Monday, November 21st, 2011
This patient was a pedestrian struck by a bus. As a result he sustained fractures of both the right and left clavicle in addition to a severe open fracture of his right leg. Note the severe soft tissue injury and the bone exposure with near complete amputation of the leg (Image 1,2).
The right leg was treated with multiple procedures. The fracture was ‘open’ which introduced the risk of infection. The initial procedure was to stabilize the fracture with an external frame (external fixator) and to sterilize the soft tissue and bone. This was done with mechanical debridement of the bone and soft tissue in addition to antibiotics delivered intravenously as well as directly into the injury zone. After the soft tissue envelope was sterilized and stabilized the fractures were stabilized with a locking plate applied percutaneously on the side of the leg where the soft tissue was intact (Image 3).
Currently his fractures have healed. He is back to school and his every day activities. Note the open fracture soft tissue injury which was brought to full closer and healing without the use of muscle flap or skin grafting (Image 4) Note the small incision which was used to insert all of the hardware which extends from the knee to the ankle (Image 5) Note the patient is completely healed, weight bearing without any skeletal deformity (Image 6).
Monday, November 21st, 2011
This patient sustained an open (compound) fracture of the mid-shaft tibia as a result of a skateboarding accident (Image 1, 2). He was taken to the operating room for urgent debridement and stabilization of the fracture. The wound was surgically debrided and an external fixation system was applied to the leg (Image 3,4).
Radiographs done afterwards showed a large area of bone loss as a result of the injury (Image 5). Definitive treatment was exchange of the external fixator for an intramedullary device performed with bone grafting to the deficient area. The fracture went on to heal with bone restoration as well as normal length and alignment of the leg (Image 6,7)
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Monday, November 21st, 2011
This patient sustained a markedly comminuted fracture of the distal femur. As you can see in the x-rays (Image 1), the injury had caused a fracture with many separated and displaced segments; the knee joint was also interrupted with separation of the both medial and lateral condyles.
A surgical reconstructive procedure was performed to piece back together all of the separate pieces and to restore the bone to normal alignment and length. This was accomplished with a specially designed orthopedic implant using also a synthetic bon grafting material to facilitate the healing process (Image 2).
Friday, January 28th, 2011
This gentleman was involved in a motorcycle accident. He sustained a severely comminuted fracture of his tibia plateau. You can see from the x-rays (1,2) and CT scan (3) that the knee joint was severely disrupted with near complete destruction of the articular surface of the tibia.
The procedure to reconstruct the joint was done in 3 stages. As you can see from the postsurgical x-rays (4,5) the joint surfaces were successfully reconstructed.
In the clinical photograph (6) you can also see by the multiple small incisions that the implants to reconstruct the joint were placed percutaneously (multiple small incisions). This method of placing the implants is technically demanding however the clinical results are much better in most cases since the soft tissues are not disrupted. The patient’s knee and leg was restored to an appearance of normal (7). He has returned to work and normal activities. I recently saw him in the office and he is now 10 years from the accident and surgery. He continues to do well at this time and has what he describes as manageable pain. His only recent treatment has been sodium hyaluronate injections which is a medicine used to lubricate the joint.
