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#fracturefriday #OrthoTwitter #handtwitter @DrMoghtaderi @AmyMMooreMD @sanjkakar @mike_hayton @JuncturaTheorum @hunter_alistair @NuelleHandMD 55yo woman. FOOSH. Ouch. Go.
Honest question: in the age of corona, limiting contacts, saving resources, should we be getting CT scans on all of these? Should we just bring the kitchen sink and be ready? #COVID #OrthoTwitter @SandyGebhartMD @congenitalhand @HandPodcast
You got your precious CT with its #coronavirus and sarcoma risks. Did it answer all your Qs? Can you tell if elbow is stable? Do you know what you are going to do with radial head? @CaliforniaOrtho @hand_specialist @Dr_RyanRose @DrConnos @DrewAlbertMD @SteveLanierMD
Seeing that coronoid fracture as @DrTateGreditzer recognized, made me concerned for instability. I brought my gear for that as well as fixing versus replacing the RH
I vowed to never do an external fixator for a closed elbow fracture again so I had the IJS ready. (Disclosure: consultant for @SkeletalInfo )
But how does one prepare an I JS when there is a comminuted lateral column fracture?
In my pick ups is a significant portion of the lateral epicondyle. That is where the guide pin is supposed to go.
I initially thought like @DrMoghtaderi and was going to try to just use headless screws for the lateral epicondyle, but it was more comminuted than I thought and the ligament was attached to those small fragments.
I probably could have fixed the radial head with a plate as it was not that comminuted and had a complete neck fracture, but given the other sources of instability in the elbow I wanted the bony stability to be full and immediate.
I put in a trial radial head and got my guide pin for an IJS ready in case I had residual instability. At this point, the elbow is still unstable.
Give him the comminution of the lateral epicondyle and the instability, I wanted to get robust fixation there so I opted to plate it. But I wanted to make sure my plate did not interfere with IJS placement should I later need it
I threaded the plate over the guide wire for the IJS to make sure that it wouldn’t interfere with the axis pin if I needed to place it. I then reduced the fragments underneath the plate and got control of them with screws through the plate
Once the fragments were secured, the elbow regained stability between an intact ligament and a replaced radial head.
Belt and suspenders repair of ligaments over the ORIF
Stable in full ROM irrespective of supination or pronation #fracturefriday #Orthopedics @AAOS1 @HandSurgeryAssn @HandSociety
Not dislocated yet! Post mold splint. Out 5-8x daily for rom 90- full flexion. Increase extension 10 degrees each week. D/c splint at 4 weeks. #handtherapy #OT @HandPodcast @ChrisDyMD @DKennedyHands
