Artroscopia y ortopedia: Discusión entre pares /45yrs/male presented with compound type 3A comminuted fracture distal 1 / 3rd tibia with b/l superior inf rami comminuted fracture with bladder and urethral injury

Rahul B Tanga

45yrs/male presented with compound type 3A comminuted fracture distal 1 / 3rd tibia with b/l superior inf rami comminuted fracture with bladder and urethral injury.patient was taken up emergency laparotomy and bladder repair was done and followed with orif with im/il nailing tibia with primary closure of the wound. How many would prefer nailing vs fixator in this case?

Rahul B Tanga Critical comments?
Sanjay Ganorkar fixateur
Alok Singh Internal fixation is recomended....in type3b.....provided u address the wound well by debd and good antibiotics
Aymen Shaaban Yes Sir if you sure that the wound is clean ILN is better
Anoop R. Nair I would follow same ...debridement is the key. Well done as usual expected from you.
Abubaker Musa Ex fx then after wound close & CBC, ESR ,SRP normal can IMTN doing
Santosh Mahapatra Ex-fix...
Hossam Almaz IMN CAN BE USED UP TO TYPE 3b provided that good ab coverage . Daily care of the wound ,, good wound depridement
Abdulalim Shaheen Nice.
Sushil Vijay IMN gives good result if closure done with care of wound as early as possible . Debridement is the key with coverage of bone... delayed closure in such cases can get infected. .. my professor managed around 80 such injuries with immediate closure... none infected .. post op all did well..
Kir Pat Good, approach…Is it reamed or undreamed?
Vaibhav Sadigale ILN is choice with gud debridement..
Rahul B Tanga Thanks Dr anoop nair.
Rahul B Tanga Thanks Dr Kiran patel. Reamed nail.
Kir Pat Literature doe not advise reaming or invasiveness in such open #s….
Sharma Pervaind almost always i go for primary debridement and nailing ,fixator delays everythng
Rahul B Tanga I wanted to put 10 mm diameter nail so reamed it
Sharma Pervaind gud job ,keep a close watch'..
Kir Pat Fixator beyond 20 days ,high chances of infections
Rahul B Tanga Patient was quite hefty so put 10mm nail.
Rahul B Tanga Thanks Dr peravind
Sharma Pervaind dr tanga i always go for unreamed nailing
Rahul B Tanga Ya true dr Kiran patel I agree with you. But at times patient turn up as late as 3 months from fixator application for exchange nailing. Then wat to do?
Kir Pat Fixator gives false sense of security to pt and surgeon,esp mono lateral, I n such case I will go for illizarow compression, wt bearing as a osteoinduction factor
Rahul B Tanga Recently I had operated transverse fracture proximal tibia with impending compartment syndrome. First sitting I had done CRIF with fixator with mini fasciotomy. Patient turned after 3 months .now did fixator removal gap of 2 weeks followed with fibulectomy + orif with nailing + bg.
Aditya Menon Iln preferrd..only doubt is immed.closure vs delayed...its a personal choice nd on table decision after debridement
Shahin Tavafi perfect
Arvind Jain Nailing with MRSA antibiotics has ever come out good option.
Ahmed Albushtra nice
Anurag Sharma Debridement is the vital aspect....our prof would tell us that surgery for open fracture actually encompasses two parts adequate debridement followed by fixation the surgeon should scrub again after debridement and redrape the patient
Mukesh Gupta Gupta as usual super sir,can we use endres nail in this situation to lessen the chance of infection
Anupam Srivastava Antibiotic Impregnated Nail preferred choice to purchase nail in future ...I think so .

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