By Priv.-Doz. Dr. U. Heim, Priv.-Doz. Dr. K. M. Pfeiffer (auth.)
Operation on fractures of shafts and joints is mainly indicated within the higher arm, forearm, femur and tibia. accidents in those components can generally be effectively handled via the ideas defined within the "AS IF guide of inner Fixation," by way of early workouts. The fixation of small fragments that are of such biomechanical significance, has hitherto given detached effects, specifically while the distal components of the hand and foot are concerned. The implants and tools built by means of Dr. Heim and attempted out via as though contributors in the course of contemporary years have now been assembled right into a "small fragment set," that is now on hand. those implants have considerably multiplied the scope of as though instrumentation for inner fixation. Pannike first in comparison the applying of the small fragment set with the traditional tools utilized in hand surgical procedure. Heim and Pfeiffer in cooperation with Meuli, illustrate during this quantity the small fragment set, elucidating in a didactic demeanour the composition of the set, the symptoms for its use, and its approach to program to all compatible fractures. adequate stable effects were secured to set up the usefulness of this improvement. the subsequent quantity could as a result be considered as an enormous complement to the ASIF guide. It makes it transparent back that each inner fixation calls for a excessive point of technical ability, a feeling of accountability, and intensely light dealing with of the tender tissues.
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Additional resources for Small Fragment Set Manual: Technique Recommended by the ASIF-Group
Particularly in the hand, the implant may represent a relatively large foreign body which may interfere with extensor movements. After removal of metal implants, we often find an obvious improvement of extension and flexion. Removal of the small cancellous screws should not be delayed, since the narrow 42 thread-free screw neck invokes substantial periostosis. Here the resistance to the withdrawal of the screw may lead to breakage of the screw neck. The appropriate time for removal of small screws in combined internal fixation with larger implants is usually determined by the removal of the metal from the main fracture.
Examples: Comminuted fracture of the lateral malleolus. Transverse and oblique fractures of metatarsals. 25 c) Stabilization Rule 2: Rule of Number of Threads Where internal fixation with plates is applied, the screws should fix the main fragment with several threads. As bending an'd shearing forces increase with body weight, the number of threads required for effective stabilization increases from the peripheral to the proximal parts of the skeleton. In phalanges, three threads in each cortex are sufficient, in metacarpals and metatarsals four threads in each cortex should be placed in each fragment.
40a). Here the primary removal ofloose fragments and resection of the head to an extent of about 1 cm is recommended as prophylaxis against arthrosis. Although this shortening of the upper radius is far from being ideal, it is the lesser evil. b) Fissure Fractures In this fracture the head remains uninjured while a sharp edge fragment is split off and displaced to a greater or lesser degree. The anular ligament may be intact. Operation is recommended even if the X-ray only shows a fissure fracture.
Small Fragment Set Manual: Technique Recommended by the ASIF-Group by Priv.-Doz. Dr. U. Heim, Priv.-Doz. Dr. K. M. Pfeiffer (auth.)