Orthopaedic Discussion Forum

Spine | Trauma | Limb Reconstruction | Orthopaedic Surgery

[Orthopaedic Discussion Forum @bone_mechanic]

@traumacito @Ortho_AnkleFoot @anklefootmd @AnkleInstitute @TheFootAnkleDoc @FootAndAnkleMD @BostonFootAnkle @CJFooteMD @footankle @generalorthomd @OrthoFolks @drdeepakinamdar @cmcdeepak @DrBhavinJadav

[Orthopaedic Discussion Forum @bone_mechanic]

@anilbhatortho @pkmadridista @KiniPushpa @OrthopodReg @OrthoFolks @DrBhavinJadav @OrthoM8 Orthopaedics : Correlate clinico - radiological mobility.

[Orthopaedic Discussion Forum @bone_mechanic]

@anilbhatortho The second image :

Coronal section cut of the green chillies are always better than cutting it transversely.

Must have added a great taste 😁🔪☘️👍🏻

[Orthopaedic Discussion Forum @bone_mechanic]

@DeformityDoc @generalorthomd @OrthoFolks Haha, I didn't mean to hurt.
I strongly appreciate your skills and looking forward to read your experiences.

Yes , this vaginal speculum must frees the surgeon's hand to perform the other tasks simultaneously.

👍🏻

[Orthopaedic Discussion Forum @bone_mechanic]

#orthotwitter
#Orthopedics
#surgery
@generalorthomd
@OrthoFolks

Name of this instrument and it's use.

[Orthopaedic Discussion Forum @bone_mechanic]

@DeformityDoc @generalorthomd @OrthoFolks This is Auvard speculum.

It has no use in Orthopaedic Surgery except throwing it on the face of a person who asks to describe it's use in Orthopaedics.

🔪🦴✨

[Ryan Hess, MD @RyanHessMD]

I know we are orthopedic ‘surgeons’, but that doesn’t mean we always have to operate to help someone. A very kind note from a grateful patient 😌

Sometimes (often?) good communication, reassurance and our time are all that are needed to help our patients. #PatientCenteredCare

[John Shields, MD, FAAOS @jointdocShields]

Intra-op:
Fractured post.
Liner revision only.

See post still in the notch.

[Orthopaedic Discussion Forum @bone_mechanic]

@fundamentalofSM Nature and God has given such healing capabilities to humans that these cases and conditions do not require any additional treatment until and unless a surgeon is hungry for knife and blood.
Therefore, let the nature heal it in a better way.

[Orthopaedic Discussion Forum @bone_mechanic]

@fundamentalofSM Psuedo Jones

[Orthopaedic Discussion Forum @bone_mechanic]

@Ortho_Jake @kneedoclond @rkh_md

[Orthopaedic Discussion Forum @bone_mechanic]

@Ortho_Jake One of the commonest mechanical failures in Orthopaedics.

Rx- Remove the screws
Open reduction and internal fixation with Tension band wiring - 2 K wires of size 1.8mm and figure of eight with SS wire of size 18mm.
Immobilize with above knee slab for 2 wks.
Works brilliantly ✨

[Orthopaedic Discussion Forum @bone_mechanic]

@Ortho_Jake Always remember - Unnecessary hardware depicts surgeon's incapabilities.
Therefore, trust the significant biomechanics.
Mesh plate,star plate,moon plate, etc etc aren't required for such logic demanding case.

Go with simple TBW with a figure of 8 configuration.
It will do well.

[Orthopaedic Discussion Forum @bone_mechanic]

@tatcantarelli Great case.
Once we get the immediate post op xray,one should be ready for such failures either from the surgeon' part or the patient.
Screw size was the biggest concern here followed by faulty post op rehab.
That's why POP slabs were invented to immobilize the notorious pt.

[Orthopaedic Discussion Forum @bone_mechanic]

@drtalmac2 @InvictaOrtho @StressHoop @CenterRotation KEY - Damage Control Orthopaedics.

Ilizarov is the gold standard here.

Or

Biplanar external fixator followed by definitive fixation through plates if the soft tissue permits but requires the nop notch skills experience.
Counsel the patient for atleast 3-4 future surgeries.

[Orthopedic Surgeon @TexasOrthopedic]

Know the depth, or #dontdive. Tips for #safediving from the #AAOS: https://t.co/ndeeaczbWO

[Orthopaedic Discussion Forum @bone_mechanic]

@kneedoclond Thank you for sir.

As the construct looks stable, PWB walking with walker on the second post op day.
FWB will be allowed only after clinico-radiological union.( Atleast after 8 weeks )

[Orthopaedic Discussion Forum @bone_mechanic]

#orthotwitter
#MedTwitter
@kneedoclond @KneeUnit @DrBhavinJadav @DeepuSethi @OrthoFolks @ExeterKnee @kneeguyuk
Case:
3 months old malunited proximal third tibia # f/b a MVA which was then treated conservatively by a quack outside.
Presented to us for definitive mx.
Rx Plan?

[Orthopaedic Discussion Forum @bone_mechanic]

@kneedoclond @OrthoFolks @KneeUnit @clinic_knee @ExeterKnee @sinicropispine @DrBhavinJadav

[Orthopaedic Discussion Forum @bone_mechanic]

Anterolat incision,previously formed callus extracted,# ends freshened f/b fract reduction through axial traction & valgus force.
Used a standard raft plate and screws according to the fracture geometry.
The extracted callus was then made into chunks and re inserted as a BG.

[Orthopaedic Discussion Forum @bone_mechanic]

@kneedoclond @OrthoFolks @DrBhavinJadav @KneeUnit @DeepuSethi @ExeterKnee @kneeguyuk Since , the patient was young and healthy.
What if we do not do the bone grafting from iliac crest ( traditionally ) but use the same healthy callus as a potential autograft?
Why to waste that healthy callus?
Why can't it be used as an autograft?
Since it was fresh(3 months old).

[Orthopaedic Discussion Forum @bone_mechanic]

@kneedoclond @OrthoFolks @DrBhavinJadav @KneeUnit @DeepuSethi @ExeterKnee @kneeguyuk So I decided to plate it.
Now my question is :
Bone graft was surely needed , what should be the source for the bone graft?
Why or why not ?