Plates and Respect for the Soft Tissues: when to use the Ex Fix vs - - PowerPoint PPT Presentation

▶
plates and respect for the soft tissues when to use the
SMART_READER_LITE
LIVE PREVIEW

Plates and Respect for the Soft Tissues: when to use the Ex Fix vs - - PowerPoint PPT Presentation

Mar 27, 2023 321 likes •597 views

Plates and Respect for the Soft Tissues: when to use the Ex Fix vs when the fibula is the answer William T. Obremskey MD MPH MMHC Vanderbilt Orthopedic Trauma A Pilon fx is a SEVERE soft tissue injury The Bones just happen to be

slide-1
SLIDE 1

Plates and Respect for the Soft Tissues: when to use the Ex Fix vs when the fibula is the answer

William T. Obremskey MD MPH MMHC Vanderbilt Orthopedic Trauma

slide-2
SLIDE 2
  • A Pilon fx is a SEVERE soft tissue injury…
  • The Bones just happen to be broken!!
slide-3
SLIDE 3

When to Ex Fix?

  • You are not Defintive Surgeon!!
  • Ex Fix and Phone a Friend!
slide-4
SLIDE 4
  • 55 year old man
  • engineer
  • fall from ladder
  • isolated L ankle injury

O/E

PMH: neg Non smoker

slide-5
SLIDE 5

BB

slide-6
SLIDE 6

BB

slide-7
SLIDE 7

BB

slide-8
SLIDE 8
  • Blood flow and soft tissue oxygenation are

impaired after high-energy plafond fx

  • When NOT to operate!

“UNSAFE”

CT angiogram post-injury day 2

Staged Treatment

slide-9
SLIDE 9

When to Ex Fix?

  • Severe Soft tissue injury
slide-10
SLIDE 10

Red Blisters Clear Blisters Open Fracture

slide-11
SLIDE 11

When to Ex Fix?

  • Severe Contamination
slide-12
SLIDE 12

When to Ex Fix?

  • Fibula Fx is distal!
slide-13
SLIDE 13

BN

slide-14
SLIDE 14

BN

slide-15
SLIDE 15

BN

slide-16
SLIDE 16

BN

slide-17
SLIDE 17

When the Fibula is the Answer

  • When Shaft fx and SHORT!
slide-18
SLIDE 18
slide-19
SLIDE 19
slide-20
SLIDE 20
slide-21
SLIDE 21
slide-22
SLIDE 22
slide-23
SLIDE 23
slide-24
SLIDE 24

Is Routine Plating of the Fibula Necessary?

Retrospective review with two groups – one with fibular plating, the other without

  • Plating 5/22 fibular wound infections (23%), no tibial

infections and 1/22 malunion (5%)

– MORE FIBULAR PROBLEMS!

  • No plate –1/31 tibial infections, 6/31 malunions

(19%)

  • Fix fibula – A few wound problems (none needed an
  • peration) is better than Malunions
slide-25
SLIDE 25

When to Ex Fix (only)?

  • You are not Defintive Surgeon!!

– Ex Fix and Phone a Friend!

  • Severe Soft Tissue Injury
  • Bad Contamination
  • Fibula is distal
  • Fibula not fractured
slide-26
SLIDE 26

When to Fix Fibula?

  • Shaft fx and SHORT
  • You are definitive surgeon