Date post: | 24-Jul-2015 |
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Health & Medicine |
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• A DEBATABLE FRACTURE
• ALL WILL HAVE DIFFERENT EXPERIENCES
• ALL WILL HAVE DIFFERENT OPINIONS
• MOST OF US ARE IN FAVOUR OF TREATING IT CONSERVATIVELY
Neerav Modi, 8511010070
CASE SELECTION
WE CAN OPERATE ALL DISPLACED AND COMMUNITED CLAVICLE FRACTURES EXCEPT LATERAL 3RD FRACTURE
WE CAN NOT OPERATE CLAVICLE WITH A VERY NARROW CANAL
Neerav Modi, 8511010070
BENEFITS
• MINIMALLY INVASIVE
• COSMETIC- small incision
• RESONABALY EXCELLENT ALIGNMENT
• EXCELLENT OUT COME
Neerav Modi, 8511010070
DRAWBACKS
• IMPLANT IMPINGEMENT
• WE CAN BREAK CLAVICLE WHILE NAGOCIATING NAIL
• SOMETIMES DELAYED UNION
• IMPLANT REMOVAL IS MUST
Neerav Modi, 8511010070
PREPARATIONS
• ALWAYS KEEP C-ARM ON AFFECTED SIDE
• ALWAYS CHECK FOR REDUCTION BEFORE DRAPPING
• Surgeon will operate from opposite side
• CHOICE OF IMPLANT is “ TAN NAIL”, we can use K-wire or Rush nail
• ALWAYS KEEP SET OF PLATES READY
• ALWAYS KEEP SS WIRE SET READY
• Keep threaded K- wire/pin for manipulation
Neerav Modi, 8511010070
• INCISION- 1 CM, VERTICAL AND MEDIAL OVER MEDIAL END OF CLAVICLE.
BLUNT DISSECTION TO FEEL MEDIAL END
Neerav Modi, 8511010070
SURGICAL TECHNIQUE
• ENTRY- WITH 2 MM K WIRE FROM MEDIAL END AND NAGOTIATE WIRE IN AS POSSIBLE.
DILATE THE ENTRY WITH 2.5MM AND 3 MM WIRE
Neerav , 8511010070
• NAGOCIATION OF TAN NAIL IN ENTRY • GO SLOWLY WITH FEELING OF BONE AND CANAL UPTO
FR SITE • REDUCTION OF FRACTURE AND NAGOCIATE NAIL IN
DISTAL FRAGEMENT • GO AS MUCH AS POSSIBLE DISTALLY • TAKE CARE WHILE GOING DISTALLY AS NAIL MAY PIERCE
LATERAL END • IF POSSBLE PUT ONE MORE NAIL
Neerav Modi, 8511010070
Neerav Modi, 8511010070
• AFTER CONFIRMATION AND SATISFACTION ABOUT REDUCTION AND NAIL PLACEMENT,…
‘DO REMEMBER TO WITHDRAW NAIL UPTO 1 CM, BEND IT, CUT IT AND RE-INSERT IT BY GIVING COUNTER PRESSURE TO CLOSE THE FR GAP’.
• CLOSURE OF WOUND
• SHOULDER ARM POUCH WITH RIB BELT
• SUBSEQUENT FOLLOW UPS AND MOBILISATION
Pre-Op
Post-Op
4 months post op
45,F OPERATED 5 MTHS BACK, IMPLANT REMOVAL DONE
Neerav Modi, 8511010070
28,F OPERATED MTH BACK WITH SEVERE COMMUNITION & NARROW CANAL , MOBILISED SINCE ONE MTH, ALL MOVEMENTS PRESENT
2 MTH POST OP
Neerav Modi, 8511010070
B/O SMALL CANAL FURHTER INSERTION OF NAIL WAS NOT POSSIBLE, 2 MTH F/U SHOWS GOOD MOVEMENTS AND UNION