Colegio Mexicano de Ortopedia y Traumatología

Colegio Mexicano de Ortopedia y Traumatología
CMO en linea....

sábado, 7 de septiembre de 2013

Discusión entre pares/ 3 years old #, operated elsewhere, what happened & what to do?


3 years old #, operated elsewhere, what happened & what to do?


  • Ujagar Singh Remove implant, IF with LCP/BG. Difficult case but I know you can do it.....
  • Ahmed Azab god help you
  • Said Eldeeb Remove implant!!!!!!! Howwww
    Hace 20 horas a través de móvil · 
  • Ajith S Ortho To remove the implant you can autoclave an ordinary hacksaw with ordinary blade, you can get small size hacksaw from a hardware shop,,,, if you don't have any Ss saws in OT.
    Hace 19 horas a través de móvil ·
  • Arvind Jain use gigli saw,cut one third nail n straighen.then extract
  • Ajith S Ortho You can not cut a nail with Giglis saw as easy as a carpenters hacksaw. Try it, if you have no experience. I used to cut IM nails of any thickness so fast with small hacksaw.
    Hace 19 horas a través de móvil 
  • Jasjot Singh Sir cut the nail with a carbon tipped bit used in lathe machines it works.
    Hace 19 horas a través de móvil · 
  • Mohammed Ali U can straighten the nail by pressuring..then extract it proximal..u can leave the separated part lower distal ..and plate..
    Hace 19 horas a través de móvil · 
  • Muhammed Al Sherbeeny May be corticotomy of distal part to remove the distal segment of nail then remove the proximal locking screws then extract the proximal part of nail from fracture site. LCP will be good sound.
    Hace 19 horas a través de móvil ·
  • Gourishankar Asati Open band site cut the nail . remove proximal part and screw . then distal part then distal screw. try to remove distal most part of nail intramedullay with long length forceps like disc forever if not possible leave as such . open reduction. intramedullary lock nail bone graft
    Hace 19 horas a través de móvil ·
  • Lokesh Sharoff cut d nail .. remove proximal part .. 
    den use a nail extractor (device similar to screw extractor) which is long .. and remove d distal part of it .. 
    y isn't anybody thinkin to use a nail extractor device ?
  • Mantu Jain how to cut the nail?
  • Lokesh Sharoff carbon tip bit ..
  • Hany Khalil trial of straightening the nail ,if no cut it by saw,fix by plate
  • Shwet Orthopaedics Nail an be cut with Jumbo Cutter provided some space for its tip to enter... 
    Hace 18 horas a través de móvil ·
  • Mohmd Kamal Sir, a very difficult case.
    I would recommend, (Trial of removal and re-fixation with bone graft):
    1. With no radial nerve affection, Plan an anterolateral approach.
    2. Through the old # site cut the nail using rod cutter preferably with carbon tip (of the spine fixation system) with metal saw as a secondary.
    3. Removal of proximal part of the nail through a proximal incision.
    4. Removal of the broken part of the distal with removal of the distal locking screw.
    5. For the most distal part of the nail:
    a. Through a small bone window at the tip and pushing it proximally to the # OR
    b. My recommendation to leave it as it will not affect the fixation.
    6. Fresh the edges and autogenous bone graft + fixation using locked plate.
    7. The patient should be warned about possibility of radial nerve affection due to the suspected stretch of the nerve in correcting the deformity; so accompanied 1 cm shortening may be justified.
    Good Luck
  • Ajith S Ortho You can not straighten a nail with your hands, it make break the bone sure.
    Hace 17 horas a través de móvil 
  • Ajith S Ortho Avoid advices or suggestions from intelligence alone,,,, experience on similar situations are more important in practice.
    Hace 17 horas a través de móvil · 
  • Ajith S Ortho You can not cut a round nail with a cutter....
    Hace 17 horas a través de móvil · 
  • Shwet Orthopaedics Why can not cut a nail with Jumbo CutterAjith S Ortho... ???
    Hace 17 horas a través de móvil 
  • Ajith S Ortho Shwet , if have cut a nail earlier, it is a good advice, ,,,,,,,,, juniors talk with guesses, orders with bad experiences ....
    Hace 17 horas a través de móvil ·
  • Indrajeet Deshmukh Rmv d prox n dist scrws, open d # site n cut d nail wid d bst way pssbl, rmv d nail, rmv d dist prt of brkn nail by nail extrctr, d 1 whch is used 2 rmv d broken nail, freshen, locknv plate n graft it. Its d only way
    Hace 16 horas a través de móvil ·
  • Mohmd Kamal Dr. Ajith S Ortho, does 12 cases of such a deformed nail considered to be an experience or not>>>> if so i am still with my recommendation to Dr. Pardeep Sharma
  • Dilip Mehta Use hack saw cut from center ... tjen remove... I know its tough but we trust u.atb
    Hace 13 horas a través de móvil · Me gusta 
  • Tabu Muri Pliz try straightening under iitv. It usually works. Give gentle n intemittent pressure over the convex portion. I dont think cortex will give away easily in the bone where a stout nail got bent n broken.
    Hace 12 horas a través de móvil 
  • Gowni Kiran Kumar Reddy First straighten the nail on table after anaesthesia then remove it
    Hace 11 horas a través de móvil · 
  • Shwet Orthopaedics We have cut many IM nails bent over and broken like this... Ajith S Ortho... BJMC Ahmedabad and NHL Ahmedabad gets complicated cases from all over India... And this is easiest way because nothing else has worked... and Juniors are best... Implant removal is often performed by Juniors so I would appreciate every idea of them unless it is not injuring soft tissues... 
    Hace 11 horas a través de móvil · 
  • Shwet Orthopaedics Someone must launch a Nail Cutting Saw - Stryker System 007 
    Hace 11 horas a través de móvil
  • Gowni Kiran Kumar Reddy Bone is already broken u can straighten it easily then pull the nail out remove the distal screw open the fracture site lift the arm up the broken piece will fall back remove and do LCP or else leave the broken distal part of nail but remove the screw
    Hace 11 horas a través de móvil · 
  • Pradeep Gupta Remove hardware and freshen fracture site and plate ,removal of hardware step wiseI
    Hace 9 horas a través de móvil · 
  • Sharma Pervaind removal of impalnt and plating wid bone graft
  • Arvind Verma main thing is that to remove nail rest every body knows what to do cutting of nail is best option straightening may creat complication may struck in nerrow canal at isthmas.
  • DrHariprasad Chowdary Munnangi Open fracture site, U can cut the nail with sterilized axa blade
    Hace 6 horas a través de móvil ·
  • Ahmed Abd El Razek i just wanna know history of this pt how he did that ???? 
    Hace 3 horas a través de móvil ·
  • Ravi Biradar under Anaesthesia straighten the nail by correcting the deformity, remove the nail with bolts, leave the distal more part of nail as it is.ORIF with LCP and bg
  • Jitender Pal AN ATTEMPT TO STRAIGHTEN IS WARRANTED, THOUGH NOT OVERZEALOUS. NAIL IS BENT SO MUCH, THERE IS HIGH CHANCE THAT IT IS POSSIBLE, AS NAIL IS WEAK AT POINT WHERE IT HAS BENT. ABOUT THE REST ENOUGH HAS ALREADY BEEN SAID
  • Binit Singh if u have any extracted old nail or can arrange from any company people,try to cut it with jumbo cutter or saw outside.if u can mange with jumbo cutter,that will give some fair idea before u take the patient on table.the distal most part can be left inside if not able to take it out with long forceps or any other instrument. Fix with plate(either lcp or lc dcp,according to bone strength and age) and bone graft and shortening if needed to prevent too much soft tissue stretching.easier said then done.all the best.do post post op pics