Ваш регион

Москва

Wheeless' Textbook of Orthopaedics

Wheeless' Textbook of Orthopaedics

C.R. Wheeless MD

URL
Wheeless' Textbook of Orthopaedics

Knee Fusion using External Fixation

- See: Ilizarov Technique - Discussion: - advantages: - allows arthrodesis in presence of active infection; - external fixation is adjustable; - allows access to the soft tissues; - leaves no longstanding foreign body; - requires little additional soft-tissue dissection; - disadvantages: - non-rigid fixation; - potential cause of neurovascular injury; - requires second procedure for removal of fixator; - Technique: - implant removal; - preparation of the osseous bed; - preparation of the bone ends should expose vascular bone, provide bone apposition, correct limb alignment, and preserve as much bone stock as possible; - when bone cuts are being performed, extramedullary TKR cutting jigs can be used to achieve alignment and bone apposition; - bone resection should be limited to one to two mm of bone from the femur and tibia; - proximal part of tibia is be cut 1st to provide cut that is 90 deg to coronal plane and has the desired degree of posterior slope in the sagittal plane; - limb is aligned in 0 to 5 degrees of valgus, and the distal part of femur is cut parallel to the cut tibial surface; - bone ends should be vascular, stable, apposed, & in correct flexion and valgus; - application of the external fixator; - most external fixators are weak in anteroposterior bending; - addition of an anterior frame with half-pins improves fixation; - for knee arthrodesis, a biplanar Ex Fix w/ sagittal pins and a ventral frame to control anteroposterior bending forces provides improved fixation; - femoral pins: - 3 centrally threaded 5 mm transfixing pins are placed in distal part of the femur from medial to lateral, w/ femoral vessels being avoided; - two anterior half-pins are placed in distal part of femur & two are placed in the proximal part of the tibia and connected to the frame; - increased stability is achieved by placing the anterior pins as far as possible from the arthrodesis site; - bone-grafting; - bone graft is placed about the periphery of the arthrodesis site to allow revascularization from the surrounding soft tissues; - posterior bone graft should be placed before the external fixator is tightened; - Post Op: - external fixation is maintained until clinical union of arthrodesis site has been achieved, usually at ten to twelve weeks; - after external fixator has been removed, a cylinder cast is used for four to twelve weeks or until radiographic union is present; - Example using Ilizarov: Failed total knee arthroplasty treated by arthrodesis of the knee using the Ace-Fischer apparatus. Single plane and biplane external fixators for knee arthrodesis.

Knee Fusion using External Fixation

- See: Ilizarov Technique - Discussion: - advantages: - allows arthrodesis in presence of active infection; - external fixation is adjustable; - allows access to the soft tissues; - leaves no longstanding foreign body; - requires little additional soft-tissue dissection; - disadvantages: - non-rigid fixation; - potential cause of neurovascular injury; - requires second procedure for removal of fixator; - Technique: - implant removal; - preparation of the osseous bed; - preparation of the bone ends should expose vascular bone, provide bone apposition, correct limb alignment, and preserve as much bone stock as possible; - when bone cuts are being performed, extramedullary TKR cutting jigs can be used to achieve alignment and bone apposition; - bone resection should be limited to one to two mm of bone from the femur and tibia; - proximal part of tibia is be cut 1st to provide cut that is 90 deg to coronal plane and has the desired degree of posterior slope in the sagittal plane; - limb is aligned in 0 to 5 degrees of valgus, and the distal part of femur is cut parallel to the cut tibial surface; - bone ends should be vascular, stable, apposed, & in correct flexion and valgus; - application of the external fixator; - most external fixators are weak in anteroposterior bending; - addition of an anterior frame with half-pins improves fixation; - for knee arthrodesis, a biplanar Ex Fix w/ sagittal pins and a ventral frame to control anteroposterior bending forces provides improved fixation; - femoral pins: - 3 centrally threaded 5 mm transfixing pins are placed in distal part of the femur from medial to lateral, w/ femoral vessels being avoided; - two anterior half-pins are placed in distal part of femur & two are placed in the proximal part of the tibia and connected to the frame; - increased stability is achieved by placing the anterior pins as far as possible from the arthrodesis site; - bone-grafting; - bone graft is placed about the periphery of the arthrodesis site to allow revascularization from the surrounding soft tissues; - posterior bone graft should be placed before the external fixator is tightened; - Post Op: - external fixation is maintained until clinical union of arthrodesis site has been achieved, usually at ten to twelve weeks; - after external fixator has been removed, a cylinder cast is used for four to twelve weeks or until radiographic union is present; - Example using Ilizarov: Failed total knee arthroplasty treated by arthrodesis of the knee using the Ace-Fischer apparatus. Single plane and biplane external fixators for knee arthrodesis.
 
 
 
Задать вопрос
Самое популярное

Когда и как потерять девственность

Девственность и куриное яйцо. Какая между ними связь? А такая, что жители племени куаньяма, что живет на границе с Намибией, в древности лишали девочек девственности при помощи куриного яйца. Ненамно

Всё о температуре тела

Температура тела - комплексный показатель теплового состояния организма человека, отражающий сложные отношения между теплопродукцией (выработкой тепла) различных органов и тканей и теплообменом между

10 способов сбросить 5 кг

Небольшие изменения в питании и образе жизни помогут изменить ваш вес. Хотите сбросить лишние килограммы? Не переживайте, вам не придется морить себя голодом или делать изнурительные упражнения. Иссл

О насНаши клиентыРеклама медицинских центровМаркетинг для салонов красоты и SPA
Рейтинг Nedug.Ru - клиники Москвы, клиники Петербурга
© 2000-2016 Nedug.Ru. Информация на этом сайте не призвана заменить профессиональное медицинское обслуживание, консультации и диагностику. Если вы обнаружили у себя симптомы болезни или плохо себя чувствуете, то необходимо обратиться к врачу для получения дополнительных рекомендаций и лечения. Все замечания, пожелания и предложения присылайте на [email protected]