CRIF – (Closed Reduction Internal Fixation) FIXATION
(Image Source: Physiorehab)
With the rapid rise in longevity the femoral neck fractures are also increasing at an exponential rate. The femoral neck fracture is also termed as hip fracture. It occurs near the point of origin or the proximal end of the femur near the hip. The femur is the largest bone in the human body and it is vulnerable and prone severe fracture. Most of the times the femur neck fracture occurs due to osteoporosis, a medical condition in which the bones become brittle and fragile from loss of tissue, typically as a result of hormonal changes, or deficiency of calcium or vitamin D. It is one of the most common consequences of injuries in the elderly people. With the advancement in surgical techniques and medical & health care the method of femoral fixation and the associated risks factors such as non union and Avascular Necrosis (AVN) has not much changed in past fifty years.
Emergency internal fixation is one of the main options for the treatment of displaced femoral neck fractures. The process contains both Open Reduction Internal Fixation (ORIF) and Closed Reduction Internal Fixation (CRIF).
What is CRIF
Closed Reduction Internal Fixation (CRIF) is reduction without any open surgery which is followed by internal fixation. It is also termed as Clamp and Rod Internal Fixation system which is a modular implant system composed of clamps, rods and screws. The rod could be cut according to the length required and contoured in the plain surface of the bone. The screws fix the rod to the bone with the help of the clamps. Together the complete structure offers greater flexibility to the orthopedic surgeons. There are variety of implants such as rods, clamps and screws that are used depending upon the shape and size of the bone to be treated.
Mewar Hospital is the biggest chain of orthopedic hospitals in Rajasthan and Madhya Pradesh serving the humanity through the pristine profession of medical & health care. Our experienced team orthopedic surgeons have successfully carried many ORIF and CRIF fixation.
CRIF has an advantage that it avoids the injury to the medial circumflex femoral artery. However, the pressure formed by CRIF due to prolonged extension on the fracture table reduces the blood supply to the femoral head. The repeated forceful manipulation increases the risk of Avascular Necrosis (AVN).
It is found after many different analyses that the risk can chances of AVN of femoral head are quite significant and higher after CRIF as compared to ORIF. However, there are no significant differences in the healing rate for the two kinds of reduction processes. ORIF has advantages as compared with CRIF in terms of AVN for the treatment of femoral neck fractures.
The Key Features of CRIF
There are various key benefits and features associated with CRIF procedure and implants etc. They could be clubbed as follows:
Size: They are available in three sizes as mini, small and medium which can be used according to the requirement or the bone size.
Screws: It uses the standard cortical and cancellous screws.
Techniques: It can be used with open or minimally invasive techniques.
Rod Size: Rod sizes are versatile and can be cut to length according to the requirements.
Rod Fitting: The rods can be contoured in multiple planes for automatic optimal fitting. This offers optimum support to the bones.
Clamps: Clamps can be positioned anywhere on the rod and they can be rotated to any side of the rod to allow maximum screw placement.
Inventory: The entire clamp system is versatile that requires much less inventory.
CRIF Procedure
The usual procedure of a CRIF involves the following set of procedures:
1. Choice of fixation method: According to the type of fracture the choice of internal fixation is made as the method of treatment. Depending upon the stability required the surgeon could choose a sliding hip screw type of implant.
2. Positioning of the patient: The patient is positioned supine on the fracture table. The uninjured led is placed on a leg holder. The reduction is checked in both AP and lateral view.
3. Technique of insertion: The next step requires positioning the guide wire on the neck and hammering into the head. This would help in insertion of the guide wire for the DHS screw.
4. Insertion of the guide wire: In the further step the guide wire is inserted through an aiming device into the subchondral bone of the head.
5. Determination of the length of the DHS screw: The length of the DHS screw is determined with the help of a measuring device.
6. Drilling: After adjusting the triple reamer the hole is drilled of chosen length for the screw and the plate sleeve.
7. Screw insertion: The appropriate screw is mounted on the handle and inserted over the guide wire. By turning around the handle it gets advanced into the bone. It is not recommended to push forcefully as it may distract the fracture. After the screw has reached the required place the plate is placed in position.
8. Fixation of the DHS plate: In the last step the DHS plate is affixed with the screws. In case of femur the plate with femur is fixed with one or more screws. For additional stability cannulated screw above DHS is also inserted.
Source: http://www.mewarhospitals.com/crif-fixation/
What is the availability of the clamp and rod fixators ? Is it available in india ?
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