Segmental fracture treatment at Black Lion and St Paul
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Segmental fracture treatment at Black Lion and St Paul's hospitals Dr Yiheyis Feleke Addis Ababa University Ethiopia. Orthopedics and physiotherapy department at Black Lion hospital Addis Ababa University. Introduction.

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Segmental fracture treatment at black lion and st paul s hospitals dr yiheyis feleke

Segmental fracture treatment at Black Lion and St Paul's hospitals

Dr Yiheyis Feleke

Addis Ababa University

Ethiopia


Segmental fracture treatment at black lion and st paul s hospitals dr yiheyis feleke

  • Orthopedics and physiotherapy department at Black Lion hospital Addis Ababa University


Introduction

Introduction

  • Segmental fracture-a fracture of long bone at two separate levels with the intermediate fragment having an intact tubular structure

  • A result of high energy trauma

  • Severe multiple organ system injuries

  • Difficult to treat


Goals of treatment

Goals of treatment

  • Stabilization of the patient

  • Stabilization of the fracture

  • Early mobilization of the patient

  • Prevention of infection

  • Functional rehabilitation

     Intramedulary nailing is the treatment of choice


Segmental fracture treatment at black lion and st paul s hospitals dr yiheyis feleke

  • 698 patients treated with Sign nail at Black Lion and St Paul's between Jan 2009-July 2012

  • 83 segmental fractures

  • Sex- 19 female, 64 male

  • Age – Mean 37 ( 20-71) years


Segmental fracture treatment at black lion and st paul s hospitals dr yiheyis feleke

  • Mechanism of injury

    • Road traffic accident - 74

    • Fall down accident -9

  • Nature of fracture

    • Closed -70

    • Open- 13 (Gustillo Anderson type1and 2)


Segmental fracture treatment at black lion and st paul s hospitals dr yiheyis feleke

  • Fracture Site

    • Femur - 55

      • Antegrade28,

      • Retrograde27

  • Tibia - 24

  • Humerus – 5

  • Time from injury to Surgery

    • average 25 (5-64) days

  • Fracture reduction open

  • Hand reaming


Segmental fracture treatment at black lion and st paul s hospitals dr yiheyis feleke

  • most patients had other associated injuries

  • prophylactic antibiotics were given for all patients.

  • Complication

    • 3 wound infection

  • Follow up:

    • Average 54 (14-86) weeks


Case 1

Case 1

  • Age 55 yrs

  • Female

  • Hit by a car

  • Right tibia segmental

  • Open Gustilo 1

  • Debridement 30 hrs after injury

  • Delayed Primary wound closure after five days


Case 1 post op

Case 1- Post Op

  • Fracture reduction open (distal only)

  • Hand reaming

  • Standard nail

  • Proximal and distally locked with 2 screw

  • Antibiotics


Case 1 follow up

Case 1 – follow up

  • No complication

  • Knee flexion > 90º

  • No deformity

  • X-ray good fracture healing


Segmental fracture treatment at black lion and st paul s hospitals dr yiheyis feleke

Right, Tibia, Segmental, Gustilo type 1

1 year after surgery


Right tibia segmental gustilo type 1 1 year after surgery

Right, Tibia, Segmental, Gustilo type 1 1 year after surgery


Case 2

Case 2

  • Age 18 years

  • Male

  • Hit by car

  • Right, Segmental,

    Tibial fracture

  • Compound , Gustilo II


Case 2 post op

Case 2 – post op

  • Injury to debridement 3 and5 days

  • Reduction open

  • Hand reaming

  • Standard Nail with one

    screw above and below


Case 3

Case 3

  • Age 30

  • Male

  • RTA

  • Left femur

  • Segmental

  • Closed


Case 3 post op

Case 3 – post op

  • Surgery –after 64 days

  • Retrograde femur

  • Standard nail & locked with 2 screw above and below

  • Reduction - open both sites , Difficult

  • Bone graft from illiac


Case 3 follow up

Case 3, Follow up

  • No complication

  • Knee flexion > 90 degrees

  • X ray after 8 months good callus


Case 4

Case 4

  • Male

  • Age71 years

  • Hit by a motor bicycle

  • Segmental femur, rt

  • Closed

  • 59 days after injury

  • Delayed union proximal fracture

  • Healed distal fracture


Case 4 post op

Case 4- Post op

  • Ante grade

  • Hand reaming

  • Standard Nail, locked with 2 distal & 1 proximal

  • Bone graft from reaming

  • Distal fracture united


Case 4 follow up

Case 4 - Follow up

  • No complication except Shortening 1cm

  • Knee movement >90 degrees

  • Good callus


Segmental fracture treatment at black lion and st paul s hospitals dr yiheyis feleke

Case 4 - Follow up

Right, Antegrade Femur, Segmental, Closed


Neck shaft

Neck/shaft


Segmental fracture treatment at black lion and st paul s hospitals dr yiheyis feleke

pop1

6months after


Case 6

Case 6

  • Age 45years

  • Male

  • Left humerus fracture

  • Segmental closed

  • Radial nerve entrapment

  • Ipsilateral shoulder dislocation


Case 6 post op

Case 6 – Post op

  • Antegrade humerus

  • Open reduction

  • Standard Nail locked with 2 screw Proximal and Distal

  • Exploration of radial nerve

  • Reduction of dislocation


Segmental fracture treatment at black lion and st paul s hospitals dr yiheyis feleke

35 years

Male

Segmental,

closed Falling


Segmental fracture treatment at black lion and st paul s hospitals dr yiheyis feleke

Follow up 6 months


Case 8

Case 8

  • 60 yrs

  • Female

  • Right Segmental femur

  • Closed


Case 8 post op

Case 8 Post op

  • Surgery after 12 days

  • Retrograde

  • Open

  • Hand reaming

  • Standard Nail, locked with 2 screw Proximal and Distal

  • Prophylactic antibiotic


Case 8 follow up

Case 8 , Follow up

  • Wound infection After 8 weeks of surgery

  • Debrided and antibiotic

  • Infection controlled after 3 weeks


Segmental fracture treatment at black lion and st paul s hospitals dr yiheyis feleke

24/M


Post op x ray

Post OP x-ray


Follow up after 2 years

Follow up after 2 years


Case 10

Case 10

  • Age 50 years

  • Male

  • Falling

  • Left tibia segmental

  • closed

  • Surgey-13 days after injury


Case 10 post op

Case 10 Post op

  • Standard nail ,

    locked distal &

    proximal with 2 screw

  • Mini incision distal


Post op

Post op


Follow up x ray

Follow up x-ray


Segmental fracture treatment at black lion and st paul s hospitals dr yiheyis feleke

Squat

and

smile


Segmental fracture treatment at black lion and st paul s hospitals dr yiheyis feleke

  • Segmental fracture-common

  • Difficult to treat

  • Different kinds of treatment

  • Deformities

  • Infection

  • None union

  • Joint stiffness


Segmental fracture treatment at black lion and st paul s hospitals dr yiheyis feleke

  • Sign nailing is a treatment of choice

  • Stable fixation

  • Early joint movement

  • Special equipment not needed


Thank you

Thank you


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