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Nailing compound fractures when / safety evidence DR.G.S.KULKARNI MIRAJ
HISTORY of open fractures American Civil War Mortality 26% France – Russian war Amputee
Nailing in open fractures 1. Improved technique debridement. 2. Use of AB bead pouch and Rod 3. Vaccume assisted closure 4. Newer designs of nails & plates. 5. Perioper. AB
Corner stone of Open fracture-Debridement 1.Wound - Extend longitudinally- 2.Exploration Fasciotomy 3.Debridement 4.Irrigation 5.AB Beads 6.VAC – not a substitute
Adv. nailing in open # 1.Early stabilization of open fracture controls pain,swelling, mobility inflammation 2. Mobility-Further soft tissue damage 3. Early mobilization of jt & pt. 4 CPM
IMN Adv. 1.Biomechanically superior, maintain L, alignment and rotation 2.Early wt. bearing 3.Less rate of secondary surgery
Adv. of immediate IF Unkinks A,V and lymphatics, improves circulation at fracture zone
Ext. Fix –meta-analysis Adv : union - 94 % infection - 16% chro. Osteo - 4% -Giamondis JBJS, Br. 2006
Complication of Ext. Fix 1.Pin loosening 2.Pin tract inf. 32 % 3.Mal-union 4.Exchange nailing- inf to 30% 5. “Non-union machine “
IMN IMN is a safe, effective method for open fracture I, II, III A & B S.Malvin JAAOS, Feb 2010
Reamed V/s Unreamed Reaminng-- Adv 1. larger diameter – better fracture stability 2. Implant failure less 3. Reaming deposit B.G. 4. Periosteal blood supply ++
Reaming. Metaanalysis failed to show an increased risk of re-operation No increased rate of infection or nonunion - Bhandari Et al JBJS B 2001 :
Multicentric level 1 study open fractures 460 Reamed210 Unreamed196 Does not support superiority of either. SPRINT Group JBJS Am 2008 Debate is ongoing
Reamed Disadv - 1. Reduced intramedullary blood supply, but Periosteal blood supply Thermal necrosis a) use sharp reamers, increment by 0.5 mm b) gentle reaming –back & forth
Poor result of IMN 1.Inadequate debridement 2.Inappropriate soft tissue closure 3.Thermal necrosis 4.Severe contamination + late arrival These are contra-indications
Literature 143 cases of open tibial shaft fractures.Primary IMN has Favourable results. Deep infection – 3 % - Koker & Tornetta JOT 2007
Exchange ex fix to IMN Safety period 10 days till soft tissue recovery < 14 days ( Varies from 7 to 28 days) Shorter period reduces infection rate - JS Melion et al JOT Feb 2010
Do not do primary IMN Severe contamination Inadequate debridement Delayed arrival AB Rod + Ex. Fix 7-10 days IMN
JAGRUTI M DAY 1 Debride A-B Rod AO Ex Fix 1st VAC
JAGRUTI MANCHAREKAR DAY 1 DAY 5
JAGRUTI M After 3 changes of VAC, 2 nd Skin graft DAY 9
JAGRUTI M After 1 yr
VAC & I.F. OF OPEN FRACTURE With VAC it is possible to nail or plate IIIB open # as VAC is an excellent interval coverage
Almost no role of plaster splint or plaster cast with window in open fracture.
External Fixator in Open #s Advantages 1. Pins away from fracture zone 2. No additional open surgery 3. Access to wound dressing and plastic surgery 4. Early mobilisation
External Fixator Disadvantages : 1.Pin tract infection 2.Risk of infection of later ORIF 3.Soft – tissue impaling stiff jt. 4.Pin loosening Ex fix as a definative treat not favoured
Nailed on day 1 of injury
Amar Sawant 15 days old
AMAR SAWANT Amar Sawant
AMAR SAWANT Amar Sawant
Hebbal Hasan Open fracture+ pilon IMN on day 1
Hebbal Hasan Both united
CONCLUSION Corner stone of fracture debridement IMN is a safe, effective method Two stage nailing –I) AB rod II) ILIMN a) severe contamination b) delayed arrival
Open Fracture Management P. Blachut Division of Ortho Trauma Vancouver General Hospital University of British Columbia.
Introduction to Fractures Fractures - definitions, healing and management.
Complication of p.o.p : 1- tight cast lead to vascular compression and compartment syndrome if this happen then the cast either removed compartment syndrome.
External Fixation Indications and Techniques. Objectives Identify the following as they pertain to external fixation: – Advantages & disadvantages – Indications.
Management of Open Tibia and Femur Fractures with the SIGN Intramedullary Nail System Paul Whiting M.D. and Daniel Galat M.D. SIGN Conference – September.
The objectives of debridement 1)Extension of traumatized wound to allow identification of zone of injury 2)Detection & removal of foreign material, especially.
Diaphyseal fractures in children Mohamed M. Zamzam Associate Professor & Consultant Pediatric Orthopedic Surgeon KKUH, Riyadh, Saudi Arabia.
Dr.Metwally Shaheen ( FRCSI) Ortho. Consultant ( Head 0f Orthopedic Department SGH-J ) Fractures Treatment and Complications.
Flexible Intramedullary Nailing or External Fixation for Pediatric Femoral Shaft Fractures Soo-Sung Park M.D., Jae-Bum Park M.D. Department of Orthopaedic.
Open Fractures. Goals of Open Fracture Management Prevent Infection Antibiotics Debridement Irrigation Salvage Limb Fixation Soft Tissue Coverage.
Tibial Plateau Fractures Mechanism of injury: Varus or valgus force combined with axial loading as in: 1. Car striking a pedestrian (bumper fracture).
TIBIA FRACTURES. The tibia is subcutaneous. More commonly fractured and more commonly sustain an open fracture than any other bone. 1.
FRACTURE FEMUR Lec.- 2 Sadeq Al-Mukhtar Consultant orthopaedic surgeon.
A Thesis Presented to the Graduate School Faculty of Medicine, University of Alexandria In partial fulfilment of the requirements of the Master Degree.
Fractures By Amal. Types of fractures: Complete fractures The bone is completely broken into two or more fragments.
Intramedullary Nailing Basic Principles Presented by Michael Sochacki, MD Developed by Rahul Banerjee, MD.
Saving Lives By Strengthening Our Region’s Trauma Care System December 5, 2013 JASON SANSONE, MD CASE STUDIES IN ORTHOPEDIC INJURY.
The principles of intra- articular fracture care Joseph Schatzker M.D., B.Sc.,(med.), F.R.C.S.(C )
Mohit Bhandari, MSc, MD, FRCSC Associate Professor, McMaster University, Hamilton, Ontario Femoral Nailing: Reamed vs. Unreamed.
1. 2 Treatment of open fractures (compound) 3 4 Patient with open fractures have multiple injuries and severe shock. At the site accident the wound.
Presented by Intern Huang, Yu-Hao
Fractures of the femur AO Principles Course Leeds 2005 Module : Principles of operative management of common fractures David L Shaw.
Principles of Fracture Management for Primary Care Physicians Ed Schwartzenberger PGY 3 Orthopaedics.
PILON EXTERNAL FIXATION LAB. Theory of External Fixation “Damage Control” Provides stability while letting the soft tissues heal Does not burn bridges.
MANAGEMENT OF CONGENITAL PSEUDARTHROSIS OF TIBIA WHITE TEAM.
Dr Saleh W Alharby
Pediatric Femoral Shaft Fractures Orthopaedic Trauma Association Resident Fracture Course 2014.
Type C: 4/5 patients treated successfully by functional bracing Campbell et al Type C: 2/3 healed successfully with nonoperative management Kumar.
TECHNIQUES OF ABSOLUTE AND RELATIVE STABILITY INCLUDING EXTERNAL FIXATION PRESENTER:DR.MUNENE FACILITATOR:DR.MUTISO.
CDR JOHN P WEI, USN MC MD 4 th Medical Battallion, 4 th MLG BSRF-12 EXTREMITY INJURIES IN THE BATTLEFIELD.
Fracture shaft of the femur While the powerful muscles surrounding the femur protect it from all but the powerful forces it cause sever displacement of.
Distal Third Femoral Shaft Fracture: Antegrade vs. Retrograde Nailing Michael Zlowodzki MD University of Minnesota Department of Orthopaedic Surgery.
Arthroscopic Treatment of Tibial Plateau Fractures John F. Meyers, M.D.
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Timby/Smith: Introductory Medical-Surgical Nursing, 11/e Chapter 61: Caring for.
Fracture Classification Lisa K. Cannada, MD Emory University Created March 2004; Revised January 2006.
Joseph Borrelli, Jr. MD Professor and Chair Department of Orthopaedic Surgery University of Texas – Southwestern Medical Center Dallas, TX Introduce the.
Introduction into Traumatology and Orthopedics. History of Traumatology and Orthopedics. Regeneration of the bone tissue. Tutor: Kostiv S. Ya.
Fractures general management. A high velocity injury should always be treated according to the Advanced Trauma Life Support (ATLS) guidelines with attention.
Dr.AbdulWAHID M Salih Ph.D. Surgery LIMBS INJURY.
Early Weight Bearing After Lower Extremity Fractures in Adults By.Dr samah sami nooh Resident in al hada arm forces hospital.
Module #13 Brian C Toolan, MD Shepard Hurwitz, MD Basic Techniques in External Fixation Developed by the Surgical Skills Task Force of the American Board.
A study performed by MSF team in Amman project to treat Iraqi victims of violence Presented by : Dr.Ali Al-Ani MSF orthopaedic surgeon.
Operative Treatment of Fractures &instrumentation Dr.Khalid. A. Bakarman,MD,SSC(Ortho) Assistant Prof. pediatric Orthopedic Consultant Orthopedic trauma.
Fracture treatment A/ Reduce the fracture: Closed reduction Open reduction Articular fractures: Need anatomical reduction.
Combat extremity Wounds Combat Extremity Wounds. . “ Improvements in body armor have reduced axial trauma, but the overall percentage of skeletal trauma.
Re-written by: Daniel Habashi General Principles Of Fractures Treatment.
Complex Ligament Injuries of The Knee H.Makhmalbaf MD Consultant Knee Surgeon Assistant Professor Orthopaedics Mashad University of Medical sciences.
Extracapsular Fractures. Intertrochanteric Fractures Common in elderly, osteoporotic women. They unite easily, rarely cause Osteonecroses. Mechanism.
External Fixation In Pilon Fractures Gillian Jackson North West Regional SpR Teaching 14 th March 2008.
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