Surgery External Fixateur Consists of three components: o The pins Which enter through the skin and engage

e the bone Vary in shape and design and size Smooth trochar pointed pins End threaded negatively profiled pins End threaded positively profiled pins No point positively profiled end threaded pins o Connecting bar Transmits the bulk of the forces Vary in design and size and material Rods may be stainless steel, titanium or carbon fibre Carbon fibre and titanium = lighter And carbon fibre is radiolucent o Clamps Combine the first two Vary in design: K-E clamp Secure as camp Imex clamp

Application of Type 1a ex fix to tibia 1 connecting bar 6 positively threaded pins 6 I-K clamps Combination wrench Drill bit Drill sleeve Anatomy of proximal tibia Has a relatively thin cranial aspect, the tibial tuberosity in cross section, is triangle in shape with majority of bone being palced caudally in pin placement, engage maximum bone stock with pin pin located towards caudal cortex will engage more bone Palpate landmarks of the proximal tibia: o Tibial tuberosity o Patellar tendon o Patella o Proximal aspect of tibia

Tensing skin of proximal tibia, identify position approximately 2/3 of the way to the caudal cortex With the skin tensed, make a 1 cm releasing incision through the skin until bone is encountered Drill guide should be placed directly on bone and protect soft tissues When drilling: Make sure parallel to joint surface and drilling in a medial to lateral direction Pin is then placed through drill hole and inserted under slow speed Following releasing skin incision, place most distal pin o must be drilled in a medio to lateral direction parallel to the joint, being sure not to enter the joint itself Similar to placement of most proximal pin, distal pin is now placed Care is taken not to drill too quickly Once placed most proximal and distal of pins, the fracture can now be reduced in a closed fashion Once reduced, the connecting bar is then applied to the two pins The SK clamp o Has a primary bolt which accepts the pin and a secondary bolt which tightens the clamp to the connecting bar o Connecting rod is placed through the hole o A second clamp is then placed on the rod o The pins are then placed through the primary bolt of the SK clamp o The clamps are then finger tightened o Once connected to the pins and connecting bar, we need to tighten the clamps o Make sure the primary bolt is nearer to the bone than the secondary bolt o Clamp should be approx 1 cm from the skin so it will not impinge the soft tissue structures o The further the clamp will be, the mechanically weaker it will be Primary bolt should be stabilized with a primary wrench while socket wrench can tighten it Combination wrench can hold the clamp while the bolt is tightened Now will place the third and fourth pins o Should be no closert than one bone diameter o First remove secondary bolt o It engages bolts