Ortopedia Pediátrica y Cirugía Articular: Discusión entre pares / 45 yrs male, motorcycle accident, 12 days old tibial plateau fracture schatzker 5, ao 41c31, closed reduction, ligamentotaxis...

45 yrs male, motorcycle accident, 12 days old tibial plateau fracture schatzker 5, ao 41c31, closed reduction, ligamentotaxis, fixed by cannulated hip screw. Expert comments plz n also future management???

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Nitin Rashi Bither revise

13 horas · Me gusta · 3
Vijayanand Addanki Lateral locking plate with or without medial buttress plate..depending on intra op stability. ..maintenance of intra articular congruity is a must

13 horas · Me gusta · 3
Suhas Singh Bad fixation...

13 horas · Me gusta · 5
Mohamed Ghazoly doule plating &graft

13 horas · Me gusta · 1
Suhas Singh Thaactually sir, your post op x ray is worse ....you have attempted CRIF.i suppose...! Was a traction table used ???

13 horas · Me gusta · 1
DrAvinash Mahender Your medial screw has missed the medial frag ( which is posteromedial)

13 horas · Me gusta · 2
DrAvinash Mahender Your lat condyle looks intact btw... So posteromedial buttress plating will be enough.... Do a ct and plan

13 horas · Me gusta · 1
P.s. Balaji Disaster. Who planned

13 horas · Me gusta · 1
P.s. Balaji Put lat plate . And ordinary buttress plate post.med

13 horas · Me gusta
Sagar Patel Revised with bilateral platting with bone grafting

13 horas · Me gusta
Mavv Prasad Redo with medial n post medial plating

13 horas · Me gusta
Shahab Ud Din I appreciate ur work but ct scan in preop: planning is essiental for management. Ideal fixation bilateral locking plates / illiozarove

12 horas · Me gusta
Aldrich Fernandez Lateral plate and buttress plating on the medial

12 horas · Editado · Me gusta
Alok Jain Remove screws...
Lateral
&
POSTERO MEDIAL
Plating.....
Will not require bone graft....

12 horas · Me gusta · 4
Manpal Narula We all know what kind of fixation this is and the poor prognosis if we leave it like this . Needs lateral buttress plate with elevation and BG .posteromedial separate plate is must through a sep incision. Please try to get ct scan in these fractures

12 horas · Me gusta · 2
Srinivas Daravathu orif dual plating,lateal and posteromedial

12 horas · Me gusta · 1
Arvind Verma Jangid Ilizarove is safe soln for this

12 horas · Me gusta
Vishal Garg posteromedial plate with 2 medial screws????

12 horas · Me gusta · 3
Mahibul Islam Redo it

12 horas · Me gusta
Ajit Saigal Have to revise. Reduction / bone grafts & Anterolateral plate. Check fixation .If needed medial plate fixation

11 horas · Me gusta · 1
Camais Blinque Open, take out screws, need reduction and medial plate.

11 horas · Me gusta
Mohit Kumar The post op is worse than preop....remember the first commandment of any surgery "thou shall do no harm"

11 horas · Me gusta · 3
Omar Elsaid who did this fixation

11 horas · Me gusta
Jai Vardhan Singh Bicondylar fracture,coronal split of medial condyle, with significant articular depression ( more on post-op)and communition. Posteriomedial Buttressing should be done with BG+ additional buttress plate/ screws from lateral side.

11 horas · Me gusta · 1
Mayur Jejurikar This case waz referred to our institute

10 horas · Me gusta
Vikas Saxena Revise it

10 horas · Me gusta
Sandeep Gavhale Preop x ray better than post-op

10 horas · Me gusta · 2
Vikas Raj Articular surface not well reduced. Redo the surgery
Get a ct to understand fracture configuration
Use a plate and bone graft if needed

10 horas · Me gusta
Sudhir Pai All principles of periarticular fixation violated. Biplate (lateral + PM plates+elevation+ Bg

10 horas · Me gusta · 3
Anoop R. Nair Nil special ...repeat all of above comments in block bold letters.

10 horas · Me gusta
Trimbak Patel Medial condyle always fix with the buttress plate.

10 horas · Me gusta · 1
Mohamed Omar Ihe post X-Ray is more worse than the pre

9 horas · Me gusta
Ahmed Emad Reyad medial conyle = plate

9 horas · Me gusta
Mamdouh Magdi El Bannan Revise very bad

9 horas · Me gusta
Mamdouh Magdi El Bannan It may need double plating

9 horas · Me gusta
Ambdnya Yogesh Khandalkar U made it intraarticular displaced fracture by fixation

8 horas · Me gusta
Dinesh Loganathan U need to do a posteromedial buttress plating

8 horas · Me gusta · 1
Pratyush Gupta revise for sure. either ask before fixation if you dont know the management or dont show cases which will depress your teachers.

8 horas · Me gusta · 2
Mayur Jejurikar Dr pratyush Gupta sir it's not done by m

8 horas · Me gusta
Pratyush Gupta i am sorry for hard words but please spread the words to surgeon if you can. we would love to guide

8 horas · Me gusta
Mayur Jejurikar I ll definitely do tat sir

8 horas · Me gusta
Narayana Prasad It's a classical example how a case may be buggered up. Is there any pre op CT available ? How can u manage a type 5 scht. With this kind of fixation? You should boldly go head and redo it without any hesitation. Patient may be unhappy for the time being when you ask for a redo, if you don't do it he will be ur lifelong enemy.

7 horas · Me gusta · 1
Narayana Prasad To plan for further work, CT is a must

7 horas · Me gusta
Abdul Maleque Bad fixation indeed.....

6 horas · Me gusta
Paul Antony First we should a CT
Then make a plan
so many sites are there how yo manage these types of fractures
At least go through AO site surgery reference. It is free. They have covered it nicely

5 horas · Me gusta
Ahmad Bo-Eisa It is very bravery of you Mayur Jejurikar to post such a case. Thank you. We all do mistakes.

Schatzker type 5 even though it looks more benign preop,
Ideally, after soft tissue improve, open reduction is needed with reduction of depression and fix it with subcondral screws and a lateral hokey plate preferably LCP. Another postero medial small fragment semitubular plare may be needed.
Avoid cast as possible and start early ROM.
Another method is a ring fixation.

5 horas · Me gusta · 5
Bibek Rai Revise with medial buttress plate, articular congruity and BG.

4 horas · Me gusta
Mustafa Abdelhaleem there is a central dep. in the art. surface of lat. condyle and not reduce , needs grafting and batrous plate + no compression was done , soon revision should be done by grafting and batrous plate in the lat. side with another 2 short serrated cancellous screws in the medial condyle

4 horas · Me gusta
DrHrishikesh Mahadik Ariticular surface is not reduced. Patient will develop OA knee in future. Should have used stienmann pin as a joystick to reduce the fracture and bone clamp to hold it before putting the cannulated screws.. Did u use traction table???

4 horas · Me gusta
Drcn Dwivedy Revision is must.further arthroscopy needed after union.

4 horas · Me gusta
Anil Mittal Ct is must 3d. Then treat on table heavy traction with calc. Pin and then pass a cannulated screw by closed means from lat. Side under c arm. Then fix med cond by ao 3.5 upper tibia postero medial plate

3 horas · Me gusta · 1
Kishore Panda BOTH SIDE PLATING WITH BG

3 horas · Me gusta
Narayana Prasad The key in this type of fracture is the reconstruction of posterio medial corner o some time the posterior wall itself. Without a proper CT we cannot go further at all. I feel it's criminal to do such fixation and invite litigation

3 horas · Me gusta · 2
Santosh Mahapatra Why.... handle these fractures with tender care or else they will be a hell....BOL...

3 horas · Me gusta
Arun Govindasamy Implant removal, open reduction and internal fixation posterior buttress plating.

3 horas · Me gusta
Narayana Prasad Tender care means not to compromise on biology, by preserving we should go ahead. To plan on the incision a CT is mandatory, 3d is more a luxory

3 horas · Me gusta · 1
Gautam Chakraverty after ct a posteromedial plate

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Gautam Chakraverty rafting may or maynot be done

3 horas · Me gusta
Ajay Khare It's need double voila plating

2 horas · Me gusta