Discusión entre pares / 24yrs/male presented with compound type 2 communited supracondylar fracture with intercondylar chunk with lateral hoffas + segmental distal 1/4th fracture femur ...

Indian-Orthopaedic Research-Group

Rahul B Tanga

24yrs/male presented with compound type 2 communited supracondylar fracture with intercondylar chunk with lateral hoffas + segmental distal 1/4th fracture femur and patient was B negative blood group with HB% 7.2gm%.patient was transfused 2 units of whole blood and was taken after 2 days of trauma. 2 units of whole blood and 2 units of packed cells was reserved for surgery.orif with 6.5mm cc screw + 4 mm cc screw fixation for lateral hoffas + 10 holed distal femur LCP + intercondylar chunk was fixed with k wire + primary BG .patient was operated under tourniquet and was transfused 2 units of blood intra op and two units post op.

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  Rahul B Tanga Critical comments?

  1 hora · Me gusta
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  Trimbak Patel Buttressing the posterior spike of hoppas fragment with washer & cc screw would have added more stability. The plate does not appear to locking, would have added to the rigidity. Job good doned.

  1 hora · Me gusta · 3
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  Anil Sood How much of trauma dear

  1 hora · Me gusta · 1
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  Praganesh KV Hoffa left unreduced... should have been fixed with priority..

  1 hora · Me gusta · 2
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  Anoop R. Nair Yes ..Hoffa needs to be tackled other wise A+

  59 min · Me gusta · 1
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  Ajeet Dhakar such fractures appear difficult on xray.. even more difficult to operate. well done

  58 min · Me gusta · 2
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  Praganesh KV when you are opening this fracture with such vast dissection, fixation of hoffa shouldnt be a problem... this will go in nonunion and result in stiff knee also... just giving critical comment.. not criticizing your job dr rahul..

  56 min · Editado · Me gusta · 2
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  John Rabadi Very Good

  54 min · Me gusta · 1
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  Arabind Shah Difficult case managed well.

  52 min · Me gusta · 1
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  M Bukhsh Shahwani Well done

  45 min · Me gusta · 1
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  Shriniwas Sandikar Good.

  42 min · Me gusta · 1
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  Anuj Agrawal There is a huge intra-articular step at the Hoffa's fracture. The anteroposterior screw intended to fix it has failed to engage it, and the screw head should have been countersunk, being placed in the trochlea. I am sorry to say, but both the reduction and fixation are not acceptable in this case.

  37 min · Me gusta · 3
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  Ashutosh Chaudhari Anuj don't u think that the X-ray is oblique not true lat , the countersinking yes but a really bad frac , my only question is why the kwire

  34 min · Me gusta · 1
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  Anuj Agrawal The view looks fine to me. A step visible in any view, is a step.
  Yes, the fracture was difficult, but not by the standards of Rahul. This reduction is not Rahulesque.

  27 min · Me gusta · 1
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  Rahul B Tanga Thanks everyone for your valuable inputs.hoffas reduction was checked under c arm and was satisfactory even in oblique views.anteriorly too much of communition so thin plate of bone was available to place hoffas screw and was scared to over drill to avoid splintering.as lot of BG is been stuffed posteriorly so it's appears to be unreduced. I will still would take oblique views and confirm hoffas reduction and if not satisfactory then will plan accordingly.as ashutosh has pointed out its not true lateral view.ashutosh k wire is holding intercondylar chunk of bone as it was unable to pass even 4 mm cc screw.trust me guys it was nightmare case for me on table due to fracture fro file and patient was B negative and had to finish within tourniquet time. I could count number of fragments on table.hope I will improve in my next case.thanks

  23 min · Me gusta · 1
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  Jignesh Patel Excellent skills...........

  20 min · Me gusta · 1
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  Rahul B Tanga I agree with you anuj step in any view is step. Will get oblique views and reassess and if required will revise hoffas.

  19 min · Me gusta · 1
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  Eslam Khalaf great effort, but it was 4 illezaroff

  17 min · Me gusta
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  Rahul B Tanga Anuj thanks for compliments.

  15 min · Me gusta · 1
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  Prafull Meherishi Was it externally compound....?post op infection

  12 min · Me gusta
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  Prafull Meherishi Did u use distractor to achieve perop reduction

  10 min · Me gusta