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- 22 year old male
- Injured 16 days ago
- Ex-fix at local hospital
- Referred for definitive treatment
- Isolated injury
CASE 4
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Figure 2a: PTT interposed in fracture site. The anteromedial corner of the talus is seen in the inferior aspect of the wound.
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Figure 2b. Diagram depicting entrapped posterior tibial tendon preventing reduction of both pilon fracture and ankle joint.
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Figure 2c: Tendon is pushed posteriorly back into place; the distal tibial fracture and talus are now reduced.
SLIDE 6 Figure 3: Anteroposterior radiograph of ankle 3 weeks post-
- peratively, revealing accurate reduction of the fracture and ankle.
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Figure 4a: Medial aspect of ankle, one week after surgery. Region of pressure necrosis has demarcated
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Figure 4b: Medial wound 5 weeks post operatively demonstrating skin healing.
SLIDE 9 Eddie the Eagle
- 38 yr old alcoholic
- Unknown recent
injury
isolated fracture
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injury
clinically
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- 4 weeks later
- Drainage from
upper arm
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- 27 year old female
- Fell off bike 4 weeks ago
- OR (forearm) at local hospital
- Revision OR (elbow) 3 days later
- Advised to have further surgery
- Came for second opinion
- Closed, isolated, NV intact
CASE 2
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Why is the radial head still dislocated?
SLIDE 19 Why is the radial head still dislocated?
- Malreduction of the ulna
- Malreduction of the ulna
- Malreduction of the ulna
- Malreduction of the ulna
- Malreduction of the ulna
- Malreduction of the ulna
- Malreduction of the ulna
- Malreduction of the ulna
- Maybe something stuck in the joint
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- 53 yr old male
- Injury 8 weeks ago
- OR at local hospital
- Now infected, painful, active drainage
- Referred for definitive care
CASE 12
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SLIDE 27 16 year old, kid “prodigy” fell on longboard w hile at college.
Transferred from OSH 1 week
- later. No reduction attempt.
Significant blistering/soft tissue swelling
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Attempted closed reduction at 1 w eek
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Ex fix at 1 w eek
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ORIF at 3.5 w eeks
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14 months, back to full activity
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Potpourri Trauma: Upper Extremity Case
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60 M open bbffx s/p MVA treated in Jamaica 4 months ago
Slightly elevated CRP, normal ESR Resolving radial nerve palsy
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6 months postop
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ROH, serial I& D, Abx cement
Deep purulent collection Soft, nonviable bone at
SLIDE 37 IV Abx for MDR Pseudomonas
- 8 weeks of IV abx
- Inflammatory markers
remain normal 1 mo off
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What Next?
– 7 cm ulnar bone defect – 2.5 cm radial bone defect
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Ex-Fix removed
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Radial shortening and ulnar vascularized fibular autograft
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