OSET 2017 David B. Weiss, MD University of VA Dept. Orthopaedic - - PowerPoint PPT Presentation

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oset 2017 david b weiss md university of va dept
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OSET 2017 David B. Weiss, MD University of VA Dept. Orthopaedic - - PowerPoint PPT Presentation

Dec 10, 2023 508 likes •729 views

OSET 2017 David B. Weiss, MD University of VA Dept. Orthopaedic Surgery Disclosures OTA- Education Committee DepuySynthes- Consulting Globus Medical- Consulting AO North America- Teach Courses Elsevier- Royalties METRC-

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SLIDE 1

OSET 2017 David B. Weiss, MD University of VA

  • Dept. Orthopaedic Surgery
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SLIDE 2

Disclosures

  • OTA- Education Committee
  • DepuySynthes- Consulting
  • Globus Medical- Consulting
  • AO North America- Teach Courses
  • Elsevier- Royalties
  • METRC- Site PI
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SLIDE 3
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SLIDE 4

This Dude’s been shot!!!

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SLIDE 5

61 yo M Shotgun to left thigh (close range) during home invasion

FBI.gov (Mannequin)

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Low vs High Velocity

  • Low velocity (<1000 ft/sec)- typical handgun

– Damage confined to missile tract- – More deformity of bullet – Less zone of injury – Can treat like closed fracture – High Velocity (<2000 ft/sec) will be blast and increased soft tissue damage- need more extensive debridement. – Shotgun at close range considered high energy – Treat as open fracture

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SLIDE 7

Deformation increases with velocity

Library.med.utah.edu

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SLIDE 8

Cavitation

from www.Quora.com

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SLIDE 9

Management of GSW

  • ATLS principles
  • Follow the bullet tracks- look for entry and

exit wounds

  • Neuropraxia often transient from shockwave
  • r bone displacement
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SLIDE 10

38 yo M accidental 9mm to thigh

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SLIDE 11

38 yo M accidental 9mm to thigh

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SLIDE 12

Post Op

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SLIDE 13

21 yo F 40 caliber

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SLIDE 14

Post Op

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SLIDE 15

15 mos post op-returned to sport

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High velocity injury

Contrast with pistol injury To femur This has much bigger zone of injury and fragmentation

Orthobullets.com

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Helpful tips

  • Understand type of GSW if known (handgun vs

rifle)

– High velocity will need extensive debridement

  • Shotgun blast at close range treat like open fx-

lots of tissue destruction (may have wadding in wound)

  • Powder burns on skin indicate close range (more

energy)

  • Not necessary to debride all fragments but some

may block IM canal (study images closely)

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SLIDE 18

Back to the first case

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SLIDE 19

Success (at least for now)