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 • METRC- Site PI University of Virginia Orthopaedic Surgery
The Problem University of Virginia Orthopaedic Surgery
44 yo Male s/p MCC University of Virginia Orthopaedic Surgery
University of Virginia Orthopaedic Surgery
Vascular injury (again) University of Virginia Orthopaedic Surgery
60 yo F fall down steps University of Virginia Orthopaedic Surgery
CT Scan Anteromedial posteromedial 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 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 University of Virginia Orthopaedic Surgery
Treatment- Staged • Ex-fix- • Goals- reduced knee, stable • Allow vascular repair if necessary 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 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 University of Virginia Orthopaedic Surgery
Ex fix applied and vascular repair and 4 compartment fasciotomies University of Virginia Orthopaedic Surgery
ORIF at 6 weeks University of Virginia Orthopaedic Surgery
Summary • Complex injury • Important to reduce to stable position and evaluate for concomitant NV injuries and other system injury • Zone of injury may progress • Better to proceed cautiously and stage treatment University of Virginia Orthopaedic Surgery
Questions/Discussion University of Virginia Orthopaedic Surgery
David B. Weiss, MD Division Head Orthopaedic Trauma University of Virginia
David B. Weiss, MD Division Head Orthopaedic Trauma University of Virginia
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