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Wheeless' Textbook of Orthopaedics

Wheeless' Textbook of Orthopaedics

C.R. Wheeless MD

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Wheeless' Textbook of Orthopaedics

Transfixation Wire Properties:


- See: 
       - Safe Zone of Pin Insertion:
         Wires Insertion Techniques:

- Wire Characteristics:
       - in general 1.5 to 1.8 mm wires need no incision or drill sheath,
              but larger, 2.0 wires may be inserted w/ sheath thru incision;
              - larger diameter wires will increase stiffness of the frame;
              - generally, the 1.8 mm wire is used for the humerus, tibia, and femur;
              - in smaller patients 1.5 mm wires should be used;
       - wire tips:
              - trocar tip is used for metaphyseal bone;
              - bayonet tip is used for diaphyeal bone;
              - these wires have a special cutting tip so that
                     predrilling is not required;

       - olive wires:
              - used to assist in indirect reduction;
              - wire is inserted w/ goal of applying tension to the ball inorder to
                     pull the fracture into alignment;
              - olive wires require a small incision of skin only;
              - cautions: olive wires may tend to cut thru cancellous bone, resulting
                     in loss of reduction;
              - note: when olive wires are inserted they should be marked inorder that
                     the correct end will be pulled out bone at the time of fixator removal;

       - titanium pins:
              - see: properties of titanium;
              - may have a lower incidence of infection than stainless steel;
              - more flexible than stainless steel, however, use of 6 mm pin brings
                     pin stiffness upto par w/ stainless steel;

- Ring Characteristics:

- Stability of Construct / Position of Pins:
       - see safe zone of pin insertion for tibial frx;
       - wire diameter and wire tension are important factors in frame stability;
       - large fragments require 2 levels of fixation w/ 2 wires (or one wire and
             one half pin) at each level of fixation;
       - short fragments may be fixed w/ one ring w/ a drop wire (in which
             case the insertion pin is offset from the ring by 1-2 cm);
       - stability is increased by having pins transfix bone at right angles at each
             level within anatomic constrainst;
             - if pins are to be crossed at the same level, it is prudent to insert
                   one pin above the ring and another below the ring;

- Pin Attachment to Frame:
     - never bend a pin to meet a frame, but instead, either remove and reinsert
           the pin, or use spacers to attach the pin to the fixator;
     - wires are attached to ring using either cannulated or slotted fixation bolts,
           the choice depending on which bolt minimizes wire bending;
     - w/ one wrench holding the fixation bolt stationary, the remaining wrench tightens
           the fixation nut;

- Wire Tensioning:
     - tensioning is performed thru slotted wire fixation bolt;
     - tensionig is carried out by fixing one end of the wire and tensioning the
           other wire;
     - wires are tensioned between 100-130 kg of force;
     - frame stiffness will be increased by increasing wire tension, which has the
           effect of decreasing motion at the fracture site;

- Post Op:
     - it is essential to check periarticular wires for signs of inflammation or
           superficial infection, inorder to avoid possible septic arthritis;
     - it is essential that the wire tension be checked, since loss of tension will
           result in loss of frame stability;



Transfixation Wire Properties:


- See: 
       - Safe Zone of Pin Insertion:
         Wires Insertion Techniques:

- Wire Characteristics:
       - in general 1.5 to 1.8 mm wires need no incision or drill sheath,
              but larger, 2.0 wires may be inserted w/ sheath thru incision;
              - larger diameter wires will increase stiffness of the frame;
              - generally, the 1.8 mm wire is used for the humerus, tibia, and femur;
              - in smaller patients 1.5 mm wires should be used;
       - wire tips:
              - trocar tip is used for metaphyseal bone;
              - bayonet tip is used for diaphyeal bone;
              - these wires have a special cutting tip so that
                     predrilling is not required;

       - olive wires:
              - used to assist in indirect reduction;
              - wire is inserted w/ goal of applying tension to the ball inorder to
                     pull the fracture into alignment;
              - olive wires require a small incision of skin only;
              - cautions: olive wires may tend to cut thru cancellous bone, resulting
                     in loss of reduction;
              - note: when olive wires are inserted they should be marked inorder that
                     the correct end will be pulled out bone at the time of fixator removal;

       - titanium pins:
              - see: properties of titanium;
              - may have a lower incidence of infection than stainless steel;
              - more flexible than stainless steel, however, use of 6 mm pin brings
                     pin stiffness upto par w/ stainless steel;

- Ring Characteristics:

- Stability of Construct / Position of Pins:
       - see safe zone of pin insertion for tibial frx;
       - wire diameter and wire tension are important factors in frame stability;
       - large fragments require 2 levels of fixation w/ 2 wires (or one wire and
             one half pin) at each level of fixation;
       - short fragments may be fixed w/ one ring w/ a drop wire (in which
             case the insertion pin is offset from the ring by 1-2 cm);
       - stability is increased by having pins transfix bone at right angles at each
             level within anatomic constrainst;
             - if pins are to be crossed at the same level, it is prudent to insert
                   one pin above the ring and another below the ring;

- Pin Attachment to Frame:
     - never bend a pin to meet a frame, but instead, either remove and reinsert
           the pin, or use spacers to attach the pin to the fixator;
     - wires are attached to ring using either cannulated or slotted fixation bolts,
           the choice depending on which bolt minimizes wire bending;
     - w/ one wrench holding the fixation bolt stationary, the remaining wrench tightens
           the fixation nut;

- Wire Tensioning:
     - tensioning is performed thru slotted wire fixation bolt;
     - tensionig is carried out by fixing one end of the wire and tensioning the
           other wire;
     - wires are tensioned between 100-130 kg of force;
     - frame stiffness will be increased by increasing wire tension, which has the
           effect of decreasing motion at the fracture site;

- Post Op:
     - it is essential to check periarticular wires for signs of inflammation or
           superficial infection, inorder to avoid possible septic arthritis;
     - it is essential that the wire tension be checked, since loss of tension will
           result in loss of frame stability;



 
 
 
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