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A-1229 Base phalanx 1
Lars Vadstrup, Denmark
Friday, June 15, 2018 · 11:19 a.m. · 08m 30s
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00:00:01
i guess it's just have to get used to this one a good morning thank you to the chairman for this opportunity to
00:00:09
show my news off um of bayes factors the treating bayes
00:00:15
factors of the proximal filings in the tried dated fingers
00:00:21
as you may know uh so john charlie plenty of hip replacement surgery he
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stated that the reputation of a surgeon may stand as much in jeopardy
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from a fracture of the proximal filings as from any fracture of the femur
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in my praxis it's clear that the fact of the proximal filings is not a trivial fact yeah
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um and it should not be treated as one it to serve the skills of
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an expert surgeon and a junior resident together not the upcoming certain alone
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and the take home message if at all possible choose conservative treatment for
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bayes factors of the proximal filings in the tribe dated fingers
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when doing a a clinical examination it's uh you need
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to know that these type disciple factors of them
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uh most common injuries to the skeleton system and
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accounts for approximately ten percent of all factors
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the traumas is most likely related to sports activities but being from ten to thirty years of age
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work related from the thirty two seventy years souls and you to fall from a standing position
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in the seven it to us and uh peyton above have extension and abduction of the finger
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uh of the older think is tentacles base fracture of the
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proximal phalanx most frequent to the fourth or fifth finger
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when you examine a finger pay attention to the soft tissue
00:01:55
uh and to the tendon um function of the animals finger as the bottom of the flex attendant
00:02:02
chills cunt is concede users of the palmer aspect of the filing gail bone
00:02:07
just the sensory function of the did you two and as mentioned by the three other speakers
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check for any rotational uh uh um so it will angle asian
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playing radio grabs p. a.'s lead roles an oblique you
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should always be performed when a factor is suspected
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prob assessment of the intrude ten should include radio graphs of
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the entire hands to root out any associated factors
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you know it alls at also fact regulation up to
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twenty five degrees is acceptable in an extra articulate
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fracture but not more than ten degrees of lateral a mobile law and relations should be accepted
00:02:53
again rotational deformities a clinical diagnosis not assessed on radio
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crafts and you should not accept any rotational deformity
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introducing a treatment platter it should be of no surprise that my first choice of
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treatment is body taping the injured finger to the neighbouring one for five weeks
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this is a united not displaced on minimal displays fracture
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when dealing with that displays factor one should consider close production followed by body
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taping and then you said of radio perhaps you now to pick it
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apart when we do a clinical follow up and one and two weeks and
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then to route in the on set a late onset rotational deformity
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we find find no need for additional rated graphs at their at these uh intervals
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it's important to encourage patients to perform flex an extension of the injured finger every
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hour at home and we again we use body saving for five weeks
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at this place non read usable factor we require surgery you should always consider closed production
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and put continues fixation with k. wires screws taking anatomy of the finger into consideration
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external fixation is indicated in open fractures with concomitant soft tissue injury
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as close reduction an external fixation provides the needed stabilisation with minimal
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risk of worsening the soft tissue lesion course by the trauma
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if none of the mentioned method is suitable for the fact
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an open adoption and and so on fixation is needed
00:04:35
using this type of procedure it's very important that the fixation is rigid
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enough to allow early mobile i station for a good functional outcome
00:04:47
standard treatment for bayes factors of the proximal filings should focus upon function
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and to a lesser extent exactly position of the fractured digit
00:04:58
my pratt tract is body taping is always used if the factor is not displaced a
00:05:02
stable of this place and staple after closed reduction allowing you mediate apply station
00:05:11
displacements more than two millimetres already all novels in or sharing fractures of the proximal would have
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this is nice closed or open reduction and
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fixation as john stability may be compromised
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when using pocket chain yes okay wires or open surgery knowledge of the thing and that's i mean is mandatory
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we'll straighten here shows safe zones folk a wiring mark would green colour
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it's obvious that the such it'll bands of the extensive hit the lateral bands and the extended to
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get warm to the net selves leaves little room for job okay wire or screw placement
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the central part of the extent attendant is identified also lee at the m. p. joint
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and on either side of this there's a triangle uh save so at the base of the proximal filings
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care should be taken to avoid penetrating the last roll bands of the extent
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apparatus when introducing k. one s. at the biases of the proximal filings
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in this case closed reduction and close k. wiring was possible
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but also intrinsic plus spent it's used for two weeks before active training
00:06:20
without anyway pairing started on the supervision of a hand therapist
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k. y. as i removed the outpatient clinic at three four weeks
00:06:29
after surgery body taping issues afterwards for two weeks if necessary
00:06:36
been so screws should be placed in the plane that crosses the fact a plane
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at least to pin all screwed i am it's it's from the factory line
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when using lack screws maximal factor compression is obtained obviously
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to emphasise using open reduction an internal or in this case spoke attain
00:06:56
yes okay wiring it's very important that the fixation is rated enough
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to allow a little play station within one to two weeks to achieve the best possible functional outcome
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if open surgery is required for fracture repetition of allah
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approach to the base of the filings is recommended
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prognosis
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conservatively treated factors with immediate normalisation report good or excellent
00:07:25
stalls concerning range of motion then absence of pain in the majority
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of cases of one year follow up after the trauma
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if initial fixation is indicated close production and k. y. yeah stabilisation
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as a better prognosis band open reduction ad interim fixation
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as the lead uh in general has been reported to carry out a rather high risk of complication
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such as reduced mobility increase infection rate and nerve damage
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let alone the need for re operation to remove hardware or perform internalise is
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so in conclusion focus should be on the restoration of think of function
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and to a lesser extent exactly position of the fractured digit
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if at all possible choose conservative treatment a bayes factors of
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the proximal filings in the tribe did your fingers
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choosing open adoption an internal fixation then make sure that the fixation that route is
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