Internal Fracture Fixation (2 of 4)

Question 1

What is orthopedic wire made of?

Answer 1

Stainless steel

Question 2

What is the benefit of thicker wire (lower gauge)?

Answer 2

Increased tensile strength

Question 3

What is orthopedic wire never used for?

Answer 3

The sole method of fx fixation

NOTE: Exception is some mandibular fractures

Question 4

What 3 things is orthopedic wire typically used with?

Answer 4

IM pins
External skeletal fixators
Plates

Question 5

What are 3 applications for orthopedic wire?

Answer 5

Cerclage wire (+/- skewer pins)
Tension bands (avulsion fractures)
Interfragmentary wire

Question 6

What is cerclage wire?

Answer 6

Wire places circumferentially around the bone column to cause compression across the fracture line (oblique fx)

Question 7

What are the 5 major rules for cerclage wire placement?

Answer 7

Only use on long oblique or spiral fx
Place at least 2 cerclage wires
Place 0.5cm from fx ends, spaced ~0.5-1x bone diameter apart
Place the wire perpendicular to the bone
Cut the wire leaving 2-3 twists or a 5-10mm arm

Question 8

When considering cerclage for long oblique or spiral fx, what 2 conditions must exist?

Answer 8

Fracture line >2x bone diameter

Must be able to reconstruct the bone column (so it can bear weight)

Question 9

Why should you not bend over the twist in the cerclage wire?

Answer 9

It loosens the wire

Question 10

What situation would you use cerclage and skewer pins?

Answer 10

Short oblique fractures

Question 11

How is a cerclage and skewer pin applied?

Answer 11

K-wire placed through fracture segments perpendicular to the fracture and cerclage wire is placed around the bone to hold pieces together

Question 12

What is the purpose of a tension band wire?

Answer 12

To neutralize the pull of muscle/tendons on the fracture fragment

Question 13

When is a tension band wire indicated?

Answer 13

Avulsion fractures and some osteotomies

Question 14

What are 6 clinical applications for a tension band wire?

Answer 14

Acromion
Olecranon
Greater trochanter
Patella
Greater tuberosity
Lateral malleolus

Question 15

What are the general 4 steps to applying a tension band wire?

Answer 15

1. Reduce the fragment and drive 2 K-wires across the fx
2. Drill hole through both bone cortices distal to the fx line to pass orthopedic wire
3. Pass wire through the hole and figure-eight around the ends of the pins and back to other end of wire
4. Tighten wire via twist

Question 16

What is an interfragmentary wire?

Answer 16

Used like sutures to hold bone fragments together

Question 17

What is the indication for an interfragmentary wire?

Answer 17

Simple fx of flat, non-weight bearing bones that interdigitate well

Question 18

What is the most common use for an interfragmentary wire?

Answer 18

Mandibular and maxillary fx

Question 19

What are Steinmann pins often referred to as?

Answer 19

Intramedullary pins

Question 20

What are Steinmann pins made of?

Answer 20

Stainless steel

Question 21

What are Kirschner wires?

Answer 21

Small Steinmann pins

NOTE: Can be easily bent

Question 22

What type of points can you find on a Steinmann pin?

Answer 22

Trochar vs. chisel

Smooth vs. threaded

Question 23

What type of points can you find on a Kirschner wire?

Answer 23

Trochar point

Smooth vs. threaded

Question 24

What are the 6 different Steinmann pin applications?

Answer 24

Intramedullary placement
Cross pinning
Rush pinning
Diverging pins
Skewer pin
Tension band constructs

Question 25

What are two types of intramedullary placement of Steinmann pins?

Answer 25

Single pin | Stack pinning

Question 26

What is Cross pinning most commonly used for?

Answer 26

Salter-Harris fx

Question 27

What are 3 advantages of Steinmann pins?

Answer 27

Less expensive than plates/screws Smaller surgical approach with less surgical time Easy to remove if necessary

Question 28

What are 2 disadvantages of Steinmann pins?

Answer 28

Only resists bending (bone can still rotate and distract) | Pin migration

Question 29

How do you place an Intramedullary pin?

Answer 29

In medullary cavity of bone

Question 30

Why would you place an intramedullary pin?

Answer 30

To help restore length and maintain alignment

Question 31

What is an IM pin almost never indicated as the sole form of fixation?

Answer 31

Because only resists bending forces, needs to be fortified with other fixation methods

Question 32

What 6 bones can IM pins be used in?

Answer 32

``` Humerus Femur Tibia Ulna Metatarsals Metacarpals ```

Question 33

What bone is an IM pin contraindicated for?

Answer 33

Radius because of the shape, you will end up passing the pin through the articular surface

Question 34

What must IM pins NEVER do?

Answer 34

penetrate the joint surface

Question 35

What are 2 methods of placing and IM pin?

Answer 35

Normograde | Retrograde

Question 36

If you're using an IM pin and cerclage, what diameter pin do you want?

Answer 36

70% canal fill

Question 37

If you're using an IN pin and a place, what diameter pin do you want?

Answer 37

35-40% canal fill NOTE: This smaller diameter is because you don't want the pin to be in the way of the screws

Question 38

What is stack pinning?

Answer 38

Using 2 or more smaller diameter pins

Question 39

What are 3 reasons stack pinning is not really practiced anymore?

Answer 39

No mechanical advantage Higher incidence of migration Increased damage to medullary blood supply

Question 40

What is cross pinning?

Answer 40

Use of small diameter Steinmann pins or K-wiresto engage the near and far cotex NOTE: Pins will cross above the fx line

Question 41

When is cross pinning indicated?

Answer 41

Simple, transverse fractures that are close to the joint, especially Salter-Harris type 1 and 2 fxs

Question 42

What is Rush pinning?

Answer 42

Uses 2 IM pins that are forced to curve and have 3 points of contact

Question 43

When is Rush pinning indicated?

Answer 43

Some Salter-Harris fxsx and supracondylar fxs

Question 44

What is a diverging pin technique used for?

Answer 44

To stabilize Salter-harris type 1 fxs of proximal humerus or femoral head

Question 45

What must a diverging pin technique do?

Answer 45

Achieve anatomical reduction to promote normal physeal anatomy and bone growth