Tension band wiring is done in following except?
Correct Answer: Colie's Fracture
Description: Ans. C. Colle's Fracture. (Ref Maheshwari orthopaedics 3rd/pg. 24 & 139)Maheshwari orthopaedics 3rd/pg. 24 mentions........................|||Tension-band wiringTension-band plateTension-band fixation|||iUsed for producing dynamic compression in Patella, Olecranon & transverse malleolus .Used for Humerus & Tibia .Used for Tibia .RECENT ADVANCES IN Rx OF FRACTURES:# A.O. method# Cast (functional) bracing# Ilizarov's techniqueA.O. method:In this method the following principles are used to achieve stable fixation:# A. Inter-fragmentary compression i.e., achieving compression between different fragments.# B. Splinting (splinting fracture fragments internally or extrenally)# C. Combination of A and B.A. Inter-fragmentary compression i.e., achieving compression between different fragments.a. Static compressionb. Dynamic compression# Methods of producing static compression:- a). Lag screw- b). Compression plating- c). External fixator# Methods of producing dynamic compression:- a). Tension-band wiring e.g. Patella & Olecranon - b). Tension-band plate e.g. Humerus & Tibia - c). Tension-band fixation e.g. Tibia .B. Splinting.a. IM splinting: e.g. Kuntscher's nailing for+shaft of femur.b. EM splinting: e.g. plating without compression (neutralising plate), or plate supporting the without fixing it (buttress plate) sometimes used for tibial condyle .c. Outside the body e.g. external fixators used merely to hold the fragments.C. Combination of A and B.e.g. for Spiral of shaft of femur.Cast (functional) bracing# Popularized by Sarmiento (1973)# Done if fracture reduction is satisfactory, and once the swelling subsides - usually 2-3 weeks after injury.# Most commonly used for of the shaft tibia. It is also used for femoral/humerus shaft, and other fractures.Ilizarov's technique# * Infected non-union of long bones is a problem in the developing countries.# * Persistent infection, deformity, shortening, bone loss, joint stiffness and disability complicate the non-union.# * Secondary procedures are often required for correction of bone defects and deformity.# * Ilizarov method deals with all the above problems simultaneously and offers a kind of universal remedy for infected non-unions.# *The stability of the fixation and provision for bone transport allows bridging of bone defects, limb lengthening, early weight bearing ambulation and joint mobilization.# The basic principle of Ilizarov's technique is that Osteogenesis requires dynamic state, which causes dormant mesenchymal cells at the non-union gap to differentiate into functioning osteoblasts.# Distraction or compression is carried out at lmm/day.# This is done is four settings i.e. l/4th mm four times a day.# It is useful in management of:- Limb lengthening- Non-union especially resistant to conventional methods of Rx or those associated with deformity or shortening.- Deformity correction, which may be congenital or acquired.- Osteomyelitis can be treated as this technique offers possibility of excision of necrotic bone - creating a gap, which can be made up by transporting a segment of bone from either end.- Arthrodesis can be performed by crushing articular surfaces against each other, and thus stimulating union between opposite bones.# Advantages:- Immediate load bearing- Healthy viable bone in place of de-vascularized bone- Correction of more than one problems by one-stage operation.# Disadvantages:- Inconvenience- Long duration Rx- Pin-tract infection- Nerve palsy by pin insertion or traction- Joint stiffness of the soft tissues by external fixator.
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Orthopaedics
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