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Segmental fracture treatment at Black Lion and St Paul\'s hospitals Dr Yiheyis Feleke

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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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Presentation Transcript
slide1
Segmental fracture treatment at Black Lion and St Paul\'s hospitals

Dr Yiheyis Feleke

Addis Ababa University

Ethiopia

slide3
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

slide6
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
slide7
Mechanism of injury
    • Road traffic accident - 74
    • Fall down accident -9
  • Nature of fracture
    • Closed -70
    • Open- 13 (Gustillo Anderson type1and 2)
slide8
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
slide9
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
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
slide23

Case 4 - Follow up

Right, Antegrade Femur, Segmental, Closed

slide25
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
slide28
35 years

Male

Segmental,

closed Falling

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
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
slide40

Squat

and

smile

slide41
Segmental fracture-common
  • Difficult to treat
  • Different kinds of treatment
  • Deformities
  • Infection
  • None union
  • Joint stiffness
slide42
Sign nailing is a treatment of choice
  • Stable fixation
  • Early joint movement
  • Special equipment not needed
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