case examples an isolated injury in an adult, bicycle crash treatment options?
TRANSCRIPT
![Page 1: Case Examples An isolated injury in an adult, bicycle crash Treatment options?](https://reader035.vdocuments.site/reader035/viewer/2022062314/56649d825503460f94a682cd/html5/thumbnails/1.jpg)
Case Examples
An isolated injury in an adult, bicycle crashTreatment options?
![Page 2: Case Examples An isolated injury in an adult, bicycle crash Treatment options?](https://reader035.vdocuments.site/reader035/viewer/2022062314/56649d825503460f94a682cd/html5/thumbnails/2.jpg)
Case Examples
Healing via callus formation – secondary bone healing
![Page 3: Case Examples An isolated injury in an adult, bicycle crash Treatment options?](https://reader035.vdocuments.site/reader035/viewer/2022062314/56649d825503460f94a682cd/html5/thumbnails/3.jpg)
Case Examples
An adult, s/p MVC. Ipsilateral femur fracture. Has comminution and more displacement…Treatment options and predict type of bone healing
![Page 4: Case Examples An isolated injury in an adult, bicycle crash Treatment options?](https://reader035.vdocuments.site/reader035/viewer/2022062314/56649d825503460f94a682cd/html5/thumbnails/4.jpg)
Case Examples
What is technique of this fixation – the goal regarding type of healing?
![Page 5: Case Examples An isolated injury in an adult, bicycle crash Treatment options?](https://reader035.vdocuments.site/reader035/viewer/2022062314/56649d825503460f94a682cd/html5/thumbnails/5.jpg)
Case Examples
No callus formation – primary bone healingAbsolute stability was achieved with this fixation technique
![Page 6: Case Examples An isolated injury in an adult, bicycle crash Treatment options?](https://reader035.vdocuments.site/reader035/viewer/2022062314/56649d825503460f94a682cd/html5/thumbnails/6.jpg)
Case Examples
What is standard of care for this isolated, closed femur fracture?What do you predict healing will be?
![Page 7: Case Examples An isolated injury in an adult, bicycle crash Treatment options?](https://reader035.vdocuments.site/reader035/viewer/2022062314/56649d825503460f94a682cd/html5/thumbnails/7.jpg)
Case Examples
![Page 8: Case Examples An isolated injury in an adult, bicycle crash Treatment options?](https://reader035.vdocuments.site/reader035/viewer/2022062314/56649d825503460f94a682cd/html5/thumbnails/8.jpg)
Case Examples
The IM device allows micro-motion at the fracture
Relative stability
Healing by callus formation
![Page 9: Case Examples An isolated injury in an adult, bicycle crash Treatment options?](https://reader035.vdocuments.site/reader035/viewer/2022062314/56649d825503460f94a682cd/html5/thumbnails/9.jpg)
Case Examples
Another femur fracture:• 15 years old• Treatment options?
![Page 10: Case Examples An isolated injury in an adult, bicycle crash Treatment options?](https://reader035.vdocuments.site/reader035/viewer/2022062314/56649d825503460f94a682cd/html5/thumbnails/10.jpg)
Case Examples
What fixation strategy was used? What type of healing do you anticipate?
![Page 11: Case Examples An isolated injury in an adult, bicycle crash Treatment options?](https://reader035.vdocuments.site/reader035/viewer/2022062314/56649d825503460f94a682cd/html5/thumbnails/11.jpg)
Case Examples
Dynamic Compression to achieve absolute stability
Primary bone healing
No callus formation
![Page 12: Case Examples An isolated injury in an adult, bicycle crash Treatment options?](https://reader035.vdocuments.site/reader035/viewer/2022062314/56649d825503460f94a682cd/html5/thumbnails/12.jpg)
Case ExamplesAnother example of absolute stability by reduction and internal fixation with compression
No Callus formation – Primary bone healing
![Page 13: Case Examples An isolated injury in an adult, bicycle crash Treatment options?](https://reader035.vdocuments.site/reader035/viewer/2022062314/56649d825503460f94a682cd/html5/thumbnails/13.jpg)
Case Examples
• So does internal fixation using a plate always lead to primary bone healing?
![Page 14: Case Examples An isolated injury in an adult, bicycle crash Treatment options?](https://reader035.vdocuments.site/reader035/viewer/2022062314/56649d825503460f94a682cd/html5/thumbnails/14.jpg)
Case Examples
• Multi-fragmentary humerus fracture, isolated injury. No nerve palsy
• Treatment options and type of healing?
![Page 15: Case Examples An isolated injury in an adult, bicycle crash Treatment options?](https://reader035.vdocuments.site/reader035/viewer/2022062314/56649d825503460f94a682cd/html5/thumbnails/15.jpg)
Case Examples
A technique of relative stability – bridge plate. Allows micromotion and callus formation – secondary bone healing
![Page 16: Case Examples An isolated injury in an adult, bicycle crash Treatment options?](https://reader035.vdocuments.site/reader035/viewer/2022062314/56649d825503460f94a682cd/html5/thumbnails/16.jpg)
Case Examples
![Page 17: Case Examples An isolated injury in an adult, bicycle crash Treatment options?](https://reader035.vdocuments.site/reader035/viewer/2022062314/56649d825503460f94a682cd/html5/thumbnails/17.jpg)
Case Examples
Treated with SHS for neck and a relatively short retrograde nail – just past fracture.Was painful, hardware failing, and not united at 5 months. How does the strain theory apply to the problem? Too much or too little? How to correct?
![Page 18: Case Examples An isolated injury in an adult, bicycle crash Treatment options?](https://reader035.vdocuments.site/reader035/viewer/2022062314/56649d825503460f94a682cd/html5/thumbnails/18.jpg)
Case Examples
• There was too much strain concentrated at the simple fracture gap
• Revision to longer and bigger reamed IM nail.
• Added stability and stimulated local biology
• Bridging completed and callus matured
![Page 19: Case Examples An isolated injury in an adult, bicycle crash Treatment options?](https://reader035.vdocuments.site/reader035/viewer/2022062314/56649d825503460f94a682cd/html5/thumbnails/19.jpg)
Case Examples
• Treatment options?
![Page 20: Case Examples An isolated injury in an adult, bicycle crash Treatment options?](https://reader035.vdocuments.site/reader035/viewer/2022062314/56649d825503460f94a682cd/html5/thumbnails/20.jpg)
Case Examples
What is goal of this technique of fixation? What type of healing do you expect?
![Page 21: Case Examples An isolated injury in an adult, bicycle crash Treatment options?](https://reader035.vdocuments.site/reader035/viewer/2022062314/56649d825503460f94a682cd/html5/thumbnails/21.jpg)
Case Examples
• 4 months• IT fx healed• Shaft fx without callus
despite an attempt at bridging fixation
• Why not?• What to do?
![Page 22: Case Examples An isolated injury in an adult, bicycle crash Treatment options?](https://reader035.vdocuments.site/reader035/viewer/2022062314/56649d825503460f94a682cd/html5/thumbnails/22.jpg)
Case Examples
The construct was too stiff, not enough motion and likely compromised biologyConverted to a technique that more effectively created relative stability Higher Strain over the comminuted areaCallus formed and matured – SECONDARY BONE HEALING
![Page 23: Case Examples An isolated injury in an adult, bicycle crash Treatment options?](https://reader035.vdocuments.site/reader035/viewer/2022062314/56649d825503460f94a682cd/html5/thumbnails/23.jpg)
In summary - Bone Healing
• Primary or Secondary: Either is “good” • The goal is to use your skill to create the proper
environment for either type of healing• ABSOLUTE STABILITY - SIMPLE PATTERNS (no Strain)• RELATIVE STABILITY - COMMINUTED FRACTURES (some
strain)• Recreate anatomic length, alignment, and rotation of
the limb• Allow early motion and rehabilitation• The ultimate goal of restoration of function