[ORT-L] Segmental Tibia Fx - Orthopedics Forum


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[ORT-L] Segmental Tibia Fx

jjbrooksmd at gmail
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Jan 28, 2007, 6:27 PM

Post #1 of 7 (3658 views)
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[ORT-L] Segmental Tibia Fx	Can't Post

The list has been awfully quiet for a while so I figured I'd toss one
out there....

46 y.o male tree surgeon had a tree fall on him. Closed injury, NVI,
no compt syndrome. PMH sig for IDDM, tobacco chewer. Otherwise thin,
vigorous & healthy.

Films attached.

Thoughts on surgical treatment appreciated.

Jeff

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

The information contained in this electronic mail transmittal may
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is intended only for the use of the designated recipient(s) named
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you.

Attachments:

Segmental Tibia.ppt (188 KB)

william.obremskey at Vanderbilt
New User

Jan 28, 2007, 6:58 PM

Post #2 of 7 (3658 views)
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RE: [ORT-L] Segmental Tibia Fx [In reply to]	Can't Post

Standard antegrade reamed IMN, keep IMN lateral and anterior to avoid fx
valgus and apex anterior deformities.

Some tricks or issues in attached talk. Good luck and share post ops.

WTO

William T Obremskey MD MPH

Vanderbilt Orthopedic Trauma

Director of Orthopedic Trauma Research and Education

Medical Center East - South Tower

Suite 4200

Nashville, TN 37232-8774

615-936-0112- office

615-936-1566- fax

________________________________

From: ORT-L-owner@www2.aaos.org [mailto:ORT-L-owner@www2.aaos.org] On
Behalf Of Jeff Brooks
Sent: Sunday, January 28, 2007 8:28 PM
To: ORT-L@www2.aaos.org
Subject: [ORT-L] Segmental Tibia Fx

The list has been awfully quiet for a while so I figured I'd toss one
out there....

46 y.o male tree surgeon had a tree fall on him. Closed injury, NVI, no
compt syndrome. PMH sig for IDDM, tobacco chewer. Otherwise thin,
vigorous & healthy.

Films attached.

Thoughts on surgical treatment appreciated.

Jeff

Attachments:

Proximal and Distal Tibia Shaft Fractures.ppt (8.91 MB)

alex at weborto
New User

Jan 28, 2007, 8:56 PM

Post #3 of 7 (3658 views)
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Re: [ORT-L] Segmental Tibia Fx [In reply to]	Can't Post

Hello Jeff,

Monday, January 29, 2007, 7:27:42 AM, you wrote:

JB> The list has been awfully quiet for a while so I figured I'd toss one
JB> out there....

THX!

JB> 46 y.o male tree surgeon had a tree fall on him. Closed injury, NVI,
JB> no compt syndrome. PMH sig for IDDM, tobacco chewer. Otherwise thin,

I would perform minimally reamed closed locked nailing. The upper
fracture is a bit proximal. We use small wire distractor. Inserton of
two wires into the proximal fragment prevents typical apex-anerior
angulation and AP translation. Poller wires is second trick to avoid
valgus and the above mentioned sagittal plane problems.

--
Best regards,
Alexander N. Chelnokov
Ural Scientific Research Institute
of Traumatology and Orthopaedics
7, Bankovsky str. Ekaterinburg 620014 Russia

---
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george.s.thomas at gmail
New User

Jan 28, 2007, 10:23 PM

Post #4 of 7 (3658 views)
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Re: [ORT-L] Segmental Tibia Fx [In reply to]	Can't Post

Closed interlocking nailing would be my choice. Excuse me if it is a dumb
question but what is a tree surgeon?

On 1/29/07, Jeff Brooks <jjbrooksmd@gmail.com> wrote:
>
> The list has been awfully quiet for a while so I figured I'd toss one out
> there....
> 46 y.o male tree surgeon had a tree fall on him. Closed injury, NVI, no
> compt syndrome. PMH sig for IDDM, tobacco chewer. Otherwise thin, vigorous &
> healthy.
>
> Films attached.
>
> Thoughts on surgical treatment appreciated.
>
> Jeff
>
>
>
> 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
>
>
> The information contained in this electronic mail transmittal may contain
> healthcare information and is protected by law. This message is intended
> only for the use of the designated recipient(s) named above. If the reader
> of this transmission is not the intended recipient(s), you are notified that
> any disclosure, dissemination, distribution or duplication of its contents
> is strictly prohibited. If you have received this transmittal in error,
> please notify the sender by return e-mail and delete the transmittal
> immediately. Thank you.
>
>
>
>
>
>
>

--
George Thomas,
Editor, Indian Journal of Medical Ethics,
www.issuesinmedicalethics.org
Railway Hospital,
Chennai, India.

mas at alum
New User

Jan 29, 2007, 12:14 AM

Post #5 of 7 (3658 views)
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RE: [ORT-L] Segmental Tibia Fx [In reply to]	Can't Post

You might consider a long LISS plate to avoid the difficulties of nailing
proximal tibia fractures.

mas

_____

From: ORT-L-owner@www2.aaos.org [mailto:ORT-L-owner@www2.aaos.org] On Behalf
Of Jeff Brooks
Sent: Sunday, January 28, 2007 9:28 PM
To: ORT-L@www2.aaos.org
Subject: [ORT-L] Segmental Tibia Fx

The list has been awfully quiet for a while so I figured I'd toss one out
there....

46 y.o male tree surgeon had a tree fall on him. Closed injury, NVI, no
compt syndrome. PMH sig for IDDM, tobacco chewer. Otherwise thin, vigorous &
healthy.

Films attached.

Thoughts on surgical treatment appreciated.

Jeff

wdburman at frontiernet
New User

Jan 29, 2007, 3:43 AM

Post #6 of 7 (3658 views)
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Re: [ORT-L] Segmental Tibia Fx [In reply to]	Can't Post

See previous case discussion "Unhappy (valgus) tibial nailing"
http://www.hwbf.org/hwb/conf/alex57/ptib.htm

Bill Burman, MD
HWB Foundation
http://www.hwbf.org

>The list has been awfully quiet for a while so I figured I'd toss
>one out there....
>
>46 y.o male tree surgeon had a tree fall on him. Closed injury, NVI,
>no compt syndrome. PMH sig for IDDM, tobacco chewer. Otherwise thin,
>vigorous & healthy.
>
>Films attached.
>
>Thoughts on surgical treatment appreciated.
>
>Jeff
>
>?
>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
>
>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
>
>
>The information contained in this electronic mail transmittal may
>contain healthcare information and is protected by law. This message
>is intended only for the use of the designated recipient(s) named
>above. If the reader of this transmission is not the intended
>recipient(s), you are notified that any disclosure, dissemination,
>distribution or duplication of its contents is strictly prohibited.
>If you have received this transmittal in error, please notify the
>sender by return e-mail and delete the transmittal immediately.
>Thank you.

---
[This E-mail scanned for viruses by Declude Virus]

jjbrooksmd at gmail
New User

Jan 30, 2007, 7:56 PM

Post #7 of 7 (3658 views)
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Re: [ORT-L] Segmental Tibia Fx [In reply to]	Can't Post

A tree surgeon is an arborist -- climbs trees and cuts branches,
fells trees, etc etc. Not infrequent ED visitors around the CT
suburbs....

Attached are the postop films - Used an 11mm statically locked,
reamed IMN and 2 blocking screws: 1 A --> P on the lateral side to
prevent valgus placed before reaming, and a Med --> Lat posterior
blocking screw to prevent ant translation.

Jeff

Thanks for that prior discussion on Alex's case - very helpful.

Alex: when you use that thin wire distractor for nailing, where do
you place the wires exactly? Do you keep them really proximal (i.e.,
intracapsular) then remove after IMN in place? Do you leave them? The
pics seem to show the pt with the fixator on yet not on a sterile
field (does that mean you leave it on for a period of time?).

Attachments:

Segmental Tibia.ppt (349 KB)

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