Ortopedia Pediátrica. Traumatología y Reemplazos articulares: Discusión entre pares / 22 year old male with compound segmental fracture of rt tibia / Opiniones!!!!

Paras Gupta

22 year old male with compound segmental fracture of rt tibia, wound about 2*1 cm on anterior aspect at proximal and mid 3rd jnc.Managed by ETN and Post slab for 3 week for minimally displaced intra-articular proximal tibia.

Gopal Goel 1.Proximal varus+ 2. Proximal reduction not acceptable 3. Intercondylar fragment ( visible in post op X Ray ) has not been fixed. Proximal Plating in addition to nailing would have been better
Hesham Azzam Also, if there is Ankle x Ray
Mahantesh Akki nail entry lower , a ant derotation plate and nailing would have solved the problem
Sadasivan Anand Kumar Bad fixation. Entry point should have been proximal and you could have fixed the condyle with the screws
Yogesh Gaikwad Re fixation.
Hesham Azzam Advice :
Generally , in orthopaedic , don't treat two fractures by one implant .
Mohammad Zahir Shah Ahamadi Bad fixation, open # bist fixation Ex fix
Rajendra Pipal ETN right choice but entry point should as high as possible for these type of fractures
Ashish Patidar 1.intercondylar fragment need to be fixed 2.nail enetry should be higher.proximal fragment may be supplemented with posterior medial plate.
Anurag Sharma Tricky one .....you might need to revise it later ...for now wound management should be top priority

Hace 12 horas · Me gusta
Pravin Siddharth
Abhijit Bhosale Needs re-doing, I'm amazed with your guts of posting x-Ray of crap fixation!!!!!!!!!!!!!!! Ilizarov is best in this to tackle both fractures. For coronal split of proximal fragment, screws are needed in addition!
Pravin Siddharth No body bcms an expert srgn in a day, every one does mistake
I really appreciate dt dr. Paras has posted this case
"Learning" is a long, continious curve.....
Gulzar Sahota Dr Abhijit Bhosale it is a fixation done by one of our fellow orthopaedic surgeon callin it crap is nt d rt language . All of us r human beings .u r welcum to put forward ur comments suggestions
Gulzar Sahota Dr Pravin Siddharth thanks fr showin d pic of d entry point
Abhijit Bhosale Percutaneously done internal decoration.....
Abhijit Bhosale It's sad that we don't recognise the simple principles of fracture fixation. We don't operate on woods like carpenter. They get 2nd chance, we don't! It's a question of patient's life. We don't have rights to play with it! Gulzar, my friend, imagine this pt is your mother or father and someone does this fixation, what will your reaction be? Would you happily tell the surgeon to revise it or would you raise questions about his/her decision making?? I rest my case. You can check my comments on those who have done excellent jobs!
Ashit Mehta U need to have a way out. Everyone makes mistake but to post it, is courage which evryone would not have.
U need to revise. Remove locking bolt
Paras Gupta thanks all for healthy criticism.
Ashit Mehta Locking bolts to be removed. Retrive the nail back. Fix the proximsl fr with plate. Try to pass the nail thro same entry, if not successful go for prox entry as very well shown here.
Paras Gupta Dr Abhijit, I welcome your comments but somtimes it happens even in hands of very experienced surgeons.Sometimes we could not get enough time in OT , sometimes our assistant is not ready with all implants inspite of instructions.Anyway I am not justifieng me for poor fixation but just to realize you that it may happen to anybody.
Amit Sehgal Dr.abhijit this case being done by his resident in medical college....plan was to fix it with plating....but plate of required length was not available.....so nail was done......if entry would have been bit proximal..this could have been a good fixation....but this was put in IOS group so that we can assess ourself n our choice of implant...

Hace 9 horas · Me gusta · 1
Chandan Kishor Amit Senegal sir... why plate or nail only... why not fixation with proximal lag screw and ilizarov.. will it not serve the purpose in such type of fracture...??
Ashit Mehta I think this forum is for learning. It is not to be sentimental about patients. Everyone cares about patients. Mistajes do happen. When I go through some of the text books I find x rays of fixation look horrible and not acceptable at present. I used to find it good few yrs back. I find my fixation better with yrs passing. Everyone tries to do better than before and is constantly learning.
It is better to suggest way out rather tnan harsh criticism. Or else such X rays would never be posted here and learning would stop and we would be seeing all good fixation only.
Abhijit Bhosale There is no harm in using 2 plates for fixation if you don't have facility of Ilizarov or long plates. In that case yes, there will be a stress riser in between the two plates. But you can counsel pt pre-operative ku and warn about removal of implants after 12-18 months or so. The lessons learnt from this case are--
1) don't compromise on implants
2) if you don't have facility, send the pt somewhere else, and being honest with pt about the facts
3) it's better to discuss such complex cases beforehand, in patient's best interest
4) the most important thing is 'GET IT RIGHT THE FIRST TIME'
Abhijit Bhosale Ashit, the first thing is we treat patients and not the radiographs, my friend! Any mistake of decision on our part will have right or wrong effect on patients. After all we are for them, isn't it? It's not about sentiments, but the right choice for right pt at the right time.
Narayan Bs Friends, this forum is followed by many ortho surgeons all over the world. Kindly see to that the criticism is healthy. Many surgeons does unethical wrong to worst fixation. Everybody will not be even bold enough to share with their close friends. I believe in sharing our mistakes so that others sould not repeat them.....
Dr Narayan, Muscat, Sultanate of Oman.
Ashit Mehta Abhijit no one denies. The statement that u use that get it right the first time is one that I always follow. But mistakes can happen and we must try to show the way out. But for his keeping this x ray here thete could not have been discussion on doing it the right way and which is the right way.
Those of us who would not have done such case in past would learn the right way, the next tome they get such a case.
Patients at large benefitted from discussion on a mistake by a colleague. Isnt it. So I want such cases are posted and we analyze scientifically and show a way out.
I agree revising is easier said than done. But if u dont ur competitor or colleague would do and it might defame u more.
Yogesh Gaikwad Just to change & cool down....
FIRST SHOT IS ALWAYS THE BEST SHOT.
....LOL..
Anuj Agrawal This has to be revised undoubtedly. Despite recent detailed discussions on the tips and tricks for nailing proximal fractures, none has been applied in the case.
Abhijit Bhosale Unofficial language is prohibited on the forum. You could have simply stated the job done is suboptimal and unacceptable.
Such complex cases should be planned well in advance, and should be properly supervised, if passed down to the level of residents.
Satya Ranjan Patra Nothing wrong with the implant... Only poor technique....
Jitendra Tavri gloomy

H
Abdulalim Shaheen No ankle x ray.
Santoshkumar Sahu in dis x-ray,d # line is prox to d herzog's bend...which means,it'll end up in a varus deformity at some point of time,on top of dat fixation is poor......in my opinion lat.condylar locking plate wid a properly placed nail 'll do d job 4 u....
Yogesh Gaikwad I agree with Anuj Agrawal , when someone is posting such type of case & if he is following the group , this type of # was discussed in brief .
Question is in this case..
I Think. ....Ver más
Yogesh Gaikwad Sorry.
I will go with surgeon choice of fixation.
I will put IM NAIL with all inventory in my hand with experience ,...Ver más