cmacpc
Networker
Need some guidance:
1: I&d of Open distal Radius fracute and open ulnocarpal dislocation including soft tissue and bone.
2. Open reduction under flouro control of Open distal radius fracture and open ulnocarpal joint dislocation.
3. Stabilzation of open fracture and dislocation radius/ulna w/external fixation.
4. Open wound Closure.
5. Application of posterior mold.
Both bones, were dislocated distal ulna and comminuted distal radius fracture were exposed through open wound which was around 5 cm from the wrist joint. using a curette and knife debridement of devitalized tissue including bone was performed.
When I felt satisfied with the I&D to bone I focused my attention to perform the reduction of this open fracture and dislocation, this was a difficult procedure since the distal radius had comminuted intraarticular fractures and also because the ulna was completely dissociated from the carpus. Performing different gentle maneuvers of traction, radial and ulnar deviation with volar deviation under fluoro contro were able to obtain good reduction.
The wrist joint was very unstable and the ulna easily dislocated again. For that reason, I decided to perform stabilization with external fixation under fluoro control and AP, lateral, and oblique views, 2 pins at the level of the 2nd metatarsal bone. After confirming the correct location of these hemi pins, the ex fix was assembled obtaining a very good stabilization of the radius fraction and ulna dislocation. Again under fluoro control we confirmed the good reduction of the fracture dislocation at the level of the wrist on the AP, sagittal, lateral and oblique views.
Next I focused my attention on the open wound. The wound was noted to be clean without signs of contamination and no active bleeders. I decided to close the open wound using a combination of 2-0 vicryl, and 3-0 nylon. Next using Doppler, it was confirmed a good pulse at the level of the ulnar and radial arteries. At this point I decided to finish the surgical procedure.
Any input wound be appreciated as I am kind of rusty to ortho
TIA
1: I&d of Open distal Radius fracute and open ulnocarpal dislocation including soft tissue and bone.
2. Open reduction under flouro control of Open distal radius fracture and open ulnocarpal joint dislocation.
3. Stabilzation of open fracture and dislocation radius/ulna w/external fixation.
4. Open wound Closure.
5. Application of posterior mold.
Both bones, were dislocated distal ulna and comminuted distal radius fracture were exposed through open wound which was around 5 cm from the wrist joint. using a curette and knife debridement of devitalized tissue including bone was performed.
When I felt satisfied with the I&D to bone I focused my attention to perform the reduction of this open fracture and dislocation, this was a difficult procedure since the distal radius had comminuted intraarticular fractures and also because the ulna was completely dissociated from the carpus. Performing different gentle maneuvers of traction, radial and ulnar deviation with volar deviation under fluoro contro were able to obtain good reduction.
The wrist joint was very unstable and the ulna easily dislocated again. For that reason, I decided to perform stabilization with external fixation under fluoro control and AP, lateral, and oblique views, 2 pins at the level of the 2nd metatarsal bone. After confirming the correct location of these hemi pins, the ex fix was assembled obtaining a very good stabilization of the radius fraction and ulna dislocation. Again under fluoro control we confirmed the good reduction of the fracture dislocation at the level of the wrist on the AP, sagittal, lateral and oblique views.
Next I focused my attention on the open wound. The wound was noted to be clean without signs of contamination and no active bleeders. I decided to close the open wound using a combination of 2-0 vicryl, and 3-0 nylon. Next using Doppler, it was confirmed a good pulse at the level of the ulnar and radial arteries. At this point I decided to finish the surgical procedure.
Any input wound be appreciated as I am kind of rusty to ortho
TIA