[ORT-L] Tibia Fx - Segmental Defect (Sohn)


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[ORT-L] Tibia Fx - Segmental Defect (Sohn)

sohnrog at yahoo
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Jun 20, 2008, 11:29 PM

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[ORT-L] Tibia Fx - Segmental Defect (Sohn)	Can't Post

Dear Forum,

I am taking care of a 21 y/o Marine who was shot in the leg with an M-16 from close range. He was on base (Camp Pendleton) when this happened.

The patient has a medial and lateral wounds with extensive soft tissue injury (open grade 3C) with the Posterior Tibial Artery repaired on the night of injury. Fasciotomies were not necessary because his entry and exit wounds essentially exploded medially and laterally. Initial debridment left him with approximately 6" of missing bone from the mid-shaft. I ex-fixed him and have taken him back for a 2nd and 3rd look I and D. It looks like soft tissue coverage will not be too much of an issue due to his slightly shortened position as well as the large amount of dead muscle that I removed. He is post-injury day #4 and now wound is improved. I'll be able to close his medial wound directly and place a skin graft over his lateral wound in a couple days.

Right now, he is stabilized in an ex-fix and I'm planning my next step. I have seen the previous similar cases from 2003 and was wondering if any of you have new ideas on how to treat this segmental defect. I haven't seen it published, but I have seen some data out of Ortho Indy showing good results with plating, followed by RIA aspirate bone grafting. I have placed an ABX spacer "log" of PMMA with hopes of him forming a pseudomembrane. However, I don't feel I have burned any bridges yet and wanted some input.

Patient is sensate with good blood flow. He would like to salvage the limb. He does not smoke and is very healthy.

Thanks in advance for your input.

Sincerely,

Roger Sohn
Mission Viejo, CA

odesky2000 at yahoo
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Jun 21, 2008, 2:00 AM

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Re: [ORT-L] Tibia Fx - Segmental Defect (Sohn) [In reply to]	Can't Post

Hi! Can you give the pictures of the leg and X-rays?
Odessky Jacob M.D.
Assaf Harofeah Medical Center
Zerifin, Israel

----- Original Message ----
From: Roger C. Sohn <sohnrog@yahoo.com>
To: ORT-L@www2.aaos.org
Cc: Roger C. Sohn <sohnrog@yahoo.com>
Sent: Saturday, June 21, 2008 9:29:57 AM
Subject: [ORT-L] Tibia Fx - Segmental Defect (Sohn)

Dear Forum,

I am taking care of a 21 y/o Marine who was shot in the leg with an M-16 from close range. He was on base (Camp Pendleton) when this happened.

The patient has a medial and lateral wounds with extensive soft tissue injury (open grade 3C) with the Posterior Tibial Artery repaired on the night of injury. Fasciotomies were not necessary because his entry and exit wounds essentially exploded medially and laterally. Initial debridment left him with approximately 6" of missing bone from the mid-shaft. I ex-fixed him and have taken him back for a 2nd and 3rd look I and D. It looks like soft tissue coverage will not be too much of an issue due to his slightly shortened position as well as the large amount of dead muscle that I removed. He is post-injury day #4 and now wound is improved. I'll be able to close his medial wound directly and place a skin graft over his lateral wound in a couple days.

Right now, he is stabilized in an ex-fix and I'm planning my next step. I have seen the previous similar cases from 2003 and was wondering if any of you have new ideas on how to treat this segmental defect. I haven't seen it published, but I have seen some data out of Ortho Indy showing good results with plating, followed by RIA aspirate bone grafting. I have placed an ABX spacer "log" of PMMA with hopes of him forming a pseudomembrane. However, I don't feel I have burned any bridges yet and wanted some input.

Patient is sensate with good blood flow. He would like to salvage the limb. He does not smoke and is very healthy.

Thanks in advance for your input.

Sincerely,

Roger Sohn
Mission Viejo, CA

alex61 at gmail
New User

Jun 21, 2008, 2:02 AM

Post #3 of 4 (757 views)
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Re: [ORT-L] Tibia Fx - Segmental Defect (Sohn) [In reply to]	Can't Post

Dear Roger

2008/6/21 Roger C. Sohn <sohnrog@yahoo.com>:

> wondering if any of you have new ideas on how to treat this segmental
> defect. I haven't seen it published, but I have seen some data out of Ortho
> Indy showing good results with plating, followed by RIA aspirate bone
> grafting. I have placed an ABX spacer "log" of PMMA with hopes of him
> forming a pseudomembrane. However, I don't feel I have burned any bridges
> yet and wanted
>

List of options can be continued with bone transport either with ex-fix or
over nail, cage repacement with or without aspirate BG...
Can you pls show x-rays and appearance of the limb/wounds?

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

emalpgi at gmail
New User

Jun 21, 2008, 7:20 AM

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Re: [ORT-L] Tibia Fx - Segmental Defect (Sohn) [In reply to]	Can't Post

hi team,,
the best is the ring fixator,,, if u can dock ok,, otherwise graduall
docking plus proximal osteotomy,,if possible on distal too, it will increase
the blood supply as well will shorten the duration of tt,, i guess this
should be the treatment of choice for such injuries..

On Sat, Jun 21, 2008 at 1:30 PM, jacob odesky <odesky2000@yahoo.com> wrote:

> Hi! Can you give the pictures of the leg and X-rays?
>
>
>
> Odessky Jacob M.D.
>
> Assaf Harofeah Medical Center
>
> Zerifin, Israel
>
>
> ----- Original Message ----
> From: Roger C. Sohn <sohnrog@yahoo.com>
> To: ORT-L@www2.aaos.org
> Cc: Roger C. Sohn <sohnrog@yahoo.com>
> Sent: Saturday, June 21, 2008 9:29:57 AM
> Subject: [ORT-L] Tibia Fx - Segmental Defect (Sohn)
>
> Dear Forum,
>
> I am taking care of a 21 y/o Marine who was shot in the leg with an M-16
> from close range. He was on base (Camp Pendleton) when this happened.
>
> The patient has a medial and lateral wounds with extensive soft tissue
> injury (open grade 3C) with the Posterior Tibial Artery repaired on the
> night of injury. Fasciotomies were not necessary because his entry and exit
> wounds essentially exploded medially and laterally. Initial debridment left
> him with approximately 6" of missing bone from the mid-shaft. I ex-fixed
> him and have taken him back for a 2nd and 3rd look I and D. It looks like
> soft tissue coverage will not be too much of an issue due to his slightly
> shortened position as well as the large amount of dead muscle that I
> removed. He is post-injury day #4 and now wound is improved. I'll be able
> to close his medial wound directly and place a skin graft over his lateral
> wound in a couple days.
>
> Right now, he is stabilized in an ex-fix and I'm planning my next step. I
> have seen the previous similar cases from 2003 and was wondering if any of
> you have new ideas on how to treat this segmental defect. I haven't seen it
> published, but I have seen some data out of Ortho Indy showing good results
> with plating, followed by RIA aspirate bone grafting. I have placed an ABX
> spacer "log" of PMMA with hopes of him forming a pseudomembrane. However, I
> don't feel I have burned any bridges yet and wanted some input.
>
> Patient is sensate with good blood flow. He would like to salvage the
> limb. He does not smoke and is very healthy.
>
> Thanks in advance for your input.
>
> Sincerely,
>
> Roger Sohn
> Mission Viejo, CA
>
>
>

--
May Almighty bless us all

Dr Emal Wardak
MBBS "SMS, Jaipur"
MS "Ortho" PGI Chd, India
Member of NZIOA,IAA "India"
AADO "Hong Kong", SICOT
Orthopaedic Surgeon
Kabul
0093-707034241
http://www.jaxtr.com/emalpgi

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