00:20 Rail and its matching dovetail profile clamp
01:00 Central clamp, End clamp and Swivel clamp
04:40 T clamp for metaphyseal bone region (condyles)
06:00 T-Ball and Socket clamp for metaphyseal bone region
07:15 Ball and Socket clamp for metaphyseal bone region
07:35 Dyna ring clamp used in lengthening of bones
09:00 Screwhole and Drillhole guides
11:00 Incision and drilling with Trocar and screw guide into the bone
11:35 2mm guide wire or K-wire usage
12:15 Schanz screw holder
12:30 Tapered Schanz screws
13:20 Compression-Distractor Unit (CDU)
Fig. 11a
The most common rail fixators consist of three parts namely clamp, rail rod and the schanz screws (Fig. 11a)
The clamp has a dovetail profile which slides onto the rail rod and is tightened onto the rail rod by tightening the holding screws on the clamp (Fig. 11a)
Fig. 11b
There is a type of rail external fixator called a monolateral fixator which is a single unit with proximal and distal clamps attached together by an hinge (for angulation) and linear actuator (for compression or distraction of two bone segments) (Fig. 11b)
Fig. 11c
The hinge of the monolateral fixator should always lie on the angle bisector of the planned proximal and distal axis on the bone (Fig. 11c)
The angulation of the fixator should be of the same angle as the magnitude of angulation of the bone (Fig. 11c)
When the correction of bone happens taking hinge of rail fixator as the ACA and it passes through the angle bisector line of the planned axis, then the resultant proximal and distal axis becomes parallel and vertical Lengthening ('SL') of distal segment occurs w.r.t proximal bone segment (Fig. 11c)
Fig. 11d
When the correction of bone happens taking hinge of rail fixator as the ACA and it passes above or below the angle bisector line of the planned axis, then the resultant proximal and distal axis becomes parallel but horizontal Translation ('ST') of distal segment occurs w.r.t proximal bone segment (Fig. 11d)
A video guide is provided below on the application of Rail Fixator on tibial and femur bone:
How to apply rail fixator on tibial bone
A video guide on the application of Rail Fixator on a tibia bone
Annotations:
0:16 Choosing correct length of rail for the bone
0:40 Use of different clamp templates on the rail
1:10 Checking schanz screw guide fitting through all holes of clamp templates
1:40 Drilling through a drill guide into the first hole at the one end clamp template and last hole in the other end clamp template. Ensure that the drilled screws are perpendicular to this axis and in the centre of tibial lateral width.
3:35 Remove the template clamps. Place actual clamps on the schanz screws and tighten the actual clamps to a rail rod
4:20 Placement of Compression-Distractor Unit (CDU) between the clamps above and below the osteotomy site for lengthening of the bone
How to apply rail fixator on femoral bone
A video guide on the application of Rail Fixator on a femur bone
Annotations:
0:25 T clamp configuration for the distal femur
0:40 Screw guide sleeve used in T clamp hole
1:18 Central or end clamp in proximal femur shaft. Drilling in the centre of lateral femur width perpendicular to the bone
1:38 Ensure orientation of the rail in antero-lateral position for the femur
2:30 Use of sandwich plate in central clamps to ensure schanz screws passing through central clamp intersect the bowed femur shaft correctly in the lateral width center
