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A-1295 Extra-articular fractures
Riccardo Luchetti, Italy
Wednesday, June 13, 2018 · 4:16 p.m. · 15m 44s
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yes now you have heard a lot of theoretical and by mechanical ah uh situations
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of the of the fractures in the show you know some practical parts
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we had reason we know that there are lots of different types of
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inch articulate fractures here are some examples and we know well
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that in um we need an additional c. t. scan infractions in in in try to colour
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fractures it's always necessary oh in our case we always make a a c. t. v.
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ah and the other question we have is there any option for conservative treatment because we should not forget
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uh it was for a long time it was the option to choose conservatively
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but now we think there is no more or nearly no more option
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especially younger patient to go for a conservative treatment the next question is is
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there any option for uh are just caught because he's to treatment
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we say yes but only in special cases the most important
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questions are when you're a analysts a fraction like this
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uh from which side side should you uh approach your surgical
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uh appearance really come from the bowler said from that also
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said or even combined and then as we were before
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uh we started in early two thousand with only one plate and then uh on the market and then the
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in the from the years there are more and more plates and now we have a huge selection of plates
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and the surgical approach and the fact us of the specific plates
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election depends on the key fragments as beaverton the lecture before
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now in my lesson i will show you uh how we treat these key fractures
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here for example we have a reduced elevate q. fracture as we seen
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before the problem is ups yeah the shift on the radio side
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when you see uh this x. ray this doesn't look very spectacular
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but when you make a. c. t. scan as we know we we have to do it you see that there is a i cap
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uh in the article or sure face and also there's a fracture line into the shaft of
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the radius so when you just have the plane x. way you would not see this
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what was the trouble about this the treatment we do we make uh open reduction we
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reduce the gap in the article or surveys and then we stimulated with a plate
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when you have a door so the lunar fragment the key fragment as in
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this case but the loon rate is fixed to this to this fragment
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uh then we go for a dorsal approach as you see it here
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we open the china we have a good view into the
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trance or face we reduce uh the article the steps
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and then uh we fix it with the plate in this case it was only a small plate necessary
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in some cases like in this case this is also a a key fragment
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uh it was possible to reduce it uh with the k. wire in the cup onto taking
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yeah that means that you just put a k. wire into the fact aside from the torso side
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and the traction and then you can reduce it anatomically and so in this case it's not not not
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a necessary to go from the door so side in this case you can also come from the wall or set
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because we think uh that the plate positioning on the wall aside is much less complicated
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many come from then from the process that because on the doors a set
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a more sometimes you have problems with the extends attendance and most of the time you have to remove the hardware
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here i should actually uh uh an example uh um uh which failed this
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was ah the the x. ray with that door so okay key fragment
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and he received the c. t. scan and on the c. t. scan you also see that there is
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a central imperfection so we think there is no way to go from the wall or set
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the search and started from the wall or said then made also an additional access from that also said
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and that was the x-ray a. p. after the operation which looks
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quite good but when you see on the lateral view
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you see that there is something how are not incorrect position and you
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when you make a c. t. scan you see the problem
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so how did we solve it are they in the next operation was so we
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started on the older side we remove the screws a hundred to still
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i sighed and then go for an additional dorsal approach
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reduce the fragment put on the dorsal plate
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and then get have got some houses some sex cruise again from the bowl aside
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and additional we use like a wire between the lunar
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eight and uh and the radius for six weeks
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to reduce the load to this fragment and to avoid the re dislocation
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and this is the result of this patient after three man's radiological and clinically
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so the next key fragment is we have isolated our bowler loon it for said fragment
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as he as you see here
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ah on the x. ray you hardly see it on the c. t.
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scan you conceded was also some days as some weeks ago
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ah and here also open reduction temper a fixation with like
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a buyer and then fix it with the plate
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other key fragments as we heard other bowler written fractures with the dislocation of
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luna to the border side faces here and here very small remain
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in this case we use either a hoax plates or special tonight for set plates
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uh i seen this part you see these small fragment and body also can see
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is the sup looks asian of the loon it to the bowler set
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we make opal reduction and then temporary fix this small room
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with the cable with k. buyers and then fix it
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uh with this folk plates and also we use here uh for
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temporary fixation of the corpus escape where to reduce the load
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and this was the result of this patient eight weeks i eight months after the injury
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sometimes we combine this whole cup plates with the additional plates like here this
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uh adaptive plate or also you can use the f. b. l. plate
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or as in this case we use this a loon it for said specific
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plates because the problem that the pathology was only the late for set
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uh here you see uh the complete about our first set in this
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case we go for our of all our approach and for stabilisation
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we use a frame plate because we're here we have the pathology over the whole uh radius part
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here is the c. t. scan hand the benefit of this
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frame plate is that you can place it very distillate
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but you have to remove it because you are on the over there what the shade land
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so this was the result of the six month this is another case in this case we
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have that a pathology torso with the loon late so we go for it also approach
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and also here we fix it uh with cable as an uh with this frame
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plate and also about for it using the low to use this k. wearers
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if we have a central infection like in this case see you can only most
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of the time you can see only the mounting the c. t. scan
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uh we normally we go for it also approach because on on the dorsal approach you have a much
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better view into the tried surveys less here you see the impacted fragment you can reduce it
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ah hand then fix it from the torso side depending on the on the
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uh on the amount of the other the size of the fragment
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in some rare cases as you see it here you see here this centrally action here and the c.
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t. scan it is also possible to do it too stable as it from the border set
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as here you you re to use it with the scale bias which uh inserted through the two
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through the uh holds up to the drilling a points of the of the of the plate
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and then reduce the central fragment fix it temporarily risque
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wires and then fix it uh with uh
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screws and this is the result of this patients after six weeks
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when you have multiple fragments uh and see if you have
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destruction of the surveys the c. t. is minimum mandatory
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you go ah either from the bowler approach or from the torso approach
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or you make both approaches and you have a lot of
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play that that it can you selected for the specific fixation
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most of the time we use either the whole or correction plate or the fracture plate uh it's
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just a classic style but or yeah orientated if we have the problem here understand that
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you need to support from the plate in this area like in this case
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we used 'cause you see the communication and a radio style right we use this uh
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reconstruction played our here is a case where we use the friction plate
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the adaptive plate uh we use when we need to support on
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the loon it for set and the close to the does
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the really will not giant and one of the benefit is also that you can place it quite the still the
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here a case with this pathology also you on that will not set this is the plate
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and now we also use the f. b. l. plate ah
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for sick with not fractures and vulnerable of fragments
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it has so uh by the anatomical of a film it support it supports the learned for set
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and the reshape here are reduces the context to the f. b. attend and
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as you see here this small a unit for said fragment
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um the corpus is shifted to the bowler said so this is the key fragment
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and here you see you can place this uh f. p.
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l. played barrett easter these by uh on the on
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our side it should be orientated on the on our on our own aside and also you have yeah
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in comparison to the high adaptive play that bit more support on the radio set
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here is another case with this fracture hand here you
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see these twisted a fragment on the dorsal side
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and also he it is learned for said fragment so in this case we started on the bowler side
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fix the the wanted to set with this f. b. l. plate and then made
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an additional approach on the door so set and food and feed this uh
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twisted fragment into the fact aside and it was not
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necessary to go here for an additional fixation
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and this was the man's after the operation the clinical and the radiological without
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the difference between the f. b. l. and the adaptive plate is that
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the f. b. l. plate can placed verity study of the
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to our minds a little bit more does the then the then the adaptive plate it he also has a benefit
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that it's a have a little bit more uh improved radio support with the f. b. l. play ah
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this and the recess here i uh really uh minimises the context to the f.
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b. l. plate and that's why when you look at the latter's view of
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the song creek areas are not uh i'm i'm not important because that for the
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tandem of the f. b. l. is in the cap of the plate
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then if you have a completely uh commuted fractures there's also the
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possibility to go for fractal specific fixation you one example how
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this is just an example you can also do the the plate but in this case we started here on the radio site
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and put it says yes screw on the radio side and then on the radio border side we put this plate
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and then there was a also fracture line here on the on the loan
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it for set and this week got additional with a small plate
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so this is an example for a fact a specific fixation that's was the result after twelve months
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when you have ah come in you that fractures on the dorsal side
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uh extension freak to sometimes it's necessary to go for a door sill plate
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the benefit or not also site is that you read you you
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can read used on fragments you can inspect the door so
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uh try and surveys you can't lift central impacted fragments much better than from the hole are set
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you can also go for factors specific fixation and what's not but i was
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also important you can go for the aurora uh s. l. ligament reconstruction
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this is a case for our quite an old lady this we decided also to go from the torso
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said fix it from the door says that and go for a vision of e. s. l. ligament
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so how is our decision making in such complicated cases
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are we go for an a. c. t. scan and then we see the dislocation
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of the fracture we see the position and the amount of the fragments
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we to clear with the look is there a key fragment yes or no i
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and also very important is to see the position of the loon right
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in this case you see there's the city's can't hand on
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the plane x-ray you hardly see these central impacted fragment
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so what was our decision uh_huh we said yes there is a key fragment
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how we see it on the loan it it's bowler so we have to go first hard to go from the bowler side
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and we have the central infection this we can't uh reduce from the
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war aside so we have to go for the torso side
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so we started with the whole area for her approach hand first uh fix
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these five fragments on the whole i said with a a reconstruction plate
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and then a next step we went from the door so side
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we inspected the server face we lifted the central in action
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temporary fixed it with k. wires and then fixed to fix the fragments with two
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small plates here you see this is this carefully this is the radio part
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the central high action it lifted and temporary fix the decay buyer
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and then the own are fractured torso factor fragment is also
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fixed with this a small plate and this was the reese
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out quite a lot of hardware in a small bone
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so what is the conclusion huh ah it's very important to recognise the
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fact a pet and for the classification and for the operative treatment
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we think it's very important to make a c. t. scan we
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can must identify the key corners and then go for it
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are you be hand use different types of plates is specific to the types of fracture
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and always keep in mind for the fixation of the speaks to pacific fragment and if it's necessary
Conference Program
A-1294 Update on imaging
Wolfgang Hintringer, Austria
June 13, 2018 · 4:06 p.m.
261 views
A-1295 Extra-articular fractures
Riccardo Luchetti, Italy
June 13, 2018 · 4:16 p.m.
222 views
A-1296 Intra-articular fractures
Christoph Pezzei, Austria
June 13, 2018 · 4:33 p.m.
191 views
