arthroplasties

• Hemiarthroplasty

– Bipolar

• Small femoral head

articulates with metal cup

(lined with polyethylene)

which fits into native

acetabulum

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Arthroplasties

• Knee arthroplasty

– TKA (cemented, non-constrained)

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Arthroplasties

• Knee arthroplasty

– TKA (cemented, constrained)

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Arthroplasties

• Knee arthroplasty

– Unicondylar knee replacement

• Younger patients, usually medial, done to buy time

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Arthroplasties

• Revision arthroplasty

– Primary arthoplasty removed due to infection

or failure

– Tip-off = long stem

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Arthroplasties

• Revision arthroplasty

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Arthroplasties

• Revision arthroplasty

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Plates

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Tibial

condylar

plate

Blade

plate

Reconstruction

plate

Calcaneal

plate

LISS

plate

Dynamic

compression

plate (DCP)

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Plates

• Multiple functions

– Compression

• Rigid fixation

• Apply compression across fracture

– Neutralization

• Hold fragments in place

• Used in conjunction with lag screws

– Buttress

• Fracture reduced, but used to “lock-in” frags

• Used in tibial plateau

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Plates

• Types of plates

– Dynamic compression plate

• Allows compression across fracture

• Can be any of the 3 types

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Plates

• Types of plates

– Dynamic compression plate

• Locking Compression plate

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Plates

• Types of plates

– Dynamic compression plate

• Low Profile

– Reduced contact with

periosteum may increase

blood flow to fracture

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Plates

• Types of plates

– Dynamic compression plate

• Low Profile

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Plates

• Types of plates

– Tubular plates

• Aka “1/3 tubular”

• Looks like DCP

• Areas of limited ST

– Dist fib, ulna

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Plates

• Types of plates

– Blade plate

• Blade attached to side plate

• Blade through large frags

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Plates

• Types of plates

– Reconstruction plate

• Aka “Recon” plate

• Very malleable, cut to length

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Plates

• LISS plate

– Less Invasive

Stabilization System

– Contoured to specific

bone

– Reduced ST injury

– Distal femur, prox tib

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Spinal Fixation

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Spinal Instrumentation

• Rod

• Laminar hooks

• Pedicle screw

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Spinal Instrumentation

• Rod

• Laminar hooks

• Pedicle screw

• Cerclage wire

– laminar or spinous process

• Cross-link

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Spinal Instrumentation

• 5 basic types

– Distraction/Compression

– Segmental instrumentation

– Derotation or coupled systems

– Pedicle screw (Translational) systems

– Anterior instrumentation

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Distraction/Compression

• Harrington rods

– 1950’s

– Allows distraction of concave

margin of curvature

– Ratcheted rod with

opposed laminar hooks

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Segmental

• Luque rods

– Smooth rod with

multiple wires which

pull spine to rod

– Distributes force

over many segments

(Galveston technique)

(Luque rectangle)

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Coupled systems

• Cotrel-Dubousset

– Aka “CD rod”

– Hooks on rods

– Allows compression

and distraction on

same rod

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Pedicle screw

• Pedicle screws

– 50-75% into body

– Does not rely on intact

posterior elements

(ideal after posterior

decompression)

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Posterior instrumentation

• In practice, use combinations that work

best for each curve

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Anterior Instrumentation

• Allows very strong

lateral forces

– Actually lateral fixation

– Bad results when anterior

– Same principles

• Screw purchase slightly

weaker because body is

mostly cancellous bone

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Anterior Instrumentation

• Interbody devices

– Interbody cage

– Main function is to restore

disc height

– PLIF

• Posterior Lumbar

Interbody Fusion

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Anterior Instrumentation

• Interbody devices

– Interbody cage

– Main function is to restore

disc height

– PLIF

• Posterior Lumbar

Interbody Fusion

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Anterior Instrumentation

• Interbody devices

– Interbody cage

– Main function is to restore

disc height

– PLIF

• Posterior Lumbar

Interbody Fusion

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Anterior Instrumentation

• Interbody devices

– Interbody cage

– Main function is to restore

disc height

– PLIF

• Posterior Lumbar

Interbody Fusion

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Anterior Instrumentation

• Interbody devices

– Interbody cage

– Main function is to restore

disc height

– PLIF

• Posterior Lumbar

Interbody Fusion

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Take Home Points

• Non-circumferential = Splint

• Circumferential with split = Bivalved

• Thin wire that’s bent = K-wire

• Thicker pin not bent = Steinmann pin

• Screw with naked shank = Lag screw

• Screw across fx = Interfragmentary screw

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Take Home Points

• If open surgery = ORIF

• If K-wires only = CRPP

• Femur = rod

• Tibia = nail

• Plate = plate

• Tension bands and syndesmotic screws

are allowed to break

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Take Home Points

• 1 side of joint = hemiarthroplasty

• Both sides = total (beware the bipolar!)

• Rods, hooks, pedicle screws, cross links

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References

• Taljanovic MS, et al. Joint arthroplasties and prostheses.

Radiographics 2003; 23(5): 1295-1314

• Taljanovic MS, et al. Fracture fixation. Radiographics 2003; 23(6):

1569-90

• Foster MR. A functional classification of spinal instrumentation. The

Spine Journal 2005; 5: 682-94

• Calder SJ, et al. Unipolar or bipolar prosthesis for displaced

intracapsular hip fracture in octogenarians. JBJS (Br) 1996; 78B(3):

391-94

• Roberts CC, Chew FS. Radiographic imaging of hip replacement

hardware. Seminars in Roentgenology 2005; 40(3): 320-332

• Miller TT. Imaging of knee arthroplasty. Eur J Radiology 2005; 54(2):

164-77

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References

• Gausepohl T, et al. Fine thread versus coarse thread A comparison

of maximum holding power. Injury Int J Care Injured 2001; 32: SD1-

7

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Web Site Credits

• www.gentili.net

• www.rad.washington.edu/mskbook/orthopedichardware.

html

• www.narang.com

• en.wikipedia.org/wiki/Cast

• www.professionalsafetyrx.com

• www.alphamedical.com

• www.supports4u.com