Case discussion dr  leal
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Case discussion dr leal Presentation Transcript

  • 1. Case # 1 40Y Male Supracondylar Femoral Fracture & ORIF After 11 months of pain an no bone healing, He had Deeop venous thrombosis and Pulmonary Embolysm. Due to a possible complication he was sent to us for ESWT treatment. I performed ESWT. He did well for almost ayear an the X ray were preetty good,. When he started muscle rehab, he had pain again and the xrays were not as good. There is a gap again on the X rays. Question: WOULD YOU TRY ESWT AGAIN OR WOULD YOU GO FOR SURGICAL TREATMENT FOR THE PSEUDOARTHROSIS ????? Carlos Leal MD Fenway Medical Bogota
  • 2. jhkhkjhjk April 2010 11 months after ESWT Pain during Physical Therapy X rays show fracture site again Jun 2009 10 Months after surgery Complicated with DVT and Pulmonary embolism ESTW Treatment for delayed union Dec 2009 6 months after ESWT No pain, stable knee no crutches. Starts physiscal activity Male 40yr Horse traimer Horse backriding accident AP X-RAYS Carlos Leal MD Fenway Medical Bogota
  • 3. April 2010 11 months after ESWT Pain during Physical Therapy X rays show fracture site again Jun 2009 10 Months after surgery Complicated with DVT and Pulmonary embolism ESTW Treatment for delayed union Dec 2009 6 months after ESWT No pain, stable knee no crutches. Starts physiscal activity Male 40yr Horse traimer Horse backriding accident LATERAL X-RAYS Carlos Leal MD Fenway Medical Bogota
  • 4. Case # 2 35Y Male – Orthopedic Surgeon Parachute Accident 16 months ago This colleague was treated with ORIF and did not heal. The tyibia healed well, and the metaphyseal region looks good. Hoverer, the last x-rays show a n oblique fracture line onb the distal diaphysis. No infection found, He was treated for the delayed union with open surgery, allografts – Autografts, growth factors and osteoconductors. He is in crutches at the moment. Question: WOULD YOU TRY ESWT IN THIS CASE, AFTER SURGICAL TREATMENT AND GRAFTING ???? Carlos Leal MD Fenway Medical Bogota
  • 5. Aug 2009 7 Months after surgery Tibial Hardware removed. Part of femoral hardware removed. Grafted and augmented with Growth Factors Carlos Leal MD Fenway Medical Bogota
  • 6.
    • Apr 2010
    • Months after
    • Grafting Surgery
    • Stable
    • Pain with loads
    Carlos Leal MD Fenway Medical Bogota
  • 7.
    • Apr 2010
    • Months after
    • Grafting Surgery
    • Stable
    • Pain with loads
    Carlos Leal MD Fenway Medical Bogota