casediscussion 2nd day课件.ppt

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 1 Case 1 Case 4 Lt. femur Lt. femur Lt. femur Post op 20 weeks femur Case 5 Case 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 Case 4 Case 4 What 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 weeks What went wrong?What principle was broken? Humerus surgery 4 months prior Neuro-vascular intact Sudden pain and deformity What went wrong?What principle was broken? After debridement, choice of stabilization ? 1. Plate 2. IM nail 3. Hybrid External Fixator 4. Tubular External Fixator Postoperatively 2 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 graft Pre contour of LCP metaphyseal plate before surgery Position ? Tourniquet ? Which bone first ? Approach ? Reduction ? Type of implant ? Intraoperative x-ray 5 month xrays 6 weeks * Case discussion II Case 1 Case 2 Male 41 years Car accident Isolated injury Close 30 yr old male Motorcycle accident Closed and isolated injury of femur Neurovascular exam – Normal No other injury Male 41 years Car accident Isolated injury Close Any other investigations? What is the management ? - Operative type? Timing of surgery? Male 41 years Car accident Isolated injury Close What type of stability do you need : For the shaft ? - Absolute ? - Relative ? For the articular fracture ? - Absolute How would you expect these fractures to heal? I