Discusión entre pares / 22 yr old , RT hand , very distal frac with subluxation of the carpus - lip frac

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Ashutosh Chaudhari

22 yr old , RT hand , very distal frac with subluxation of the carpus - lip frac , what do u guys recommend

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  Srinivas Daravathu Ligamentotaxis,k wire ,ext fix

  
  
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  Vaibhav Sadigale Its volar barton fracture dislocation. .. try to plate it or else ligamentotaxis..

  
  
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  Drmahesh Dama smith fr?

  
  
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  Abhijeet Tribhuwan Ligamento taxis

  
  
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  Ashutosh Chaudhari srinivas how to pass the wires ,its displaced volarly

  
  
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  Srinivas Daravathu Obliquely Thru radial styloid tip ,it's a very distal transverse fracture rather than volar Barton

  
  
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  Srinivas Daravathu Like this

  

  
  
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  Sanjay Ganorkar do a ct with 3D ..might look like overkill ..but is very imp to understand the fracture anatomy..if unaffording do a x ray in traction

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  Ashutosh Chaudhari bartons is an intra articular frac ,this is a very distal frac like a volar lip frac ,the management is what i am debating ,hoping to get away with the synthes volar lip plate but a very distal frac ,srinivas ,the ligamentotaxis will get length ,how to maintain the reduction ,have ordered a ct ,but just wondering what are my other options if not enough place for plate

  
  
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  Srinivas Daravathu

  

  
  
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  Srinivas Daravathu http://www.orthoproviders.com/?p=137

  
  
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  Sanjay Ganorkar if the fracture is like what you predict the best bet is a k wire passed from the radial styloid ..perhaps two of them in different directions

  
  
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  Srinivas Daravathu

  

  13 horas · Me gusta
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  Ashutosh Chaudhari so sanjay u say closed with wiring ,the wrist to be immobilised in what position ,srinivas this is not the plate i had in mind ,look up synthes volar rim plate its diff

  
  
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  Ashit Mehta Volar lip fracture. Reduce it, take image. Pass k wires from radial styloid to proximal fragment. If u want additional support u may add jess.
  Volar lip plate of synthes is another option but fracture is too distal.

  
  
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  Srinivas Daravathu

  

  
  
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  Ashutosh Chaudhari yes srinivas that the one i had in mind

  
  
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  Srinivas Daravathu Distal screws can be intra focal

  
  
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  Ashutosh Chaudhari i know thats why am wondering once i open if i can't plate ,how to go about it ,

  
  
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  Srinivas Daravathu I wud opt for ligamentotaxis,ext fix and k wires

  
  
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  Sanjay Ganorkar ashutosh i generally use chinese fingertrap for traction on the thumb or index finger and then under c arm pass a k wire ..you can see the image in the ap and lateral & reduce the fracture ..once you try it you will be surprised how easy it is

  
  
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  Ashutosh Chaudhari sanjay what cast woul

  
  
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  Ashutosh Chaudhari sorry would u apply in dorsiflexion ,volarflexion or neutral ,the reduction will come ,the question is will wires from the radial styloid maintain it and prevent displacement

  
  
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  Sanjay Ganorkar once you got the position anatomically right and the k wires in then a neutral position is good

  
  
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  Pankaj Walecha Its a complex #... That's something no one can change....as u r rightly thinking that after opening u may not be able to get a good hold even with volar rim plate...and eventually u may put the pt in plaster afterwards ( bad combination...brings unremediable stiffness).... Rather keep it simple...try to do as much as possible with k wires and maintain length with an ex fix.....u may not get the best reduction of articular surface ( acceptable in such a case..as its a non wt bearing joint)...but u can keep the wrist reduced and hopefully would get a good functional outcome..counsel the pt well

  
  
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  Bibek Rai Ligamentotaxis, ex fix and k- wires.

  
  
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  Pankaj Walecha In all probabilities you have to prevent the wrist from getting dislocated....also as u have a limited bone stock in distal fragment... U run a very high chance of hardware related problems ..so better avoid it...

  
  
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  Kir Pat Ashutosh Chaudhari, take CT scan view and in distraction view for articular communition, This definetly needs butress plating along with rafting K wires...Ligament avulsion need to be adressed..If too much chondral injury, Silicon foil
  intermit ted
  between the
  remnants of the
  articular surface
  and the carpus as suggested by Karl-Josef Prommersberger along with distraction plating and grouting bg

  
  
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  Kir Pat

  

  
  
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  Bibek Rai Ulnar styloid # also need fixation.

  
  
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  Awadhesh Yadav The #is right at the place where...ligaments attach to the distal radius.....no gain in opening it n buttressing with plate....indirect reduction with k wires n holding it with modular ex fix seems more logical......though i,would order AO distal radius set for the shake of back up lmplant,in case ,after traction i get more of the lip,,,i must say,,,,rate case in an adult...very common in children with thurston holland fragment....so i would like to fix it like that,....going
  minimally,getting maximal reduction......of course stable one.....graft...+_

  
  
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  Kir Pat Awadhesh Yadav,Ligamentotaxis work where stongest palmar lig is intact , not in this sublux inj ,and without viewing intermediate lunate fossa coln (major pillar) ,very difficult to state abt distraction mechanics of reduction

  
  
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  Awadhesh Yadav Very true. Kir pat sir,without ct,how can we comment on the lunate fossa......

  
  
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  Vispi Jokhi I think Keep everything ready. It will not be as tough as you think. Best bet synthes plate. Bail out exfix and tricortical graft and k wires. Can give u ahand if u need it.