Elements of Fracture Fixation

Author: Thakur> Anand J.  

Publisher: Elsevier Health Sciences APAC‎

Publication year: 2012

E-ISBN: 9788131231678

P-ISBN(Paperback): 9788131203385

Subject: R683 fracture, bone damage

Keyword: 一般理论

Language: ENG

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Description

An excellent book covering the biomechanical and clinical aspects of each 'element' of fracture fixation and informs on different effective methods of use in a very concise and lucid manner. Exceedingly valuable for postgraduate students, orthopaedic surgeons and teaching faculties as the book provides the basics and biomechanics of both new and old elements of fracture fixation. The simple sketches and descriptions will help the students and trainees to easily understand the basic and scientific rationales of modern operative fracture treatment. Techniques and implants involved in the management of fracture have been discussed in detail. Provides current knowledge on structure, design, material properties and functions of screws, plates, nails, wires and external fixators. Contains the relevant facts about commonly used implants in a simple and precise language. Essentially deals with metals used in fracture fixation and with the elements in some details. Deals with the structuring of the wreckage of the old bones. Highlights the different instruments used in fracture fixation along with the methods. New to this Edition New chapter on osteoporosis and fracture fixation. New topics included in this edition are: totally novel concepts of screw design and effective plate fixation, methods in osteoporotic bone stabilization, biomechanics of elastic stable intramedullary nail, innovative methods and devices to prevent cutout of sliding hip screw, fresh information on cable fixat

Chapter

Loading modes and fracture patterns

Bending and axial compression

Torsion

Useful definitions

Stress risers

Fracture fixation construct

Compression

Stiffness

Near and far cortex

Stable and rigid fixation

Elasticity

Plasticity

Ductility

Toughness

Brittleness

Spiral

Helix

Working length

Chapter 2 - Metals and materials for fracture fixation

Introduction

Metal working methods and their effects on implants

Forging

Casting

Rolling and drawing

Milling

Cold working

Annealing

Case hardening

Machining

Broaching

Surface treatment

Polishing and passivation

Nitriding

Fabrication of implants

Corrosion and its varities

Galvanic corrosion

Crevice corrosion

Pitting corrosion

Fretting corrosion

Stress corrosion

Intergranular corrosion

Ion release

Standard organizations

Metals in orthopaedic use

Stainless steel

Cobalt-chromium alloys

Titanium alloys

Bioabsorbable polymers

Mechanical properties

Fracture fixation

Clinical relevance

Metal failure

Metal removal

Mixing of implants

Chapter 3 - Bone Screws

Anatomy of a screw

The head

Recess

Countersink

Function

The shaft

Run out

The thread

Core diameter

Pitch

Lead

Outside diameter (thread diameter)

Thread design

The tip

Self-tapping tip

Non-self-tapping tip

Corkscrew tip

Trocar tip

Self-drilling self-tapping tip

Screw types

Machine and wood screws

Cortical and cancellous screws

Self-tapping screw

Non-self-tapping screw

Fully and partially threaded screws

Cannulated screw

The herbert screw

Screw insertion

Drill bit

Principles of cutting instruments

Drill size nomenclature

Heat generation in drilling

Effects of heat on the bone

Factors affecting heat production

Techniques to minimize heat production

Mechanics of drilling

Drill bit failure

The power drill

The drill sleeve

Drilling depth

Pilot hole

Importance of a pilot hole

Measurement of screw length

Tapping

Countersink

Washers

Insertion

Efficiency of screw insertion

Screw removal

Holding power of the screw

Definition

Modifying factors

Screw failure

Clinical considerations

The lag screw

Fixation of a spiral fracture

Chapter 4 - Bone plates

Introduction

Classification

NEUTRALIZATION PLATE

COMPRESSION PLATE

BUTTRESS PLATE

CONDYLAR PLATE

General principles of plate fixation

Screw related factors

Bone related factors

Construct related factors

Effect of compression

Additional principles of plate fixation

Tension band plate

Prebending of plate

Plate fixation of oblique long bone fractures

Minimizing stress concentration at the plate–bone junction

How many screws?

Locked internal fixator plate

Biomechanics of LIFP19

Length of the LIFP

Plate removal

Removal of LIFP

Regional considerations

THE FEMUR

Shaft

Distal femur

The condylar buttress plate

Subtrochanteric fracture of the shaft of the femur

THE TIBIA

THE HUMERUS

Shaft

The distal humerus

The proximal humerus

THE RADIUS AND ULNA

THE HAND AND THE FOOT

Precontoured plates

Clavicle plate

Distal humerus plate

Radial head plate

Olecranon plates

Plates for joint dislocation

Chapter 5 - Intramedullary nailing

Introduction

Principle of splintage

Bone response to nailing

Effect on circulation

Side effects of reaming

Bone healing after nailing

Nail design

Cross-section

Diameter

Curves

Reamed and non-reamed nails

Slotted and non-slotted nails

Interlocking nail

Dynamic locking

Poller screw

Dynamization

Closed and open nailing

Reaming of the medullary canal

Nail removal

Regional considerations

THE FEMUR

THE TIBIA

THE HUMERUS

THE RADIUS AND ULNA

Elastic stable intramedullary nailing

Biomechanics

The femur

The humerus

The tibia

Chapter 6 - Hip fixation

Introduction

Anatomy and forces acting on the hip joint

Causes of hip fracture and associated forces

Classification of hip fractures

Need for fracture fixation

Factors affecting fracture fixation

Fixation devices

FUNCTIONAL SEGMENTS OF A FIXATION DEVICE

FIXED ANGLE NAIL-PLATE

SLIDING HIP SCREW

Supplementary fixations for SHS

SHS LOCKING DEVICE

TROCHANTER SUPPORTING PLATE

BIAXIAL COMPRESSION PLATE

PERCUTANEOUS COMPRESSION PLATE

INTRAMEDULLARY DEVICE

MULTIPLE LAG SCREWS

COMPARATIVE FEATURES OF FIXATION DEVICES

GUIDE WIRE

Hip fracture and osteoporosis

Regional considerations

EXTRACAPSULAR FRACTURE

INTRACAPSULAR FRACTURE

IMPLANT REMOVAL

Chapter 7 - Wire, cable and pins

Introduction

Wire

MATERIAL

Size nomenclature

Classification of sutures

Factors affecting the strength of the wire

Effect of time

Twisted wire

Kinks and knots

Effect on blood supply of the bone

METHODS OF FASTENING

INSTRUMENTS TO HANDLE WIRE

USES OF WIRE

Tension band wiring

INTRODUCTION

GENERAL PRINCIPLES

REGIONAL CONSIDERATIONS

The patella

The greater trochanter of femur

The greater tuberosity of humerus

The medial malleolus

Lateral end of the clavicle

Unusual sites

Cerclage wiring

The tibia and femur

Patello-tibial cerclage

Parham bands

The Patridge band

The Mennen plate

Wire cables

Bilateral cable tension banding

PINS

USES OF KIRSCHNER WIRE

Provisional fixation

Definitive fixation

REGIONAL CONSIDERATIONS

The tibial plateau

Lower end of the humerus

Crossed pins

Two lateral pins

Forearm bones

The radial head

Intra-articular fracture

Arthrodesis

Traction

STEINMANN PIN

Chapter 8 - External fixators

Introduction

Classification

Pin fixator

Ring fixator

Instrumentation

The pin (schanz screw, half-pin are synonyms)

The tip

The thread

The core

The shaft

The Clamp

The central body

Compression-distraction system

Frames

Unilateral uniplanar frame

Unilateral biplanar frame

Bilateral uniplanar frame

Bilateral biplanar frame

Modular frame

Mechanical properties of external fixators

Number of pins

The pin diameter

Distance between bone and support column

Pin-clamp interface

Pin-bone interface

Preloading

Fracture healing with external fixation

Unilateral uniplanar versus bilateral biplanar frame

Unilateral uniplanar frame with varying rigidity

Effect of fracture type on its healing in external fixation

Use of minimal internal fixation

Compression versus no compression under external fixation

Constant rigid versus dynamic compression under external fixation

Plate fixation versus external fixation

Dynamization

Bone grafting in external fixation

Frame construction

Infection and pin loosening

Pin related causes

Soft tissue related causes

Surgeon related causes

External fixator, what next?

Removal of an external fixator

Regional considerations

The tibia

Periarticular fractures of the lower leg

The femur

The radius and ulna

External fixation of the wrist and hand

The humerus

The pelvis

Screw placement in the pelvis

Polytrauma patient

Use of external fixation in children

The developing countries and external fixation

War, natural catastrophe and external fixation

Supplement

Ring fixators

Rings

Half-ring with curved ends

Arches

Ring connections

Bolts and nuts

Nuts

Rods and plates

Rods

Threaded sockets and bushings

Supports, posts, and half-hinges

Washers

Wrenches

Frame assemblage

General

Ring position and force distribution

Ring inclination

Space between skin and ring

Ring position at FON sites

Ring orientation

Wire positioning on the same ring

Wire with stopper

Wire tensioning

Wire fixation

Guide wire

Pulling or traction wire

Schanz screws or half pins

Hinges

Hinge function

Acknowledgement

Chapter 9 - Osteoporosis and fracture fixation

Osteoporosis

Impaction

Buttressing

Splintage

Augmentation

Anchoring methods

EXTRAMEDULLARY IMPLANTS

Sliding hip screw (SHS)

Talon hip compression screw

Locked proximal femur plate

INTRAMEDULLARY IMPLANTS

Load distribution and angle stable fixation

PLATE OSTEOSYNTHESIS UTILIZING ANCHORING ARMS

Tension band wiring

Load dispersing washer

Augmentation techniques using bone substitutes

PMMA

Hydroxyapatite-coated pins

Resorbable polymeric insert

Regional considerations

The proximal humerus

The distal radial

The hip

The lower end of femur

The tibial plateau

Ankle fractures and the distal fibula

Bibliography

Index

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