Practices around the world incorporate IMEX® equipment into a variety of useful, non-traditional techniques. These "tips-and-tricks", also known as "pearls", are helpful in simplifying common tasks, surgical techniques, or brainstorming a new application for existing components. Our goal is to make them readily available for veterinarians and technicians to benefit from each other's experiences. Please feel free to submit useful tips and tricks.
Fixation pins placed through liberal release incisions in anatomically-positioned, non-devitalized soft tissues will go a long way in reducing pin tract morbidity. Keep these points in mind when creating release incisions and determining pin placement location.
Points to Consider
- Incisions should be made with tissues in a neutral, relaxed position.
- Muscles should be bluntly dissected whenever possible
- A release incision at least 1 cm in length made parallel to the long axis of the bone is adequate at most pin placement sites.
- Some cases require longer release incisions or release in another plane to alleviate soft tissue tension at a pin site.
- After pin placement, move joints through their normal ranges of motion to evaluate for adequate release
The importance of liberal release incisions cannot be overemphasized. Surgeons often lean toward the-smaller-the-better but with a few simple techniques, post-op complications can be avoided.
One of the most common questions we receive from veterinarians and technicians is, "How do I simplify packing of our ESF kits?" Various answers come to mind, some involving expensive trays and others requiring only a handful of supplies found in most veterinary practices.
"After tensioning fixation wires, how do I handle the sharp ends?" Two schools of thought exist; one group prefers to leave wires long and then pigtail or roll them. The second group prefers to cut fixation wires as close as possible to their fixation point.
A simple two-ring circular fixator construct is often used to distract fractures out to length and facilitate reduction when performing minimally invasive plate osteosynthesis. This is particularly useful when addressing antebrachial or crural fractures.
This technique replaces the need for K-wires and a tension band. Use the appropriate sized Interface® pin to transfix the repositioned tuberosity into its optimal location. I usually will place two pins at slightly varying angles to insure good purchase of the bone.
Craniodorsal hip luxation is a common problem in dogs. For various reasons, open reduction techniques are often employed to restore hip integrity and function.
A quick and simple method for correct assembly of the SK® external fixation clamp can eliminate this frustration while providing the surgeon or technician with an easy-to-remember technique.
Cut ends of fixation pins and IM pins have one thing in common - sharp ends that present a hazard to the surgeon, patient and owners. Daniel Lewis, DVM, DACVS at the University of Florida eliminates this danger with a quick-fix post surgery.
Pre-drilling of pilot holes has become a standard in external fixator pin placement. Pre-drilling is typically achieved through drill sleeves that fit securely into an SK® ESF clamp. This method works well for pilot holes drilled after the initial proximal and distal pins are placed. But what about these first two pins?
Use a large, multi-compartment tackle box to organize and sort inventory of various ESF components. Individual drawers and slots are labeled for easy identification. If circular external skeletal fixation (CESF) or hybrid-CESF components are stocked, additional boxes may be required.