14 yr old boy …minimal swelling…conservative or crif with k wires? pls opine
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Aly Elzawahry Can appreciate a double injury of the extensor mechanism, avulsion of the tibial apophysis and an anterior step at the trochlear goove. Would have to reduce that step.- Harsh Singh We hv done 2-3 case of similar type…tr reducing in a fracture table n do p/c pinning wid smooth pin.2 pins through epiphysis..1 pin through d thurston holland fragment…
Prabir Bala closed reduction and percutenious pinning.pop slab for 4_5weeks then gradual movement..we have done some cases with excellent result
Abdullrab Almarwanya FOR ANSWERING YOUR Q? NEED MORE CLEAR X RAY to differentiate Salter type II from type IV Displaced Salter Types II fracture – CR primarily traction with gentle manipulation , and percutaneous fixation with either smooth wires or screws, followed by a cast for 6 weeks with the knee in 10° of flexion. Anatomic reduction is desirable but in children near maturity, up to 5° of varus or valgus angulation is acceptable.
Displaced Salter Types IV fractures necessitate anatomic reduction with internal fixation by closed or open methods with screws followed by a cast for 6 weeks.
Sanjay Joseph Appears to be SH type 2. The condyles are extended. CR and k wires with a cast should suffice.
Rajeev Nirawane Its SH type 2. CR & 6.5 mm cc screws (2)with washer in the metaphyseal fragment. protect in slab for about 4 wks- Rajeev Nirawane hyperextension not corrected. This fracture requires reduction in flexion. Prone position facilitates this.( like triceps in SC humerus the quadriceps is usefull for this). My choice 6.5mmcc screws
- Sanjay Joseph I’m afraid to say that the fixation will have to be redone otherwise this child will have a grossly hyperextended knee. Please don’t take this personally. It can happen to anyone.
Mohamed Abdelhalim The distal epiphysis hyperextended I think u need reoperate with forceful flexion reduction to retain the epiphyseal anatomical position- Sanjay Joseph Re-operate. Better to face the parents now than for them to come to you with a hyper-extended knee. In the long term, as the deformity is in the plane of movement of the knee, it may remodel, but it will be very difficult to keep the parents happy esp …Ver más
- Sanjay Joseph Also for positioning, place the patient supine with the leg hanging off the edge at 90°. Place a small sandbag under the thigh proximal to the fracture. This will overcome the quadriceps. Surgeon to sit on a stool. Withdraw k wires, reduce and pass the…Ver más
