BIPOLAR PROSTHESIS

0511N MOORE PROSTHESIS

Fenestra +
11
2

[ Thompson prosthesis
also fixed one but no

fenestra ]

omovm + btw head &

neck [ see video]

d
•
Head fixed I neck % mourn in i
,
2
plane - e .

•
Unipolar i. e. mourn only btw acetabulum & head +

@ 1 i btw head btw head

plane - e & neck
a acetabulum
 •
smooth curve @ entire rod INTRA MEDULLARY

INTERLOCKING
NAIL @ FEMUR
** Benefit of interlocking i -
e -
put
screws to fix rod i bone ?
d

gives rotational stability

btw proximal & distal fragments

[ vertical displacement
"

preven of

rod & horizontal / vertical displacmoffragm

achieved even c- out screws merely
just by placing rod ]
INTRA MEDULLARY

INTERLOCKING
NAIL @ TIBIA

angle + called Herzog

bend
d
while in situ , angle points
anteriorly
 CLOVER SHAPED
INTRA
MEDULLARY
NAIL
/
K -

MAIL
( k= kuntscher
o
-

interlocking i.
)
,

not much

rotational
stability
•
A hole is + but that is

not for placement of

interlocking screw
but for extraction
-

.
 My Clover shaped
y
 EXTERNAL FIX ATOR

( components )

( to connect tube to tube in case 1 .

Tube
for
y
eg .
We have to put ext . fixation
on both femur & tibia )
"
3- Tube to tube →

clamp

4. Schanz pin
y l threaded at end )

attach tube c- Schanz

pin
-

•
called universal as can be rotated
or
put @ any dire en
11

2.
Universal
✓

clamp

>

5. spanner
1 to
tighten
screws)
 Tube c-

Schanz pin joined

via
universal
clamp .
 see uses
>
r

BONE NIBBLER
BONECUTTER
 to scoop iliac crest
-

graft
Bothendsharp
+ Single side t

CHIZEL sharp bevelled

-
BONE GOUGE
T
✓

OSTEOTOME <

d
PERIOSTEUM
ELEVATOR
L

Thumb

d Rest
+
BONE HOLDER

FORCEPS

[ little broken ]
lock system +

I
 LC DCPOF
-

larger size

^
1. DCP
2. LC -

DCP
[ Dynamic compress
"

3. Recon plate [ limited contact

plate ]
( or Reconstruct plate) DCP]

t
I smoothie .

e
"

Serrat noserr @ bone

canbebent i. can on

side
side
be used over bony
I
well as *
straight as
press necrosis
.

curved bony surfaces . Prevents Press -

of underlying
necrosis
periosteum in
contact c- plate
I
Poor bone
healing
as periosteum provide
vascular
supply .
 DYNAMIC HIP SCREW ( DHS ) -

components
•
It is a type of sliding hip screw

B. Triple
→
Barrel of -
Reamer ← Diameter
plate "
for lag
Has 3 diameters
screw

c. DHS plate

Diameter for
A.
↑ Lag screw a barrel of

plate
[ Inserted from lateral
neck femur till head]
11 ← shoulder
since screw has to

be inserted bone has

to be

reamed
I

Triple Reamer used

** c- time lag screw keeps sliding backwards in DHS plate when patient do
mobiliz
"
ele This :O T compressive forces on # fragments c- time
-
.

I promote healing [ see video & imagine]

 BONE HOOK

used
during
•
5×1-0

pull bone .
 •
can be fully or partially threaded
SCREWS → •
3- types
✓

CANCELLOUS ,
<
d LOCKING
CORTICAL
d
d • For cancel tous bone
For cortical bone
•
Head also has threading
•
•
wider thread for
•
Used c- locking plate i. e.
•
Narrow threading s Cd gap better hold has
hole for screw also
c- core) "

ftp.qq.E threading :O screw-

11111 head fixes correspondingly

init when screw is
screwed .

Although its an Cancellous

interlocking screw s
g
screw

( used in inlramed
.

interlocking nail but

locking
d
threading is v
screw
cortical)

} →
threading
@ head .
Partially threaded cancel tous
screw .
Holes in plates may be
•
smooth
•
threaded
• combi hole [ both + ]

ANATOMICAL PLATE

OF DISTAL

FEMUR
Id

significance is

just to show

combi hole
i. e. it is a

combi hole plate .

I see next photo ]

Threaded hole >

portion

>

smooth
portion
STAINLESS STEEL WIRE

•
for Tension band
wiring 5

# cerci
age .
 DENHAM PIN

STEINMANN PIN •
threaded @
centre
☐
smooth
good hold @
•

•
use : cortical tract cancellous
as cortical bone bone
can
Used @ calcaneum
•

hold smooth
pin tracn

SCHANZ
PIN
d

used in

ext.fi/ator
K -

WIRE

(K -

Kirschner )
 DRILL BID

☐
to drill bone

before putting screw

bid used is 1- 2mm

smaller than

screw diameter

11

(apply common

sense)
 DEPTH GAUGE

☐
Plate put
u

drilling done c-
drill bid for screw

placement
d
NOW , to see depth of

screw required
according to drill

depth ,
we

use depth gauge .

Reading
←
 BONE TAP

To make
threading
•

in bone
after
drilling so that
screws can be

put
 SQUARE
NAIL

•
used in framed .

fixn of
forearm bones
 CANNULATED CAN CELLO US SCREW [ Ccs]
7- =
canal + for cancel tous bone

11 [ threading like
: cannot be cancel tous screw]
o
directly
screwed into bone
I
put guide wire [ thinner
thank wire
screw
] ,
put over it & wire removed then

•
Use =
# Neck

femur
 ←
One end
lush curved
RUSH NAIL
 DRILL SLEEVE

•
After placing plate while
,

drilling sometimes t

fat / soft tissue

above bone eg Obese.

people
I
if
directly drilling
started ,
9T soft tissue

damage
I
Drill sleeve make soft

tissue aside
while drilling :
.

Prevent soft tissue

damage .
 Annexure - III

Orthopaedic Instruments and Implants

INSTRUMENTS
PERIOSTEUM ELEVATOR
The periosteum elevator is used to elevate the periosteum.
Elevation of the periosteum is necessary in all operations on
the bone because all the important structures such as vessels,
nerves, tendons, etc. are outside the periosteum, and therefore,
once the periosteum is elevated, the surgeon is in a safe plane.
All the muscles of the extremity are attached to the periosteum,
and are lifted off the bone with periosteum.

The periosteum is not elevated in some operations such as

excision of osteochondroma, where the periosteum is excised
with the osteochondroma to avoid recurrence. Periosteum
elevators are of different shapes and sizes depending upon (b) Double-action bone cutter

OSTEOTOME
BONE LEVER
It is used to lever out a bone from the depth of a wound after
blade. Some of the osteotomies commonly performed are: (i)
the bone and the periosteum, and thus retracts the soft tissues.
(ii) corrective osteotomy for deformities such as genu varum
(bow legs), genu valgum (knock knees), etc.

BONE NIBBLER BONE CHISEL

It is like an osteotome except that only one of its surfaces is
various sizes and with different angle of the nose. Some of the
or levelling a bone surface e.g., for levelling excessive callus,
removing an osteochondroma, etc.

are mechanically superior. MALLET

BONE CUTTER
It is used for cutting a bone into small pieces e.g., for cutting BONE CURETTE
This is used for curetting a cavity in the bone or for removing
ends, and with double-action type.

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372 | Essential Orthopaedics

Curettage is performed for: (i) benign tumours such as Plate-holding forceps:

enchondroma, giant cell tumour; and (ii) infections such as suitable size is placed over the fracture and held with the help
tubercular cavity of the bone, osteomyelitis, etc.

BONE GOUGE
This is a concave bladed chisel used for cutting on round

in the bone.

BONE AWL
This is a pointed thin instrument for making a hole in the bone
bone e.g., for tendon attachment.
TRACTION INSTRUMENTS
Kirschner wire: This is thin, straight steel wire, of diameter
fIxation of small bones; (ii) for giving traction e.g., for applying
traction through the olecranon; (iii) for fixing fractures in

Steinmann pin: This is a stout, straight steel rod, of diameter

common sites being upper end of tibia, supracondylar region
of the femur and calcaneum.
BONE HOLDING FORCEPS
There are different types of forceps for holding a bone (Fig- Bohler's stirrup: This is a device used for holding a Steinmann
of the stirrup are used to hold the pin. It is possible to change
forceps. the direction of traction without moving the pin inside the
bone, thus avoiding loosening of the pin.

K-wire stirrup with tensioner: When skeletal traction is to be

applied with the help of K-wire, the strength of the wire is
increased by subjecting it to an axial tension by a tensioner

Skull traction tongs: These are tongs to apply skull traction in

are Crutchfield tongs, Blackburn tongs, etc.

Fergusson's forceps IMPLANTS

NAILS
fractures of long bones. Some of the nails used commonly
are as follows:
This is used for internal fixation of
fracture of the femoral shaft.
This is used for internal
fixation of fracture of the femoral neck.
This is used for internal fixation of fracture of the
tibial shaft.

This is used for fractures of forearm bones.
This is used for some special situations in long
bone fractures.
This is used for internal fixation of inter-
trochanteric fractures of the femur.
Kuntscher's cloverleaf intra-medullary nail (K-nail): Kuntscher, a
German surgeon devised the intramedullary nail for internal
fixation of femoral fractures. The nail is a hollow tube with a
cloverleaf shape in cross section.
The fixation by K-nailing is based on the concept of three
point fixation i.e., when a straight rod passes through the
curved medullary cavity of the femur, it fixes the bone at
cloverleaf shape is designed to give good rotational stability to
which the hook of the extractor is introduced while removing
The size of a K-nail required for a particular case is found by
determining the length and diameter of the nail required. The
length is measured from the tip of the greater trochanter to
it. The diameter is determined on an X-ray, from the width of
the medullary cavity at the isthmus.
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Annexure III | 373
The nail can be inserted by two techniques. In the first
technique, the nail is inserted from the fracture site, and is
hammered proximally till it comes out of the trochanter. The
fracture is reduced and the nail driven back into the distal
fragment. This is called retrograde nailing. In the second
technique, the nail is introduced from the greater trochanter
nail comes up to the fracture site, the guide-wire is removed,
the fracture reduced under vision, and the nail driven home.
removal usually a minimum two years after operation. For
this, the hook of an extractor is engaged into the nail at the
extractor.
Some common complications of K-nailing are: (i) nail getting
stuck; (ii) splintering of the cortex while hammering the nail;
(iii) proximal migration of the nail, leading to bursitis over
its protruding end; (iv) distal migration of the nail leading to
stiffness of the knee; and (v) infection.
Smith-Peterson nail (SP nail):
cannulated triflanged nail is an implant used for internal
fixation of a fracture of the neck of the femur. The advantages
of its triflanged shape are that: (a) it prevents axial rotation
374 | Essential Orthopaedics

of the fragments; and (b) it cuts only a little bone to provide PLATES AND SCREWS
good stability. The nail is cannulated because it is threaded These are used for fixing two bony fragments. Different types
over a guide-wire introduced at the correct site under X-ray of plates are available; these may be heavy duty broad and

Screws may be used alone or in combination with a plate.

Dynamic Hip Screw (DHS): This is a device used for the Different types of screws used in orthopaedic practice are as

slides freely inside the barrel, so that if there is collapse at non-tapping screw is better than a self tapping screw because in
the fracture site, the screw does not cut out of the cortex; it
telescopes into the barrel. interface causing necrosis of the bone, and thus loosening of the
 Annexure III | 375

femur. The acetabulum is replaced by a plastic (polyethylene)

acetabulum cup, and the head by a steel component. The

components are fixed to respective bones by bone cement

(Polymethylmethacrylate).

Muller's total hip prosthesis:

prosthesis except that the size of the head of this prosthesis

Total knee prosthesis: There are several designs available (Fig-

screws. For a non-tapping screw, threads are cut in the bone with articular surfaces of femur, tibia and patella are replaced by
a special instrument, called a bone tap metallic (for femur) and polyethylene (for tibia and patella)
prosthesis. Common prosthesis used are Insall-Burstin knee,
PROSTHESES Freeman-Samuelson knee, etc.

Austin-Moore prosthesis: This is used for replacement of femoral

head in a case of fracture of the neck of the femur in elderly
persons. The prosthesis has a head with a small neck and a

the stem for the hook of the extractor, used while removing
the prosthesis. The stem has two fenestrations in its middle,
through which the bone supposedly grows and helps in
fixation of the prosthesis. This prosthesis can thus be used
only without cement because the use of cement would make
its removal, if required, difficult.

Thompson prosthesis: This is a prosthesis for the head of the

indicated in cases where the neck of the femur is absorbed
e.g. in old fractures of the femoral neck. It can be used with
or without cement.

Charnley's total hip prosthesis:

This is a prosthesis for the
replacement of both, the acetabulum and the head of the

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376 | Essential Orthopaedics
IMPLANT MATERIAL IN ORTHOPAEDICS
A number of implants are used in orthopaedics. These may
be used as a temporary device, e.g., a steel rod used for
fixation of a fracture; or as a permanent, device, e.g. a total
hip prosthesis used for replacing a damaged hip joint. The
material used for these implants is foreign for the body,
and is subjected to harsh chemical environment of the
body. A usual foreign body, subjected to this environment
shall evoke a reaction from the body which may range
from a benign to a chronic inflammatory response. To
avoid this, the implant materials used in our body are so
designed that they have suitable mechanical strength and
are biocompatible. Implant materials can be divided in the
following categories:
Metals: These have been used for fixation of fractures, for
a long time. The most common one is stainless steel. The
fracture fixation is titanium based alloy. Titanium is stronger
and lighter than steel. For manufacturing components for joint
replacement, cobalt based alloys are preferred as these have
high resistance to corrosion.
Non-metals: The most common non metal material is
some form of plastic. Following non-metals are commonly
used:
This is used
for making acetabular cup for total hip, and the plastic
insert for knee replacement.
This is used as an anchoring agent to
fix metallic components to the bone. Chemically it is
powder form of polymethacrylate with liquid
methylmethacrylate, a dough like material is formed
something like an ordinary cement which sets on adding
water. This process is exothermic and irreversible.
Ceramics: Ceramics have been used to design
articulating surfaces of artificial joints. These are more
resistant to wear, but disadvantage is that these are
brittle.
Silicon: Silicon implants are used for artificial inter-
phalangeal joints in the form of silicon elastomer
(silastic).
This is used for manufacturing artificial
ligaments.