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Segmental fracture treatment at Black Lion and St Paul's hospitals Dr Yiheyis Feleke

Segmental fracture treatment at Black Lion and St Paul's hospitals Dr Yiheyis Feleke Addis Ababa University Ethiopia. Orthopedics and physiotherapy department at Black Lion hospital Addis Ababa University. Introduction.

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Segmental fracture treatment at Black Lion and St Paul's hospitals Dr Yiheyis Feleke

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  1. Segmental fracture treatment at Black Lion and St Paul's hospitals Dr Yiheyis Feleke Addis Ababa University Ethiopia

  2. Orthopedics and physiotherapy department at Black Lion hospital Addis Ababa University

  3. Introduction • Segmental fracture-a fracture of long bone at two separate levels with the intermediate fragment having an intact tubular structure • A result of high energy trauma • Severe multiple organ system injuries • Difficult to treat

  4. Goals of treatment • Stabilization of the patient • Stabilization of the fracture • Early mobilization of the patient • Prevention of infection • Functional rehabilitation  Intramedulary nailing is the treatment of choice

  5. 698 patients treated with Sign nail at Black Lion and St Paul's between Jan 2009-July 2012 • 83 segmental fractures • Sex- 19 female, 64 male • Age – Mean 37 ( 20-71) years

  6. Mechanism of injury • Road traffic accident - 74 • Fall down accident -9 • Nature of fracture • Closed -70 • Open- 13 (Gustillo Anderson type1and 2)

  7. Fracture Site • Femur - 55 • Antegrade28, • Retrograde27 • Tibia - 24 • Humerus – 5 • Time from injury to Surgery • average 25 (5-64) days • Fracture reduction open • Hand reaming

  8. most patients had other associated injuries • prophylactic antibiotics were given for all patients. • Complication • 3 wound infection • Follow up: • Average 54 (14-86) weeks

  9. Case 1 • Age 55 yrs • Female • Hit by a car • Right tibia segmental • Open Gustilo 1 • Debridement 30 hrs after injury • Delayed Primary wound closure after five days

  10. Case 1- Post Op • Fracture reduction open (distal only) • Hand reaming • Standard nail • Proximal and distally locked with 2 screw • Antibiotics

  11. Case 1 – follow up • No complication • Knee flexion > 90º • No deformity • X-ray good fracture healing

  12. Right, Tibia, Segmental, Gustilo type 1 1 year after surgery

  13. Right, Tibia, Segmental, Gustilo type 1 1 year after surgery

  14. Case 2 • Age 18 years • Male • Hit by car • Right, Segmental, Tibial fracture • Compound , Gustilo II

  15. Case 2 – post op • Injury to debridement 3 and5 days • Reduction open • Hand reaming • Standard Nail with one screw above and below

  16. Case 3 • Age 30 • Male • RTA • Left femur • Segmental • Closed

  17. Case 3 – post op • Surgery –after 64 days • Retrograde femur • Standard nail & locked with 2 screw above and below • Reduction - open both sites , Difficult • Bone graft from illiac

  18. Case 3, Follow up • No complication • Knee flexion > 90 degrees • X ray after 8 months good callus

  19. Case 4 • Male • Age71 years • Hit by a motor bicycle • Segmental femur, rt • Closed • 59 days after injury • Delayed union proximal fracture • Healed distal fracture

  20. Case 4- Post op • Ante grade • Hand reaming • Standard Nail, locked with 2 distal & 1 proximal • Bone graft from reaming • Distal fracture united

  21. Case 4 - Follow up • No complication except Shortening 1cm • Knee movement >90 degrees • Good callus

  22. Case 4 - Follow up Right, Antegrade Femur, Segmental, Closed

  23. Neck/shaft

  24. pop1 6months after

  25. Case 6 • Age 45years • Male • Left humerus fracture • Segmental closed • Radial nerve entrapment • Ipsilateral shoulder dislocation

  26. Case 6 – Post op • Antegrade humerus • Open reduction • Standard Nail locked with 2 screw Proximal and Distal • Exploration of radial nerve • Reduction of dislocation

  27. 35 years Male Segmental, closed Falling

  28. Follow up 6 months

  29. Case 8 • 60 yrs • Female • Right Segmental femur • Closed

  30. Case 8 Post op • Surgery after 12 days • Retrograde • Open • Hand reaming • Standard Nail, locked with 2 screw Proximal and Distal • Prophylactic antibiotic

  31. Case 8 , Follow up • Wound infection After 8 weeks of surgery • Debrided and antibiotic • Infection controlled after 3 weeks

  32. 24/M

  33. Post OP x-ray

  34. Follow up after 2 years

  35. Case 10 • Age 50 years • Male • Falling • Left tibia segmental • closed • Surgey-13 days after injury

  36. Case 10 Post op • Standard nail , locked distal & proximal with 2 screw • Mini incision distal

  37. Post op

  38. Follow up x-ray

  39. Squat and smile

  40. Segmental fracture-common • Difficult to treat • Different kinds of treatment • Deformities • Infection • None union • Joint stiffness

  41. Sign nailing is a treatment of choice • Stable fixation • Early joint movement • Special equipment not needed

  42. Thank you

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