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A-1228 Malunion
Hermann Krimmer, Germany
Friday, June 15, 2018 · 11:04 a.m. · 11m 25s
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so good morning nodding thank you
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my disco show end just a short note where i'm
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coming from i'm working in the sauce of germany
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and my town is close to the big lake and to the border of austria and switzerland
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and back to my talk when such that had done
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of mulder occasion or curves and patience at present is presented is it
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then there is absolute need for correction as it really we can eh
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represents says the it is ability of sick complete n. function
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first of all we have to think about what causes my union
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of course fate conservative treatment is one major reason
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and for that reason look for the patient not only physics
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rate we all know the problem this moderate asian
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which is all the look if you don't precisely check it's a functional so patient
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next is faith operatives treatment sometimes very tiny could plates
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amounted but they are in the wrong position
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and even afterwards after the operation you see a significant model rotation
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frequency in our unit is quite less that i think about two to three percent
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that means you are dealing there's about one of the major effect just the uh and
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the number of correctional stick to me it's like less
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now looking in the literature uh and where
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are the areas which courses modification
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and probably jesus want cable will shows us it's wide
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half and half so it means it's cost by my union that semantic
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opposites as well as by my union of suffered in sheets
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concerning the fee outcome does a paper from the nineties from switzerland the success rate
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after correction is very high so it means correction austere to me in case of my union
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it's really a valuable operation from patients point of view
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as well as from surgeons point of view
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first of all major point is to avoid it's it means to avoid
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so risks of an instability oft operative treatment we just discussed before
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is there still a neat or is it still valuable to meet screws
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i feel it depends on the fracture anyway two
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screws on not enough to screws still represents
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an unstable situation and then we have says
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risk that secondary dislocation normal rotation occurs
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that means if the fracture type allow us to use black screws
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you routinely should use at least three data for all five as you
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can see here and then really you can get a stable
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situation but if there is any doubt avoided tinkle foreplay because we
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really have now tiny implants available and it makes it
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a very easy concerning decision making we have to want a two
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major questions that means when is the right time for surgery
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should we go at once after fail treatment should be great and segment is
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so region of c. austere to me especially in case of financial fractures
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there's no doubt about set correction is best done close to the previous fracture
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that on the other hand when we have a mole rotation course preferential
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fractures and the goal for correctional state to me of course we
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have an increased risk of ten mediation at th and set a financially
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this and then of course we have also restriction of motion
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and for that reason it's to pay to the two goal for that matter coppers because every it's safe and the risk of ten minute
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teaching is less but we have to do see onset we cannot leave
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this question open and concerning time for surgery i of course
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usually after fail treatment even if it's conservative operative
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usually you have a page and this restriction of motion because sometimes they
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are long time it will be lost and you also have
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restriction of motion it's unable fingers and then it's not a good time to go initially
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for surgery you should wait and before a corrected for lunch last year to me
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based on a maximum range of motion should the reach of surfing
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a joint and then you have to wait and after set
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you can start with you operative procedure so first of all
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look for the function of a enable think yes
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next is very r. c. austere to me these
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are different uh papers published and probably
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there is one paper i have to go back there's one paper say three did
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uh fractures that's a medical bills as well as it's a felon
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shields but all correction bet on it so much accomplished
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reason for that is so argument is to avoid ten annotations maybe
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call for correctional state to me at the uh ten sheets
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the other publication they three d. to nine letter cobble sense
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excellently fractious and say state add subtract side so what
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would you recommend well what's all philosophy area of c. austere to me
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in case of anger that they're from deformities are without doubt about we have to go close
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to the fractures side because otherwise we really have appended finger and concerning rotational deformity
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we recommend to stay at some previous fracture
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and one major reason is also it's a balance of so intrinsic muscles because when you
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goal for correctional still to me far away from the previous fracture saying you know
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sometimes coming to concern is a balance of saying frantic model and foresight reason
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there the recall mandate to call all so close to the fracture side
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make sure reason for this document is said we don't have any more this
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problem because this is passed this is really possible but it was reality
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nowadays we don't have any more to use is partly implants
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we have tiny small implants and the risk of ten in the
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tuition is much less then as we had in the past
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concerning the technique we really need to precise technique and it's not that easy
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let me know when you have to correct the rotation deformity and
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that needs really exactly have to be corrected because
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otherwise says still remains some kind of disability
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makes this we have really to protect a soft tissue that
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means to avoid ten annotations to look for ten gliding
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and one major reason is to use tiny implants and segment
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is to start was really more belies station and
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i feel very good the trick or tape which i learned from my
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colleagues from austria is if you spend your neighbour finger s. and
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upon this makes it very easy for you after the last your to
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me to bring your finger into right position be on all
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if you have all your finger small but it's not that easy
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to precisely check uh serve correction of rotation next is
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that type of plate or it's a technique for the last
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year or two me and be prefers the special plate
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this is sliding own which allows you a correctional of about uh up to
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twenty five degrees which usually is enough and after free mounting displayed
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as you can see here you put up or you remove the plate then
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you perform your last your tummy between says to always and next time
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the plate is mounted began insane you can really precisely check so correction of rotation
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and then you have tended your neighbour fingers into the pond you just have to
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put on your fingers in the right position as you can see here
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and then you can't be really safe set you have
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corrected in the desire at that position because
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it still remains a challenge to really be are precisely after such a correctional stick to it
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faint operative treatment perfect plate looks pretty nice but the function
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uh obviously was forgotten what's the section and then uses this pattern of course
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you have to remove displayed and cool for correction austere to
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me it's a felon she'll as well and you can
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you use the same technique as you see here after
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the oblique of tessa horizontal or steel to me
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and corrections and you have to fix your plate and next step especially
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when you call for correctional sitting at a felon she did very usually
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use the dos approach list ten split it's absolutely necessary to
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start as early molestation because otherwise really end up
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is the c. v. restriction of motion and that's very importance it does speak
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on and you have really to speak as you patiently explaining some necessity
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for this are really moby laceration concerning angle letter from deformities
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there is no doubt about we don't have to
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discuss we have to go for correction we have to call for correction close to sit previous fracture
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and this is usually done by a close match was due to me but
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usually be away yeah use a very small tiny
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shop saw plate because otherwise and that's a
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problem set you lost your to me is not lost your thumb is not really precise
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and then it makes after that so mounting of separate really very difficult
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but is a close match posted to me it's the same thoughtful approach stanton split and start
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as early more below station in both these stabilisation we usually prefers it screwed plates
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and is at least a four screws proximal and distal and this
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allows you really really to start this early mobile association
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so in summary form a union especially a rotational deformity correction last year to
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me we recommend how close to the bring this fracture a real
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re mounting the blade makes it safe and easy and early mobile laceration is really pretty reckless it
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