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Basic surgical techniques

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Abstract

This chapter aims to outline the general organizational approach to the surgical fixation of fractures, along with describing some of the basic surgical techniques involved in fracture reduction and fixation. Fracture surgeries are often demanding in terms of technical skill needed, equipment requirements, time and also concentration by the surgeon. Preparation is vital for all aspects of the operation. : Fracture reduction; Insertion of intramedullary pins; Insertion of interlocking nail; Application of cerclage wire; application of tension-band wiring; Placement of external skeletal fixators; Insertion of positional screw; Application of lag screw; Application of dynamic compression plate; Application of neutralization plate; Application of bridging plate; Pin-plate stabilization.

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/content/chapter/10.22233/9781910443279.chap11

Figures

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11.1 A surgical safety checklist to be used when performing orthopaedic surgery.
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11.2 Reduction using countertraction. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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11.3 Toggling technique. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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11.4 Levering technique. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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11.5 Use of pointed reduction forceps to complete reduction. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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11.6 Pusher pin technique. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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11.7 Use of a reduction device. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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11.8 (a) Normograde pin insertion. (b) Retrograde pin insertion. (c) Fracture is reduced and pin driven across the fracture site. (d) Pin is impacted into the distal metaphysis, taking care not to penetrate the joint. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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11.9 Application of an interlocking nail. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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11.10 Cerclage wiring using a twist knot. (a) Full cerclage. A secure, even twist knot is created. This is usually bent over whilst continuing to twist the wire, to maintain tension, and is then cut short. The wire must be fully tightened and should be perpendicular to the bone. (b) Hemicerclage. The wire is applied through a bone tunnel. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.
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11.11 Application of a single loop cerclage. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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11.12 Application of a double loop cerclage. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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11.13 Application of a tension-band wire. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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11.14 Application of a modified type 2 (type 2b) external skeletal fixator to a tibial fracture. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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11.15 Insertion of a positional screw: (a) drill, (b) measure, (c) tap and (d) place screw. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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11.16 Insertion of a lag screw. The screw direction should be as close as possible to perpendicular to the fracture line. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.
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11.17 Application of a pre-stressed plate. (a) Exact contouring of a plate to a bone can result in a narrow gap in the trans cortex after screw tightening. (b) The plate can be pre-stressed to create a slight curve in the plate over the fracture line. (c) Following screw tightening the trans cortex is compressed. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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11.18 Application of a compression plate. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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11.19 Application of a neutralization plate in conjunction with lag screws. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.
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11.20 Application of a bridging plate. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.
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11.21 Application of a pin–plate construct. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

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