Friday fractures teaser

RE: Friday fractures teaser

David Mills — Sat, 16 Jul 2016 01:46:49 GMT

[quote user="Lucy Fleming"]It's Friday and it's been a long week so be gentle...i[/quote]

Join the club - perfect Friday afternoon case this one!

[quote user="Lucy Fleming"]Can it ambulate on its little RJB-ed legs?[/quote]

Not really, well not yet, still quite sore but we'll see what the hard drugs bring overnight.

[quote user="Malcolm Ness"]he problems/risks/complications associated with treating multiple fractures are always synergistic rather than additive![/quote]

Yes, as I feared!

[quote user="Malcolm Ness"]

My first choice treatment would be to re-align the fractures and fix with SOP locking plates applied medially to each tibia taking care to place the screws exclusively in the diaphysis and not beyond the epiphyses.

A valid 'plan B' would be IM pin plus Ex fix: a smallish (1-2mm) IM pin exiting the tibia proximally without involving the major epiphysis and embedded distally into the metaphysics - again, not crossing the epiphysis. A 4 pine Ex fix with a single connecting bar should be placed on each tibia, agin keeping all 4 pins in the diaphysis. Use threaded pins and pre-drill.

[/quote]

Glad ex-fix is a viable option. SOP plates are a bit beyond our budget here, but ex fix with IM pin is eminently possible.

[quote user="Malcolm Ness"]Sure, the bones will heal if left alone but the aim of fracture management is to restore function. Similarly, while R-J or casts could be considered, the risk of significant and lasting joint pathology/stiffness/dysfunction is considerable.[/quote]

This was my worry - the fractures under GA are reducible but eminently unstable and I can't see them healing straight enough or predictably enough by conservative management.

Thanks again Malcolm for detailed response. Sadly I won't get to attempt this one next week as off on holiday but will report back once my better qualified cert-holder collegaue has done it.

We've currently got 4 fractures lined up to repair next week - not unusual - but anyone looking to get their hands on orthopaedic cases in London, we've jobs going at the moment

RE: Friday fractures teaser

Malcolm Ness — Fri, 15 Jul 2016 19:58:37 GMT

This is a collection of unusual fractures and my first stop - in spite of the obvious trauma - would be to review/correct the diet.

There are similar, almost transverse fractures of the tibias and fibulas. In addition, there is an avulsion of the ischial physis on the left side. This is not markedly displaced and can probably be left alone but it involves the origin of a large part of the hamstrings so I would be repeating the rads a week or so down the line to make sure that it hasn't moved any further. If it does then surgical fixation (wiring) will be indicated.

The bilateral tibial fractures are challenging - the problems/risks/complications associated with treating multiple fractures are always synergistic rather than additive!

This should see the kitten able to walk and use the limbs from day one and that is an important consideration in restoring full function. Sure, the bones will heal if left alone but the aim of fracture management is to restore function. Similarly, while R-J or casts could be considered, the risk of significant and lasting joint pathology/stiffness/dysfunction is considerable.

The pin can be left long to facilitate its removal - I would pull the pins after 2-3 weeks and the Ex fix after 4-5 weeks.

RE: Friday fractures teaser

Lucy Fleming — Fri, 15 Jul 2016 18:24:05 GMT

It's Friday and it's been a long week so be gentle...it's fractured both HLs right? I'm not just going mad and seeing Ls and Rs everywhere? Can it ambulate on its little RJB-ed legs?

RE: Friday fractures teaser

Richard Carter — Fri, 15 Jul 2016 18:19:02 GMT

Is the answer that its a kitten and both parts are in the same room so will heal with reduction and RJB?

RE: Friday fractures teaser

Richard Carter — Fri, 15 Jul 2016 18:12:33 GMT

is there enough bone for a small ex-fix so can extend the bar as grows?