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A-1213 Compound fractures
Thomas Giesen, Switzerland
Thursday, June 14, 2018 · 9:54 a.m. · 13m 37s
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00:00:02
good morning and thank you very much for the invitation uh to
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talk about this uh quite challenged him as a compound fractures
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a compound fractures i'll probably defining their hand surgeon to treat
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the compound fracture you need to be able in
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skilled in everything uh in every teacher you should become
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pretending skin coverage tendon nerve reconstruction bone fixation
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um they're challenging because every injury reason eek as very difficult even with the same soul
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to reproduce the same injury put these reason is very difficult to find anything 'cause
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an evidence based because the pull of the page and i'm not on the chain yes
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last but not least the patient expectation now the or very really meet reality that
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patient one seized his hand back and see what's in these is not possible
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when the patient arrive uh the crucial moment in compound fracture he's decision making
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and this why at the first first uh uh contact of the patients should
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be done with the decision should be done the the most senior surgeon
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the relevant information is sometimes up very difficult to collect because the patient
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may be comes of it into baited are when the injury happened
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how did this happen what that patient work in what are
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some special believes then we will see some cases
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and uh some uh uh channel information but but all that
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you stick in to put dies your michael surgical work
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we got in examinations sometimes it's very difficult in compound fracture too
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uh there for a an examination with depression awake and sometimes it's better to
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examine the patient directing theatre what you need to know before starting is
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if kelly's any i'm not vascular i segment how stable
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is the skeleton end to the degree of contamination
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therefore what you need for sure is an x. ray and even better a. c. t. scan on
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the city's count can show you some he did injuries to sometimes
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and not at all obvious especially if you have multiple fractures
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and there i and under the fewer relatively uh i'm less common indicated in the cage
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classification uh for open faction to go through another some can work uh
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at that definition between step to win three there is a
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gap of ten centimetres of their opened want in of course in the hand with ten centimetres yeah read it the breeze
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um there's set i'll i'll take a um classification there might
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be use a more practical uh for the use
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but again would just my opinion uh they uh does it kind
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of surgery distill it means they use more than evidence based
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regarding time is normally believing general term ontology that open
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faction that should be treated the media yeah immediately
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this might not be debt to forehand factors which are some case uh
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at if there is sufficient a soft tissue over for the bones
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or you can achieve it uh we did talk or are the mean
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if there is sufficient stability of the balls that you can provide
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with this plane or you have the capability to put data extender fixate
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or end if different one is sufficient clean you can delay
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i'm not one week or two weeks my you can delay they are constructed
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momentum so the moment you do did big surgery to reconstruct their hand
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we kept in the principle of strategy
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decide from the very beginning walk to save and what not to say
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it and one for about one main principle is simply fine
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it's all radiate very difficult surgery you're facing over
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eighty in some cases hours under the microscope
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so don't pertain to the construct a free single a element of the
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hand because this is time consuming and not producing at that result
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that's why this strategy should be done but the most senior surgeon in in house
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once the plane is down to everything in one operator time according to what you can do
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but to these in a very very important principle expressed by the french uh hun surgical school and i may come
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hand surgical school back in the seventies soul is not a new concept to everything in one operated on
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some practical to could proceed to structure their structure does especially if you have multiple fingers
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uh is for practical reason imaging you have to use the image intensified and the microscope
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if you do fingerprint finger you have to do imagine things fire out microscope out image
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intensified well when you do one structure per structure you are much more efficient
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and there's also some um advantages uh regarding
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basket station time in also psychological advantages
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and the other thing looks all these don't throw anything away because you don't know
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what's gonna uh help you to reconstruct uh some part of the thing
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get the bride meant ease the most difficult part of the surgery not technically because
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the bride it's easy technically button walk to the bride want to lead
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these part needs such a clinical line any judgement that a a is
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the most difficult part of the job actually comes into the strategy
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both fixation we heard right now about all
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the possible uh be technique we had
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i think one of the main consider headphone some not small fee more t. b.
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and it's very difficult concept to company especially from hand surgery like
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neither of from our topic uh groups must be quick
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and does not have to provide oldies or act reside in normal
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bone fixation because many times to run against the clock
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shortening he's an option shorten in a bowl even few millimetres makes you procedure much easier
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because dinner would reach the artery will reach the tandem will reach
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you make of very very complicated surgery the situated the scene
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we um so different option for both fixation does a an
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example for the open factory can fix it like this
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using the another concert is quite difficult for me at least
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two county attaining thinking we didn't painted these published
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bone graft acute bone graft ease an option and see last week spacer
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are they in option the main criticism is about confection
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but the bone graft and this elastic space that you're putting in your finger on your hand
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arctic clean this part of your surgery directly space last could guess their lives so
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reverse crazy asian i personally prefer to do detain first if somebody needs to be done
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and uh for the obvious you minute some graft uh so expected before surgery already depressed print
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uh one lake in case you foresee do you mind me the draft instead on me tonight just
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to say oh my god i need this stuff and ah we need to prep the like
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regarding tend to repair there are some concept there apply to
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uh these kind of injury reflects or have forward on extensive if you have or side
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bending the finger is much more important than extending the finger completely
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and this current on the back of the hand many times producing
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what is called inelastic record and we show you some case
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um take sense attended p. on the m. c. p. probably ten no
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need in extensive injury to be reconstructive like you're a reconstructed acutely
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for dependent user technique we can also confidential suture this uh it's a classic uh trying to
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do is a confidential with published is no needed imagine if you had eleven tendons
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and you have to do eleven c. conference just suture you can imagine how much time do you say uh forty sparked
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every player will perform them acutely and immediately because is the golden type
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for the nerve to be reconstruct provided the you can cover you know
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every construction we did good gas colour eyes i'm a teacher
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skin coverage is a p. it would need to book just for days everyone
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has this kills his knowledge is convention what is the best flat
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there are several things the unknown for example don't cover the stamp of the
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finger with the muscle or flap because distance we go through the flat
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right and uh in caucasian distilled debatable how good the bed
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is they your t. on the hand because intel kitchen
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the the dam is is very thick but this is maybe a copy
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some cases is open factor uh office some as you can
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see we put on the thumb directly a bone graft
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uh primarily and then uh it was a a defect or the user if even as flat
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uh from the from the patient is home to sixty cages tuesday thinness keen the only
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thing skin he had on his body the rest was to fact for some
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so use a a retrograde free dinners flat from the foot we to course like ten don't probably we do need to do that
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and uh this is the result which you can see the thumb is healed and is the final result
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this function is an explosion trauma sorry for the pro productive
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uh a picture for the bad but uh like i
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couldn't find a bit to preach to show all the disaster
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uh the muscles are destroyed unexploded deflect some also
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we stopped operated patient five year five hours of peace came
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yeah so we were really rash ration against the clock
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that's why i fix the radius with a plate because was easy and there was is
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it effecting the on now but they need to reverse cries so just put a
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take a while just to have some stability reversed colour eyes the bone reconstructed
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median nerve with the swirl nerve and then uh over temporary like this
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later we came back with the the free or sticker diana's feeble to reconstruct the on the side of the forum
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and this is the primary and as a result after one year because of pull flexion
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we perform and a free functional aggressively is a visit three months so we'll we'll yeah
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uh hoping is getting better than that but so okay for
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someone it doesn't have very much and it's already something
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we got to be indication the belief of the patient index finger has
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a two level so by implication would know what colour eyes tape
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easy indication for computation is not for the plantation to level
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index finger so too is it competition uh the patient he'd everything and prayed in
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every possible way not to have these amputated he wanted this finger back
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so there's a defect on the m. c. p. joint we put various elastic trustees is
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on the ends to be joint and we're of us clueless the
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finger apart of discovering the first web to ten needed to
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be correct that that is is the result uh functional result is
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not a nice finger but the patient is that it
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i just explore some tram now that the prime it is fine to we had only one finger
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and it could be um could be replanted a colleague of mine mine is can only replanted
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and in there in the forum on the on the lottery and then you can see the problem here there's nothing
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left to the skin of the palm he's dying so we wait for this king
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to die and then we uh raised a flow to a u. t. flap
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it's not the best flat but it is easy to do if neutral
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and we reconstruct the palm we we only amputated and replanted day
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a finger on the tip of the fourth may take out again is not perfect and that but that is better than no
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and these days the last case i can show you this another case in which it is a professional motorbike at
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it is the little finger which you can see is missing the completely the p.
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l. p. joint is away i'm playing with the ethics santa fixate or
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we thought about replacing the p. l. p. joint to taking from this elastic block we
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caught the kind of a large cost is we stumble lies with a a tightrope
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and then again yeah we cover with the feeding us flat from the forum
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and first things exactly then we divide we did not reconstruct extends
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obtained and the little finger does not have any extends attendant
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that's what i said before about the day um recording of this competition
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if you look at the the look at the ring finger yesterday peeping but if
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you look at the little finger is extending just because the last record
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the patient we're sure is still going a motorbike uh because uh had a three months later it is that i just fracture
Conference Program
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A-1206 Epidemiology
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A-1206 Epidemiology Q&A
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A-1207 Evidence
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A-1208 Conservative
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A-1213 Compound fractures
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