[ORT-L] Tibia and ankle fracture


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[ORT-L] Tibia and ankle fracture

nswolfso at usc
New User

Jun 16, 2008, 3:46 PM

Post #1 of 11 (966 views)
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[ORT-L] Tibia and ankle fracture	Can't Post

Dear colleuges:

I would appriciate your opinion about surgical ( ORIF) approach of the treatment of 36 yo otherwise healthy person with closed tibia and ankle fractures ( good soft tissues) and no other associated injuries.

Thanks

Nik

Nikolaj Wolfson, MD, FRCSC
Assistant Professor of Orthopaedic Surgery
Department of Orthopaedic Surgery
Keck School of Medicine
University of Southern California
nswolfso@usc.edu
(323) 226-7346 phone
http://www.usc.edu/medicine/orthopaedic_surgery

The information contained in this document and any attachment is privileged and confidential under state law, including Evidence Code section 1157 relating to medical professional peer review documents and Government Code Section 6254 relating to personnel records.

This message, including any attachments, contains confidential information intended for a specific individual and purpose. If you are not the intended recipient, you should delete this message. Any disclosure, copying, or distribution of this message, or the taking of any action based on it, is strictly prohibited.

Attachments:

Tibia and Ankle Fracture OTA.ppt (6.17 MB)

mqsd25 at aol
New User

Jun 17, 2008, 2:19 AM

Post #2 of 11 (955 views)
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Re: [ORT-L] Tibia and ankle fracture [In reply to]	Can't Post

After close view of the X rays and CT slices, I would suggest to fix this fracture with LCP distal tibial plate, and that will need fixing the Fibula with 3rd tubulat plate to give stability and eas of reduction. I will ignore the small posterior fragment.
Elastic fixation , early NWB mobilisation and satrt wt. bearing at 6 to 8 weeks.
Nailing is an option but may split open the fracture down to articular surface, may be ok in expereinced hands.

?I have similair??cases? and did well post op with LCP distal plates, but fracture must be reduced well, if these is gap fracture will? end up with delayed union.

MR Mohammad Maqsood
consultant orthopaedic surgeon
Lincoln county Hospital
Lincoln

-----Original Message-----
From: Nikolaj Wolfson <nswolfso@usc.edu>
To: ORT-L@www2.aaos.org
CC: orthopod@googlegroups.com
Sent: Mon, 16 Jun 2008 23:46
Subject: [ORT-L] Tibia and ankle fracture

Dear colleuges:

I would appriciate your opinion about surgical ( ORIF) approach of the
treatment of 36 yo otherwise healthy person with closed tibia and ankle
fractures ( good soft tissues) and no other associated injuries.

Thanks

Nik

Nikolaj Wolfson, MD, FRCSC
Assistant Professor of Orthopaedic Surgery
Department of Orthopaedic Surgery
Keck School of Medicine
University of Southern California
nswolfso@usc.edu
(323) 226-7346 phone
http://www.usc.edu/medicine/orthopaedic_surgery

The information contained in this document and any attachment is privileged and
confidential under state law, including Evidence Code section 1157 relating to
medical professional peer review documents and Government Code Section 6254
relating to personnel records.

This message, including any attachments, contains confidential information
intended for a specific individual and purpose. If you are not the intended
recipient, you should delete this message. Any disclosure, copying, or
distribution of this message, or the taking of any action based on it, is
strictly prohibited.

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william.obremskey at Vanderbilt
New User

Jun 17, 2008, 8:45 AM

Post #3 of 11 (946 views)
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RE: [ORT-L] Tibia and ankle fracture [In reply to]	Can't Post

IMN tibia and possible orif of fibula. Be careful or will be
malaligned. See paper

William T Obremskey MD MPH
Vanderbilt Orthopedic Trauma
Associate Professor Divsion of Orthopedic Trauma
Director of Orthopedic Trauma Research and Education
Suite 4200 Medical Center East - South Tower
Nashville, TN 37232-8774
615-936-0112- office
615-936-1566- fax
-----Original Message-----
From: ORT-L-owner@www2.aaos.org [mailto:ORT-L-owner@www2.aaos.org] On
Behalf Of Nikolaj Wolfson
Sent: Monday, June 16, 2008 5:47 PM
To: ORT-L@www2.aaos.org
Cc: orthopod@googlegroups.com
Subject: [ORT-L] Tibia and ankle fracture

Dear colleuges:

I would appriciate your opinion about surgical ( ORIF) approach of the
treatment of 36 yo otherwise healthy person with closed tibia and ankle
fractures ( good soft tissues) and no other associated injuries.

Thanks

Nik

Nikolaj Wolfson, MD, FRCSC
Assistant Professor of Orthopaedic Surgery
Department of Orthopaedic Surgery
Keck School of Medicine
University of Southern California
nswolfso@usc.edu
(323) 226-7346 phone
http://www.usc.edu/medicine/orthopaedic_surgery

The information contained in this document and any attachment is
privileged and confidential under state law, including Evidence Code
section 1157 relating to medical professional peer review documents and
Government Code Section 6254 relating to personnel records.

This message, including any attachments, contains confidential
information intended for a specific individual and purpose. If you are
not the intended recipient, you should delete this message. Any
disclosure, copying, or distribution of this message, or the taking of
any action based on it, is strictly prohibited.

Attachments:

11obrem.pdf (56.6 KB)

nswolfso at usc
New User

Jun 17, 2008, 10:01 AM

Post #4 of 11 (943 views)
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Re: RE: [ORT-L] Tibia and ankle fracture [In reply to]	Can't Post

Dear Dr. Obremsky:

Thank you for the advise and the reference.
What would you fix first: fibula/ankle or tibia?
What is you opinion about integrity of the syndesmosis? If you check it in OR and find it has been violated ( opens up on either External rotation or Cotton test ) how would you fix it? Syndesmosis screw/s, posterolaterall fixation of the posterior mal?
What is you opinion on addressing posterior mal fracture and the significance of its size in the desicion making process?

Sorry for so many exiting questions

Thanks

Nik

Nikolaj Wolfson, MD, FRCSC
Assistant Professor of Orthopaedic Surgery
Department of Orthopaedic Surgery
Keck School of Medicine
University of Southern California
nswolfso@usc.edu
(323) 226-7346 phone
http://www.usc.edu/medicine/orthopaedic_surgery

The information contained in this document and any attachment is privileged and confidential under state law, including Evidence Code section 1157 relating to medical professional peer review documents and Government Code Section 6254 relating to personnel records.

This message, including any attachments, contains confidential information intended for a specific individual and purpose. If you are not the intended recipient, you should delete this message. Any disclosure, copying, or distribution of this message, or the taking of any action based on it, is strictly prohibited.

----- Original Message -----
From: "Obremskey, William T" <william.obremskey@Vanderbilt.Edu>
Date: Tuesday, June 17, 2008 9:18 am
Subject: RE: [ORT-L] Tibia and ankle fracture
To: ORT-L@www2.aaos.org
Cc: orthopod@googlegroups.com

> IMN tibia and possible orif of fibula. Be careful or will be
> malaligned. See paper
>
> William T Obremskey MD MPH
> Vanderbilt Orthopedic Trauma
> Associate Professor Divsion of Orthopedic Trauma
> Director of Orthopedic Trauma Research and Education
> Suite 4200 Medical Center East - South Tower
> Nashville, TN 37232-8774
> 615-936-0112- office
> 615-936-1566- fax
> -----Original Message-----
> From: ORT-L-owner@www2.aaos.org [mailto:ORT-L-owner@www2.aaos.org] On
> Behalf Of Nikolaj Wolfson
> Sent: Monday, June 16, 2008 5:47 PM
> To: ORT-L@www2.aaos.org
> Cc: orthopod@googlegroups.com
> Subject: [ORT-L] Tibia and ankle fracture
>
>
> Dear colleuges:
>
> I would appriciate your opinion about surgical ( ORIF) approach
> of the
> treatment of 36 yo otherwise healthy person with closed tibia and
> anklefractures ( good soft tissues) and no other associated injuries.
>
> Thanks
>
> Nik
>
>
>
> Nikolaj Wolfson, MD, FRCSC
> Assistant Professor of Orthopaedic Surgery
> Department of Orthopaedic Surgery
> Keck School of Medicine
> University of Southern California
> nswolfso@usc.edu
> (323) 226-7346 phone
> http://www.usc.edu/medicine/orthopaedic_surgery
>
> The information contained in this document and any attachment is
> privileged and confidential under state law, including Evidence Code
> section 1157 relating to medical professional peer review
> documents and
> Government Code Section 6254 relating to personnel records.
>
>
> This message, including any attachments, contains confidential
> information intended for a specific individual and purpose. If
> you are
> not the intended recipient, you should delete this message. Any
> disclosure, copying, or distribution of this message, or the
> taking of
> any action based on it, is strictly prohibited.
>
>
---
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william.obremskey at Vanderbilt
New User

Jun 17, 2008, 2:13 PM

Post #5 of 11 (941 views)
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RE: RE: [ORT-L] Tibia and ankle fracture [In reply to]	Can't Post

Plate fibula first posterolateral, Syndesmosis will be OK, but fix with
3.5 mm scres anteriorly if injured. Perc Screws AP into post. Mall.
Size does not matter just reduction. Can clamp from lateral incision
and perc anteriorly if needed.
IMN tibia with Reamed IMN

WTO

William T Obremskey MD MPH
Vanderbilt Orthopedic Trauma
Associate Professor Divsion of Orthopedic Trauma
Director of Orthopedic Trauma Research and Education
Suite 4200 Medical Center East - South Tower
Nashville, TN 37232-8774
615-936-0112- office
615-936-1566- fax
-----Original Message-----
From: ORT-L-owner@www2.aaos.org [mailto:ORT-L-owner@www2.aaos.org] On
Behalf Of Nikolaj Wolfson
Sent: Tuesday, June 17, 2008 12:01 PM
To: ORT-L@www2.aaos.org
Subject: Re: RE: [ORT-L] Tibia and ankle fracture

Dear Dr. Obremsky:

Thank you for the advise and the reference.
What would you fix first: fibula/ankle or tibia?
What is you opinion about integrity of the syndesmosis? If you check it
in OR and find it has been violated ( opens up on either External
rotation or Cotton test ) how would you fix it? Syndesmosis screw/s,
posterolaterall fixation of the posterior mal?

What is you opinion on addressing posterior mal fracture and the
significance of its size in the desicion making process?

Sorry for so many exiting questions

Thanks

Nik

Nikolaj Wolfson, MD, FRCSC
Assistant Professor of Orthopaedic Surgery
Department of Orthopaedic Surgery
Keck School of Medicine
University of Southern California
nswolfso@usc.edu
(323) 226-7346 phone
http://www.usc.edu/medicine/orthopaedic_surgery

The information contained in this document and any attachment is
privileged and confidential under state law, including Evidence Code
section 1157 relating to medical professional peer review documents and
Government Code Section 6254 relating to personnel records.

This message, including any attachments, contains confidential
information intended for a specific individual and purpose. If you are
not the intended recipient, you should delete this message. Any
disclosure, copying, or distribution of this message, or the taking of
any action based on it, is strictly prohibited.

----- Original Message -----
From: "Obremskey, William T" <william.obremskey@Vanderbilt.Edu>
Date: Tuesday, June 17, 2008 9:18 am
Subject: RE: [ORT-L] Tibia and ankle fracture
To: ORT-L@www2.aaos.org
Cc: orthopod@googlegroups.com

> IMN tibia and possible orif of fibula. Be careful or will be
> malaligned. See paper
>
> William T Obremskey MD MPH
> Vanderbilt Orthopedic Trauma
> Associate Professor Divsion of Orthopedic Trauma
> Director of Orthopedic Trauma Research and Education
> Suite 4200 Medical Center East - South Tower
> Nashville, TN 37232-8774
> 615-936-0112- office
> 615-936-1566- fax
> -----Original Message-----
> From: ORT-L-owner@www2.aaos.org [mailto:ORT-L-owner@www2.aaos.org] On
> Behalf Of Nikolaj Wolfson
> Sent: Monday, June 16, 2008 5:47 PM
> To: ORT-L@www2.aaos.org
> Cc: orthopod@googlegroups.com
> Subject: [ORT-L] Tibia and ankle fracture
>
>
> Dear colleuges:
>
> I would appriciate your opinion about surgical ( ORIF) approach
> of the
> treatment of 36 yo otherwise healthy person with closed tibia and
> anklefractures ( good soft tissues) and no other associated injuries.
>
> Thanks
>
> Nik
>
>
>
> Nikolaj Wolfson, MD, FRCSC
> Assistant Professor of Orthopaedic Surgery
> Department of Orthopaedic Surgery
> Keck School of Medicine
> University of Southern California
> nswolfso@usc.edu
> (323) 226-7346 phone
> http://www.usc.edu/medicine/orthopaedic_surgery
>
> The information contained in this document and any attachment is
> privileged and confidential under state law, including Evidence Code
> section 1157 relating to medical professional peer review
> documents and
> Government Code Section 6254 relating to personnel records.
>
>
> This message, including any attachments, contains confidential
> information intended for a specific individual and purpose. If
> you are
> not the intended recipient, you should delete this message. Any
> disclosure, copying, or distribution of this message, or the
> taking of
> any action based on it, is strictly prohibited.
>
>
---
[This E-mail scanned for viruses by Declude Virus]

---
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nswolfso at usc
New User

Jun 17, 2008, 3:07 PM

Post #6 of 11 (940 views)
Shortcut

Re: RE: RE: [ORT-L] Tibia and ankle fracture [In reply to]	Can't Post

Thanks. BTW: why fibula posterolaterally? Why not just lateral?

Nikolaj Wolfson, MD, FRCSC
Assistant Professor of Orthopaedic Surgery
Department of Orthopaedic Surgery
Keck School of Medicine
University of Southern California
nswolfso@usc.edu
(323) 226-7346 phone
http://www.usc.edu/medicine/orthopaedic_surgery

The information contained in this document and any attachment is privileged and confidential under state law, including Evidence Code section 1157 relating to medical professional peer review documents and Government Code Section 6254 relating to personnel records.

This message, including any attachments, contains confidential information intended for a specific individual and purpose. If you are not the intended recipient, you should delete this message. Any disclosure, copying, or distribution of this message, or the taking of any action based on it, is strictly prohibited.

----- Original Message -----
From: "Obremskey, William T" <william.obremskey@Vanderbilt.Edu>
Date: Tuesday, June 17, 2008 2:14 pm
Subject: RE: RE: [ORT-L] Tibia and ankle fracture
To: ORT-L@www2.aaos.org

> Plate fibula first posterolateral, Syndesmosis will be OK, but fix
> with3.5 mm scres anteriorly if injured. Perc Screws AP into post.
> Mall.Size does not matter just reduction. Can clamp from lateral
> incisionand perc anteriorly if needed.
> IMN tibia with Reamed IMN
>
> WTO
>
> William T Obremskey MD MPH
> Vanderbilt Orthopedic Trauma
> Associate Professor Divsion of Orthopedic Trauma
> Director of Orthopedic Trauma Research and Education
> Suite 4200 Medical Center East - South Tower
> Nashville, TN 37232-8774
> 615-936-0112- office
> 615-936-1566- fax
> -----Original Message-----
> From: ORT-L-owner@www2.aaos.org [mailto:ORT-L-owner@www2.aaos.org] On
> Behalf Of Nikolaj Wolfson
> Sent: Tuesday, June 17, 2008 12:01 PM
> To: ORT-L@www2.aaos.org
> Subject: Re: RE: [ORT-L] Tibia and ankle fracture
>
> Dear Dr. Obremsky:
>
> Thank you for the advise and the reference.
> What would you fix first: fibula/ankle or tibia?
> What is you opinion about integrity of the syndesmosis? If you
> check it
> in OR and find it has been violated ( opens up on either External
> rotation or Cotton test ) how would you fix it? Syndesmosis screw/s,
> posterolaterall fixation of the posterior mal?
>
> What is you opinion on addressing posterior mal fracture and the
> significance of its size in the desicion making process?
>
> Sorry for so many exiting questions
>
> Thanks
>
> Nik
>
>
> Nikolaj Wolfson, MD, FRCSC
> Assistant Professor of Orthopaedic Surgery
> Department of Orthopaedic Surgery
> Keck School of Medicine
> University of Southern California
> nswolfso@usc.edu
> (323) 226-7346 phone
> http://www.usc.edu/medicine/orthopaedic_surgery
>
> The information contained in this document and any attachment is
> privileged and confidential under state law, including Evidence Code
> section 1157 relating to medical professional peer review
> documents and
> Government Code Section 6254 relating to personnel records.
>
>
> This message, including any attachments, contains confidential
> information intended for a specific individual and purpose. If
> you are
> not the intended recipient, you should delete this message. Any
> disclosure, copying, or distribution of this message, or the
> taking of
> any action based on it, is strictly prohibited.
>
>
> ----- Original Message -----
> From: "Obremskey, William T" <william.obremskey@Vanderbilt.Edu>
> Date: Tuesday, June 17, 2008 9:18 am
> Subject: RE: [ORT-L] Tibia and ankle fracture
> To: ORT-L@www2.aaos.org
> Cc: orthopod@googlegroups.com
>
> > IMN tibia and possible orif of fibula. Be careful or will be
> > malaligned. See paper
> >
> > William T Obremskey MD MPH
> > Vanderbilt Orthopedic Trauma
> > Associate Professor Divsion of Orthopedic Trauma
> > Director of Orthopedic Trauma Research and Education
> > Suite 4200 Medical Center East - South Tower
> > Nashville, TN 37232-8774
> > 615-936-0112- office
> > 615-936-1566- fax
> > -----Original Message-----
> > From: ORT-L-owner@www2.aaos.org [mailto:ORT-L-
> owner@www2.aaos.org] On
> > Behalf Of Nikolaj Wolfson
> > Sent: Monday, June 16, 2008 5:47 PM
> > To: ORT-L@www2.aaos.org
> > Cc: orthopod@googlegroups.com
> > Subject: [ORT-L] Tibia and ankle fracture
> >
> >
> > Dear colleuges:
> >
> > I would appriciate your opinion about surgical ( ORIF) approach
> > of the
> > treatment of 36 yo otherwise healthy person with closed tibia
> and
> > anklefractures ( good soft tissues) and no other associated
> injuries.>
> > Thanks
> >
> > Nik
> >
> >
> >
> > Nikolaj Wolfson, MD, FRCSC
> > Assistant Professor of Orthopaedic Surgery
> > Department of Orthopaedic Surgery
> > Keck School of Medicine
> > University of Southern California
> > nswolfso@usc.edu
> > (323) 226-7346 phone
> > http://www.usc.edu/medicine/orthopaedic_surgery
> >
> > The information contained in this document and any attachment is
> > privileged and confidential under state law, including Evidence Code
> > section 1157 relating to medical professional peer review
> > documents and
> > Government Code Section 6254 relating to personnel records.
> >
> >
> > This message, including any attachments, contains confidential
> > information intended for a specific individual and purpose. If
> > you are
> > not the intended recipient, you should delete this message. Any
> > disclosure, copying, or distribution of this message, or the
> > taking of
> > any action based on it, is strictly prohibited.
> >
> >
> ---
> [This E-mail scanned for viruses by Declude Virus]
>
> ---
> [This E-mail scanned for viruses by Declude Virus]
>
>
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william.obremskey at Vanderbilt
New User

Jun 18, 2008, 3:56 AM

Post #7 of 11 (887 views)
Shortcut

RE: RE: RE: [ORT-L] Tibia and ankle fracture [In reply to]	Can't Post

Rotation. This is an external rotation injury. Lateral would work as
well, but I believe that PL is better biomechanically.

William T Obremskey MD MPH
Vanderbilt Orthopedic Trauma
Associate Professor Divsion of Orthopedic Trauma
Director of Orthopedic Trauma Research and Education
Suite 4200 Medical Center East - South Tower
Nashville, TN 37232-8774
615-936-0112- office
615-936-1566- fax

-----Original Message-----
From: ORT-L-owner@www2.aaos.org [mailto:ORT-L-owner@www2.aaos.org] On
Behalf Of Nikolaj Wolfson
Sent: Tuesday, June 17, 2008 5:07 PM
To: ORT-L@www2.aaos.org
Subject: Re: RE: RE: [ORT-L] Tibia and ankle fracture

Thanks. BTW: why fibula posterolaterally? Why not just lateral?

Nikolaj Wolfson, MD, FRCSC
Assistant Professor of Orthopaedic Surgery
Department of Orthopaedic Surgery
Keck School of Medicine
University of Southern California
nswolfso@usc.edu
(323) 226-7346 phone
http://www.usc.edu/medicine/orthopaedic_surgery

The information contained in this document and any attachment is
privileged and confidential under state law, including Evidence Code
section 1157 relating to medical professional peer review documents and
Government Code Section 6254 relating to personnel records.

This message, including any attachments, contains confidential
information intended for a specific individual and purpose. If you are
not the intended recipient, you should delete this message. Any
disclosure, copying, or distribution of this message, or the taking of
any action based on it, is strictly prohibited.

----- Original Message -----
From: "Obremskey, William T" <william.obremskey@Vanderbilt.Edu>
Date: Tuesday, June 17, 2008 2:14 pm
Subject: RE: RE: [ORT-L] Tibia and ankle fracture
To: ORT-L@www2.aaos.org

> Plate fibula first posterolateral, Syndesmosis will be OK, but fix
> with3.5 mm scres anteriorly if injured. Perc Screws AP into post.
> Mall.Size does not matter just reduction. Can clamp from lateral
> incisionand perc anteriorly if needed.
> IMN tibia with Reamed IMN
>
> WTO
>
> William T Obremskey MD MPH
> Vanderbilt Orthopedic Trauma
> Associate Professor Divsion of Orthopedic Trauma
> Director of Orthopedic Trauma Research and Education
> Suite 4200 Medical Center East - South Tower
> Nashville, TN 37232-8774
> 615-936-0112- office
> 615-936-1566- fax
> -----Original Message-----
> From: ORT-L-owner@www2.aaos.org [mailto:ORT-L-owner@www2.aaos.org] On
> Behalf Of Nikolaj Wolfson
> Sent: Tuesday, June 17, 2008 12:01 PM
> To: ORT-L@www2.aaos.org
> Subject: Re: RE: [ORT-L] Tibia and ankle fracture
>
> Dear Dr. Obremsky:
>
> Thank you for the advise and the reference.
> What would you fix first: fibula/ankle or tibia?
> What is you opinion about integrity of the syndesmosis? If you
> check it
> in OR and find it has been violated ( opens up on either External
> rotation or Cotton test ) how would you fix it? Syndesmosis screw/s,
> posterolaterall fixation of the posterior mal?
>
> What is you opinion on addressing posterior mal fracture and the
> significance of its size in the desicion making process?
>
> Sorry for so many exiting questions
>
> Thanks
>
> Nik
>
>
> Nikolaj Wolfson, MD, FRCSC
> Assistant Professor of Orthopaedic Surgery
> Department of Orthopaedic Surgery
> Keck School of Medicine
> University of Southern California
> nswolfso@usc.edu
> (323) 226-7346 phone
> http://www.usc.edu/medicine/orthopaedic_surgery
>
> The information contained in this document and any attachment is
> privileged and confidential under state law, including Evidence Code
> section 1157 relating to medical professional peer review
> documents and
> Government Code Section 6254 relating to personnel records.
>
>
> This message, including any attachments, contains confidential
> information intended for a specific individual and purpose. If
> you are
> not the intended recipient, you should delete this message. Any
> disclosure, copying, or distribution of this message, or the
> taking of
> any action based on it, is strictly prohibited.
>
>
> ----- Original Message -----
> From: "Obremskey, William T" <william.obremskey@Vanderbilt.Edu>
> Date: Tuesday, June 17, 2008 9:18 am
> Subject: RE: [ORT-L] Tibia and ankle fracture
> To: ORT-L@www2.aaos.org
> Cc: orthopod@googlegroups.com
>
> > IMN tibia and possible orif of fibula. Be careful or will be
> > malaligned. See paper
> >
> > William T Obremskey MD MPH
> > Vanderbilt Orthopedic Trauma
> > Associate Professor Divsion of Orthopedic Trauma
> > Director of Orthopedic Trauma Research and Education
> > Suite 4200 Medical Center East - South Tower
> > Nashville, TN 37232-8774
> > 615-936-0112- office
> > 615-936-1566- fax
> > -----Original Message-----
> > From: ORT-L-owner@www2.aaos.org [mailto:ORT-L-
> owner@www2.aaos.org] On
> > Behalf Of Nikolaj Wolfson
> > Sent: Monday, June 16, 2008 5:47 PM
> > To: ORT-L@www2.aaos.org
> > Cc: orthopod@googlegroups.com
> > Subject: [ORT-L] Tibia and ankle fracture
> >
> >
> > Dear colleuges:
> >
> > I would appriciate your opinion about surgical ( ORIF) approach
> > of the
> > treatment of 36 yo otherwise healthy person with closed tibia
> and
> > anklefractures ( good soft tissues) and no other associated
> injuries.>
> > Thanks
> >
> > Nik
> >
> >
> >
> > Nikolaj Wolfson, MD, FRCSC
> > Assistant Professor of Orthopaedic Surgery
> > Department of Orthopaedic Surgery
> > Keck School of Medicine
> > University of Southern California
> > nswolfso@usc.edu
> > (323) 226-7346 phone
> > http://www.usc.edu/medicine/orthopaedic_surgery
> >
> > The information contained in this document and any attachment is
> > privileged and confidential under state law, including Evidence Code
> > section 1157 relating to medical professional peer review
> > documents and
> > Government Code Section 6254 relating to personnel records.
> >
> >
> > This message, including any attachments, contains confidential
> > information intended for a specific individual and purpose. If
> > you are
> > not the intended recipient, you should delete this message. Any
> > disclosure, copying, or distribution of this message, or the
> > taking of
> > any action based on it, is strictly prohibited.
> >
> >
> ---
> [This E-mail scanned for viruses by Declude Virus]
>
> ---
> [This E-mail scanned for viruses by Declude Virus]
>
>
---
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nswolfso at usc
New User

Jun 18, 2008, 9:34 AM

Post #8 of 11 (871 views)
Shortcut

Re: RE: RE: RE: [ORT-L] Tibia and ankle fracture [In reply to]	Can't Post

OK.

PL is your choice. Great.

Thanks.

Nikolaj Wolfson, MD, FRCSC
Assistant Professor of Orthopaedic Surgery
Department of Orthopaedic Surgery
Keck School of Medicine
University of Southern California
nswolfso@usc.edu
(323) 226-7346 phone
http://www.usc.edu/medicine/orthopaedic_surgery

The information contained in this document and any attachment is privileged and confidential under state law, including Evidence Code section 1157 relating to medical professional peer review documents and Government Code Section 6254 relating to personnel records.

This message, including any attachments, contains confidential information intended for a specific individual and purpose. If you are not the intended recipient, you should delete this message. Any disclosure, copying, or distribution of this message, or the taking of any action based on it, is strictly prohibited.

----- Original Message -----
From: "Obremskey, William T" <william.obremskey@Vanderbilt.Edu>
Date: Wednesday, June 18, 2008 3:57 am
Subject: RE: RE: RE: [ORT-L] Tibia and ankle fracture
To: ORT-L@www2.aaos.org

> Rotation. This is an external rotation injury. Lateral would
> work as
> well, but I believe that PL is better biomechanically.
>
> William T Obremskey MD MPH
> Vanderbilt Orthopedic Trauma
> Associate Professor Divsion of Orthopedic Trauma
> Director of Orthopedic Trauma Research and Education
> Suite 4200 Medical Center East - South Tower
> Nashville, TN 37232-8774
> 615-936-0112- office
> 615-936-1566- fax
>
> -----Original Message-----
> From: ORT-L-owner@www2.aaos.org [mailto:ORT-L-owner@www2.aaos.org] On
> Behalf Of Nikolaj Wolfson
> Sent: Tuesday, June 17, 2008 5:07 PM
> To: ORT-L@www2.aaos.org
> Subject: Re: RE: RE: [ORT-L] Tibia and ankle fracture
>
> Thanks. BTW: why fibula posterolaterally? Why not just lateral?
>
> Nikolaj Wolfson, MD, FRCSC
> Assistant Professor of Orthopaedic Surgery
> Department of Orthopaedic Surgery
> Keck School of Medicine
> University of Southern California
> nswolfso@usc.edu
> (323) 226-7346 phone
> http://www.usc.edu/medicine/orthopaedic_surgery
>
> The information contained in this document and any attachment is
> privileged and confidential under state law, including Evidence Code
> section 1157 relating to medical professional peer review
> documents and
> Government Code Section 6254 relating to personnel records.
>
>
> This message, including any attachments, contains confidential
> information intended for a specific individual and purpose. If
> you are
> not the intended recipient, you should delete this message. Any
> disclosure, copying, or distribution of this message, or the
> taking of
> any action based on it, is strictly prohibited.
>
>
> ----- Original Message -----
> From: "Obremskey, William T" <william.obremskey@Vanderbilt.Edu>
> Date: Tuesday, June 17, 2008 2:14 pm
> Subject: RE: RE: [ORT-L] Tibia and ankle fracture
> To: ORT-L@www2.aaos.org
>
> > Plate fibula first posterolateral, Syndesmosis will be OK, but
> fix
> > with3.5 mm scres anteriorly if injured. Perc Screws AP into
> post.
> > Mall.Size does not matter just reduction. Can clamp from
> lateral
> > incisionand perc anteriorly if needed.
> > IMN tibia with Reamed IMN
> >
> > WTO
> >
> > William T Obremskey MD MPH
> > Vanderbilt Orthopedic Trauma
> > Associate Professor Divsion of Orthopedic Trauma
> > Director of Orthopedic Trauma Research and Education
> > Suite 4200 Medical Center East - South Tower
> > Nashville, TN 37232-8774
> > 615-936-0112- office
> > 615-936-1566- fax
> > -----Original Message-----
> > From: ORT-L-owner@www2.aaos.org [mailto:ORT-L-
> owner@www2.aaos.org] On
> > Behalf Of Nikolaj Wolfson
> > Sent: Tuesday, June 17, 2008 12:01 PM
> > To: ORT-L@www2.aaos.org
> > Subject: Re: RE: [ORT-L] Tibia and ankle fracture
> >
> > Dear Dr. Obremsky:
> >
> > Thank you for the advise and the reference.
> > What would you fix first: fibula/ankle or tibia?
> > What is you opinion about integrity of the syndesmosis? If you
> > check it
> > in OR and find it has been violated ( opens up on either External
> > rotation or Cotton test ) how would you fix it? Syndesmosis
> screw/s,> posterolaterall fixation of the posterior mal?
> >
> > What is you opinion on addressing posterior mal fracture and the
> > significance of its size in the desicion making process?
> >
> > Sorry for so many exiting questions
> >
> > Thanks
> >
> > Nik
> >
> >
> > Nikolaj Wolfson, MD, FRCSC
> > Assistant Professor of Orthopaedic Surgery
> > Department of Orthopaedic Surgery
> > Keck School of Medicine
> > University of Southern California
> > nswolfso@usc.edu
> > (323) 226-7346 phone
> > http://www.usc.edu/medicine/orthopaedic_surgery
> >
> > The information contained in this document and any attachment is
> > privileged and confidential under state law, including Evidence Code
> > section 1157 relating to medical professional peer review
> > documents and
> > Government Code Section 6254 relating to personnel records.
> >
> >
> > This message, including any attachments, contains confidential
> > information intended for a specific individual and purpose. If
> > you are
> > not the intended recipient, you should delete this message. Any
> > disclosure, copying, or distribution of this message, or the
> > taking of
> > any action based on it, is strictly prohibited.
> >
> >
> > ----- Original Message -----
> > From: "Obremskey, William T" <william.obremskey@Vanderbilt.Edu>
> > Date: Tuesday, June 17, 2008 9:18 am
> > Subject: RE: [ORT-L] Tibia and ankle fracture
> > To: ORT-L@www2.aaos.org
> > Cc: orthopod@googlegroups.com
> >
> > > IMN tibia and possible orif of fibula. Be careful or will be
> > > malaligned. See paper
> > >
> > > William T Obremskey MD MPH
> > > Vanderbilt Orthopedic Trauma
> > > Associate Professor Divsion of Orthopedic Trauma
> > > Director of Orthopedic Trauma Research and Education
> > > Suite 4200 Medical Center East - South Tower
> > > Nashville, TN 37232-8774
> > > 615-936-0112- office
> > > 615-936-1566- fax
> > > -----Original Message-----
> > > From: ORT-L-owner@www2.aaos.org [mailto:ORT-L-
> > owner@www2.aaos.org] On
> > > Behalf Of Nikolaj Wolfson
> > > Sent: Monday, June 16, 2008 5:47 PM
> > > To: ORT-L@www2.aaos.org
> > > Cc: orthopod@googlegroups.com
> > > Subject: [ORT-L] Tibia and ankle fracture
> > >
> > >
> > > Dear colleuges:
> > >
> > > I would appriciate your opinion about surgical ( ORIF)
> approach
> > > of the
> > > treatment of 36 yo otherwise healthy person with closed tibia
> > and
> > > anklefractures ( good soft tissues) and no other associated
> > injuries.>
> > > Thanks
> > >
> > > Nik
> > >
> > >
> > >
> > > Nikolaj Wolfson, MD, FRCSC
> > > Assistant Professor of Orthopaedic Surgery
> > > Department of Orthopaedic Surgery
> > > Keck School of Medicine
> > > University of Southern California
> > > nswolfso@usc.edu
> > > (323) 226-7346 phone
> > > http://www.usc.edu/medicine/orthopaedic_surgery
> > >
> > > The information contained in this document and any attachment is
> > > privileged and confidential under state law, including
> Evidence Code
> > > section 1157 relating to medical professional peer review
> > > documents and
> > > Government Code Section 6254 relating to personnel records.
> > >
> > >
> > > This message, including any attachments, contains confidential
> > > information intended for a specific individual and purpose.
> If
> > > you are
> > > not the intended recipient, you should delete this message. Any
> > > disclosure, copying, or distribution of this message, or the
> > > taking of
> > > any action based on it, is strictly prohibited.
> > >
> > >
> > ---
> > [This E-mail scanned for viruses by Declude Virus]
> >
> > ---
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> >
> >
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jjbrooksmd at gmail
New User

Jun 18, 2008, 10:32 AM

Post #9 of 11 (871 views)
Shortcut

Re: [ORT-L] Tibia and ankle fracture [In reply to]	Can't Post

nik,

can you please re-send the x rays for this case? for some reason my
mail program blocks some messages from the OTA server.

thanks,

jeff

On Jun 17, 2008, at 5:19 AM, mqsd25@aol.com wrote:

> After close view of the X rays and CT slices, I would suggest to
> fix this fracture with LCP distal tibial plate, and that will need
> fixing the Fibula with 3rd tubulat plate to give stability and eas
> of reduction. I will ignore the small posterior fragment.
> Elastic fixation , early NWB mobilisation and satrt wt. bearing at
> 6 to 8 weeks.
> Nailing is an option but may split open the fracture down to
> articular surface, may be ok in expereinced hands.
> I have similair cases and did well post op with LCP distal
> plates, but fracture must be reduced well, if these is gap fracture
> will end up with delayed union.
>
> MR Mohammad Maqsood
> consultant orthopaedic surgeon
> Lincoln county Hospital
> Lincoln
>
>
> -----Original Message-----
> From: Nikolaj Wolfson <nswolfso@usc.edu>
> To: ORT-L@www2.aaos.org
> CC: orthopod@googlegroups.com
> Sent: Mon, 16 Jun 2008 23:46
> Subject: [ORT-L] Tibia and ankle fracture
>
> Dear colleuges:
>
> I would appriciate your opinion about surgical ( ORIF) approach of
> the
> treatment of 36 yo otherwise healthy person with closed tibia and
> ankle
> fractures ( good soft tissues) and no other associated injuries.
>
> Thanks
>
> Nik
>
>
>
> Nikolaj Wolfson, MD, FRCSC
> Assistant Professor of Orthopaedic Surgery
> Department of Orthopaedic Surgery
> Keck School of Medicine
> University of Southern California
> nswolfso@usc.edu
> (323) 226-7346 phone
> http://www.usc.edu/medicine/orthopaedic_surgery
>
> The information contained in this document and any attachment is
> privileged and
> confidential under state law, including Evidence Code section 1157
> relating to
> medical professional peer review documents and Government Code
> Section 6254
> relating to personnel records.
>
>
> This message, including any attachments, contains confidential
> information
> intended for a specific individual and purpose. If you are not the
> intended
> recipient, you should delete this message. Any disclosure,
> copying, or
> distribution of this message, or the taking of any action based on
> it, is
> strictly prohibited.
>
> AOL's new homepage has launched. Take a tour now.

jjbrooksmd at gmail
New User

Jun 18, 2008, 2:00 PM

Post #10 of 11 (867 views)
Shortcut

Re: [ORT-L] Tibia and ankle fracture [In reply to]	Can't Post

Nik,

Here's my two cents, for what it's worth:

My inclination would be to treat this as 2 separate injuries, the
bimal Fx (first), then the tibial shaft Fx.

I'd first fix the ankle with standard lateral fibular plate and 2 A--
>P lag screws, ORIF med mall, Cotton test (will be neg is my bet),
then scoot a femoral distractor pin from medial to lateral, shooting
behind your medial mal lags, thru same incision. second med -> lat
distractor pin proximally, posterior to nail entry site. Then apply
large AO distractor and dial in your varus/valgus, rotation & length
(flex/ext is harder to control so use bumps +/- f-tool from synthes'
nancy nail set if you have one). once it's anatomic (i find parallax
is a tough to deal with when trying to judge reduction so stop a
minute and get sterile plain x rays to be sure you're close to 0
degrees v/v f/e) pass wire, ream & nail. watch carefully that you
dont lose reduction. the nail will have poor control of the distal
frag b/c of comminution and infra-isthmic location of fx so get as
many interlocks distally as you can, and bring the nail all the way
down to within 3-4 mm of the plafond. after distal locking release
traction on distractor to make sure you dont nail it overdistracted
and then lock proximally. make sure this doesnt make nail proud at
the knee, maybe choose a 1cm shorter nail then make up with endcap to
be flush at entry site.

Good luck! Let us know what you do.

Jeff

On Jun 18, 2008, at 1:32 PM, Jeff Brooks wrote:

> nik,
>
> can you please re-send the x rays for this case? for some reason my
> mail program blocks some messages from the OTA server.
>
> thanks,
>
> jeff
>
>
> On Jun 17, 2008, at 5:19 AM, mqsd25@aol.com wrote:
>
>> After close view of the X rays and CT slices, I would suggest to
>> fix this fracture with LCP distal tibial plate, and that will need
>> fixing the Fibula with 3rd tubulat plate to give stability and eas
>> of reduction. I will ignore the small posterior fragment.
>> Elastic fixation , early NWB mobilisation and satrt wt. bearing at
>> 6 to 8 weeks.
>> Nailing is an option but may split open the fracture down to
>> articular surface, may be ok in expereinced hands.
>> I have similair cases and did well post op with LCP distal
>> plates, but fracture must be reduced well, if these is gap
>> fracture will end up with delayed union.
>>
>> MR Mohammad Maqsood
>> consultant orthopaedic surgeon
>> Lincoln county Hospital
>> Lincoln
>>
>>
>> -----Original Message-----
>> From: Nikolaj Wolfson <nswolfso@usc.edu>
>> To: ORT-L@www2.aaos.org
>> CC: orthopod@googlegroups.com
>> Sent: Mon, 16 Jun 2008 23:46
>> Subject: [ORT-L] Tibia and ankle fracture
>>
>> Dear colleuges:
>>
>> I would appriciate your opinion about surgical ( ORIF) approach
>> of the
>> treatment of 36 yo otherwise healthy person with closed tibia and
>> ankle
>> fractures ( good soft tissues) and no other associated injuries.
>>
>> Thanks
>>
>> Nik
>>
>>
>>
>> Nikolaj Wolfson, MD, FRCSC
>> Assistant Professor of Orthopaedic Surgery
>> Department of Orthopaedic Surgery
>> Keck School of Medicine
>> University of Southern California
>> nswolfso@usc.edu
>> (323) 226-7346 phone
>> http://www.usc.edu/medicine/orthopaedic_surgery
>>
>> The information contained in this document and any attachment is
>> privileged and
>> confidential under state law, including Evidence Code section 1157
>> relating to
>> medical professional peer review documents and Government Code
>> Section 6254
>> relating to personnel records.
>>
>>
>> This message, including any attachments, contains confidential
>> information
>> intended for a specific individual and purpose. If you are not
>> the intended
>> recipient, you should delete this message. Any disclosure,
>> copying, or
>> distribution of this message, or the taking of any action based on
>> it, is
>> strictly prohibited.
>>
>> AOL's new homepage has launched. Take a tour now.
>

nswolfso at usc
New User

Jun 18, 2008, 2:51 PM

Post #11 of 11 (867 views)
Shortcut

Re: [ORT-L] Tibia and ankle fracture [In reply to]	Can't Post

Jeff:

Great. That is as close to what I would do as it gets. I often like to hold my reduced tibial fracture with Weber clamp/s while I am reaming it, so this way I do not loose reduction and assure the nail and the Tibia are as close to the perfect final alignment as it can be.

As to the way of intra operative X Ray and X ray parallax: Over a year ago I have started a project on assessment of intaroperative tibial alignment in IM nailing of tibia. This is especially relevant to the distal 1/3 fractures but would also apply to the femur. I have started with the survey using OTA web site ORT-L@www2.aaos.org and you may be got my questioner. It was also used at the OTA meeting last year. II have some interesting numbers from both trauma and community trained surgeons. The next stage is to see what happens in OR and after: correlation between intra operative C arm images and large plate x rays and follow up in relationship to the final alignment and the effect of degree of alignment on outcome.

What do you think about this kind of a study and would you like to participate? May be other trauma surgeons can express their opinion on this subject to. Multicenet study of this kind would be great.

As to the case I am not sure I will be doing it even. Our system a bit strange this way.

Thank again for you opinion,

Nik

Nikolaj Wolfson, MD, FRCSC
Assistant Professor of Orthopaedic Surgery
Department of Orthopaedic Surgery
Keck School of Medicine
University of Southern California
nswolfso@usc.edu
(323) 226-7346 phone
http://www.usc.edu/medicine/orthopaedic_surgery

The information contained in this document and any attachment is privileged and confidential under state law, including Evidence Code section 1157 relating to medical professional peer review documents and Government Code Section 6254 relating to personnel records.

This message, including any attachments, contains confidential information intended for a specific individual and purpose. If you are not the intended recipient, you should delete this message. Any disclosure, copying, or distribution of this message, or the taking of any action based on it, is strictly prohibited.

----- Original Message -----
From: Jeff Brooks <jjbrooksmd@gmail.com>
Date: Wednesday, June 18, 2008 2:21 pm
Subject: Re: [ORT-L] Tibia and ankle fracture
To: ORT-L@www2.aaos.org

> Nik,
>
> Here's my two cents, for what it's worth:
>
> My inclination would be to treat this as 2 separate injuries, the
> bimal Fx (first), then the tibial shaft Fx.
>
> I'd first fix the ankle with standard lateral fibular plate and 2
> A--
> >P lag screws, ORIF med mall, Cotton test (will be neg is my
> bet),
> then scoot a femoral distractor pin from medial to lateral,
> shooting
> behind your medial mal lags, thru same incision. second med -> lat
>
> distractor pin proximally, posterior to nail entry site. Then
> apply
> large AO distractor and dial in your varus/valgus, rotation &
> length
> (flex/ext is harder to control so use bumps +/- f-tool from
> synthes'
> nancy nail set if you have one). once it's anatomic (i find
> parallax
> is a tough to deal with when trying to judge reduction so stop a
> minute and get sterile plain x rays to be sure you're close to 0
> degrees v/v f/e) pass wire, ream & nail. watch carefully that you
> dont lose reduction. the nail will have poor control of the distal
>
> frag b/c of comminution and infra-isthmic location of fx so get as
>
> many interlocks distally as you can, and bring the nail all the
> way
> down to within 3-4 mm of the plafond. after distal locking release
>
> traction on distractor to make sure you dont nail it
> overdistracted
> and then lock proximally. make sure this doesnt make nail proud at
>
> the knee, maybe choose a 1cm shorter nail then make up with endcap
> to
> be flush at entry site.
>
> Good luck! Let us know what you do.
>
> Jeff
>
>
> On Jun 18, 2008, at 1:32 PM, Jeff Brooks wrote:
>
> > nik,
> >
> > can you please re-send the x rays for this case? for some reason
> my
> > mail program blocks some messages from the OTA server.
> >
> > thanks,
> >
> > jeff
> >
> >
> > On Jun 17, 2008, at 5:19 AM, mqsd25@aol.com wrote:
> >
> >> After close view of the X rays and CT slices, I would suggest
> to
> >> fix this fracture with LCP distal tibial plate, and that will
> need
> >> fixing the Fibula with 3rd tubulat plate to give stability and
> eas
> >> of reduction. I will ignore the small posterior fragment.
> >> Elastic fixation , early NWB mobilisation and satrt wt. bearing
> at
> >> 6 to 8 weeks.
> >> Nailing is an option but may split open the fracture down to
> >> articular surface, may be ok in expereinced hands.
> >> I have similair cases and did well post op with LCP distal
> >> plates, but fracture must be reduced well, if these is gap
> >> fracture will end up with delayed union.
> >>
> >> MR Mohammad Maqsood
> >> consultant orthopaedic surgeon
> >> Lincoln county Hospital
> >> Lincoln
> >>
> >>
> >> -----Original Message-----
> >> From: Nikolaj Wolfson <nswolfso@usc.edu>
> >> To: ORT-L@www2.aaos.org
> >> CC: orthopod@googlegroups.com
> >> Sent: Mon, 16 Jun 2008 23:46
> >> Subject: [ORT-L] Tibia and ankle fracture
> >>
> >> Dear colleuges:
> >>
> >> I would appriciate your opinion about surgical ( ORIF)
> approach
> >> of the
> >> treatment of 36 yo otherwise healthy person with closed tibia
> and
> >> ankle
> >> fractures ( good soft tissues) and no other associated injuries.
> >>
> >> Thanks
> >>
> >> Nik
> >>
> >>
> >>
> >> Nikolaj Wolfson, MD, FRCSC
> >> Assistant Professor of Orthopaedic Surgery
> >> Department of Orthopaedic Surgery
> >> Keck School of Medicine
> >> University of Southern California
> >> nswolfso@usc.edu
> >> (323) 226-7346 phone
> >> http://www.usc.edu/medicine/orthopaedic_surgery
> >>
> >> The information contained in this document and any attachment
> is
> >> privileged and
> >> confidential under state law, including Evidence Code section
> 1157
> >> relating to
> >> medical professional peer review documents and Government Code
> >> Section 6254
> >> relating to personnel records.
> >>
> >>
> >> This message, including any attachments, contains confidential
> >> information
> >> intended for a specific individual and purpose. If you are not
>
> >> the intended
> >> recipient, you should delete this message. Any disclosure,
> >> copying, or
> >> distribution of this message, or the taking of any action based
> on
> >> it, is
> >> strictly prohibited.
> >>
> >> AOL's new homepage has launched. Take a tour now.
> >
>
>
---
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