jjbrooksmd at gmail
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Aug 1, 2006, 4:02 PM
Post #2 of 2
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Re: Pelvic Ring Disruption in 16 yo (was RE: [ORT-L] 3Month old
fracture neck of femur)
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Dear Chip, et al.
I agree about additional info, which I'm getting from the 2
institutions in which she's already been evaluated with radiation
exposure in both locations (ie, trying to avoid excessive radiation
exposure). The 2 CT cuts and the inlet/outlets I posted yesterday
were all I was sent on her transfer to me. (long story).
This patient happens to be the daughter of my boss' boss (I cannot
further elaborate on that without violating HIPAA). I realize that I
shouldn't let that influence my treatment decisions, but it's hard
not to.
To complicate things, she & her family have been told by another
fellowship-trained ortho trauma doc at a major NYC teaching hospital,
to which she was sent in my absence, that "she doesn't need surgery".
Now I'm back from a restful vacation and she's here at my medical
center under my care for 'definitive treatment'. When I repeat the x
rays tomorrow after she's been OOB NWB (PID 6) I may gain some ammo
(convincing that she needs surg) if there's the slightest hint of
interval displacement, but my guess is they'll be very similar as
she's had almost no pain (she's just about off narcotics at 5 days).
I can't help but look at that L SI joint and feel some angst at
leaving it as-is (subluxed). I wouldn't leave a type II AC
separation. This was my reason for posting the case - to see if it
would be crazy for agreeing with the first doc's opinion, which has
been firmly ingrained in the pt's and her father's minds. Deep down I
agree with the operative 'voters' thus far. Hmmmm.
Is there any level I or II evidence that surgery will benefit this
young lady?
UGH!
I'll post the images as soon as I get them.
Jeff
On Aug 1, 2006, at 6:07 PM, Chip Routt wrote:
> It’s difficult to make a good rec without info.
>
> The reality is that she has a displaced pelvic ring disruption,
> already...there you go.
>
> Yes I’m concerned.
>
> Screw decisions are based on numerous factors and just not so
> simple to cookbook.
>
> I don’t remove them.
>
> Chip
>
>
>
>
>
>
>> Jeff, Chip, et al,
>>
>> In light of further evidence (the inlet view in Jeff’s response),
>> I still believe that this can be treated non-operatively but may
>> require more restricted activity in addition to the already
>> mentioned careful monitoring for evidence of displacement. The CT
>> in the Power Point sent with the original post does show the
>> fracture but it appears to be minimally displaced. However, with
>> both sides of the sacrum involved, I might be more inclined to
>> place bilateral SI screws without fixing or ex-fixing the front.
>>
>> Chip, would you be concerned with any effort to reduce the left
>> side if you were going to place screws?
>>
>> I’m still interested in others’ views on screw placement ( 1 vs 2,
>> S1 &/or S2, remove after healing or leave).
>>
>> Thanks,
>>
>> Fred
>>
>>
>> Frederic B. Wilson, M.D.
>>
>> Assistant Professor
>>
>> Traumatology & Adult Reconstruction
>>
>> Department of Orthopaedic Surgery
>>
>> Louisiana State University Health Sciences Center
>>
>> 2020 Gravier St., Room 728
>>
>> New Orleans, LA, 70112
>>
>> Phone: (504) 568-4680
>>
>> Fax: (504) 568-4466
>>
>> Cell: (504) 994-4555
>>
>> fbwilson@earthlink.net
>>
>>
>> -----Original Message-----
>> From: ORT-L-owner@www2.aaos.org [mailto:ORT-L-owner@www2.aaos.org]
>> On Behalf Of Chip Routt
>> Sent: Tuesday, August 01, 2006 1:11 AM
>> To: ORT-L@www2.aaos.org
>> Subject: Re: [ORT-L] 3Month old fracture neck of femur
>>
>> Did you notice that her left hemipelvis is displaced cranially?
>>
>> Did you compress her pelvis to assess its instability?
>>
>> Is her right sacral fracture real?
>>
>> Do you have a lateral sacral image or CT reformats?
>>
>> Thanks-
>>
>> Chip
>>
>>
>>
>>
>>
>>
>>
>>
>> Dear list members,
>>
>>
>> young lady, pinned under a car last Thurs, coming to me for second
>> opinion. My question is the role for surgery in this case. Would
>> anyone fix the L SI joint. Other?
>>
>>
>> Thanks in advance.
>>
>>
>> M.L. Chip Routt, Jr.,M.D.
>> Professor-Orthopedic Surgery
>> Harborview Medical Center
>> 325 Ninth Avenue
>> Box 359798
>> Seattle, WA 98104-2499
>> phone 206-731-3658
>> FAX 206-731-3227
>
>
> M.L. Chip Routt, Jr.,M.D.
> Professor-Orthopedic Surgery
> Harborview Medical Center
> 325 Ninth Avenue
> Box 359798
> Seattle, WA 98104-2499
> phone 206-731-3658
> FAX 206-731-3227
> --
>
Jeffrey J Brooks, MD
Orthopaedic Surgery & Sports medicine center
1290 summer street, #4400
Stamford, ct 06905
(203) 323-7331
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