[ORT-L] OP or NON-OP pelvic Fx??


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[ORT-L] OP or NON-OP pelvic Fx??

jjbrooksmd at gmail
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Jul 31, 2006, 7:14 AM

Post #1 of 6 (546 views)
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[ORT-L] OP or NON-OP pelvic Fx??	Can't Post

Dear list members,

young lady, pinned under a car last Thurs, coming to me for second
opinion. My question is the role for surgery in this case. Would
anyone fix the L SI joint. Other?

Thanks in advance.
Jeffrey J. Brooks, MD
Orthopaedic Surgery & Sports Medicine Center
1290 Summer Street, #4400
Stamford, CT 06905

Attachments:

Non op pelvis question.ppt (938 KB)

Bruce_Ziran at HMIS
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Jul 31, 2006, 7:53 AM

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Re: [ORT-L] OP or NON-OP pelvic Fx?? [In reply to]	Can't Post

I would base it on her level of pain. Looks like a quasi stable pattern,
with a little SI involvement and undisplaced anterior component. I have
seen many of these go on to heal, but occasionally, they can shift.
Usually, significant pain heralds injury worse than xray appearance, which
is where the fractured ended up, not where it has been. If treated, I think
I would just use screw in back to keep it where it is.
Bruce H. Ziran, M.D.
Director of Orthopaedic Trauma
St. Elizabeth Health Center
Associate Professor of Orthopaedic Surgery
Northeast Ohio Universities College of Medicine

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frg at myfastmail
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Jul 31, 2006, 8:41 AM

Post #3 of 6 (546 views)
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Re: [ORT-L] OP or NON-OP pelvic Fx?? [In reply to]	Can't Post

I think in this case: less is better

----- Original message -----
From: Bruce_Ziran@HMIS.ORG
To: ORT-L@www2.aaos.org
Date: Mon, 31 Jul 2006 10:53:30 -0400
Subject: Re: [ORT-L] OP or NON-OP pelvic Fx??

I would base it on her level of pain. Looks like a quasi stable pattern,
with a little SI involvement and undisplaced anterior component. I have
seen many of these go on to heal, but occasionally, they can shift.
Usually, significant pain heralds injury worse than xray appearance,
which
is where the fractured ended up, not where it has been. If treated, I
think
I would just use screw in back to keep it where it is.
Bruce H. Ziran, M.D.
Director of Orthopaedic Trauma
St. Elizabeth Health Center
Associate Professor of Orthopaedic Surgery
Northeast Ohio Universities College of Medicine

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dpzamorano at hotmail
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Jul 31, 2006, 9:17 PM

Post #4 of 6 (543 views)
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RE: [ORT-L] OP or NON-OP pelvic Fx?? [In reply to]	Can't Post

you could do nothing but I think that posteriorly he is slightly translated cephalad. i would put him in traction and fix the SI joint with percuataneous IS screw fixation

DPZ

David P. Zamorano, MD

Assistant Chief, Orthopaedic Trauma Service
Dept. of Orthopaedic Surgery
Harbor/UCLA Medical Center
Office (310) 222-2716
Fax (310) 533-8791
dpzamorano@hotmail.com

From: "Jeff Brooks" <jjbrooksmd@gmail.com>
Reply-To: ORT-L@www2.aaos.org
To: ORT-L@www2.aaos.org
Subject: [ORT-L] OP or NON-OP pelvic Fx??
Date: Mon, 31 Jul 2006 10:14:41 -0400

Dear list members,

young lady, pinned under a car last Thurs, coming to me for second
opinion. My question is the role for surgery in this case. Would
anyone fix the L SI joint. Other?

Thanks in advance.
Jeffrey J. Brooks, MD
Orthopaedic Surgery & Sports Medicine Center
1290 Summer Street, #4400
Stamford, CT 06905

><< Nonoppelvisquestion.ppt >>

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fbwilson at earthlink
New User

Jul 31, 2006, 9:19 PM

Post #5 of 6 (543 views)
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RE: [ORT-L] OP or NON-OP pelvic Fx?? [In reply to]	Can't Post

Jeff,

I have treated several similar fractures non-operatively. I would make her
touch down weight-bearing on the left, control her pain, and follow her with
AP, Inlet, and Outlet views at one and two weeks just to make sure that
nothing is shifting. I generally follow these patients at 1, 2, and 3 months
and don't start PT until about 10-12 weeks. If, as a young lady, you have
concerns about her reliability, you can discuss percutaneous screw fixation
of the Left SI joint with her. It won't really speed her recovery time and
will still require protected weight bearing. If a discussion of the risks
doesn't scare her away, the screw(s) may help everyone rest easier.

I would love to hear the opinion of the list members about one vs. two
screws, indications for placement at S1 and/or S2 and indications for screw
removal after healing.

Frederic B. Wilson, M.D.

Assistant Professor

Traumatology & Adult Reconstruction

Department of Orthopaedic Surgery

Louisiana State University Health Sciences Center

2020 Gravier St., Room 728

New Orleans, LA, 70112

Phone: (504) 568-4680

Fax: (504) 568-4466

Cell: (504) 994-4555

fbwilson@earthlink.net

-----Original Message-----
From: ORT-L-owner@www2.aaos.org [mailto:ORT-L-owner@www2.aaos.org] On Behalf
Of Jeff Brooks
Sent: Monday, July 31, 2006 9:34 AM
To: ORT-L@www2.aaos.org
Subject: [ORT-L] OP or NON-OP pelvic Fx??

Dear list members,
sorry if this came thru 3 times - I had trouble with my email program.

young lady, pinned under a car last Thurs, coming to me for second
opinion. My question is the role for surgery in this case. Would
anyone fix the L SI joint. Other?

Thanks in advance.

Jeff

Jeffrey J. Brooks, MD
Orthopaedic Surgery & Sports Medicine Center
1290 Summer Street, #4400
Stamford, CT 06905

jjbrooksmd at gmail
New User

Aug 1, 2006, 5:05 AM

Post #6 of 6 (542 views)
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Re: [ORT-L] OP or NON-OP pelvic Fx?? [In reply to]	Can't Post

Hi Chip. In response to your questions:

Did you notice that her left hemipelvis is displaced cranially?
no

Did you compress her pelvis to assess its instability?
yes, and I could not detect instability. nor did she have pain with
traction/compression on her leg (vertical shear stress examination)

Is her right sacral fracture real?
I think so. I can see it on the image below

Do you have a lateral sacral image or CT reformats?
no, but I will (these were done at another institution)

Thanks-

Chip

On Aug 1, 2006, at 12:19 AM, Frederic B. Wilson, M.D. wrote:

> Jeff,
>
>
> I have treated several similar fractures non-operatively. I would
> make her touch down weight-bearing on the left, control her pain,
> and follow her with AP, Inlet, and Outlet views at one and two
> weeks just to make sure that nothing is shifting. I generally
> follow these patients at 1, 2, and 3 months and don’t start PT
> until about 10-12 weeks. If, as a young lady, you have concerns
> about her reliability, you can discuss percutaneous screw fixation
> of the Left SI joint with her. It won’t really speed her recovery
> time and will still require protected weight bearing. If a
> discussion of the risks doesn’t scare her away, the screw(s) may
> help everyone rest easier.
>
>
> I would love to hear the opinion of the list members about one vs.
> two screws, indications for placement at S1 and/or S2 and
> indications for screw removal after healing.
>
>
> Frederic B. Wilson, M.D.
>
> Assistant Professor
>
> Traumatology & Adult Reconstruction
>
> Department of Orthopaedic Surgery
>
> Louisiana State University Health Sciences Center
>
> 2020 Gravier St., Room 728
>
> New Orleans, LA, 70112
>
> Phone: (504) 568-4680
>
> Fax: (504) 568-4466
>
> Cell: (504) 994-4555
>
> fbwilson@earthlink.net
>
>
> -----Original Message-----
> From: ORT-L-owner@www2.aaos.org [mailto:ORT-L-owner@www2.aaos.org]
> On Behalf Of Jeff Brooks
> Sent: Monday, July 31, 2006 9:34 AM
> To: ORT-L@www2.aaos.org
> Subject: [ORT-L] OP or NON-OP pelvic Fx??
>
>
> Dear list members,
> sorry if this came thru 3 times - I had trouble with my email
> program.
>
> young lady, pinned under a car last Thurs, coming to me for second
> opinion. My question is the role for surgery in this case. Would
> anyone fix the L SI joint. Other?
>
>
> Thanks in advance.
>
> Jeff
>
>
> Jeffrey J. Brooks, MD
> Orthopaedic Surgery & Sports Medicine Center
> 1290 Summer Street, #4400
> Stamford, CT 06905
>
>

Jeffrey J Brooks, MD
Orthopaedic Surgery & Sports medicine center
1290 summer street, #4400
Stamford, ct 06905
(203) 323-7331

Attachments:

grissler1.jpg (293 KB)

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