Trauma concepts and fixations
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Transcript of Trauma concepts and fixations
PLATES
Standard cortical screw e compressing plate to surface of the bone, providing friction and stability.
Locking head screw providing angularstability and preservation of periosteal blood supply.
PLATES
Benefits of locking plates
Osteoporotic bones
• Angular stability• Increase pullout strength of screws
PLATES
Role of lock plates in musculoskeletal infection / LRS
Option for fixing fractures immediately after removing ext fix (Eg: in open fractures)
As fracture stabilizer in damaged bone following osteomyelitis treatment
Role of lock plate in fixing distraction osteogenesis cases (consolidation phase)
PROX FEMUR FRACTURE
STABILITY of fracture is key
Based on how intact is the posteromedial buttress and if is reverse obliquity/subtrochanteric
If stable: DHS is adequate
If unstable: PFN or Proximal Femur Lock plate
PROX FEMUR FRACTURE
Decision for prox femur lock plate: when entry point highly comminuted – greater trochanter comminution
Or when too many fragments especially at the posteromedial buttress
Experience before: not enough screws could be placed within NOF due to its size causing instability
CANNULATED SCREW
Why is it easy?
Most reductions are held by wires – as not to damage the bone
If can immediately put screw in over the said wire – easy and simple…
Hence the development of cannulted screw fixations
CANNULATED SCREW
Not all fractures can be held with enough stability with screws only – usually large single piece fractures
CANNULATED SCREW
Headless cannulated screws
Usually fractures that would require the screw head be exposed unto the joint surface
As the principle of fixing a fracture thru lag screw should be from small piece unto large piece
WE EXPECT
Available implants and instruments Majority sizes should always be available and
updated
Especially screw sizes
Implant reps should be present whenever cases are being done Especially if involving new implants
Provide input on the surgical pearls and pitfalls of using the implants – u are exposed to more surgeons
WE EXPECT
Adequate training and experience exchange between surgeons whenever introducing new concepts or fixations
Would be good if the reps that introduce any new or upcoming breakthoughs
Implant reps should be contactable at any working times for easy enquiries
An easy and patient friendly payment process
WE EXPECT
Implant reps should be contactable at anytime during working hours for easy enquiries
An easy and patient friendly payment process
Preferably if it can be settled quickly and without hassle
WHAT WOULD BE NICE
Free implants (<RM 1000) are available readily at the hospital – including the instruments – enable quick and easy fixations even during oncall hours