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Wrinkle Corner
Injury, 9, 329-330
329
Printed in Great Britain
Wrinkle Corner A simple external fixation method using wire and bone cement C. H. Wynn-Jones Wexham Park Hospital, Slough TIJE author has used a simple method of external fixation using conventional Denham and Steinmann pins, wire and bone cement. The technique has been used in unstable tibial fractures with marked skin and soft tissue damage (Fig. 1) and also for arthrodesis of the knee. In the latter, the arthrodesis zone is compressed by winding wire around the pins and tightening by means of another short pin utilizing the 'Spanish windlass' method. In all cases the fixation was firm. There was no skin burn from the hot cement and pins (the pins were cooled with sterile cold saline). A
Fig. 1. X-rays of an open fracture of the mid-shaft of the tibia with marked soft tissue damage. Immobilized by the described method, skin grafting was performed as a delayed primary procedure and early posterior bone grafting performed with the device in situ.
Fig. 1
Fig. 2. Views of device in situ in the same patient. Suspending the limb prevents oedema and early mobilizing exercises to the knee and ankle can be performed comfortably. The plastazote foot splint with elastics to the pins (expecially where the main muscle damage is anterior) is important to prevent an equinus deformity.
330
criticism of this technique is that no adjustment is possible. We have used an image intensifier on the operating table to check the tibial fractures initially and have not found it necessary to readjust the fracture. To give the firmest fixation, 3 pins above and 3 below the fracture should be used. Wire of the same metal as the pins is wound around the pins. The thickness of the wire should be approximately 20 swg (0-914 ram). A loose mesh only should be formed and the cement pressed into place. The
Injury: the British Journal of Accident Surgery Vol. 9/No. 4
wire increases the strength of the cement and also prevents it from sagging by acting as an armature. The completed fixation is shown in Fig. 2. If 3 approximately parallel pins cannot be inserted because, for example, of local tissue damage, screws can be inserted radially into good bone through undamaged tissue and wire wrapped round them with cement, leaving the damaged area exposed in such a way that it can receive appropriate surgical treatment and be grafted without inconvenience.
Requests for reprints should be addressed to: Mr. C. H. Wynn-Jones, FRCS, Senior Orthopaedic Registrar, Wexham Park Hospital, Slough, Berkshire.
329
Printed in Great Britain
Wrinkle Corner A simple external fixation method using wire and bone cement C. H. Wynn-Jones Wexham Park Hospital, Slough TIJE author has used a simple method of external fixation using conventional Denham and Steinmann pins, wire and bone cement. The technique has been used in unstable tibial fractures with marked skin and soft tissue damage (Fig. 1) and also for arthrodesis of the knee. In the latter, the arthrodesis zone is compressed by winding wire around the pins and tightening by means of another short pin utilizing the 'Spanish windlass' method. In all cases the fixation was firm. There was no skin burn from the hot cement and pins (the pins were cooled with sterile cold saline). A
Fig. 1. X-rays of an open fracture of the mid-shaft of the tibia with marked soft tissue damage. Immobilized by the described method, skin grafting was performed as a delayed primary procedure and early posterior bone grafting performed with the device in situ.
Fig. 1
Fig. 2. Views of device in situ in the same patient. Suspending the limb prevents oedema and early mobilizing exercises to the knee and ankle can be performed comfortably. The plastazote foot splint with elastics to the pins (expecially where the main muscle damage is anterior) is important to prevent an equinus deformity.
330
criticism of this technique is that no adjustment is possible. We have used an image intensifier on the operating table to check the tibial fractures initially and have not found it necessary to readjust the fracture. To give the firmest fixation, 3 pins above and 3 below the fracture should be used. Wire of the same metal as the pins is wound around the pins. The thickness of the wire should be approximately 20 swg (0-914 ram). A loose mesh only should be formed and the cement pressed into place. The
Injury: the British Journal of Accident Surgery Vol. 9/No. 4
wire increases the strength of the cement and also prevents it from sagging by acting as an armature. The completed fixation is shown in Fig. 2. If 3 approximately parallel pins cannot be inserted because, for example, of local tissue damage, screws can be inserted radially into good bone through undamaged tissue and wire wrapped round them with cement, leaving the damaged area exposed in such a way that it can receive appropriate surgical treatment and be grafted without inconvenience.
Requests for reprints should be addressed to: Mr. C. H. Wynn-Jones, FRCS, Senior Orthopaedic Registrar, Wexham Park Hospital, Slough, Berkshire.