Cirugía de Columna y Articulaciones: Discusión entre pares / 34 yr male, 3 month old fracture treated elsewhere. No signs of union. What are the options?

Indian-Orthopaedic Research-Group

Rohit Lamba

34 yr male, 3 month old fracture treated elsewhere. No signs of union. What are the options?

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Rohit Lamba Had discharge for 3 weeks after surgery. Controlled by antibiotics.

Ayer a las 1:32 · Me gusta
Sanjay Tripathi There should not be any screw over fracture site..as per my opinion....

Ayer a las 2:13 · Me gusta · 1
Srinivas Daravathu was the fracture fully exposed by long lateral incision

Ayer a las 2:22 · Me gusta
Subhash Mohite There is big gap proximal # site, this implant is not going to work, if no infection I would prefer implant removal! fix with expert tibia nail with BG,subsequent dynamisation distal screw

Ayer a las 2:29 · Me gusta · 3
Rohit Lamba Yes the primary surgeon did a full monty.

Ayer a las 2:29 · Me gusta
Wildan FaRis Bad soft tissue condition?

Ayer a las 2:31 · Me gusta
Ahmed Abdelaala Waite&see up to 6 month from opration because. Revesion of this operation is very &deficult

Ayer a las 2:38 · Me gusta
Gaurav Singh It seems dis ws done using mippo trchnique..if it been over 6 mnths or so revise with ilizarov ring fixator with fibulotomy at fracture site.. No need for bone grafts in ilizarov..

Ayer a las 3:02 · Me gusta
Gaurav Singh N ya bad or good soft tissue will nt change ur plan of treatment

Ayer a las 3:03 · Me gusta
Manikandan Jeyaprakash Delayed union , bone graft or platelet inj,

Ayer a las 3:04 · Me gusta · 1
Srinivas Daravathu it has lost all its hematoma due to wid opening ,it defnitely needs medullary reaming to stimulate bone growth now,remove plate and do reamed extert tibia nailing,no graft needed

Ayer a las 3:11 · Me gusta · 2
Srinivas Daravathu this plate is a weak construct ,it wont withstand wt bearing in future

Ayer a las 3:12 · Me gusta
Srinivas Daravathu this needed mipo plating or etn at first place

Ayer a las 3:14 · Me gusta · 1
Rustom Adi Mody Ilizarov. Best way to hold all fragments and compress them.

Ayer a las 3:35 · Me gusta · 1
Kamlesh Dutta Tiwari wait 3 months.control inf fully.seg## takes time.prox.frag unites earliar.

Ayer a las 3:53 · Me gusta · 1
Srinivas Daravathu if its in dynamic mode,we can expect union,it is in static mode,if there are any chances of union ,by this time there wud hav some callous attempt

Ayer a las 3:57 · Editado · Me gusta
Srinivas Daravathu immobizling a 35 yr old for 6 months ?wat is the purpose of surgery?

Ayer a las 3:59 · Me gusta
Harshavardhan Patil Can try stem cell injection

Ayer a las 4:04 · Me gusta · 1
Karthikeyan Mani Primarily the problem is due to attempted reduction of # with plate rather than reduction first and plating the attempted lagging proximally also might be an afterthought

Ayer a las 4:09 · Me gusta
Karthikeyan Mani The principal of LCP NOT FOLLOWED length of plate , reduction before fixation

Ayer a las 4:11 · Me gusta · 1
Karthikeyan Mani My contention is that mippo is only for metaphyseal # not for diaphyseal ones because of minimal tolerance of even slight malreduction by lcp am I correct

Ayer a las 4:15 · Me gusta · 1
Bhabani Lenka N now u can go for bone grafting....m

Ayer a las 4:41 · Me gusta
DrMabrouk Ortho Interlocking nailing

Ayer a las 5:44 · Me gusta
Ralf Gahr you will get distal nonunion and valgus Deviation. if soft tissues allow: remove plate and nail; no graft needed

Ayer a las 5:54 · Me gusta
Aldrich Fernandez Bone graft

Ayer a las 6:01 · Me gusta
Srinivas Daravathu In the second X-ray fibula shows callus , tibia does not , it's going into nonunion

Ayer a las 6:04 · Me gusta
Masoodh Basha Even though a lock plate has been used, not one cortical scree has been locked. Most probably it was not done Mippo style.
The proximal fracture has been lagged without compression.
On the whole, it's a very rigid fixation without fracture compression, allowing the fracture to stay separated.

Criticising the surgery is easy now, what could have been done differently; and what to do now are the questions.
The clinical picture and pre op xrays will help.

Ayer a las 6:33 · Me gusta · 1
Rohit Lamba Clinically skin has healed. There is one small sinus at the end of suture line which is silent presently.

Ayer a las 6:46 · Me gusta
Swapnil Kothadia Pl give detail history. .Wheather open or closed. ..skin condition. ..why fibula wire removed. ...

Ayer a las 6:55 · Me gusta
Suneet Rajshekhar Wait for another 2 months then revise. Non wt bearing mobilisation

Ayer a las 7:53 · Me gusta
Suneet Rajshekhar The delay in callus could simply be because of the infection

Ayer a las 7:55 · Me gusta
Drrk Verma It's going to unite

Ayer a las 10:19 · Me gusta
Rohit Lamba Closed fracture to begin with. Extensive incision given. Developed infection after a month. Now sinus closed.

Ayer a las 10:30 · Me gusta
Rohit Lamba Primary surgery and subsequent follow up elsewhere. Showed up today in opd. Wanted me to say that the surgery was improper which I refrained from. Hope everyone does the same when you get post op complications of others.

Ayer a las 10:33 · Me gusta · 1
Srinivas Daravathu U did right?

Ayer a las 10:36 · Me gusta
Srinivas Daravathu R u going to take up the case now ?

Ayer a las 10:36 · Me gusta
Rohit Lamba He's a labourer. I work in a corporate hospital. He can't afford. Referred him to St stephens

Ayer a las 10:41 · Me gusta
Srinivas Daravathu Good for u

Ayer a las 10:42 · Me gusta
Masoodh Basha Dr.Verghese is in St.Stephens?

Ayer a las 11:42 · Me gusta