Clavicle nailing
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THOUGH CLAVICLE FRACTURES HEAL EFFORTLESS, BUT WE SHOULD TRY TO MAKE IT HEAL ALIGNED.
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Clavicle nailing
- 1. CLAVICLE NAILING BY NEERAV MODI
- 2. • A DEBATABLE FRACTURE • ALL WILL HAVE DIFFERENT EXPERIENCES • ALL WILL HAVE DIFFERENT OPINIONS • MOST OF US ARE IN FAVOUR OF TREATING IT CONSERVATIVELY Neerav Modi, 8511010070
- 3. CASE SELECTION WE CAN OPERATE ALL DISPLACED AND COMMUNITED CLAVICLE FRACTURES EXCEPT LATERAL 3RD FRACTURE WE CAN NOT OPERATE CLAVICLE WITH A VERY NARROW CANAL Neerav Modi, 8511010070
- 4. BENEFITS • MINIMALLY INVASIVE • COSMETIC- small incision • RESONABALY EXCELLENT ALIGNMENT • EXCELLENT OUT COME Neerav Modi, 8511010070
- 5. DRAWBACKS • IMPLANT IMPINGEMENT • WE CAN BREAK CLAVICLE WHILE NAGOCIATING NAIL • SOMETIMES DELAYED UNION • IMPLANT REMOVAL IS MUST Neerav Modi, 8511010070
- 6. PREPARATIONS • ALWAYS KEEP C-ARM ON AFFECTED SIDE • ALWAYS CHECK FOR REDUCTION BEFORE DRAPPING • Surgeon will operate from opposite side • CHOICE OF IMPLANT is “ TAN NAIL”, we can use K-wire or Rush nail • ALWAYS KEEP SET OF PLATES READY • ALWAYS KEEP SS WIRE SET READY • Keep threaded K- wire/pin for manipulation Neerav Modi, 8511010070
- 7. • INCISION- 1 CM, VERTICAL AND MEDIAL OVER MEDIAL END OF CLAVICLE. BLUNT DISSECTION TO FEEL MEDIAL END Neerav Modi, 8511010070 SURGICAL TECHNIQUE
- 8. • ENTRY- WITH 2 MM K WIRE FROM MEDIAL END AND NAGOTIATE WIRE IN AS POSSIBLE. DILATE THE ENTRY WITH 2.5MM AND 3 MM WIRE Neerav , 8511010070
- 9. • NAGOCIATION OF TAN NAIL IN ENTRY • GO SLOWLY WITH FEELING OF BONE AND CANAL UPTO FR SITE • REDUCTION OF FRACTURE AND NAGOCIATE NAIL IN DISTAL FRAGEMENT • GO AS MUCH AS POSSIBLE DISTALLY • TAKE CARE WHILE GOING DISTALLY AS NAIL MAY PIERCE LATERAL END • IF POSSBLE PUT ONE MORE NAIL Neerav Modi, 8511010070
- 10. Neerav Modi, 8511010070 • AFTER CONFIRMATION AND SATISFACTION ABOUT REDUCTION AND NAIL PLACEMENT,… ‘DO REMEMBER TO WITHDRAW NAIL UPTO 1 CM, BEND IT, CUT IT AND RE-INSERT IT BY GIVING COUNTER PRESSURE TO CLOSE THE FR GAP’. • CLOSURE OF WOUND • SHOULDER ARM POUCH WITH RIB BELT • SUBSEQUENT FOLLOW UPS AND MOBILISATION
- 11. OPERATED C/O 35,M WITH SEGMENTAL FRACTURE Neerav Modi, 8511010070
- 12. RECENTLY OPERATED, 48,M Neerav Modi, 8511010070
- 13. Pre-Op Post-Op 4 months post op 45,F OPERATED 5 MTHS BACK, IMPLANT REMOVAL DONE Neerav Modi, 8511010070
- 14. 28,F OPERATED MTH BACK WITH SEVERE COMMUNITION & NARROW CANAL , MOBILISED SINCE ONE MTH, ALL MOVEMENTS PRESENT 2 MTH POST OP Neerav Modi, 8511010070 B/O SMALL CANAL FURHTER INSERTION OF NAIL WAS NOT POSSIBLE, 2 MTH F/U SHOWS GOOD MOVEMENTS AND UNION
- 15. C-ARM VIDEO Neerav Modi, 8511010070