Complex elbow fracture-dislocation in a 25M (C2748)
25 / M - Presented in ER with complaint of left elbow pain after RTA.
What is the best treatment option for this complex elbow fracture-dislocation?
Soft tissue status for this patient was not favourablefor open reduction and internal fixation, we proceed with cross elbow external fixation. fractures are very complex (high comminution) with inadequate bone stock. Alternative to internal fixation are arthroplasty which can be a reasonable option for this patient.Primary total elbow arthroplasty in complex fractures of the distal humerus.Sørensen BW, Brorson S, Olsen BSWorld J Orthop. 2014 Jul 18. doi: 10.5312/wjo.v5.i3.368. 5. (3). :368-72PMID: 25035841 (Link to Abstract)Hemiarthroplasty for the treatment of distal humerus fractures: short-term clinical results.Argintar E, Berry M, Narvy SJ, Kramer J, Omid R, Itamura JMOrthopedics. 2012 Dec. doi: 10.3928/01477447-20121120-06. 35. (12). :1042-5PMID: 23218618 (Link to Abstract)
What is the most common type of malalignment after intramedullary nailing of distal 1/3 extra-articular tibia fractures when compared with plating?
It comes up as preferred response ROTATIONAL
Acetabular fracture with posterior wall involvement in a 58M (C2747)
58 / M - The patient presented to ER after RTA with Left hip pain
What is your preferred approach for ORIF of this fracture?
LISS Distal Femur
LISS System for stabilisation of a distal femur fracture - Arvind von Keudell, MD
Pelvic Ring Fractures
Good question.I do not use it at my hospital simply for cost reasons. It runs about $5,000-8,000 per dose, so is prohibitively expensive. I think it would have to show a positive cost-benefit ratio for it to be implemented as the standard of care. Just my thoughts.
Femoral shaft nonunion in a 39F s/p MVA (C2744)
39 / F - A 39 year old female patient presents status post-MVA 10 months ago where she suffered a right femur fracture. This was treated with a intramedullary nail (Xrays shown).
History of suspected infection with +ve CRP, mild fever, and thigh pain with swelling 3 weeks post-operatively which was treated with antibiotics, no surgical debridement was done.
No history of wound discharge, or discharging sinus.
Patient presented to me 4 weeks ago with pain at fracture site. CRP was 1/24, now its 1/12 after 4 weeks of oral empirical antibiotics administration
Update: CRP is -ve now
How would you manage this patient?
Infected till proven otherwise. Markers better only after treatment (suppression) with po antibiotics. Stop antibiotic x2wk. Take out hardware, debried, & culture x 4-6. IV & local antibiotic beads (Ca SO4 I think) May have to plate acutely if grossly unstable. (or staged?) and graft to obtain union. Forteo?
Good to find out laboratory wise parameters were responding and went down, radiological signs of distal nail rocking very clear, I agree with replacing with bigger static nail preferable with an AP distal locking screw hole facility because the distal femoral fragment been used well regard the current nail, of course curettage for C\S ,refreshing & bone grafting vs substitutes, with NWB to get radiological signs of callus formation, same time with continues static muscle ex. ,knee ROM to reach a SLR.
Anaesthesia. 2005 Jun;60(6):613-6.
Does any one used recombinant factor vii in the management of hemodynamically unstable pelvic injury?The use of recombinant activated factor VII in the control of haemorrhage following blunt pelvic trauma.Udy A, Vaghela M, Lawton G, Sigston PAnaesthesia. 2005 Jun. pii: ANA4154. doi: 10.1111/j.1365-2044.2005.04154.x. 60. (6). :613-6PMID: 15918835 (Link to Abstract)
Hip Pelvis. 2015 Dec;27(4):278-82. Epub 2015 Dec 30.
Leg Compartment Syndrome
Dr. Ortho - thanks for the post and link to the article. Anything that increases compartment pressure has a risk of leading to compartment syndrome, and your quoted article reveals just that.Compartment Syndrome of the Gluteus Medius Occurred without Bleeding or Trauma: A Case Report.Kong GM, Kwon YU, Park JHHip Pelvis. 2015 Dec. doi: 10.5371/hp.2015.27.4.278. 27. (4). :278-82PMID: 27536637 (Link to Abstract)
to achieve healing you should remove proximal screws & let the pt to start wt bearing as tolerated.Give him oral Vit D, calcium & strontium
what is the opinion of the surgeon whp posted the case ??
Bull Hosp Jt Dis. 2002-2003;61(1-2):32-9.
There is no accurate diagnosis of infection. Before deciding on a treatment I would take cultures of the non-union focus after 2 weeks without antibiotics and perform a In-labelled WBC scan to decide definitive treatment.
A 30-year-old male falls off the roof and sustains the injury seen in Figure A. Multiple attempts at a closed reduction are made, but are unsuccessful. Entrapment of which of the following structures is the most likely etiology?
Posterior tibial tendon
Anterior tibial tendon
Flexor hallucis longus
never mind, its in one of the comments by Dr. Szatkowski (http://www.orthobullets.com/testview?qid=2889). I have frequently seen people do this. it does not work that way. Thanks anyway though. you guys here have done an amazing job putting together an excellent review source!.
Well done :)
A 6-year-old boy with progressive bilateral genu varum undergoes the surgeries shown in Figure A. On postoperative rounds later that day, the patient appears sedated after several doses of pain medication. His toes are pink with brisk capillary refill however, passive motion of his toes causes pain. Among the answer choices listed, what is the best management strategy for this child?
Elevate his legs and reevaluate on morning rounds
Adjust his pain medication to accommodate for his increasing pain
Administer a muscle relaxant for leg spasms
Cast removal and measurement of compartment pressures with a standard device
Examine the cast for areas of constriction and reevaluate in the morning
Dr. Anonymous - I'd agree with you there over simply masking the issue with additional narcotics. I've updated the choice to include cast removal.
Dr. Anonymous - which links are in parentheses? The link to the abstract in the references section above works fine on chrome and safari. Let us know so we can check out or fix the issue.