Colegio Mexicano de Ortopedia
sábado, 31 de agosto de 2013
Discusión entre pares
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Indian Orthopaedic Research Group
Hanume Gowda S N
Very good job...
Great job done
Manoj Kumar Shukla
Very good job
DrHariprasad Chowdary Munnangi
Dear rahul, my seniors say, circlage wiring interupts periosteal blood supply and results in sclerotic segments, but ur xray is showing good amount of callus. Is it bcos of bone marrow inj? Wats ur opinion abt circlage wiring in ur experience?
Discussion awaited frm other viewers too.
Madhu Chandra P
Wonderful Dr rahul.no words to describe
Ambdnya Yogesh Khandalkar
Myo Thant Syn
Great. Glad for patient.
FANTASTIC WORK ...CONGRATULATION
great work ..
Excellent, job. No words. Pls keep followup of pt its good education, , thanks 4 sharing sir.
Very well done
its great... good job...
Good example of Perfect Orthopaedics
After how many days of trauma did you operate on this patient..it's really a job excellently done, did u put a bone graft,what is your post op protocol ?...and yes members i would also like to know about the encirclage wire interupting with the periosteal blood suppl
very good job sir...want to kw whether fragments were completely detached from soft tiisue while operating?? did u use any augmentation for union bone garfting o BM ASPIRATION?? post op protocol plz??
Hanume Gowda S N
As a rule I always try not to do a circlage wiring. ..It interferes with healing..
The whole idea of closed nailing is defeated when fracture is opened. ..
Plating had complication mainly related to open reduction. .
But advantage was endosteal blood supply. ..
In closed nailing we disturb the endosteal bloid supply.. depending on the periostel and soft tissue supply along with fracture haematoma. ..
If you nail and do open reduction then devascularisation is much more...
More chances of delayed and nonunion...
Also infection. ..
There are situations like soft tissue interposition when we need to do open reduction bit then such situations are far and few....
it was type3a open with internal degloving .quadriceps tear on table.most of the fragments were detatched from soft tissues.fragments were almost in the subcutaneous plane .in this case there is no question of closed nailing. I have done similar 4 cases and used encirclage and all are doing well.i have operated this case within 3hrs of trauma.i have injected bone marrow c arm guided at 6 weeks.partial weight bearing was started at 4weeks.
dis is really praiseworthy,gud job
Amit K Srivastava
For this fracture 3 months is less time to allow fwb
I would have been a bit cautious as in this case there are many fractures
When done in such cases and with minimal stripping of soft tissues encirclage wiring is a good option...
It should hold the fragments, does not need to be excessively tightened, just enough to help with fixation by nail or plate. These days percutaneous encirclage wire passers are available which do help in minimal stripping though no experience to do percutaneous wiring...
Hanume Gowda S N
Dr Rahul what you have done is very good...
My comments were for Adrians query...and also in general.....
big fan of urs sir....
how were you able to do within 3 hr of trauma ? I mean how did you manage to convince the anaesthetist to give anaeshesia within 3 hrs of trauma...In the hospital where I am working they always prefer the pt to be nil orally for atleast 6 hrs preoperatively..reasons best known to them and least understood by me.I guess they have a different protocol in a private hospital.
dr adrian usually for spinal or epidural technically speaking 4 to 5hrs nbm is fine.always try to operate within 6hrs of trauma to reduce chances of infection.
where is your post op. x-ray?
Ramendra Narain Singh
Great job , needs to be presented at Ioa conference
thanks to one and all
though i m always skeptical about the encirclage in an open #.now i will reconsider my belief
. superlative effort .congrates
Sadique Ahmed Khan
excellently done....hw long is the follow up?
thanks dr somnath its just 3months post op follow up
Colegio Mexicano de Ortopedia y Traumatología
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