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

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