#vehicularcollision

[orthopedics]

I miss fixing leg deformities with an intramedullary device. I remember using a Küntscher nail for my first tibia done in residency. I cut it, bent it, and filed it myself. The implant easily passed through the proximal fragment only to engage the distal fragment’s medial cortex with its narrow slot. Something felt wrong and I stopped hammering the nail in. Fluoroscopy confirmed my error and we had to backslap the nail out, re-reduce the fracture and drive the implant back in. With newer nail generations, the relative procedural ease is dramatic. Here we have AO 42B3b and 4F2Aa injuries for a fragmentary wedge fracture of the tibial mid-diaphysis and simple transverse fracture of the fibular proximal shaft. Closed, reamed, antegrade intramedullary nailing of the tibia was performed using indirect reduction fixed with relative stability. A small gap was appreciated in the immediate postop xray and with progressive weightbearing, proceeded to break the most distal of two proximal screws at the nail border. Dynamization was done for us by the patient, but it didn’t help us in removing the retained threaded portion later on. This is a very basic case but it is meaningful in that patients always return to your clinic grateful for their mobility and return to activity. And that as you rise up to more sophisticated procedures, the basics always keep you rooted. #orthopaedics #footandankle #ORIF #lisfranc #patienthappy #aotrauma #pieytobillo #bacolodfootdoctor #firstloveistrauma #pedestrian #radiology #fracture #trauma #roadtrafficaccident #couldbeworse #vehicularcollision

[orthopedics]

Swipe! A broken bone can heal with or without the supervision of a doctor, with or without manipulation, immobilization, or surgery. But having it seen by a professional is a key step in having less pain, getting good outcomes and being productive once more. For this patient, pain got worse after surgery, routine medications weren’t helping, and motivation was poor to do physical therapy. (A) The bone scan was performed to confirm clinically evident complex regional pain syndrome, Sudeck atrophy. There is increased uptake on all three phases with diffuse activity around the knee and ankle. (B) AP and lateral radiographs show an AO 42B3c fragmentary wedge fracture to distal tibia diaphysis and 4F2Ba multifragmentary fracture of the proximal fibular diaphysis. (C) Closed reduction internal fixation with minimally invasive plate osteosynthesis was done. (D) Postop one year with good remodeling. (E) Postop five years with radiologic union. (F) Bone scan at seven years postop shows decreased uptake compared to baseline. Clinically, the patient has improved to work again. We should strive for patient comfort first and foremost. Good x-rays do not necessarily mean happy patients. A nail would have made another excellent option. #orthopaedics #footandankle #CRIF #MIPO #tibia #patientnowhappy #chronicpain #aotrauma #pieytobillo #physicaltherapy #bacolodfootdoctor #firstloveistrauma #pedestrian #radiology #fracture #trauma #roadtrafficaccident #couldbeworse #vehicularcollision #empathy #bonescan

[orthopedics]

Swipe! Treating the elderly can be quite challenging, but they are dear patients. Finding out how and why they fell, explaining their options, them nodding in understanding to each statement said, then asking to repeat what you just said for more or less four cycles, addressing pain, and advising on the postop regimen, are real issues. Some of them have hearing problems, some of them can’t see very well. Which is why they probably smile and nod all the time, say how handsome their doctors are, express how the nurses are a delight. But grandparents are rightfully so those and more. They were parents before, perfecting the art of calming their kids who were crying maybe from hunger, an ache somewhere, or just sleepy. They explained well but weren’t listened to, they explained thinking they meant well but the other end wasn’t having any of it. It’s magic to hold a grandmother’s hand during morning rounds to reassure her everything will be fine, even if you know she will not comply with weight-bearing instructions. (A) This is a bilateral ankle injury, forward facing radiograph above with lateral views below show an AO 44B2.2o transsyndesmotic fibula fracture with a medial malleolus fracture and a rupture of the anterior syndesmosis Wagstaffe-Le Fort avulsion (LH SER4) on the right and an AO 44A2.3 Infrasyndesmotic transverse fibula injury with a medial malleolar fracture (LH SAD2) on the left. (B) Intraoperative fluoroscopy shows provisional and definite fixation. (C) X-rays two years after surgery before implant removal. Granny always brings brownies each time she visits the clinic. #orthopaedics #footandankle #ORIF #ankle #laugehansen #patienthappy #aotrauma #pieytobillo #bacolodfootdoctor #firstloveistrauma #dancinginthekitchen #radiology #fracture #trauma #grandma #couldbeworse #vehicularcollision #empathy #morningrounds

[orthopedics]

Swipe! Lower extremity trauma based on my census comes mainly from road traffic accidents involving motorcycles. Remove the alcohol, add more discipline, and bikes should be a great way to move around; not to mention the numerous sports options. AO 43C3.2 Complete, multifragmentary articular and metaphyseal fracture of the distal tibia on radiographs (A). CT cuts show articular fragments (B). Cine-CT 3D Reconstruction (C). Intraoperative fluoroscopy shows fibular ORIF with plate and screws then minimally invasive plate osteosynthesis of the tibia medially (D). Postoperative x-rays (E). Postoperative x-rays after two years show radiographic union (F). Postoperative x-rays after removal (G). Back to the scooter ever since. I think this fracture pattern lies borderline in terms of management. It may easily confuse the trainee on mixing principles of reduction and methods of fixation. #orthopaedics #footandankle #ORIF #MIPO #CRIF #patienthappy #hardwareremoval#aotrauma #pieytobillo #bacolodfootdoctor#firstloveistrauma #motocross #radiology #ultrasound #fracture #trauma #fauxmalleolar #roadtrafficaccident #almostpilonbutnotquite #vehicularcollision