David B. Weiss, MD Division Head Orthopaedic Trauma University of - - PowerPoint PPT Presentation

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david b weiss md division head orthopaedic trauma
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David B. Weiss, MD Division Head Orthopaedic Trauma University of - - PowerPoint PPT Presentation

May 02, 2023 202 likes •388 views

David B. Weiss, MD Division Head Orthopaedic Trauma University of Virginia Disclosures OTA- Education Committee DepuySynthes- Consulting Globus Medical- Consulting AO North America- Teach Courses Elsevier- Royalties

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David B. Weiss, MD Division Head Orthopaedic Trauma University of Virginia

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University of Virginia Orthopaedic Surgery

Disclosures

  • OTA- Education Committee
  • DepuySynthes- Consulting
  • Globus Medical- Consulting
  • AO North America- Teach Courses
  • Elsevier- Royalties
  • METRC- Site PI
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University of Virginia Orthopaedic Surgery

The Problem

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University of Virginia Orthopaedic Surgery

44 yo Male s/p MCC

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University of Virginia Orthopaedic Surgery

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University of Virginia Orthopaedic Surgery

Vascular injury (again)

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University of Virginia Orthopaedic Surgery

60 yo F fall down steps

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University of Virginia Orthopaedic Surgery

CT Scan

Anteromedial posteromedial

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University of Virginia Orthopaedic Surgery

Initial Management

  • Reduce dislocation
  • Evaluate pre and post neurovasc status
  • Ankle Brachial Index (ABI)
  • Consider vascular referral

– Abnml ABI (<0.9) – Hx of vascular diagnosis – Other physical findings

  • (expanding hematoma popliteal fossa)
  • High energy- good secondary survey when able
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University of Virginia Orthopaedic Surgery

OR management

  • Ex-Fix
  • Evaluate compartments

– Can measure intra-op (account for temp decr MAP intraop) – Prophylactic release if obtunded?

  • Return to fight another day
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University of Virginia Orthopaedic Surgery

Treatment- Staged

  • Ex-fix-
  • Goals- reduced

knee, stable

  • Allow vascular

repair if necessary

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University of Virginia Orthopaedic Surgery

Treatment- staged

  • Can get CT scan in reduced position to identify

fx patterns

– Look at pattern – Other fx lines

  • Can watch injury evolve

– Fx blisters – Compartment syndrome – Vascular injury

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University of Virginia Orthopaedic Surgery

Treatment

  • Return to OR when stable
  • Good pre op plan
  • Appropriate team and equipment

– Want the A team – Is that you? – Is that you at Midnight?

  • Don’t get burned
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University of Virginia Orthopaedic Surgery

Ex fix applied and vascular repair and 4 compartment fasciotomies

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University of Virginia Orthopaedic Surgery

ORIF at 6 weeks

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University of Virginia Orthopaedic Surgery

Summary

  • Complex injury
  • Important to reduce to stable position and

evaluate for concomitant NV injuries and

  • ther system injury
  • Zone of injury may progress
  • Better to proceed cautiously and stage

treatment

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University of Virginia Orthopaedic Surgery

Questions/Discussion