Player is loading...
A-1173 PIP problems after trauma and surgery, pearls and tricks for success
Donald Lalonde, Canada
Friday, June 15, 2018 · 11:04 a.m. · 10m 46s
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
if
00:00:03
there is a book about a wide awake and surgery but i'm not making any money on all of the money goes to the
00:00:10
clean and green effort of the hand association which is dedicated to
00:00:14
promoting less unnecessary cost and unnecessary garbage and hand surgery
00:00:19
there's also no money being made on the wall went surgery a website
00:00:25
like said if you don't let it dry it doesn't die this
00:00:29
lady is eighty two years old she scanned her knuckles the
00:00:32
night before i met her you can see that she has exposed
00:00:36
lateral bands you can see that the head of the
00:00:41
a proximal phalanx is totally exposed the cartilage is exposed in
00:00:46
fact a lot of that cartilage is gone from the
00:00:50
p. i. p. join the central slip is totally gone and
00:00:54
she does not have enough skin to cover this
00:00:58
but if you don't let the tissues dry they don't die you don't need flaps
00:01:05
so all i did was to put one or two tacking sutures this lady
00:01:09
never went to the operating room we did this in the clinic
00:01:13
and then we put vaseline and call band tape so that the tissues did not dry and die
00:01:20
and then we put a relative motion flexion splint to prevent her developing uh put near
00:01:27
those who want to know more about relative motion splint thing at two o'clock this afternoon in this room
00:01:33
we're gonna talk more about mechanism and put in your treatment so here she came to the hospital
00:01:40
every day for one week while the therapists changed the dressing
00:01:45
and here she is that one week she starting to form granular asian
00:01:48
tissue over that p. i. p. joint over the exposed tendons
00:01:53
and then after week she was able to do it by herself at home getting in
00:01:57
the shower every day you don't need sailing in tap water is just fine
00:02:02
and here you can see that at three months the skin is
00:02:06
healed and came out of the relative motion flexion splint
00:02:10
and it's six months here she is with a pretty decent range of
00:02:14
motion no flaps no grafts just don't let it dry and die
00:02:22
this is a patient with a bad dislocation was two weeks ago and then uh we saw
00:02:29
you twenty four hours after that uh_huh yeah we put human is probably motion elections one
00:02:35
because when we get a pencil test like the the the us to that's happened
00:02:42
his p. i. he was out straight so that meant that a lot of bands were dorsal
00:02:48
enough when the m. p. is flexed but he wasn't going to little narrative form
00:02:54
and so instead of splitting him alone gets to because
00:02:58
all the light that really wants to get stuff
00:03:02
we put in our our motion questions so let's look at your movement today
00:03:07
and show your best best without hurting too much you're bringing all your fingers here we go grey
00:03:14
does that her there was little but is definitely not also but for the most part
00:03:18
no right and straight nose just you can write in shows the exercises that amanda give you do
00:03:27
you've also that's working well so one of the best trips check that
00:03:33
tracks to a stop p. i. p.'s deafness after k. wearing
00:03:38
is really protected movement we move all of our reasonable
00:03:41
patients just like our flex or cannons and
00:03:45
they come back at three days after surgery and they're tied harder
00:03:49
to pain guided movement they can't do what hurts they
00:03:54
also can't be on advil or tylenol theory is it ten
00:03:58
days after surgery you started moving at three days
00:04:05
and stream
00:04:06
what does that hurt uh yes she yeah it's getting to where it hurts yeah the
00:04:13
whole dental patient yeah perfect thirteen so we will have pain guided healing if
00:04:19
they don't do what hurts they won't get haywire infections this is a very important
00:04:24
concept and if they don't do what hurts they won't take their bonaparte either
00:04:29
i take the pins out when the fractures are no longer sorta pal patient that's clinical healing
00:04:35
x. ray healing is useless in finger fractures as you well know
00:04:42
this is the dorsal fracture dislocation and i like randy like
00:04:47
to treat them with dorsal blocking k. wires but awake
00:04:50
so i can see how stable they are
00:04:54
and i can also teach them about pain guided healing during the surgery
00:04:59
if they don't do what hurts they won't get pinned tract infections in guided healing
00:05:07
this is another early protected movement after k. where this is in the d. i. p.
00:05:12
a joint fracture but still they end up with p. i.
00:05:16
p. stiffness frequently don't play and so during the
00:05:20
surgery you talk to them about early protected movement which
00:05:23
we started at her for her at three days
00:05:27
in her the fracture was no longer sore at two weeks so that's when i
00:05:31
pull the pens out in here she is it six months after surgery
00:05:37
even when i have to open them and this lady i did have to open
00:05:42
we still do early protected movement as long as they are reasonable people and as long as they're not on
00:05:48
painkillers but i want you to look at the expense or lag that i have it for months
00:05:53
this is before we started using relative motion flexion splitting to
00:05:58
correct extends or lag after injuries of the finger
00:06:05
this is a common problem we all see it people come in and they look like that after fracture
00:06:11
and it has a common solution i met this lady two months after her fracture
00:06:19
first thing i do is the pencil test for her the pencil
00:06:22
test that simulates relative motion flexion splitting relative motion means
00:06:27
that the m. p. joint is more flex than the affected finger that's why it's called the relative
00:06:33
motion flexion split in her it took the pain away and it forced p. i. p. extension
00:06:40
the three months ago we had a crush injury of the distal phalanx of this finger and the
00:06:47
i saw the patient a month after or two months after that and she couldn't extend
00:06:51
are shown in your other hand how much you could extend is like half was
00:06:55
like that can extend anymore and that that's why i met her home oh
00:07:01
and so we put her in this relative motion inflections one which forced extension
00:07:06
a very happy i've he my problem was that her
00:07:10
two months shoes walking around my best ignoring finger and then couldn't extend that
00:07:16
because of hyper extension yeah he joined in harmony
00:07:21
so does forced her to use the finger again of course to extend
00:07:26
and she's been working twenty four seven for one thing i think you just
00:07:29
told me is that within two hours of calling this one on
00:07:33
your finger file uh_huh swelling was better and noisy that half ass
00:07:38
yeah so one just two hours and no no swelling come over yeah right
00:07:43
so take your slide off now please and show me a your
00:07:48
full extension so you got all your extension back when when street
00:07:52
in uh the speaker before me is brilliant she's the
00:07:55
one who taught me that these splints allow the patience to
00:07:58
exercise while they're living instead of stopping living to exercise
00:08:06
uh this is a patient with a very bad to patrons contract
00:08:10
are very fixed p. i. p. very fixed d. i. p.
00:08:15
and during surgery awake look at him trying to extend after i got all the
00:08:20
cord out i have full passive extension there he can't extend it because his
00:08:25
m. p. e. is hyper extending so we show him that when
00:08:29
we simulate a relative motion flexion split we take out
00:08:33
the m. p. hyper extension the enemy of p. i. p.
00:08:37
extension three days after the surgery in the clinic
00:08:41
here he is with his relative motion flexion split is gonna wear that
00:08:45
twenty four seven except for at night he wears this plant
00:08:50
he goes home he looks after his wife who has alzheimer's rebates for he feeds her i
00:08:56
know all these things because we talked about it during the surgery while he was away
00:09:01
and here he is a two and a half weeks after
00:09:03
surgery see how the m. p. hyper extension is controlled
00:09:07
and the p. i. p. extension is so much better than that surgery and here it is that one year
00:09:13
so i would recommend that you all consider starting to use relative motion
00:09:17
flexion splints especially in the little finger after do patron surgery
00:09:24
i prefer to treat finger fractures closed just like randy
00:09:28
whatever possible sometimes you have to open them
00:09:31
but never open a fracture that you can treat close
00:09:34
because even though you love to see the anatomy
00:09:37
when you're looking at that anatomy all that space is gonna fill with loud
00:09:42
that lot becomes callous and scar so that anything you can do closed
00:09:48
i try to do post so i got this fracture it two weeks old and you're thinking oh man i gotta open that
00:09:54
i well i didn't and i didn't get a perfect x-ray either but you know what i did i'm awake
00:10:02
he got a full range on the table without a perfect x-ray i donate a perfect x-ray i need perfect movement
00:10:09
and if i had opened that i don't think i would regard as good movement as i got
00:10:14
accepting a less than perfect x-ray i don't treat x. rays i treat patients
00:10:20
this is a bad fracture involving two joints the m. p. joint and the
00:10:25
p. i. p. joint for me the only way to treat that
00:10:30
is with us and so this is a distraction through the head of
00:10:35
the middle phalanx and here she is a twelve weeks post op
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
