Peer van der Zwaal

Orthopedic trauma and shoulder surgeon, MD/PhD

[Peer van der Zwaal @PeerZwaal]

@ChipRoutt Thank you. Noticed you use this plate configuration often for stabilizing de QLP and PC. Getting right trajectory of screws through plate in PC is relatively easy, using IP-interval. However, I often struggle with this trajectory in superior ramus.

[Peer van der Zwaal @PeerZwaal]

@ChipRoutt Thank you for this great case. Very impressive how you handeled the impacted fragment. Do you maybe have intra-op clinical photo of where the intrapelvic plate precisely sits? These screws can hard to hit…. I’d appriciate to learn

[Peer van der Zwaal @PeerZwaal]

@traumaticum If non pathological, good metaphysis on ct and good cuff on ultrasound: consider single stage ORIF + stemless tsa. Otherwise: ORIF, let heal, evaluate patient. Do stemmed tsa/rsa (if needed) in second stage.

[Peer van der Zwaal @PeerZwaal]

@traumaticum X-ray suggests that there could be pathological basis for the fracture: stop-think-stage. Further evaluate the possible lesion (ct/mri) and do work-up protocol unknown primary (lab, pet-ct, sometimes biopsy). Nobody wants ‘whoops’ surgery.