jjbrooksmd at gmail
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Apr 7, 2007, 7:52 AM
Post #2 of 3
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Re: [ORT-L] Pregnancy with # Capitellum
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I vote for ORIF, ASAP. Lateral approach. Radius is sagging/dislocated
out the back. Simple excision of the capitellar fragment will lead to
a posteropateral rotatory instabiliby pattern.
Pre & postop OB evaluation/fetal monitoring of their choice. GA in
the 3rd trimester of an uncomplicated pregnancy in a low-risk mom (I
assume this is the case??) is fairly straightforward. Waiting will
only make matters worse. She's going to need a good elbow to care for
her baby!
Jeffrey J. Brooks, MD
Orthopaedic Trauma Surgery
Hand & Upper Extremity Surgery
Stamford, CT
On Apr 7, 2007, at 10:35 AM, Dr Harpal Singh Selhi wrote:
> Dear All,
>
> I have a patient with Displaced # capitellum 10 days old, treated with
> massage by a bone setter for 6 days.
>
> Patient is pregnant in her 9th month.
>
> I seek ur opinion regarding
>
>
> Should I intervene or postpone?
>
> Intervention should be to excise the fragment or internally fix it?
>
> I consulted the obs and anes consultant, they feel not much risk in
> anesthesia as she is beyond 37 weeks, so even she goes into premature
> labour, should not be a problem.
>
> Kindly suggest the line of management
>
>
> Harpal
>
> Dr Harpal Singh Selhi
> (Adult Joint Recon, Sports and Hand Surgery)
>
> Associate Prof of Ortho Surgery,
> DMC & Hospital, Ludhiana (INDIA)
>
> Resi:
> 527-L, Model Town, Ludhiana-141002 (Punjab)
>
>
> -----Original Message-----
> From: ORT-L-owner@www2.aaos.org [mailto:ORT-L-owner@www2.aaos.org]
> On Behalf
> Of Alexander Chelnokov
> Sent: Wednesday, April 04, 2007 4:22 PM
> To: Rob Schultz
> Subject: Re: [ORT-L] infected nonunions
>
> Hello Rob,
>
> Wednesday, April 4, 2007, 8:18:23 AM, you wrote:
>
> RS> Please help me find info on the debridement/placement of abx
> PMMA in
> RS> infected long bone defects followed by autogenous graft. Did Dr.
> Lindsay do
>
> J Orthop Trauma. 2002 Nov-Dec;16(10):723-9.
>
> Intramedullary infections treated with antibiotic cement rods:
> preliminary
> results in nine cases.
>
> Paley D, Herzenberg JE.
>
> Rubin Institute for Advanced Orthpaedics, International Center for
> Limb
> Lengthening, Baltimore, Maryland 21215, USA.
> dpaley@lifebridgehealth.org
>
> The treatment of intramedullary infections after nailing usually
> includes
> removal of the rod, debridement of the canal, and, in many cases,
> insertion
> of
> antibiotic-impregnated cement beads. These beads offer no
> mechanical support
> and
> are difficult to remove if left in place for more than 2 weeks. We
> present
> an
> alternative for filling the medullary canal's noncollapsible dead
> space with
> an
> antibiotic-impregnated cement rod. This rod can be custom-made at
> the time
> of
> surgery, using different diameter chest tubes as molds and
> embedding a 3-mm
> beaded guidewire within the cement. The smooth molded surface of
> this nail
> makes
> extraction of the cement rod relatively easy. The cement rod also
> provides
> some
> limited temporary support to the fracture or nonunion site while the
> infection
> is being treated. After 6 weeks, the rod can be removed and
> replaced with a
> definitive metal intramedullary nail, with or without bone grafting
> to treat
> the
> previously infected fracture or nonunion site. We retrospectively
> reviewed
> nine
> cases of intramedullary infection treated with antibiotic-
> impregnated molded
> cement rods. These included six femora, two tibiae, and one
> humerus. The
> cause
> of infection was lengthening or transport over nail in six cases,
> fixator-augmented nailing of osteotomies in two, and fracture
> fixation in
> one.
> The follow-up period after surgery ranged from 38 to 48 months. No
> recurrent
> infection occurred during this follow-up period, and no patient
> required
> antibiotics after the rod was removed. In all cases, the canal
> cultures were
> negative after rod removal. The cement rod was removed between 29
> and 753
> days
> after implantation. Fracture of the rod occurred in one case in
> which the
> rod
> was left in place for more than 1 year. We conclude that this
> method is a
> relatively simple and inexpensive alternative for the treatment of
> intramedullary infections.
>
>
>
> --
> Best regards,
> Alexander N. Chelnokov
> Ural Scientific Research Institute
> of Traumatology and Orthopaedics
> 7, Bankovsky str. Ekaterinburg 620014 Russia
>
> ---
> [This E-mail scanned for viruses by Declude Virus]
> <capitellum.jpg>
Jeffrey J Brooks, MD
Hand & Upper Extremity Surgery
Orthopaedic Trauma Surgery
Orthopaedic Surgery & Sports medicine center
1290 Summer Street, #4400
Stamford, CT 06905
(203) 323-7331
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