Discusión entre pares / 45yrs /male presented with closed comminuted fracture distal 1 /4th tibia with closed displaced fracture...

https://www.facebook.com/groups/indian.ortho/
Indian Orthopaedic Research Group

Rahul B Tanga

45yrs /male presented with closed comminuted fracture distal 1 /4th tibia with closed displaced fracture distal 1/3rd fibula with impaction component and a k/c/o DM and IHD.patient was treated with orif with 1 /3rd tubular plating fibula and crif with mippo DTLCP tibia.

• 

  Rahul B Tanga Valuable inputs?

  27 de diciembre a la(s) 2:43 · Me gusta
• 

  Ashish Sanghavi Sorry to say but improper reduction

  27 de diciembre a la(s) 2:46 · Me gusta · 2
• 

  Rahul B Tanga Ashish this what i could achieve on table

  27 de diciembre a la(s) 2:47 · Me gusta · 1
• 

  Ashish Sanghavi Rahul have a look at Ur ap x ray.

  27 de diciembre a la(s) 2:48 · Me gusta · 1
• 

  Dr-Fadi Abu Ayyash Needs good reduction bcz its an articular surface

  27 de diciembre a la(s) 2:49 · Me gusta · 3
• 

  Rahul B Tanga Ya even i am not satisfied but it appeared ok on table.

  27 de diciembre a la(s) 2:50 · Me gusta · 1
• 

  Dr-Fadi Abu Ayyash I advice to put on rx fix for 2wks then definitive ttt

  27 de diciembre a la(s) 2:50 · Me gusta
• 

  Dr-Fadi Abu Ayyash Ex

  27 de diciembre a la(s) 2:50 · Me gusta
• 

  Jayant Sharma In this type of case I will initially apply a JESS distractor and k wires with fibula plating. Wait for swelling to subside soft tissue healed. Then after 3 weeks depending on the integrity of articular surface will plate and bone traft

  27 de diciembre a la(s) 2:54 · Me gusta · 20
• 

  Budha Prakash Not as par your previous post...sorry..why this happened ...Pl.post

  27 de diciembre a la(s) 2:55 · Me gusta · 2
• 

  Dr-Fadi Abu Ayyash I agree with u jayat

  27 de diciembre a la(s) 2:56 · Me gusta · 1
• 

  Khin Zaw Hein I prefer Ilizarov fixator

  27 de diciembre a la(s) 3:02 · Me gusta · 1
• 

  Frederick Leones Iglesia There is no perfect surgery. Sometimes, unexpected things happens. However, may we learn to find out what went wrong, for improvement for all our colleagues.

  27 de diciembre a la(s) 3:04 · Me gusta · 4
• 

  سعد جاب الله My plan is plating of z fibua , mini open reducion and screw fixation of z articular surface , hybrid fixator

  27 de diciembre a la(s) 3:05 · Me gusta · 2
• 

  Frederick Leones Iglesia Hybrid exfix will do. Dr Rahul B Tanga, what was fixed first?

  27 de diciembre a la(s) 3:06 · Me gusta · 1
• 

  Mohamed Waheeb Why not Ilizarov ????

  27 de diciembre a la(s) 3:08 · Me gusta · 1
• 

  Amr Reda I agree with mr Jayant Sharma

  27 de diciembre a la(s) 3:21 · Me gusta · 1
• 

  Ahmad Fayyaz Bajwa Well mipo in such fractures??.. the pilon tilt has not been corrected.. 
  I wud prefer one third or small frac dcp on fibula. And ilizarov across ankle for tibia

  27 de diciembre a la(s) 3:22 · Me gusta · 1
• 

  Amr Reda But u did ur best at the theater we just comment to help each other for the proper decision

  27 de diciembre a la(s) 3:24 · Me gusta · 8
• 

  Shah Nisar There appears fx of medial mallolus also

  27 de diciembre a la(s) 3:24 · Me gusta · 1
• 

  Frederick Leones Iglesia I agree with Dr. Amr Reda

  27 de diciembre a la(s) 3:27 · Me gusta · 2
• 

  Alok Jain Rahul B Tanga
  
  There is distraction at Fibular shaft fracture...
  &
  There is something fishy at lateral malleolus....
  Needs further assesment...

  27 de diciembre a la(s) 4:04 · Me gusta · 2
• 

  Marwan Hossam Elshafie Ex fix it from the start

  27 de diciembre a la(s) 4:06 · Me gusta · 1
• 

  Harsh Abhay Watch out for skin ... Illizarov would have been good

  27 de diciembre a la(s) 4:07 · Me gusta · 2
• 

  Udaya Bhaskar Tupakula Ankle ex fix with k wires and rush nailing for fibula is treatment of choice in this case.

  27 de diciembre a la(s) 4:13 · Me gusta · 1
• 

  Chandan Kishor Rahul B Tanga sir kindly share ur on table experience of this case as we all know the reduction is not according to your skills..

  27 de diciembre a la(s) 4:19 · Me gusta · 1
• 

  Amit Varshney Boss this is not ur 100%

  27 de diciembre a la(s) 4:21 · Me gusta · 1
• 

  Doc Anoop Kalia Absolute stability should be the aim rather than relative stability for such a fracture.. Mippo should not have been done in this case acc to my opinion. This is not your best Rahul B Tanga sir... Anyways its easier to comment than to operate... Thanks

  27 de diciembre a la(s) 4:35 · Me gusta · 6
• 

  V Joseph Simon Ankle fixator till wrinkle sign +ve..covert to definitive Rx..post op soft tissues look tense

  27 de diciembre a la(s) 4:35 · Me gusta · 1
• 

  Hanuman Dh I doubt abt skin healing. ...

  27 de diciembre a la(s) 5:43 · Me gusta · 2
• 

  Omar Alfeky Respect soft tissue first cast with Windows dressing twice daily. Antibiotics untill complete wound healing

  27 de diciembre a la(s) 5:53 · Me gusta · 2
• 

  Brahmaraju TJ Have u precontoured tibial plate?

  27 de diciembre a la(s) 7:51 · Me gusta · 1
• 

  Gopal Goel Rahul B Tanga I am gr8 admirer of your surgery but this one is in valgus

  27 de diciembre a la(s) 8:05 · Me gusta · 2
• 

  Ashit Mehta Ankle is in valgus. Only plating fibula at first stage and waiting for better skin condition for later date with definitivefixation would have been better.

  27 de diciembre a la(s) 9:22 · Me gusta · 2
• 

  Kiran Vasavada never mind...open out ..remove tibial fixation re do at favourable time..

  27 de diciembre a la(s) 10:03 · Me gusta · 2
• 

  Doc Umair Rana I belive this will go in healing process without redue

  27 de diciembre a la(s) 10:36 · Me gusta · 1
• 

  Devendra Kumar P Stability?

  27 de diciembre a la(s) 11:20 · Me gusta · 1
• 

  Pradeep Kumar Shetty Sir have been following ur posts...this is only case where there is an inadequate reduction... Agree with you... U operated.... U will know the intra operation problem.. But this requires redo as the joint is incongruous... But precaution.. Might be difficult to redo...may require bone graft

  27 de diciembre a la(s) 12:00 · Me gusta · 1
• 

  Abrm Rys Interesting case! I like the way you management this case, maybe some graft would be excellent. Reduction have details in valgus and anteversion. Thanks for sharing your cases!

  27 de diciembre a la(s) 13:02 · Me gusta
• 

  Nasir Ali Nicely attempted. .. Distal tibia , badly comminuted , u might felt much difficult situation to manage that. 
  Good job

  27 de diciembre a la(s) 15:25 · Editado · Me gusta · 1
• 

  Hassan Saɪnaɪ Wælcyrge agree with Sir Dr Srinivas Daravathu
  Next time follow the role of >> Span then Scan then Plan 
  Span Scan Plan 
  specially in articular surface fracture to make use of ligamentotaxis 
  you needed a CT also in this case 
  Good Luck next time Rahul B Tanga

  27 de diciembre a la(s) 16:23 · Me gusta · 4
• 

  Srinivas Daravathu Rahul have u used a distractor for reduction?

  

  27 de diciembre a la(s) 16:29 · Me gusta · 2
• 

  Srinivas Daravathu The defect in tibia fracture site needed bg

  27 de diciembre a la(s) 16:29 · Me gusta · 3
• 

  Srinivas Daravathu My choice of implant wud be anterolateral plate and a small medial butress plate along with bg by anterolateral app

  27 de diciembre a la(s) 16:46 · Editado · Me gusta · 1
• 

  Srinivas Daravathu Plates don't need to be soo long though

  

  27 de diciembre a la(s) 16:44 · Editado · Me gusta · 6
• 

  Srinivas Daravathu Only with good skin condition

  27 de diciembre a la(s) 16:47 · Editado · Me gusta · 1
• 

  Awadhesh Yadav 1 yr fuc of antplafond #..skin was not good...blisters present. Ant.medialy...now came for implant removal....no bg was done.....thought of that if not united adequetly.had to preserve i popfor 2 monts..

  

  27 de diciembre a la(s) 18:40 · Me gusta
• 

  Rahul B Tanga Thanks everyone for valuable inputs.span scan and plan could had been done but was bit confident of doing primary plating of both fibula and tibia so went ahead with the same.it was a surprise to see to see check xray.ya there is definitely tilt of articular surface and valgus at ankle. There is impaction component in fibula and tibia due to which it appears to be distracted but on table comfirmed by 2 cortices contact.planning to wait for 3weeks and then will screw redjustment alignment of articular surface and bg.

  27 de diciembre a la(s) 23:09 · Me gusta · 3
• 

  Falah Khewka Is the last fibular screw syndesmotic lag?

  27 de diciembre a la(s) 23:28 · Me gusta
• 

  DrPramod Lamichhane Here the issue is not the soft tissue or union, but ankle mortise. Soft tissue will get ok and fracture will unite one day. But because of oblique mortise pt may have pain and arthritis.

  27 de diciembre a la(s) 23:30 · Me gusta · 2
• 

  Sangram Sabat Nice sir, I feel patient should be operated once the soft tissue injury is settled

  Ayer a las 1:27 · Me gusta
• 

  Sanjay Dhawan Dear Rahul B Tanga as rightly said it is not of ur level.
  
  What I see it has 2 elements ...Ver más

  29 min · Me gusta · 1