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or in the spec place your talk about a letter capital give easier fracture of
00:00:07
the financial relationship with his talk and uh
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or fracture are obviously classifiers blah
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uh the the kind of trauma and the kind of for a remote trust that we can spear in common
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so this is not different from other district we have something because that
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are very important to you deem as well in the for me
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the the most important is that my rotation on fingers has to
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uh arrive to this stuff for it to come so it's very
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easy to understand that and putting local anaesthesia and asked patiently
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with local anaesthesia we can also do oman averse to
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reduce the factual and uh has recently say
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the majority of the to cover factor helped treats consent
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x. rays it's important to oblique x. rays or necessity for
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for us for a second third and fourth and she's
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that's o. k. a. c. t. scan these the way this is not like a structure
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uh the evidence that we have to think about
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anatomical consideration index and middle finger fixed
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otherwise it for the fourth and fifth the finger are
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much more more by and they accepted much more problem
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of flexion of the end of our trip
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so the anatomy is very important the structure that we have
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uh are very in deep netiquette predicament are very strict factor that doesn't permit to that
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the couples to have a problems of a a stability so the majority
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of singles charts factor can be treated in a conservative way
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we can accept walked what we say is surgical ten
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degree of flexion for the first twenty degree
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reflection for the third forty and thirty degree of affection for the last two
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fingers so this is what is acceptable if arrives someone
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with a punch and neck factor and is forty degree we can say
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you can stay like that because your finger can overlap
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problem with the mobility over the fifth thing
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so what the shortening is very important we have uh the uh
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uh the six this is the rule of uh can i
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come back that the rule leaves the tolerance the maximum tolerances
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six millimetres wide as intrusive method doesn't work very well
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and we lose ten degree of extension every
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three four millimetre of uh uh shortening my rotation we can not
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the sack tomorrow station is uh if we have one millimetre
00:03:18
of my my rotation of the medicare plus we and one
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point five centimetre of my the rotation in the palm
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so the best method to to treat when possible this kind of fracture is conservative
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and uh the even normalisation of this patient also we'd i
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say strange thing with the m. f. a. next ancient
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normally we cannot say that in hand surgery congress doesn't make
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any difference because normally this population is very yelling
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and is moved so if we can put the metric
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apple a fallen geo joint in extension for
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uh twenty five days nothing happened this is the most rated by uh a lot of uh
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the work on that so we can put our local is these yeah
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longitudinal finger trap can give a have to distract the fracture then we have to do
00:04:15
a three point of pressure to stop belies our uh the cast and our correction
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these are the five uh ways to do a cast uh
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and uh uh a former check out for fractures
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there is no evidence that there is one better the another
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i will show you because isn't a structured corset
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this is the way uh uh to fix the uh the last two finger together
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uh this is with the m. p. extensions so these kind
00:04:48
of from a religious and we don't want to see
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you you you more belies the m. f. but in this factor we can do that in the and patient
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then we can email belies only one finger uh and
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uh these can be do statically a war dynamically
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these trick as a a a way to stop the lies uh
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with the tension with distraction and the last method is the
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a very quicker and uh easy method they didn't move up and to
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uh uh uh uh attention than so this is the first method
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this is the second with the e. p. joined that are free to
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this is the third where do we we try to move
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old finger are not uh involved in the problem
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this is the fourth method with the traction and the traction it can be
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done at the end of the reduction i think the these my
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best metaphor to fractures and this is the last one in these very nice paper
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uh all methodist good that there are no one that is better than that
00:06:07
so this is a case of a musician treated in this way you see at the end do we have
00:06:12
a lead to shorten in but no impairment into for a lounge to do you know a fracture
00:06:20
so it's traces very important three times during
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the the treatment because this composition is
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possible and any secondary displacement had to be sent to the operator you
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time time does very rare because normally is the bayes that is involved to stop the thirty degree
00:06:41
of articulation we have a a good be tolerance so normally is treated cause set the tea
00:06:48
in a stable fracture multiple fractures shorten it by more than five
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six seven s. millimetres or if we have a my rotation
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every time we have this problem we have to do some surgery
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the first zoologist uh first kind of surgery this is my really opinion because we
00:07:06
have no evidence also on that is to do something that is biological so
00:07:13
not attach ten done and how the structure do not detached intrinsic masses soul
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i prefer being get into that account per painting intimate to larry
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techniques for extended techniques if we have a long spear fracture
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two screws or three screws are very well accepted
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we can use place we say should only only in
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few cases normally when we have multiple fractures
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or uh other kind of problem but uh the reason
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later review will for you but target that say that plate
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is a a useful in five percent of patients
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of these uh with these fractures uh these are the painting get and uh and one
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biological methods and the the advantages is that these hair element to
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jason no problems tendon and we have no to remove october
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i got a very quick this is a different technique to do the same results uh
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this is the painting and that we can do and they're a great or retrograde uh
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uh this is another case uh from a a proximal distal
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uh backed exist also the possibility to put from the east of the proximal is very important
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to have m. f. flexed so too did not have problem on this the up
00:08:44
but uh we have other much more interesting technique so we
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one needle that is blocked and probably you know these uh
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uh a vertically technique door done by george or be
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some years ago there is a a very nice uh instrumentation for this kind of structure
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you have to do a little hole then you put your pin and and
00:09:08
and the u. bend a naval and uh you block the pain
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uh so the factory stable you can use only one being very nice procedure
00:09:18
another very good in clever proceed use will describe my
00:09:22
opinion some eight days ago it was so yesterday
00:09:26
and now the second can you talk about that so we put the
00:09:28
screw into the metal couple born and that's can be happy
00:09:33
applied also to other fractures and this is very nice because you
00:09:37
can move immediately from the these are some cases from uh
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a pocket p. no job this is another very old uh treatment so so to put
00:09:49
together all that the car was with some quiche and why then we can uh
00:09:55
use also lethal extender fixation to to bring together all these pieces
00:10:01
this is another very nice option without open a fracture if
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and then if you do that also in wide awake you can check immediately if
00:10:11
there is uh my rotation and you can move a little beat your synthesis
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uh play tennis to this is i think one of the most um and difficult uh
00:10:22
the problem because uh uh uh they create sometimes a lot of problems
00:10:27
with tendons so if we need really that we have to use but uh really
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uh in the has well i told you in five percent of cases out of necessity
00:10:39
uh this is the way to put the plate uh we have to respect the tissue we have
00:10:43
not device cries all the bone otherwise we have problem of when you when you are not
00:10:48
and uh these are the fractures that can be sold with bass i've
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seen that multiple fracture as a good choice for this kind of
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operation uh what about two alone
00:11:03
good solution for long shaft to and longwood
00:11:07
spiro oblique factual much more in the
00:11:10
second etiquette about that is free and it's not protected by the audience
00:11:16
lasts a a and talk about a compound fracture when we are in this
00:11:21
situation we have to reverse cries we have adopted problem to do
00:11:25
probably the best choices plates because you have to move you can do what you want box we need in this case
00:11:32
to be fast and very rapid to do all the other things so location
00:11:37
or wire is the solution that normally is choose and in these cases
00:11:43
so this is the final to put text box no surgical i think if it's possible is the best uh
00:11:50
external fixation or preening second way to treat a
00:11:54
intimate the listed elicitation very important uh
00:11:57
because leave you free and the patient move a screw
00:12:02
good option for second but across about and
00:12:05
longer uh the fractures plate always if
00:12:10
we don't have other possibility and i thank you very much for your attention

Conference Program

A-1226 Metacarpal diaphysis
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June 15, 2018 · 10:30 a.m.
117 views
A-1226 Metacarpal diaphysis - Q&A
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June 15, 2018 · 10:42 a.m.
A-1227 Metacarpal subcapital
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June 15, 2018 · 10:47 a.m.
A-1227 Metacarpal subcapital - Q&A
Hebe Kvernmo, Norway
June 15, 2018 · 11 a.m.
A-1228 Malunion
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A-1228 Malunion - Q&A
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A-1229 Base phalanx 1
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103 views
A-1229 Base phalanx 1 - Q&A
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June 15, 2018 · 11:27 a.m.
A-1230 Phalanx extraarticular
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A-1230 Phalanx extraarticular - Q&A
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