Ortopedia y Traumatología Pediátrica: Discusión entre pares / 45yrs/male presented closed short subtrochanteric fracture femur with ?...

martes, 22 de abril de 2014

Discusión entre pares / 45yrs/male presented closed short subtrochanteric fracture femur with ?...

Indian-Orthopaedic Research-Group FB

Rahul B Tanga

45yrs/male presented closed short subtrochanteric fracture femur with ? Impending compartment syndrome of thigh .plan A was CRIF with recon nailing even with full traction and indirect reduction techniques failed and at the same time addiction of 2odegrees was not possible for entry point .so plan B ORIF 6 holed PFLCP+ BG done.

Una foto de Rahul B Tanga.

Una foto de Rahul B Tanga.

Una foto de Rahul B Tanga.

Una foto de Rahul B Tanga.

- Rahul B Tanga Critical comments?
  
  Hace 15 horas · Me gusta
- Said Abdelhaleem After all good fixation
  
  Hace 15 horas · Me gusta
- Jha Sudhanshu wow...bravo...perfect reduction...bless ur skill
  
  Hace 15 horas · Me gusta
- Khin Zaw Hein I have some exp .last week , I did closed reduction fail so proceed open reduction and recon nailing . Your operation is nicely and congr
  
  Hace 15 horas · Me gusta
- Khin Zaw Hein I afraid plating in femur ,thank
  
  Hace 15 horas · Me gusta
- Ameen Mohammed Nice ..is that okee in lateral view
  
  Hace 15 horas · Me gusta
- Alhamwi Talal There is a high chanse for nonunion
  The best choice is inter lucking nail
  
  Hace 15 horas · Me gusta · 1
- Naini Kumar show how long is the plate? it should have 8 holes
  
  Hace 15 horas · Me gusta
- Veerabhadra Javali Nice job. When ORIF done Nailing would be better?
  
  Hace 15 horas · Me gusta
- Tarun Desai U really have a good operative hand dr rahul great work done
  
  Hace 15 horas · Me gusta · 1
- Abhinav Agr looks like ? Pathologic # to me ( like the alendronate induced S.T. # Femur)... was it trivial trauma ???
  
  Hace 14 horas · Me gusta
- Yogesh Gaikwad Such type of # are always in flexion & abduction even after putting on # table.These # are very tricky to reduce.I try to do it in lat. Position so that distal fragment can easily aligned with proximal.
  Another trick is by putting percutaneous pin you can manipulate the fragment.
  Proximal femoral lock plate is very rigid implant (factory of non and delayed union).
  Reduction and plate placement is good , hope it will run smoothly.
  
  Hace 14 horas · Me gusta · 3
- Shrikrishna Dhone k nail with BG
  
  Hace 14 horas · Me gusta · 1
- Anuj Agrawal Typical flexion, abduction, external rotation of proximal fragment seen in subtrochanteric fractures. A trochanteric entry point (PFN) is easier in such cases than piriformis fossa (recon nail). Percutaneous pin or clamp has to be frequently applied to control the proximal fragment.
  Even if open manipulation/reduction was required, a nail would have been biomechanically better. Some surgeons (not you Rahul) have a faulty concept that once you open, put a plate..
  
  Hace 14 horas · Editado · Me gusta · 4
- Vinit Yadav u cudhave used synthes gt entry nail for dis fracture or long pfn also. plating wont allow early wt bearing and chances of infection, morbidity and nonunion increases.
  
  Hace 14 horas · Me gusta · 2
- Vinit Yadav did u close it after plating? i think u dint as it was impending compartment syndrome.
  
  Hace 14 horas · Me gusta · 1
- Vinit Yadav one thing more is it mandatory to do primary bone graft whenevr u open ne fracture?
  
  Hace 14 horas · Me gusta · 1
- Anuj Agrawal Just on a lighter note, seeing the frequency of primary bone grafting in your patients, it would be interesting to conduct a cross-sectional study of the population at your place, to see the prevalence of missing iliac crests : )
  
  Hace 14 horas · Me gusta · 11
- Shrikrishna Dhone Any time u can check civil hospital THANE, ALIBAG, ULHASNAGAR ALSO BONE BANK TATA.My ot staff sister is so much trained no sooner graft taken she used to close the wound.Anuj my teacher the way he had taught to take graft was beautiful.First only elevate cortical portion take cancellous bone resuture elevated portion,even ij u get to see pt he will have normal iliac crest
  
  Hace 14 horas · Editado · Me gusta · 1
- Rajendra Prasad very good fixation with excellent reduction. Intramedullary fixation is better choice even in case of ORIF.
  
  Hace 14 horas · Me gusta
- Sudhir Pavithra Nailing is always preferred.. as pointed earlier percutaneous schanz with t handle to reduce the fracture by pushing the proximal fragment .. this reduction should be continuous till t nail is introduced. . So t pin should b unicortical.. one can use F tool also.. if not possible at all then open, reduce and nail it..
  
  Hace 14 horas · Me gusta
- Ashwini Sood I think we r not discussing this case properly.In my experience and opinion this is a real SUBTROCHANTERIC FRACTURE.& a Subtrochanteric # requires absolute stability for the union , weather done in a closed manner or ORIF because biology ( blood supply ) is excellent in this area.I have done many such #s with our old but trusted K nail.
  
  Hace 14 horas · Me gusta · 3
- Ashwini Sood Also Y bone graft ? Any reason in particulat ?
  
  Hace 14 horas · Me gusta · 2
- Shrikrishna Dhone prevention better than cure
  
  Hace 14 horas · Me gusta · 1
- Vijay Singh Orif was done onsupine position on general table or traction table ans please
  
  Hace 14 horas · Me gusta
- Sanjay Sharma second generation interlocking nailing closed with locking screws in the neck would have been better option , blood supply is crucial as this area is prone for non union
  
  Hace 14 horas · Me gusta
- Rahul B Tanga Thanks everyone for your valuable inputs.
  
  Hace 13 horas · Me gusta
- Rahul B Tanga Dr nainikumar it's 6 holed plate.
  
  Hace 13 horas · Me gusta
- Paudel Sushil Very very tricky fracture for CRIF
  
  Hace 13 horas · Me gusta
- Shrikrishna Dhone IN our MS exam 1985 external examiner used to confirm with internal how mant subtroc candidate has operated?
  
  Hace 13 horas · Me gusta
- Prakash Agrawal was it nearly impossible to do nailing in this patient ......I don't think so....and indication of plating in subtroch transverse fracture in my literature is "impossible nailing"...you have gifted ur patient 6-8 wks of immobilization and definitely waste of precious Iliac crest....TRY PLAN C next time.....................just joking..
  
  Hace 13 horas · Me gusta
- Rahul B Tanga Dr abhinav agarwal it's not pathological.histort of high velocity trauma.
  
  Hace 13 horas · Me gusta
- Rahul B Tanga Thanks Dr yogesh gaikwad. I am not comfortable operating in lateral position.in my series even in 85 yrs female similar fracture one month old United
  
  Hace 13 horas · Me gusta
- Ajay Gupta I think everyone has different level of expertise and in ot when things are not going your way and its taking a lots of time doc thinks of how to get good reduction and finish the case off. I think Bg has been done more for peace of mind.
  
  Hace 13 horas · Me gusta · 1
- Rahul B Tanga Dr anuj agarwal Even long pfn was kept on table not much adduction was Possible and compartment was tight .All possible techniques of indirect reduction were attempted.i know yOu are never in favour of this implant and say what I have got good results with this implant and I have proved it ennumber of times .I am happy my patients are extremely happy with my results.so what else is expected from surgeon's point of view
  
  Hace 13 horas · Me gusta
- Rahul B Tanga Dr yinit yadav though it's not obvious xray but on table some amount of comminution was noted so went ahead with bg.its not mandatory .
  
  Hace 13 horas · Me gusta
- Rahul B Tanga Dr anuj agarwal even literature says if more than 50% of the cylinder communition is there then do bg.
  
  Hace 13 horas · Me gusta
- Rahul B Tanga Dr shrikrishna Dhone even I follow similar technique when only cancellous graft is required.
  
  Hace 13 horas · Me gusta
- Rahul B Tanga Dr sudhir pathra all possible techniques were attempted.even I have mentioned in my album.
  
  Hace 13 horas · Me gusta
- Rahul B Tanga Dr vijay Singh supine on fracture table.
  
  Hace 13 horas · Me gusta
- Rahul B Tanga Dr Prakash agarwal next time similar case comes I will surely give call to you so that you can convert impossible into possible things.next time you will be my plan C.wait for my call.just kidding
  
  Hace 13 horas · Me gusta · 1
- Sadique Ahmed Khan Gud one again Dr.Rahul.. but I would have preferred nailing without bg.
  
  Hace 13 horas · Me gusta · 1
- Aditya Soral A nail is better if you are attempting biological fixation. If you have already opened the fracture site, u pretty much disturb the # environment taking the sheen away from nailing. I think rahul you have done good job.
  
  Hace 13 horas · Me gusta · 1
- Aditya Soral I too would prefer the same implant
  
  Hace 13 horas · Me gusta · 1
- Prakash Vekaria Right selection for difficult fracture. I always love ORIF. No chance for interposition of soft tissue-cause of non union
  
  Hace 12 horas · Me gusta · 1
- Rustom Adi Mody Very nice job, but biomech forces will be high so protect construct
  
  Hace 12 horas · Me gusta
- Rahul B Tanga thanks dr sadique
  
  Hace 12 horas · Me gusta
- Rahul B Tanga thanks dr aditya
  
  Hace 12 horas · Me gusta
- Rahul B Tanga thanks dr prakash vekaria
  
  Hace 12 horas · Me gusta
- Rahul B Tanga thanks dr rustom adi mody
  
  Hace 12 horas · Me gusta
- Alok Choudhary excellent rahul
  
  Hace 12 horas · Me gusta · 1
- Santosh Mali great job done!!!
  
  Hace 12 horas · Me gusta · 1
- Harshavardhan Patil Y not open reduction and nailing
  
  Hace 12 horas · Me gusta · 1
- Anuj Agrawal Rahul B Tanga There is no harm in primary bone grafting, there are surgeons who graft all cases.
  However, in an attempt to defend yourself, don't go to the extent to say there is >50% comminution (Winquist Hansen type III) in this case!
  This case clearly has minimal comminution, radiologically WH type I, no way more than type II.
  This is a forum of orthopaedic surgeons, and such statements of yours will not go down well.
  How many members agree that there is more than 50% comminution in this case?
  
  Hace 12 horas · Me gusta · 2
- Pavneesh Lohan Why not long pfn
  
  Hace 12 horas · Me gusta
- Rahul B Tanga dr anuj agrwal i am not trying to defend myself, it was you who told that i bg almost all cases and this comment and some study is required and i believe its totally unaaceptable you to comment when its not required nor anyone has asked you, you should stick to the present case and comment in a formal way, informal comments should be avoided so that it will avoid unhealthy discussion.in this case i have done bone grafting for my satisfaction and as told by one the member .but more than 50% communition was told in contest to other cases which have operated in the past and you raised issue about those cases .(seeing the frequency of primary bone grafting in your patients, it would be interesting to conduct a cross-sectional study of the population at your place, to see the prevalence of missing iliac crests), this particular comment in the bracket was totally irrelevant in contest to the present album. try to avoid such statements.hope will have healthy discussions in future.
  
  Hace 12 horas · Me gusta
- Rahul B Tanga 85yrs old female presented with 1month old neglected subtrochanteric fracture femur.
  
  Hace 12 horas · Me gusta
- Rahul B Tanga short subtrochanteric fracture.
  
  Hace 12 horas · Me gusta
- Rahul B Tanga immediate post-op
  
  Hace 12 horas · Me gusta
- Rahul B Tanga immediate post op
  
  Hace 12 horas · Me gusta
- Rahul B Tanga 3months post-op showing uniting fracture and patient was walking fwb with walker.
  
  Hace 12 horas · Me gusta
- Anuj Agrawal When did I mention that you bg almost all cases?
  And the comment you have mentioned began with 'on a lighter note', and most members took it in light humour.
  I always believe in healthy discussions, you know that..
  
  Hace 12 horas · Me gusta · 1
- Rahul B Tanga 3months post-op
  
  Hace 12 horas · Me gusta
- Rahul B Tanga dr anuj agarwal its better to end that discussion.lets share knowledge and believe in ourselves.
  
  Hace 12 horas · Me gusta
- Anuj Agrawal As you say my friend..
  
  11 horas · Me gusta · 1
- Nishikant Kumar IF you are going with orif these plates are not ideal inmy point of view; 3 proximal screw is not good for such fractures; even ao has withdrawn such plates.have revised a few such fixed fractures going in varus collapse . what i use if doing orif is a newer plate with 5 proximal screw ; medtronic has these plates; have done abt 30 cases ; all united; no bone grafting in any.
  
  11 horas · Me gusta
- Vasu Juvvadi After open reduction...it would be good if u preferred to nail...
  
  11 horas · Me gusta · 1
- Rahul B Tanga Dr nishikant even I have series of 15 cases and all United and one was revised with the same pflcp.
  
  11 horas · Me gusta
- Sachin Kumar Mall Good reduction and fixation dr Rahul B Tanga but i prefer OR and pfn in such difficult cases
  
  11 horas · Me gusta · 1
- Sachin Kumar Mall
  
  11 horas · Me gusta · 2
- Latif Abdul Dcs may be another option
  
  11 horas · Me gusta
- Sanjay Sharma closed recon nailing is best option
  
  10 horas · Me gusta
- Sachin Kumar Mall Agree dr Sanjay Sharma CR is best but no harm in doing OR and nailing if CR is difficult
  
  10 horas · Me gusta
- Arvind Verma Jangid i have been in AAOS 2014 new orleans USA WITH DR MUKHI. symposium was on proximal femoral plate lcp vs im nail. clearly mentioned beaware of lcp in proximal femoral fracture. more then 30 % failure rates while using lcp.
  
  10 horas · Me gusta · 1
- Arvind Verma Jangid THIS CASE SIMPLE INTERLOCK NAIL WAS ALSO GOOD OPTION.
  
  10 horas · Me gusta
- Rahul B Tanga Dr verma what should be ideal distance between your nearest locking bolt from fracture site according to AO
  
  10 horas · Me gusta
- Vinit Yadav surely u have done d case nicely, but most of us wud have gone for intramed nailing . and considering impending compartment syndrome u have open the site and then applied plate wid tight closure of wound, doesnt it vl enhance compartment pressure?
  
  9 horas · Me gusta
- Arvind Verma Jangid Campbell says if lesser trock is part of proximal frag u can do simple ILN.
  
  9 horas · Me gusta
- Sanjay Sharma subtronchanteric fracture high failure rate, non union, implant failure, dont disturb the blood supply by opening
  
  8 horas · Me gusta · 1
- Ashwini Sood By basic understanding of #s around the hip joint
  1 Inter-trochanteric ---- Collapsing device
  2 Pertrochanteric or reverse oblique --- DCS or ABP...Ver más
  
  6 horas · Me gusta · 1
- Parit Agarwal U have done ling pfn or nailing also.
  
  2 horas · Me gusta

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