EXTERNAL FIXATION
INTERNAL FIXATION
 A technique of immobilization in which a series
of transfixing pins are inserted thru the bone and
attached to a frigid externa metal frame.
 Used mainly in the management of open fracture
with severe soft tissue damage
EXTERNAL FIXATION - ADVANTAGES
 Permits rigid support of severely comminuted
open fracture, infected non unions and infected
unstable joints o Facilitates wound care and soft
tissue reconstruction
 Allows early function of muscles and joints
CIRCULAR FIXATION
 Used primarily for limb lengthening
 For correction of angulation and rotation defects
 For treatment of non-union
CIRCULAR FIXATION
 The apparatus consists of thru - the bone tension
wires placed above and below the site being
treated.
 The wires are attached to fixator rings
surrounding the limbs
 The rings are connected to one another by
telescoping rods
CIRCULAR FIXATION
 Adjustments are made daily about 1mm/day) to
stimulate callus and bone formation
 Weight bearing is encouraged
 When desired length or correction is achieved,
the fixator is left in place w/o further adjustment
until bone is healed.
 Patient's compliance is essential
INTERNAL FIXATION
 A technique of immobilization in which pins,
wires or rods are inserted thru the bone and are
kept in the body for a period of time to repair
any damage (usually resulting from fracture).
 Patient is followed up and is scheduled to return
for removal of the pins after thorough evaluation
CLOSED REDUCTION
 A noninvasive procedure where bone fragments
are brought into position by manipulation under
local anesthesia.
OPEN REDUCTION
 A type of procedure where reduction and
alignment of the fracture is done through
surgical incision inside the operating room.
 Stabilization of the reduced fracture with the use
of metal screw, plates, nails or pins
 Done with open reduction
 ?
 ?
 Autologous - from self
 Homologous from another person/ donor
ARTHROPLASTY
 Repair of a joint that may be done through the
use of an arthroscopic or through open joint
repair procedures.
 ls reconstructive surgery to restore joint motion
and function to relieve pain.
 Total joint arthroplasty - or JOINT
REPLACEMENT; is replacement of both
articular surfaces with metal or plastic
component
JOINT REPLACEMENT/ARTHROPLASTY
A. Total Replacement of both articular surfaces within
the joint
B. Partial replacement of a joint surface within the joint.
COMMON TYPES OF ARTHROPLASTY:
 Total hip replacement - the replacement of a
severely damaged hip with an artificial joint.
 Total knee replacement an implant procedure in
which tibial. femoral and patellar joint surfaces
replaced are because of destroyed knee joint.
MENISCECTOMY
 Excision of damage meniscus (fibro cartilage) of
a joint - usually in the knee.
2 Methods of Limb Amputation
Open/ Guillotine
 used to patient who are poor surgical risks -
Wound heals by granulation and secondary
closure follows in about one week
Closed/ Myospastic Flap
 residual limb is covered with skin flap - flap of
skin is sutured posteriorly
Commonly used with vascular diseases
2 Methods of Dressing after Amputation
Soft Dressing
 Secured with elastic bandage
 Permits wound inspection Used to those who are
not allowed early weight bearing
Closed/ Rigid plaster dressing
 Occasionally, the pain worsens with stress, anxiety,
 Applied immediately after surgery with POP and weather changes.
slab
 Controls edema Pain is usually intermittent. The frequency and
 Minimizes pain on movement intensity of attacks usually decline with time
 Shapes residual limb
 Permits attachment of prosthetic extension and Management:
early ambulation
 Anti-depressants (sedatives)
Rehabilitative Care
 Relaxation techniques
 Early mobilization
 Ambulation - with assistive devices  Biofeedback
 Weight - bearing as advised
 Distraction
Prevention of complications:
 Spinal Nerve Stimulation
 Compartment syndrome
 Shock  Vibration therapy
 Atelectasis and pneumonia
 Infection  Acupuncture, others
 Thromboembolism
Compartment Syndrome
 Fat embolism
 others
 Compression of nerves, blood vessels, and
muscle inside a closed space (compartment)
After a Limb Amputation:
within the body.
 Phantom Limb Sensation - or Phantom pain
 leads to tissue death from lack of oxygenation
sensation could be present
due to the blood vessel being compressed by the
raised pressure within the compartment.
 is the sensation that an amputated or missing
limb (even an organ, like the appendix) is still
 Most often involves the forearm and lower leg
attached to the body and is moving appropriately
with other body parts
Management- focuses on release pressure
EXPLANATION:
Vessels are no longer compressed; capillaries are
functional
 When a limb is amputated, many cut nerve
endings are terminated at the residual limb.
Fat embolism
 These nerve endings can become inflamed, and
 an embolism usually develops as a result of
are thought send anomalous signals to the brain.
physical trauma such as fracture of long bones,
soft tissue trauma and burns.
 These signals, being functionally nonsense, are
thought to be interpreted by the brain as pain.
 Symptoms usually, recur 13 days after a
traumatic injury and are predominantly
 occurs when nerves that would normally pulmonary - i.e. Dyspnea, chest pain, etc.
innervate the missing limb because pain
 The syndrome manifests more frequently in
Other symptoms:
closed fractures of the pelvis or long bones
 Warmth Fat embolism symptoms
 Cold  shortness of breath
 Itching  hypoxemia
 Squeezing  neurological - agitation, delirium, or
 Tightness  coma
 Tingling  petechial rash
The missing limb often feels shorter and may feel as
 anemia
if it is in a distorted and painful position.
 Low platelets
Occasionally, the pain worsens with stress, anxiety,
and weather changes.

The missing limb often feels shorter and may feel as

if it is in a distorted and painful position.