case related for small group discussion

1. Gashaye T.
Case discussion II

2. Case 1-14yrs sustain ankle twist while playing football
and presented with 06 hours
 Dx -Distal tibial salter
harris /triplane
fractures
 What examinations
need attention?
 Soft tissue condition
 Swelling
 Proximal leg
tenderness
 Distal neurovascular
condition

3.  What other more imaging you need?
 CT-scan is best investigation modality to asses
fracture personality, displacement and articular step
off
 Why this fracture is common to this age?
 Also known as transitional fracture
 It is based on appearance of physeal ossification
and closer order specific to distal tibia follow central
,medial, lateral

4. Treatment,implant option for fixation
and how do you follow?
 Treatment --surgical
 Displacement >2mm
 Significant articular step off
 Either closed or open reduction
 Open reduction anteriolateral approach- reduction
clamp
 Epiphyseal screw parallel fixation one to
epiphysis other to metaphysis then short leg cast

5. Case 2/ X ray
 Diagnosis
 Rt Fibular deficiency or Fibular hemiamelia
 With missed lateral ray
 Associated conditions
 Anteriomedial bowing of tibia
 PFFD,Coxa vara
 Lateral ray absent,short tibia
 ACL deficit
 Unstable knee and ankle
 CTEV
 DDH
 Tarsal coalition
 Genu valgum
 LLD

6. Classification
 Achterman & kalamachi
 Amount of fibula present
 Type IA
 Portion of fibula present
 Proximal fibular epiphysis distal to level of proximal
tibiaphysia and distal fibula proximal to talus
 Type IB
 Partial absence of fibula
 Distal portion is unable to support the ankle joint
 Type II
 Complete absence of fibula

7. Other
 Frantz and O’Rahilly Classification
 Intercalary..foot normal
 Terminal..foot abnormal with absence ray esp lateral ray
 Longitudnal
 Coventry and Johnson Classification
 TYPE I-partial absence
 TYPE II-complete complete
 TYPE III-bilateral fibular absence
 Birch Classification
 Consider LLD
 Functionality of foot
 Upper limb anomaly

8. birch classication

9. Management
 Goal -treatment based on
 Stablity &level of ankle and foot
 Function
 Degree of limb shortening
 Option
 Observation
 Contralateral limb shortening
 Limb lengthening
 Both
 Amputation
 Syme or boyd amputation

10. CASE 3/12 yrs female,fall down at 09 yrs
 Diagnosis
 Neglected /missed
montaggia fracture
dislocation
 Radiocaptular line lost
 Dislocated radial head
 Ulnohumeral joint OK

11.  What likely functional limitation do you expect
with this condition?
 Supination more than pronation
 Elbow flexion /extention ROM
 Hand grip strength

12.  What other imaging do you like to have?
 Proper forearm x ray including wrist
 Elbow CT and MRI

13.  Do you like to operate or not to?
 Yes
 Open reduction with ulnar osteotomy ± anular
ligament reconstruction
 Expected operative & nonoperative management
 Good radiological and clinical out come as
compared to non operative
 ROM
 Elbow deformity
 Pain
 Degenerative change

14. Case IV/40 yrs old male sustain RTA 01 day
Presented with chest and arm pain,1cm wound over distal
arm
 approach patient
 What examinations
need attention
 Do you like to fix or
not to this fracture
and why?
 What are options of
fixation and timing of
fixation?

15. Case V/50 yrs female fall from 3m
height,Isolated injury
 Diagnoses
 Classification
 Implant options for
fixation
 complications

16. Case VI/6yrs boy fall while playing presented with
pain and swelling around elbow
 Diagnosis
 How do you like to examine?
 Classification
 Management options and
timing
 What is the management
algorithm for this kind of
injury based on pulse and
perfusion

17.  Thank you!