Player is loading...
A-1171 PIP problems after trauma and surgery, pearls and tricks for success
Mike Hayton, Wrightington, UK
Friday, June 15, 2018 · 10:30 a.m. · 11m 01s
Embed
Embed code is not allowed
This talk is part of a Private webcast, embeding is not permited.Transcriptions
Note: this content has been automatically generated.
00:00:00
joyce and tips and tricks i'm sorry if there's any repetition we've kind of looked
00:00:05
at each of the slides and there's a bit of overlap between us
00:00:07
but that's never about thing could you just see two uh two angles of the same
00:00:11
problem so let's look at beach only a deformity effects in the p. i. p.
00:00:16
it's not fun to audience so um we'll understand that doesn't extends the lack p. i. p. joint
00:00:22
and they're hyper extension at the d. i. p. joint thing classically else's tasks
00:00:27
and is used to a critically examines commercially this new reverse i'll since test
00:00:32
uh that we're in the process of writing go at the moment
00:00:35
so as you know the central slip is evolution a
00:00:39
off the yeah bases the um middle filings
00:00:43
and therefore it cannot extend the p. i. p. joints but the thing
00:00:47
it cancels strangers n. x. then i read the lateral bounce
00:00:51
i'm not holes on the actual pounds which then causes hyper extension of the t. i. p. joint
00:00:57
so this would be classically else's fast with your patients us and to put the hound over the side of the table
00:01:04
asked him to actively extended the p. i. p. joint and then that
00:01:08
the i. p. join short time now we're all familiar with that
00:01:11
but i was found it pretty well could test it was not
00:01:14
physically sensitive so one bad just decided just for the handover
00:01:19
and do well since test in reverse um i found this formal sensitive so you can
00:01:24
press try this one is seldom the rest the troll or even at lunchtime
00:01:27
so here it is and you can see this as a sports person middle finger
00:01:33
reach only i don't think we need a clinical exam to make the diagnosis
00:01:37
us and just like the handover i'm gonna do is no little thing the first asked him to push
00:01:41
against maybe it's nice and floppy is far more sensitive than doing it it with a productive down
00:01:47
and here you can see he's got pretty rigid d. i. p. job because recruiting those lateral bands
00:01:55
and just go back to the little that industry you can see that's nice
00:01:58
and floppy so reverse else's test um is a is a yeah
00:02:03
relatively new technique so how do we treat softly should be twenty eighth
00:02:07
traditionally it was a yeah every g. p. i. p. join splints
00:02:11
and i got a sports practised as many of you have a page is
00:02:14
absolutely hate this uh this p. i. p. splints gives the fingers right
00:02:20
encourage them to use the d. r. p. joint it must've been twelve or
00:02:23
thirteen years ago when i heard don't speaking about the relative motion splints
00:02:28
um which is far more functional for these patients it's gonna be young splints it causes the
00:02:34
m. p. joe to flex a and they're able then to make a a face
00:02:38
i do like to draw uh the enough to me on my patients it allows them to add to understand what the pathology us
00:02:45
i like to show them i'm a comical models of the condition and drawings uh and we have to say
00:02:50
that pictures speak a thousand words which is useful 'cause some of my sports people don't know thousand words
00:02:55
so it is that it is useful to uh to to to show that you can see here is a very functional
00:03:00
splints of these people can get on with their daily activities as opposed to a very rigid split that they couldn't
00:03:06
and uh and don't show this video uh many years ago of how function is operate on
00:03:11
that just to to credit him and uh he may well be talking about this
00:03:15
i yeah was that asked the bridgetown society about ten years ago to
00:03:18
explain the by mechanics of this in front of a synthesiser audience
00:03:21
i got absolutely toasted 'cause that i really didn't understand i'm just gonna do another another think uh so
00:03:26
uh i don't really understand it so hopefully dom in his tool may yet elaborate on that
00:03:31
and you can also use this when on the board of digits i it's very useful for that middle and
00:03:36
ring finger but he is a a a sin the splint for b. and index finger very functional
00:03:45
and then he is one for the little finger the yeah interrupt latencies room for these kids
00:03:51
now then very rarely you will get a dislocation that won't reduce you
00:03:55
get a phone from the physical therapy still say the fingers our
00:03:59
it's an belated is rotated of cold of older people appointed to these packages will go back
00:04:05
what has happened in a situation is the head of the yeah i'm
00:04:10
proximal filings with the compiles as bottom hole through that the fact
00:04:15
and then the soft tissue sipping clothes back behind it a lotta bands of close down behind it
00:04:21
so this was a plate i did he wouldn't really really kate eh i don't remote are risk i
00:04:26
relocated i went back in and i've been i think leafy i wanted to really dislike eighty
00:04:31
you the pictures so how much cameras lined up i was like before i knew it was really gets you
00:04:36
have to believe me that the head of the possible things that come out fruit that the fact
00:04:41
and the soft issues that locked behind it which you so the
00:04:44
dislocation with rotation that will reduce needs open explorations that's at
00:04:50
a great it don't just keep pulling on these uh on these fungus oh i simply did that was put a soft
00:04:55
bona get down into the footprints reattach that the cup was which is just
00:05:00
along the interval between the latter bans on the yeah central slit
00:05:04
and rehab and he really is up to you know start doing pretty well and probably come to see me for another injury
00:05:10
or something like that but still it's having it c. d.'s will speak usually come back the rubber home or whatever
00:05:17
so where p. i. p. join dislocations are often trivial rising
00:05:19
go unreported absolutist okay twenty mine played of the is
00:05:23
and always get it actually on these so come up the one on the left
00:05:27
it for worse normal on the right because don't just discharge them keep
00:05:31
an eye on them at six weeks a week just to make sure they
00:05:34
don't develop a fixed flexion contraction which can be extremely difficult to resolve
00:05:39
so at least if they do develop that and you'll be monitoring them you've kind of
00:05:43
moulded about if you discharge no one week or two weeks in the guest a
00:05:47
contractor is them very difficult then to uh get that confidence by so to tell
00:05:52
the the only may get a contract you will that will help you out
00:05:55
and then how do we deal with this i was watching telly i was watching watching this much from the piece of my own home
00:06:01
about nine o'clock uh so what happened it was coming off of the logo to ms later i got a
00:06:05
phone call to i just seen it but even the ground asylum label the slippers on but also yeah
00:06:11
so and i avoided they don't so i said well let's face time so good safeway impact is use
00:06:17
based on using it in the uh and the uh u. h. where face times allowable zoo is
00:06:23
uh you can see injuries you can see pathology new can make decisions it
00:06:27
doesn't replace a face to face consultation recently get you a long way
00:06:32
so we made us all about this guys found was to see the police brian
00:06:37
to make the ball as sticky so they can catch the ball in my day we didn't have that much what we'll drop the ball might able
00:06:42
so not only stinky for the boldly sticky for the grounds legal all the
00:06:47
all the modes which i will listen see how contaminated it was
00:06:51
so it was pretty contaminated so what i tell them to do was put a ring
00:06:55
blocking you need it clean it put a ring lock in in the medical room
00:06:59
i don't want to figure out what what what which ones on the sideline
00:07:05
depend on the level of contamination within gonna make some decisions in the next few
00:07:08
hours but i would tell them to read you sit there and that
00:07:11
so that they articulate cartilage doesn't dry out i think that's the biggest rest for these basically just wait for
00:07:18
i was rather on the way to the hospital or majors you room before you know the article cartilage
00:07:23
is dry and debt so watch watch watch reduce it and then we
00:07:27
can take an action with a might be take the off
00:07:31
gently so it looks to join watch watch watch i might close the primarily
00:07:36
x. ray table obviously and ivy aunts about six for the next five days a remote otherwise they should
00:07:42
what three faction and again for this pick selection contraction do not we had of all like
00:07:48
do not reply the fall on for the third time you don't work with people played because
00:07:53
the whole place will though is a structure that's got a range of off any
00:07:56
concerts hearing how can you put your situation in the region all you're gonna
00:08:01
close down the concertina with the other side you would use a fixation contract you are
00:08:05
far rather have a absent all play like i have that if expansion contractor
00:08:11
which many of these get if you're repair uh probably to don't remember probably
00:08:16
no then you wanna know how to twist the dental while i could go out there yeah i know you do
00:08:21
and you wanna know how to do this though so your x. rays were better than your calling
00:08:25
rounding up okay
00:08:33
see you press is put it around a pencil
00:08:37
or what
00:08:40
oh yeah go on t. v. right alright that's the best fit the the dead
00:08:45
ah
00:08:48
oh i don't you love this though you know the
00:08:52
right right okay so uh just the the last so that it's ah p. l.
00:09:02
p. off what's the we've got a section of the year after lunch so
00:09:06
hopefully we'll put some or you know i do all these white away there's tons and tons about it one way surgery
00:09:12
so i will comment on that but my yeah it's it for uh doing a p.
00:09:16
i. p. um is very fast on really quick search as you can see
00:09:21
centre the next patient yeah i do essential slit splitting is my probes last
00:09:27
different approaches lateral bowler the one i get to work for me is
00:09:32
knife straight to bone
00:09:36
uh just a little way down and then i gently
00:09:39
peel both sides off like opening a ball
00:09:45
you get the normal exposure
00:09:49
when you do northwest you do need to uh excise the actual actually
00:09:53
comments i'll show you how to do that in the second show
00:09:58
go around the side
00:10:01
one side and then on the other side and then at the end when we're gonna close this so i'm just gonna do a running locked p. d. s. c. to all
00:10:07
the way down i'm not gonna reattach the central slip i used to i used to
00:10:12
make drill holes in the base of the possible failed simple what central slip down
00:10:16
and it was joe di us a long time ago city what you do that as well just gonna that's
00:10:21
ways not to go he said don't do that i was always worried that it would really really tight
00:10:26
you just said it just as a reading locks each or two where reattach down
00:10:30
but don't not the last fifteen years or so without any particular problems
00:10:34
so i love this approach this is my go to approach for off the bus
00:10:36
they eagerly flexing it release the clutch illegals put knife inside the joints
00:10:44
and then just move it around and then you just suddenly see a sort of open on the lap tools alright what you believe the
Conference Program
A-1171 PIP problems after trauma and surgery, pearls and tricks for success
Mike Hayton, Wrightington, UK
June 15, 2018 · 10:30 a.m.
180 views
A-1170 PIP problems after trauma and surgery, pearls and tricks for success
Randy Bindra, Australia
June 15, 2018 · 10:42 a.m.
117 views
A-1172 PIP problems after trauma and surgery, pearls and tricks for success
Gwendolyn van Strien, The Netherlands
June 15, 2018 · 10:52 a.m.
410 views
A-1173 PIP problems after trauma and surgery, pearls and tricks for success
Donald Lalonde, Canada
June 15, 2018 · 11:04 a.m.
204 views
