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.
Positioning a patient with a mandibular fracture for optimal access to the oral cavity, ensuring proper reduction/dental occlusion, and placing implants easily can be challenging. Uncomplicated scenarios, such as unilateral, linear (non-comminuted), mid-body mandibular fractures can be repaired via a lateral approach.
Countersinking of intramedullary pins is occasionally required in femoral, tibial, and humeral fractures to minimize morbidity due to joint interference or soft tissue impingement, most notably sciatic nerve irritation dorsal to the trochanteric notch.
Manipulation of limbs during orthopedic procedures relies on drapes being free to move. Unfortunately, drapes often do not realign when limb manipulation is complete. Attaching self-retaining weights to each corner of the surgical drape brings them neatly back into position after limb manipulation.
A high probability exists that you've seen various ways of organizing external fixation pins, potentially from some of our past tips or from a method devised out of your own organizational needs. Methods can vary from practice to practice as each requires different pin styles, sizes and lengths based on case load.
Unicondylar fractures of the distal humerus are fairly common in small animal orthopedics. Fractures of the lateral aspect of the condyle are more commonly seen than medial fractures. The radius is the main weight bearing bone of the antebrachium and the radial head articulates with the lateral aspect of the condyle.
How do you accurately reduce and maintain reduction of a tibial plateau leveling osteotomy (TPLO) while testing for tibial thrust before plate application? Robert Sikes, DVM, Diplomate ACVS, an early disciple and friend of TPLO inventor Dr. Barclay Slocum, shares his solution.
In the early days of using smooth pins with external skeletal fixation, minimal, if any soft tissue release was recommended. Since threaded fixation pins have become the standard, most authors and teachers recommend utilizing a drill sleeve to prevent tissue trauma.
A method commonly performed with orthopedic surgery to reduce contamination is the application of vet wrap and sterile drape material; a preventative measure easily accomplished with minimal pre-planning.
Occasionally we see customers doing something with a product that merits bringing it to the attention of others. Several customers have been utilizing the angular hinge of the circular external skeletal fixation system to construct a simple, non-locking hinged fixator for temporary use across joints.
A popular technique that has been successful for spanning joints with all sizes of SK® frames is the utilization of modified single SK® clamps to form an adjustable articulation that is quite secure. The SK® single clamp body is comprised of two different parts: a B-1 body part that is placed on the side closest to the pin-gripping portion of the primary bolt with a threaded hole for the secondary bolt, and a B-2 body part that is placed on the opposite side with a smooth hole for the secondary bolt.