Wednesday 15th April at 8pm

With the global COVID-19 pandemic, orthopaedic surgeons are being challenged to consider whether many of the fractures that we have become accustomed to treating surgically can actually be managed non-operatively. As our ability to carry out general anaesthesia and specialist blocks becomes constrained and our desire to keep patients out of hospital intensifies, this webinar considers the fundamental question of which fractures can be safely managed non-operatively, and what that treatment looks like.

Join us on Wednesday 15th April at 8pm to hear our panels thoughts and discuss with them. Sign up here.

Wrist Fracture

34 yr old, non dominant wrist.  Motorbike accident.  Closed, NV intact.

Points for consideration

In a theatre-constrained environment is this suitable for Non-op treatment?

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If attempting non-operative treatment, would you re-manipulate and plaster?

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As part of your routine follow-up, at what time point would you accept the position and stop getting regular x-rays (eg each week), and just schedule the patient for cast removal in a few weeks time.

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If going non-operative, what would the end-point of initial treatment be?

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What would the final function be like with non-operative management at 2-3 years if the fracture lost reduction to the original pre-manipulated position?

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Tibial Plateau

35 yrs female – pedestrian vs her dog.  Hit from behind with posterolateral depression.  CT shows no medial extension.

Can this reasonably treated non operatively?

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What are your main concerns about treating this non-operatively?

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Ankle Fracture

60 yrs bus driver, tripped down a step.  Closed injury, no NVD.  PMH – Cirrhosis, SLE, DM (tablet controlled).  COVID-19 +VE.

Ignoring the fact that he is COVID +VE, can this fracture be controlled in a cast and treated non-operatively?

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Accepting that he HAS tested positive for the virus, what are you going to do? Theatre access is reduced but not zero.

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Elderly Fracture Neck of Femur

81 yrs female.  Advanced dementia, unwitnessed fall on the medical ward having tested positive for COVID-19.  Noted to be hypoxic (sats 85% on 4L Oxygen), fast AF, heart not great.  Anaesthetist says over 90% chance of death if we operate!

This is genuine!

Is there a role for palliative treatment of NOF fractures in this setting?

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Summary

Our panel have their opinions! We would love it you post your opinions and discussion below. Please also bring your them to the live webinar to discussion on Wednesday 15th April 2019. More information, and to sign up details.

See you there

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2 Responses

  1. Why total contact casting in patient who does not have a diabetic neuropathy? No evidence for using TCC in fractures not sure why this is even an option? Similar to using distal femoral replacement for simple knee OA, wrong treatment and wrong diagnosis.

    The TCC reduces force transmission through the sole of the foot for diabetic foot ulcer off loading, allows wt bearing whilst also off loading. This man will be NWB so TCC is the wrong treatment.

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