These cases are are to get you to start thinking and questioning your knowledge ahead of the next webinar when bone goes bad: bone infection, defects and correction of deformity.
We are joined for this webinar by:
introduction to limb reconstruction techniques for the general orthopaedic surgeon. This webinar – presented by:
- Nima Heidari – The Royal London Hospital – Barts Health
- David Goodier – The Royal National Orthopaedic Hospital – Stanmore
- Hemant Sharma – Hull University Teaching Hospitals NHS Trust
49 year old male who had an open fracture of the left femur in Morocco 20 years previously. Which was treated non-op.
Since then, he’s had on/off local drainage and periods of antibiotics
- Foul smelling discharge
- Dressing changes x5/ day
- Requesting amputation (family can’t stand the smell)
Non smoker, no co-morbidities, quads adherent limiting knee flexion
32 yrs female, previous PFFD. She had 10cm of lengthening and multiple previous surgeries
- Lateral right knee pain
- MRI and arthroscopy
- Lateral compartment OA, grade-4
- Tricompartmental OA changes
- Valgus mal-alignment
- MRI and arthroscopy
- Right hip pain (she has OA hip on the same side)
- Valgus deformity of the leg
- Minor problems
- Mild valgus of right tibia
- Valgus right ankle with lateral OA changes (secondary to the longstanding valgus leg)
- Stiff hindfoot and midfoot
60 y.o. Male, falls from a ladder. Bilateral closed Pilons (this case concerns the right side). Placed into a spanning external fixator and achieved a nice reduction.
The patient got ORIF with plates. The post-op reduction looked decent and no infection. However, at 8-months the medial fixation started to fail. The patient was weight bearing with discomfort, needing crutches and a boot still.
The treating surgeons decided to revise the medial fixation and that worked nicely for a while, until the new medial plate/screws broke again!
At 29-months the pt was still on crutches and in pain, albeit a little improved (image A).
A CT seemed to show that the fracture was healed and so the hardware was taken out (image B).
1-week later, a wt-bearing x-ray clearly showed a varus non-union (image C). See also CTSo, the situation is a varus non-union. Reasonable soft tissues (will tolerate further open surgery). Never been overtly infected.
Please do post your thoughts about these cases in the comments section below.
For the answers to these questions and much more join our webinar this week, Wednesday at 8pm BST.