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Wash out, splint/ex-fix and do electively Mani Kahn MD No - - PowerPoint PPT Presentation
Wash out, splint/ex-fix and do electively Mani Kahn MD No - - PowerPoint PPT Presentation
Wash out, splint/ex-fix and do electively Mani Kahn MD No disclosures Zura rushing to definitively fix an ankle in the middle of the night. Can we really trust his judgement? Hollywood elite! NCIS New Orleans, 2017 Open ankle fractures
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Zura rushing to definitively fix an ankle in the middle of the night….
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Can we really trust his judgement?
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Hollywood elite!
NCIS New Orleans, 2017
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Open ankle fractures
- 5% incidence
- Higher energy injuries
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Well accepted dogma…
“Delayed ORIF is an acceptable alternative when soft-tissue swelling, fracture blisters, or abrasions are present that
- ffer an undesirable
environment for surgical incisions.”
- Konrath et al 1995
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Obstacles to early definitive treatment
- Multiply injured and under-resuscitated patients
- Protracted transport times
- OR availability
- Suboptimal conditions
- Trauma surgeon availability
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Role of fatigue in medical errors
- Potential for
compromised technical
- r cognitive
performance
Williamson et al. 2000
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Risk factors for infection in open fracture…
- Increasing Gustilo grade
- Lower extremity fractures
Harley et al 2002
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Open Ankle Fracture Complication Rates
- Deep infection 8%
- Skin Necrosis 14%
Hulsker 2011
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In Series’ with Immediate ORIF…
Wiss et al 1988
- 5% infection
- 8% late arthrodesis
- Longer hospital stays for
early ORIF Joshi et al 2006
- 20% complication rate
– Skin necrosis – Loss of reduction
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23 F acro-yoga injury
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Closed “reduction”
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External fixation, percutaneous pinning
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POD#10: Elective ROH, ORIF
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2 weeks postop
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3 months postop
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6 months postop
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Thank You
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Bibliography
- Konrath et al. Early Versus Delayed Treatment of Severe Ankle
Fractures: A Comparison of Results. Journal of Orthopaedic Trauma. 9(5):377-380, October 1995.
- Hulsker et al. Evidence-based treatment of open ankle fractures.
Arch Orthop Trauma Surg (2011) 131:1545–1553
- Wiss et al. Immediate Internal Fixation of Open Ankle Fractures.
Journal of Orthopaedic Trauma. 2(4):265-271, 1988.
- Joshi et al. Immediate open reduction and internal fixation in open
ankle fractures. J Am Podiatr Med Assoc. 2006 Mar-Apr;96(2):120- 4.
- Williamson AM, Feyer AM: Moderate sleep deprivation produces
impairments in cognitive and motor performance equivalent to legally pre- scribed levels of alcohol intoxication. Occup Environ Med 2000;57:649- 655.