Fwd: Re: [ORT-L] [Ortho] crush distal ttibia


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Fwd: Re: [ORT-L] [Ortho] crush distal ttibia

alex at weborto
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Nov 6, 2008, 8:47 AM

Post #1 of 2 (1996 views)
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Fwd: Re: [ORT-L] [Ortho] crush distal ttibia	Can't Post

Dear ort-l@www2.aaos.org.

---------- Forwarded message ----------
From: Alexander Lerner <alex_lerner@yahoo.com>
To: Orthoforum <ortho@weborto.net>
CC:
Time: Thu, 06 Nov 2008 15:30:52 +0500
Subject: [Ortho] crush distal ttibia
Attachment: <none>

Dear Marek,
I am fully agreed with d-r Alexander Chelnokov that the skin and soft tissue condition are crucial at these stage of the treatment and also in the future. The treatment process must be staged due to high-energy trauma with severe soft tissue damage.
By my opinion, at this stage the lower limb must be fixed using unilateral Ex Fix (tibio-calcaneal bridging due to severe trauma to the ankle joint) or using hybrid Ex Fix (unilateral proximal half-pins tibial fixation combined with distal ring / 5/8ring with thin wires).
Sorry, we haven't clinical pictures. Is a radical repeat wound debridement needed?
Then, the early free microsurgical flap is a good option for closure the exposed tibial bone fragments and the fracture site. Temporary acute limb shortening or/and angulation for diminishing of the extensive soft tissue wound can be also performed.
The final skeletal stabilization may be performed using IM nailing with additional medial malleolus fixation and also positional screw for syndesmotic fixation.
Or, you can perform conversion of primary unilateral EX.Fix to finally Ilizarov frame fixation (trans-ankle), especially if the temporary acute shortening or/and angulation was chosed at early stage of the treatment. Graduate re-alignment and length restoration using Ilizarov method must be performed after wound healing.
With best wishes
D-r Alex Lerner

--- On Thu, 11/6/08, Marek Kolasniewski <orthoforum@weborto.net> wrote:

> From: Marek Kolasniewski <orthoforum@weborto.net>
> Subject: [Ortho] crush distal ttibia
> To: ortho@weborto.net
> Date: Thursday, November 6, 2008, 9:46 AM
> Dear
> Could You give us an advice ?
> 48 yo male, crush injury (esp. Gustilo IIIA ) of distal
> tibia managed nonoperatively ( cast ! ABX) for 2 days, was
> transferred to us.
>
> There,s no signs of infection but condition of skin is bad
> ( large contusion, Tscherne 3 ) What kind of treatment:
> definitivly or staged ? Internal fixation (plate) or maybe
> nail + screws ? Ilizarov is an option... <br>
>
> Best regards
> Marek Kolasniewski
> Orthopedic Trauma Unit
> Military Hospital
> Poznan
> Poland
> Marek Kolasniewski
> _______________________________________________
> Ortho mailing list
> Ortho@weborto.net
> http://weborto.net:8080/mailman/listinfo/ortho

_______________________________________________
Ortho mailing list
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---------- End of forwarded message ----------
--
Best regards,
Alexander N. Chelnokov
Ural Scientific Research Institute
of Traumatology and Orthopaedics
7, Bankovsky str. Ekaterinburg 620014 Russia

---
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nswolfso at usc
New User

Nov 6, 2008, 3:11 PM

Post #2 of 2 (1980 views)
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Re: Fwd: Re: [ORT-L] [Ortho] crush distal ttibia [In reply to]	Can't Post

Marek:

First is soft tissue. In your case it would mean to me irrigation, debridement and temporarily external fixator( we call it traveling frame). Wound should be covered if you can not close it us wound vac, if you have it. Later ( within 6 day) use a flap if there is a problem.
I would not open fibulla. Why to rash, you have ex fix doing for you what you need. Let soft tissues to calm down, swelling to go away and than nail tibia after you ORIF fibula and fix the syndesmosis if needed after your nailing is done. Do CT scan to assess the distal tibia for possible articular extension.

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

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----- Original Message -----
From: Alexander Chelnokov <alex@weborto.net>
Date: Thursday, November 6, 2008 1:44 pm
Subject: Fwd: Re: [ORT-L] [Ortho] crush distal ttibia
To: ORT-L@www2.aaos.org

> Dear friends
>
>
>
> ---------- Forwarded message ----------
> From: Marek <orthoforum@weborto.net>
> To: ortho@weborto.net
> CC:
> Time: Fri, 07 Nov 2008 00:47:26 +0500
> Subject: [Ortho] crush distal ttibia
> Attachment: <none>
>
> This injuris is open Gustilo III A with wound on medial side of
> tibia, but the mechanism of the injury made a large contusion on
> anterolateraL side of leg, especially over the fibula - its looks
> - Tscherne 3. Yes, I think traumatic woun, after exposure make
> offer possibilty for reduction, bu I,m affraid to make any Inernal
> fixation- this is 3 day witout tx - so possibility of deep
> infection is common...
> tomorrow I will try debride this, realign and stabilize temporary
> by external fixator ( spanning ). I Wonder if stbilize fibula in
> 1st OR ?
> Marek
>
>
>
> _______________________________________________
> Ortho mailing list
> Ortho@weborto.net
> http://weborto.net:8080/mailman/listinfo/ortho
>
>
> ---------- End of forwarded message ----------
> --
> Best regards,
> Alexander N. Chelnokov
> Ural Scientific Research Institute
> of Traumatology and Orthopaedics
> 7, Bankovsky str. Ekaterinburg 620014 Russia
---
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