Pelvic ex fix
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This document discusses the use of external fixation for pelvic injuries. It notes that external fixation is commonly used for emergency stabilization of pelvic ring injuries. While it provides adequate stability for some types of injuries, its stability is poor for vertically unstable type C injuries. External fixation is best as a temporary measure in the emergency department or as part of a hybrid fixation approach combined with internal fixation. Placement of screws in the supra-acetabular region is preferred to the iliac crest for better holding power and soft tissue coverage.
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Pelvic ext
This document discusses pelvic fractures and external fixation. It begins by noting that pelvic ring injuries can cause high morbidity and mortality due to hemorrhage when the pelvis is unstable. It then discusses several methods for hemorrhage control, including closed reduction of the pelvis, external fixation, pelvic packing, and angiography. The document focuses on external fixation, describing the ASIS and AIIS frame designs and considerations for pin size, number, and frame location and design. It provides details on landmark identification and surgical technique for ASIS and AIIS external fixation.
39. tibial plafond (pilon) fractures
This document discusses tibial pilon fractures, which involve fractures of the distal tibial articular surface. Key points include:
1) The term "tibial pilon" was first used in 1911 to describe the distal tibia resembling a pestle. Pilon fractures account for 7-10% of tibial fractures and usually result from high-energy mechanisms.
2) Classification systems include the Rüedi-Allgöwer system (based on articular displacement/comminution) and the AO/OTA system (which further subdivides based on extra-articular involvement and comminution).
3) Treatment involves restoring tibial alignment, stabilizing the fracture to facilitate union,
Floating Knee
This document discusses floating knee injuries, which involve ipsilateral fractures of the femur and tibia. It describes the classification system for floating knee injuries, which includes true floating knee injuries (extra-articular fractures of both bones) and various types involving articular fractures. These injuries often result from high-energy trauma and are associated with injuries to other body parts. Treatment involves stabilizing the patient, addressing any life-threatening injuries, and providing initial stabilization of the fractures often using external fixation before definitive surgical fixation of the fractures.
Masquelet technique ppt
The Masquelet technique is a two-stage process for treating bone defects using an induced membrane. In the first stage, radical debridement is performed followed by insertion of an antibiotic-loaded cement spacer and soft tissue coverage. This induces the formation of a membrane rich in growth factors. In the second stage 6-8 weeks later, the spacer is removed and cancellous bone graft is placed within the membrane chamber, which acts as a bioreactor promoting graft healing. The technique provides an alternative to bone transport or vascularized grafts for reconstructing large defects.
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Posterolateral corner injuries of knee joint
Missed posterolateral corner injuries of knee joint is a common cause for failure of ACL and PCL reconstruction only next to malpositioned tunnels.
Isolated PLC injuries are uncommon, making up <2% of all acute knee ligamentous injuries. Covey JBJS 2001
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A recent (MRI) analysis of surgical tibialplateau fractures demonstrated an incidence of PLC injuries in 68% of cases. Gardner JOT 2005
Take home message
PLC injuries to be ruled out in every case of ACL& PCL rupture.
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Grade III Chronic- Anatomic PLC recon.
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2) Classification systems include the Rüedi-Allgöwer system (based on articular displacement/comminution) and the AO/OTA system (which further subdivides based on extra-articular involvement and comminution).
3) Treatment involves restoring tibial alignment, stabilizing the fracture to facilitate union,
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This document discusses floating knee injuries, which involve ipsilateral fractures of the femur and tibia. It describes the classification system for floating knee injuries, which includes true floating knee injuries (extra-articular fractures of both bones) and various types involving articular fractures. These injuries often result from high-energy trauma and are associated with injuries to other body parts. Treatment involves stabilizing the patient, addressing any life-threatening injuries, and providing initial stabilization of the fractures often using external fixation before definitive surgical fixation of the fractures.
Masquelet technique ppt
The Masquelet technique is a two-stage process for treating bone defects using an induced membrane. In the first stage, radical debridement is performed followed by insertion of an antibiotic-loaded cement spacer and soft tissue coverage. This induces the formation of a membrane rich in growth factors. In the second stage 6-8 weeks later, the spacer is removed and cancellous bone graft is placed within the membrane chamber, which acts as a bioreactor promoting graft healing. The technique provides an alternative to bone transport or vascularized grafts for reconstructing large defects.
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Isolated PLC injuries are uncommon, making up <2% of all acute knee ligamentous injuries. Covey JBJS 2001
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Take home message
PLC injuries to be ruled out in every case of ACL& PCL rupture.
Neurovascular integrity to be checked in every case.
Grade I & II can be managed conservatively.
Grade III Acute- Repair.
Grade III Chronic- Anatomic PLC recon.
Beware of varus knee alignment.
Damage control orthopaedic surgery
Damage control orthopaedics (DCO) is an approach that temporarily stabilizes orthopaedic injuries in severely injured trauma patients to avoid worsening their condition. It focuses on controlling hemorrhage, managing soft tissue injury, and achieving provisional fracture stability through temporary stabilization methods like external fixation. This allows time for the patient's physiology to stabilize before definitive repair and reduces the risks of complications from a major orthopaedic procedure when the patient is still unstable. DCO has evolved from traditional approaches as an understanding has grown of the body's inflammatory response to trauma and risks of multiple hits.
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2) Performing closed reduction of the fracture if possible, or open reduction if needed.
3) Making an incision over the femoral neck and inserting guide wires under fluoroscopy to align the placement of screws and plate.
4) Reaming and inserting a lag screw to stabilize the fracture followed by placement of the DHS plate and fixation screws to complete the procedure.
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1) Positioning the patient supine on a traction table and obtaining x-rays to visualize the hip.
2) Performing closed reduction of the fracture if possible, or open reduction if needed.
3) Making an incision over the femoral neck and inserting guide wires under fluoroscopy to align the placement of screws and plate.
4) Reaming and inserting a lag screw to stabilize the fracture followed by placement of the DHS plate and fixation screws to complete the procedure.
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Osteotomy around the elbow is commonly performed to correct cubitus varus and cubitus valgus deformities. For cubitus varus, the most common cause is a malunited supracondylar fracture. Surgical options include lateral closing wedge osteotomy, oblique osteotomy with derotation, and medial opening wedge osteotomy with bone grafting. For cubitus valgus, causes include nonunion of a lateral condyle fracture. Surgical options are a closing wedge medial osteotomy or opening wedge lateral osteotomy. Complications of elbow osteotomy can include stiffness, persistent deformity, myositis ossificans, loss of fixation, and neurovascular injury.
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CORA (center of rotation of angulation)
This document discusses the concept of the center of rotation of angulation (CORA) in orthopedic surgery. The CORA is the point about which a deformed bone may be rotated to achieve correction of an angular deformity without introducing a translational deformity. Proper identification of the CORA allows selection of the optimal correction axis and type of osteotomy, such as opening, closing, or dome osteotomy, to realign the bone. Correction along the bisector line passing through the CORA ensures pure angular correction without residual translation. Identification of multiple CORAs indicates more complex multi-apical or translational deformities requiring different surgical techniques.
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Distal Humerus Fractures.pptx
This document discusses the challenges and solutions in the management of distal humerus fractures. Some key points:
- Distal humerus fractures are challenging due to metaphyseal comminution and the complex anatomy of the elbow joint.
- Surgical approaches such as the triceps-sparing and olecranon osteotomy approaches each have benefits and limitations.
- Parallel plate fixation has been shown to provide better stability than orthogonal plating, though both can achieve good outcomes.
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3) Treatment is challenging due to articular comminution, bone loss, and soft tissue injury. Surgical management aims to reconstruct the articular surface and metaphysis while treating soft tissues.
benign bone tumors contd...
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Pelvic ex fix
- 2. Patient with unstable pelvic injury in ED
- 3. Type C1
- 4. Pelvic injuries form about 3-4 % of all skeletal injuries but it is likely to rise as more vehicles are put on our roads ( 200%+ increase in last 5 years!) Low energy trauma in osteoporotic person High energy RTA Fall from height Earthquake/ war
- 5. Emergent application in the E.D for unstable patient with pelvic injury As adjunct to control bleeding in pelvic injury (?) As a definitive fixation in certain open injuries In combination with limited Internal fixation Children with pelvic injuries Pregnant women indications
- 7. Retroperitoneal bleed ? Urethral injury
- 9. Contraindications: Poor general condition. Local soft-tissue damage. Local infection.
- 10. The external fixator is the most commonly used treatment for surgical stabilization of the pelvic ring in emergency situations. Its advantages are ease of handling and its availability in most hospitals
- 11. The inadequate biomechanical stability of some configurations of external fixation is a concern. Although adequate holding power was measured for open-book type B injuries unstable in rotation, the load limits for vertically unstable type C injuries is poor
- 12.
- 13. On account of the superior holding power of the Schanz screws in the supraacetabular region compared with their placement in the iliac crest and on account of the superior soft-tissue coverage, the technically more demanding placement of Schanz screws in the supraacetabular area is preferred to their placement in the iliac crest.
- 14. The good and excellent results of all treatments of pelvic injuries are 79.8%, and of these 83.2% are with internal fixation solely, while 78.5% are with external fixation solely and hybrid fixation. The difference is less than 5%, and having in mind that in many cases the external fixation was irreplaceable, we would like to emphasize again that this method still has its importance and certain place today. Pavlin Apostolov, Martin Burnev, Petar Milkov Clinic of Orthopaedics and Traumatology MBAL “Saint Anna” Hospital - Varna, Bulgaria
- 15. Advantages • Percutaneous screw insertion. • Minimal soft-tissue damage. • Reduced bleeding from pelvic bones and venous plexuses thanks to the reduction. • Direct mechanical compression effect on the posterior pelvic ring. • Immediate application in the emergency ward or the intensive care unit. • Early mobilization with partial weight bearing for type B injuries thanks to pain reduction Axel Gänsslen, Tim Pohlemann, Christian Krettek Operat Orthop Traumatol 2005;17:296–312
- 16. Disadvantages • If misdirected can penetrate into hip. • May be awkward for very obese patients, particularly when sitting. • Has to be combined with internal fixation in type C injuries.
- 17. Preoperative Work Up • Pelvic radiographs, if necessary oblique views or computed tomography. • Identify type of injury & direction of instability • Antibiotics generally not necessary.
- 18. Anesthesia and Positioning • General anesthesia. • Standard supine position. • Free draping of the lower limb on the side of the injured pelvis. • Positioning of the patient in such away that the following views are possible: – view of entire pelvis; – oblique views allowing a 40° rotation in the transverse plane: inlet and outlet views; – oblique views allowing a 30° rotation in the sagittal plane: ala and obturator views.
- 19. Know where thicker bone is available for pins to hold well
- 20. To obtain the maximal screw length, and therefore an optimal screw purchase, a drilling angle of approximately 20° must be selected for the Schanz screw In the frontal plane there is a triangular area of cancellous bone along iliopectineal line.
- 21. With the patient supine, the direction of drilling is inclined approximately 10–20° caudally
- 22. The capsule of the hip originates on average 16 mm (11–20 mm) above the anterior rim of the acetabulum To avoid the screw being placed intraarticular, a distance of approximately 1.5–2 cm cranial to the anterior rim of the acetabulum should therefore be selected. This roughly corresponds to a position just cranial to the anterior inferior iliac spine.
- 24.
- 25.
- 26.
- 27. The orientation of the ala of the iliac bone is determined by palpation with an instrument [30], a Kirschner wire [28] or the finger. Only the cortical bone is perforated by the drill bit, and the Schanz screw is then introduced into the drill hole and further advanced between the two laminae of the iliac bone without predrilling.
- 30. Tamponade effect is doubtful
- 31. Everyone treating pelvic injuries should know how to do a good external fixation. Temporary emergent Tx in ED May be used as part of hybrid stabilization May be definitive in open injuries – (colostomy) Supra-pubic fixation preferable to iliac crest (superior) fixation summary
- 32.