case discussion 3r day课件.ppt

Case 2 45 yrs old man falls 6 feet at work on construction site Nondominant arm Closed injury Distal NV status is normal No other injuries Classification What can be done to enhance your understanding of the fracture pattern ? Decision making When to operate Position Approach Reduction technique Type of implants Transverse or chevron osteotomy ? Type of implant or implants for the distal humerus ? Transpose ulnar nerve ? Fixation for the osteotomy ? Early motion or delay for a few weeks ? 55 yo banker falls off of his roof while fixing his TV antennae Suffers a closed distal tibia injury 2+ pulses, reports normal sensation No other injuries How to deal with bony and soft tissue deformity? How to maintain a reduction? Priorities? Are there known protocols for this type of injury? 10 days later soft tissues are in good shape and the case has been planned. What has the frame has done for you the pt.? What about now intraoperatively? Keep pins in? Can it help? How? Are pin sites a problem at 10 days ? 20 days ? Other clinical scenarios where spanning frames can assist in preop / intraop care of patients ? How do these frames assist in the surgeons ability to perform MIPO ? Case 3 Case 3 Mild tingling in median nerve distribution What is the initial treatment? Treatment – operative or non-operative ? Open reduction or closed reduction ? Absolute or relative stability ? What implant ? Adjuncts ? Case 4 Case 4 22 yo male Biker Fall onto dominant arm Closed, isolated injury Distal neurovascular exam - radial nerve nonfunctional sensory and motor components Case 4 Operative or non-operative treatment? Does the radial nerve condition pre-operatively influence the choice between Operative or Non op treatment? Case 4 Which surgical approach? Radial nerve identified or not? Case 4 Implant or implants to be used ? If plating is used , what is the size of plate? single or bilateral plating? plate position? Case 4 Bridge plating (relative stability) or A