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Friday, June 15, 2018 · 11:15 a.m. · 11m 57s
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to make you can make an you uh that player that you opened his p. i. p.
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and you rehabilitated did you use a relative motion flexion split three rehabilitation
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no actually is
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justin on every c. kind of what it is that's all to so it's sort of echoes
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how uh how impulsive useful words you you went back i'm pretty quickly actually yeah um
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likes on thank you so you can see that we have a lot of
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the speakers using relative motion splitting and that it has been helpful
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for us randy go haven't done yeah it can castle if someone comes with that you would near the open sort of this this
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i. e. the significance rely for bands are ineffective probably
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what would be your method of management for that
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you know so if the pencil test is negative that means that the lateral
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bands are not dorsal to the axis of the p. i. p. joint
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so in that case i think we have to go with the more traditional
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method of serial casting and when did you wanna comment on that because
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that that's what we do anyway then we treat them like a standard but you're just
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come up and speak and use the mike we can use the mike for
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questions in the audience are there any other questions in the audience please just put up your hand and she'll bring the mike to when
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yeah so this afternoon i'm gonna talk about this that um basic me you have to know
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bison and i use plaster past paris casting because patients will take off their splints
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sixty percent of our patients taking off his research showing that so i use plastic a at plaster of paris
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and put a little piece of tape underneath it so they can't slide off can stick to their finger
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then for two weeks or four weeks depending on how much is needed until that pencil
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test is positive or well works and then you can start with a relative
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motion function sometimes it will take up to two or maybe three months before you
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can do this by your estimate yes you just have to wait what's
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okay with a pencil test yes enough right now that was perfect
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there's no question that relative motion flexion splitting has greatly
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improved good near management in my hands i'm gonna talk about that a little more this afternoon at two o'clock
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but i twenty uh you don't lot open exposures bali on the joint um
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you prefer browner incision normal lateral doesn't matter uh it doesn't really matter
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i think would make black role uh you get a nice flat
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and you know maybe directly less pain memo belies the problem is your exposure on one side is not as good as the other
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with with bruno or it seems to be alright i i don't think the actual incision is made too much of a problem
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uh if i do a big black role i may do it sometimes when i'm doing the full shotgun
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uh but generally speaking if i just uh browner i have less irritation of the digital
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names i'd be less be section uh_huh so it seems to work fine for me
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oh i'm not seeing any other questions from the floor so i have another
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question for my cake and mike uh that's the first time i've seen
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when you do a p. i. p. joint or through plastic e. not re
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anchoring the central slip down in the bone and coming right through
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lifting it up like a book and then just selling it back i really like that
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yeah it's really easy so i'm a little afraid so well i'll
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just stop being afraid they don't be afraid in paradise
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is in the audience so it was joe uh quite a long time ago twelve years ago said to me
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i was always worried about what these holes in this in probably the central slate beseech really tight
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and he said just leave it'll just flop down at one stage the central slip side to side
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check the range of movement and then when the happy either just is reading walks feature lower 'cause there by
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the way we can just chat we got the tension right but i've never reattach the essentials lapses
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somebody's clever as joe di c. v. series okay good okay or yeah thank
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you for that job because it makes so much sense to me
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uh to have that approach 'cause we're also gonna go the central slip
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has to re attached to the bone it's got nowhere else to
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go it's just gonna stay there yeah i just want to add to that if she lets motion function people p. n. inflection
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you sound at a research by yeah mm do books on two thousand eighty seventeen
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and that he actually the forced on the sentence that is actually thirty percent lower it keep
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it the and began infection so we need a lot more studies to find out
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if you put an infection if there's actually less tension on your sentence it which would you tell us why you're not having a channel
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i think we take it when we have another question i would continues to resume is is the keys might be mitchell
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uh would lose there's some reason to sleep otherwise would be free
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i mean why do we have the normal anatomy with the system isn't asleep right
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that's a very good question because we're not recreating the anatomy it's a very
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it's good simply features we'll have the because it looks like it's
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right i understand and i do a little bit too but
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i'll tell you why i think it makes a lot of sense because we've
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treated so many put in years now with the relative motion splitting
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in those cases you are not re attaching the central slot that's
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not what you're doing what you're doing is you're recreating scar
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through that whole area and the two lateral bands and the central
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slip it's all turning into one mac of scar and
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it's never perfect but they get a lot less uh p.
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i. p. uh flexion contractor and they get a lot
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better the i. p. flexion and that's what counts the most so even if we don't
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recreate anatomy perfectly every time we still end up with a more functional result
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and so i can see how that works i can see how the central slipped does scar down
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jody us did you wanna comment on that did you say he was in the room
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oh okay he's not in the room story story here no okay
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right were there any other questions uh from the audience on any of these things
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how many people are doing early protected movement with their finger fractures please put up your hand
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i'll get so a lot of people are not putting patients in jail for a month i've i think that's a really
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important concept and for those of you who are still putting
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patients in jail uh please uh consider stopping doing that
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oh yeah
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uh_huh
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okay
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if you see with point
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so my central slipped i think is here you know to get ah down to that is
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gonna be really time so not a single parents each uh in that two together
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and i just you're really quick and i just do a a reading a lot suture
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oh
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a ah
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i tried what are just now
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i also just just ah
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uh if you wrote to which is uh is that a single stage yeah
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i asked myself oh it we worked reattach too it's not
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like that except it's about our ah laid out i
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this is just like a a
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yeah
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oh yeah the comment that when just made is that part of the problem
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if you do that attach it then you're made interfere with flexion
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it's one of the biggest problems with surgery for good near contractor isn't it
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is that if you bring those lateral bands up yeah you get extension but no you can't flex
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it anymore and that's what the big problem is with that whole approach for boot near surgery
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and that's why i don't do that operation for good near anymore
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i don't bring those lateral bands up because it doesn't let
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when show that the more you flex the p. i. p. and d.
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i. p. the more the lateral bands have to come down
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and if you suture them up there and if you make that whole thing stuff
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you lose flexion which is actually more important than extensions so even though
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you can get rid of a lot of extend sir lex in the and flexion is
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more important for the p. i. p. joint then extension least those are my thoughts
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yep yeah and wins to randy did you have any other final comments or when or mike
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he changes the v. i. p. flexion contract right and i i find that p. zero casting he's
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probably the best way when someone comes with the objection contract you because i can tell you
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you do a surgical release and the straight for that day in the state for that
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week and then they are back again and it's very very disheartening sighs sadly
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uh i have a i have hardly able to a joint police but i'll just put them into civil testing and
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i think that whole natural we're stretching out joints and and i find i i've started using fixate or more
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you know the fixated we can gradually distracted so some people don't tolerate being in the class they
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just find the claustrophobic feeling of having this wrapped up in a class the whole time
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i find putting a uh one of these are like fixated as we can turn a
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millimetre day gets them nicely out as well and then keep them all straight
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the other problem that we commonly see with a good near deformity
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as you put them in that cast that does this for six or eight weeks
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i think it should be the eight weeks if you're gonna do that
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um and then the problem is you take them out of the cast and
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bomb the book near comes back how often have you seen that
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a lot and so if you put them in the role of motion flexion splint as a transition
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between the p. i. p. joint extensions blunt and if you run
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that for as long as it takes in it can
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take two three months but there but i think they're working with that this afternoon i'm gonna show a guy who
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how who lifted hundreds of a pounds of sand with his relative motion split
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you can work with these things i know it's urgent was work
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with a relative motion reflections point for nader ah c. s. tear
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in the operating room double lot they're very functional sports
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and so if they wear these after they come out of their boot
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near split you can even do that as a starting point
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to treat the book nears treat them the way you have with that's plant and then put them in a relative motions blunt
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just to start and you'll see that you're going to maintain it a lot
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and the patients will know whole when they're ready to come up
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because their finger feels kind of one key if it's not right so they will help you a helpful
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okay well i think we're going to wrap it up now because we're finishing on time will let the next
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session start on time or what i think the other
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