case discussion 2n day課件

Case discussion II Case 1 44yr old obese female Fall Nondominant arm Closed injury Neurovascular exam Normal Isolated injury What is the classification ? What is the management - Conservative?- Operative? What type of stability - Absolute? - Relative? What type of fixation - Plate ? - Nail ?Case 1Case 1 Case 2Male41 yearsCar accidentIsolated injuryClose 30 yr old male Motorcycle accident Closed and isolated injury of femur Neurovascular exam Normal No other injuryMale41 yearsCar accidentIsolated injuryClose Any other investigations? What is the management ? - Operative type? Timing of surgery?Male41 yearsCar accidentIsolated injuryClose What type of stability do you need : For the shaft ?- Absolute ?- Relative ? For the articular fracture ?- Absolute How would you expect these fracturesto heal?Is there adequate fixation here?4 monthsRelative stability = indirect healing with callousAbsolute stability with lag screws = direct healing without callous Case 3Female 70 yrs olddiabetes Type Iosteoporosis, slips from ladderclosed injuryno other injuries70 yrs olddiabetes Iosteoporosis, What to do ? (Why)When to do it ?Which type of stability ?Which type of implant ?What reduction technique ?Positioning of patient ?Approach ?Postoperative X rayRelative stabilityMIPO techniqueIndirect reduction Unicortical screwsAftertreatment ?What type of healing do you expect ?3 months postop:No complaintsFull weight-bearingNow what to do ?9 months postop:No complaintsPlate removal ?Case 4 Case discussion 3 24 yrs. male car accidentLt. femur When to operate? Type of stability? - Absolute ?- Relative ?Lt. femur Relative - Intramedullary ? - Extramedullary ? - Bridging plate - External FixatorLt. femur Approach ? Reduction technique ? Type of implant ?Post op20 weeks femur4 monthsCase 5 35 years old man sustained a MCA with Type III B open fracture of right tibia. No other additional fracture or any systemic injury. He is in a stable condition. After debridement, choice of stabilization ? 1. Plate 2. IM nail 3. Hybrid External Fixator 4. Tubular External FixatorPostoperatively2 weeks postoperatively now what ?Now clean and dry at 6 weeks what is next?What is your next step of treatment ? 1. Ilizarov 2. Vascularized bone graft 3. Bone graft and BMP 4. LCP with bone graftPre contour of LCP metaphyseal plate before surgeryCase 6 55yrs old woman falls Injures dominant arm No other injuries Pulses are poor Distal function of fingers is present Closed injury Preoperative planning?Case 4 Position ? Tourniquet ? Which bone first ? Approach ? Reduction ? Type of implant ?Case 4Intraoperative x-rayCase 45 month xraysWhat went wrong?What principle was broken?What went wrong?What principle was broken?Why did this happen?What went wrong?What principle was broken? IM nailing 6 weeksWhat went wrong?What principle was broken? Humerus surgery 4 months prior Neuro-vascular intact Sudden pain and deformityWhat went wrong?What principle was broken?6 weeks