CASE 4 • 22 year old male • Injured 16 days ago • Ex-fix at local hospital • Referred for definitive treatment • Isolated injury
Figure 2a: PTT interposed in fracture site. The anteromedial corner of the talus is seen in the inferior aspect of the wound.
Figure 2b. Diagram depicting entrapped posterior tibial tendon preventing reduction of both pilon fracture and ankle joint.
Figure 2c: Tendon is pushed posteriorly back into place; the distal tibial fracture and talus are now reduced.
Figure 3: Anteroposterior radiograph of ankle 3 weeks post- operatively, revealing accurate reduction of the fracture and ankle.
Figure 4a: Medial aspect of ankle, one week after surgery. Region of pressure necrosis has demarcated
Figure 4b: Medial wound 5 weeks post operatively demonstrating skin healing.
Eddie the Eagle • 38 yr old alcoholic • Unknown recent injury • Closed, NV intact, isolated fracture
• 2 weeks post- injury • Unchanged clinically
• 4 weeks later • Drainage from upper arm
CASE 2 • 27 year old female • Fell off bike 4 weeks ago • OR (forearm) at local hospital • Revision OR (elbow) 3 days later • Advised to have further surgery • Came for second opinion • Closed, isolated, NV intact
Why is the radial head still dislocated?
Why is the radial head still dislocated? • Malreduction of the ulna • Malreduction of the ulna • Malreduction of the ulna • Malreduction of the ulna • Malreduction of the ulna • Malreduction of the ulna • Malreduction of the ulna • Malreduction of the ulna • Maybe something stuck in the joint
CASE 12 • 53 yr old male • Injury 8 weeks ago • OR at local hospital • Now infected, painful, active drainage • Referred for definitive care
16 year old, kid “prodigy” fell on longboard w hile at college. Transferred from OSH 1 week later. No reduction attempt. Significant blistering/soft tissue swelling
Attempted closed reduction at 1 w eek
Ex fix at 1 w eek
ORIF at 3.5 w eeks
14 months, back to full activity
Potpourri Trauma: Upper Extremity Case
60 M open bbffx s/p MVA treated in Jamaica 4 months ago Resolving radial nerve palsy Slightly elevated CRP, normal ESR
6 months postop
ROH, serial I& D, Abx cement Deep purulent collection Soft, nonviable bone at
IV Abx for MDR Pseudomonas • 8 weeks of IV abx • Inflammatory markers remain normal 1 mo off of abx
What Next? – 7 cm ulnar bone defect – 2.5 cm radial bone defect
Ex-Fix removed
Radial shortening and ulnar vascularized fibular autograft
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