My Orthopedic Surgery

Circumferential wiring of patella can sometimes be difficult, especially when it comes to threading the Stainless Steel (SS) wire through the soft tissues. The authors have experienced problems using instruments like a wire passer, wide bore white needle and a long spinal needle owing to their size and diameter. We describe the use of PVC wound drain (used in redivac sets) as a simple, fast and safe alternative for threading SS wires through soft tissues while doing the above procedure.
V Lenin Babu and K Baskaran

Lecture/presentation in the Basic Fracture Course of the Orthopaedic Trauma Association

By Douglas W. Jackson, MD ORTHOPEDICS TODAY 2006; 26:68 May 2006 The indications for “hardware removal” have often seemed somewhat subjective. There are those obvious cases where it presents mechanical symptoms or removal is necessary for another procedure to be done. In addition, surgeons often underestimate the time necessary for the removal and the patient’s return to normal activities. I have asked Dr. William T. Obremskey to share with us some insight into the current indications and potential problems with hardware removal.

Anatomical Considerations:
- osseous anatomy of proximal femur dictates where internal fixation device should be placed for maximum purchase in femoral head;
- maximum bone density is found in the area where compression & tension trabeculae coalesce in the center of the head;
- in 1838, int. trabecular system of femoral head was described by Ward;
- maximum bone density is found in area where compression & tension trabeculae coalesce in the center of the head;
- when these trabeculae are absent, surgeon can expect higher rate of failure with use of device;
- most important aspect of device insertion is secure placement of screw within the proximal fragment;
- hence, insert screw centrally to within 1 cm of the subchondral bone;
- this placement ensures adequate purchase in femoral head & solid fixation of femoral head and neck fragment to shaft fragment;
Wheeless' Textbook of Orthopaedics

Lag Screw & Neutralization Plating: Principles & Techniques. Basic Fracture Course of Orthopaedic Trauma Association

From the Basic Fracture Course of the Orthopaedic Trauma Association

The tension band concept was introduced to orthopedics by Pauwels in the 1930's and was applied to internal fixation of eccentrically loaded bone. The concept had been around in engineering circles for a long time.
OTA Basic Fracture Course