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Wires Insertion Techniques



- Discussion: 
   - tap pins through soft tissues until they meet bone, and once the wire emerges from the far cortex, it is driven through the soft tissues w/ a mallet;  
- periarticular insertion 
   - avoid impaling synovium;
   - in the knee, insert the wire 1 cm below articular surface to prevent intra-articular communication; 
   - w/ periarticular fracture, the joint capsule may be disrupted which means that insertion even 2-3 cm away from the joint line can result in septic arthritis; 
   - the risk of septic arthritis from periarticular pins, seems especially common in diabetics; 
   - w/ tibial plateau frx, consider placement of olive wires from both medial and lateral sides inorder to achieve condylar compression; 

- skin
   - attempt to enter the skin as it lies, w/o undue tension; 
   - if joint motion is permited postop, attempt to pull skin into the appropriate direction for maximum allowed joint motion; 

- muscle impalement: 
   - avoid impaling tendons (can be checked by moving distal joints, one pin rests on the periosteum); 
   - penetrate muscles at their maxium functional length (ie, the ankle should be plantar flexed as the pin travels through the dorsal compartment, and then should be dorsiflexed when the pin travels through the plantar surface); 
   - penetration of muscle may lead to muscle fibrosis; 
   - low speed drilling is used w/ frequent pauses for heat dissipation; 
   - after determining safe angle for transfixion wire at a given cross sectional level, wire is stabbed through skin & muscle to bone and then drilled across both cortices; 
   - once in bone, consider regularly stopping the drill to allow heat dissipation; 
   - when wire emerges from far cortex, it is then driven across remaining soft tissue with a mallet; 
   - wires are attached to external frame w/o bending wire to meet frame, if required small spacers may be added to frame to prevent wire bending

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